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LMAP > Older Person's Health > Flashcards

Older Person's Health Flashcards

1
Q

What are the physiological changes that lead to food intake decline?

A
  1. Decreased basal metabolic rate
  2. Decreased lean body mass
  3. Decreased sense of taste
  4. Decreased sense of smell
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2
Q

What is malnutrition?

A

is when the diet doesn’t contain the right amount of nutrients: undernutrition or over nutrition (often leading to obesity)

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3
Q

How common is malnutrition?

A

experienced by around 10% of UK over 65s equal to around 1 million people

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4
Q

What physical changes can put someone at risk of malnutrition?

A
  1. Poor dentition
  2. Swallowing difficulty
  3. Arthritis and declining coordination
  4. Deteriorating eyesight
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5
Q

What cognitive changes and poor mental health also place people at risk can put someone at risk of malnutrition?

A
  1. 22% of men and 28% of women aged over 65 experience low mood
  2. Cognitive decline (plan, buying, preparing meals): ‘normal’ cognitive decline or pathological cognitive decline
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6
Q

What medical conditions and medication risk malnutrition?

A
  1. Medical conditions which can impair appetite include cancers, heart failure, chronic kidney disease and hypothyroidism
  2. Conditions such as coeliac disease and inflammatory bowel disease can cause malabsorption syndrome
  3. Medications can impair appetite e.g. some diuretics and antihypertensives
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7
Q

Why can there be over nutrition in older people?

A

Physical or cognitive problems can lead to decreased activity and therefore increased weight

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8
Q

Why is there a risk of malnutrition in institutionalised settings?

A

e. g. nursing homes:

- If feeding not done well this risks undernutrition

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9
Q

What can malnutrition lead to?

A
  1. impaired immune function
  2. poor wound healing
  3. osteoporosis
  4. cognitive impairment
  5. mood disturbances
  6. joint and muscle pain
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10
Q

What specific deficiencies can malnutrition lead to?

A
  1. calcium
  2. vitamin D
    - Both can lead to osteomalacia
  3. vitamin C
    - lead to poor wound healing
  4. vitamin B12
    - Folate
    - lead to anaemia
    - Reduced skeletal muscle can lead to sarcopenia
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11
Q

What is important in the history for clinical assessment of nutrition?

A
  • History with family and carers if the patient consents
    1. Changes to weight and BMI
    2. Additional symptoms of malnutrition
    3. Social history e.g. living situation, care needs and functional status
    4. Mental health
    5. Drug history
    6. Past medical history
    7. Food and fluid diary
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12
Q

What examination is needed for the clinical assessment of nutrition?

A
  1. Weight
  2. BMI
  3. Dentition
    • other relevant areas e.g. dry skin, brittle nails
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13
Q

What investigations are needed for the clinical assessment for nutrition?

A
  1. Consider blood tests
  2. Others guided by history and exam
    - Malnutrition Universal screening tool (MUST)
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14
Q

What does the doctor do in the MDT for support to improve nutrition?

A
  • review medication
  • manage medical conditions
  • co-ordinate
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15
Q

What does the dietician do in the MDT for support to improve nutrition?

A
  • formal nutritional assessment

- implement recommendations

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16
Q

What does the occupational therapist do in the MDT for support to improve nutrition?

A

-assess and provide aids for shipping, cooking and feeding

17
Q

What does the social care professional do in the MDT for support to improve nutrition?

A

-assess and provide increased support e.g. carers, meal delivery

18
Q

What does the speech and language therapist do in the MDT for support to improve nutrition?

A

-assess swallowing and make recommendations

19
Q

What does the dentist do in the MDT for support to improve nutrition?

A
  • provide comfortable dentures

- address dental problems

20
Q

What is the MDT care like?

A

Care should be holistic, strengthen relationships with family and friends and occasional exercise

21
Q

What does obstructive sleep apnoea (OSA) result from?

A
  • resulting from a partial or fully blocked airway
    1. when airway becomes blocked during sleep, the brain become starved of oxygen
    2. this creates a mini arousal to reinvigorate the musculature of the airway, and this facilities a sharp intake of breath
22
Q

What is OSA often characterised by?

A

loud snoring followed by a pause in breathing and then a large gasp of air

23
Q

What is the most common primary complaint with OSA?

A
  1. often unaware of these arousals from sleep

2. excessive daytime sleepiness: EDS is an increased pressure to fall asleep during normal waking hours

24
Q

Is OSA different from somnolence and fatigue?

A
  1. distinct from somnolence, which is a broader term, simply meaning a strong desire to sleep, whether pathological or not
  2. fatigue which refers to physical and/or mental exhaustion which does not facilitate sleep and is often not alleviated by sleep
25
Q

What are people with OSA at an increased risk of?

A
  1. CVD
  2. stroke
  3. type 2 diabetes independent of weight or age
    - They also experience more serve depression
    - The pauses in breathing lead to hypercapnia, that is increased CO2 in the brain and so cellular death
26
Q

How is OSA diagnosed?

A
  • diagnosed using PSG, this is experience and resource intensive
  • stop bang questionnaire provides a useful and quick tool for GP’s to begin to make a differential diagnosis
27
Q

Why may the airway be blocked?

A
  1. The tonsils may be too large (in which case they may be removed)
  2. The jaw may be set too far back in which case you could opt for a mandibular advancement
  3. Often OSA is the result of excess weight: if there is a lot of adipose tissue at the base of the tongue and around the pharynx then it is more likely the airway will collapse when the muscles are relaxed I.e. during sleep
  4. So sleeping on your back is a risk factor, as is anything that impacts REM sleep
28
Q

What can increase severity of OSA?

A
  • alcohol

- certain classes of antidepressants because of their impact they have on muscle tone and/or on REM sleep

29
Q

What is the treatment for OSA?

A
  • Gold standard treatment for OSA is continuous positive airway pressure (CPAP)
  • This is a mask worn at night, the mask essentially blows air into the airway, creating a pneumatic splint
  • This keeps the airway open
30
Q

Is the treatment for OSA effective?

A
  1. treatment itself is very effective, showing improvements in sleep, daytime, sleepiness mood and cardiovascular outcomes
  2. compliance is generally very low, so often have to employ behaviours change techniques to encourage people to a where to their CPAP machines
31
Q

What lifestyle factors help to improve OSA severity?

A
  1. losing weight
  2. quitting smoking
  3. reducing alcohol
32
Q

Who can help with the differential diagnosis of OSA?

A
  • The bed partner can have important role to play in OSA diagnosis
  • They are the ones who will be most affected by the snoring, as the patient will be unaware of the severity of their own snoring
  • Asking the bed partner can be an important part of differential diagnosis when someone presents with excessive daytime sleepiness
33
Q

How common is insomnia?

A

affects roughly 10% of the population around 40% of the population will report a symptoms of insomnia at any one time

34
Q

What is the ICSD-3 diagnostic approach for insomnia?

A
  1. Difficulty initiating sleep
  2. Difficulty maintaining sleep
  3. Waking up early than desired
  4. Resistance going to bed
  5. Difficulty sleeping without partner or caregiver
  6. Daytime difficulties because of sleep
  7. Present for 3 months to be classed as chronic: 1-3 months short-term insomnia

LMAP (31 decks)

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