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HUNT 243 > Unit 2 lectures 21-25 > Flashcards

Unit 2 lectures 21-25 Flashcards

1
Q

“Sandwich” years

A

50s
older children and older parents
multigenerational care

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2
Q

What is it called when menopause occurs before 40 years of age?

A

Premature ovarian insufficiency

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3
Q

What does prolonged low levels of oestrogen cause?

A

vaganial dryness, overactive or discomfort in bladder.

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4
Q

How long does menopause symptoms last?

A

5-10 year

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5
Q

Advice for tolerating menopause symptoms:

A

Improve diet (increase calcium via dairy)
Regular exercise
Stop smoking
Psych treatment
*MHT or non hormonal therapy options, complimentary therapies -> refer to doctor / GP for prescription of medicines

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6
Q

What age does bone mass decline?

A

40 years old

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7
Q

DALY

A

Disability adjusted life years
Dietary is 2nd highest % of total DALY

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8
Q

Hormonal changes

A

Male: decline in testosterone and muscle mass (after 30)
Female = perimenopause and menopause

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9
Q

Perimenopause

A

Characterised by different cycle length AND fluctuations in oestrogen (mostly decline)
*Symptoms arise from decrease in oestrogen
e.g. hot flushes, mood disturbance (-> inc anxiety/depression), heavier bleeding, fatigue

30s-50s
IMPORTANT: Recognise symptom changes - because the risk factors for chronic diseases change

E.g. accelerated bone loss (due to low oestrogen)
Increase central adiposity (abdominal fat)
Lipid profile changes
Altered glucose metabolism
Increased risk for CVD

Diet to slow down bone mineral loss (increase calcium and vit d) and healthy lipid profile (low SFA and regular PA)
And prevent excess weight gain, altered lipid profile and CVD risk, healthy diet and physical activity.

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10
Q

Perinenopause treatment

A

Focus on prevention of chronc disease
and indavidualise lifestyle recommendations
becuase symptoms increase risk of chronic diseases e.g accelerated bone loss (due to low oestrogen)
Increase central adiposity (abdominal fat)
Lipid profile changes
Altered glucose metabolism
Increased risk for CVD

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11
Q

Menopause

A

occurs when you have not had regular/monthly period for 12 months (arouns 51 years old)
Decrease in estrogen = ovaries stopping to function
*Can occur for other reasons e.g. surgical menopause, chemo/radio therapy
Or can occur early due to smoking, hysterectomy, high altitude

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12
Q

Body composition changes

A

Decrease in bone mass
Increase in adiposity

*Optimal bone mass not attained = increases osteopenia and osteoporosis risk

Increases in both visceral and ectopic fat -> Increases RISK of diabetes, metabolic disturbances, high cholesterol, increasing risk of chronic disease

Visceral fat: Deep in intra-abdominal space
Ectopic fat: Accumulates in organs i.e. liver, heart, pancreas, muscles

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13
Q

MOH eating guidelines for adults

A

Eating statement 1: Enjoy a variety of nutritious foods every day (vege, fruit, wholegrains, dairy, legumes, meat)

Eating statement 2: Prepare/choose food and drink with unsaturated fats, i.e. canola, olive or rice instead of saturated fats such as butter, cream, coconut oil
Little or no added sugar
Low in sodium (if using salt use iodised)
Mostly ‘whole’ and less processed foods

Eating statement 3: Water first drink of choice rather than other drinks
Eating statement 4: If drink alcohol, keep intake low
Eating statement 5: Buy or gather, prepare, cook and store foods in ways that keep it safe to eat
*If pregnant take extra care to protect yourself from foodborne illness
Eating statement 6: encourage, support and promote breastfeeding

*Can show plate model for a visual healthy eating guide
Mostly vege and grains - naturally high in fiber.
Legumes, seafood, eggs, lean meat and low fat dairy, then fruit

Increasing prevalence of NCD, type 2 diabetes :. Vege intake reduces this

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14
Q

What proportion of kiwis are meeting fruit recommendations?

A

45% are meeting the recommendations

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15
Q

What proportion of kiwis are meeting vege recommendations?

A

ONLY 11%(1 in 9) are meting the recommendations

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16
Q

What proportion of kiwis are meeting BOTH fruit and vege recommendations?

A

ONLY 6.7% of kiwis are meeting the recommendations of both fruit and veg
*cost of food is a barrier

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17
Q

Alcohol recomendations

A

NOT recommended to have more than 2 standard drinks/d and no more than 10 standards drinks per week for women and 12 for men

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18
Q

Alcohol intake to reduce LT health risks?

A

No more than 2/day and 10/week for women
No more than 3/day and 15/week for men
At least 2 alc free days every week
*There is no safe level of alcohol intake

Increases risk of cancer (i.e. bowel and breast)
Abstinence = best for cancer prevention :. Is a modifiable risk factor
1 in 25 of cancer deaths are due to alcohol (younger than 80y/o)

Q: what is the most common type of cancer caused by alcohol?
A: breast (caused by less than 2 drinks/day on average)

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19
Q

what % of adults drink alc?

A

80% (20% ‘hazzardously’ i.e. E.g. 6+ drinks twice a week)

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20
Q

How is alcohol consumption measured?

A

AUDIT 10 question

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21
Q

Gastro esophageal reflux disease (GORD)

A

Causes inflammation in the oesophagus which is detrimental

Open lower esophageal sphincter
Relaxed smooth muscle
Pregnancy / fetus pressure
Smokers
High alcohol intake
Overweight adults

Symptoms:
Acid reflux/regurgitation
Heartburn
Bad breath
Bloating/bleching
Nausea
Pain when swallow
Sore throat/cough

Treatment:
Small and frequent meals
Avoid trigger foods e.g. fat, spicy, caffeine, alc
Maintain heathy weight
meds or surgery for severe

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22
Q

Supplement use in adults

A

*FOOD FIRST APPROACH
If heat a balanced diet including foods from all food groups, deficiencies are unlikely

Supplements are NOT regulated like foods

Supplements are regulated Under medsafe (different to food which is FSANZ)

Imported supplements have a high risk of contamination
E.g. glass shards, bacteria, doping supplements

Dose claims:
E.g. spf factor invalid around contents and concentrations

Stacking supplements: Taking multiple supplements and can lead to excessive intake of certain supplements

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23
Q

what is most used supplement for NZ adults?

A

Fish and plant oils
*Older adults more frequently use supplements!

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24
Q

Pattern of sedentary behaviour - “Prolnger”

A

Cross sectional evident
“Prologer”: poorer fasting glucose, insulin concentration, triglyceride concentration than the breaker
Longer periods of sitting = higher risk

Longitude evidence: (cohort data)
Longer bouts of time = higher risk of all cause mortality

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24
Q

What are the 5 activity statements in the NZ healthy eating and activity guidelines?

A
  1. Sit less, move more. Break up long periods of prolonged sitting
  2. Do AT LEAST 2.5hours of moderate PA per week or 1.25h of vigorous PA per week
  3. 5h of moderate PA spread across the week or 2.5h vigorous PA. For extra benefit (up until a certain point, then no additional benefit)
  4. Muscle strength training activities AT LEAST twice a week
  5. Doing some PA is better than none
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25
Q

What did meta analysis on sedentary behaviour show?

A

Above 8h a day, every additional hour of sedentary time increases relative risk by 4% of all cause mortality i.e. risk of dying.
And above 6h, 4% of CVD mortality/death
*no signifficnat evidence for cancer associations

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26
Q

Breaking up sendentary time

A

RCT evidence:
reduces glucose concentration (Postprandial glucose response) by walking for 1.40 mins every hour

Meta analysis: Walk regularly throughout day = moderate reductions in glucose

*evidence to understand why it is important to breakup prolonged periods of sitting.

27
Q

How do the NZ activity statements differ from the WHO recommendations?

A

More specific i.e. all muscle groups ar moderate or greater intensity and how to begin and progressive overload.
NZ - hours (half the amount of mod if vig)
WHO - mins and WHO encourages anyone to meet guidelines regardless of health status and ability

28
Q

Benefits of muscle strengthening exercises

A

Strength reducing CVD mortality
preventing falls
preserve bone mineral density and muscle mass

29
Q

Good practice statements

A
  • If not able to meet the recommended guidelines for PA due to chronic conditions, aim to engage in PA according to their abilities.
  • Begin with small amounts of PA and gradually increase the frequency, intensity and time.
  • Consult with a health-care professional advice for the appropriate type and amount of PA for their indavidualsied needs, abilities, functional limitations/complications, medications, and overall treatment plan.
  • Pre-exercise medical clearance is generally Unnecessary for individuals WITHOUT contradictions prior to beginning light to moderate intensity PA not exceeding the demands of brisk walking or everyday living.
30
Q

How do you asses if someone has contradictions?

A

Physical Activity Readiness Questionnaire (PAR-Q)
*if yes to any of the 7 questions, REFER to a medical professional / exercise specialist

31
Q

Consensus statements

A

THE BENEFITS OUTWEIGHT THE RISKS in indaviuals livng with long-term conditons

  1. The benefits outweigh the risks i.e. PA is safe for those with medical conditions
  2. The risk of adverse events is very low but that’s not how people feel i.e. informed convorsations with healthcare professionals can reassure people who are fearful of their condition worsening and further reduce this risk.
  3. Its not as easy as telling someone to move i.e. be aware of indaviduals concerens to help build self confidence and self efficacy
  4. Everyone has their own starting point - gradually build from it
32
Q

SIGNS OF MEDICAL REVIEW (AND STOP)

A

Dramatic increasce in breathlessness
New or wrosening chest pain (and/or glyceryl trinitrate requirement) - angina symptom
Sudden onset of rapid palpitations or irregular heartbeat
Dizziness
Reduced capacity for exercise
Sudden change in vision

33
Q

CVD risk assessment of developing CVD in next 5 years is Less than 5%

A

Limited benefit from medication management
Repeat in 5 years time
(if less than 3%, repeat 10 years time)

34
Q

CVD risk assessment of developing CVD in next 5 years is 5-10%

A

Discuss magnitude of benefits of loweing blood pressure based on evidence showing, the greater the risk, the more likely they are to benedit.

Follow-up: 5 years time 5-9%
Repeat every 2 years if 10-14%

35
Q

CVD risk assessment of developing CVD in next 5 years is greater than 15%

A

Strong evidence suppourts lowering blood pressure to prevent CVD and death

Followup: annually and repeat risk assessment

36
Q

If have CVD

A

strong evidence suppourts pharmacotherapy for modifiable risk factors and antiplatlet therapy for seccondary prevention
Follow up: annually

37
Q

Physiological changes in olderadulthood
(which influence nutrition)

A
  1. Body comp
  2. Gastrointestinal
  3. Nervous system
38
Q

Body composition changes

A
  • largest impact on nutritional status
  • 1-2% decline in lean body mass after 50 years (accelerates after 80)
  • Bone mineral and collagen removed more rapidly than replaced -> increased risk of developing osteoporosis and fractures

Overwight in older adults = more protective effect than in younger adults

less problematic in older adults
Protection, immunity etc (from more fat)
High body fat = shorter hospital stays

39
Q

Importance of protien in older adults

A

Higher protein needs due to:
- Anabolic resistance
- hypermetabolic disease (inc met)
- Apetite loss due to age, medication, f- incancial limits
1-1.5g/kg per day is recommended; depending on severity of malnutrition risk
- Decreased muscle
- Sarcopenia
- Disease related protein catabolism

Lower protien intake due to:
- Genes
- Socioeconimic conditins i.e. food security (access and ability to prep and cook)
- Physical and mental disorders
- Medical conditions
Physiological changes i.e. Low appetite

40
Q

Key sources of protein in older adults:

A

Milk, breakfast cereal, bread, meat/fish

41
Q

GI changes affecting nutrition

A
  • Decreased saliva secretion
  • Difficulty swallowing (dysphagia)
  • Decreased secretion of hydrochloric acid and digestive enzymes
  • Decreased vitB12 absorption (due to decreased acidity, as acidic environment is required for absorption)
  • Decreased peristalsis :. Less emplything (constipation/diarrhoa)
42
Q

Nervous system changes affecting nutrition

A
  • Blunted appetite and thirst regulation (fluid deprivation)
    • Declining number of olfactory receptors, blood flow to nasal smell organ, thicker nasal mucus
    • Reduced nerve conduction velocity, affecting sense of smell, taste, touch, cognition
    • Changed sleep as the wake cycle becomes shorter
    • Taste: 1/4 have difficulty tasting one of the tastes - -ve effect on eating
      Smell: increase risk of food safety i.e. cant detect off foods
43
Q

Polypharmacy

A

use of multiple meds

Interferes with appetite, digestion, metabolism, alertness

tend to experince greater weight loss, more frail and weak with low level of activity

More meds taken = more chances of
- Affecting absorbtion of another drug
- One increases a body reaction (can cause hopsitalisation)
- Memory (more meds taken, harder to memory) addiotnally, cognitive declines enhancing this
Increases risk of renal failue - inability to excrete from multiple medications

44
Q

Dehydration symptions in older adults

A

Weak upper body
speech difficulty
Dry mucous membranes in nose and mouth
Longitudinal tonge furrows
Dry tonge
Sunken apperance of eyes in their socets

45
Q

Dehydration contributors

A
46
Q

LOW INTAKE DEHYDRATION: More modifiable factor for prevention of dehydration

A
  • Physiological: decrease thirst, decreased kidney function, lower total body fluid stores
  • Psychological: cognitive impairment making it difficult to remember to drink or recognise thirst
  • Physical: reduced dexterity, poor vision, poor mobility and relyant on feeding assistance
  • Comorbidities: poorly controlled diabetes, dysphagia, early satiety
  • Environmental: hospitalised/aged care relince on carers for fluid
47
Q

Volume depletion (contributor to dehydration)

A

Diarrhoa, vomiting, hyperthermia, bleeding, diuretic medications

48
Q

Prevention of LOW INTAKE DEHYDRATION

A

ALL older adults should be considered AT RISK & encouraged to consume adequate amounts of fluids
i.e. 2L for men and 1.6L for women
- offer a range of appropriate drinks based on personal preference

49
Q

Definition of malnutrition

Global - 1/4 older adults are malnourished (or at risk)
Aus&NZ -
17% ad 63% are at risk
Prevalence is greater in women, 80+years and if multiple morbidities (comorbitiies)

IDC: international classification of disease - 10-
AM: Australian modification

A

BMI <18.5 or weight loss >5% within the past 3-6 months (additionally subcutaneous fat loss and muscle wasting)
Lack of adequate nutrients to meet the body’s needs
*important to understand timeframe of weight loss % (e.g. 3-6m or 12m)

50
Q

Prevalence of malnutrition:

A

Impact more than 1 in 3 patients in hospital
Global - 1/4 older adults are malnourished (or at risk)
Aus&NZ - 17% and 63% are at risk
Prevalence is greater in women, 80+years and if multiple morbidities (comorbitiies)

51
Q

Unintentional weight loss - Potential causes

A
  • Underlying, undiagnosed disease or illness -> Interfere with appetite and biochemical function
  • Protein-energy malnutrition
  • Poverty
  • Functional decline
52
Q

Signs of malnourishment or at risk of being malnourished

A
  • Baggy clothes, belts, jewelry
    • Eating less than usual
    • Not enjoying Favorite foods
    • Loose dentures
53
Q

Adverse effects from malnutrition in older adults

A
  • Higher risk of infection, and falls
    • Longer hospital stays
    • Loss of strength
    • Poor immunity
    • Reduced ability to do usual daily activities
    • Reduced quality of life
      Shorter life expectancy
54
Q
A
55
Q

General principles of nutritional care (Geriatric patients)

A

1) Prevention and Treatment of Malnutrition
2) Prevention and Treatment of low-intake dehydration

56
Q

Screening for malnutrition

A

screening is NOT a diagnosis - it identify those who are malnourished or at risk
Screen helps early identification for diagnosis and treatment
Screening is quick, simple and anyone can do it. E.g. admin staff, nurses, doctors, carers, family mmbers, friends and the paitient themselves

Recommended for ALL OLDER ADULTS ACROSS ALL HEALTH SETTINGS i.e. Hospital, age care, community for early identification

57
Q

How to screen for malnutrition in older adults

A
  • Anthropometry (BMI, calf circumference, mid-arm circumference)
    • Asking questions around weight loss, changes in appetite and/or food intake
    • Mini nutritional assessment tool (MNA) - most common in NZ for older adults malnutrition status (can be used in any/all settings) is a grading system. *If no BMI - use calf circumference
58
Q

3 Subcategories of malnutrition diagnosis determines which intervention used for management/intervention

A
  1. Disease-related (underlying disease) driven by inflammation
    1. Disease related with no perceived inflammation (cognition e.g. Parkinson’s disease)
  2. Malnutrition due to starvation not related to disease (e.g. hunger from appetite changes, socio economic factors or psychological factors)
59
Q

Factors influencing food intake

A
  • Dental health i.e. lose dentures
  • decreased appetite
  • psychological stress i.e. losing a loved one
  • socioeconomic status
  • physical ability to prepare and cook food and cooking faccilities
  • underlying health condition or medications
60
Q

Mangement of malnutrition (i.e. interventions)

A
  • Food first strategy: Encourage high protein and high energy foods (HPHE extras)
  • Food fortification: Fortify mashed potato with added butter, cheese etc (beneficial for getting more energy in without increasing volume)
  • Funded oral supplements if meet requirements or can get over the counter for “at risk” E.g. ensure or complan powder

Re-screening:
- Repeat MNA
- Comprehensive nutrition assessment

If at risk :. Modify intervention

What is the best intervention? (personalized once know contributing factors to malnutrition status)

61
Q

Discuss what is meant by sarcopenic obesity and considerations for older adults when contemplating weight loss.

A

obese and sarcopenia

62
Q

Identification of sarcopeinic obesity

A

Dual X-ray absorptiometry DXA)

Sceletal mussle mass / height^2

63
Q

do sarcopenic obese people weight the same as normal people?

A

yes :. CANT USE BMI FOR OLDER ADULTLS (due to body comp changes i.e. can be sarcopenic obesisy but bmi says normal)

64
Q

Malnutrition screening

A

mini assessment
easy to administer, acceptable to both health-care professionals and paitients and can identify treatable malnutrition.
screening tools: anthropometric measurment i.e. BMI, calf circumference / mid arm circumference + brief questions regarding weight loss, changes in appetite and food intake

65
Q

SAGE study

A

Osteoperosis and Sarceopenia in older adults
- Cross sectional
- 15% osteoperotic only
- 13% sarcopenic only
- 14% had both
Mini nutritinal assessment was LOWER for BOTH (osteo-sarcopenia) vs only sarcopenia or only osteoperosis

If Sarcopenia = more likely to have osteoporosis linked to deficits in nutrition and reduced funtion
and Some degree of malnutrition

co-occurance (oseto-sarcipenia) is common and = HIGHER degree of malnutrition than osteorperorsis or sarcopenia alone

Supplements are not the answer :. What

66
Q

Barriers to good nutrition in aged residential care:

A
  • Staff skills - visual portion reminders, suitable recopies (textures and nutrients etc)
    • Beliefs and nutrition - Have conversation with her to understand why we have morning and afternoon tea. It is because she needs the extra energy to reduce risk of falls and sarcopenia
      Ensure does not lose more weight
      Fortify her main meals
      Find out why she has changed eating patterns
      Activities program: to maintain physical strength which ensures well-being. (decrease anxiety and depression)
    • Feeding difficulty - Texture modification to make easier to chew. Supportive feeding
    • life long habits - feed what they like and monitor weight weekly
    • Health status - e.g. B12 injection or supplements
    • Cost - Meals that serve multiple needs for cost effectivness

Have conversation with her to understand why we have morning and afternoon tea. It is because she needs the extra energy to reduce risk of falls and sarcopenia
Ensure does not lose more weight

Fortify her main meals

Find out why she has changed eating patterns

Activities program: to maintain physical strength which ensures well-being. (decrease anxiety and depression)

HUNT 243 (7 decks)

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