General - older patients, safeguarding

Question 1

What is malnutrition?

Answer 1

Deficiencies, excesses or imbalances in a persons intake of energy and or nutrients

Question 2

What is overnutrition?

Answer 2

Overweight - BMI 25-29.9
Obesity - BMI>30
Related to heart disease, stroke, diabetes and cancer

Question 3

What is undernutrition?

Answer 3

BMI <18.5kg/m2
Unintentional weight loss of 10% body weight over 3-6 months
BMI of 20 and unintentional weight loss of >5% body weight over 3-6 months

Question 4

What oral health conditions contribute to undernutrition?

Answer 4

Sore mouth/burning
Changes in taste sensation
Increased susceptibilty to oral infections
Problems with denture fit/impaired mastication
Swallowing difficulties

Question 5

Why do people become malnourished?

Answer 5

1) Inadequate nutrient intake
2) Increased metabolic requirements i.e. are more active or at cellular level due to health condition, frugs, brain injury, cancer
3) Excessive nutrient losses e.g. B12 def from stomach removal

Question 6

What screening tool is used in nutritional screening?

Answer 6

MUST - 5 steps 1) BMI 2) Unplanned weight loss 3) Acute disease effect 4) Overall risk 5) Action

Question 7

What does it mean if nutritional support is

a) Parental
b) Enteral
c) Oral nutritional support

Answer 7

a) Delivery of nutrition IV
b) Delivery of nutritionally complete feed via tube into gut
c) Additional snacks, fortified food, oral nutritional supplements/sip feed

Question 8

What is food fortification?

Answer 8

Addition of micronutrients or energy e.g. sugar jam, butter cheese, skimmed milk powder

Question 9

What are the short term enteral methods for increasing nutritional uptake?

Answer 9

Nasogastric
Naso duodenal
Nasojejunal

Question 10

What are the long term enteral methods for increasing nutritional uptake?

Answer 10

Percutaneous endoscopic gastrotomy (PEG) - in abdomen
Radiologically inserted gastrostomy (RIG)
Balloon gastrostomy
PEG with jejunal extension
Needle catheter jejunostomy

Question 11

What are the indications for parental feeding?

Answer 11

Non functioning GIT e.g. Crohns, high output stoma, fistulae, short bowel syndrome
Inaccessible GIT e.g. intestinal obstruction
When enteral nutrition not feasible, contraindicated or not accepted by pt

Question 12

What are the central methods for perental feeding?

Answer 12

Venous into superior vena cava or right atrium (TPN)

Question 13

What are the peripheral methods for parental feeding

Answer 13

Short peripheral cannular or midline catheter (PPN)

Question 14

What is the composition of these enteral feeds?

a) Polymeric
b) High protein/high energy
c) Semi-elemental or elemental
d) Disease specific

Answer 14

a) Whole protein 1kcal/ml
b) 1.2 1.5 or 2kcal/ml
c) Oligopeptides/amino acid formulations
d) Modified fats, hypoallergenic, immune enhancing e.g. omega-3 fatty acids

Question 15

What is fraility?

Answer 15

Linked to levels of independence. Mental and physical resilience and recovery after injury/illness, at risk of severe deterioration in health from only minor insults

Question 16

What is ageing?

Answer 16

Process where structural and functional changes accumulate in organism from passage of time - not due to preventable disease or trauma

Question 17

Why do these changes occur in the CNS with increasing age:

a) Poorer short term memory
b) Harder to learn new skills
c) Increased postural hypertension and loss of bladder control
d) poorer co-ordination and fine motor control

Answer 17

a) Increased amyloid protein deposition in the cerebral cortex
b) Loss of neural tissue in the hippocampus
c) Blunting of baroreceptor complexes in the brainstem
d) Age related changes to vertebrae and discs increases pressure and slows conduction of impulses down motor neurones so reduced muscle strength

Question 18

What is a pharmacokinetic interaction?

Answer 18

Modification of action of one drug (X) by drug Y because Y alters the concentration of X reaching the site of action

Question 19

What is the pharmacokinetic interaction between chelates and tetracyclines?

Answer 19

There is an ABSORPTION interaction

Chelate stops tetracycline passing through gut wall

Question 20

What are the following changes that occur in the musculoskeletal system with increasing age?

a) Muscles
b) Bones

Answer 20

a)

Question 21

What are the changes in saliva with increasing age?

Answer 21

• Stimulated and unstimulated flow rates decrease from all SG
• Quality/composition unchanged

Question 22

What a) medical conditions and b) drugs affect saliva flow?

Answer 22

a) Sjogrens syndrome, diabetes, dehydration, salivary gland disease e.g. surgery or radiotherapy
b) Calcium channel blockes, B- blockers, a-adrenergic blockers, anti-cholinergic, diuretics

Question 23

What are the changes in the enamel with increasing age?

Answer 23

• Thins
• Loss of features e.g. mammelons
• Loss of translucency and darkens
• Cracks appear (more brittle)
• Coronal caries and tooth wear more prevalent

Question 24

What are the changes in dentine with increasing age?

Answer 24

• Less water content - cracking

- Peritubular dentine (tubular occlusion)

Question 25

What are the changes in the pulp with increasing age?

Answer 25

- Reduced pulpal space from tertiary and secondary dentine - Pulp calcification - Degeneration pulpal neurones - Widening of apical foramen as increased cementum (large distance from radiographic apex) - Vascularity and cellular content decreases

Question 26

``` What are the changes in a) fibroblasts in the PDL b) Cementum c) PDL with increasing age? ```

Answer 26

a) Reduced rate of proliferation, decreased protein and collagen production b) Thickness increases esp. in apical 1/3 c) Increased fibrosis, decreased cellularity

Question 27

What are the changes in the oral mucosa with increasing age?

Answer 27

- Loss of elastic fibres - Thickening and disorganisation of collagen - Reduced microvasculature - Impaired wound healing

Question 28

What are the clinical implications for teeth that have gone through the ageing process?

Answer 28

- Decreased pain perception - more likely to have asymptomatic pulpitis - Pulp testing unreliable - pulp stones, tubule occlusion, less water - Non patent canals

Question 29

What are the clinical implications for teeth that have gone through the ageing process?

Answer 29

- Decreased pain perception - more likely to have asymptomatic pulpitis - Pulp testing unreliable - pulp stones, tubule occlusion, less water - Non patent canals

Question 30

What are the recommended interventions in the elderly?

Answer 30

Management of long term illnesses according to NICE guidelines Falls assesssment Medication review using STOPP/START tool Comprehensive geriatric assessment

Question 31

What are the implications when treating an elderly patient?

Answer 31

- Difficulty laying flat e.g. breathless from HF or spinal injuries - Increased bleeding from procedures from drugs - Difficulty tolerating long procedures e.g. toilet breaks - Increased risk anaesthetics and sedatives - Difficulty complying with instructions if confused

Question 32

What are the definitions of a) Impairment b) Disability c) Handicap

Answer 32

a) Physical damage caused by the disease process b) Tasks that can't be performed as a result of the impairment c) Effect on the individuals lifestyle

Question 33

What are the 4 geriatric giants?

Answer 33

Instability, Immobility, Incontinence, Intellectual impairment

Question 34

What is the purpose of the National Service Framework 2001?

Answer 34

``` Rooting out ageism Person-centred care Immediate care and general hospital care Strokes falls and mental health Health promotion and disease prevention Medicines e.g. use lower doses ```