Geriatrics: nutrition and feeding Flashcards
DETERMINE predictors of malnutrition
D: disease
E: eating poorly
T: tooth loss or oral pain
E: economic hardship
R: Reduced social contact
M: multiple medications (antibiotics, anticholinergics (dry mouth), antihistamines()
I: involuntary weight loss or gain
N: need of assistsance with self care
E: elderly persons older than 80 years
What is the ABCD nutrition assessment?
A: anthropometric
B: biochemical
C: clinical
D: dietary
What is the ABCD nutrition assessment?
A: anthropometric
B: biochemical
C: clinical
D: dietary
What are alternatives to BMI?
Knee height
Fibula length
What are the clinical signs of malnutrition?
- Thin looking muscle loss (protein calorie malnutrition)
- Hair: dull, dry, easily plucked (PEM, zinc, manganese, copper deficiencies)
- Gums: bleed easily (vit C, niacin, riboflavin)
- Mouth: cheilosis, angular scars (riboflavin, folic acid deficiencies)
- Nails: fragility, spoon shaped
- Proximal muscle weakness, falls
- Hypoalbuminemia edema
What are the reasons for malnutrition?
- Recent illness
- Dysphagia (dentures fix)
- Depression
- Mouth sore
- Physical difficulty in handling cutlery
What is the management for malnutrition?
Modular formula (or fortification): glucose polymer, protein polymer
What is involved in the swallowing oral phase and how can it be affected?
Oral phase pathologies (nasal regurgitation as cannot maintain the soft palate)
Jaw weakness
Tongue and buccal weakness
Poor tongue coordination
Problems in oral sequencing: resulting in aspiration before swallowing
What is involved in the reflex phase of swallowing?
Soft palate elevation: close off nasal cavity
Laryngeal elevation: tilting down the epiglottis and adduction of vocal cords: prevent trachea from food entry
Coordinated pharyngeal constriction and cricopharyngeal relaxation: facilitate the bolus going down
What pathologies in pharyngeal stage of swallowing?
difficulty in initiating the swallowing reflex, nasal regurgitation, mid throat sticking
What problems can arise in the esophageal phase of swallowing?
oesophageal pain and obstruction, esophageal spasm, esophageal dysmotility, GE reflux
What is the bed side water swallowing test and when is it done?
Observe patient color, change in voice quality, cough, desat (>2% of SaO2)
Positive if the patient developed wet hoarse quality of voice or cough after 1 min
Done for stroke, Parkinson’s, chest infection (bronchiectasis: tram line)
What tests can be used to assess the swallowing function of patient?
VFSS (video fluoroscopic swallowing study)
FEES (fiberoptic endoscopic evaluation of swallowing)
FEEST: air pulse stimuli delivered to the mucosa to elicit the laryngeal adductor reflex
What are compensatory techniques for dyspahgia?
Seated upright
Raised head of bed at leat 30 degrees of cannot seated out
The chin down or chin tuck manouvre
Stroke patient
Tilt body to non paralyzed side (decreased bolus entrapment)
Can also do warm
Cold stimulation, tactile and pressure simulation (gag reflex will be better) which are forms of sensory stimulation
What are the 2 forms of feeding if patient cannot swallow?
NG tube (Ryles tube)
PEG (percutaneous endoscopic gastrostomy)
