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FN 3344 > Lecture 10 - Nutrition Assessment of Adults and Elderly > Flashcards

Lecture 10 - Nutrition Assessment of Adults and Elderly Flashcards

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1
Q

What are the classifications of elderly people?

A

65-74= young old
75-84=Middle old
85-99= Old old
>100= Oldest

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2
Q

what kind of screening is used for the elderly >65 and when is it appropriate?

A

Mini Nutrition Assessment (MNA)

  • with normal nutritional state
  • At risk of malnutrition
  • Malnourished
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3
Q

What is determine used for?

A

your nutritional health checklist, used for nutritional screening

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4
Q

What does determine stand for?

A 
Disease
Eating Poorly
Tooth loss/Mouth Pain
Economic Hardship
Reduced Social Contact
Multiple Medicines
Involuntary Weight Loss/Gain
Needs assistance in Self-Care
Elder Years above age 80
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5
Q

When we are taking a patient history, what information should we gather?

A

Chronic disease

  • CV health
  • Bone health
  • Dental/oral health
  • mental health

Medical Tx
Prevention of disease
Prevention of disease complications
Family History

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6
Q

During patients history what should we consider about meds?

A

Over the counter vs prescriptions

Polypharmacy

Drug nutrient, nutrient drug interactions

ex: laxatives, meds to manage diabetes, hyperlipidemias

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7
Q

How do medicines and nutrition go together?

A

People sometimes think that medical drugs do only good, not harm

Both prescription and OTC meds can have unintended consequences
-causing harm when they interact with the bodys normal use of nutrients

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8
Q

What effect to foods, nutrients and herbs have on drugs, caffeine and tobacco?

A

Nutrients increase/decrease drug action/metabolism/excretion

Herbs modify the actions of drugs

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9
Q

What effects do drugs, caffeine and tobacco have on food, nutrients and herbs?

A

Drugs increase/decrease nutrient action or excretion

Drugs modify appetite and taste

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10
Q

What effects go both ways for food, nutrients and herbs on drugs caffeine and tobacco?

A

Enhance/delay/prevent absorption

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11
Q

What information should we obtain for socio economic history when taking patient history?

A 
Age
Support System
Personal Situation
-resources, isolation
Lifestyle
-Stress, physical activity, work
Autonomy
-transportation
-housing
-activities of daily living
-Self image
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12
Q

What kind of anthropometric and body comp data do we take?

A

Wt, ht

  • Wt change: voluntary vs involuntary
  • Wt history
  • BMI
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13
Q

How do we evaluate body comp?

A 
Including muscle mass and fat deposition
-Waist circumference
-Waist to hip ratio
BMI
BIA
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14
Q

What is the BMI shift?

A

In the older person, involuntary weight loss deserves immediate attention

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15
Q

What BMI is considered underweight for >65years

A

BMI<23kg/m2 and has been associated with increased risk of mortality

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16
Q

what should the BMI range be for >65?

A

BMI should be between 24-30kg/m2

-the increase weight acts as a nutritional reserve, padding to protect bones during a fall

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17
Q

What do we monitor in seniors?

A 
Bone Mass
-tends to decrease
Fat mass
-tends to increase
Muscle Mass
-tends to decrease
Sarcopenic Obesity
-use special equipment
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18
Q

What is sarcopenia?

A

Decrease in strength and muscle mass

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19
Q

What is sarcopenic obesity?

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A

Decrease strength
Low muscle mass
Excess body fat

20
Q

What is primary sarcopenia?

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A

Skeletal Muscle Mass loss related to aging

No other evident cause

21
Q

What Is secondary Sarcopenia?

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A

Causes other than or in addition to aging

Muscle loss related to disuse, inflammation and malnutrition

22
Q

How do you classify acute vs chronic sarcopenia?

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A

Acute <6months

Chronic >6months

23
Q

What is frailty?

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A

A multidimensional syndrome with sarcopenia as the key pathophysiological feature
-describes a state of increased vulnerability to poor health outcomes

24
Q

What is the 5 criteria for frailty?

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A 
Slowness
Weakness
Low physical activity
Exhaustion
Shrinkage
25
What happens with patients that have a chronic disease?
Appear to be predisposed to frailty-inflammation
26
What kind of biochemical lab data do we look at?
CBC (rule out anemia) Bone density measurement Urinalysis to evaluate renal health and protein status Vitamin D Blood Lipid Panel (determine 10 year risk facto for CVD) Blood Glucose measurement (screening for the present of prediabetes and Type 2)
27
Why is Vitamin D important in the elderly?
As people age, synthesis declines 4x setting the stage for deficiency Many older adults drink little or no Vitamin D fortified milk and feet little or no exposure to sunlight
28
What are the recommendations for vitamin D in the elderly are?
50-70yrs: should get 600IU Over 70yrs: 800IU
29
Why is vitamin B12 important in the elderly?
Many people over the age of 50years lose the ability to produce sufficient stomach acid to make the protein bound IFF form of Fit B12 available for absorption
30
What are the Vitamin B12 serum values?
Deficient <148pmol/L Marginally Deficient >148-220 Adequate >220pmol/L
31
What clinical examination data should we look for?
``` Evaluation of Fluid status Evaluation of Energy Status Evaluation of -BP -Body Temp -Gi problems ```
32
What are the signs and symptoms of dehydration or under dehydration?
``` Thirst Oliguria Decrease skin turgor, pale skin Dry mouth/lips, thick saliva Coated, wrinkled tongue Heartache, dizziness confusion Decrease Wt Body temp Increase Decrease BP Increase HR ```
33
Why is dehydration a major risk factor?
Because the thirst mechanism may become imprecise -older people may go for long periods without drinking fluids Kidneys become less efficient at recapturing water before it is lost as urine -water loss causes some problems and worsen others
34
What other clinical examination data should we look at?
Evaluation of swallow Evaluation of presence of S&S of micronutrient deficiencies or disease states Monitoring of changes in health using S&S - appetite - sensory losses - skin infection - Mobility - depression
35
What do we look for when doing dietary assessment?
``` Usual eating pattern -Regular/random eating -Snacking -Beliefs/habits -Restriction -Disrodered eating Quantity, types, where and when food & beverages are consumed -Balance, moderation, alcohol, caffeine, food&mood Diet Hx -Wt loss attempts/dieting Who is responsible for food prep -variety? ```
36
Why do we look at energy and activity?
Energy needs often decrease with advancing age - #of active cells in each organ decreases - Reducing the bodys overall metabolic rate - Lean tissue diminishes - Older people often reduce their physical activity
37
What happens after the age of 50 in terms of energy and activity?
The recommended intake for energy assumes a 5% reduction in energy output per decade -leaves little leeway in the diet for foods of low nutrient density such as (sugars, Fats, Alcohol)
38
What other dietary assessment data should we take into account?
``` Energy intake and adequacy Macronutritent Intake and adequacy Micronutrient intake and adequacy Fluids intake Fiber intake ```
39
What is the recommended protein range for older adults?
Can range from 1.0-1.2g/kg/d to as high as 2.0 per day -used to be 0.8-1.0 Focus on 1) Type of protein 2) Timing of protein intake
40
How much protein should >65yrs get?
25-30g/meal | 2.5-2.8g leucine/meal
41
What is the exception of protein recommendations for which group of elders?
Older adults with severe kidney disease has to have a protein restriction
42
What is leucine?
Is suspected to be the only amino acid which can stimulate muscle growth and can also help prevent the deterioration of muscle with age
43
What are high leucine containing foods?
``` Sheese Soy beans Beef Chicken Pork Nuts Seeds Fish Seafood Beans ```
44
What is the protein threshold?
Threshold of leucine exists needed to trigger muscle building -small amount of protein at a time may not reach this threshold May need to discourage nibbling/grazing go ensure sufficient hunger at mealtimes
45
What is the recommended amount of protein per meal to stimulate muscle building?
30g protein/meal

FN 3344 (13 decks)

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