Nutrition & FTT Flashcards
(79 cards)
1
Q
Changes in body composition with age
A
- Decreased bone mass, lean mass, water content
- Increase total body fat (abd fat stores)
2
Q
Lower muscle mass =
A
Lower BMR/BEE (basal energy expenditure)
3
Q
BMR/BEE is essentially
A
Total body energy expenditure @ rest
4
Q
Stress & activity increase expenditures (TDEE) in older adults….
A
Can be 1.2x to up over 2x normal limits
5
Q
Protein needs
A
Females: 46g/d
Males: 56g/d
6
Q
Carbohydrate needs
A
130g/d
7
Q
Fiber needs
A
Female: 21g/d
Male: 30g/d
8
Q
Recommended water intake
A
1.5-2L/day
9
Q
Supplementation recommendations (prn)
A
Calcium, vitamin D, vitamin B12
10
Q
Older adults are at higher risk for micronutrient/vitamin ______ than young adults
A
Deficiency
11
Q
______ is the most common fluid or electrolyte distrubance in older adults
A
Dehydration
12
Q
Fluid needs
A
Females: 2.7L/d
Males: 3.7L/d
13
Q
Physiologic changes in elderly that cause dehydration
A
- Decreased perception of thirst (normal aging)
- Decreased response to changes in serum osmolality
- Reduced ability to concentrate urine following fluid deprivation
14
Q
Adequate intake of calcium
A
1200mg
15
Q
Adequate intake of Mg
A
Females: 320mg
Males: 420mg
16
Q
Adequate intake of vitamin D
A
15ug
17
Q
Adequate intake of vitamin C
A
Females: 75ug
Males: 90ug
18
Q
Adequate intake of folate
A
400ug
19
Q
Adequate intake of B12
A
2.4ug
20
Q
Adequate intake of thiamin
A
Females: 1.1mg
Males: 1.2mg
21
Q
Common signs of dehydration
A
- Decrease UOP
- Orthostatics
- Constipation
- Mucosal dryness, xerostomia
- Confusion
22
Q
Causes of dehydration
A
- Decreased PO intake
- Diarrhea
- Bleeding
23
Q
Diminished sensations related to eating/food in older adults?
A
Taste
Olfactory function
24
Q
Complaints of taste & smell dysfunction =
A
Common!
25
What can predispose older adults to unnoticed tooth destruction?
Age & history of prior restorative dentistry (makes teeth less sensitive)
26
Common oral cavity issues that DO NOT represent normal aging
- Dry mouth
- Tooth decay
- Missing teeth
- Periodontal disease
27
Common causes of tooth loss
- Inability or unwillingness to access or pay for dental care
- Loose teeth from gum dz
28
Implications of tooth loss
- Diminished chewing
| - Loss of preference for food choices that require vigorous chewing
29
What intervention is associated with tooth preservation later in life?
Preventative and restorative dental care in childhood/early adulthood
30
Are dentures covered by Medicare?
One would think but NO
31
Benefits of dentures
- Aid in ability to speak clearly
- Restore facial contours
- Restore ability to chew
32
Risk threshold for low BMI =
18.5kg/m2
33
Unintentional wt. loss of __% in 1 month or __% in 6 months is a useful indicator of nutritional risk and morbidity
5; 10
34
Poor nutritional risk and high risk morbidity is predictive of
- Functional limitations
- Increased health care costs
- Need for hospitalization
35
Inadequate nutritional intake is defined as
Average intake of food groups, nutrients, or energy 25% to 50% below any RDA threshold
36
Intake of ??
75??
37
Around what percentage of NH residents do not meet standards for adequate nutritional intake?/
5-8%
38
Low ____ is a risk indicator for morbidity & mortality
Albumin (NOT S/S)
39
Does albumin synthesis decrease with age?
No
40
Low albumin (<3.5) serves as a prognostic value for.....
Injury, disease, or inflammation
41
______ reflects short-term changes in protein status
Prealbumin
42
Acquired _______ is a nonspecific feature of poor health status
Hypocholesterolemia (<160mg/dL)
43
Hypocholesterolemia may reflect a ____________ condition
Proinflammatory
44
Older adults with low albumin & low cholesterol have higher rates of __________ than those with one or the other
M&M
45
Risk factors for poor nutritional status
- Alcohol or substance abuse
- Cognitive dysfunction
- Decrease exercise
- Depression, poor mental health
- Functional limitations (limited mobility, transportation)
- Inadequate funds
- Limited education
- Chronic disease
- Medications
- Poor dentition
- Restricted diet, poor eating habits
- Social isolation
46
What is cachexia
Complex syndrome that combines weight loss, lipolysis, loss of muscle and visceral protein, anorexia, chronic nausea, & weakness
47
Cachexia is likely d/t....
Cyctokine (IL-1, IL-6) and TNF-a
48
Cachexia is common in what two patient populations?
Late stage CA
| AIDS
49
Define wasting
The involuntary loss of fat, muscle, and protein
50
Wasting is common in what types of patients?
Chronic illness
| Chronic organ failure
51
What alleviates cachexia and wasting?
Treatment of underlying disease (NOT improved nutrition)
52
Cachexia and wasting are strongly associated with
Death
53
Define protein-energy undernutrition
Clinical (e.g. wasting, low BMI) AND biochemical (e.g. hypoalbuminemia) evidence of insufficient intake
54
Treatment of protein-energy undernutrition
Treatment of underlying disease AND provide nutritional support
55
Prevention of undernutrition
- Cater to pt. food preferences
- Avoid restrictive "therapeutic diets"
- Provide assistance
- Enhance comfort, taste, & appearance of food
- Enhance social aspect of eating; provide adequate time
- Address chewing discomfort/dysfunction
56
Most serious complication of tube feeding
Aspiration
57
Aspiration occurs in up to ____ of PEG tube pt.
Half
58
Most older person require _____-_____kcal/mL solution over 24 hours to meet nutritional needs
1500-2400
59
What causes refeeding syndrome
Results from overzealous feedings following severe undernutrition
60
Refeeding syndrome is characterized by
Severe electrolyte abnormalities (hypophosphatemia) and fluid retention
61
How to prevent refeeding syndrome
Cautiously advance nutritional therapy and closely monitor fluid & electrolyte status
- Consult RD!
62
How to treat refeeding syndrome
Intensive multidisciplinary electrolyte replacement
63
Two main approaches to older adults w/ eating difficulties
1. Careful feeding by hand
| 2. Tube feeding
64
PEG tube placement is associated w/...
Low procedure-related complication rates, substantial mortality (long-term studies)
65
Median survival after PEG tube is
<1 year
66
How many studies demonstrate improved survival, reduced pneumonia/infection, improved sx, or function, reduced pressure sores w/ PEG tube use?
NONE
67
Complications of PEG tubes
- Aspiration pneumonia
- Metabolic disturbance
- Local cellulitis
- Diarrhea
- Diminished social contact
68
What can dictate withholding or terminated artificial feeding
Patient's wishes
69
Define FTT
A syndrome manifested by wt. loss >5% of baseline, decreased appetite, poor nutrition, and inactivity
70
Sx ass. w/ FTT
- Dehydration
- Depressive sx
- Impaired immune fcn
- Low cholesterol levels
- Physical dysfcn
- Malnutrition
- Cognitive impairment
71
Causes of FTT are commonly
Unidentifiable or irreversible
72
FTT is ass. w/
- Increased infection
- Decreased cell immunity
- Hip fx
- Decubitus ulcers
73
Incidence of FTT
Hospital > NH > community
74
Comprehensive assessment of FFT includes
- Baseline functional ability
- Social support
- Environmental factors
- Physical and psychological hx
75
Goal of FTT w/u
Identify medical conditions (e.g. meds, ETOH & substance abuse, etc.) associated w/ FTT
76
Functional assessment of FFT
- Evaluate ADLs
- Get up & go
- Screen for causes of disabilities (vision, podiatry, neuro disorders)
77
Most common psychiatric disorder in the elderly
Depression (can be cause or contribute to FFT)
78
Elderly pt. with depression are more likely to present w/ physical complaints or mental/emotional complaints?
Physical
79
Treatment of FFT
* consider if you'll treat what you find before you work it up
* *consider tx if few risks (can worsen frailty)
- Exercise as tolerated
- Maintain adequate nutrition
- Treat depression w/ SSRy or mirtazipine
