Nutrition in the Older Adult Review

Question 1

Pharmacological agents such as histamine-2-receptor antagonists and proton pump inhibitors are commonly prescribed for a variety of GI disorders such as prevention and treatment of gastric ulceration. Prolonged use of these medications may most commonly contribute to the deficiency of. . .

Answer 1

Vitamin B12

Question 2

In order for vitamin B12 to be properly absorbed, it requires adequate ______ ,which decreases with age, to cleave B12 from protein in food. Then free B12 travels to the small intestine where it binds to ____ for adequate absorption

Answer 2

gastric acid

intrinsic factor

Question 3

An 85year old female is admitted to the hospital with a history of stroke, dysphagia, poor apetite with decreased intake x 1 month and 10% weight loss. The patient is evaluated by the speech pathologist who recommends a pureed, HTL diet. What is the most appropriate nutrition intervention ?

Answer 3

Initiate nocturnal EN to supplement the oral diet

Question 4

Medications that cause diarrhea while on EN create a hyperosmolar environment in the GI tract pulling fluid in, creating a laxative effect, these medications include:

Answer 4

magnesium, sorbitol, and kayexelate

Question 5

antibiotics can cause diarrhea because they decrease

Answer 5

the amount of beneficial bacteria within the GI tract increasing the risk for CDiff infection

Question 6

Narcotics such as codeine decrease GI motility and contribute to

Answer 6

constipation

Question 7

long term use of opioids can lead to this type of constipation

Answer 7

obstipation

Question 8

what is appropriate to tell the family regarding nutrition at the end of life: Dying patients rarely feel ____ or ____ due to decreased normal functions, _____ calories are needed at the end of life, patients shouldn;t be made to feel guilty if _________ and decreased ___ and ___ are a natural part of they dying process

Answer 8

1. hunger or thirst
2. fewer calories
3. they don’t wish to eat
4. food and fluid intake

Question 9

A patient in a persistent vegetative state has made their wishes known regarding artificial nutrition via an advanced directive. The decision to terminate enteral feeding for this patient is based on the ethical principle of

Answer 9

autonomy

Question 10

if a patient is not competent and there is no advanced directive available, which 2 ethical principles are important to consider

Answer 10

beneficence and non-maleficence

Question 11

the ethical principle based on respecting and upholding the patient’s right to self determination

Answer 11

autonomy

Question 12

the ethical principle based on health care providers who actively seek the good of the patient above all other priorities

Answer 12

beneficence

Question 13

the ethical principle of “to do no harm” and relates to health care providers actively seeking to prevent, minimize and relieve needless suffering and pain, avoiding harming the patient

Answer 13

non-maleficence

Question 14

the ethical principle that is related to the fair distribution of resources

Answer 14

Justice

Question 15

A Do Not Resuscitate (DNR) or Do Not Attempt Resuscitation (DNAR) orders should be a contraindication to the provision of artificial nutrition and hydration in any state; true or false

Answer 15

false, if indications for ANH exist, ANH should be started even if for a limited time trial

Question 16

ANH can be withheld or withdrawn in patients with a DNR or DNAR if

Answer 16

all concerned parties agree ANH is not meeting the agreed upon goals of the patient

Question 17

those who forgo ANH experience ____ side effects as the analgesic theory proposes that starvation boosts the production of ketones, thereby having an anesthetic effect

Answer 17

decreases

Question 18

aggressive artificial nutrition and hydration can be _____ during the end of life

Answer 18

more harmful and life threatening causing edema, ascites, nausea, vomiting, or pulmonary aspiration/congestion

Question 19

A patient has an advanced directive stating a desire to forgo medical technology including nutrition and hydration in order to prolong life. The patient is now in an irreversible, vegetative state. in deciding whether or not to continue nutrition and hydration by medical means, the patient’s surrogate decision maker must:

Answer 19

honor the patient’s expressed wishes to withdraw nutrition and hydration by medical means

Question 20

documents that allow individuals to document their treatment preferences and identify a surrogate or proxy decision maker to act in the patient’s state when he or she loses the ability to make decisions.

Answer 20

advanced directive

Question 21

in the absence of an advanced directive, where evidence of an incompetent’s person’s previous expressed wishes not to be kept alive by medical technologies meets state evidentiary standards, the exercise of that choice by a surrogate decision maker must also be honored true or false

Answer 21

true

Question 22

In an older adult who requires long term home EN, which complication is often overlooked

Answer 22

decreased urine output/dehyration

Question 23

a decreased urine output likely indicates what in an older adult

Answer 23

inadequate fluid intake /potential for dehydration/AKI

Question 24

Vitamin D (25,hydroxyvitamin D) deficiency is defined as a serum level of less than _____

Answer 24

20ng/mL

Question 25

what is considered an adequate Vitamin D (25 hydroxyvitamin D ) level

Answer 25

30 ng/mL

Question 26

Vitamin D (25,hydroxy vitamin D) deficiency can manifest as

Answer 26

muscle weakness

Question 27

what is the hallmark of frailty seen among older adults

Answer 27

sarcopenia

Question 28

age associated loss of muscle mass and strength is called

Answer 28

sarcopenia

Question 29

a multifactorial syndrome that has various phenotypes in the older adult such as quality of life, vulnerability, and disability with symptoms of 10 lb weight loss in 1 year, unintentional weight loss , self reported exhaustion and weakness is called

Answer 29

frailty

Question 30

What EN complication is the most potentially dangerous in the older adult

Answer 30

aspiration

Question 31

___ and ___ is linked to the development of dysphagia in the older adult which can cause aspiration or oral secretions leading to possible PNA/death

Answer 31

sarcopenia/frailty

Question 32

A 75 year old male with a history of aspiration PNA who was previously deemed unsafe for an oral diet is now experiencing aspiration while receiving continuous EN via his PEG. What long term feeding options are most appropriate

Answer 32

PEJ tube

Question 33

_____ EN feedings are the preferred choice for patients with an increased risk of aspiration as they can minimize the potential of reflux.

Answer 33

small bowel feedings

Question 34

An older adult getting PN may be more susceptible to metabolic complications related to _____ function. Older adults have increased problems with insulin resistance, impaired renal and micronutrient deficiencies

Answer 34

impaired cardiac function

Question 35

which tool includes the assessment of a long term care resident's ability to maintain adequate nutrition and hydration and is mandated by the center for medicate and Medicaid for certified long term care facilities

Answer 35

MDS: minimum data sheet

Question 36

a ______ is completed by an intrer-professional team in a long term care facility to assess all aspects of clinical status and facilitate problem indemnification (triggers) to see if further planning or intervention is necessary

Answer 36

MDS: minimum data sheet

Question 37

what vitamin deficiency is most likely to occur in a person who consumes alcohol of a regular basis

Answer 37

thiamine

Question 38

what medication is most likely to contribute to hyponatremia in the older adult

Answer 38

hydrochlorothiazide diuretic

Question 39

thiazide diuretics can lead to

Answer 39

hyponatremia

Question 40

loop diuretics can diminish this electrolyte

Answer 40

potassium

Question 41

An 80 year old NH resident with a history of constipation has a newly placed PEG tube. Which EN formula would be an appropriate choice to provide

Answer 41

standard 1kcalmL (has adequate fluid)

Question 42

constipation is common in the elderly so adequate ____ should be given when providing enteral nutrition

Answer 42

water flushes

Question 43

_____ addition to enteral nutrition can help propel waste through the colon

Answer 43

fiber

Question 44

if fiber is added to enteral nutrition formula, how much fluid should be given

Answer 44

1ml/kcal

Question 45

concentrated enteral formulas may not be appropriate for the elderly with constipation due to

Answer 45

not adequate in fluid

Question 46

An assessment of functional status may aid in determining nutrition risk. What provides assessment of function status?

Answer 46

hand grip strength assessment

Question 47

What vitamin consideration is most important in an older adult getting a TNA (3-in-1) PN as well as warfarin?

Answer 47

vitamin K

Question 48

vitamin ____ is present in adult MVI preparations and in lipid emulsions which affects anticoagulation therapy so closely monitor______

Answer 48

INR

Question 49

EN formulas supplemented with fiber are often used in the older adult population to prevent constipation. Which of the follow is most important if this is chosen?

Answer 49

provision of adequate water, at least 1mL/kcal

Question 50

The Plan-Do-Study Act cycle is employed as a _____ model

Answer 50

quality improvement problem solving

Question 51

What are the 4 steps of the Plan-Do-Study-Act Cycle

Answer 51

Planning phase, implementation phase, study phase, act phase

Question 52

the ___ phase of the Plan-Do-Study-Act cycle is to measure the results of the improvement effort

Answer 52

study

Question 53

the ___ phase of the Plan-Do-Study-Act is where the team will determine if changes made should be permanent an includes standardization and documentation of the processes

Answer 53

act

Question 54

which classes of medication is used in the older adult population which can contribute to anorexia

Answer 54

SSRIs, antiarrhythmics, and NSAIDS (cardiac meds, psych meds and anti rheumatoid meds)

Question 55

An older adult receiving digoxin and PN who is experiencing signs of digoxin toxicity should be assessed for

Answer 55

hypokalemia

Question 56

Digoxins are anti-arrhythmia medications often paired with diuretics. Older adults are at risk for this electrolyte derangement when receiving digoxin as their kidney function are diminished and the excretion of this medication relies solely on renal excretion

Answer 56

hypokalemia

Question 57

An older adult with poor oral intake over a 2 month period requires specialized nutrition support. What electrolyte abnormalities are associated with aggressive nutrition support ?

Answer 57

hypophosphatemia, hypokalemia, hypomagnesemia (refeeding syndrome)

Question 58

Elderly patient admissions due to adverse drug reactions can be decreased by recognizing this population has ______ sensitivity to warfarin and opiates

Answer 58

decreased

Question 59

Altered medication pharmacodynamics are altered in the elderly as they have a decrease in ____, ____ ____ and _____ leading to medication sensitivity

Answer 59

decreased hepatic blood flow decreased hepatic volume decreased first pass metabolism decrease in eGFR

Question 60

the short form mini assessment used in adults 65 and older was derived from the mini nutritional assessment in order to

Answer 60

obtain high diagnostic accuracy for detecting nutritional problems in older adults w/ a brief screening tool

Question 61

The Comprehensive Geriatric Assessment (CGA) tool includes: physical medical condition, nutrition status, mental health conditions, functional status, social circumstances and environmental as well as

Answer 61

anthropometrics, biochemical markers, meds, and quality of life

Question 62

JD is an 85 year old male whose height is 63", weight of 45 kg had a weight of 55 kg ten years ago. His weight loss has been non-volitional and gradual. he has no major health problems or changes in oral intake. What describes JD's weight loss

Answer 62

decreased lean body mass tissue from sarcopenia

Question 63

What is the most widely used tool to measure generic health related quality of life

Answer 63

SF-36

Question 64

what is one of the most widely used tools to measure health related quality of life

Answer 64

SF-36 tool

Question 65

this tool measures activities of daily living

Answer 65

Katz ADL

Question 66

this tool measures instrumental activities of daily living (using the telephone, managing finances, meal prep, transportation)

Answer 66

Lawton-Brody's IADL

Question 67

this tool is used to measure functional independence in rehab settings

Answer 67

The Functional Independence Measure (FIM)

Question 68

``` What body changes occur in older adults over time ____ bone mineral mass ____ lean body mass ______ fat deposition ____ total body water ```

Answer 68

decreased bone mineral mass decreased lean body mass increased fatty tissue decreased total body water

Question 69

Sarcopenia, the loss of lean body mass that occurs with aging is also associated with

Answer 69

decreased bone density, increased falls, glucose intolerance, decreased heat/cold tolerance, increased risk of malnutrition, increased oxidative stress

Question 70

when using cyclic PN solutions for non-stressed patients age may be an important factor in monitoring for complications because older adults have ______ rates of insulin resistance, ________glycemia, _____ free fatty acids, and ____ fluid requirements

Answer 70

increased insulin resistance hyperglycemia increased free fatty acids decreased fluid requirements

Question 71

what is the recommended daily energy intake for patients getting hemodialysis >65 years old and <65 years old

Answer 71

> 65 years: 30-35 kcal/kg | < 65 years: >35 kcal/kg

Question 72

A 65 year old who has complications associated with GI surgery was admitted to the ICU with pneumonia & septic shock. After she became hemodynamically stable, she was started on PN due to prolonged ileus. Prior to surgery, she was at her ideal weight. Currently has labs that include albumin 2.2, Cr of 1.0 & urine output is adequate. What best estimates her protein needs for initiation of PN

Answer 72

1.5 g/kg/day 2/2 her increased stress level

Question 73

in an afebrile adult with intact skin, insensible fluid loss from the lungs and skin is approimately

Answer 73

1,000mL/day

Question 74

An 87 year old female underwent a total abdominal colectomy. Her ileostomy output is 1.5-2 liters a day. Supplementation of which of the following micronutrients should be considered?

Answer 74

zinc from stool loss

Question 75

older adults are increased risk of ____, ___, ___ deficiency from decreased intake, decreased absorption when having diarrhea or high ileostomy output

Answer 75

fluid, electrolytes and zinc

Question 76

A decrease in food intake in older adults is most likely attributed to

Answer 76

decreased taste and flavor sensations

Question 77

which senses are diminished in the older adult population

Answer 77

``` decreased taste/flavor sensation decreased hunger early satiety fear of incontinence with decr. fluid intake decreased smell/olfaction ```

Question 78

A 68 year old with a history of cirrhosis is receiving EN with recent GI surgery. She has worsening hepatic encephalopathy what should be tried first

Answer 78

lower blood ammonia with lactulose and or rifaxamin

Question 79

in liver cirrhosis, how much protein is recommended to prevent catabolism and promote gluconeogenesis

Answer 79

1-1.5 g/kg/day

Question 80

if a patient with cirrhosis and hepatic encephalopathy fails to respond to medical management how much protein can be restricted to

Answer 80

0.6-0.8g/kg

Question 81

branched chain amino acids formula is still debated but considered if

Answer 81

severe encephalopathy is not responsive to aggressive medical therapy

Question 82

An 80 year old male living home alone has experienced a 15 pound unintentional weight loss in past year and a half. The clinician assessing his nutrition status finds that he has inadequate intake, what is the leas likely to contribute to his weight loss

Answer 82

a liberalized diet

Question 83

decreased oral intake can be related to chronic medical conditions requiring dietary restrictions and numerus medications impairing food intake or alter digestion, absorption, metabolism and excretion true or false

Answer 83

true

Question 84

social isolation, economic hardships, decreased functional capacity related to shopping, cooking, dementia, loss of taste and smell with difficulty chewing/swallowing impairs

Answer 84

oral intake

Question 85

______ diets make meals more palatable and acceptable for older adults

Answer 85

liberalized diets