Nutrition in elderly patients or geriatrics

Nutrition in elderly patients or geriatrics

1. Geriatric physical therapy NUTRITION PROBLEMS IN ELDERLY

2. Definition Malnutrition is a broad term commonly used as an alternative to undernutrition but technically it also refers to overnutrition . People are malnourished if their diet does not provide adequate calories and protein for growth and maintenance or they are unable to fully utilize the food they eat due to illness ( undernutrition ). They are also malnourished if they consume too many calories ( overnutrition ). .

3. Risk Factors for Poor Nutritional Health  Physiological changes with aging  A decrease in lean body tissue, reducing energy needs A loss of bone mass, increasing the risk of osteoporosis A decline in immune function, enhancing the risk of infection  Reduced taste and smell, contributing to lack of appetite Tooth loss and dry mouth, compromising food intake A decline in kidney function and in the thirst mechanism, increasing the risk of dehydration Changes in gastrointestinal function, contributing to constipation and impaired nutrient absorption (slow bowels).

4. Chronic illness - physical or psychological Diseases such as chronic obstructive lung disease (COPD) heart failure cancer infections thyroid disorders and uncontrolled diabetes can contribute to malnutrition.

5. Multiple medications The more prescription and over-the-counter (herbal, multi-vitamins, etc.) medicines you take, the greater the chance for side effects from drug interactions.  These side effects ( e.g.loss of appetite, nausea, vomiting, diarrhea) can affect our ability to consume food and our body’s ability to retain the nutrients from food.

6. Caloric/ Vitamin Intake: No. of meals per day; Weight loss> 10lbs past 6 months; Use of vitamin supplements Dentition and Swallow: Chewing and swallow food consistency; Referral to dentist, Swallow evaluation Dysphagia Taste and smell Environmental: Food availability; Able to procure food

7. Contd. Functional: Self-feed ability, Functional dependency, Maximize independence Financial : Able to afford food; Referral to social service Health Behaviors: Smoking, Excessive alcohol; Stop smoking, Reduce alcohol intake Psychological: Depression, Dementia Forgetfulness

8. The origin of the acronym “MEALS ON WHEELS” The acronym ‘MEALS ON WHEELS’ is used internationally to denote the provision of meals to people in their homes. However, it also spells out many of the root causes or contributing factors to malnutrition. Medication Emotions (depression) Anorexia/Alcoholism Late Life paranoia Swallowing problems Oral and dental disorders No Money (poverty) Wandering (dementia) Hyperthyroidism/hyperparathyroidism Enteric problems ( malabsorption ) Eating problems Low-salt low cholesterol diets Shopping and food preparation problems

9. SIGNS AND SYMPTOMS OF MALNUTRITION Loss of fat (adipose tissue) Breathing difficulties, a higher risk of respiratory failure Depression Higher risk of complications after surgery Higher risk of hypothermia - abnormally low body temperature The total number of some types of white blood cells falls; consequently, the immune system is weakened, increasing the risk of infections. Higher susceptibility to feeling cold Longer healing times for wounds Longer recover times from infections Longer recovery from illnesses Problems with fertility Reduced muscle mass Reduced tissue mass Tiredness fatigue, Irritability.

10. In more severe cases: Skin may become thin, dry, inelastic, pale, and cold Eventually, as fat in the face is lost, the cheeks look hollow and the eyes sunken Hair becomes dry and sparse, falling out easily Sometimes, severe malnutrition may lead to unresponsiveness (stupor) If calorie deficiency continues for long enough, there may be heart, liver and respiratory failure Total starvation is said to be fatal within 8 to 12 weeks (no calorie consumption at all)

11. Prevalence of under-nutrition Estimates of prevalence of under-nutrition in elderly people: Prevalence Type of population Over 10% Non- institutionalised elderly people 10 – 50% Hospitalized for acute illness 10 – 70% Long care units or nursing homes

12. Most prevalence figures relate to malnutrition in hospitals or care homes: Specific causes for concern are: Food delivered at inflexible and inconvenient times Insufficient time given to eat Lack of staff to help feed patients Patient difficulties in reaching food, using cutlery or opening food packaging Unpleasant sights, sounds and smells Limited provision for religious or cultural dietary meals.

13. How do we detect under-nutrition? A malnourished state is defined as any of the following: 1 BMI < 18.5 kg/m 2 Unintentional weight loss > 10% within the last three to six months. the Malnutrition Universal Screening Tool (MUST) Mini Nutritional Assessment and the Geriatric Nutritional Risk Index (GNRI)

14. Dehydration A key feature of malnutrition Water is rarely offered or considered as part of nutritional care. It is a vital, but overlooked component of nutrition and wellbeing. The adverse effects of poor hydration include: Kidney damage Dizzy spells Falls Constipation Urinary tract infections Cognitive impairment Pressure sores Extended recovery from illness

15. Management Liberalise the patient’s diet (review dietary restrictions) Encourage use of flavour enhancers Recommend frequent small meals and snacks. Ensure food texture suits chewing and swallowing ability Suggest ways to increase protein and energy intake by fortifying foods: Consider high energy/protein nutritional supplements (nutritional drinks are a convenient and effective way to meet requirements when appetite and/or mood are low. Ensure sufficient fluid intake Where a specific nutrient deficiency has been identified, use of a micronutrient supplement may be indicated ( eg . iron, folate , vitamin D)

16. Physical activity and exercise It has been shown that physically active individuals are less likely to develop stroke, some forms of cancer , type 2 diabetes, obesity , osteoporosis , and loss of function. Evidence is also accumulating that exercise has profound benefits for brain function, including improvements in learning and memory as well as in preventing and delaying loss of cognitive function with aging or neurodegenerative disease 

17. Professional education and training Improving professional education is key to the treatment of malnutrition. It is hugely important that health and social care professionals, and those working in residential care, become aware of the prevalence of malnutrition, and are educated about detection and prevention. Governments must make this a key priority.

18. Awareness building among the public Many of the interventions for preventing and treating malnutrition can be undertaken by friends and relatives. Greater public awareness of the problem is vital to beat malnutrition. Governments need to implement major public awareness-building campaigns to enlist the public in preventing malnutrition among older people.

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