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Malnutrition in the Geriatric Population. Corinne Moore February 23, 2006 Dr. Gariola. Malnourished or not?. Agenda. Risk factors for the development of malnutrition in the elderly Addressing these risk factors Detecting malnutrition Consequences of untreated malnutrition.

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malnutrition in the geriatric population

Malnutrition in the Geriatric Population

Corinne Moore

February 23, 2006

Dr. Gariola

agenda
Agenda
  • Risk factors for the development of malnutrition in the elderly
  • Addressing these risk factors
  • Detecting malnutrition
  • Consequences of untreated malnutrition
importance to primary care pa
Importance to Primary Care PA
  • Epidemiology makes it hard to ignore
    • 15% community-dwelling & homebound
    • 62% hospitalized
    • 85% nursing home
      • (Kagansky et al, 2005)
  • Cost of medical consequences
    • $11,000-16,000 per pt per hospital stay
  • Growing elderly population
    • Expected to double by 2030
depression
Depression
  • Depression from loss of mobility, development of chronic diseases, and death of loved ones
  • Geriatric Depression Scale (GDS)
    • Developed by Stanford University, Veterans’ Affairs, & Nat’l Institute on Aging
    • Short and long version available
    • Referral for counseling and medication if necessary
low socioeconomic status
Low Socioeconomic Status
  • NHANES III
    • Food insufficient persons had lower mean intake of several nutrients, lower intake of meat and vegetable groups, lower dietary variety, and higher risk of being underweight and in poor or fair health.
  • Be aware of local resources available to those in need
    • Local Area Agency on Aging
    • Food Stamp Program
oral health
Oral Health
  • Certain diseases and previous strokes can hinder someone’s swallowing ability
  • Signs and Symptoms
    • Coughing before, during or after swallowing food, liquids or meds
    • Swallow 3-4 times with each bolus
    • Frequent throat clearing
    • Hoarse voice or gargly breathing
    • Feeling like something is caught in their throat
    • Pocketing of food
  • Referral to Speech Pathologist
albumin
Albumin
  • Albumin has many limitations
    • Negative acute phase protein
    • Shift to extravascular pools during stress
    • Greatly affected by fluid
    • Greatly affected by liver disease
    • Long half life (~20 days)
    • Remains normal in uncomplicated PEM
  • Not a good indicator of nutrition
  • Good predictor of morbidity and mortality
prealbumin
Prealbumin
  • More accurate indicator of nutrition status
    • Less affected by liver disease
    • Less affected by fluid status
    • Shorter half-life (~2 days)
    • Decreases in uncomplicated PEM
  • It is also a negative acute phase respondent
  • Also a good predictor of morbidity and mortality
mini nutrition assessment
Mini Nutrition Assessment
  • No lab values needed
  • Initial six questions for screening purposes (total of 18)
  • Broken into four sections (anthropometric, general assessment, dietary assessment, and self assessment)
  • Can be time consuming and requires patients to be oriented
slide14
Skin
  • Malnutrition leads to thinning, drying, and loss of elasticity
  • NPULTC Study showed positive correlation between nutrient intake & development of PU
musculoskeletal system
Musculoskeletal System
  • “In the elderly, PEM had more an impact on fat free mass (lean body mass) with unchanged fat mass.” (Schneider S, 2002)
  • Decrease in skeletal muscle causes decline in strength and functional capabilities
  • May lead to instability and more falls
immune system
Immune System
  • Malnutrition + Aging= Immune function decline
  • Decline in lean body mass includes cells of immune system
  • Deficiencies of micronutrients can also result in detriment to immune system
    • “Iron deficiency was associated with impairments in cell-mediated and innate immunity.” (Ahluwalis N, 2004)
references
References

Available upon request.

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