Nutrition In The Elderly

Nutrition and Quality

of Life
Healthy food choices positively influence the quality
of life of older adults.


Older adults are at risk for inadequate dietary intakes
which may lead to:
Poor nutritional status
Decreased quality of
life
Functional disability
Increased health care
costs
Greater risk for
morbidity and mortality

Nutrition and Quality
of Life
WHO Definition: "the cellular imbalance between supply of
nutrients & energy and the body's demand for them to ensure
growth, maintenance, and specific functions

Key Point: Malnutrition comprises of both OVER and UNDER
Nutrition
Malnutrition
Prevalence of Under nutrition in our NZ
Elderly
Non-
institutionalized
>10%
Hospitalized for Acute
Illness
Long Care Units
or Nursing Homes
65-70%
45-50%
Protein Energy Undernutrition
Children
(developing
countries)
Elderly Adults
(developed
countries)
Marasmus
(equal ratio of protein
and calorie loss)
Kwashiorkor
( > protein loss :
calorie loss ratio)
Multifactorial
M EDICATIONS
E MOTIONAL PROBLEMS (DEPRESSION)
A LCOHOLISM / ANOREXIA NERVOSA
L ATE LIFE PARANOIA
S WALLOWING PROBLEMS

O RAL OR DENTAL PROBLEMS
N O MONEY

W ANDERING
H YPERS: Hyperthyroid, Hyperparathyroid, Hyperadrenalism
E NTERIC PROBLEMS
E ATING PROBLEMS
L OW SALT AND LOW CHOLESTEROL DIETS
S OCIAL ISSUES
Causes of PEU
Causes of PEU (ReMix Version)
Disease
Depression Drugs
Dentition Dementia Dysphagia
Dysguesia
Diarrhoea Dysfunction
Dr. C is a 96 year old retired
physician, who presented to
E.D 2 months ago for a right
leg cellulitis and venous stasis,
both of which are resolving
well with IV Abx. He is was
transferred to OPH for
rehabilitation with the main
goal for him to mobilize
independently with a LWF.

His daughter who is a dietician, is
concerned that Dr.C is losing
weight and looks visibly
thinner. Dr C. seems
unconcerned about his weight
loss and just repeats that he is
old now and is just not
hungry.

Snapshot of a Case
PC,HPC,PMHx,Meds, Fam Hx, Social Hx
WEIGHT LOSS: Timeline
Beliefs over Diet, Cholesterol phobia, longevity
?Dysphagia ?Coughing while eating
Dentition and Oral Hygiene
Changes in Olfaction and Taste
Smoking History ?Pack Years
Medical History
Good Alcohol History (CAGE)


Look for signs of depression (Geriatric Depression
Scale)


Assess Cognitive Function (MMSE, MoCA)
Brief Psychiatric History
Polypharmacy and
its side effects
Medications from
ALL healthcare
providers
Non-prescription
meds, vitamins,
supplements and
CAMS
Medication History
Physical Examination
General: Muscle Wasting. Stooped Posture
Skin: Dry and Scaly Skin, Petechiae, Poor wound
healing, Photosensitive Dermatitis
Hair: Thin/dyspigmented
Nails: Leukonychia, Koilonychia, Nailbed Pallor
Eyes: Night Blindness,conjunctival inflammation
Mouth: Bleeding gums, Glossitis, Hypoguesia
Neck: Thyroid Enlargement
Abdomen: Hepatomegaly, Splenomegaly
Extremeties: Bone tenderness, Joint pain, Muscle
tenderness, Muscle wasting and Oedema.
+ general systems enquiry
Malnutrition Universal Screening Tool
(MUST)

Mini Nutritional Assessment (MNA)

Malnutrition Assessment Scale (SCALES)-
Outpatient Screening Tool
Nutrition Screening Tools
Nutritional Support Strategies
Problem Solution
Loss of Appetite 1) Check Medications
2) Make Meals Appealing in
Size and Appearance
3) Drink only after meals
4) Short Walks before Meals
Chewing Problems 1) Encourage Dental and Oral
Care
2) Soft Foods that need little
mastication (soft meats in
porridge)
Swallowing Difficulties 1) SLT Referral
2) Modify food consistency
Mobility Problems 1) PT/OT input
2) Shopping and Food Prep
Assistance
Oral Nutritional Supplements
Powdered
Form
Ready
Made Form
KEY POINT: 1) GIVE THEM BETWEEN MEAL TIMES NOT DURING
2) THEY ARE NOT MEAL REPLACEMENTS
Enteral and Paraenteral Feeding
Techniques
Enteral
Paraenteral
(TPN)
NG,ND,NJ
Tubes
PEG Tube
In Crohns or
Vascular Damage
in Bowel
Summary
Undernutrition is a vicious cycle!

Remember causes of PEU : MEALS ON WHEELS/ 9Ds
Take a good Medical, Medication and Psychiatric Hx and
do an appropriate Physical Exam

Nutritional Screening Tools (MUST, MNA and SCALES)

Dont give oral nutritional supplements as meal
replacements

Lastly, the difference between enteral feeding and
parenteral feeding and when they are indicated.