Malnutrition in the

Geriatric Population
Corinne Moore
February 23, 2006
Dr. Gariola
Malnourished or not?
 Agenda

 Riskfactors for the development of

malnutrition in the elderly
 Addressing these risk factors
 Detecting malnutrition
 Consequences of untreated
malnutrition
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
Risk Factors
 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
 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.
 Beaware of local resources available to
those in need
 Local Area Agency on Aging
 Food Stamp Program
 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
Detecting Malnutrition
 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
 Nota good indicator of nutrition
 Good predictor of morbidity and mortality
 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
 Itis also a negative acute phase
respondent
 Also a good predictor of morbidity and
mortality
 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
Untreated Malnutrition
 Skin

 Malnutrition leads to
thinning, drying, and
loss of elasticity
 NPULTC Study
showed positive
correlation between
nutrient intake &
development of PU
 Musculoskeletal System
 “Inthe 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
 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

Available upon request.