🍓Medical Nutrition Therapy II Unit 18 – Geriatric Nutrition Therapy & Malnutrition

Key Concepts in Geriatric Nutrition

• Geriatric nutrition focuses on the unique dietary needs and challenges of older adults, typically those aged 65 and above
• Emphasizes the importance of maintaining adequate nutrition to support healthy aging, prevent chronic diseases, and manage existing health conditions
• Recognizes the impact of physiological, psychological, and social factors on the nutritional status of older adults
• Addresses common nutritional deficiencies (vitamin D, calcium, vitamin B12) and their potential consequences in the elderly population
• Highlights the role of nutrition in preventing and managing age-related conditions such as osteoporosis, sarcopenia, and cognitive decline
• Considers the influence of medications, dental health, and sensory changes on food intake and nutritional status
• Emphasizes the importance of individualized nutrition assessment and intervention strategies tailored to each older adult's specific needs and circumstances

Physiological Changes in Aging

• Decreased basal metabolic rate (BMR) leads to reduced energy requirements and increased risk of weight gain
• Sarcopenia, the age-related loss of muscle mass and strength, contributes to frailty and increased risk of falls
• Reduced bone mineral density (BMD) increases the risk of osteoporosis and fractures
• Changes in taste and smell perception may affect food preferences and intake
• Decreased saliva production and dental issues can impact chewing and swallowing abilities
• Gastrointestinal changes, such as reduced stomach acid secretion and slowed intestinal motility, may affect nutrient absorption
• Altered thirst sensation and decreased kidney function can lead to dehydration
• Age-related changes in hormone levels (testosterone, estrogen) influence body composition and nutrient metabolism

Nutritional Needs of Older Adults

• Energy requirements decrease with age due to reduced BMR and physical activity levels
• Protein needs may increase to support muscle mass maintenance and prevent sarcopenia
  • Recommended protein intake: 1.0-1.2 g/kg body weight/day for healthy older adults
  • Higher protein needs (1.2-1.5 g/kg/day) for those with acute or chronic illnesses
• Adequate calcium and vitamin D intake is crucial for bone health and fracture prevention
  • Recommended calcium intake: 1200 mg/day for adults over 70 years
  • Recommended vitamin D intake: 800-1000 IU/day for adults over 70 years
• Vitamin B12 requirements may increase due to age-related changes in absorption
  • Recommended vitamin B12 intake: 2.4 mcg/day for adults over 50 years
• Fiber intake should be maintained to promote digestive health and prevent constipation
• Hydration is essential, with a goal of 1500-2000 ml of fluids per day, unless contraindicated
• Nutrient-dense foods should be prioritized to meet micronutrient needs within reduced energy intake

Common Nutritional Deficiencies in the Elderly

• Vitamin D deficiency is prevalent due to reduced sun exposure, decreased skin synthesis, and limited dietary sources
  • Consequences include increased risk of osteoporosis, falls, and fractures
• Calcium deficiency often coexists with vitamin D deficiency, further compromising bone health
• Vitamin B12 deficiency is common due to age-related changes in stomach acid secretion and intrinsic factor production
  • Consequences include megaloblastic anemia, neurological symptoms, and cognitive impairment
• Iron deficiency anemia may occur due to decreased iron absorption, chronic inflammation, or blood loss
• Zinc deficiency can impair immune function, wound healing, and taste perception
• Dehydration is a frequent concern due to decreased thirst sensation, medication side effects, and mobility limitations
• Protein-energy malnutrition (PEM) can result from inadequate food intake, increased nutrient requirements, or impaired absorption
  • Consequences include muscle wasting, weakened immune response, and delayed wound healing

Malnutrition: Causes and Consequences

• Malnutrition in the elderly is a complex issue influenced by multiple factors, including physiological changes, socioeconomic status, and medical conditions
• Inadequate food intake due to poor appetite, dental problems, or physical limitations can lead to malnutrition
• Chronic diseases (cancer, heart failure, COPD) and their treatments may increase nutrient requirements or affect nutrient absorption
• Polypharmacy, or the use of multiple medications, can interfere with nutrient absorption and appetite
• Social isolation, limited access to food, and financial constraints contribute to malnutrition risk
• Cognitive impairment and dementia can impair the ability to shop for, prepare, and consume adequate meals
• Consequences of malnutrition include increased risk of infections, delayed wound healing, and prolonged hospital stays
• Malnutrition is associated with reduced quality of life, increased healthcare costs, and higher mortality rates

Assessment Tools for Geriatric Nutrition

• Mini Nutritional Assessment (MNA) is a validated screening tool for identifying malnutrition risk in older adults
  • Consists of a short form (MNA-SF) for initial screening and a full form for a more comprehensive assessment
• Malnutrition Universal Screening Tool (MUST) assesses malnutrition risk based on BMI, unintentional weight loss, and acute disease effect
• Subjective Global Assessment (SGA) evaluates nutrition status using patient history, physical examination, and functional capacity
• Biochemical markers, such as serum albumin and prealbumin, can provide insights into protein status and inflammation
• Anthropometric measurements, including height, weight, and body composition, help assess changes in nutritional status over time
• Dietary assessment methods, such as 24-hour recalls, food frequency questionnaires, and food diaries, provide information on food and nutrient intake
• Functional assessments, like handgrip strength and gait speed, can indicate overall health status and malnutrition risk

Intervention Strategies and Diet Planning

• Individualized nutrition care plans should be developed based on the comprehensive assessment of each older adult's needs, preferences, and goals
• Nutrient-dense, high-protein foods should be encouraged to meet nutrient requirements within reduced energy intake
  • Examples include lean meats, fish, eggs, dairy products, legumes, and fortified foods
• Texture-modified diets (soft, minced, or pureed) may be necessary for those with chewing or swallowing difficulties
• Oral nutritional supplements (ONS) can help meet nutrient needs when food intake is insufficient
  • ONS should be used in conjunction with food-based strategies and regularly monitored for effectiveness
• Vitamin D and calcium supplementation may be recommended for those unable to meet needs through diet and sunlight exposure
• Strategies to enhance food intake include offering smaller, more frequent meals, improving food presentation, and creating a pleasant dining environment
• Multidisciplinary interventions involving nutrition, physical therapy, and social support can improve outcomes in malnourished older adults
• Regular monitoring and adjustments to the nutrition care plan are essential to ensure ongoing effectiveness and address changing needs

Special Considerations and Case Studies

• Dementia and Alzheimer's disease present unique challenges in ensuring adequate nutrition
  • Strategies include offering finger foods, providing visual cues, and managing behavioral symptoms that affect eating
• Parkinson's disease can impact swallowing, appetite, and medication side effects, requiring specialized nutrition management
• Older adults with diabetes require individualized meal plans that balance glycemic control, medication use, and nutritional needs
• Chronic kidney disease (CKD) in the elderly necessitates careful monitoring of protein, potassium, phosphorus, and fluid intake
• Pressure ulcers and wounds require increased protein, energy, and micronutrient intake to support healing
• Palliative and end-of-life care focuses on comfort, symptom management, and quality of life, with nutrition goals adapted accordingly
• Case study: An 80-year-old woman with a history of falls, weight loss, and poor appetite
  • Comprehensive assessment reveals vitamin D deficiency, sarcopenia, and depression
  • Intervention includes nutrient-dense meals, ONS, vitamin D supplementation, and collaboration with physical therapy and mental health professionals
• Case study: A 75-year-old man with advanced Alzheimer's disease and dysphagia
  • Nutrition care plan involves texture-modified diet, finger foods, and caregiver education on feeding techniques and behavioral management strategies