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BASIC NEED FOR

GERIATRICS

ARYANTI R. BAMAHRY
The Older Population
The Older Population
Physiologic Changes
Aging is a normal biologic process physiologic function.
Organs change with age.

Body Fat mass and visceral fat


Lean muscle mass
composition Sarcopenia the age-related loss of
changes muscle mass, strength,and function,

Sedentary Life-threatening health problems


Lifestyle

Sensory Dysgeusia, loss of taste, and hyposmia


sensory stimulation may impair metabolic
Losses processes.
Physiologic
Changes
Tooth loss, use of dentures, and xerostomia (i.e., dry
mouth) can lead to difficulties chewing and
0ral Health swallowing.
Side effect of medication (ex: Dry mouth)

taste sensation and saliva production eating


less pleasurable and more difficult.
Gastro Dysphagia due to weakened tongue or cheek
muscles chewing and swallowing both difficult
intestinal and dangerous Pneumonia Aspiration
Gastric changes cancer, ulcers, and infections
Diverticulosis and constipation

Cardiovascular Heart diseases and stroke


Physiologic
Changes
renal function
Renal Renal function is also impacted by dehydration,
diuretic use, and medications, especially antibiotics.
Disease

Cognition, steadiness, reactions, coordination, gait,


Neurologic sensations, and daily living tasks
Dementia, Alzheimer's d isease, Parkinson's

Function disease or any mental disorder

Can cause mental impairment that is both


Depression transient and treatable
Physiologic Changes

Bedsores or decubitus ulcers


Pressure
Paralysis, sensory losses & rigidity
Ulcers
can all contribute to the problem
4 syndomes : impaired physical functioning,
malnutrition, depression, and cognitive impairment
Frailty & Failure to Include weight loss, decreased appetite, poor
Thrive nurrition,dehydration, inactivity, and impaired
immune function.

Presbycusis hearing loss


Cataract, Age-related macular degeneration (A
Hearing & Eyesight
MD), Glaucoma , Diabetic Retinopathy
vision loss

Immune response is slower & less efficient.


Immunocompetence
infection and cancer
Quality of Life
NUTRITION SCREENING

to evaluate nutrition status in older adults

Mini Nutritional Assessment (MNA)

An efficient, innovative, noninvasive method


to detect risk for malnutrition using questions
and anthropometric measures to determine
a malnutrition indicator score
NUTRITION ASSESSMENT

With aging, fat mass increases & height


decreases as a result of vertebral compression /
osteoporosis.
Measuring arm span or knee height to
determine HEIGHT
Mid-arm muscle circumference measures
more accurate and sensitive to weight change
than overall body composition / BMI
NUTRITION NEEDS

Many older adults have special nutrient requirements


because aging affects absorption, use, and excretion

Studies sugges that older persons have low intakes of


calories total fat; fiber; calcium; magnesium, zinc;
copper; folate; and vitamins B12, C, E, and D (USDA,
2004; USDHHS NHANES III,2006; USDHHS, 2004)
NUTRITION REQUIREMENT

BASED ON

NUTRITIONAL STATUS

HEALTH STATUS
NUTRITIONAL NEEDS
Energy
Decreased requirement (changes in body composition,
BMR, physical activity)
Calculation Energy need BW, BEE, REE/TEE, actual BW
Average calories intake:
2000 kcal/day
1600 kcal/day

Protein
- Protein intake 1g /kg BB
- Stress-full physical & psychological stimuli negative
nitrogen balance
- Infection altered GI function & metabolic changes
reduce efficiency of dietary nitrogen and nitrogen
excretion
Biomarker
Albumin indicator of protein status
Pre-albumin and RBP evaluate response to
therapy

Carbohydrate
Needed to protect protein from being used as
energy source
Approximately 45 -65% of total energy
Complex carbohydrate legumes, vegetables,
whole grains & fruits to provide phylochemical &
essential vitamins & mineral

Lipid
25-35% of total energy
Reduced SFA
Reduced fat weight control & cancer prevention
Consumption of fat < 10% affect quality of diet
and negatively affect taste, satiety & intake.
Mineral
Poor mineral status inadequate dietary intake, physiologic
changes affect the need for a nutrient & medications
Lactose intolerance (diminished lactose secretion) caused
diarrhea, discomfort from cramping, flatulence need
dietary modification
Decrease Ca transport osteoporosis & hypochlorhydria
Iron deficiency uncommon, mostly related to blood loss or
decreased absorption (caused by disease or medication)

Vitamins
Oxidative mechanism play an important role in the aging
process
Antioxidant vitamins : tocopherols, carotenoids, vit C
Cell damaged accumulate certain disease, e.g cataract,
heart disease, cancer (Ausman & Mayer, 1999)
Vitamin A
Fescanich et al,2002:
High losses of vitamin A hip fracture
Sources of vitamin A dark green, leafy & yellow-
orange fruits and vegetables provide adequate
food excessive -carotene precursor vitamin A

Vitamin C
Older adult have lower serum level of vitamin C
Vitamin C requirement increase : stress, smoking,
medication
Encouraging the consumption of vitamin C-rich food
most effective
Vitamin D
Depend on concentration of calcium and
phosphorus in the diet.
Age, sex, degree of exposure to sunlight
(decreased 60%)
Function heal skin lesionspsoriasis,
hyperproliferative disorder of cancer, actinic
keratoses
Need moderate supplementation of vitamin D and
calciumimprove bone density and prevent bone
fracture
Vitamin E
Vit E reduce the risk of CVD by reducing
the susceptibility of LDL to oxidation
vascular endothelial cell expression of
proinflammary cytokine (Meydani, 2001)
Vit E cancer prevention
Vitamin B6
Many studies older adults do not consume
enough B6
Atrophic gastritis, alcoholism & liver dysfunction
requirement
Severe deficiency homocysteine level
anemia & risk for cardiac disease
Encouraged folate rich food liver, dried
beans, broccoli, avocado, asparagus & spinach
Vitamin B12
Elderly need screening for B12
Prevalence 10-15% in age 60 cause: athropic
gastritis, bacteria overgrowth, anemia
pernicious, crohns disease, ileal resection,
malabsorbtion syndrome.
Supplement vit.B12 or injectable for all older
adults
Water
Daily fluid replacement is essential
Exercise regularly
Consume large amount of protein
Use laxative or diuretics
Live in areas wit high temperatures
Need 30-35 ml/kg BB (actual body weight) or
minimum 1500 cc/d
Increased age total body water decreases
(50%) associated with a corresponding
decrease LBM
Older risk for dehydration
Reduced thirst sensation
Reduced fluid intake
Limited access to fluid
Disminished renal function
Urinary inconvenience
Symptoms of dehydration
Electrolyte disturbance
Altered drug affected
Headache
Constipation
Thirst, Loss of skin elasticity
Weight loss
Cognitive status deterioration
Dizziness
Dry mouth & nose mucous membranous
A swollen or dry tongue
Change blood pressure
Rosessed or sunken eyes
Change in urine color or output
Speech difficulties
An insufficient fluid intake with frequent
diarrhea or vomiting, fever, illness, organ
failure or chronic disease requiring
hospitalization

Careful monitoring of fluid intake & output is


important
Dietary Planning
Food with nutrient density

Sufficient fluid, Ca, Fiber, Iron, Protein, Folic acid &


vitamins (A, D, B12 & C)

Food is the best source of vitamins

Kauffman et al, 2002-- Supplements is often


unnecessary; Vitamins, minerals, herbal supplements
used for non specific reason to stay healthy aware
potentially toxic doses

Basic diet planning principles for older based on RDA

4 or 5 smaller meals
NUTRITIONAL NEEDS
IN CERTAIN DISEASES
OF GERIATRICS
Nutrition Issues
Older risk of malnutrition
Lack of education
Financial constraints
Decreasing physical & psychological abilities
Social isolation
Treatments for multiple
Concomitant disorder/diseases
Secondary causes of malnutrition
Feeding impairment
Anorexia
Malabsorption (GIT dysfunction)
Increased nutrient needs injury or disease
Drug nutrient interactions
Disease Issues Older Population
Dysphagia
Pressure ulcers
Alzheimers
Parkinsons
Geriatric failure
DM type II
Hypertension & constipation
Dysphagia
Food can chopped, ground or pureed ---
eating regular consistencies
The consistency of liquids can be modified
to thin, nectar, honey or pudding
consistency thickening agent
Appropriate body positioning reduced the
risk of chocking
Pressure ulcers
Most common
Location below the waist, but can develop any
where
Especially: DM, CV (peripheral), chronic illness,
cognitive impairment, mobility problems,
incontinence, neurologic impairments.
Inadequate food; kilocalories, protein, zinc and
vitamin C.
Frequent monitoring of BW, skin integrity, lab.
value for nutritional status
Management of Pressure Ulcers
Based on stage and depth of damage

Therapy; frequent repositioning, use of support


surfaces, moisture reduction, debridement and
nutritional support

Risk factors: BW 15%, serum albumin level


<3,5mg/dl, total lymphocyte count <1800/L

Nutrition therapy; high protein, high energy, vitamin


C & zinc supplementation, adequate fluid intake
spare protein and tissue epithelialization.
Commercial oral supplements or tube feeding
meet higher nutrient need.
Alzheimers
Alzheimers degenerative brain disorder
irreversible memory loss and intellectual
and personality deterioration--- malnutrition
Fluctuate food intake emotional state,
confusion level
Strategic to improve care can involve
providing a simple, predictable environment
and frequent cues relating to daily activities
Parkinson diseases
Neurodegenerative disease that affects
voluntary movement
Characterized by loss of brain cells that
produce dopamine (a chemical that help direct
muscle activity)
Intervention includes; medication, exercise,
nutrition management, particularly in the
coordination of dietary protein adequacy and
timing of intake with medication
FAILURE TO THRIVE
Malnutritioncompromises the immune
system--contribute to development:
Infection/sepsis
Delayed wound healing
MODF
disability
Key Factors For Assessing Those At Risk
For Malnutrition
Weight loss Cognitive and emotional
BMI < 21 status
Serum albumin <3,5g/dl Medications
Cholesterol <160mg/dl Alcohol intake
Decreased food, fluid & institutionalizations
nutrient intake Poverty
Loss of interest in food Presence of infectious
or desire to eat disease
Anorexia Early Alzheimers
Early satiety disease
Oral health loss of ingested

Dysphagia nutrients through stools


functional status or urine
metabolic rate from

CHF
TERIMA
KASIH