Nutrition in Geriatric Patients with Fractures
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Questions and Answers

According to NICE, which of the following is a criterion for malnourishment?

  • BMI of less than 20 kg/m²
  • Eaten little or nothing for more than 10 days
  • BMI of less than 18.5 kg/m² (correct)
  • Unintentional weight loss greater than 5% within the last 3 to 6 months

    • What percentage of Europeans aged 64 years and over had intakes below the RNI for at least one of the following nutrients?

  • 25%
  • 15%
  • 21%
  • 11% (correct)

    • What is the rate of decline in muscle mass in individuals over 50 years of age?

  • 0.5-1% per year
  • 1-2% per year (correct)
  • 2-5% per year
  • 5-10% per year

    • What is the primary cause of sarcopenia?

    <p>Low intakes of protein, vitamins D and B, and antioxidants</p> Signup and view all the answers

    Which of the following nutrients is associated with osteoporosis?

    <p>Vitamin D</p> Signup and view all the answers

    Why do older adults become nutritionally vulnerable?

    <p>Due to multiple factors, including immutable and changeable causes</p> Signup and view all the answers

    What is the primary benefit of strong, consistent nutritional support for frail older adults?

    <p>Less vulnerability to malnutrition</p> Signup and view all the answers

    Which of the following is a barrier to nutritional wellbeing in older adults?

    <p>All of the above</p> Signup and view all the answers

    According to NICE, which group of people should be considered for nutrition support?

    <p>Those who are malnourished and those who are at risk of malnutrition</p> Signup and view all the answers

    What is the significance of vitamin D in older adults?

    <p>All of the above</p> Signup and view all the answers

    What is the primary origin of malnutrition in the older person, according to Dr. Juergen M. Bauer?

    <p>Depression</p> Signup and view all the answers

    What can be a consequence of decreased intake of energy and protein in older adults?

    <p>Loss of independence</p> Signup and view all the answers

    Which of the following is NOT a risk factor for malnutrition in older adults?

    <p>Regular exercise</p> Signup and view all the answers

    What is a potential consequence of an older adult's decreased functional status?

    <p>Difficulty with food packaging and cooking</p> Signup and view all the answers

    What is a potential consequence of malnutrition in older adults?

    <p>Increased risk of complications</p> Signup and view all the answers

    What is a common feature of the two patients discussed in the scenario?

    <p>Difficulty swallowing food</p> Signup and view all the answers

    What is a potential risk factor for malnutrition in older adults, according to the content?

    <p>Smoking</p> Signup and view all the answers

    What can be a consequence of depression in older adults, in terms of their nutrition?

    <p>Decreased appetite</p> Signup and view all the answers

    What is the estimated percentage of households with an older adult in the US that are food insecure?

    <p>8.7%</p> Signup and view all the answers

    What is the primary cause of malnutrition in older persons according to general acceptance?

    <p>Depression</p> Signup and view all the answers

    Which of the following is a financial consequence of poor oral health in older adults?

    <p>Significant financial burden</p> Signup and view all the answers

    What is the estimated percentage of older adults living alone in the US who are food insecure?

    <p>9.0%</p> Signup and view all the answers

    What is the relationship between polypharmacy and nutrition?

    <p>There is a complex relationship between polypharmacy and nutrition</p> Signup and view all the answers

    What is the percentage of community-dwelling elderly Iranian people who suffer from poor nutrition?

    <p>28%</p> Signup and view all the answers

    What is the primary consequence of depression in older adults?

    <p>Drop in functionality</p> Signup and view all the answers

    What is the recommended BMI for identifying malnutrition in older adults?

    <p>Less than 18.5 kg/m²</p> Signup and view all the answers

    What is the consequence of hearing and vision impairment in older adults?

    <p>Decreased functional capacity</p> Signup and view all the answers

    What is the association between polypharmacy and nutrition in older adults?

    <p>Some medications may cause issues with nutrient intake</p> Signup and view all the answers

    What is a common consequence of unintentional weight loss in patients with Alzheimer's disease?

    <p>Predictor of adverse outcomes</p> Signup and view all the answers

    What is the primary reason for older adults' inability to detect flavor in food?

    <p>Age- or disease-related reductions in chemosensory acuity</p> Signup and view all the answers

    What is the definition of food insecurity according to Starr et al.?

    <p>Limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways</p> Signup and view all the answers

    What is the consequence of obesity on nutritional vulnerability in older adults?

    <p>Increased risk of developing sarcopenia and becoming malnourished</p> Signup and view all the answers

    What is the primary consequence of depression on nutritional vulnerability in older adults?

    <p>Decreased functional status and inability to sustain themselves nutritionally</p> Signup and view all the answers

    What is the consequence of smoking on bone density in older adults?

    <p>Accelerated bone density decline</p> Signup and view all the answers

    What is the primary reason for difficulties in reading food labels among older adults?

    <p>Poor eyesight and reduced hand strength</p> Signup and view all the answers

    What is the consequence of cognitive decline on nutritional vulnerability in older adults?

    <p>Reduced functional status and susceptibility to frailty</p> Signup and view all the answers

    What is the primary consequence of food packaging-related injuries among older adults?

    <p>Cuts, bruises, and even severed fingers</p> Signup and view all the answers

    What is the consequence of metabolic changes in older adults on their susceptibility to alcohol-related diseases?

    <p>Increased susceptibility to alcohol-related diseases</p> Signup and view all the answers

    Which of the following is a risk factor for malnutrition?

    <p>Functional elements, such as packaging and cooking instructions</p> Signup and view all the answers

    What is the primary reason for the poor knowledge of malnutrition among healthcare professionals?

    <p>Lack of education and training</p> Signup and view all the answers

    Which of the following is a key clinical priority for implementation according to CG32?

    <p>Screening for malnutrition and the risk of malnutrition in all patients</p> Signup and view all the answers

    What is the primary goal of timely intervention in patients at risk of malnutrition?

    <p>To prevent further deterioration of nutrition status</p> Signup and view all the answers

    Which of the following is a key organizational priority according to CG32?

    <p>Employing at least one specialist nutrition support nurse in each hospital trust</p> Signup and view all the answers

    What is the significance of NICE's advice on the knowledge of malnutrition among healthcare professionals?

    <p>It indicates the poor knowledge of malnutrition among healthcare professionals</p> Signup and view all the answers

    Which of the following is a characteristic of malnourishment according to NICE?

    <p>BMI of less than 18.5 kg/m²</p> Signup and view all the answers

    What is the purpose of CG32?

    <p>To outline key priorities for implementation to identify people who need nutrition support</p> Signup and view all the answers

    What is the significance of considering oral, enteral, or parenteral nutrition support in patients who are malnourished or at risk of malnutrition?

    <p>It helps to prevent further deterioration of nutrition status</p> Signup and view all the answers

    Which of the following is a potential consequence of not screening for malnutrition in patients?

    <p>Further deterioration of nutrition status</p> Signup and view all the answers

    What is the primary vascular factor associated with dementia risk?

    <p>White matter hyperintensity (WMH) burden</p> Signup and view all the answers

    What is the role of genetically determined WMH burden in incident all-cause dementia?

    <p>It increases the risk of incident all-cause dementia</p> Signup and view all the answers

    What is the potential confounding factor in the association of lower BP with AD risk?

    <p>Shared genetic instruments</p> Signup and view all the answers

    What is the objective of the study?

    <p>To investigate the causal association between WMH burden, clinical stroke, BP, and dementia risk</p> Signup and view all the answers

    What type of analyses were used to study the association of genetic instruments with dementia?

    <p>Mendelian randomization (MR)</p> Signup and view all the answers

    What is the significance of the study's findings?

    <p>They suggest that WMH burden is a primary vascular factor associated with dementia risk</p> Signup and view all the answers

    What was used to derive the genetic instruments for WMH burden and BP?

    <p>Genome-wide association studies (GWASs) in European ancestry populations</p> Signup and view all the answers

    What is the consequence of accounting for potential epidemiologic biases in the study?

    <p>It improves the accuracy of the causal associations</p> Signup and view all the answers

    What percentage of patients with clinically diagnosed Alzheimer's disease have cerebrovascular lesions?

    <p>80%</p> Signup and view all the answers

    What is the expected prevalence of dementia by 2030?

    <p>75 million</p> Signup and view all the answers

    What is the primary pathologic substrate underlying the vascular contribution to cognitive decline and dementia?

    <p>Cerebral small vessel disease</p> Signup and view all the answers

    What is the strongest risk factor for white matter hyperintensity?

    <p>High blood pressure</p> Signup and view all the answers

    What is the result of mendelian randomization analysis using genetic instruments as proxies for WMH volume?

    <p>A putative causal association between WMH and dementia</p> Signup and view all the answers

    What is the hazard ratio for mortality associated with systolic blood pressure in the longitudinal analysis?

    <p>1.04</p> Signup and view all the answers

    What is the consequence of adjusting for interim stroke in the polygenic score analysis?

    <p>The association between genetic liability to stroke and dementia outcomes is attenuated</p> Signup and view all the answers

    What is the result of the longitudinal analysis examining the association between WMH burden and incident all-cause dementia?

    <p>No significant association</p> Signup and view all the answers

    What is the purpose of examining the association between WMH burden and dementia risk?

    <p>To identify a primary vascular factor associated with dementia risk</p> Signup and view all the answers

    What is the significance of the findings in the context of dementia prevention?

    <p>They emphasize the need to consider WMH in preventive strategies for dementia</p> Signup and view all the answers

    What is the primary focus of the study in the context of Alzheimer's disease?

    <p>Examining the genetic associations of vascular traits with AD risk</p> Signup and view all the answers

    What is the main reason for using a two-sample Mendelian randomization framework in the study?

    <p>To rule out potential biases and methodological issues in the analysis</p> Signup and view all the answers

    What is the primary advantage of using individual-level data from longitudinal cohorts and biobanks in the study?

    <p>To examine the association of weighted genetic risk scores with incident dementia</p> Signup and view all the answers

    What is the main assumption of the Mendelian randomization approach used in the study?

    <p>All of the above</p> Signup and view all the answers

    What is the primary advantage of using a multipronged genetic epidemiologic approach in the study?

    <p>To provide a comprehensive understanding of the causal associations of vascular traits with dementia risk</p> Signup and view all the answers

    What is the primary limitation of using summary-level data from published genome-wide association study meta-analyses in the study?

    <p>That it may be subject to methodological issues, such as reverse causation</p> Signup and view all the answers

    What is the primary purpose of examining the association of weighted genetic risk scores with incident dementia in the study?

    <p>To prioritize interventions and optimally target populations to prevent cognitive decline and dementia</p> Signup and view all the answers

    What is the primary advantage of using multistate models in the study?

    <p>To account for selective survival bias and polygenic scores</p> Signup and view all the answers

    What is the primary reason for using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline in the study?

    <p>To ensure transparency and accuracy in the reporting of observational studies</p> Signup and view all the answers

    What is the primary purpose of using individual-level data from 13 longitudinal cohorts and biobanks in the study?

    <p>To provide a comprehensive understanding of the causal associations of vascular traits with dementia risk</p> Signup and view all the answers

    Study Notes

    Nutrition in the Older Person

    Malnutrition and Depression

    • Depression is the most significant origin of malnutrition in older persons
    • Depression leads to a decrease in functional status, loss of independence, and increased risk of malnutrition
    • Risk factors for malnutrition include decreased appetite, increased satiety, age-associated changes, polypharmacy, and malabsorption

    Identifying Malnutrition

    • Malnourishment is represented by:
      • Body Mass Index (BMI) of less than 18.5 kg/m²
      • Unintentional weight loss greater than 10% within the last 3 to 6 months
      • BMI of less than 20 kg/m² and unintentional weight loss greater than 5% within the last 3 to 6 months

    Nutritional Deficiencies

    • 11% of Europeans aged 64 years and over had intakes below the Recommended Nutrient Intake (RNI) for:
      • Zinc
      • Vitamin B12
      • Vitamin C
    • 21% had intakes below the RNI for:
      • Vitamin D
      • Folic acid
      • Calcium
      • Selenium
      • Iodine

    Sarcopenia

    • Sarcopenia is the progressive depletion of muscle mass and is highly prevalent among older persons
    • Causes of sarcopenia include:
      • Low intakes of energy, protein, vitamins D and B, and antioxidants
      • Age-related changes, polypharmacy, and malabsorption

    Risk Factors for Malnutrition

    • Cognitive decline
    • Palatability
    • Psychosocial factors
    • Food insecurity
    • Functional elements, including:
      • Packaging and cooking instructions
      • Age-related eyesight degeneration and lack of strength in hands and wrists

    Nutritional Support

    • NICE advises that nutrition support should be considered for people who are malnourished or at risk of malnutrition
    • Timely intervention is essential, and healthcare professionals should not wait until weight drops if a person is at risk
    • Consider adding supplementation or taking other nutrition support actions as appropriate

    Demographics and Nutrition

    • Studies suggest that 8.7% of households with an older adult and 9.0% of older adults living alone in the US are food insecure
    • Food insecurity, poverty, socioeconomic background, and ethnicity are associated with malnutrition
    • Females are at a higher risk of malnutrition than males

    NICE Clinical Guidelines

    • CG32 provides information on tools and resources, evidence, key priorities for implementation, and recommendations for research
    • Key clinical priorities include:
      • Screening for malnutrition and risk of malnutrition
      • Considering nutrition support for people who are malnourished or at risk of malnutrition
    • Key organizational priorities include:
      • Education and training for healthcare professionals on nutrition support
      • Coordinated care from a multidisciplinary team
      • A nutrition steering committee working within the clinical governance framework

    Genetic Instrumental Variable Analyses

    • Used Mendelian randomization (MR) to investigate the causal association between vascular traits and Alzheimer disease (AD)
    • Found a putative causal association of larger white matter hyperintensity (WMH) burden with increased AD risk, after accounting for pulse pressure effects
    • Found an association of lower blood pressure (BP) with AD risk, with possible confounding by shared genetic instruments

    Vascular Traits and Dementia Risk

    • WMH burden is a primary vascular factor associated with dementia risk
    • Larger WMH burden showed evidence for a causal association with increased risk of AD
    • Blood pressure traits showed evidence for a protective association with AD
    • Genetically determined WMH burden was associated with incident all-cause dementia and AD, independently of interim stroke

    Epidemiology of Alzheimer Disease

    • The prevalence of dementia is expected to reach 75 million by 2030
    • Vascular disease is a treatable contributor to dementia risk
    • Postmortem examinations have shown that 80% of patients with clinically diagnosed AD have cerebrovascular lesions
    • Covert cerebral small vessel disease is thought to be the main pathologic substrate underlying the vascular contribution to cognitive decline and dementia

    White Matter Hyperintensity (WMH) Burden

    • WMH burden is the most common cerebral small vessel disease feature on brain magnetic resonance imaging
    • Evidence from observational studies has established strong associations of WMH with increased risk of stroke and dementia, including AD

    Blood Pressure and WMH Burden

    • High blood pressure (BP) is by far the strongest risk factor for WMH, with extensive shared genetic variation
    • Genetically determined BP levels have been found to have an inverse association with AD in several MR studies

    Methodology

    • Used a multipronged genetic epidemiologic approach to examine putative causal associations of genetically defined vascular traits with all-cause dementia and AD
    • Used two complementary approaches: 2-sample MR (2SMR) framework using summary-level data from published genome-wide association study (GWAS) meta-analyses, and individual-level data from 13 longitudinal cohorts and biobanks with prospective dementia surveillance

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    Description

    This quiz assesses understanding of nutrition in older adults with fractures, including symptoms and risk factors. It covers cases of patients with leg fractures and swallowing difficulties.

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