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?

Low intakes of protein, vitamins D and B, and antioxidants Signup and view all the answers

Which of the following nutrients is associated with osteoporosis?

Vitamin D Signup and view all the answers

Why do older adults become nutritionally vulnerable?

Due to multiple factors, including immutable and changeable causes Signup and view all the answers

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

Less vulnerability to malnutrition Signup and view all the answers

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

All of the above Signup and view all the answers

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

Those who are malnourished and those who are at risk of malnutrition Signup and view all the answers

What is the significance of vitamin D in older adults?

All of the above Signup and view all the answers

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

Depression Signup and view all the answers

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

Loss of independence Signup and view all the answers

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

Regular exercise Signup and view all the answers

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

Difficulty with food packaging and cooking Signup and view all the answers

What is a potential consequence of malnutrition in older adults?

Increased risk of complications Signup and view all the answers

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

Difficulty swallowing food Signup and view all the answers

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

Smoking Signup and view all the answers

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

Decreased appetite Signup and view all the answers

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

8.7% Signup and view all the answers

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

Depression Signup and view all the answers

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

Significant financial burden Signup and view all the answers

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

9.0% Signup and view all the answers

What is the relationship between polypharmacy and nutrition?

There is a complex relationship between polypharmacy and nutrition Signup and view all the answers

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

28% Signup and view all the answers

What is the primary consequence of depression in older adults?

Drop in functionality Signup and view all the answers

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

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

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

Decreased functional capacity Signup and view all the answers

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

Some medications may cause issues with nutrient intake Signup and view all the answers

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

Predictor of adverse outcomes Signup and view all the answers

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

Age- or disease-related reductions in chemosensory acuity Signup and view all the answers

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

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

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

Increased risk of developing sarcopenia and becoming malnourished Signup and view all the answers

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

Decreased functional status and inability to sustain themselves nutritionally Signup and view all the answers

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

Accelerated bone density decline Signup and view all the answers

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

Poor eyesight and reduced hand strength Signup and view all the answers

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

Reduced functional status and susceptibility to frailty Signup and view all the answers

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

Cuts, bruises, and even severed fingers Signup and view all the answers

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

Increased susceptibility to alcohol-related diseases Signup and view all the answers

Which of the following is a risk factor for malnutrition?

Functional elements, such as packaging and cooking instructions Signup and view all the answers

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

Lack of education and training Signup and view all the answers

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

Screening for malnutrition and the risk of malnutrition in all patients Signup and view all the answers

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

To prevent further deterioration of nutrition status Signup and view all the answers

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

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

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

It indicates the poor knowledge of malnutrition among healthcare professionals Signup and view all the answers

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

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

What is the purpose of CG32?

To outline key priorities for implementation to identify people who need nutrition support 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?

It helps to prevent further deterioration of nutrition status Signup and view all the answers

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

Further deterioration of nutrition status Signup and view all the answers

What is the primary vascular factor associated with dementia risk?

White matter hyperintensity (WMH) burden Signup and view all the answers

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

It increases the risk of incident all-cause dementia Signup and view all the answers

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

Shared genetic instruments Signup and view all the answers

What is the objective of the study?

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

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

Mendelian randomization (MR) Signup and view all the answers

What is the significance of the study's findings?

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

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

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

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

It improves the accuracy of the causal associations Signup and view all the answers

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

80% Signup and view all the answers

What is the expected prevalence of dementia by 2030?

75 million Signup and view all the answers

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

Cerebral small vessel disease Signup and view all the answers

What is the strongest risk factor for white matter hyperintensity?

High blood pressure Signup and view all the answers

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

A putative causal association between WMH and dementia Signup and view all the answers

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

1.04 Signup and view all the answers

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

The association between genetic liability to stroke and dementia outcomes is attenuated 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?

No significant association Signup and view all the answers

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

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

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

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

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

Examining the genetic associations of vascular traits with AD risk Signup and view all the answers

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

To rule out potential biases and methodological issues in the analysis Signup and view all the answers

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

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

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

All of the above Signup and view all the answers

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

To provide a comprehensive understanding of the causal associations of vascular traits with dementia risk 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?

That it may be subject to methodological issues, such as reverse causation 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?

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

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

To account for selective survival bias and polygenic scores 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?

To ensure transparency and accuracy in the reporting of observational studies 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?

To provide a comprehensive understanding of the causal associations of vascular traits with dementia risk 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.