Elderly II_2021.pdf

NDT 2234 Lifespan Nutrition Nutrition in the elderly II Dr Megan Chong Hueh Zan Division of Nutrition and Dietetics International Medical University Miss K visited her uncle recently. Her uncle is a 65 years old retired teacher living with his wife. Her uncle told K he hasn’t been eating...

NDT 2234 Lifespan Nutrition Nutrition in the elderly II Dr Megan Chong Hueh Zan Division of Nutrition and Dietetics International Medical University Miss K visited her uncle recently. Her uncle is a 65 years old retired teacher living with his wife. Her uncle told K he hasn’t been eating well but his weight remains stable over the years. He is not as strong as before. He used to go hiking every Sunday but lately he cant as he experienced some pains in the knees. K wonders if her uncle is at higher health risks. How is nutritional status being assessed for elderly? Learning outcomes At the end of lecture, students would be able to : Identify and explain the nutritional risks of the elderly population Assess and interpret the nutritional status of older adults using screening tools Health risks of the elderly population The aging process is associated with significant changes in body weight and body composition-progressive loss of skeletal muscle mass and body fat increase and redistribution. Body weight and BMI gradually increase during adult life and usually reaching their peaks at 50s and tend to decrease after the age of 60 year old (Flegal et al., 2002).  Health risks of the elderly population In the younger population, a plot of the relative risks (RRs) of mortality and morbidity against BMI always presented with a U-shaped, or J-shaped curve with the minimum mortality close to a BMI of 25 kg/m2. However increasing evidence showed that among the elderly, elevated BMI may demonstrate lower all-cause and cardiovascular mortality compared to those with normal weight - a paradoxical condition known as “obesity paradox”. Thinness carries a greater risk of mortality than overweight. Health risks of the elderly population Hence, the adult overweight classification- BMI 25- 29.9 kg/m2 –may not be appropriate for the elderly. The available evidence indicates that the normal weight range of 22–27 kg/m2 should be used for Adjusted HRs (95% CI)* for total mortality rate by body mass index (BMI; kg/m2) category in elderly men and women. BMI 25–27.4 constitutes the older persons (Nutrition reference category. *Adjusted for smoking status, age, marital status, Screening Initiative, 2002). educational level and study site. (Source: Kvamme et al, 2012)  Health risks of the elderly population Advancing age is associated with a decreased in lean body mass, basal metabolic rate and generally lower level of physical activity, prompt the tendency of overweight and sarcopenic obesity. Nevertheless, the golden years are definitely not the time for extreme diets or drastic weight loss. Weight loss has been discouraged among elderly, partly because of health concerns over inadvertent reductions in muscle and bone mass, which is known to accompany overall weight loss. Rapid weight loss often leads to a loss of lean body mass among the elderly. Health risks of the elderly population When unintended weight loss occurs, older adults are losing muscle which: increases their fall risk decreases their ability to do daily tasks decreases their level of independence increases their risk of mortality Malnutrition risks amongst the elderly Protein-Energy malnutrition (PEM) amongst the elderly population: 5-12% in community PEM may: Increase severity of disease 30-61% hospitalized patients Reduces immune response Impairs wound healing 40-85% in long-term care facilities Decrease functional status Can increase drug effects due to changed metabolism 9  Malnutrition risks amongst the elderly Older Adults are at increased risk of inadequate diet/malnutrition from: Amarya S et al (2015). Diseases - acute/chronic Physical limitations, impaired functional status Inability to chew, poor oral health, changes in sensory Social isolation/depression Low income Alcohol use and abuse Drug - nutrient Interactions Affect intake, absorption and utilisation of nutrients 10  Assessing Nutritional Status Malnutrition screening tools to identify individual at risk Anthropometric data BMI, waist circumference, percent weight change Involuntary weight loss > 10% (high specificity) Changes in body composition Changes in biomarkers eg albumin Fluid accumulation Grip strength 11 Assessing Nutritional Status DETERMINE checklist Integrates a list of warning signs of poor nutritional health in older adults Assessing Nutritional Status  Assessing Nutritional Status DETERMINE checklist Integrates a list of warning signs of poor nutritional health in older adults Assessing Nutritional Status  Assessing Nutritional Status Mini-Nutritional Assessment (MNA) Combines 6 screening questions in stage 1 with 12 assessment questions in stage 2 More extensive and include: Mid-arm & calf circumferences Questions related to lifestyle Medications Dietary intake Anthropometrics Blood chemistries Assessing Nutritional Status Assessing Nutritional Status MNA is available at www.mna-elderly.com  Assessing Functional Status IADL – Index activity of daily living The test involves the conduct of 7 activities Grocery Shopping  Meal preparation  Driving or using public transportation  Taking medications  Laundry  Using telephone Score ranges from 0 (low function, dependent) to 8 (high function, independent) for women  Managing finances and 0 through 5 for men to avoid potential  Housework gender bias. Assessing Functional Status  Assessing Functional Status Katz Activities of Daily Living (ADL) Scale Components Bathing Dressing Toileting Transfer Rated by level of assistance required-Independent, or needing Grooming some assistance/unable to perform task Feeding SCORING: 6 = High ( independent) 0 = Low (very dependent 22 Assessing Functional Status Assessing Functional Status 1. Why norm BMI cut off for obesity is not recommended for the elderly population? 2. Why malnutrition can increase mortality risk for the elderly? 3. Why weight reduction is not recommended to the elderly? 1. Why norm BMI cut off for obesity is not recommended for the elderly population? Obesity paradox-lowest mortality when BMI range 24-28kg/m2 2. Why malnutrition can can increase mortality risk for the elderly? Increase severity of disease Decrease functional status Can increase drug effects due to changed metabolism 3. Why weight reduction is not recommended to the elderly? Weight loss in elderly is usually accompany by reductions in muscle and bone mass Summary The WHO BMI cut off for obesity is not recommended for the elderly population. Muscle loss from weight loss may increases risk of fall, lowers physical functionality and higher risk of mortality. Malnutrition amongst the elderly can increase severity of disease and mortality. DETERMINE checklist and MNA are malnutrition screening tools to identify individual at risk of malnutrition; IADL and ADL can be used to assess functionability References Winter JE et al (2014). BMI and all-cause mortality in older adults: a meta- analysis. Am J Clin Nutr. 99:875-890. Kvamme J, Holmen J, Wilsgaard T, et al. (2012). Body mass index and mortality in elderly men and women: the Tromsø and HUNT studies. J Epidemiol Community Health. 66:611-617. MNA Mini Nutritional Assessment. Nestle Nutrition Institute Website. https://www.mna-elderly.com/. Accessed May 17, 2020. Krause’s Food & Nutrition Therapy. Saunders Elsevier (2008) Nutrition Through the Life Cycle. Peter Marshall (2008) Amarya S et al (2015). Changes during aging and their association with malnutrition. Journal of Clinical Gerontology & Geriatrics 6:78-84 THANK YOU