dietary considerations

prevalence

25% have clinical dx of malnutrition, all OA at high risk
highest in acute/subacute care settings, lowest in community dwelling
largest impact > 80 yrs, females, > 1 comorbidity, rural areas

malnutrition

low BMI or involuntary weight loss vs micronutrient deficiencies

cachexia

loss of muscle without loss of fat mass
multifactorial degenerative illness: extreme weight loss, fatigue, weakness that cannot be reversed with supplemental nutrition

malnutrition risks

higher age = higher risk developing disease = higher risk malnutrition
associated with increased morbidity, mortality, physical decline
negatively impacts independence with mobility and ADLs
contributes to development geriatric syndromes

cachexia associated diseases

CA, HIV/AIDS, COPD, CHF, kidney failure

impact of malnutrition

lack of ability to recover from disease (increased risk sickness and death after trauma/surgery)
malnutrition-related protein catabolism and micronutrient deficiency leading to compromised immune function (increased risk infection, reduced wound healing)
impaired ability to gain weight, recover muscle mass, compromised cog function

model of development of malnutrition in higher age

overfeeding/high caloric intake and sedentary lifestyle → ectopic fat accumulation → inflammaging → anorexia of aging → malnutrition

pathological vs aging process

disease-related malnutrition leads to rapid skeletal muscle wasting
age-related malnutrition is associated with a slower but progressive loss of muscle mass

dx of malnutrition

weight loss: 5% in past 6 months or > 10% beyond 6 months
low BMI: < 20 if < 70 yrs, < 22 if > 70 yrs
reduced muscle mass according to validated body comp
and reduced food intake of assimilation or any chronic GI condition that adversely impact food assimilation or absorption

screening tools

subjective global assessment (requires online training), mini nutritional assessment (has been known to over dx)

guiding principles for healthy eating

fruits and vegetables: > 5 servings/day
whole grains: 100-150 g/day
fiber: 19-28 g/day
protein: 1.2 g/kg BW or 25-30 g/meal
fats: 20-35% total daily caloric intake
fluids: women 1.6 L, men 2 L

myplate nutrition tips 60+

add seafood, dairy or fortified soy, beans, peas and lentils to maintain muscle mass
add fruits and veggies to meals and snacks, make eating a social event, track and discuss dietary supplements with your healthcare provider
eat enough protein and fortified food to help with vitamin B12 absorption

evidence based nutrition practice guideline

medical nutrition therapy provided by RDN is recommended for overweight/obese
for weight loss should have at least 14 MNT encounters over at least 6 months
for maintenance schedule monthly MNT encounters for at least a year

academy of nutrition and dietetics CPG

food environ associated with dietary intake especially less consumption of veggies and fruits and higher body weight
fast food consumption increased risk weight gain, overweight, obesity
screen time associated with overweight and obesity

recommendations for safe weight loss

up to 2 lbs per week or up to 10% baseline BW in 6-12 mo period or a total of 3-5% baseline BW if CV risk factors are present

unintentional weight loss

10 lbs or at least 5% of body weight over the past 6 mo-1 yr

unintentional weight loss causes

aging, psychosoc, CA, GI, oral/dental, neuro, infections, meds

changes with aging

decline in sensory function, reduced effectiveness of chewing, slowed gastric emptying, change in hormones, malabsorption of nutrients, constipation

psychosoc changes

depression, social isolation, anxiety, alcohol or substance misuse

meds with nutritional side effects

antibiotics, opiates, NSAIDs, benozodiazepines, antihistamines, anticholinergics, dopamine agonists, ACE inhibitors

nutritional deficiency in OA

undernourishment and obesity both exist and contribute to decreased fitness
increased use of taste enhancers influences nutritional intake (impacts fluid balance and activity tolerance), drug/dietary interactions influence intake

most common nutrient deficiencies

vitamins A, C, D/calcium, B12, protein thiamine, iron, folic acid, zinc

contributing factors to nutrient deficiency

taste/smell, oral/dental, GI dysfunction (dec saliva, gastromucosal atrophy, reduced GI motility, reflux, basal metabolic rate), loss of interest, social support, lack of mobility

vitamin A deficiency

bitot’s spots, hair loss, impaired taste

protein deficiency

edema, enlarged liver, global muscle wasting

vitamin B12 deficiency

mild dementia (reversible), peripheral sensory loss, optic neuritis, pallor

calcium deficiency

poor reflexes, slow mental processing, depression, low bone mineral density

dehydration in OA

most common fluid and electrolyte disorder in OA, water should make up 50% total BW and be replaced daily but most OA only take in 30% what they need
female > male, meds contribute, fluid intake choices

importance of fluids

body temp regulation, metabolic processes, lubrication of joints, digestion, respiration, nutrient distribution, vestibular, others
many already affected by typical and patho aging

mild signs dehydration

dry mouth and tongue reversed with fluid intake, lightheaded or dizzy, weakness, HA, lethargy

moderate signs dehydration

confused or irritable, lack of sweating, dark urine with decreased output, low BP, high HR

severe signs dehydration

LOC, disorientation, fever

consequences of prolonged dehydration

increased risk of short or long term alterations in physiological, cog, psych status
decreased quality of life, muscle spasm, kidney dysfunction, med reactions, seizures, hospitalization, coma, death

recommended fluid intake

0.46 oz per pound BW

PT subjective

food and nutrition related hx: beliefs/attitudes (food preference/motivation), food environ, dietary behaviors, diet experience, meds and supplements, physical activity

PT objective

height, weight, BMI vs body comp, waist circumference, weight hx
nutrition focused physical findings: ability to communicate, affect, amputations, appetite, BP, body language, HR

components of exam recommended by NPTE

dietary hx, psychosoc, body comp, sensory function (taste and smell), dental disease/function, ability to feed self and swallow, integument condition/swelling, compliance to special diets, functional assessments (ADLs, mobility)

goals, outcomes, interventions

assist in monitoring nutritional intake if allowed by state, assist in health promotion, maintain physical function and activity