Geriatric Nutrition Presentation
Geriatric Nutrition Presentation
Geriatric Nutrition Presentation
http://www.aecom.yu.edu/nutrition/presentation/Presentation.htm
CJ Segal-Isaacson EdD, RD
Alice Fornari, EdD, RD
Judy Wylie-Rosett, EdD, RD
Session Objectives
• Nutrition presentations:
http://www.aecom.yu.edu/nutrition/presentation/Presentation.htm
Disease Dentition
Depression Dysgeusia
Drugs Dysfunction
Dementia Diarrhea/Malaborption
Dysphagia
1. Wallace JI, Schwartz RS. Epidemiology of weight loss in humans with special
reference to wasting in the elderly. International Journal of Cardiology. 2002/9
2002;85(1):15-21.
Discussion Question #9
1.Zocor a. depression
2.Norvasc b. hepatitis
3.Atenolol c. peripheral edema
1 with b
2 with c
3 with a
Discussion Question #11
•Increased appetite:
– NSAIDS, “Megace” and Antihistamines.
Discussion Question #12
1. Wilson MM, Philpot C, Morley JE. Anorexia of aging in long term care: is dronabinol an
effective appetite stimulant?--a pilot study. J Nutr Health Aging. Mar-Apr 2007;11(2):195-
198.
– Growth Hormone
• A 4 week trial showed slightly faster weight gain than no
medication but no long-term sustained effect over food
alone.1 Growth hormone in other settings have shown
increased mortality. Also, growth hormone must be given
by injection.
– Oxandrolone and Nandrolone
• Several small trials in the elderly with androgenic analogs
have not shown they lead to enhanced weight gain.
– Testosterone (In men with low levels)
• May be useful for elderly men with hypogonadism to build
muscle back.
1. Chu LW, Lam KS, Tam SC, et al. A randomized controlled trial of low-dose recombinant
human growth hormone in the treatment of malnourished elderly medical patients. J Clin
Endocrinol Metab. May 2001;86(5):1913-1920.
– Cyproheptadine
• This is an antihistamine that increases appetite through
its antiserotonergic effect on 5-HT2 receptors in the
brain. However, a trial done in 1990 did not show that
cyproheptadine was effective in promoting weight gain in
cachexic cancer patients.
1. Kardinal CG, Loprinzi CL, Schaid DJ, et al. A controlled trial of cyproheptadine in cancer
patients with anorexia and/or cachexia. Cancer. Jun 15 1990;65(12):2657-2662.
Brief 24 Hour Food Recall
• Mrs. H lives alone and reports that she shops and cooks
for herself. She says that she eats two meals a day and that
she eats pretty much the same thing every day. Her 24 food
recall for yesterday is:
• Morning: 1 cup of instant coffee with non-dairy creamer, 1
tsp sugar and 1 slice toast with 1 tsp margarine and 1 tsp
jam.
• Noon: 1/2 can chicken noodle soup, 3-4 saltines and 1 slice
American cheese.
• Evening: 1 broiled chicken thigh, 1 spoonful of string
beans and 1 spoonful rice.
• She drinks at least 5 cups of water a day and sometimes
has a cup of tea with 1 teaspoon sugar and 2-3 vanilla
wafer cookies before bed.
• She takes a daily multivitamin/mineral supplement.
Discussion Question #13
– Breakfast?
– Lunch?
– Dinner?
– Evening Snack?
Total: On a good day, maybe 1000 calories!
– Breakfast: ~200 calories
– Lunch: ~200-300 calories
– Dinner: ~200-300 calories
– Evening Snack: ~ 200 calories
Discussion Question #14
Light 30 30
(also use if patient is
elderly or overweight)
Moderate 40 37
Heavy 50 44
(also use if patient is
underweight)
Discussion Question #15
• Although the RDA for protein for adults is set at 0.8 g/kg
ideal body weight, a study by Campbell et al.1 found that
0.8 g/kg was inadequate to maintain nitrogen balance. They
found that 1-1.25 g/kg of ideal body weight was necessary.
Campbell, W. W., Crim, M. C., Dallal, G. E., Young, V. R., & Evans, W. J.
(1994). Increased protein requirements in elderly people: new data and
retrospective reassessments. Am J Clin Nutr, 60(4), 501-509.
Discussion Question #16
1. Wallace JI, Schwartz RS. Epidemiology of weight loss in humans with special
reference to wasting in the elderly. International Journal of Cardiology. 2002/9
2002;85(1):15-21.
Discussion Question #18
• When you see Mrs. H for her follow-up in two months she
reports improved mobility, appetite and sleep. Her weight
has stabilized and she tells you about two new friends she
has made at the senior citizen center.
Conclusions for Malnutrition and Weight Loss:
This scale has three possible evaluations for each of the seven
questions: independent, needs some assistance, or dependent. Each
item is evaluated individually.
Depression Screening Instrument: Mood Scale: Short Form
Choose the best answer for how you have felt over the past
week)
1. Are you basically satisfied with your life? YES
2. Have you dropped many of your activities and interests?
YES
– Your next contact with him is at the ICU after a severe stroke
leaves him partially paralyzed on his left side and mildly
aphasic.
Hypertension, Stroke and Dysphagia cont.
Discussion Question:
1. Is Mr. Edwards also dysphagic? If the speech therapist is
not immediately available, what is a basic and safe
technique to assess this at his bedside?
Assessing Dysphagia:
Patient sits upright and drinks 30 ml water.
– Dysphagia if any one of four symptoms:
1. Delayed swallowing
2. Drooling
3. Coughing within 1 minute of swallowing
4. Dysphonia
• Do not mix solid foods and liquids in the same mouthful and do
not "wash foods down" with liquids, unless you have been
instructed to do so by the therapist.
– TPN???
PEG Tube
• Indications for a PEG Tube
– Patients who have been unable to eat adequately for at least
5 days and who are likely to require the tube for at least 3 to
4 weeks.