Geriatri 2 Npa

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Nutrition in Aging Part 2 Agussalim Bukhari Nurpudji A. Taslim Nutrition Department School of Medicine Hasanuddin University @ 2005

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Transcript of Geriatri 2 Npa

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Nutrition in AgingPart 2

Agussalim BukhariNurpudji A. Taslim

Nutrition DepartmentSchool of Medicine

Hasanuddin University@ 2005

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NUTRITION REQUIREMENT

BASED ON

NUTRITIONAL STATUS

HEALTH STATUS

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NUTRITIONAL NEEDS

Energy Decreased requirement (changes in body composition, ↓ BMR, ↓ physical activity) Calculation Energy need BW, BEE, REE/TEE, actual BW Average calories intake:

♂ 2000 kcal/day

♀ 1600 kcal/day

• Protein• Campbell,1996

- protein intake 1g /kg BB

- stress-full physical & psychological stimuli negative

nitrogen balance- infection altered GI function & metabolic changes

reduce efficiency of dietary nitrogen and increased nitrogen

excretion

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Biomarker Albumin indicator of protein status Pre-albumin and RBP evaluate response to therapy

Carbohydrate Needed to protect protein from being used as energy

source Approximately 45 -65% of total energy Complex carbohydrate legumes, vegetables, whole

grains & fruits to provide phylochemical & essential vitamins & mineral

Lipid 25-35% of total energy Reduced SFA Reduced fat weight control & cancer prevention Consumption of fat < 10% affect quality of diet and

negatively affect taste, satiety & intake.

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Mineral Poor mineral status inadequate dietary intake, physiologic

changes affect the need for a nutrient & medications Lactose intolerance (diminished lactose secretion) caused

diarrhea, discomfort from cramping, flatulence need dietary modification

Decrease Ca transport osteoporosis & hypochlorhydria Iron deficiency uncommon, mostly related to blood loss or

decreased absorption (caused by disease or medication)

Vitamins Oxidative mechanism play an important role in the aging process Antioxidant vitamins : tocopherols, carotenoids, vit C Cell damaged accumulate certain disease, e.g catarac, heart

disease, cancer (Ausman & Mayer, 1999)

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Vitamin A Fescanich et al,2002: high losses of vitamin A hip

fracture Sources of vitamin A dark green, leafy & yellow-orange

fruits and vegetables provide adequate food excessive β-carotene precursor vitamin A

Vitamin C Older adult have lower serum level of vitamin C Vitamin C requirement increase : stress, smoking,

medication Encouraging the consumption of vitamin C-rich food

most effective

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Vitamin D

Depend on concentration of calcium and phosphorus in the diet

Age, sex, degree of exposure to sunlight ( decreased 60%)

Function– heal skin lesions—psoriasis, hyperproliferative disorder of cancer, actinic keratoses

Need moderate supplementation of vitamin D and calcium—improve bone density and prevent bone fracture (Dawson-Hughes 1977)

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VITAMIN E

Epidemiologic studies Vit E reduce the risk of CVD by

reducing the susceptibility of LDL to oxidationvascular endothelial cell expression of proinflammary cytokine (Meydani, 2001)

Vit Ecancer prevention

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Vitamin B6

Many studiesolder adults do not consume enough B6

Atrophic gastritis, alcoholism&liver dysfunctionrequirement

Severe deficiencyhomocysteine levelanemia&risk for cardiac disease

Encouragedfolate rich foodliver, dried beans, broccoli, avocado, asparagus&spinach

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Vitamin B12

Elderly need screening for B12 Prevalence 10-15% in age 60 (Baik&

Russel, 1999), cause: athropic gastritis, bacteria overgrowth, anemia pernicious, crohn’s disease, ileal resection, malabsorbtion syndrome(Hoffbrand & Provan, 1997)

Supplement vit.B12 or injectable for all older adults

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Water

Daily fluid replacement is essential Exercise regularly Consume large amount of protein Use laxative or diuretics Live in areas wit high temperatures

Need 30-35 ml/kg BB (actual body weight) or minimum 1500 cc/d

Increased agetotal body water decreases (≠50%) associated with a corresponding decrease LBM

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Older risk for dehydration Reduced thirst sensation Reduced fluid intake Limited access to fluid Disminished renal function Urinary inconvenience

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Symptoms of dehydration

Electrolyte disturbance Altered drug affected Headache Constipation Thirst, Loss of skin elasticity Weight loss Cognitive status deterioration Dizziness Dry mouth & nose mucous membranous A swollen or dry tongue Change blood pressure Rosessed or sunken eyes Change in urine color or output Speech difficulties

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An insufficient fluid intake with frequent diarrhea or vomiting, fever, illness, organ failure or chronic disease requiring hospitalization

Careful monitoring of fluid intake & output is important

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Dietary Planning Food with nutrient density

Sufficient fluid, Ca, Fiber, Iron, Protein, Folic acid & vitamins (A, D, B12 & C)

Food is the best source of vitamins

Kauffman et al, 2002-- Supplements is often unnecessary; Vitamins, minerals, herbal supplements used for non specific reason to stay healthy aware potentially toxic doses

Basic diet planning principles for older based on RDA

4 or 5 smaller meals

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Nutrition Issues

Older risk of malnutrition Lack of education financial constraints Decreasing physical & psychological

abilities Social isolation Treatments for multiple Concomitant disorder/diseases

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Secondary causes of malnutrition

Feeding impairment Anorexia Malabsorption(GIT dysfunction) Increased nutrient needs injury or

disease Drug nutrient interactions

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Disease Issues Older Population

Dysphagia Pressure ulcers Alzheimers Parkinsons Geriatric failure DM type II Hypertension & constipation

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Dysphagia

Food can chopped, ground or pureed --- eating regular consistencies

The consistency of liquids can be modified to thin, nectar, honey or pudding consistency– thickening agent

Appropriate body positioning– reduced the risk of chocking

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Pressure ulcers Most common Location below the waist , but can

develop any where Especially: DM, CV (peripheral), chronic

illness, cognitive impairment, mobility problems, incontinence, neurologic impairments.

Inadequate food; kilocalories, protein, zinc and vitamin C.

Frequent monitoring of BW, skin integrity, lab. value for nutritional status

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Management of Pressure Ulcers

Based on stage and depth of damage

Therapy; frequent repositioning, use of support surfaces, moisture reduction, debridement and nutritional support

Risk factors: BW 15%, serum albumin level <3,5mg/dl, total lymphocyte count <1800/L

Nutrition therapy; high protein, high energy, vitamin C & zinc supplementation, adequate fluid intake 9 spare protein and tissue epithelialization. Commercial oral supplements or tube feeding – meet higher nutrient need.

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Alzheimer’s

Alzheimer’s – degenerative brain disorder– irreversible memory loss and intellectual and personality deterioration--- malnutrition

2,5 millions– USA Fluctuate food intake –emotional state,

confusion level Strategic to improve care can involve

providing a simple, predictable environment and frequent cues relating to daily activities

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Parkinson diseases

Neurodegenerative disease that affects voluntary movement

Characterized by loss of brain cells that produce dopamine (a chemical that help direct muscle activity)

Intervention includes; medication, exercise, nutrition management, particularly in the coordination of dietary protein adequacy and timing of intake with medication

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FAILURE TO THRIVE

Malnutrition—compromises the immune system--contribute to development: Infection/sepsis Delayed wound healing MODF disability

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Key Factors For Assessing Those At Risk For Malnutrition Weight loss BMI < 21 Serum albumin <3,5g/dl Cholesterol <160mg/dl

Cognitive and emotional status Medications Alcohol intake

Decreased food, fluid & nutrient intake Loss of interest in food or desire to eat

institutionalizations Poverty Presence of infectious disease

Anorexia Early satiety Oral health Dysphagia functional status

Early Alzheimer’s disease loss of ingested nutrients through stools or urine metabolic rate from CHF

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