Malnutrition in the Geriatric Population Corinne Moore February 23, 2006 Dr. Gariola

Malnourished or not?

Agenda  Risk factors for the development of malnutrition in the elderly  Addressing these risk factors  Detecting malnutrition  Consequences of untreated malnutrition

Importance to Primary Care PA  Epidemiology makes it hard to ignore 15% community-dwelling & homebound 15% community-dwelling & homebound 62% hospitalized 62% hospitalized 85% nursing home 85% nursing home (Kagansky et al, 2005)(Kagansky et al, 2005)  Cost of medical consequences $11,000-16,000 per pt per hospital stay $11,000-16,000 per pt per hospital stay  Growing elderly population Expected to double by 2030 Expected to double by 2030

Risk Factors

Depression  Depression from loss of mobility, development of chronic diseases, and death of loved ones  Geriatric Depression Scale (GDS) Developed by Stanford University, Veterans’ Affairs, & Nat’l Institute on Aging Developed by Stanford University, Veterans’ Affairs, & Nat’l Institute on Aging Short and long version available Short and long version available Referral for counseling and medication if necessary Referral for counseling and medication if necessary

Low Socioeconomic Status  NHANES III Food insufficient persons had lower mean intake of several nutrients, lower intake of meat and vegetable groups, lower dietary variety, and higher risk of being underweight and in poor or fair health. Food insufficient persons had lower mean intake of several nutrients, lower intake of meat and vegetable groups, lower dietary variety, and higher risk of being underweight and in poor or fair health.  Be aware of local resources available to those in need Local Area Agency on Aging Local Area Agency on Aging Food Stamp Program Food Stamp Program

Oral Health  Certain diseases and previous strokes can hinder someone’s swallowing ability  Signs and Symptoms Coughing before, during or after swallowing food, liquids or meds Coughing before, during or after swallowing food, liquids or meds Swallow 3-4 times with each bolus Swallow 3-4 times with each bolus Frequent throat clearing Frequent throat clearing Hoarse voice or gargly breathing Hoarse voice or gargly breathing Feeling like something is caught in their throat Feeling like something is caught in their throat Pocketing of food Pocketing of food  Referral to Speech Pathologist

Detecting Malnutrition

Albumin  Albumin has many limitations Negative acute phase protein Negative acute phase protein Shift to extravascular pools during stress Shift to extravascular pools during stress Greatly affected by fluid Greatly affected by fluid Greatly affected by liver disease Greatly affected by liver disease Long half life (~20 days) Long half life (~20 days) Remains normal in uncomplicated PEM Remains normal in uncomplicated PEM  Not a good indicator of nutrition  Good predictor of morbidity and mortality

Prealbumin  More accurate indicator of nutrition status Less affected by liver disease Less affected by liver disease Less affected by fluid status Less affected by fluid status Shorter half-life (~2 days) Shorter half-life (~2 days) Decreases in uncomplicated PEM Decreases in uncomplicated PEM  It is also a negative acute phase respondent  Also a good predictor of morbidity and mortality

Mini Nutrition Assessment  No lab values needed  Initial six questions for screening purposes (total of 18)  Broken into four sections (anthropometric, general assessment, dietary assessment, and self assessment)  Can be time consuming and requires patients to be oriented

Untreated Malnutrition

Skin  Malnutrition leads to thinning, drying, and loss of elasticity  NPULTC Study showed positive correlation between nutrient intake & development of PU

Musculoskeletal System  “In the elderly, PEM had more an impact on fat free mass (lean body mass) with unchanged fat mass.” (Schneider S, 2002)  Decrease in skeletal muscle causes decline in strength and functional capabilities  May lead to instability and more falls

Immune System  Malnutrition + Aging= Immune function decline  Decline in lean body mass includes cells of immune system  Deficiencies of micronutrients can also result in detriment to immune system “Iron deficiency was associated with impairments in cell-mediated and innate immunity.” (Ahluwalis N, 2004) “Iron deficiency was associated with impairments in cell-mediated and innate immunity.” (Ahluwalis N, 2004)

References Available upon request.