Nutrition Theme Course Academic Year 2004-2005 Geriatric Nutrition http://www.aecom.yu.edu/nutrition/presentation/Presentation.htm Nutrition Theme Course Academic Year 2004-2005 CJ Segal-Isaacson EdD, RD Alice Fornari, EdD, RD Judy Wylie-Rosett, EdD, RD

Session Objectives Identify practical ways of integrating nutrition assessment and treatment into geriatric medicine. Identify geriatric nutrition resources on the web. Discuss a geriatric nutrition case focused on involuntary weight loss

The Nutrition Screening Initiative From the American Academy of Family Physicians at: http://www.aafp.org/x16081.xml Resources include: PDF format Booklet on Nutrition in Chronic Disease Management for Older Adults for physicians: http://www.aafp.org/x16105.xml PDA version of booklet to load on Palm or PC for quick onsite retrieval of screening information: http://www.aafp.org/x16105.xml Determine Your Health Nutrition Screening Tool For Patients with related printed materials: http://www.aafp.org/x17367.xml

Covers nutrition assessment and treatment for the following diseases: Physicians’ Booklet/PDA on Nutrition in Chronic Disease Management for Older Adults Covers nutrition assessment and treatment for the following diseases: Cancer COPD CHD Dementia Diabetes Mellitus Hypertension (Incorrect description of DASH Diet --Go to NHLBI instead: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/ Osteoporosis

Determine Your Health Nutrition Screening Tool I have an illness or condition that made me change the kind and/or amount of food I eat. Yes (2 pts.) I eat fewer than 2 meals per day. Yes (3 pts.) I eat few fruits or vegetables, or milk products. Yes (2 pts.) I have 3 or more drinks of beer, liquor or wine almost every day. Yes (2 pts.) I have tooth or mouth problems that make it hard for me to eat. Yes (2 pts.) I don't always have enough money to buy the food I need. Yes (4 pts.) I eat alone most of the time. Yes (1 pts.) I take 3 or more different prescribed or over-the-counter drugs a day. Yes (1 pts.) Without wanting to, I have lost or gained 10 pounds in the last 6 months. Yes (2 pts.) I am not always physically able to shop, cook and/or feed myself. Yes (2 pts.)

How To Score Nutrition Screening Tool 1-2 points Low Risk 3-5 points Moderate Risk >5 points High Risk Maximum of 22 points possible

Other Geriatric Nutrition Resources AECOM Family Medicine Lecture on Geriatric Nutrition by Dr. Darwin Deen at: http://www.aecom.yu.edu/family/presentations/gernut.ppt Scottish Intercollegiate Guidelines Network: Management of Patients with Stroke: Identification and Management of Dysphagia http://www.sign.ac.uk/pdf/sign20.pdf Baylor College of Medicine, 2000: Involuntary Weight Loss in the Elderly at: http://www.geri-ed.com/modules/Weight/weight.htm

Involuntary Weight Loss in the Elderly Baylor College of Medicine http://www.geri-ed.com/modules/Weight/weight.htm Epidemiology One year documented weight loss of greater than 4% was the single best predictor of death within two years (Wallace et al.). Common in older persons, especially: The oldest old, >85 years. Nursing home residents (up to 45%). Hospitalized patients (10-30%). Persons with depression.

Involuntary Weight Loss in the Elderly cont. The causes of weight loss in most cases are unexplained (about 25% in most studies). While a common diagnosis in this age group, contrary to widely held belief, malignancy has not been shown to be the major cause of weight loss in this age group. The two-year mortality rate in those elderly with significant weight loss ranges from 9-28%.

Involuntary Weight Loss in the Elderly cont. Risk Factors: Social Factors: isolation, neglect, abuse, poverty, inability to purchase or cook food. Oral, chewing, and swallowing problems. Poor appetite. Dementia, especially with wandering or other behavioral changes.

Involuntary Weight Loss in the Elderly cont. Risk Factors cont. Depression: (seen in up to 36% of NH residents with weight loss). Tremors or other increased motor activity (Parkinson’s, tardive dyskinesia). Neoplasms (up to 36% of hospitalized patients with recent weight loss).

Involuntary Weight Loss in the Elderly cont. Risk Factors cont. Infectious and inflammatory disorders. Endocrine disorders: hyperthyroidism, diabetes. Medications