Malnutrition in the Malnutrition in the Geriatric PopulationGeriatric Population

Corinne MooreCorinne Moore

February 23, 2006February 23, 2006

Dr. GariolaDr. Gariola

Malnourished or not?Malnourished or not?

AgendaAgenda

Risk factors for the development of Risk factors for the development of malnutrition in the elderlymalnutrition in the elderly

Addressing these risk factorsAddressing these risk factors Detecting malnutritionDetecting malnutrition Consequences of untreated Consequences of untreated

malnutritionmalnutrition

Importance to Primary Care PAImportance to Primary Care PA Epidemiology makes it hard to ignoreEpidemiology makes it hard to ignore

15% community-dwelling & homebound15% community-dwelling & homebound 62% hospitalized62% hospitalized 85% nursing home85% nursing home

• (Kagansky et al, 2005)(Kagansky et al, 2005)

Cost of medical consequencesCost of medical consequences $11,000-16,000 per pt per hospital stay$11,000-16,000 per pt per hospital stay

Growing elderly populationGrowing elderly population Expected to double by 2030Expected to double by 2030

Risk FactorsRisk Factors

DepressionDepression

Depression from loss of mobility, Depression from loss of mobility, development of chronic diseases, and development of chronic diseases, and death of loved onesdeath of loved ones

Geriatric Depression Scale (GDS)Geriatric Depression Scale (GDS) Developed by Stanford University, Veterans’ Developed by Stanford University, Veterans’

Affairs, & Nat’l Institute on AgingAffairs, & Nat’l Institute on Aging Short and long version availableShort and long version available Referral for counseling and medication if Referral for counseling and medication if

necessarynecessary

Low Socioeconomic StatusLow Socioeconomic Status

NHANES IIINHANES III Food insufficient persons had lower mean Food insufficient persons had lower mean

intake of several nutrients, lower intake of intake of several nutrients, lower intake of meat and vegetable groups, lower dietary meat and vegetable groups, lower dietary variety, and higher risk of being underweight variety, and higher risk of being underweight and in poor or fair health.and in poor or fair health.

Be aware of local resources available to Be aware of local resources available to those in needthose in need Local Area Agency on AgingLocal Area Agency on Aging Food Stamp ProgramFood Stamp Program

Oral HealthOral Health

Certain diseases and previous strokes can Certain diseases and previous strokes can hinder someone’s swallowing abilityhinder someone’s swallowing ability

Signs and SymptomsSigns and Symptoms Coughing before, during or after swallowing food, liquids or Coughing before, during or after swallowing food, liquids or

medsmeds Swallow 3-4 times with each bolusSwallow 3-4 times with each bolus Frequent throat clearingFrequent throat clearing Hoarse voice or gargly breathingHoarse voice or gargly breathing Feeling like something is caught in their throatFeeling like something is caught in their throat Pocketing of foodPocketing of food

Referral to Speech PathologistReferral to Speech Pathologist

Detecting MalnutritionDetecting Malnutrition

AlbuminAlbumin

Albumin has many limitationsAlbumin has many limitations Negative acute phase proteinNegative acute phase protein Shift to extravascular pools during stressShift to extravascular pools during stress Greatly affected by fluidGreatly affected by fluid Greatly affected by liver diseaseGreatly affected by liver disease Long half life (~20 days)Long half life (~20 days) Remains normal in uncomplicated PEMRemains normal in uncomplicated PEM

Not a good indicator of nutritionNot a good indicator of nutrition Good predictor of morbidity and mortalityGood predictor of morbidity and mortality

PrealbuminPrealbumin

More accurate indicator of nutrition statusMore accurate indicator of nutrition status Less affected by liver diseaseLess affected by liver disease Less affected by fluid statusLess affected by fluid status Shorter half-life (~2 days)Shorter half-life (~2 days) Decreases in uncomplicated PEMDecreases in uncomplicated PEM

It is also a negative acute phase It is also a negative acute phase respondentrespondent

Also a good predictor of morbidity and Also a good predictor of morbidity and mortalitymortality

Mini Nutrition AssessmentMini Nutrition Assessment

No lab values neededNo lab values needed Initial six questions for screening purposes Initial six questions for screening purposes

(total of 18)(total of 18) Broken into four sections (anthropometric, Broken into four sections (anthropometric,

general assessment, dietary assessment, general assessment, dietary assessment, and self assessment)and self assessment)

Can be time consuming and requires Can be time consuming and requires patients to be orientedpatients to be oriented

Untreated MalnutritionUntreated Malnutrition

SkinSkin

Malnutrition leads to Malnutrition leads to thinning, drying, and thinning, drying, and loss of elasticityloss of elasticity

NPULTC Study NPULTC Study showed positive showed positive correlation between correlation between nutrient intake & nutrient intake & development of PUdevelopment of PU

Musculoskeletal SystemMusculoskeletal System

““In the elderly, PEM had more an impact In the elderly, PEM had more an impact on fat free mass (lean body mass) with on fat free mass (lean body mass) with unchanged fat mass.” unchanged fat mass.” (Schneider S, 2002)(Schneider S, 2002)

Decrease in skeletal muscle causes Decrease in skeletal muscle causes decline in strength and functional decline in strength and functional capabilitiescapabilities

May lead to instability and more fallsMay lead to instability and more falls

Immune SystemImmune System

Malnutrition + Aging= Immune function Malnutrition + Aging= Immune function declinedecline

Decline in lean body mass includes cells Decline in lean body mass includes cells of immune systemof immune system

Deficiencies of micronutrients can also Deficiencies of micronutrients can also result in detriment to immune systemresult in detriment to immune system ““Iron deficiency was associated with Iron deficiency was associated with

impairments in cell-mediated and innate impairments in cell-mediated and innate immunity.” (Ahluwalis N, 2004)immunity.” (Ahluwalis N, 2004)

ReferencesReferences

Available upon request.Available upon request.