NUTRITION IN GERIATRIC PATIENTS

Click to edit Master subtitle style

BY DR.RAJAT ANAND

5/3/12

Contents

Introduction Classification of nutrients Effect of nutrients on specialized cells Balanced diet Nutrient needs and requirements of the elderly Factors that effect nutritional status Other risk factors Assessing nutritional status of the elderly Protein Energy Malnutrition Nutritional guidelines Diet suggestions for denture wearers
5/3/12 Common problems faced by denture wearers and

INTRODUCTION

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Brief history

The Canon of Medicine, written by Abu Ali Ibn Sina(Avicenna) in 1025, was the first book to offer instruction in the care of theaged, foreshadowing moderngerontology and geriatrics. In a chapter entitled "Regimen of Old Age", Avicenna was concerned with how "old folk need plenty of sleep" and how their bodies should beanointedwithoil, and 5/3/12 recommendedexercisessuch as

The

famousArabic physician,Ibn AlJazzarAl-Qayrawani (Algizar, circa 898-980), also wrote a special book on the medicine and health of the elderly, entitledKitab Tibb alMachayik

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he

first modern geriatric hospital was founded in Belgrade, Serbia in 1881 by doctorLaza Lazarevi. geriatrics in the United Kingdom really began with the "Mother" of Geriatrics, Dr. Marjorie Warren. Warren emphasized that rehabilitation was essential to 5/3/12 the care of older people.

Modern

Classification of nutrients

By origin chemical compositionnutritive valuemicro and macro nutrients.

By By By

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Classification

By Chemical Composition carbohydrates proteins fats vitamins minerals

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Classification

By nutritive value

1.Cereals and millets 2.pulses(legumes) 3.Vegetables 4.Nuts and oil seeds 5.Fruits 6.Animal foods 7.Fats and oils 8.Sugar and jaggery 9.Condiment and spices 10.Miscellaneous foods.
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Classifications
Macro

nutrients

-carbohydrates -proteins -fats.

Micro

nutrients

-vitamins
-minerals
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Specialized cells and nutrition

Epithelial cell
Vitamin

protein

A and

are essential for the normal proliferation of epithelial cells.

Specialized cells and nutrition

Fibrobla st

Vitamin

c, zinc,

copper and protein Are important in collagen formation.

Specialized cells and nutrition

Cementoblast and cementocytes

For protein matrix of cementum vit c zinc,copper,and protein are essential. To calcify the matrix;

protein, calcium, phosphorus, and vit D are essential.

Amelobla st

Specialized cells and nutrition

For protein matrix of enamel vit-A, vit-c, zinc,

copper and protein are essential.

To calcify the protein matrix

protein, calcium, phosphorus, vitamin D,and fluoride improve quality of apatite formed.

Specialized cells and nutrition

odontobla sts

For protein matrix of dentin; vitA ,vitC, zinc, copper, and protein are essential. To calcify matrix; protein, calcium, phosphorus, and vitD are essential. Fluoride improves apatite crystal.

Specialized cells and nutrition

Osteocyte, osteoblast and osteoclast.

Imp.

Nutrient for formation of alveolar bone are; vitA, vitC, vitD, zinc, copper, calcium and phosphorous.

Balanced Diet

Its defined as a diet which contain different types of foods,possessing the nutrients carbohydrates,fats,proteins,vitamins and mineralsin a proportion to meet the requirements of the body .

Balanced diet is highly variable.

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Balanced Diet

The National expert group constituted by the Indian Council of Medical research has recommended the composition of the balanced diet for indians.This is done taking into account the commonly available foods in india.The composition of the balanced diet (vegetarian and non vegetarian)for an adult man and adult woman are shown in the following tables

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Group 1. Cereal Grains and Products. Foods such as rice, wheat, jowar, bajra, ragi etc are in this group.

Group 2. Pulses And Legumes. The food stuffs in this group are pulses and legumes (eg beans, soya beans, peas, Rajmah.

Group 3. Milk , Nuts and Meat Products. They include milk, curd, skimmed milk, cheese, almonds, groundnuts, chicken, meat, liver, egg, fish . 5/3/12

Group 4. Fruits And Vegetables. These include green leafy vegetables, yellow or orange fruits and vegetables such as papaya, mango, carrots,tomato, pumpkin, stems, leaves and flowers of plants, ladies finger, bringals, bittergourds and other gourds, cabbage, cauliflower, drumsticks. Fruits such as amla, lemons, oranges.

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Group 5. Fats And Sugars All these foods supply energy or calories vegetable oils, vanaspati, ghee, cream, sugar and jaggery ,commonly available cooking oils include mustard oil, coconut oil , groundnut oil, palmolein oil, and sunflower oil.

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Nutritional Requirements for elderly Pateints

CALORIES

Calories requirement less with advancing age due to decreased energy expenditure and due to a decrease in the BMR. Energy allowances for persons between 51-75 yrs. Is reduced by 10% of that of young adults and for over 75 yrs. It reduces by 20-25% Elderly people should select nutrient dense food as they eat less

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Nutritional Requirements for the Older Patient

Estimated total daily energy need (based on body weight): 25-30 kcal/kg/day

Estimated total daily energy need (based on basal energy expenditure; BEE): Harris-Benedict Equation Male BEE = 66 + (13.7 x kg) + (5 x cm) (6.8 x age) Female BEE = 655.1 + (9.563 x kg) + (1.850 x cm) (4.676 x age)

Results should be multiplied by 1.5 to estimate energy expenditure of ill elderly patients
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Nutritional Requirements for the Older Patient

Carbohydrates

should comprise 45-65% of total calories Fat should comprise 20-35% of total calories Protein should comprise 10-35% of total calories Fluid : 30ml/kg/day or 1ml per kcal intake

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Nutritional Requirements for the Older Patient

Estimation

of protein:

(0.8 to 1.5)gm/kg/day Restriction of these amounts may be indicated in renal or hepatic insufficiency
Estimation

of fiber: (complex carbohydrates are the preferred fiber source) Men: Women: 30 gm/day 21 gm/day
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Proteins

1.

Animal Sources

- eggs, milk, mutton, fish, poultry, liver etc.

Plant sources - pulses and legumes, cereals, nuts, beans, oilseeds etc. Class I proteins are derived from animal sources contain all essential amino acids needed . Egg.
2.

Class II is derived from pulses and legumes, cereals, vegetables, nuts and they do not contain all the essential amino acids they lack in one or more amino acids.

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Elderly may consumes less protein than adults for the following reasons: Protein foods are more expensive Meat is hard to chew and swallow Preparation of meat requires equipment and physical energy Consumption of milk decreases with age

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Fats

The current recommendation by INDIAN NUTRITION BOARD is that fats should comprise 10-35% of dietary calories

it

can lead to CVS problems like hypertension,atherosclerosis etc.

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CARBOHYDRATES

They are the compounds of carbon, hydrogen and oxygen. Each gram of carbohydrate provides 4 Kcal of energy.

By the digestion of starch and sugar, glucose is formed and absorbed into the blood.

Some carbohydrates are stored in the form of glycogen in muscles and liver.

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WATER
Inadequate

intake of fluid by elderly will lead to rapid dehydration and associated problems such as hypotension,elevated body temperature,dryness of mucosa,decreased urine output etc. normal conditions the goal for fluid intake should be at least 30ml/kg body wt/day elderly should at least drink 8 glasses of water or juices or milk.
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Under

An

Calcium

RDA of calcium is 800mg In elderly it should be increased to 1000mg. There is also an speculation that a long term calcium intake of 1000-1200mg per day can delay or prevent development of osteoporosis Dietary sources milk and its products , dried beans and peas , canned salmon , green leafy vegetables . Functions of calcium are : Formation of bones and teeth Blood clotting Contraction of muscles Cardiac action
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Calcium intake of post menopausal women is co related with mandibular bone mass, patients with dentures who have excessive ridge resorption report lower calcium intakes .

A chronically low calcium intake results in a negative calcium balance . In 1997 the NATIONAL ACADEMY OF SERVICES recommended that an 5/3/12 adequate amount of calcium for men

NUTRITION IN GERIATRIC PATIENTS

Click to edit Master subtitle style

BY DR.RAJAT ANAND

5/3/12

Contents

Introduction Classification of nutrients Effect of nutrients on specialized cells Balanced diet Nutrient needs and requirements of the elderly Factors that effect nutritional status Other risk factors Assessing nutritional status of the elderly Protein Energy Malnutrition Nutritional guidelines Diet suggestions for denture wearers
5/3/12 Common problems faced by denture wearers and

Aging factors that effect nutritional status

Physiologic Cognitive Oral

factors

factors factors factors

factors

Economic

Psychologic

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Physiologic factors
It

includes physical status gastrointestinal functioning sensory changes immune changes dehydration
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1) 2) 3) 4) 5)

Physical status

1) during the adult years there is a steady decrease in lean body mass of about 6.3 % for each decade of life

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Gastrointestinal functioning

With age there is decreased peristalsis,decreased Hcl secretion and altered oesophageal motility

Reduction in the levels of some digestive enzymes including salivary amylase,pancreatic amylase , lipase,pepsin&trypsin

BrodeurJM,LaurinD: patient intake and gastrointestinal disorders related to masticatory performances in elderly,JPD1970:468473,1993 5/3/12

Sensory changes
It

includes:

Visual Hearing Changes

in taste and smell

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Changes in taste and smell

TASTE: during normal aging many individuals experience less chemosensory sensation.

SMELL

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Immune changes
Immune

responsiveness decreases in elderly and as a result infection is the fourth leading cause of death in elderly.

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Dehydration
It

is caused by a decline in renal function and a total body water metabolism.

Thirst

threshold of elderly is also impaired making thirst a poor indicator of hydration status.
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Cognitive factors

Cognitive function decline with advancing age.It ranges from simple memory deficit to profound dementia.

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Oral factors
1) Xerostomia also called dry mouth or hyposalivation effects almost one in five older people

2) Oral infection conditions:

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Dentate status
Reduced

chewing ability is related to an overall reduction in functional capacity & general health

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Economic factors
Economic

factors are the major forces that determine the variety & nutritional adequacy of diet.

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Psychological factors
Because

eating is a very much social activity , loneliness can result in malnutrition, loss of spouse or a friend may result in loss of eating

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OTHER FACTORS AFFECTING NUTRITION

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Effect of denture on taste & swallowing

A

full upper denture can have impact on the taste & swallowing ability .

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Effect of dentures on food choices,diet quality & general health

Effects varies among the individuals. Some people compensate the masticatory inability by choosing processed or cooked food rather than fresh foods & by chewing longer than swallowing, others may eliminate the entire food groups from their diet

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In

the large group of free living elders , inferior diets were associated by denture wearing, low income & low educational attainment . The elders who were wearing 1 or 2 denture had 20% decline in the nutritional quality of their diets compared to dentate peers intake of vitamin A , calcium & fibers also declines as the number of teeth are decreased . The dentate elders eat more fruits & 5/3/12 vegetables

Replacing

the ill fitting dentures with new ones doesnt necessarily results in improved dietary intake . Similarly exchanging the optimal complete dentures for the implant supported dentures has not resulted in significant improvement in the dietary selection & intake Elders with poor oral function reports decline in quality of life
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Drugs that can cause ANOREXIA

digoxin / lithium

narcotic K+

analgesics

phenytoin SSRIs Ca++ H2

supplements bromide

furosemide ipratropium

channel blockers receptor antagonists / PPIs chemotherapy

theophylline spironolactone levodopa

Francesco, V.D., et al. The fluoxetine Aging; Anorexia of metronidazole journal of Digestive Diseases 25(2):129-137; 5/3/12 2007

Any

Drug-Nutrient Interaction
Drug
Alcohol Antacids Antibiotics, broad-spectrum Digoxin Diuretics Laxatives Lipid-binding resins Metformin Phenytoin/Salicylates Trimethoprim

Reduced Nutrient Availability

Zinc, vitamins A, B1, B2, B6, folate, vitamin B12 Vitamin B12, folate, iron, total kcal Vitamin K Zinc, total kcal (via anorexia) Zinc, magnesium, vitamin B6, potassium, copper Calcium, vitamins A, B2, B12, D, E, K Vitamins A, D, E, K Vitamin B12, total kcal Vitamin D, folate/Vitamin C, folate Folate

ASSESSING NUTRITIONAL STATUS

Methods for evaluation of nutritional status include data collection from the following areas:medical social history,clinical examination including(both physical signs and certain anthropometric measures),dietary assessment and biochemical tests.Appropriate dietary counseling should be offered to the patient only after the collection of data confirms a nutritional problem.
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TRIPHASIC NUTRITIONAL ANALYSIS

Phase I
Obtaining

information from a medical social history,conducting selected anthropometric measurements

DCNA:NEED FOR GERIATRIC DENTAL EDUCATION;1989Jan:33(1),109125 5/3/12

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protein

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Iron

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Niacin

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Riboflavin

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Thiamine

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Vitamin-A

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Goitre

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Vitamin-D

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QUALITATIVE DIETARY ASSESSMENT

The purpose of the dietary assessment is to determine what an individual is eating now what he or she has eaten in the past and recent changes in the diet.

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PHASE II

Semiquantitative dietary analysis assesment

Biochemical

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Semiquantitative dietary analysis

The service of a Registered Dietitian,serving as a consultant,is invaluable at this level of assessment.

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Biochemical assesment
Heamatologic

tests can be usefull.

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PHASE III
The

final phase of analysis is reserved for more complex nutritional problems and should be accomplished under the direction of a physician. The analysis in this phase include comprehensive nutritional biochemical assays of blood,urine and tissues,as well as tests of metabolic and endocrine function
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Nutritional Screening and Assessment

Nutrition Screening Initiative (NSI):

collaborative effort of AAFP, ADA, and the National Council on Aging

NSI

completed a study in 1996, revealing evidence that older patients admitted to the hospital in poor nutritional states had longer stays and increased rates of complications than well-nourished patients.

Bagley, B; Nutrition and Health (Editorial); AFP, 57(5): March 1, 1998

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Nutritional Screening and Assessment

The

NSI developed a screening tool that can be completed by patients, family members, or a health care professional The tool consists of 10 questions which are scored and placed in 3 categories: No nutritional risk 0-2 points Moderate nutritional risk 3-5 points
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Nutritional Screening and Assessment

NSI (points apply to YES answers)

I have an illness or condition that made me change the

kind and/or amount of food I eat (2)

I eat fewer than two meals per day (3) I eat few fruits or vegetables, or mild products (2) I have 3 or more drinks of beer, liquor, or wine almost

every day (2) to eat-2

I have tooth or mouth problems that make it hard for me I dont always have enough money to buy the food I

need (4)

I eat alone most of the time (1) I take 3 or more different prescribed or OTC drugs per

day (1)

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Nutritional Screening and Assessment

Mini

Nutritional Assessment (MNA) is a validated screening and assessment tool for identifying elderly patients with or at risk for malnutrition by the Nestl Research Center, in collaboration with hospital clinicians
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Developed

Nutritional Screening and Assessment

The

MNA obviates the need for blood tests to screen and monitor a patients nutritional status of two sections: Screening and Assessment

Composed

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Nutritional Screening and Assessment

MNA

Screening: In the screening section, five questions are asked, and the patient's BMI (Body Mass Index) is calculated, using the patient's height and weight. From these six items, a score is calculated, which will indicate whether there is possible malnutrition Screening score: (max. 14 pts) > 12 pts Normal; not at risk < 11 pts Poss. malnutrition; go to assessment
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Nutritional Screening and Assessment

MNA

Assessment: Clarifies whether there is a future risk of malnutrition, or if malnourishment is currently present. The assessment section is comprised of 10 questions, and two anthropometric measures mid-arm circumference and calf circumference. Scoring (max. 16 pts); when added to screening score, total max is 30 pts. If total is 17-23.5 pts, pt is at risk of malnutrition and if <17 pts, the pt is malnourished.
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Nutritional Screening and Assessment

The

MNA has demonstrated acceptable internal consistency, inter-observer reliability, and validity in studies of community-dwelling, hospitalized, and nursing home elderly individuals around the world and in the U.S.

Beck, A., et al. European Journal of Clinical Nutrition. Nov 2001, Vol 55(11); 1028-33 5/3/12

Nutritional Screening and Assessment

Limitations

of use of MNA:

Lack of familiarity with the requirement of measuring both midarm and calf circumference

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Nutritional Screening and Assessment

Geriatric

Nutritional Risk Index (GNRI): requires measurements of height, albumin, and weight at admission (also ideal weight as calculated from the Lorentz equation). Nutritional risk is graded based on results of calculations. It is a more reliable prognostic indicator of morbidity and mortality in elderly. Low albumin and elevated C-Reactive protein correlate statistically with increased nutritional risk (stronger than with prealbumin)
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Body Size Classification

Body Size Underweight Normal weight Overweight Obesity Extreme Obesity Body Mass Index (kg/m) < 18.5 18.5-24.9 25-29.9 30 40
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Protein energy malnutrition

PEM is usually secondary or subclinical until a primary disease develops or existing chronic problems are exacerbated.

The most common presenting symptom of PEM in elderly is confusion or an altered mental state.

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Protein energy malnutrition

However dehydration is probably the single most common cause of acute confusional states in elderly hospitalised pts. Infection is a frequent complication of PEM

Physical Signs of PEM are: Hair loss, flaky paint dermatitis ,glossitis , dry skin and sunken eyeballs

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Risk factors for PEM

Chronic or intercurrent illness Edentulous Vision impairment Alcohol abuse Polypharmacy Social isolation Loss of spouse Depression Poverty Mental impairment
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Nutrition guidelines for patients undergoing Prosthodontics

1. Limit:
. . . . .

sweets regular coffee and tea greasy or fatty foods alcohol oil, margarine, and "junk" foods
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Guidelines continued

Eat a variety of foods Build diet around complex carbohydrates Have at least five servings of fresh fruits and vegetables daily Limit bakery foods which are high in fats and simple sugars Eat 4 servings of calcium rich foods daily Limit intake of processed foods rich in sodium and fat Consume at least 8 glasses of water, juices or milk daily Select fish,poultry,lean meat,eggs or dried peas and beans everyday. For patients who cannot meet their nutritional 5/3/12

Common Problems and Suggested

Flatulence or gas: Eat smaller, more frequent meals Burning sensation, heartburn, Belching or bloating: Avoid alcohol, carbonated beverages, and high fat foods such as some sweets, meats, oils and margarine, and high-fat dairy foods. Eat slowly and chew foods well. Avoid lying down after meals. If you do, keep head and back elevated at a 30-degree angle. Consider reducing aspirin intake Ask physician to check medications. Difficulty in chewing: See dentist if problem is poorly fitting dentures. Cut food into small pieces and chew food at a comfortable, unhurried pace. Cook some vegetables and fruits to soften. Difficulty in swallowing: Ask physician to check medications. Drink plenty of water. Use lozenges or hard candies to keep throat moist. 5/3/12

Solutions

Constipation: Eat liberal amounts of whole grains as well as vegetables and fruits. Try dried fruits such as prunes or figs, or drink prune juice. Drink 6 to 8 glasses of fluid, especially water, each day. Limit greasy or fatty foods such as high-fat dairy foods, oils and margarine, fried foods, high fat sweets and 5/3/12 meats. Limit use of antacids. Get

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Continuation of Table 1

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Diet Suggestions For Denture Wearers

chew longer , eat slowly and cut fibrous foods such as apples and carrots into bite sized pieces. * pudding * milkshake * Fruit smoothies ( no seeds) * instant breakfast drinks * yogurt * mashed potatoes * oat meal * cream soups * ice cream & custards
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NUTRITION IN GERIATRIC PATIENTS

Click to edit Master subtitle style

BY DR.RAJAT ANAND

5/3/12

Contents

Introduction Classification of nutrients Effect of nutrients on specialized cells Balanced diet Nutrient needs and requirements of the elderly Factors that effect nutritional status Other risk factors Assessing nutritional status of the elderly Protein Energy Malnutrition Nutritional guidelines Diet suggestions for denture wearers
5/3/12 Common problems faced by denture wearers and

Anthropology and anthropometry

1)"From 2)"The

Savage to Negro" (1998) Lee D. Baker p.14 Mismeasure of Man" Stephen Jay Gould (1981) the early 20th century, anthropometry was used extensively by anthropologists in the United States and Europe. One of its primary uses became the attempted differentiation between 5/3/12 differences in

During

The

wide application of intelligence testingalso became incorporated into a general anthropometric approach, and many forms of anthropometry were used for the advocacy ofeugenics policies. During the 1920s and 1930s, though, members of the school ofcultural anthropologyof Franz Boasalso began to use 5/3/12 anthropometric approaches to

Anthropometric

approaches to these types of problems became abandoned in the years after the HolocaustinNazi Germany, who also famously relied on anthropometric measurements to distinguishAryansfromJews. This school of physical anthropology generally went into decline during the 1940s
5/3/12

During

the 1940s anthropometry was used byWilliam Sheldonwhen evaluating hissomatotypes, according to which characteristics of the body can be translated into characteristics of the mind. Inspired byCesare Lombroso's criminal anthropology, he also believed thatcriminalitycould be predicted according to the body type. 5/3/12 This use of anthropometry is today

Review of literature

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Effect of dentures on food choices,diet quality & general health

Effects varies among the individuals. Some people compensate the masticatory inability by choosing processed or cooked food rather than fresh foods & by chewing longer than swallowing, others may eliminate the entire food groups from their diet

5/3/12

Common Problems and Suggested

Flatulence or gas: Eat smaller, more frequent meals Burning sensation, heartburn, Belching or bloating: Avoid alcohol, carbonated beverages, and high fat foods such as some sweets, meats, oils and margarine, and high-fat dairy foods. Eat slowly and chew foods well. Avoid lying down after meals. If you do, keep head and back elevated at a 30-degree angle. Consider reducing aspirin intake Ask physician to check medications. Difficulty in chewing: See dentist if problem is poorly fitting dentures. Cut food into small pieces and chew food at a comfortable, unhurried pace. Cook some vegetables and fruits to soften. Difficulty in swallowing: Ask physician to check medications. Drink plenty of water. Use lozenges or hard candies to keep throat moist. 5/3/12

Solutions

Replacing

the ill fitting dentures with new ones doesnt necessarily results in improved dietary intake . Similarly exchanging the optimal complete dentures for the implant supported dentures has not resulted in significant improvement in the dietary selection & intake Elders with poor oral function reports decline in quality of life
5/3/12

TRIPHASIC NUTRITIONAL ANALYSIS

Phase I

Obtaining information from a medical social history,conducting selected anthropometric measurements

DCNA:NEED FOR GERIATRIC DENTAL EDUCATION;1989Jan:33(1),109125 5/3/12

Calcium

intake of post menopausal women is co related with mandibular bone mass, patients with dentures who have excessive ridge resorption report lower calcium intakes .

A chronically low calcium intake results in a negative calcium balance . In 1997 the NATIONAL ACADEMY OF SERVICES recommended that an 5/3/12 adequate amount of calcium for men

Nutritional Requirements for the Older Patient

Estimated total daily energy need (based on body weight): 25-30 kcal/kg/day

Estimated total daily energy need (based on basal energy expenditure; BEE): Harris-Benedict Equation Male BEE = 66 + (13.7 x kg) + (5 x cm) (6.8 x age) Female BEE = 655.1 + (9.563 x kg) + (1.850 x cm) (4.676 x age)

Results should be multiplied by 1.5 to estimate energy expenditure of ill elderly patients
5/3/12

Gastrointestinal functioning

With age there is decreased peristalsis,decreased Hcl secretion and altered oesophageal motility

Reduction in the levels of some digestive enzymes including salivary amylase,pancreatic amylase , lipase,pepsin&trypsin

BrodeurJM,LaurinD: patient intake and gastrointestinal disorders related to masticatory performances in elderly,JPD70:468-473,1993 5/3/12

A concept analysis of malnutrition in the elderly Cheryl Chia-Hui Chen Lynne S. Schilling RN MN PhD and Courtney H. Lyder ND FAAN JPD70:248273,1994

Malnutrition is a frequent and serious problem in the elderly. Today there no doubt that malnutrition contributes signicantly to morbidity and mortality in 5/3/12

is

The definition of malnutrition in the elderly is determined as following: faulty or inadequate nutritional status; undernourishment characterized by insufcient dietary intake, poor appetite, muscle wasting and weight loss. In the elderly, malnutrition is an ominous sign. Without intervention, it presents as a 5/3/12 downward

Nutritional Screening and Assessment

Nutrition Screening Initiative (NSI):

collaborative effort of AAFP, ADA, and the National Council on Aging

NSI

completed a study in 1996, revealing evidence that older patients admitted to the hospital in poor nutritional states had longer stays and increased rates of complications than well-nourished patients.*

Bagley, B; Nutrition and Health (Editorial); AFP, 57(5): March 1, 1998

5/3/12

The high prevalence of malnutrition in elderly diabetic patients: implications for anti-diabetic drug treatments U. M. Vischer, L. Perrenoud, C. Genet, S. Ardigo, Y. RegisteRameau and F. R. Herrmann JPD 62 1997: 159-165 Type 2 diabetes usually occurs in the context of obesity and associated insulin resistance. Current treatment recommendations are based on lifestyle modifications and incremental drug therapy. However, this approach could lead to inappropriate priorities upon ageing, when 5/3/12 diabetes may be compounded by malnutrition and

Malnutrition

is highly prevalent in elderly diabetic inpatients and, paradoxically, contributes to good glycaemic Malnutrition should be screened for in these patients and, when present, should prompt a revision in diet and drug In particular, the possibility 5/3/12 of reducing unnecessary drug

control.

therapy.

Nutrition screening process for patients in an acute

public hospital servicing an elderly, culturally diverse population

Elizabeth FREW, Jennifer SEQUEIRA and Robyn CANT JPD1998 APRIL :213-217 The study identified a proportion of acute hospital patients for whom nutrition screening using Malnutrition Screening Tool was difficult because of limited applicability if a patient was unable to communicate.
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Use

of the Malnutrition Screening Tool modified by an additional frail/underweight observation was practical in a systematic nutrition screening process and assisted the containment of dietitians workloads. Further research is warranted to develop or modify a subjective tool valid for the screening of all targeted hospital patients.
5/3/12

Associations between self-assessed masticatory ability, nutritional status, prosthetic status and salivary flow rate in hospitalized elders V Dormenval, P Mojon, E Budtz-JrgensenOral Diseases (1999) 5, 323 OBJECTIVES: To compare the association between selfassessed masticatory ability and nutritional status with general health.

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CONCLUSIONS:

Malnutrition in hospitalized elders is primarily associated with recent loss or lack of appetite and complaints related to dentures are associated with poor Saliva rate due to decrease in body fluids.

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Assessing the Nutritional Status of the Elderly: The Mini Nutritional Assessment as Part of the Geriatric Evaluation Yves Guigoz, Bruno Vellas, and Philip J. Garr

Nutrition Reviews, Vol. 54, No. 1 January 2000: (11) 59-65

5/3/12

Nutritional Screening and Assessment

The

MNA has demonstrated acceptable internal consistency, inter-observer reliability, and validity in studies of community-dwelling, hospitalized, and nursing home elderly individuals around the world and in the U.S.

Beck, A., et al. European Journal of Clinical Nutrition. Nov 2001, Vol 55(11); 1028-33 5/3/12

Nutrition guidelines for patients undergoing Prosthodontics

1. Limit:
. . . . .

sweets regular coffee and tea greasy or fatty foods alcohol oil, margarine, and "junk" foods
5/3/12

Drugs that can cause ANOREXIA

digoxin / lithium

narcotic K+

analgesics

phenytoin SSRIs Ca++ H2

supplements bromide

furosemide ipratropium

channel blockers receptor antagonists / PPIs chemotherapy

theophylline spironolactone levodopa

Francesco, V.D., et al. The fluoxetine Aging; Anorexia of metronidazole journal of Digestive Diseases 25(2):129-137; 5/3/12 2007

Any

Minimising undernutrition in the older inpatient Dawn Vanderkroft et. Al. Int J Evid Based Healthc 2007; 5: 110181 The findings of the review support the use of oral supplements to minimise undernutrition

in elderly inpatients. The results also emphasise the need for more high-quality research using appropriate outcome measures in the area of minimisation of undernutrition, particularly interventions that make alterations to the hospital diet and address support for feeding patients at the ward level. 5/3/12

Protein and energy supplementation in elderly people at risk from malnutrition (Review) Milne AC, Potter J, Vivanti A, Avenell AThe Cochrane Library 2009, Issue 2

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Protein energy malnutrition

Assessing nutritional status in elderly is a difficult task because of age related changes.The incidence of PEM in hospitalised patients ranges from 35-65% and most hospitalised patients are over the age of 65.The scope of problem of PEM in elderly hospitalised pts. Therefore ,demands attention. PEM is usually secondary or subclinical until a primary disease develops or existing chronic problems are exacerbated.for eg. PEM develops secondary to chronic heart,lung ,liver diseases.Elderly pts. Respond appropriately to systemic insults although a return to basal levels takes longer.Undiagnosed PEM impacts on wound healing,infection defence and metabolic response to stress.The most common presenting symptom of PEM in elderly is confusion or an altered mental state.Changes in mental status may be associated with cardiac failure,cerebrovascular accident,sepsis or various metabolic dysfunctions.
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Protein energy malnutrition

However dehydration is probably the single most common cause of acute confusional states in elderly hospitalised pts. Infection is a frequent complication of PEM Physical Signs of PEM are: Hair loss, flaky paint dermatitis ,glossitis , dry skin and sunken eyeballs

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Nutrigenomics: where are we with genetic and epigeneticmarkers for disposition and susceptibility? Reviews Vol. 68(Suppl. 1):S38S47 Kussmann, Lutz Krause, and Winfried Siffert revelation of the human genome
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Nutrition Martin The

Nutrigenomic

techniques help researchers elucidate individual responses to

nutritional interventions holistically and help with the design of personalized diets adapted to individual needs. Human genetics has revealed insights into health and
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in disease susceptibility genes has so far been limited in terms of helping to foresee a health trajectory. Epigenetics encompasses alterations of genetic material that do not affect the DNA nucleotide sequence; these include DNA methylation patterns,
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SUMMARY

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Conclusion

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REFERENCES

Biochemistry and nutrition; Mosbys den rev; 3rd edition Oral medicine and nutrition ; Touger and Decker 1st edition Oral physiology ; Lavelle Yurktas AA:Dietary selection of persons with natural and artificial teeth.JPD 14:695-697,1964

Wayler Ah:impact of complete dentures and impaired natural dentition on masticatory performance and food choice in elderly: JPD49:427-433,1983 5/3/12

Natwon AB:GERIATRIC NUTRITION, boston CBI Publishing co.1980 DCNA:GERIATRIC NUTRITION AND DIETARY COUNSELING FOR PROSTHODONTIC PATIENT;2003Apr:47(2),355-371

DCNA:NEED FOR GERIATRIC DENTAL EDUCATION;1989Jan:33(1),109-125 ZARB,BOLENDER :PROSTHDONTIC TREATMENT FOR EDENTULOUS PATIENTS;12TH ED.:nutrition care for denture wearing patient:56-69 SHILS,YOUNG:modern nutrition in health and disease;7th ED. PAPAS AS,LINDA C:geriatric dentistry aging and oral health A Senior's Guide to Good Nutrition -- The Vegetarian Resource Group.htm 5/3/12 Konikoff, R.A. (March, 1999). A modified food guide for people

Indiancookery.comBalanced Diet.htm Kribbs PJ:comparison of mandibular bone in normal and osteoporotic women,JPD63:218222,1990 BrodeurJM,LaurinD: patient intake and gastrointestinal disorders related to masticatory performances in elderly,JPD70:468-473,1993 KapuaKK , Soman SD:masticatory performance and efficiency in denture wearers,JPD14:687694,1964 Toguer-Decker et al:effects of teeth loss and dentures on diet habits,JPD75:831-837,1996
5/3/12 Slagter AP et al: Masticatory ability,Denture

Than k you

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