Recommendations for Nutritional Assessment and Management in Older Adults
Learn about the impact of aging on nutrition, the risks of malnutrition in older age, and the importance of nutritional assessments and dietary counseling. Find out why oral supplemental nutrition is recommended for older individuals affected by undernutrition.
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Presentation Transcript
Malnutrition Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
Aging physiological changes negative impact on nutritional status intrinsic capacity Sensory impairments (a decreased sense of taste and smell, for example), poor oral health, Isolation, loneliness and depression increase the risk of malnutrition in older age changes in body composition after the age of 60 years decrease in fat-free mass and lean mass, and an increase in fat mass progressive decrease in body weight Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
Stable body weight overall masks such age-related changes in body composition. Older people who do not consume enough protein are at increased risk of developing sarcopenia, osteoporosis and impaired immune response. Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
Recommendation 2 Oral supplemental nutrition with dietary advice should be recommended for older people affected by undernutrition. Quality of the evidence: moderate Strength of the recommendation: strong Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
Nutritional assessments should be specific to the older person and include nutritional history, records of food intake or 24-hour dietary recall, physical examination with particular attention to signs of inadequate nutrition or overconsumption, and specific laboratory tests if applicable. There are several tools available to assess nutritional status in older people . Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
Assessment of muscle mass and muscle strength must be included in the assessment of nutritional status. Dietary counselling to ensure a healthy diet that provides adequate amounts of energy, protein and micronutrients should be encouraged for all older people, including those who are at risk of or affected by undernutrition. Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
It is important to consider specially formulated supplementary foods (in ready-to-eat or milled form), which are modified in their energy density, protein, fat or micronutrient composition, to help meet the nutritional requirements of older people. Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
Mealtime interventions (including family-style meals and social dining) are important approaches for managing undernutrition in older people. Consider family-style meals or social dining for older people living alone or who are socially isolated. Protein absorption decreases with age. Low protein intake is associated with loss of lean body mass, and standard protein intake may not be sufficient for older people. Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
Refer older people with evidence of potentially serious underlying physical illness (gross cachexia, rapid weight loss, obstruction or difficulty swallowing, vomiting, chronic diarrhoea, abdominal pain or swelling) for medical review by a physician or specialist Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
Oral supplemental nutrition Oral supplemental nutrition is the provision of additional high-quality protein, calories and adequate amounts of vitamins and minerals tailored to the individual s needs assessed by a trained health care professional. The assessment allows for the best source and vehicle for these nutrients to be defined, whether through the use of supplements, nutrient-rich commercial or non-commercial nutritional formulations. foods, or specialized Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
Moderate-quality evidence showed that administration of oral supplemental nutrition plus dietary advice could prevent mortality and improve weight gain in older people affected by undernutrition Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
The implementation of this recommendation may have major resource implications, particularly in the training of staff members. However, in many low- and middle-income countries, community health workers deliver nutritional interventions for children affected by undernutrition and for pregnant mothers. Based on this experience, the GDG concluded that training could be undertaken for existing human resources to implement these recommendations Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
Provision of dietary advice will aid an older persons understanding of the need for oral supplemental nutrition and will ensure that their dignity and human rights are respected Dr Niloofar Motamed Community Medicine Internship- ICOPE-BPUMS 4/27/2019
