Webinar “Evaluación nutricional ideal del adulto mayor”.

Name: Webinar “Evaluación nutricional ideal del adulto mayor”.
Uploaded: 2022-09-02T12:17:38.000Z
Duration: 1 h 46 min 39 s

Assessment of Nutritional Status and Caregiver Impact

Understanding Malnutrition and Its Causes

Discusses the various factors leading to malnutrition, including social isolation, loss of partners, limited economic resources, and caregiver stress.

Emphasizes the need for comprehensive genetic assessments to evaluate cognitive decline, depression, autonomy in medication management, and caregiver collapse.

Multidisciplinary Evaluation Approach

Highlights the importance of a multidisciplinary evaluation that includes medical assessments of physical health, mental capacity (cognitive decline), and social environment.

Stresses that poor nutrition can lead to significant physical and psychological issues such as increased dependency and infections.

Nutritional Assessment Challenges

Points out difficulties in accurately assessing daily nutritional intake due to lack of knowledge about food composition (e.g., protein content in lentils).

Questions audience knowledge on carbohydrate content in common foods like rice or sugar levels in fruits, indicating a general gap in nutritional literacy.

Methods for Dietary Evaluation

Describes prospective dietary assessment methods requiring individuals to record their food intake over time but acknowledges challenges due to literacy and willingness.

Suggests retrospective methods where individuals recall their food consumption over recent days; however, this is also hindered by cognitive limitations.

Anthropometric Measurements

Discusses the calculation of Body Mass Index (BMI), emphasizing the need for tools like skinfold calipers for accurate body composition analysis.

Mentions practical challenges faced by healthcare providers regarding equipment availability for precise weight measurement and ideal weight calculations.

Nutrition Assessment in Geriatrics

Importance of Creatinine and Lymphocytes

Creatinine is a final product of creatine degradation, indicating muscle mass loss.

Lymphocyte levels can be affected by inflammation, making them less reliable for nutritional evaluation during the pandemic.

Nutritional Markers and Their Implications

LDL cholesterol and C-reactive protein should be interpreted cautiously as markers of malnutrition; inflammation can elevate these levels.

Low micronutrient levels (B6, B12, selenium) are linked to functional decline and cognitive dysfunction in older adults.

Evaluating Nutritional Status

The context of nutritional assessment is crucial: whether it's retrospective or current, stable or acute conditions must be considered.

The Mini Nutritional Assessment (MNA) consists of 18 questions assessing nutritional risk; scores above 23.5 indicate good nutrition.

Geriatric Nutritional Tools

MNA is specifically designed for older adults but may not perform well in non-institutionalized seniors.

NRS 2002 focuses on hospitalized patients using BMI, recent weight loss, and dietary changes to assess risk.

Functional Assessment Challenges

The Malnutrition Universal Screening Tool (MUST), while easy to use, lacks functionality measures and primarily assesses disease impact.

Global Subjective Assessment relies on clinical history including weight change and gastrointestinal symptoms; it correlates with hospital stay duration and complications.

Addressing Sarcopenia in Older Adults

Geriatric Risk Nutritional Index detects muscular dysfunction related to sarcopenia, aiding nutritional support and early rehabilitation.

Recommendations for community-dwelling older adults include using MUST due to its ease of use by patients or family members.

Current Trends in Geriatric Nutrition

NRS remains relevant for assessing increased nutritional needs based on illness severity among elderly patients.

Physical deconditioning has been observed even in younger populations during the pandemic; signs include difficulty with daily activities like lifting objects.

This structured summary provides an overview of key discussions regarding geriatric nutrition assessment tools, their implications for health outcomes, and the importance of contextual evaluations.

Understanding Functional Deconditioning and Nutritional Assessment

The Impact of Physical Effort on Health

Individuals may experience palpitations during minimal physical activities, such as carrying grocery bags or even bathing, indicating a decline in functional capacity.

Difficulty in performing everyday tasks can signal functional deconditioning; patients may struggle with basic movements like standing up from a chair or bed.

Consequences of Deconditioning

Functional deconditioning can lead to chronic pain due to muscle, tendon, or joint injuries, resulting in altered postures and muscle atrophy.

Patients often begin walking more slowly and relying on furniture for support, which exacerbates their mobility issues.

Rapid Assessment Protocol for Nutritional Risk

A quick assessment protocol is introduced that can be utilized in various settings (home, clinic, hospital), focusing on malnutrition risk and sarcopenia.

Participants are encouraged to use a QR code linked to an online tool for efficient nutritional evaluation without consuming much consultation time.

Factors Influencing Nutritional Risk

Key risk factors include age (75+), frailty, history of cancer treatment, chronic wounds, diabetes, intestinal diseases, renal disease, or liver disease.

The assessment includes calculating the Body Mass Index (BMI), which helps identify potential malnutrition risks based on recent weight loss.

Evaluating Sarcopenia Risk

The assessment allows healthcare providers to evaluate sarcopenia risk without direct patient contact by assessing the ability to lift weights equivalent to common household items.

Questions regarding mobility assistance and the ability to perform sit-to-stand movements help gauge functional strength and predict sarcopenia risk effectively.

Follow-Up Actions Based on Assessment Results

If assessments indicate low nutritional status or high sarcopenia risk, appropriate interventions should be initiated promptly.

This streamlined approach enables family members or assistants to conduct preliminary evaluations before professional consultations.

Nutrition Assessment and Protocols

Importance of Timely Nutritional Assessment

The initial assessment takes about 15 minutes, which is crucial for determining nutritional risk. This time investment can enhance the quality of consultations.

Encouragement for assistants, residents, and students to conduct preliminary assessments with patients before formal consultations to facilitate informed decision-making.

Methods of Evaluation

Various methods can be employed depending on the setting (clinic, home, or hospital). For instance, measuring height using arm span as a proxy when patients cannot stand.

In private consultations, thorough nutritional evaluations are encouraged; in hospitals, the severity of the patient's condition must be assessed alongside nutritional status.

Addressing Nutritional Risks

After identifying risks through assessments like NRS 2002 or quick screenings like r Maple, it’s essential to determine physical issues affecting nutrition (e.g., chewing difficulties).

If a patient shows no nutritional risk, they may continue their current dietary habits. However, if risks are present, further investigation into physical and mental health issues is necessary.

Social and Environmental Factors

Consideration of social factors such as family dynamics and support networks is vital. Patients may require community resources like senior clubs or church groups for social interaction.

Assessing food acquisition methods is important; some patients may rely on repetitive meals due to convenience or lack of resources.

Nutritional Interventions

When addressing malnutrition, it's critical to recommend diverse fruits and vegetables while ensuring adequate hydration based on body weight calculations.

Discussion on various nutritional supplements available (e.g., Ensure Clinical), tailored for specific conditions such as diabetes or renal issues. Each supplement serves different caloric and protein needs based on individual health circumstances.

Nutrition and Care for Patients with EPOC

Nutritional Recommendations for EPOC Patients

Emphasizes the importance of a high-calorie, high-protein diet for patients with EPOC to minimize CO2 production. Suggests timing of supplements should be considered carefully.

Advises against administering supplements during breakfast; recommends taking them in small sips throughout the morning to avoid gastrointestinal discomfort such as gas or diarrhea.

Highlights that evening supplementation can help prevent hypoglycemia and aid in converting sugars into glycogen, which is crucial for body repair during sleep.

Assessing Patient Needs

Discusses the necessity of physical rehabilitation and exercise, stressing that without financial means or support, it’s challenging to encourage patients to engage in physical activity.

Stresses the importance of comprehensive assessments to identify malnutrition, obesity, or other conditions that inform intervention strategies tailored to individual patient needs.

Holistic Approach in Patient Care

Recommends understanding all aspects of a patient's life—psychological, social, economic—to create effective care plans.

Encourages collaboration within healthcare teams and planning activities both individually and collectively based on patient problems.

Importance of Hydration and Nutrition

Underlines hydration, nutrition, and physical activity as critical components of health management. This serves as a reminder of foundational practices in patient care.

Addressing Common Dietary Practices

Traditional Meal Patterns

Responding to questions about traditional Mexican breakfast habits (coffee with milk and bread), suggests incorporating more nutritious options like eggs or fruit while maintaining cultural relevance.

Adjustments for Older Adults

Discusses adapting meal patterns for older adults who may have limited diets; encourages including fruits before bedtime as healthy snacks.

Body Mass Index Considerations

Addresses whether BMI cutoffs should change for older adults due to physiological changes like height loss; suggests adjusted ideal ranges between 23.5 - 27.

Supplementation Challenges

Protein Supplementation Concerns

Raises concerns regarding the acceptance of protein supplements among patients; discusses how flavorings might affect their willingness to consume casein-based products.

Nutritional Strategies for Patients in Critical Care

Increasing Amino Acid Intake

The use of gelatin is suggested as a method to increase amino acid intake, which can be purchased in various forms. It dissolves in hot liquids without altering taste or consistency.

Adding a tablespoon of gelatin to morning coffee or evening soup can provide an additional 15 grams of amino acids without changing the flavor of the food.

Importance of Oral Health Evaluation

Dr. Nancy emphasizes the significance of oral health assessments, noting that many patients have conditions that hinder proper eating.

There are concerns about how oral pathology scales should be integrated with general health evaluations, especially regarding risks associated with poor oral health.

Risks Associated with Malnutrition

Poor oral health can lead to decreased chewing ability and reduced food intake, increasing malnutrition risk and potentially raising hospitalization mortality rates by 20%.

Effective evaluation should focus on actionable insights rather than just data collection; practical interventions are crucial for patient outcomes.

Clinical Recommendations for Intensive Care Patients

In cases like a sarcopenic patient in intensive care with low albumin levels, early nutritional intervention is critical. Delayed action may lead to severe infections and complications.

The recommendation includes using nasogastric tubes for feeding if necessary, ensuring adequate protein and calorie intake to prevent malnutrition.

Dietary Management Challenges

Hospital diets often resemble recipes but may not cater adequately to fragile patients. It's essential to allow flexibility in dietary restrictions unless medically necessary.

Observations indicate that patients frequently do not consume all provided meals; thus, overly restrictive diets could exacerbate their nutritional deficits.

Nutritional Management for Nephropathy Patients

Protein Intake Recommendations

For nephropathy patients, if they are diabetic and need to limit sugars, increasing insulin dosage can be a solution. The recommended protein intake is approximately 0.8 grams per kilogram of body weight.

A patient weighing 70 kg should consume around 56 grams of protein daily, which equates to over 200 grams of meat or two eggs with some milk in the morning.

Hospital sandwiches often contain minimal protein (e.g., cheese and ham on bread), which may not meet dietary needs; a proper sandwich should include more nutritious ingredients like beans, mustard, mayonnaise, lettuce, and tomato.

Calculating Ideal Weight

To determine ideal weight for a bedridden patient, consider that each leg accounts for about 18% of total body weight. If both legs are amputated, subtract 36% from their previous weight to find the new ideal weight.

Thickeners for Food

Commercial thickeners may not be widely available; however, food thickeners can be found in baby food sections at supermarkets. Alternatives like gelatin or cornstarch can also effectively thicken foods without altering their taste.

Cornstarch is well-received by patients as a thickening agent due to its neutral flavor profile.

Nutritional Support Before Surgery

For malnourished elderly patients scheduled for surgery, oral supplements are recommended if gastrointestinal function is adequate. These supplements provide necessary proteins, carbohydrates, fats, vitamins, and minerals.

In cases where oral intake isn't possible due to health conditions (like being unconscious), enteral nutrition via feeding tubes may be utilized.

Supplement Recommendations for Elderly Patients

For older adults with high energy expenditure due to underlying health issues, caloric-dense supplements such as Ensure Clinical or similar products are advisable based on individual renal function and nutritional needs.

Closing Remarks

The speaker expresses gratitude towards participants and acknowledges the importance of shared knowledge in geriatric care. They emphasize the value of experience alongside academic learning in improving patient outcomes.

The discussion highlights ongoing developments in geriatrics within institutions like UNAM and encourages continued education among healthcare professionals involved in elder care.

International Congress Announcement

Upcoming Events in Geriatrics

The speaker expresses gratitude for the invitation and the opportunity to share insights, emphasizing the importance of collaboration in geriatrics.

An announcement is made regarding the International GEATRIMS Congress, scheduled for September 26-28. The event will feature both in-person and hybrid formats to accommodate various participants.

Attendees are encouraged to participate in this significant gathering, which aims to foster discussions on advancements and challenges within the field of geriatrics.

Additionally, a reminder is given about the National Congress of the Mexican Academy of Geriatrics, set for late October, highlighting ongoing educational opportunities in geriatrics.