Geriatric Nutritional Assessment
12
Kumar Dharmarajan and Kenneth L. Minaker MD
Questions and Answers
1. Which of the following findings should trigger a more indepth assessment for undernutrition?
a. Weight loss of 5%/2 years in community dwelling elderly
b. Body mass index (BMI) £ 25 in hospitalized elderly
c. Dietary intake £75% of most meals in long-term care
d. All of the above
e. None of the above
Answer: c.
–– In community dwelling elderly, the following would be
concerning: ³5% weight loss/6 months, BMI < 22,
BMI ³ 30, Simplified Nutritional Appetite Questionnaire
(SNAQ) score £ 14, or Mini Nutritional Assessment
(MNA) score < 24
–– In hospitalized elderly, look for the following: BMI £ 20,
albumin <3.5 g/dL, prealbumin <15 ng/dL, transferrin
saturation <200 mg/dL, dietary intake < estimated
caloric needs, absolute lymphocyte count <800/mm3,
or total cholesterol <130 mg/dL
–– In long-term care, be alert to the following: ³5%
weight loss/30 days, ³10% weight loss/6 months, or
dietary intake £75% of most meals
2. Which of the following are common causes of malnutrition in older adults?
a. Neurocognitive changes including dementia and
depression
b. Polypharmacy
c. Physiologic changes with aging such as reduction in
taste, salivation, and smell, as well as reduced gastric
emptying time
d. Socioeconomic factors
e. All of the above
Answer: e.
All of the above may contribute to undernutrition in older
adults. The mnemonic “Malnourished” can be used to
generate a differential as given in Table 12.1.
3. Which of the following general causes of undernutrition
in older adults is most responsive to oral nutritional
supplementation?
a. Starvation
b. Sarcopenia
c. Cachexia
Answer: a.
The starvation phenotype occurs when an older person takes
in insufficient calories and nutrition to maintain weight due
to lack of access to food, mechanical limitations preventing
food ingestion, or inability to absorb ingested nutrients.
Etiologies include polypharmacy, oral disease, and lack of
social support to overcome functional, cognitive, and psychiatric limitations. Treatment involves rectification of the
underlying cause and nutritional supplementation.
In contrast, both sarcopenia and cachexia are much
more resistant to supplementation. Sarcopenia is defined
as loss of muscle mass, quality, and function that accompanies aging. Treatment involves resistance exercise and
other physical activities. Cachexia involves significant
loss of both muscle and adipose tissue, often due to
chronic illness and cytokine up-regulation. Nutritional
supplementation is rarely beneficial without amelioration
of the underlying cause.
4. “Common-sense” approaches to increase oral intake in
patients with dementia include which of the following?
a. Abandonment of overly restricted diets
b. Family assistance with feeding
c. Improvement in the overall dining environment
d. All of the above
C.S. Pitchumoni and T.S. Dharmarajan (eds.), Geriatric Gastroenterology,
DOI 10.1007/978-1-4419-1623-5_12, © Springer Science+Business Media, LLC 2012
113
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K. Dharmarajan and K.L. Minaker
Answer: d.
In cognitively impaired patients who are malnourished,
a number of common-sense nonpharmacologic methods
should be used to increase oral intake. These include
meeting food preferences, avoiding diets that are overly
restricted for salt, cholesterol, saturated fat, or glucose,
ensuring proper serving temperature, providing favorite
high-calorie foods, and providing intermeal snacks. In
addition, residents with dementia at skilled nursing
facilities (SNFs) may benefit from family members’
help with mealtime assistance and feeding. These facilities should also provide food in well-lit, well-decorated,
unhurried, and “appetizing” environments.
5. In advanced dementia, tube feeding has been shown to
increase or improve which of the following?
a. Lifespan
b. Functional status
c. Quality of life
d. All of the above
e. None of the above
Answer: e.
It is critical to know that long-term enteral and parenteral
feeding in patients with advanced dementia has not been
shown to prolong life, improve functional status, decrease
pressure ulcers, or increase quality of life. In contrast,
careful mouth feeding for comfort can be a reasonable
and beneficial strategy for both patient and caregiver, even
in the context of known aspiration.
6. Treatment of overnutrition/obesity in older persons should
not include which of the following?
a. Endurance exercise
b. Resistive exercise
c. Marked caloric restriction
d. Well-balanced diets such as Dietary Approaches to
Stop Hypertension (DASH) and Mediterranean
diets
Answer: c.
Extreme diets such as marked caloric restriction have
not been well studied in older adults and should not be
routinely recommended as they can worsen sarcopenia
and both micro and macronutrient deficiencies.
However, recommendation that older persons consume
diets low in saturated fat and cholesterol, high in fiber
including fresh fruits and vegetables, high in plant proteins, and plentiful in vitamins, minerals, and trace elements such as DASH and Mediterranean diets is almost
always prudent. In addition, both endurance and resistive exercise can attenuate the age-related decline in
total energy expenditure and lower visceral fat.