Nutritional problems. Age-related diseases Functional impairments Drug-induced nutritional deficiencies

Transcription

1 Nutritional problems Age-related diseases Functional impairments Drug-induced nutritional deficiencies

2 Protein energy Vitamins Fibre Water Malnutrition >Deficiencies Obesity Hypervitaminosis >Excesses

3 Undernutrition Categories > Community dwelling > Hospitalized >Institutionalized (nursing home) Burden of acute and chronic disease differs Oncology Nutritional requirements vary

4 65 +

5 Aging = Loss Muscle mass Muscle strength Bone mass Hormone production Co-occurrence suggests > common risk factors > overlap in pathophysiology

6 Weight loss is common Poor outcome BMI < 22 > higher 1-yr mortality >poorer functional status BMI < 20.5 in men > Landi 75 y Calle EE,New F et al. J Engl Am J Geriatr Med 1999;341: Soc 1999;47: > 20% higher mortality BMI < 18.5 in women > 75 y > 40% higher mortality. Key factor is recent weight loss

7 Age distribution in BMI class Age distribution according to BMI % Age Category 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Vandewoude et al, Cachexia Conf < BMI P<0.001

8 Age-related loss of muscle mass 65% 10 pounds of older using men and their women armscannot lift is clinically important >diminished strength and exercise capacity > decline in function

9 Age-related loss of muscle mass Arts I et al, J Am Ger Soc, 2007:55,

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11 Causes of skeletal muscle loss Voluntary Involuntary

12 Causes of skeletal muscle loss Starvation > pure protein-energy deficiency >reversed by replenishment of nutrients Cachexia >severe wasting > accompanying disease states Sarcopenia > age-related decline in muscle mass

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14 In the Geriatric Oncology patient Ageing Nutritional intake Cancer

15 In the Geriatric Oncology patient Sarcopenia Ageing Nutritional Starvation intake Cachexia Cancer

16 Nutritional Assessment to identify patients at risk to identify patients who could benefit from an intervention prognosis to evaluate the intervention Screening should increase alertness

17 Risk>General >Geriatrics SNAQ: NRS: Short Nutritional Nutritional Risk Score Assessment Assessment Actual NSI: MUST: Malnutrition Screening Universal Initiative Pathology MNA: nutritional Mini Nutritional statusassessment Screening Tool >Swallowing disorders

18 Did you lose weight unintentionally? Did >6 you kg experience in the past 6 a months decreased appetite SNAQ Did well-nourished moderately feeding you malnourished use over supplemental the past month? drinks or tube 1 >3 kg in the past months 32 over the past month? 1 severely malnourished 123 Kruizinga et al, Am J Clin Nutr 2005;82:

19 NRS Kondrup et al, Clin Nutr 22, , 2003

20 NSI Lipschitz, NSI, Washington DC, 1991

21 MUST BAPEN, 2008

22 MNA Antropometric measurements Global evaluation Diet Subjective assessment

23 MNA Screening >6 items >If positive (11 points or below): go to Assessment

24 TOTAL SCORE (max. 30 points) Score Risk 24 None 17 score < 24 At risk of malnutrition < 17 Malnourished

25 Problems in Geriatric patients Validation of instruments not in older people (SNAQ) age as riskfactor (NRS)

26 Problems in Geriatric patients Validation of instruments Anthropometry > Bedridden patients > Mobility problems >Body length is not constant

27 BMI? Age Weight Length BMI BMI is doubtful parameter in older people

28 Problems in Geriatric patients Validation of instruments Anthropometry Social and psychic factors > Subjective impression > Dementia - depression

29 Conclusion Nutritional assessment should be part of routine evaluation of the geriatric oncology patient Nutritional assessment should be framed in a larger CGA (comprehensive geriatric assessment) addressing several functional domains

30 Conclusion Difference should be made between assessment of risk and actual nutritional status Body weight assessment with specific attention to unintended weight loss is essential BMI should be interpreted with caution (overestimation due to shorter body length)

31 Conclusion Increased alertness Subjective global assessment Willingness for early intervention