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Geriatrics
Nutrition at the old people
Courses of Geriatrics
 


 

Introduction:

The life expectancy in France east one longest in the world.

It increases unceasingly.

The population of more than 75 years will have increased by 40% from here 2010.

Action on 2 levels:

• Prevention of the disease by the nutrition

• Treatment of the complications: the food is a care

Physiological ageing:

A - ORAL AGEING:

3% of the old people keep healthy teeth.

50% present a total loss of teeth.

Defective dental hygiene in 100% of the cases in the services of geriatrics.

Consequences:

• Appearance of perlèche

• Apparatuses source of iatrogenic affections when the resins become porous

Modifications of the tooth:

• Yellowing of enamel

• Proliferation of the dentine

• Reduction of the pulp cavity

• Retraction of the gum

• Accumulation of dental plaque: disease parodontale

• Washing away of the tooth

• Appearance of decays on the level of the collet

Involve a modification of the food practices.

Cause protidic and vitamin deficiencies.

The good state of the oral cavity takes part in the maintenance of the nutritional statute.

The dental care and hygiene should not be neglected at the old subject.

B - DISTURBANCES OF THE TASTE:

Phenomenon which makes it possible to distinguish savours.

The loss of the taste is always accompanied by anorexia.

The taste is a key factor of the appetite.

1) CAUSES OF THE DISTURBANCE OF THE TASTE:

a) Drugs:

They can modify the taste.

Can involve a reduction in salivation.

The food being soaked correctly, the molecules carrying savours will be less active.

b) Nutritional factors:

• Dehydration: dryness of the mouth

• Malnutrition: the cellular budding of the buds of the taste slows down

• Deficit in B3 vitamin and zinc

• Alcoholism

c) local Factors:

• Oral Mycoses

• Burns

• Irradiations

• Chemicals

d) Neurological factors:

• Any lesion of the cranial nerves

• AVC

• Surgery ORL

e) Pathological factors:

• Digestive Mycoses

• Multiple Scleroses

• Hypothyroïdie

• Viral affections

f) Deterioration of the cellular receivers:

• Dehydration

• Tobacco

• Drugs

2) IN CONCLUSION, IT WILL BE NECESSARY:

• To modify or stop the responsible drugs

• To treat the deficiencies

• To treat dehydration

• To stimulate the taste

C - AGEING OF THE DIGESTIVE SYSTEM:

The mucous membranes adapt and can compensate for their own ageing.

This one involves a reduction late and moderate in absorption:

• Of greases

• Of glucids

• Of certain vitamins

• Of the folates

Needs and deficiencies:

A - WATER:

Water is the most abundant compound of the human body.

It plays of the major roles in the organization:

• Waste disposal

• Thermoregulation

Reduction in the proportion in the organization with ageing.

The risk of dehydration is very important.

1,5 liters of water minimum per day.

More 500 DC per degree of temperature to the top of 37° in the event of fever.

B - ENERGY:

Contrary to the generally accepted ideas, the energy needs for the old people are at least equivalent to those of the young adults.

1) THE ENERGY EXPENDITURE:

60% for the basal metabolism which practically does not vary with the age 10% related to the heating effect of the food 30% related to the physical exercise: the expenditure necessary for the same exercise is larger.

2) REQUIREMENTS IN ENERGY:

> 30 cal/Kg/jour.

C - PROTEINS:

Essential component of all the alive beings. 1 g/Kg/j for an adult 1,25 g/Kg/j for an old person.

But the proteins will be correctly used only if they are accompanied by a sufficient contribution in calories.

In the event of hypercatabolism, the requirements out of proteins will be increased.

D - LIPIDS:

They provide energy in the most concentrated form.

They bring the essential fatty acids.

Stocks of energy of the organization constitute

1) REQUIREMENTS IN LIPIDS:

Practically the same ones as the adult: 35% of the AET.

2) CHOLESTEROL:

It is essential to the life: precursor of various hormones, the vitamin D and biliary salts necessary to the absorption of greases.

No the mode hypocholestérolémiant after 70 years, except if the hypercholesterolemy were known and treated.

E - GLUCIDS:

Source of energy most quickly usable.

1) REQUIREMENTS OUT OF GLUCIDS:

Being equivalent to those of an adult: 50% of the AET (total energy contribution)

The old people present a particular craving for the sweetened products.

They limit their complex sugar contributions involuntarily.

The daily glucidic contributions will have to come in majority from complex glucids: bread, rices, vegetables dry.

2) INTOLERANCE WITH GLUCOSE:

Caused by the reduction in the production of insulin.

F - VITAMINS:

Group at the high risk of vitamin deficiency.

1) FACTORS OF RISKS:

The same ones as those of the denutrition:

• Too weak energy Contributions

• Inadequate Cooking

• High Needs for physiological reasons

• Loneliness, social insulation, weakness of the resources

2) CONSEQUENCES:

Many consequences:

• B1, B3, B6, B12, C, Acid folic: behavior and mood

• B9, B12: weaken macrocytaire

• C: Reduction in the absorption of iron

• B6, B9, C, D, E: immunizing deficit

• D: osteomalacia, fractures To check the food contributions.

Supplémentation in the event of malnutrition or of surgical stress.

G - TRACE ELEMENTS AND MINERALS:

Microphone-nutrients for which the requirements are not met when the total energy contributions are lower than 1500 Kcal/j.

1) MINERALS:

a) Requirements out of calcium:

1200 to 1500 mg/j.

Must be coupled with a contribution of D3 vitamin: 800 UI/j.

b) Requirements out of magnesium:

Increased by:

• Stress

• Alcoholism

• Treatment diuretic

• Corticoid Treatment

• Parenteral Food

Need for complémenter.

2) TRACE ELEMENTS:

a) Iron:

Ageing is not a factor of risk of deficiency out of iron.

Needs: 15 mg/j.

In general covered by the food contributions.

The systematic supplémentations are dangerous because of oxidizing effect.

b) Zinc:

Its deficiency disturbs the taste.

It intervenes in the cicatrization of the wounds.

The insufficiency of contribution out of zinc is frequent at the subjects in institution.

Nutrition low in crudenesses.

Complementation in case:

• Of agueusy

• Disorders of the cicatrization

• Prolonged Artificial recharge

c) Selenium:

It would play a fundamental part in protection against the effects of ageing by its antioxydant action.

Its prolonged administration can prove to be toxic.

A contribution is advised during a prolonged artificial nutrition: 100 to 200 µg/j.

H - FIBRES:

Major components of the membranes of the vegetable cells.

Regulating role of:

• Digestive motricity

• Functions of digestion

• Absorption

• Metabolism of glucids and the lipids

• Absorption of rock salt

Needs: 20 to 25 food fibre g/j:

• 150 G of bread

• 200 G of green vegetables

• 1 crudeness

• 2 believed or cooked fruits

• 200 G of potatoes

Malnutrition:

Ageing with him only is not responsible for malnutrition.

However with the age, the events at the origin of a reduction in the contributions increase.

The inflammatory phenomena can make rock the nutritional state quickly.

Important to detect any risk of denutrition as soon as possible.

A - EVALUATION OF THE NUTRITIONAL STATE:

There is not ideal marker.

1) MEASUREMENTS ANTHROPOMETRIC:

a) Weight

A loss of weight of 2 kg in 1 month or 4 kg in 6 months must alert.

b) Index of body mass

c) Circumference brachiale < 23 cm

Calf: < 31 cm

D) Measure cutaneous folds

Thickness of the cutaneous folds tricipal or subscapular.

2) BIOLOGICAL MEASUREMENTS:

Measure circulating proteins.

a) Albumin:

Value of alarm: 35 g/l.

Serious malnutrition: < 30 g

b) Préalbumine:

Lowered in the denutrition.

Go up very quickly with the renutrition.

Value of alarm: 200 mg/l.

Serious malnutrition: < 150  mg

c) CRP:

Inflammatory protein.

Its rise indicates the recent character and the intensity of the ignition.

Half-life of 12 h.

Pathological value > 20 mg/l.

d) Orosomucoïde:

Protein of the ignition.

Translated the seniority of the inflammatory process.

Allows to calculate the PIMI.

3) VITAL FORECAST:

PIMI:

• 1 to 10: weak risk

• 11 to 20: risk average

• 21 to 30: major risk

• > 30: vital risk

4) QUESTIONNAIRES Of NUTRITIONAL EVALUATION:

a) MNA:

Minis nutritional assessment.

b) Roast evaluation of Brocker:

Simpler.

> 3: subject at the risk.

B - CONSEQUENCES OF MALNUTRITION:

They are multiple:

a) AEG:

Hypercatabolism involving a vicious circle.

b) Disorder psychic:

Apathy.

Depressive syndrome.

Insanity.

c) Exhaustion of the reserves of the organization:

Any acute accident leads to the overconsumption of nutrients.

The old person never reconstitutes completely her reserves after an acute episode.

d) Immunizing deficiency:

Expose the old person to the infections.

e) Medicamentous toxicity:

Reduction in the albumin rate.

Involve an increase in the free and active shape of certain drugs.

f) Deprive of microphone-nutrients:

There are several signs of alarm of malnutrition:

• Insufficient financial Incomes

• Loss of physical or psychic autonomy

• Widowhood, loneliness, depressive state

• Oral Problems

• Voluntary restrictive Modes

• Disorders of swallowing

• Two meals per day only

• Constipation

• More than 3 medicamentous specialities per day: surmedicalisation

• Loss of 2 KG in the last month or 4 kg in the last 6 months

• Albuminémie < 35 g

• Any acute severe disease

Food and dietetics:

The food needs for an old person are the same ones as those of the adult.

Food must be varied and appétissante, taken preferably as a group or family.

A - VARIOUS CONTRIBUTIONS NECESSARY:

See photocopies.

B - VARIOUS RESTRICTIVE MODES:

If they are essential transitorily for certain pathologies:

• They should not be prescribed with the long course

• They must be revalued in the following weeks

a) The mode diabetic:

One treats the diabetes only with the top of 1,4 g/l.

Removal of only fast sugars.

b) Hypocholestérolémiant mode:

Not beyond 70 years.

C - MODES HYPERCALORIQUES AND HYPERPROTIDIQUES:

Are to allow the cellular restoration by an effective anabolism protidic.

1) ORAL FOOD:

has) Traditional food:

• Eggs, ham

• Cheese, cream-coloured fresh

• Dried milk

b) Dietetic complements:

• Liquids, creams

2) FOOD ENTERALE:

Since the oral way becomes impossible.

Must be used without delay.

Prolonged during a sufficient time to see the effects.

3) PARENTERAL FOOD:

Food and institution:

The food act is not only biological.

It has a social role.

The food must remain a source of pleasure until the end of the lifetime.

The meal must be one privileged moment.

A - DEVELOPMENT OF THE MENUS:

The menus are establish by professionals starting from basic food plans.

The goal is to respect food balance in function:

• Of the recommended food needs

• Of psychological and physiological considerations

• Of technical considerations: seasons, conservation

• Of economic considerations

B - THE MEAL:

The framework and user-friendliness stimulate the appetite and support the food catch.

Questionnaire on the food tastes and practices, as well as the religious considerations.

To order the meals according to the tastes of the patient.

To envisage a pleasant framework: temperature, luminosity, accoustics…

To pay attention to the plan of table: provision and distribution.

To think of announcing the menu.

To pay attention to the presentation of the dishes or the plates.

1) IF THE PERSON CAN ONLY EAT:

To help a person to eat, it is not inevitably to give him the beakful.

To install the patient comfortably.

To make sure that the person can be useful herself of her forks and spoons.

To think of unpacking conditioned food.

To make drink during the meals, even if it is not thirsty.

Not to press the patient, whom it can take his time.

2) IF THE PERSON CANNOT ONLY EAT:

It is necessary to be conscious that to be made give to eat is a source of gene, frustration, impatience and impotence.

C - MONITORING NURSE:

The team must make sure that:

• The received meal is in conformity with the order

• Texture is appropriate for the health of the patient

• The patient ate, and in which quantity

• The patient drank

• The prescribed dietetic products were consumed

If a food monitoring is installation, the IDE must make sure that the documents are filled out.

To supervise the food conservation in the rooms.

The food is a care.

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