Geriatrics

Question 1

Energy requirements for a geriatric patient involves a caloric ___ to increase longevity.

Answer 1

restriction

Question 2

Geriatrics should decrease energy level (caloric intake) by ___% while still meeting ___ needs.

Answer 2

decrease caloric intake by 25-30% while still meeting protein, vitamin, and mineral needs

Question 3

energy requirements

Fontana et al. research showed that reducing ___ may slow the rate of aging.

Answer 3

metabolic rate and oxidative stress

Question 4

energy requirements

When reducing metabolic rate and oxidative stress, you may be slowing the rate of aging by reducing ___ and promoting ___.
You still need to maintain ___.

Fontana et al.

Answer 4

reducing inflammation and promoting nutrient intake
maintain base metabolic rate

Question 5

macronutrients

How many calories per serving is considered low, moderate, and high for geriatrics?

Answer 5

Low: 40 calories
Moderate: 100 calories
High: 400 calories or more

Question 6

macronutrients

Geriatrics should limit saturated fat and trans fat to ___%.

Answer 6

less than 10%

Question 7

macronutrients

When looking at total carbohydrates/fiber, if that number is above ___, geriatrics should stay away from that food.

Answer 7

10

Question 8

macronutrients

For geriatrics, ___ or more is considered “high fiber”.

Answer 8

5 grams

Question 9

macronutrients

What is the recommended daily intake of sugar for geriatric men?
What is it for geriatric women?

Answer 9

Men: 37 grams
Women: 25 grams

Question 10

The average American is eating ___ servings of veggies a day.

Answer 10

less than one

Question 11

macronutrients

According to NANES 2017-2018 data, men and women over 50-years-old consume excess ___, and not enough ___.

Answer 11

excess sugar
not enough fiber

Question 12

micronutrients

There is a ___ in skin’s ability to make Vitamin D as we age.

Answer 12

four fold decrease

Question 13

micronutrients

How much Vitamin D is recommended daily for elders?
What is the upper tolerable limit for elderly?

Answer 13

2000IU daily (especially in winter months)
upper limit = 4000IU

Question 14

micronutrients

Vitamin B12 is naturally less available in elderly.
30% of elderly suffer from ___ and ___.

Answer 14

atrophic gastritis and decreased absorption of B12

Question 15

micronutrients

Symptoms of Vitamin B12 deficiency in geriatrics may be causing ___ signs/symptoms.

Answer 15

neuropathy

Question 16

micronutrients

What would be advised for an elder with Vitamin B12 deficiency?

Answer 16

“Food first” supplementation:

• emphasize protein in diet
• look for food fortified with B12

Question 17

micronutrients

Which vitamin increases with age in plasma and liver stores, making older adults more susceptible to toxicity?

Answer 17

Vitamin A

Question 18

micronutrients

What would be advised for an elder with Vitamin A toxicity?

Answer 18

• Whole foods first
• Retinoic acid/retinal at or under 700mcg or 2333IU

Question 19

micronutrients

Which vitamin is associated with enhaced cognitive function and improved immune function in elders?

Answer 19

Vitamin E

Question 20

micronutrients

Actual geriatric intake of Vitamin E from food is ___ than RDA.

Answer 20

significantly lower

need supplementation

Question 21

micronutrients

An elder should supplement Vitamin E up to ___IU.
What are the risks of higher doses than this?

Answer 21

up to 400IU
Higher doses increase heart disease risk and longer blood clotting times (hemorrhage)

Question 22

micronutrients

How much calcium is recommended for women aged 50 to 64 not taking estrogen supplement?
How much calcium is recommended for menopausal women taking estrogen?

Answer 22

Not taking estrogen: 1500mg
Taking estrogen: 1000mg

Question 23

micronutrients

All men and women after age 65 should take ___mg of calcium daily.

Answer 23

1200mg

Question 24

RANKL pathway

After menopause, declines in estrogen often lead to excessive bone ___ activity.

Answer 24

remodeling

osteoporosis

Question 25

OPG is made by ___ to inhibit ___, thus ___.

Answer 25

made by **osteoblasts** to inhibit **RANKL**, thus **osteoclastic activity**

Question 26

RANKL leads to maturation of ___.

Answer 26

osteoclasts

Question 27

# osteoporosis Why do bones thin and weaken postmenopause, sometimes leading to fracture?

Answer 27

* Less estrogen increases RANKL * RANKL overwhelms OPG * More osteoclasts than osteoblasts * Osteoblasts can't keep up

Question 28

In postmenopausal women, as estrogen declines, ___expression increases.

Answer 28

RANK Ligand | osteoporosis

Question 29

Elevated RANK Ligand levels in postmenopausal women leads to increased ___.

Answer 29

osteoclast formation, function, and survival | osteoporosis

Question 30

# micronutrients Males over age 31 should consume ___mg of magnesium daily. Females over age 31 should consume ___mg of magnesium daily.

Answer 30

Males: **420mg** Females: **320mg**

Question 31

# micronutrients The average older adult male consumes ___mg of sodium per day. However, an older adult should have no more than ___mg of sodium per day.

Answer 31

average male consumes **4900mg** sodium/day should have no more than **1500mg** sodium/day

Question 32

# micronutrients Adequate potassium intake for an elder is ___mg per day, and will balance ___ intake.

Answer 32

**4700mg** per day, and will balance **sodium** intake

Question 33

# micronutrients What are some good sources of potassium for older adults?

Answer 33

* Fruits and veggies * Juices and drinks e.g. coffee, tea, orange juice

Question 34

# eating well What is meant by "DASH diet"?

Answer 34

Dietary Approach to Stop Hypertension

Question 35

DASH diet is low in ___ by containing fewer ___ than the typical American diet.

Answer 35

low in **saturated fat, cholesterol, and total fat** by containing fewer **sweets, added sugars, sugary beverages, and red meats**

Question 36

Which foods are focused on by a DASH diet?

Answer 36

* Fruits, vegetables, and fat-free or low-fat dairy products (7-8 servings fruits and veggies/day) * Whole grains, fish, poultry, beans, seeds, and nuts

Question 37

Successful diets are ___ changes.

Answer 37

slow and steady

Question 38

What are some physiological changes that may alter eating habits in elders?

Answer 38

Sensual awareness changes: * Taste and smell due to olfactory impairment * Oral health: chewing and swallowing * Appetite and thirst

Question 39

How might a geriatric patient's oral health be contributing to their eating habits?

Answer 39

* 25% of people over 60 have no natural teeth * Saliva becomes thick resulting in difficult swallowing foods

Question 40

How does appetite and thirst change eating habits in geriatric patients?

Answer 40

Appetite regulating cues in elderly are blunted If chronically underfed or overfed, they will continue to do so | inability to adapt to changes

Question 41

What is the acronym for risk factors towards geriatric eating habits?

Answer 41

**DETERMINE**: * Disease * Eating poorly * Tooth loss/mouth pain * Economic hardship * Reduced social contact * Multiple medicines * Involuntary weight loss/gain * Needs assistance in self care * Elder years above age 80

Question 42

Elderly are at a ___ risk of food poisoning.

Answer 42

higher

Question 43

What are some reasons geriatrics may be at higher risk of food poisoning?

Answer 43

* Limited vision * Decreased sense of smell * Forgetfulness

Question 44

What is considered the "true fountain of youth"?

Answer 44

Physical activity

Question 45

Physical activity such as walking can be recommended for any patient to improve ___ and ___.

Answer 45

cognitive function and balance

Question 46

What type of physical activity can be recommended to an elder to maintain or improve balance?

Answer 46

* **Resistance or weight-bearing activities**: muscle strengthening involving all major muscle groups **2 times per week** * **Aerobic exercise**: at least **150 minutes** of moderate intensity **per week**

Question 47

What are some recommendations for an elder to avoid irritants (chemical or mechanical) of GERD?

Answer 47

* Avoid food sensitivites * Eat smaller meals * Sit upright for two hours before bed * Lower fat meals and less alcohol * Eat protein throughout the day * Weight loss

Question 48

What are some risk factors for constipation in elders?

Answer 48

* Dehydration * Medications (especially NSAIDs) * High iron and other mineral supplements (antacids)

Question 49

What are some remedies for elders with constipation?

Answer 49

* Adequate fluid intake (mineral water) * Slight increase in insoluble fiber * Magnesium (400mg or more)

Question 50

What are some recommendations for elders with osteoarthritis in order of most to least evidenced?

Answer 50

* **Weight loss** * **Plant-based diets** * Vitamin D * EFAs * Chondroitin and glucosamine ( seemingly more effective with herbs such as Boswellia)