lecture 20

Question 1

describe the determine checklist (4)

Answer 1

• self assessment for older adults
• screening and educational
• inexpensive
  10 simple questions to indication high nutritional risk

Question 2

What is malnutrition?

Answer 2

Deficiency, excess, or imbalance of energy or nutrients.

Question 3

In older adults, malnutrition is most often due to what?

Answer 3

Undernutrition (energy and/or nutrients).

Question 4

What is sarcopenia?

Answer 4

Loss of muscle mass and strength with aging.

Question 5

What is cachexia?

Answer 5

Disease-related loss of muscle mass and strength, usually with fat loss.

Question 6

What is the goal of nutrition screening?

Answer 6

Early identification of individuals at risk of malnutrition.

Question 7

What happens after someone is identified as at risk?

Answer 7

They receive a full nutrition assessment.

Question 8

What is sensitivity?

Answer 8

Ability to correctly identify those WITH the condition.

Question 9

What is specificity?

Answer 9

Ability to correctly identify those WITHOUT the condition.

Question 10

What are the 3 steps in the nutrition care pathway

Answer 10

Screening –> Assessment –> Intervention

Question 11

Name 5 categories assessed in nutrition tools.

Answer 11

Anthropometrics, dietary intake, factors affecting intake, clinical conditions, social factors.

Question 12

Examples of anthropometric measures

Answer 12

BMI, weight change, arm circumference, calf circumference

Question 13

Examples of dietary intake factors (in assessment tools)

Answer 13

Change in intake, intake/eating frequency, intake of certain foods, food avoidances, fluid intake, use of meal replacers, supplements, nutrition support.

Question 14

Factors affecting food intake (in assessment tools)

Answer 14

Chewing problems, swallowing problems, appetite, feeling of fullness, ability to taste, ability to shop, ability to cook, ability to feed self, financial resources

Question 15

Examples of Clinical condition factors (in assessment tools)

Answer 15

Presence of disease/illness, GI symptoms, medication use, motor disability, cognitive function, psychological stress.

Question 16

examples of social factors (in assessment tools)

Answer 16

Living situation, eating with others, social isolation, alcohol intake, smoking.

Question 17

what levels of unintentional weight loss are concerning?

Answer 17

> 5% in 1 month, >7.5% in 3 months, >10% in 6 months.

Question 18

what is included in a nutrition-focused physical assessment?

Answer 18

Musculature, body fat, mucosa, hair, skin, nails, eyes.

Question 19

what is included in functional assessment

Answer 19

Activities of daily living (ADL), instrumental activities of daily living (IADL), functional measures of muscle mass.

Question 20

what other areas are assessed clinically

Answer 20

Cognitive function, psychological function, socioeconomic factors, health factors.

Question 21

4 examples of dietary assessment methods

Answer 21

24-hour recall, food records (3–7 days), food frequency questionnaire, diet history.

Question 22

4 protein status markers in biochemical assessment

Answer 22

Albumin, transferrin, prealbumin (transthyretin), retinol-binding protein.

Question 23

Immune function assessment

Answer 23

Lymphocyte count

Question 24

Serum cholesterol assessment example. what does this indicate?

Answer 24

Hypocholesterolemia occurs late. this indicates late malnutrition

Question 25

What else is included in biochemical assessment

Answer 25

Vitamin and mineral biomarkers

Question 26

What is comprehensive assessment based on and what does it do

Answer 26

Anthropometric, clinical, dietary, and biochemical information. it diagnoses malnutrition/undernutrition and develops treatment plan.

Question 27

Why is comprehensive assessment not used routinely

Answer 27

High resource requirements (time, cost, expertise)

Question 28

List ALL Screening and Assessment Tools tools

Answer 28

Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Canadian Nutrition Screening Tool (CNST), DETERMINE (Nutritional Screening Initiative), SCREEN II

Question 29

Purpose of Mini Nutritional Assessment (MNA)? and target population?

Answer 29

Identify nutritional risk and diagnose malnutrition in older adults

Question 30

Structure of MNA and categories (3)

Answer 30

Screening section (6 questions) + full assessment (12 additional questions) Professionally administered; short form can be self-administered Categories: Normal, at risk, malnourished

Question 31

Purpose of Subjective Global Assessment (SGA)? and target population?

Answer 31

to diagnose undernutrition and assess risk of complications in clinical populations (e.g., hospitalized patients, those with medical conditions)

Question 32

How is it administered, and what are the categories?

Answer 32

Professionally administered Categories: A (well-nourished), B (mild–moderate undernutrition), C (severe undernutrition).

Question 33

Does SGA detect nutritional risk?

Answer 33

no

Question 34

What is PG-SGA?

Answer 34

Scored Patient-Generated Subjective Global Assessment: Adapted from SGA to have the screening section completed by the patient

Question 35

Purpose of Canadian Nutrition Screening Tool (CNST)?

Answer 35

Screen hospitalized patients to identify those needing SGA or nutrition consult.

Question 36

How is CNST structured, what are the questions? What does the patient need to answer to indicate nutrition risk?

Answer 36

Professionally administered 2 questions - have you lost weight in the past 6 months without trying? - have you been eating less than usual for more than a week? the patient needs to answer TWO "yes" indicate nutrition risk

Question 37

3 examples of self-administered tools

Answer 37

Self-MNA, DETERMINE checklist, SCREEN II

Question 38

Advantages of self-administered tools

Answer 38

Inexpensive, can screen large numbers, target community-dwelling older adults, raise awareness.

Question 39

disadvantages of self-administered tools

Answer 39

Lower sensitivity and specificity, not diagnostic

Question 40

DETERMINE Checklist purpose and target population

Answer 40

Screening and educational tool for Community-dwelling older adults.

Question 41

DETERMINE Checklist number of questions? What factors does it assess? categories?

Answer 41

10 questions assesses diet, intake-related activities, weight loss, social factors, economic factors, medical conditions, medications, oral health. categories: if they answer yes to.... Good (0-2) Moderate nutritional risk (3-5) high nutritional risk (6 or more)

Question 42

7 examples of nutrition intervention approaches?

Answer 42

Liberalize diet Fortify diet Provide food/meal preferences Recommend vitamin/mineral supplements Oral Nutritional Supplements (ONS) Enteral nutrition Parenteral nutrition

Question 43

Goals of Nutrition Intervention

Answer 43

Provide sufficient energy, protein, and micronutrients Maintain or improve nutritional status Maintain or improve function, activity, and rehabilitation capacity Improve quality of life Reduce morbidity Reduce mortality

Question 44

Determinants of Nutritional Status (individual factors)

Answer 44

physical activity, dietary intake, social contacts, independence, health status, functional status, attitude/beliefs, appetite, loneliness, knowledge, skills.

Question 45

Determinants of Nutritional Status (macrosystem factors)

Answer 45

Location, education, income, living situation, culture.