Nestle Supplement 2

NUTRITION AND THE OLDER PERSON TABLE 6. The Mini-Nutritional Assessment (MNA) Scale TABLE 7. SLUMS Screen Mental Status (SLUMS) Examination Name Is patient alert? __/1 __/1 __/1 Age Level of education 1 1. What day of the week is it? 1 2. What is the year? 1 3. What state are we in? 4. Please remember these five objects. I will ask you what they are later. Pen Tie House Car Apple 5. You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20. How much did you spend? 1 2 How much do you have left? 6. Please name as many animals as you can in one minute. 0 0-4 animals 1 5-9 animals 2 10-14 animals 3 15+ animals 7. What were the five objects I asked you to remember? 1 point for each one correct. 8. I am going to give you a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24. 0 87 1 649 1 8537 9. This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o’clock. 2 Hour markers okay 2 Time correct 1 10. Please place an X in the triangle. 1 Which of the above figures is largest? 11. I am going to tell you a story. Please listen carefully because afterwards, I’m going to ask you some questions about it. Jill was a very successful stockbroker. She made a lot of money on the stock market. She then met Jack, a devastatingly handsome man. She married him and had three children. They lived in Chicago. She then stopped work and stayed at home to bring up her children. When they were teenagers, she went back to work. She and Jack lived happily ever after. 2 What was the female’s name? 2 What work did she do? 2 When did she go back to work? 2 What state did she live in? TOTAL SCORE Saint Louis University __/3 __/3 __/5 __/2 __/4 __/2 __/8 SCORING HIGH SCHOOL EDUCATION 27-30 20-26 1-19 Normal MCI Dementia LESS THAN HIGH SCHOOL EDUCATION 20-30 15-19 1-14 WA Banks and JE Morley. Memories are made of this: Recent advances in understanding, cognitive impairment, and dementia. J Gerontol Med Sci 2003;58A:314-21. screened utilizing the Get-Up-and-Go (should be completed in under 30 seconds) or the 6-meter walk (completed in under 5.8 seconds). SARCOPENIA Sarcopenia is defined as age-related loss of muscle.The degree of sarcopenia is best calculated by determining the appendicular lean mass using a DEXA machine and dividing this by height squared. A person is then said to be sarcopenic if his or her appendicular mass is less than 2 standard deviations of that of a young person. Computed tomography or magnetic resonance imaging can also be used to determine muscle wasting. The advantage of these techniques is they can identify intramuscular fat — myosteatosis. Intramuscular fat causes a decrease in power for a given lean mass. Ultrasound is gaining momentum as an appropriate measure of sarcopenia. Bioelectrical impedance can be utilized in large epidemiological studies but has questionable value for individual comparisons. The prevalence of sarcopenia is variable depending on the study. Janssen et al21 reported a prevalence of 7% in men and 10% in women based on NHANES data. Baumgartner et al22 found a prevalence of over 50% in persons over the age of 80 years. In addition, his group drew attention to the problems of the obese sarcopenic or “fat frail” individual, demonstrating in a longitudinal study that obese sarcopenia was more predictive of future disability and mortality than was sarcopenia.23 Sarcopenia itself is highly predictive of future disability and has been calculated to produce $18.4 billion in excess costs to the US health system.21 Numerous genes have been found to be associated with strength and body mass, and these genes also appear to predict the development of sarcopenia in later years. Examples of these genes are the myostatin gene (GDF8), the vitamin D receptor (VDR Bsm1) gene, the angiotensin converting enzyme gene, and the androgen receptor gene (CAGrepeats). In addition, it has been shown that grip strength at age 70 years correlates strongly with birth weight.24 To maintain muscle mass (for the order of 1.2 g/kg–1.5 g/kg), a high-protein content in the diet is essential. This protein content needs to be high in branch change amino acids (leucine, isoleucine, and valene), as these amino acids promote protein synthesis and inhibit proteolysis. Creatine supplementation together with exercise increases muscle power more than exercise alone in older persons.25 DECEMBER 2007 • 27

Table of Contents Feed for the Digital Edition of Nestle Supplement 2

Nestle Supplement Table of Contents Introduction to Weight Loss in Older Persons Diagnosis and Management of Oropharyngeal Dysphagia in the Elderly The Danger of Weight Loss in the Elderly Nutrients and Frailty

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