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Nutrition, Hearing and Vision, Falls

by Charles Vega, MD
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    00:00 What about nutrition in older adults? In general, appetite and body weight decline with age and there is this reduction in lean mass and it’s replaced by fat mass.

    00:11 That process continues during middle age through older adulthood until about age 65 to 70 years when it tends to stabilize.

    00:20 Unintentional weight loss is a pretty common condition among older adults and it is associated with a higher risk for morbidity and mortality.

    00:29 So, why do older adults lose weight? Of course, the big worry is cancer.

    00:34 So, we have to think about the concept of an undiagnosed tumor in promoting weight loss.

    00:40 I think much more commonly, it's due to psychiatric effects, depression and cognitive effects, early dementia.

    00:50 And those are the reasons we might see some weight loss.

    00:53 Don't forget about medications cause, many of which promote nausea or may cause constipation.

    01:02 That can reduce appetite.

    01:04 And then social isolation and changes in their social environment.

    01:08 I always find that losing a special loved one, especially if they lived with that individual, is a high risk for weight loss.

    01:17 And so, I've definitely seen that multiple times.

    01:20 And that's where you want your social worker to be involved and/or a counselor, mental health professional.

    01:27 But that said, in nearly 30% of cases, and depending on what study you’re looking at, the cause of the weight loss is unexplained.

    01:37 So, standard workup for these patients with unexplained weight-loss, CBC, comprehensive metabolic panel, a TSH, a sed rate, lactate dehydrogenase level which is – can be a sign of tumor breakdown, and urinalysis.

    01:52 So, one thing to consider would be an abdominal ultrasound for these patients looking for a tumor, but it’s a also good chance – again, if they have – particularly, if they have a good five-year life expectancy, maybe it's time to go and readdress.

    02:06 You know, you never did get that second round of colorectal cancer screening.

    02:10 We should order today.

    02:11 Or breast cancer or whatever cancer has been left unscreened.

    02:14 Maybe this is a good impetus to do it.

    02:17 Let’s talk about hearing and vision among older adults.

    02:19 Presbycusis is a very common condition.

    02:23 It almost seems to be universal among older adults, and so that's usually associated with a high frequency hearing loss.

    02:31 Yet, the Preventive Service Task Force recommends asking seniors about their hearing, but no objective testing is necessary on a broad basis.

    02:39 For patients who failed – come in, I can’t hear as well, you put them through audiometry, usually it's a high-frequency hearing loss.

    02:49 They should be referred to otolaryngology for anything like a failed hearing test if they have chronic otitis media or they have – certainly, if they have sudden hearing loss, but the treatment is usually going to be hearing aids for presbycusis.

    03:03 And then also watch out for conditions such as macular degeneration for your exam.

    03:07 It’s very important, macular degeneration.

    03:09 That's a peripheral field loss versus a cataract, which is the central visual loss.

    03:15 But the Preventive Service Task Force recommends against routine ophthalmoscopy, looking for evidence of any of these conditions.

    03:24 Now, falls are an important cause of morbidity and mortality among older adults.

    03:31 In 2014, it’s estimated that 27,000 seniors died related to falls.

    03:37 And nearly a third of US seniors experienced a fall in 2014 and a third of those cases required medical attention.

    03:46 So, they’re pretty serious.

    03:48 So, one thing I really like is the Tinetti balance and gait evaluation.

    03:53 The get up and go test is another term for this.

    03:56 It's sitting in a chair, then getting up, walking 10 feet in front of you, turning around, walking back and sitting down.

    04:04 So, if the timing on that is under 16 seconds, that's normal.

    04:09 There are actually some nomograms that give patients a little bit more time based on their age.

    04:15 So if they’re 94, they may not be able to the Tinetti test in the same time the 68-year-old does it.

    04:22 But a good general rule on my practice is, if it's 15 seconds or less, they’re okay.

    04:29 What does that mean they’re okay? It means that their risk of falling is lower.

    04:33 They shouldn’t have a high risk of falls based on this evaluation.

    04:37 That test has demonstrated good sensitivity for fall risk.

    04:41 What should we be doing to prevent falls? For those patients with a positive Tinetti test and/or who have a history of fall, that's the best predictor as a history of previous fall.

    04:51 Think about physical therapy and activity with targeted training.

    04:55 So, a lot of times, they will have to – it's not just about doing just general exercise.

    04:59 Try to do some targeted training and that’s where the physical therapies comes in.

    05:04 Vitamin D isn't just healthy for bones.

    05:06 It can actually help prevent falls.

    05:08 So, these patients should be taking vitamin – all older adults should be taking a vitamin D and getting enough vitamin D in their diet.

    05:16 And then securing the household environment.

    05:17 This is something that a home visit can be really helpful to do.

    05:22 So, avoiding clutter, avoiding loose rugs, those things that make people suffer mechanical falls.

    05:27 And then thinking about assistive devices as well as equipment in the home such as a bedside commode, shower chair and grab bars that can prevent falls at the most frequent sites of serious falling.

    05:41 Let’s talk about smart prescribing among older adults.

    05:45 So, over a third of adults at age 60 or more take five or more prescriptions per day.

    05:50 About half also take over-the-counter drugs at the same time.

    05:55 There is a significant risk of drug-drug interactions.

    05:59 About 1 in 20 – if you just take a bunch of random adults and pluck out their medications, about 1 in 20 has a risk of a serious drug-drug interaction.

    06:09 And it's thought that 30% of admissions due to delirium and falls and also unnecessary hospital admissions are due to inappropriate drug interactions and/or side effects.


    About the Lecture

    The lecture Nutrition, Hearing and Vision, Falls by Charles Vega, MD is from the course Geriatric Care. It contains the following chapters:

    • Nutrition in Older Adults
    • Hearing and Vision
    • Falls and Prevention
    • Smart Prescribing for Older Adults

    Included Quiz Questions

    1. ...increase in total body weight
    2. ...decrease in appetite
    3. ...decrease in lean mass
    4. ...increase in fat mass
    1. Lipase
    2. Thyroid stimulating hormone
    3. Complete blood panel
    4. Complete metabolic panel
    5. Lactate dehydrogenase
    1. High frequency sensorineural hearing loss
    2. Low frequency sensorineural hearing loss
    3. Noise induced sensorinerual hearing loss
    4. Conductive hearing loss
    5. Ménière's disease
    1. Simply ask the patient about their hearing
    2. Routine otoscopy at at annual clinic visits
    3. Annual tympanometry starting at the age of 65
    4. Annual audiometry starting at the age of 75
    5. Weber test and Rinne test at annual clinic visits
    1. ...15 seconds
    2. ...10 seconds
    3. ...8 seconds
    4. ...24 seconds
    5. ...30 seconds
    1. Over 5
    2. About 4
    3. 2-3
    4. 1-2

    Author of lecture Nutrition, Hearing and Vision, Falls

     Charles Vega, MD

    Charles Vega, MD


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