NFPE and Nutrient Deficiencies in the Elderly

Detecting Nutrient Deficiencies with NFPE

The process of conducting a Nutrition Focused Physical Exam, or NFPE, begins with an overall observation, head-to-toe examination, functional indicator assessments, and concludes with a patient interview. NFPE can be used to detect malnutrition and nutrient deficiencies, which can be especially useful in the geriatric population. The geriatric population has a unique set of nutritional needs; they require less energy but often the same amount of vitamin and mineral nutrients as a younger population. Other challenging aspects of this population include medications, cognitive impairment, and differences in environment through the lifespan.

For identifying vitamin D and calcium deficiencies, it is important to look at histories and risk factors, such as history of falls, broken bones, muscle weakness, dental caries, hypertension, osteoporosis, cognitive decline, depression, and chronic pain. Dietitians should consider height changes, sun exposure, and dietary intake of these nutrients when assessing for deficiencies. A meta-analysis has found that concentrations of 25-hydroxyvitamin D less than 20 ng/mL (< 20 ng/mL is considered a deficiency) have been associated with falls. Supplementation recommendations for vitamin D vary from 1,000 IUs daily of D3 to 50,000 IUs weekly of D2.

Folate deficiency can present with fatigue, weakness, palpitations, diarrhea, yellow pallor, sore red tongue, impaired concentration, and eventually megaloblastic anemia, and can be caused by medications, dialysis treatment, alcohol abuse, chronic hemolytic disease, celiac disease, and other conditions. When identifying folate deficiencies, use naturally lighting to look for color changes. Biochemical levels of homocysteine should also be assessed, and if homocysteine is high, folate, B12, and B6 should be assessed and supplemented. B12 deficiencies should be ruled out before folate is supplemented so as not to mask a B12 deficiency. Studies have indicated that despite folate fortification in food, the geriatric population continues to be deficient in this nutrient.

B12 deficiency symptoms include hyperpigmentation of the skin, especially at joints and knuckles, vitiligo, angular stomatitis, weakness, gait abnormalities, dementia, loss of appetite, diarrhea, Hunter’s glossitis, edema, pallor, megaloblastic anemia, and other gastrointestinal and neuromuscular symptoms. Some risk factors of deficiency include atrophic gastritis, decreased gastric acid, chronic alcohol consumption, vegan diets, and inability to consume protein foods as good sources of B12. Pigmentation in knuckles and joints should be observed under natural lighting. B12 deficiencies should be treated with supplementation and by correcting the underlying cause, when possible.

Nutrient deficiencies in aging populations should not be accepted as part of the aging process. Dietitians should identify and treat these issues early on to optimize care for this growing population.

AC

Martin, C. (2018). Detect nutrient deficiencies with NFPE. Today's Dietitian, 20(3). Retrieved from: http://viewer.zmags.com/publication/10096222#/10096222/1