FOXcast SLP: The Crossroads of Aging: An Intersection of Malnutrition, Frailty, and Sarcopenia

Welcome to FOXcast SLP. A podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at FOXRehab.org.

Jimmy McKay, PT, DPT: On the phone right now is Patrick Berner. Patrick is a physical therapist and a registered dietitian a great combo. Patrick welcome to the show.

Patrick Berner, PT, DPT, RDN Thanks for having me Jimmy.

Jimmy: You were involved in an article that’s called the crossroads of aging. Intersection of malnutrition frailty and sarcopenia. If listeners want to take a look at this they can find it in topics in Geriatric Rehabilitation. Jan March 2019 volume 35. You were involved with this along with Richard Severin a physical therapist. Ken Miller a PT and Jacob May a PhD and another registered dietitian. Pretty cool mix first of all just talk about how you guys decided to get together and put something like this out.

Patrick: Yeah. So originally it started with Ken Miller had kind of reached out to me since he was going to be a guest editor for the for the Journal. And he wanted to look a little bit into kind of medication interactions in the older adults. Ironically at the same time a side thing that was going on was actually Rich Severin and Jacob May were working on kind of a malnutrition seminar for the dietetics world. Jacob had reached out to Rich to kind of get a perspective of the rehab population in regards to the malnutrition. So Ken reached out to me I quickly reach out to Rich and Jacob to kind of see their inputs as well. Really looking at the rehabilitation population and the older adult and more specifically malnutrition because of its prevalence in that population.

Jimmy: Really the intersectional relationship between malnutrition, frailty, sarcopenia in those older adults that physical therapists, occupational therapists, speech language pathologist treat. But also registered dietitians amongst other health care professionals. Really highlighting malnutrition specifically as a leading risk for disability morbidity mortality in older adults. That’s something that’s within the PT scope of practice. I love the fact that your PT and RDC kind of you kind of toe both worlds.

Patrick: I love it as well so that’s kind of my mission to really enforce and kind of highlight that nutrition is a part of the rehab profession.

Jimmy: So why is malnutrition a problem? What are the risks? Potential outcomes that you see?

Patrick: So malnutrition is interesting that it does have kind of multifactorial causes but why malnutrition is important in the older adult is that it can it can unfortunately kind of spiral out into various different outcomes. Starting out as far as what malnutrition is, an individual may have a lack of nutritional intake you know whether or not it’s energy protein and they’re just not getting enough of what their body needs right. So what happens is as you start to have unfortunate consequences of that. The body’s just not getting what it needs right on its day to day. You start to have loss of muscle mass which is the biggest thing within the rehab population that you want to be concerned of because you’re not taking in enough protein. So the body starts breaking down its protein reserve which is that skeletal muscle mass. So when you start to break down that skeletal muscle mass and you have loss of muscle mass that’s your sarcopenia. You think if you lose your mass right your muscle mass you’re then going to have that resultant weakness and that’s going to be your frailty. So then it just kind of spirals right that individual just continues to not get enough food and not get enough energy and protein. And it just cycles through to where they had that reduced mobility frailty and then which can result to you know ultimately disability, injuries and just kind of loss of independence.

Jimmy: Yeah and I love that you know we interact on social media together and you’d like to follow Patrick online on Twitter it is @thefuelphysio is that sometimes clinicians who are outside of the dietetics field think it’s not within their scope of practice. And you like to remind them that that’s not what would you say to a clinician. PT an OT and SLP, when they look at something in terms of diet nutrition as something they definitely should pay attention to and get involved in?

Patrick: So you have to look at it as nutrition affects everything what you as a clinician eat yourself more to your patients or clients consume on a day to day is going to affect how their body moves and how it functions. I mean that’s the biggest thing you know looking speaking to the physical therapy world being a PT myself. You know we try and term our so the movement expert. Right well you can focus in on movement alone but you have to consider everything that affects movement and how that body moves is going to be affected by what that person eats on a day to day. Think of it just kind of the fuel that you provide to the engine.

Jimmy: Think we should look as physical therapists as OTs as SLPs. We should look at it less like it’s someone else’s job is something else we should take an interest in as well. And now nutritional needs and medication interactions that’s something that clinicians deal with on a regular basis. Those two things come into play. Talk about that a little bit.

Patrick: Yeah. So it kind of gets really complicated when you look at medication and especially with the older adults because you at times have a medication medication interaction which can be severe. And you know that’s of course led into the hands of the physician that kind of handle that. But it’s those basic things as far as nutritionally whether or not what that person is going to eat is going to affect their medications. Right so the biggest one that kind of comes to mind is the intake of vitamin K while a person is taking a blood thinner. Sometimes the misconception is to completely avoid vitamin K in your dark leafy greens but in reality consistently consuming that amount of dark leafy greens that you are always taking and cannot change it so that it doesn’t affect how that medication is going to work. Another one that kind of plays in to the physical therapy occupational therapy side of things is, and this is based on a little limited research, but is the amount of protein that an individual with Parkinson’s takes. Right for the medication that that patient may take for Parkinson’s if they had a high protein meal with that it’ll actually reduce the effects of that medication such as kind of a couple examples that you kind of see big picture. And it just kind of important to know as a clinician what that person eats on a day to day in when they eat it may interact or decrease the effect of their medications.

Jimmy: On top of medications function as well energy levels if you might. You might know in some of your documentation that the patient is a little bit like a basically low on energy and if you’re questioning why you should be asking yourself why.

Patrick: Absolutely. And nutrition is going to be one of those big components of that. And Jimmy you know just me I look at an individual a patient client big picture right. So it could be the nutrition but it could also be how that patient is sleeping or how they’re managing their stress and everything really ties in together about what they’re eating you know what’s providing that energy day to day is absolutely one of the most important.

Jimmy: Let’s talk about practical screening tools and referrals along with basic education versus medical nutrition therapy.

Patrick: The amazing thing about screening for malnutrition is that it’s really easy you know referring to the article we just picked three standardized nutritional screening tools. Traditionally the tools that are used in the acute care setting but can also be applied to separate food or community dwelling older adults. You know one of them is called the amount nutrition screening test. Right. And it’s really just two simple things. Has that individual had a change or loss in appetite and have they had a significant weight loss that was unintentional. So it’s just those two major things really. And that’s a part of the other screening tools as well as looking at that change in appetite and looking at that unintentional weight loss which would lead to think that that person is not getting in enough energy or protein to sustain their day to day. That their bodies just kind of wasting away and having that unintentional weight loss. What I love about this screening tools and about just those two major questions is that they can easily be used by any clinician out there right. It could be a quick little one to two minute conversation with your patient just to kind of pick up on whether or not it it’s happening and then kind of going from there determining whether or not it’s something as a clinician within your scope and kind of dependent upon the setting as well is really going to pick what you should do going forward.

Jimmy: Really utilizing interdisciplinary approaches towards this malnutrition screening effective and feasible you’ve actually got a course right now if you wanted to check out the fundamentals of integrating attrition into PT practice you can find out online again follow Patrick at the fuel physio on Twitter or fuel physio dot com. I think it’s something I don’t know what the actual number of hours in a day PT curriculum specifically are dedicated to attrition but I bet you advocate her for a lot more right.

Patrick: Yeah absolutely. So there’s not a lot that’s being offered in DPT education traditionally if lucky about 30 minutes to an hour. Lately I’ve kind of started going into DPT programs and trying to help them be set up a little bit. Providing more practical application and evidence informed information so that a clinician can integrate it appropriately into their practice because it is going to differ state by state depending on the physical therapy and the dietetics practice. And that’s one of the pretty much one of the most important things you need to realize is that it is very state to state even outside of the Practice Act and the limitations that you may be put inside as a clinician. It’s important to regardless have a referral partner have that registered dietitian that’s in your community that you can collaborate with on a day to day and that you can work with and whether or not that patient’s needs are just basic or whether or not they are complicated and complex. You still. Have somebody to bounce ideas off for. Or to hand that patient off to for better patient care.

Jimmy: So in this article the crossroads of aging which again you could find topics in Geriatric Rehabilitation volume 35, really highlighting despite the improvements in the screening procedures which you just mentioned. Many older adults are still at risk for malnutrition. It’s just not being identified which prevents effective management. And as clinicians PT OTs SLPs who are we’re being able to interact with these older adults every day. Thankfully for for a longer period of time. A lot of times. For about an hour. That’s something I think we can we can really pick up on using these screening procedures. It’s an opportunity that we should be capitalizing on.

Patrick: Absolutely. And just being a rehab professional right we are spending the most time with our patients. And when it comes to looking at malnutrition you know that being so simple as those two major questions it should be easy to integrate that into the 45 to an hour time that you’re spending with your patients and then even going down the road of finding out what are there barriers and why are they having these things go on. Why is there change in appetite and how can they facilitate better intake.

Jimmy: Last thing you say to the audience of PTs OTs and SLPs he’s working with older adults in what they should pay attention to in terms of trying to prevent malnutrition try to prevent frailty? Trying to prevent that sarcopenia like you mentioned. What should be the one thing that they hold on to the next time they’re working with an older adult.

Patrick: The one thing would be to always consider that even if that patient doesn’t look like they’re malnourished they still could be. One of the big misconceptions is that you know older adults who are overweight or obese that they can’t be malnourished right because they have so much storage of body fat et cetera. But those individuals can still be malnourished. So the biggest takeaway would be do not go off of the physical presentation of that patient. It needs to be delved in a little bit deeper. We just know that anyone can be malnourished despite what their physical attributes look like.

Jimmy: Yeah that’s a great point is don’t don’t go off what your eyes are looking at what is malnourished look like? So make sure you don’t just discount that. Patrick appreciate your time again. If you want to follow my lines enough you’ll find the other Web sites fuelphysio.com and the crossroads of aging at an intersection of malnutrition throughout the sarcopenia. Is in topic in Geriatric Rehabilitation. January and March 19 at volume 35. Thanks for sharing a little bit of your insight in to nutrition with older adult.

Patrick: Thanks Jimmy appreciate the opportunity.

Thanks for listening to FOXcast SLP. It’s brought to you by FOX rehabilitation. FOX clinicians work hard love their work and get the respect they deserve. Sound good? Then you’ll love the autonomy to work in your own style and the support you get to achieve excellence. Plus freedom and flexibility to have a personal life whether it’s your first day or you’ve been around for a while. Your contribution is acknowledged and rewarded. That’s what makes FOX a success. Happy well-trained clinicians make great health care. Are you a fit for FOX. Find out now at FOXrehab.org.