Case Scenario: Use the case information presented below to answer
LJ is a 78-year-old white male who lives alone with his dog in a second story apartment. His wife passed away 3 years ago. LJ lives off a very fixed income mainly coming from his monthly social security check. He has one daughter who lives about two hours away and visits every other weekend to help him grocery shop and prepare meals.
LJ has a medical history of obesity, metabolic syndrome (MetS), and osteoarthritis (OA) in his hands, knees, and hips. He currently takes a statin for his hypercholesterolemia, hydrochlorothiazide (HCTZ) and ACE inhibitor (ACEI) for his hypertension (HTN), metformin for his diabetes, and tramadol for his OA. He presents to your clinic complaining of increasing pain in his joints (rate as 7 of 10 on pain scale, moderate pain), decreased mobility, fatigue 50% of the time (rated as a 5 on a scale of 0 to 10 with 0 = no energy and 10 = most energy he has ever had), and weight loss. He indicates that he has lost about 20 pounds over the past 6 months without even trying. Although he remains ambulatory, his increasing pain and fatigue prevent him from being able to grocery shop and prepare meals on his own when his daughter is not around. As a result, he doesn't always feel like eating, and when he does eat, he eats a lot of pre-packaged, highly processed foods that are easy to prepare (i.e., quick microwave or oven bake). His 24-hour diet recall reveals that he is eating about 1500 kcal per day - 250 g carbohydrate (mainly refined with about 15 g fiber), 35 g fat (25 g saturated fat and 10 g MUFA/PUFA), 45 g protein, 2000 ml fluid per day.
Q1. LJ presents with symptoms that could lead to the diagnosis of sarcopenia, malnutrition, and/or frailty syndrome.
For each diagnosis describe what information from the case is leading you towards or away from that diagnosis. Include your rationale, including diagnostic criteria and be sure to reference as appropriate.
Q2. For each diagnosis, what additional information would you need to rule in or rule out the diagnosis? Be specific, provide rationale, and provide references.
Q3. Explain how at least four of the nine hallmarks of aging are contributing physiologically and metabolically to LJ's decline in functional status and overall health. Provide references.
Q4. Using evidence-based guidelines, list four nutrition-specific interventions that you would outline for LJ to halt the progression of his functional decline and improve his health. Be specific by writing recommendations that tell LJ what and how to implement the intervention. Provide rationale and references.
Q5. Using evidence-based guidelines, list three specific physical activity guidelines you would outline for LJ to halt the progression of his functional decline and improve his health. Be sure to provide the recommended weekly routine, rationale for each exercise, and references.