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Older adults are at nutritional risk due to a number of factors Poor dietary intake Chronic medical conditions Variety of physical, economic, and social factors
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Nutrition Assessment for the Older Adult
Chapter 16
Nutritional Status
• Older adults are at nutritional risk due to a number of factors– Poor dietary intake– Chronic medical
conditions– Variety of physical,
economic, and social factors
Nutritional Risk Factors for Older Adults
Nutritional Status
• Assessment of nutritional status• Nutritional screening• Detection of risk for malnutrition and early
intervention
Nutrition Screening
• Process of identifying characteristics known to be associated with nutritional problems
• Purpose– To identify individuals who are at nutritional risk
or who are malnourished
• Nutrition screening tools for older adults– The Nutrition Screening Initiative– Mini-Nutrition Assessment
Nutrition Screening
• Goals of Nutrition Screening– Keep older adults at home and in community-
based settings – Facilitate the prevention and early detection of
nutrition-related complications – Contribute to positive health outcomes
• Identify and treat nutritional risk factors
Nutrition Screening
• Goals of Nutrition Screening– Characteristics of a screening process
• Completed in any setting• Facilitates the completion of early intervention
goals• Includes the collection of relevant data on risk
factors• Determines the need for a nutrition assessment• Is cost-effective
Nutrition Screening
• Nutrition Screening Instruments– A diverse coalition of more than 25 national
health, aging, and medical associations– Goal
• To promote routine nutrition screening and intervention for older adults as a cost-effective strategy to improve the health of older Americans
Nutrition Screening
• Nutrition Screening Instruments– DETERMINE
• A self-assessment screening tool to increase older adults’ awareness of their nutritional status
• Promotes routine nutritional screening• Low scores indicate low risk of poor nutritional
status• Based on DETERMINE checklist, a more in-
depth assessment is performed
Nutrition Screening
• Nutrition Screening Instruments– Mini Nutrition Assessment
• “Gold standard” • Quick, economical, and noninvasive method for
assessing the nutritional risk of frail older persons
• Useful in clinical practice• Used in community and clinical setting• Does not require biochemical tests
Nutrition Screening
• Nutrition Screening Instruments– Mini Nutrition Assessment identifies
• Prevalence and risk of malnutrition in community-dwelling older adults
• Prevalence of undernutrition in outpatient and home care older adults
• Prevalence of undernutrition and the risk of malnutrition in hospitalized and institutionalized older adults
Nutrition Screening• Nutrition Screening Instruments
– Mini Nutrition Assessment uses• Community based individuals before they enter
nursing facility• In hospital and long-term care facilities
–Screening and assessment–Monitoring changes in nutritional status
over time • Distinguishing between levels of nutrition• Reassessing and monitoring nutrition status• A guide for a successful nutritional intervention
Nutrition Screening• Other Nutrition Screening Methods
– The Nutrition risk Index• Identifies those in need of nutritional
interventions and more in-depth assessment– SCALES
• Identifies those at nutritional risk
Nutrition Screening
Nutrition Screening
• Other Nutrition Screening Methods– Subjective Global Assessment
• Identifies those at risk of nutrition-associated complications and death
Nutrition Screening• Other Nutrition Screening Methods
– Additional Assessment Tools• SNAQ
– Identifies those at risk for anorexia-related weight loss
• MUST–Screen for risk of malnutrition
• Nutrition Risk Screening (NRS 2002)–Used for hospitalized patients who need
nutrition support
Nutrition Assessment
• Definition and Purpose– To interpret and expand on data from the
nutrition screening process– See Table 16-2 for Nutrition assessment methods,
purpose and components, and methods
Nutrition Assessment
• Components of Nutritional Assessment– Anthropometrics– Biochemical– Clinical – Dietary– Psychosocial– Economic– Functional– Mental health status– Oral health status
Nutrition Assessment
• Components of Nutritional Assessment– Used as a guide to help establish a history or
evidence of risk factors – Used to determine the client’s risk level
Nutrition Assessment
• Components of Nutritional Assessment– Four primary components
• Anthropometric measurements• Biochemical parameters• Clinical assessment• Dietary history
Nutrition Assessment
• Anthropometry– Measurement of body size, weight, and
proportions– Helps establish protein-energy reserve– Used to monitor the appropriateness and
effectiveness of nutrition intervention– Body weight, height, various circumferences,
skinfold thickness
Nutrition Assessment
• Weight– Most routinely collected measure– Rough estimate of energy stores– Indicators should be recorded– Weight changes
• Peaks during 40s and 50s• Holds steady until about age 60• Predictor of negative health outcomes• Change in body composition
Nutrition Assessment
• Weight– Weight for Height
• Used to compare to standards most representative of the population being evaluated
Nutrition Assessment
• Height– Should be measures annually– Surrogate Measures of Height
• When not able to obtain a standing height– Arm Span– Total Arm Length– Knee Height
Nutrition Assessment
Segmented Measurements of an Older Adult
Chernoff R. Geriatric Nutrition. 3rd ed. Sudbury, MA: Jones & Bartlett; 2006, p. 437. Reproduced with permission.
Nutritional Assessment
• Body Mass Index– Correlates significantly with body fatness– Does not consider the variable height loss with age
Nutritional Assessment
• Height– Body Composition
• Evaluate changes in muscle and fat
– Circumference Measurements• Evaluate changes in muscle and fat
– Waist-to-Hip Ratio• Association between fat distribution and health
outcomes
Nutritional Assessment
• Height– Arm Circumference
• Monitors for measurement changes
– Calf Circumference• More sensitive indicator of the loss of total body
muscle mass
– Skinfolds• Correlates to body fatness
Nutritional Assessment
• Height– Bioelectrical Impedance Assessment
• Measures body composition
– Creatinine Height Index• Assesses total body skeletal muscle mass or body
composition
– Dual-energy X-ray Absorptiometry (DXA)• Determines body fat, fat distribution, and bone density
Nutritional Assessment
• Biochemical Measures/Laboratory Data– Factors that Influence Biochemical Markers
Nutritional Assessment
• Biochemical Measures/Laboratory Data– Protein Status
• Predict protein-energy-malnutrition– Albumin
• Measures visceral protein status– Serum Transferrin
• A sensitive marker of protein status– Prealbumin
• Useful indicator of nutritional status
Nutritional Assessment
• Biochemical Measures/Laboratory Data– Total Lymphocyte Count
• Indicator of immunocompromise– Cholesterol
• Assess risk of cardiovascular disease– Iron Status/Anemias
• Screen for malnutrition• Iron deficiency anemia
Nutritional Assessment
• Biochemical Measures/Laboratory Data– Hemoglobin
• Used to detect iron deficiency anemia– Hematocrit
• Used to evaluate iron status– Mean Corpuscular Volume
• Indicates some types of anemia
Nutritional Assessment
• Biochemical Measures/Lab Data– Folate Status
• Evaluate hemolytic disorders and detect megaloblastic anemia
– Vitamin B12• Used to identify pernicious anemia and
megaloblastic anemia
Clinical Assessment
• Physical Assessment– Refer to Table 16-6 for Clinical Signs of Nutritional
Deficiencies– Goal of Clinical Assessment
• To reveal information about one’s current state of health
– Oral Status• Can be the cause or result of poor nutrition
Clinical Assessment
• Clinical Assessment– Medication Use
• May decrease appetite or alter metabolism– Alcoholism
• Often hard to detect• Alcohol intake replaces consumption of
nutrient-dense foods and beverages
Physical Disabilitiesand Functional Status
• Functional Declines– Often considered to be a natural consequence of
the aging process• Functional Dependence
– Dependence• Requiring assistance with an activity most of
the time– Independence
• The activity can be performed without assistance
Physical Disabilitiesand Functional Status
• Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)– Inability to perform the nutrition-related ADLs and
IADLs suggest increased risk for poor nutritional status
– Goal to identify difficulties early so that treatments can be implemented
Cognitive and Psychological Function (Mental Status)
• Depression– Leading cause of unexplained weight loss in older
adults– Recognized as a treatable cause of weight loss– Medication side effects
• Assessment of Mental Status– Screening tools used to detect dementia
Social, Psychological,and Economic Factors
• Income– Low-income adults have low intakes of many
nutrients– Food assistance programs available
• Social Isolation– Absence of social interactions
• Cultural Factors, Food Preferences, and Religious Beliefs
Dietary Assessment
• Purpose of Dietary Assessment– Provide insight into past and current food-intake
behaviors
• Classifications– Retrospective
• 24-Hour Recall• Food Frequency Questionnaires• Dietary History
Dietary Assessment
• Classifications– Prospective Methods
• Record of food intake obtained at the time the food is consumed
– Food Security• A person has access to enough food for an
active, healthy life at all times
Conclusion
• Nutrition screening and assessment can be used as the basis for initiating a plan of care for the older adult
• It is important to consider each older adult as a unique individual with individual nutritional needs and concerns
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