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Part II Nutrition Assessment, Consequences, and Implications Figure 18.1 Nutrition Support Decision Algorithm
Is patient able to meet nutritional needs with diet and supplementation?
Yes No need for nutritional support No
Consider nutrition support Check advance directives
Does the patient have a functioning GI tract?
Yes
Consider use of enteral support
Then NO tube feed
No Ask:
Is patient agreeable to tube feeding?
Yes Enteral Short term 6 weeks or less
Use nasogastric or orogastric tube feeding
IVG Tube
Long term > 6 weeks
Use gastric or jejunal tube feeding
GI/JG Tube
Will support be long term or short term?
Short term 7 days or less
Use peripheral feeding (PPN)
PPN
Regularly monitor patient’s ability to consume oral diet and supplements to sustain nutritional status and meet nutritional recommendations
Discontinue tube
feeding Progress to oral diet GI = gastrointestinal ; IVG = intravenous gastronomy ; JG = jejunostomy/gastrostomy.
Source: Data from A.S.P.E.N. Nutritional Support Curriculum. 2nd ed. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) ;2012.
that of hypoalbuminemia and can be used as a preoper- ative parameter to determine risk for nutrition deterio- ration (6,7). Older adults should be frequently screened for nutritional risk factors because their nutritional status tends to decline more rapidly than that of younger adults and because they respond more slowly to nutrition therapy (5). The Academy of Nutrition and
Dietetics Evidence Analysis Library (EAL) has more detailed information on nutrition screening tools (www.andeal.org/).
Malnutrition is more common in older clients of nursing facilities and other long-term care facilities than in community-dwelling individuals. It is estimated that 17% to 65% of older adults are malnourished, with