84

Part II Nutrition Assessment, Consequences, and Implications

TABLE 6.7 Shortcut Method for Estimating Adult Energy Needs Estimated Energy Requirements

Older adults, healthy Older adults, acutely or chronically ill Older adults, underweight Obese, critically ill individuals

Unintended weight loss, weight maintenance for healthy older adult

Unintended weight loss, weight maintenance for underweight older adult

Pressure ulcer Paraplegia Tetraplegia

18–22 kcal/kg in women 20–24 kcal/kg in men

18–22 kcal/kg in women 20–23 kcal/kg in men

27–28 kcal/kg 22 kcal/kg body weight

25–35 kcal/kg in women 30–40 kcal/kg in men

23–30 kcal/kg

Higher for weight gain 30–35 kcal/kg 28 kcal/kg 23 kcal/kg

Source: Reprinted with permission from DHCC Pocket Resource for Nutrition Assessment; 2013:18.

who is edentulous, has poor teeth, or has ill- fitting den- tures before recommending a consistency alteration. Oral status includes evaluation of texture modification. An older adult who has difficulty swallowing may also require texture modification. The RDN, speech lan- guage pathologist, and occupational therapist should work as a team in evaluating the need for thickened liquids, texture modifications, and self-help feeding devices.

Constipation and Diarrhea Constipation and diarrhea are both risk factors that should be addressed in a nutrition assessment. Older adults frequently use over-the-counter laxatives. Laxative abuse is widespread and can induce a state of malabsorption. When constipation progresses to fecal impaction, associated symptoms include anorexia, con- fusion, and fecal incontinence; thus impaction itself predisposes to dehydration and to further diminution of nutritional status. Chronic diarrhea can lead to dehy- dration and weight loss, which increases the risk for malnutrition.

Sensory Impairment Visual impairments can contribute to decreased food intake at meals. Interviewers should alert caregivers to give verbal cues for meal placement using the clock method. Decreased peripheral vision requires moving the food into the line of sight. Ask the older adult (not family or friends) how much help is needed. For example: Should meat be cut? Should bread be but- tered? Should the location of the food on the plate be described? Many persons who have lost their sight have worked out solutions to locating their food and do not like being treated as if they cannot help themselves (53).

Individuals who experience difficulties with aspects of taste perception may have similar problems with perception of smell. The ability to identify common food odors and to discriminate among foods may be impaired. Some studies indicate that there is a decline in olfactory function during the life span (54). Smoking may alter taste and smell, and this change may impair oral intake and decrease meal satisfaction. Older adults who smoke are less sensitive to smell than nonsmokers. A positive association between olfactory impairment and BMI has been reported (55). There