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Part II Nutrition Assessment, Consequences, and Implications

(58) to help identify additional problems. Figures 6.5 and 6.6 (see pages 101 and 102) serve as guides for the interdisciplinary team working with older adults to manage and seek solutions to nutrition problems.

CLIENT HISTORY

The final domain involves gathering personal, medical, family, and social history data from the older adult or family members. In health care settings, this informa- tion is often recorded in the medical record, but an interview should be conducted to gather additional information. Personal history includes age, gender, race/ethnicity, socioeconomic status, living arrange- ments, literacy, and education level. Medical/health history includes disease states, conditions, and illnesses that may impact nutritional status. The information should be obtained to determine the state of diagnosis (acute or chronic), length of time since diagnosis, and education or nutrition counseling associated with disease. (See Table 6.10 for risk factors related to undernutrition.)

Psychological and Social Factors The prevalence of cognitive impairment, clinical depression, depressive symptoms, dementia, other psychiatric disorders, and psychological disturbances, along with their potential impact on nutritional status, are considerable in older adults (59). Dementia has been associated with B-12 deficiency (60), and malnu- trition is often associated with dementias and depres- sion caused by metabolic disorders, drug toxicity, hypothyroidism, and confusion (60,61). Psychological history must be evaluated in older adults, including eating disorders (eg, bulimia, early satiety, autism, rapid pace of eating). In long-term care facilities, up to 35% of residents may experience clini- cally significant depressive symptoms or depression (62). Depression is not a normal part of growing older and is a treatable medical condition. However, older adults are at increased risk due to chronic health condi- tions and are often misdiagnosed and undertreated (63). The decline is perpetuated by unfamiliar settings as the individual is transferred across the continuum of care from the least restrictive home care environment to extended-care facilities.

Social factors such as literacy level or language barriers; religious beliefs that alter intake of desired nutrients, calories, or food groups; social isolation; and caregiver or social support systems should be evalu- ated. Examining socioeconomic factors, the living/ housing situation, and the geographic location of the home should also be included in the assessment.

TABLE 6.10 Risk Factors That May Lead to Undernutrition

Type of Risk Social issues

Mechanical barriers

Examples

Lack of socialization No help with meals Poverty

Diminished/altered taste Eats slowly

Ethnic preferences not available Poor eyesight Poor health Poor hygiene

Poor motor coordination Requires culturally accepted food

Medical conditions

Interference with eating due to ●

cholelithiasis

congestive heart failure ● diabetic gastroparesis ● malabsorption syndromes

●

Increased energy needs due to: ● ● ●

burns cancer

chronic obstructive pulmo- nary disease

● ●

fractures infections

● wounds

Psychological conditions

Anorexia Dementia Depression

Late-life paranoia Cultural Factors

Cultural factors that alter intake of desired nutrients, energy, or food groups can affect nutritional status. The RDN must be aware of specific groups of food that are eliminated based on cultural or religious preference. A food preferences form, such as the one shown in Figure 6.7 (see page 103), can be used to gather data that help to determine food choices. Figure 6.8 (see pages 104– 105) (64) provides information about selected ethnic food practices.

Infections

Infections, acute and chronic, can result in weight loss (65). Clostridium difficile (C. diff ) bacteria causes