Chapter 6 Nutrition Assessment of Older Adults

diarrhea, which results in weight loss for approximately one-fourth of residents (66). Poor nutrient absorption in older adults can be a consequence of Helicobacter pylori (H. pylori) bacteria (67). Any treatment or therapy should be evaluated, including chemotherapy, dialysis, ostomy, gastric bypass, amputation, organ transplant, or palliative/end-of-life care.

COMPARATIVE STANDARDS During the nutrition assessment, critical thinking takes place to identify what standards should be used to compare the data against, that is, what is the appropri- ate comparative standard? How much energy is too much or too little? How much protein or fluid is too much or too little for this particular client? Those com- parative standards are then used in the assessment process in combination with the data collected from the client or medical record to determine the appropri- ate interventions to resolve or diminish the nutrition problems identified.

Energy Needs

There is limited information available for using predic- tive equations on older adults. The Academy has com- pleted an extensive literature search on the assessment of energy expenditure that is available in the EAL. Indirect calorimetry is the most accurate method to determine energy needs, but availability of this measure is limited (68). Both Mifflin-St Jeor and Harris-Benedict equations have a tendency to overesti- mate the caloric needs. To estimate kilocalories for healthy adults, the Mifflin-St Jeor equation is the most accurate for normal weight and obese individuals, including older adults. However, there are insufficient data in those over age 85 and for nonwhite ethnic groups. To estimate energy needs of critically ill patients/clients, utilize Penn State (69) or Ireton-Jones formulas (9). See Table 6.11 (page 106) to calculate the resting energy expenditure (REE) from the Mifflin-St Jeor. REE may need adjustment for activity, but factors have not been established (see Table 6.11). The Dietary Guidelines for Americans 2010 provides estimated calorie needs per day based on physical activity for adults over 51 years of age.

Protein Requirements

The protein content of the body changes with age as muscle diminishes and body fat increases. The loss of lean body mass is accelerated with inactivity, including bed rest of as little as three days. The exact protein intake for older adults has not been established. The RDA for protein in adults over age 51 is 0.8 g/kg, but protein needs may be 1 g/kg for older adults (16).

Fluid Requirements

Baseline fluid requirements are determined by various methods. Three methods were reviewed by the EAL, but no evidence was found to establish or validate the equations (70). The equations are cited extensively and are included here:

● Weight method (Holliday-Segar method) ➤

100 mL/kg for first 10 kg body weight + 50 mL/kg for second 10 kg body weight + 20 mL/ kg for remaining kg body weight (less than 50 years of age) or + 15 mL/kg for remaining kg body weight (over 50 years of age) (71)

● RDA method (energy method): 1 mL/kcal ● Fluid balance method: Urine output + 500 mL/d

The EAL review of literature found that there is no evi- dence that identifies a clinical or biochemical marker of hydration status in adults older than 65 years of age (72). Older adults tend to have a decreased thirst sensa- tion; even healthy adults have reduced thirst after extended water deprivation. Meeting fluid needs is critical.

Special consideration for fluid replacement should be given to older adults with severe vomiting, diarrhea, or elevated temperature because dehydration is a concern. When calculating needs, select the method most appropriate for the client.

Other Nutrient Requirements Nutrient requirements in older adults vary because of the effects of aging on absorption, use, and excretion of nutrients. The DRIs serve as reference values when forming the basis for planning and assessing the intakes of older adults. It is important to realize that these recommendations are based on healthy adults rather than older adults who may have multiple comorbidities.

SUMMARY

The nutrition screening and assessment processes form the basis for initiating a plan of care for the older adult. The data are compared to criteria, relevant norms, and standards for interpretation and decision-making. In the assisted-living or home care environment, the screening process may be completed by a designated health care professional who then notifies the RDN of high-risk older adults. As new information is obtained, the RDN/NDTR may revisit previous steps of the process to reassess, add, or revise nutrition diagnoses, modify interventions, and monitor parameters. Such monitoring may include observing for and recognizing emergence of new risk factors (eg, acute medical illness, pressure ulcers, or fever), evaluating

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