Chapter 6 Nutrition Assessment of Older Adults Figure 6.1 Determine Your Nutritional Health Form

The Warning Signs of poor nutritional health are often overlooked. Use this you know is at nutritional risk.

Read the statements below. Circle the number in the yes column for those that apply to you or someone you know. For each yes answer, score the number in the box. Total your nutritional score.

DETERMINE YOUR

NUTRITIONAL HEALTH

I have an illness or condition that made me change the kind and/or amount of food I eat. I eat fewer than 2 meals per day.

I eat few fruits or vegetables, or milk products.

I have 3 or more drinks of beer, liquor, or wine almost every day. I have tooth or mouth problems that make it hard for me to eat.

YES 2 3 2 2 2

I don’t always have enough money to buy the food I need.4 I eat alone most of the time.

I take 3 or more different prescribed or over-the-counter drugs a day. Without wanting to, I have lost or gained 10 pounds in the last 6 months.

1 1 2

I am not always physically able to shop, cook, and/or feed myself.2 TOTAL

Total Your Nutritional Score. If it’s — 0–2 3–5

Good! Recheck your nutritional score in 6 months.

You are at moderate nutritional risk. See what can be done to improve your eating habits and lifestyle. Your office on aging, senior nutrition program, senior citizens center, or health department can help. Recheck your nutritional score in 3 months.

6 or moreYou are at high nutritional risk. Bring this checklist the

health or social service professional. Talk with them about any problems you may have. Ask for help to improve your nutritional health.

Remember that warning signs suggest risk, but do not represent diagnosis of any condition. Turn the page to learn more about the warning signs of poor nutritional health.

Source: Reprinted with permission by the Nutrition Screening Initiative, a project of the American Academy of Family Physicians and the American Dietetic Association, funded in part by a grant from Ross Products Division, Abbott Laboratories Inc.

These materials developed and distributed by the Nutrition Screening Initiative, a project of:

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