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Part II Nutrition Assessment, Consequences, and Implications

TABLE 7.1 Body Weight and Nutritional Risk

% Usual Body Weight

85–95 75–84 <75

Nutritional Risk Risk of mild malnutrition

Risk of moderate malnutrition Risk of severe malnutrition

Source: Data are from reference 22.

the older adult may not be able to stand up straight or may have spinal curvatures.

BMI: BMI measures weight in relation to height as an indicator of body composition. Body mass index can be used as a general guideline to monitor trends in the older adult but is not diagnostic of an individual’s health. It is important to keep in mind that BMI is only one piece of the puzzle and does not take into account muscle mass.

Energy requirements: Several methods exist for esti- mating energy requirements. Deciding which method to use is generally based on data availability and the older adult’s clinical status. There is limited informa- tion available for using predictive equations on older adults, especially those over 80 (29). Equations used to estimate energy expenditure often tend to overestimate the caloric needs of the older adult.

Medications

Adults older than 65 tend to take more medications than younger people because they are more likely to have chronic disorders such as high blood pressure, diabetes, and arthritis. On average, older individuals take four or five prescription medications and two over-the-counter (OTC) drugs each day. Food-drug interactions or timing of the medication administration may be responsible for reduced food intake (30-32). Medication side effects such as anorexia, dry mouth, dyspepsia, and nausea have been associated with loss of taste, appetite, and weight. Table 7.2 (see pages 111–112) presents an overview of drugs associated with involuntary weight loss/UWL (33-35).

NUTRITION DIAGNOSIS

Once a comprehensive nutrition assessment is com- pleted and the RDN has identified UWL, nutrition diagnoses and nutrition diagnostic statements written in PES (problem, etiology, signs and symptoms) format will be developed. The nutrition diagnosis is reviewed routinely as the individual’s condition

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changes (see Chapter 5). Box 7.3 (see page 113) lists selected nutrition diagnoses that may be relevant for older adults with UWL and offers examples of PES statements (36).

NUTRITION INTERVENTION Nutrition intervention offers a reasonable expectation of benefit and should be provided to those who have experienced UWL. Interventions must be consistent with the individual’s advance directives, informed choice, goals, and preferences and must be evaluated routinely to determine if stated goals are achieved or if a change in nutrition interventions is required. The goal of MNT is to maintain or restore the individual’s usual body weight by using food/nutrient delivery and environmental considerations (21,36,37). This may be challenging to the RDN because recent findings indi- cate that older adults tend not to return to their previ- ous weight after an illness or transient nutrient and fluid deficiency (20,21,30). Interventions are adjusted routinely based on the older adult’s responses, out- comes, and needs (36,37).

Food/Nutrient Delivery Considerations ●

Provide foods/fluids that satisfy cultural, ethnic, religious, and personal preferences.

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Individualize diets (low-fat, diabetic/calorie- controlled, cardiac, and altered consistency diets) to the least restrictive. For many older adults residing in nursing and community-based facili- ties, the benefits of less-restrictive diets outweigh the risks.

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Swallowing abnormalities are common but do not necessarily require modified diet or fluid tex- tures, especially if these restrictions adversely affect food and fluid intake. Increase the nutrient density of foods; for example, increase protein content by adding milk powder, cheese, eggs, and peanut butter. Increase fat and calories by adding margarine or butter, mayonnaise, sour cream, and half and half. Increase calories by adding sauces, gravies, and corn syrup.

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Provide medical food supplements between meals, preferably 1 hour before or after meals.

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Consider a multivitamin and mineral supplement when the appetite is poor to supplement vitamins and minerals until appetite improves.

Encourage physical exercise (weight-resistant) to improve appetite and promote formation of lean body mass versus fat.

Use enteral feeding if consistent with advance directives.