PREFACE

The practice of medical nutrition therapy and the care of the older adult have continued to evolve based not only on advancing science but on a change to a more person-directed care model in part because of the baby boomer generation. This new group of clients has an awareness of health care and potential expectations. Many have taken an active role in wellness and physi- cal activity and have high expectations when it comes to nutrition care and the healthcare delivery system. It is commonplace to think of nursing facilities and older adults together—to consider nursing facilities as the primary option for older adults who need care while regarding older adults as the population most likely to use nursing facilities. But there are good rea- sons to reconsider such assumptions. On the one hand, changes in health care delivery have led to the devel- opment of home health agencies and assisted living; on the other hand, there is a continued need for facilities that can handle individuals of all ages with cognitive dysfunction, spinal cord injury, or other illnesses and injuries requiring subacute or rehabilitative services. As a result, a wide range of clients with varying needs and living environments presents new challenges and opportunities for dietetics professionals. The demands of the registered dietitian nutrition- ists (RDNs) are even stronger. RDNs must provide a high level of medical nutrition therapy for the individuals they assist: assessing nutrition needs, developing goals for clients, directing the imple- mentation of nutrition plans to meet those goals, documenting relevant data, and evaluating results with outcomes research in mind. Along with all of this, the stresses of the changes in Medicare, the Patient Protection and Affordable Care Act (ACA),

and all laws must be taken into account. This book provides RDNs with up-to-date, useful material for use in this ever-changing environment. Although it is not intended to be all-inclusive, Nutrition Care of the Older Adult provides important guidance and the foundation for the nutrition care of older adults wherever they call home—nursing home, assisted living, independent living, or the house down the block. Information set forth in this book is based on current and up-to-date research and evidence-based guidelines available in the scientific and medical literature but, as always, should be reviewed in light of any new research findings and clinical guidelines as they become available.

For this revision, we once again sought out profes- sionals within our field as well as experts outside the dietetics profession who are passionate about promot- ing the health of the older adult. We are grateful to the contributors for sharing their expertise. We are also indebted to the reviewers who took the time to thoughtfully critique the content. Proper nutrition care is crucial for all our clients. Demand for our services is even stronger with the growing number of older adults. We urge our readers to accept the challenge to meet the nutritional needs of clients and provide excellent, quality care for all those served using the knowledge gleaned from the following chapters.

Kathleen C. Niedert, PhD, RD, CSG, LD, FADA Editor-in-Chief Marla P. Carlson Editor