Chapter 9 Consequences of Poor Oral Health

Brodeur et al suggested that older adults with poor chewing capacity take more medications for gastroin- testinal disorders than older adults with no chewing difficulty (24).

THE ROLE OF THE REGISTERED

DIETITIAN NUTRITIONIST The Academy defines the nutritional assessment step of the Nutrition Care Process (NCP) as a “systematic process of obtaining, verifying and interpreting data in order to make decisions about the nature and cause of nutrition-related problems” (25). A thorough review of the medical history will provide information about acute or chronic diseases and conditions that may place the older adult at risk for dental problems. By combin- ing this information and completing a methodical inter- view using questions similar to those in Box 9.1, the RDN will have a comprehensive insight into the oral status of the older adult prior to completing the nutrition-focused physical assessment. Standards of care indicate that the RDN should perform a nutrition- focused physical assessment that evaluates abnormities in body systems, muscle and subcutaneous fat wasting, physical signs of malnutrition, edema, difficulty swal- lowing, and oral health (26). Since “nutrition” starts in the oral cavity, evaluating the oral cavity for non-

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normal conditions that impact overall nutrition is a component of completing a nutrition-focused physical assessment (27). The Centers for Medicare & Medicaid Services (CMS) outlines in the interpretative guide- lines for long-term care facilities under F325 that the nutrition assessment should include a description of the older adult’s general appearance, including oral health and dentition, with a focus on the oral cavity to include condition of mouth, teeth, and gums (28). Nutritional risk evaluation, at a minimum, includes subjective statements relative to diet, oral health, and weight history as well as objective assessment of height, weight, and the condition of the oral cavity. Nutritional risk factors are defined as “characteristics that are asso- ciated with an increased likelihood of poor nutritional status” (29). Nutritional risk is based on the type and extent of risk factors present. The older adult who lives alone, has lost more than 10% total body weight in six months, and has difficulty chewing is at significant risk (30,31). Box 9.1 lists nutritional risk questions (32); identifying risk factors such as those outlined in Box 9.2 (see page 137) will provide the basis in developing the plan of care whether for the older adult residing in his or her home, in assisted living, or in a long-term care facility (33).

Improved dietary quality can be achieved with nutrition intervention, starting with screening for

BOX 9.1 Nutritional Risk Questions to Ask Older Adults About Oral Symptoms

Weight ●

● ● ● ●

Has your weight changed at all in the past 6 months? If yes, how?

If weight loss, was it intentional?

If weight loss was intentional, what type of diet were you following and for how long? If weight gain, what are possible reasons you can attribute to weight gain?

● Do your clothes fit differently now than they did 6 months ago (1 clothing size = about 10 lb)?

Diabetes ●

●

How do you manage your diabetes in terms of any special diet, medications, monitoring? If you take insulin, what is the type, quantity, and dose schedule? ● Do you follow any special diet?

Hyposalivation/xerostomia ●

●

Do you have any difficulty chewing or swallowing? If yes, with liquids, thin or thick solids, semisolids, or all?

● Has this difficulty been progressive in degree of difficulty and types of foods? Is swallowing painful? If yes, when? Can you eat a meal or snack without needing liquids? If no, how many cups of liquids do you need to consume?

● ● ●

Have there been any changes in your medications or nutrient/herbal supplement use? If yes, describe changes.