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Part II Nutrition Assessment, Consequences, and Implications BOX 9.1 cont. Nutritional Risk Questions to Ask Older Adults About Oral Symptoms

Taste ●

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Describe any changes in taste that have occurred; what types of food, beverage? ● Has medication (Rx or OTC) changed at all during this time?

Is your sense of taste different or missing or does everything taste bad/metallic? How does it taste? ● Do you have any difficulties chewing or swallowing food? If yes, what?

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● Do you take any vitamin, mineral, herbal, or other nutrition supplements? If yes, what, how much, what form, what frequency? ● Do you follow any special diet?

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Activities of daily living ●

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Do you do your own food shopping and preparation? If no, what help do you have/need?

● Do you ever run out of money for food during the month?

Oral function risk factors ●

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Do you have any difficulty opening your mouth, biting, chewing, or swallowing foods or fluids? If yes, detail what foods/fluids cause difficulty and how.

● How often during the day do you eat, including meals and snacks?

● How many times a day do you drink sweetened coffees, teas, soda, juices, or other sweet beverages? ● When in the course of the day do you brush your teeth?

Osteoporosis risk ●

How many servings of dairy products do you have on a typical day? (1 serving = 1 oz cheese or 1 c yogurt or milk)

● Do you take a calcium and/or vitamin D supplement? If yes, what is the name and how much do you take in 1 day?

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● Do you get any physical activity or exercise in the course of a day or week? If yes, how many times a week and for how long? If a woman, are you peri- or postmenopausal?

● ● ● Have you or a first-degree relative broken one or more bones?

Source: Touger-Decker R, Mobley C, Epstein JB. Approaches to oral nutrition health risk screening and assessment. In: Nutrition and Oral Medicine. 2nd ed. New York, NY: Humana Press; 2014:356.

nutrition risk and basic guidance on healthy food selections. Referrals to an RDN for medical nutrition therapy (MNT) should be a routine component of dental practice (1,23). Conversely, when planning MNT, RDNs should be encouraged to routinely con- sider the oral manifestations of diseases and medica- tions or the oral problems faced by those who wear dentures and experience related problems (22,23,34). Soinu et al showed that as the number of oral health problems (for example, chewing and swallowing dif- ficulties, oral cavity pain, and xerostomia) increased, so did the prevalence of malnutrition (35). Screening older adults for oral health problems leads to inter- ventions that help deter further decline in oral func- tion, reduce complications of disease process, and reduce recovery time (34,36). Using the Mini

Nutritional Assessment (MNA), a reliable screening and assessment tool developed to measure nutritional status of older adults, Soinu et al reported an associa- tion between malnutrition, poor oral status, and oral health problems (35,37,38).

Moving from the screening phase to the actual assessment of the older adult, the standardized Nutrition Care Process Terminology (NCPT) provides assessment and monitoring and evaluation terminology in the Nutrition-Focused Physical Assessment domain. The nutrition assessment leads to the determination of whether an oral-health problem (nutrition diagnosis) exists, and the NCPT provides nutrition diagnosis ter- minology to capture oral-health conditions. Swallowing difficulty (NC-1.1) and biting/chewing (masticatory)