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Part II Nutrition Assessment, Consequences, and Implications

Short Nutritional Assessment Questionnaire (SNAQ), a four-item screening test; the Mini Nutritional Assessment (MNA), which represents the most widely accepted and validated nutrition assessment tool for older adults regardless of setting; and the Subjective Global Assessment (SGA). The SNAQ is a short, simple appetite assessment tool that predicts weight loss in both community-dwelling and facility resi- dents. It mainly examines appetite- and anorexia- related weight loss. Originally comprised of 18 ques- tions, the current MNA now consists of 6 questions and streamlines the screening process. The current MNA retains the validity and accuracy of the original MNA in identifying older adults who are malnour- ished or at risk of malnutrition. The revised MNA short form makes the link to intervention easier and quicker and is now the preferred form of the MNA for clinical use. Because it is quick, economical, and noninvasive, it makes it a useful tool for both ambulatory older adults living in the community setting and individuals living in extended care com- munities. Questions are weighted and the total desig- nates a malnutrition indicator score. The SGA was originally introduced to assess the patient for malnu- trition at the bedside, without the need for precise body composition analysis. Although not originally developed for older adults, it has been found to iden- tify those at risk of nutrition-associated complications and death. The SGA includes questions about changes in weight and dietary intake, gastrointestinal distur- bances, and functional capacity. The SGA is another validated assessment tool, but when compared to the MNA, the MNA was found to be more appropriate for the identification of malnutrition in the older adult (7).

NUTRITION ASSESSMENT Following the screening process and referral to the RDN, the NCP begins with nutrition assessment (see Chapter 5). The purpose of the nutrition assessment is to obtain, verify, and interpret data needed to identify nutrition-related problems (diagnoses), their causes, and significance. The assessment defines nutritional status using medical, nutrition, and medication histo- ries; recent condition changes; nutrition-focused physical examination; interview with client and/or caregiver; anthropometric measurements; and labora- tory data. It “includes the organization and evaluation of information to declare a professional judgment” (8) and involves critical thinking (see Box 6.1) and interpretation of data gathered during the nutrition screening/assessment and data from other health pro- fessionals (eg, rehab therapists, respiratory therapists, psychologists) (3).

BOX 6.1 Steps in Critical Thinking ●

● ● ●

Determine the need for additional information.

Select assessment tools and procedures that match the situation.

Apply assessment tools in valid and reliable ways.

● Distinguish relevant from irrelevant data. ● Distinguish important from unimportant data. ● Validate the data.

Nutrition assessment data are organized into five domains per the eNCPT:

● ● ● ● ●

food/nutrition related history anthropometric measurements

biochemical data, medical tests, and procedures; nutrition-focused physical assessment client history

FOOD/NUTRITION RELATED HISTORY The RDN begins the assessment by examining the cli- ent’s food and nutrient intake; food and nutrient admin- istration, including diet history, medication, and complementary/alternative medicine use; beliefs and behaviors; and factors affecting access to food.

Oral Nutrition Intake:

Food and Beverage Intake Intake has been found to decline with age (9). Although not required by federal regulations, docu- mentation of the client’s intake of foods and bever- ages is an essential part of the assessment process. A food intake record reports the percentage of food eaten at the meal and records beverage intake in ounces. This type of record is useful to document food replacements that are offered. Food replace- ments should be offered to older adults at risk for malnutrition, such as those eating less than 50% to 75% of the meal. It is important to document the percentage of snacks consumed as well. Since accurate food intake records can be challeng- ing to maintain in nursing facilities, many facilities have implemented electronic documentation tools that capture meal and snack intake. Intake records should be completed immediately after the meal. In some instances, food intake records will be kept only on those residents who are at high nutrition risk and those who

Determine appropriate data to collect.