Chapter 6 Nutrition Assessment of Older Adults

are in the 7-day look-back period awaiting Minimum Data Set (MDS) assessment.

Baseline fluid requirements are determined by various methods. In older adults, water accounts for approximately 50% of the person’s weight—10% less than in a younger adult. The decrease is associated with a corresponding decrease in lean body mass (10). Older adults tend to have a decreased thirst sensation; even healthy adults have reduced thirst after extended water deprivation. Meeting fluid needs is critical. Special consideration for fluid replacement should be given to older adults with severe vomiting, diarrhea, or elevated temperature because dehydration is a concern. When calculating needs, select the method most

BOX 6.2 Fluid Status ●

●

BOX 6.3 Factors That May Alter Fluid Requirements

The following may increase fluid needs: ●

Anabolism ● Burns

● Constipation ● Dehydration ● Diarrhea ● Emesis ● Fevera

● Fistulas/drains ● Hemorrhage

Congestive heart failure/edema = 25 mL/kg of body weight

Normal fluid status = 25 to 30 mL/kg of body weight

● 1 mL/kcal ●

100 mL/kg for first 10 kg body weight + 50 mL/kg for second 10 kg body weight + 15 mL/kg for remaining kg body weight.

Or shortcut to this method: [Body Wt (kg) − 20] × 15 + 1,500 mL

Source: Adapted from Chidester JC, AA Spangler AA. Fluid intake in the institutionalized elderly. J Am Diet Assoc. 1997;97:23-28, with permission from American Dietetic Association.

appropriate for the client considering factors that may alter fluid requirements (see Boxes 6.2 and 6.3)

Method 1 for Determining Fluid Requirements

Daily fluid requirement (mL) = Weight (kg) × 25 to 35 mL:

●

25 mL/kg for congestive heart failure or renal disease

● 30 mL/kg for average adults ●

35 mL/kg for patients with infection or draining wounds

Method 2 for Determining Fluid Requirements Estimate 1,000 mL for the first 10 kg actual body weight + 50 mL fluid/kg for the next 10 kg actual body weight (or 1,500 mL for the first 20 kg of body weight)

● Hot or dry environments ● Hyperventilation ● Hypotension ● Medications

● Nasogastric suctioning ● Polyuriab

● Air mattress ● Weeping wounds

The following may decrease fluid needs: ●

● Edema ● Fluid overload

● Hepatic failure with ascites ● Medications ● Renal failure

●

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

● Significant hypertension “Third spacing” of fluids

● aFluid needs increase 7% for each degree Fahrenheit above

normal; 13% for each degree Celsius. bPoor glucose control; excess alcohol, caffeine; osmotic diuresis

Source: Reprinted with permission from Dietetics in Health Care Communities. DHCC Pocket Resource for Nutrition Assessment, 2013 Revision. Chicago, IL: Dietetics in Health Care Communities; 2013:21.

+ 15 mL fluid/kg for each additional kg over 20 kg (add this to the base of 1,500 mL).

Method 3 for Determining Fluid Requirements

Daily fluid requirements (mL) = 1 mL per kcal of intake. Note: If a patient’s energy intake is poor, this method will underestimate fluid needs in many cases.

Cardiac disease (especially congestive heart failure)

75