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Part II Nutrition Assessment, Consequences, and Implications

Method 4 for Determining Fluid Requirements

Daily fluid requirements (mL) = [Body weight (kg) – 20] × 15 + 1,500.

Method 5 for Determining Fluid Requirements

●

Average healthy adult: 30 to 35 mL/kg body weight

● Adult 55 to 75 years: 30 mL/kg body weight ● Adult over 75 years: 25 mL/kg body weight

Protein Requirements

The protein content of the body changes with age as muscle mass diminishes and body fat increases. Older adults can expect a 2% to 3% loss of lean body mass per decade (11). Munro and Young recommend that 12% to 14% of the total energy consumed by older adults be in the form of protein if energy intakes are decreased (12). This may necessitate increased protein intake. The exact protein intake for older adults has not been established, but the suggested range is 1 to 1.25 g/kg/d for severe protein depletion (albumin level less than 2.1) (13-15). Usual body weight (UBW) is used in calculating the dietary protein requirements for an underweight person (10). Since the body synthesizes only 30 g of protein per meal, protein may need to be distributed through meals and snacks (16). (See Table 6.1.)

TABLE 6.1 Protein Needs for Adults Condition

Normal (adult)

Hepatitis or cirrhosis without encephalopathy

Older adults over age 65 CKD

Pressure ulcer Critical illness

0.8 0.8–1 1

1.2–1.5 1.2–1.5 1.2–2

Source: Reprinted with permission from DHCC Pocket Resource for Nutrition Assessment 2013;19.

Diet History

Either a 24-hour recall or a food frequency question- naire is often used to determine the usual dietary intake of older adults. Unfortunately, the reliability of either of these can be questioned due to changes in short-term memory with age. However, these methods do provide a bit more complete and detailed description of the qualitative and quantitative aspects of food intake within the limitations of the client and the training of the RDN in gathering this type of information.

Estimated Protein Needs (g/kg)

General and Therapeutic Diets The diet order is a general or modified/therapeutic diet prescribed by the primary care practitioner and docu- mented in the medical record as part of a treatment plan. An older adult has likely followed a modified diet prescribed with onset of disease(s). He or she may have had structured diet education/ counseling from a health care professional or he or she may have selected a diet after reading commercial books or using online resources. Assessment of the diet order should include the older adult’s current nutritional status and the impact of limiting nutrients on that status. Restricted diets are known to pose nutrition problems, especially for older adults who have enjoyed eating a variety of foods. A limitation of nutrients, such as sodium or fat, often leads to a reduction in intake, which leads to weight loss. Studies conducted with older adults with diabetes found no positive results to following a caloric- specific diet versus a controlled carbohydrate diet (17-19). The Position of the Academy of Nutrition and Dietetics on individualized nutrition approaches for older adults details the positive benefits of a liberal- ized diet (20).

Food Security Food security means access by all people at all times to enough food for an active, healthy life. Therefore, asking sensitive questions during diet history will become even more important as the number of seniors with financial instability increases. The Administration on Aging (AoA) reported that in 2012, over 3.9 million older adults were below the poverty level (21). Another 2.4 million were “near poor,” defined as an income level at poverty level to 125% of this level. The Academy’s Evidence Analysis Library (EAL) recom- mends that the RDN should screen (or refer for screen- ing) all older adults for eligibility in US Department of Agriculture (USDA) programs and OAANP. Identifying those who have utilized food assistance programs in the past may provide insight into potential nutrient deficiencies (see Chapter 2).