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Part II Nutrition Assessment, Consequences, and Implications

negative outcomes are associated with weight loss in overweight older adults, such as loss of muscle mass and decrease in bone mineral density.

It is well known that changes in body weight can have a significant impact on nutritional health in older adults; therefore, achieving and maintaining a stable usual body weight is generally the preferred standard. If weight loss is planned, the appropriate protocol is to use a regime with moderate caloric restriction and appropri- ate calcium and vitamin D supplementation along with regular exercise (29). Major benefits of anthropometry over other nutritional assessment procedures are the ease with which the measurements can be taken, relatively low cost, and noninvasive natures. However, the ability to obtain adequate and reproducible data depends on being able to obtain accurate measurements. For various reasons, the usefulness of most anthropometric measures as predictors of nutritional status in older adults is ques- tionable (30).

Standard Measures Stature

In older adults, height measurements alone do not reflect current nutritional status but can be used for estimating a person’s energy needs or appropriate body weight. For consistency, facilities should have a written protocol for determining a standard method for measurements. Heights are to be measured at admission and yearly. Self-reporting of height is not an acceptable method of obtaining this measurement. To obtain height for an ambulatory client, the health professional should do the following:

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Have the person being measured wear minimum clothing so that posture can be clearly seen.

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Instruct the person to stand tall, with bare heels as close together as possible, legs straight, arms at sides, shoulders relaxed, head erect, and eyes looking straight ahead.

● Have the person take a deep breath. ●

Take measurement at the point of the person’s maximum inspiration with your eyes at headboard level, to avoid errors due to parallax.

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Record measurement to the nearest 0.1 cm or 0.125 inches; repeated measurements should agree within 1 cm or 0.5 inch.

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Compare present measurement with previous stature measurement(s) and with reference tables or graphs to determine change and to aid with interpretation of measurements.

To estimate the height of those unable to stand up straight, the bed-bound, the nonambulatory, and those

with spinal deformations such as kyphosis, dowager’s hump, and osteoporosis, one of the following methods (measurement must be documented as an estimate) may be used (31-33). For both men and women, arm span measurement is roughly equal to height at matu- rity (within approximately 10%). Span measurement is calculated as follows:

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With the upper extremities, including the hands, fully extended and parallel to the ground at a 90-degree angle to the torso, measure the distance between the tip of one middle finger and the tip of the other middle finger.

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Span measurement remains constant in spite of decreasing height and is an acceptable alternative method of establishing height.

● Document as estimated height.

For those clients who cannot hold arms out straight, calculate as follows (34):

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Measure from the sternum notch to the tip of the middle finger (often called the demispan).

● Double this number. ● Document as estimated height.

This method may not provide accurate measurements for Asians, African Americans, or clients with spinal deformities such as kyphosis, osteoporosis, arthritis, or contractures (30).

Stature can also be estimated from knee height using Chumlea’s formula (31). For this to be used, the individual must be able to fold the knee and the ankle to a 90-degree angle. The knee-height caliper is used to measure length of the leg from the bottom of the foot to the top of the patella. The knee height is inserted into a mathematical formula and converted to stature. Measurement of individual body segments can also be used for older adults who have severe neuromuscular deformities. In this method, segment lengths are mea- sured between specific bony landmarks and as vertical distances between a flat surface and a bony landmark, but they should not be measured from joint creases. Older adults who are unable to stand, are coma- tose, or are critically ill can have height determined using a recumbent method, as follows (11):

● Stand on the right side of the body. ●

Align body so that the lower extremities, trunk, shoulders, and head are straight (the person should be lying flat).

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Mark at the crown of the head and the base of the heels (may mark sheet).

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Measure length with measuring tape between marks.