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Part II Nutrition Assessment, Consequences, and Implications

Example: [(115 – 105)/115] × 100 = 8.7% weight loss

The seriousness of weight loss can be described as either significant or severe. According to CMS, within the MDS, significant weight loss is the following (51):

● 5% in 30 days ● 7.5% in 90 days ● 10% in 180 days

Severe weight loss is considered if the client loses more than (52)

● 2% in 1 week ● 5% in 1 month ● 7.5% in 3 months ● 10% in 6 months

Energy Needs An estimate of energy needs must be completed for each client. Several methods exist for estimating energy requirements. Deciding which method to use is gener- ally based on data availability and the older adult’s clini- cal status. To estimate kilocalories, calculate the basal energy expenditure (BEE), as specified in Tables 6.5 and 6.6 (see pages 96–97), and multiply it by the injury factor (Box 6.5) and the activity factor (Box 6.6) (33). Table 6.7 (see page 84) shows a shortcut method for estimating adult energy needs per kilogram (34-36).

BIOCHEMICAL DATA, MEDICAL

TESTS, AND PROCEDURES Biochemical changes precede clinical signs of defi- ciency. Several biochemical measures are available for assessing nutritional status, but as with anthropo- metric measures, problems exist with the use of these indices in the assessment of older individuals, as other factors besides nutrient intake are known to influence levels in the body. The older adult’s general state of health—including hydration status, past and present history of diseases, intake of alcohol, tobacco use, and intake of prescribed and over-the-counter drugs—can produce alterations in biochemical data. There is also a lack of age-adjusted reference data for appropriate interpretation of the results of these studies, yet they are still used to help diagnose dis- eases, support nutrition diagnoses, and evaluate the interventions utilized within the NCP. In the spirit of cost-effectiveness, payers of health care, including managed care organizations and Medicare, limit the type and number of laboratory tests. The RDN should request only those tests essential and diagnostically

BOX 6.5 Formulas for Calculating Energy Needs

Harris Benedict Men: BEE=66.5 + 13.8(W) + 5(H) – 6.8(A)

Women: BEE=655.1 + 9.6(W) + 1.9(H) – 4.7(A)

W=weight in kg, H=height in centimeters, A=age in years

Mifflin St Jeor Equation Male: RMR = (10 × weight) + (6.25 × height) – (4.92 × age) + 5

Female: RMR = (10 × weight) + (6.25 × height) – (4.92 × age) – 161

Use weight in kilograms and height in centimeters.

Modified Penn State RMR (kcal/d) = Mifflin(0.71) + TMAX(85) + VE(64) – 3,085

Equation uses BMS calculated using the Mifflin-

St Jeor equation, minute ventilation (VE) in liters per min (L/min), and maximum temperature in prior 24 hour (TMAX) in degrees Celsius

Ireton-Jones

IJEE – 1925-10(A) + 5(W) + 281(S) + 292 (T) + 851(B)

A = age in years, W = weight in kilograms S = Sex (Male = 1; Female = 0)

T = diagnosis of Trauma (where present = 1; where absent = 0)

B = diagnosis of Burn (where present = 1; where absent = 0)

BOX 6.6 Activity Factors

1.2: for clients confined to bed 1.3: for ambulatory clients 1.5–1.75: for most normally active persons 2.0: for extremely active persons

Source: Reprinted with permission from Consultant Dietitians in Health Care Facilities. CD-HCF Pocket Resource for Nutrition Assessment, 2001 Revision. Chicago, IL: Consultant Dietitians in Health Care Facilities; 2001:39.