Chapter 6 Nutrition Assessment of Older Adults

related to assessing and determining interventions. Many of the biochemical tests and procedures are covered in other chapters, but a few will be discussed here.

Protein Assessment

Several biochemical measurements are available that may or may not reflect dietary protein intake. Serum albumin, prealbumin, retinal-binding protein, transfer- rin, hemoglobin, total lymphocyte count, cholesterol, and total iron-binding capacity at one time had been commonly used for evaluating protein status. In recent studies, it has been determined that these markers more accurately suggest severity of the inflammatory response instead of impaired nutrition.

Cholesterol Assessment

Cholesterol is used as an indicator of malnutrition and poor health status in the older adult. When cholesterol levels decline along with other indicators of protein status, nutrition needs are probably not being met. In older adults, the problem may be chronic failure to thrive, very low intake, or overall declining status. Cholesterol level as a disease predictor is different in older adults than it is in younger adults. There is a decreased association between serum cholesterol and coronary heart disease with advancing age. Cholesterol of less than 160 mg/dL may be an indicator of malnu- trition and may be a predictor of mortality.

Hydration Status

The use of serum sodium, blood urea nitrogen, serum osmolality, and urine specific gravity to determine hydration status is common. Decisions regarding hydration status should use not only the laboratory measures but also issues identified in the physical examinations and the individual’s overall clinical con- dition to determine care.

Nutritional Anemia

Hematologic assessment is often used to screen for mal- nutrition. Common deficiencies in this area include iron deficiency, megaloblastic anemia, pernicious anemia, and anemia of chronic disease. Chronic disease, use of excessive aspirin intake or anti-inflammatory medicine, vitamin B-12 or folate deficiency, and protein-energy malnutrition can all lead to abnormal laboratory levels (see Chapter 11 for further assessment of nutritional anemias). Hematocrit and total lymphocyte count are routinely obtained in both hospital and long-term care settings. Hemoglobin and hematocrit are used together to evaluate iron status. Since most of the iron in the body is found in the hemoglobin of the red blood cells, it

Vitamins and Minerals Individuals who have had bariatric surgery or have fat malabsorptive disorders are at greatest risk for deficien- cies of the fat-soluble vitamins—A, D, E, and K. Numerous tests are available for assessing these as well as the adequacy of other specific vitamins and minerals.

NUTRITION-FOCUSED PHYSICAL ASSESSMENT

Nutrition-focused physical findings empower the RDN to use a more hands-on approach to assessing the older adult’s nutrition-related components of health. The Nutrition Care Process Terminology (NCPT) defines Nutrition focused physical assessment as “findings from a nutrition-focused physical exam, interview, or the medical record including muscle and subcutaneous fat, oral health, suck/swallow/breathe ability, appetite, and affect” (1). Areas to include are overall appearance; body language; cardiovascular- pulmonary; extremities, muscles, and bones; digestive system (mouth to rec- tum); head and eyes; nerves and cognition; skin; and vital signs. Table 6.8 (see pages 98–100) lists signs of malnutrition.

Chewing and Swallowing An evaluation of the digestive system starts at the mouth. Any problems encountered while chewing or swallowing foods, beverages, or medication are risk factors and should be noted on the assessment. The prevalence of edentulism in the noninstitutionalized population is higher in those over age 85 and higher in older adults with family income below the poverty line (52). Many older adults do not seek dental care, as this service is not covered under Medicare. The RDN should examine the mouth for broken or missing teeth or swollen or bleeding gums, asking the older adult to remove dentures if appropriate. A dry mouth with reduced saliva production may be a sign of dehydration or a result of medications (eg, bron- chodilator, psychotropic medications). Many medica- tions list altered taste, loss of taste, or xerostomia as a side effect. Lesions in the mouth and sore or bleeding gums affect oral intake.

Dental problems such as loose-fitting dentures, root caries, or missing teeth may require the assistance of the social service director to contact the dentist and correct the problem. Carefully observe the older adult

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can be used to detect iron-deficiency anemia associated with malnutrition. Usually the hematocrit percentage is three times the Hemoglobin concentration in grams per deciliter. Hematocrit is affected by hydration status and an extremely high white blood cell count.