50 CHAPTER 4 | Nutrition Assessment of Older Adults


the day. It is important for the multidisciplinary team, including the RDN, to assess older adults as needed for such changes.


Physical Activity


Older adults are encouraged to participate in physical activity at least 5 days per week. The target is 150 min- utes per week of moderate-intensity activity, with two sessions per week of strength, balance, and flexibil- ity activities.45


Physical activity can positively affect


the cardiovascular system, musculoskeletal system, and cognitive function and also increase well-being. Because age-related decline in appetite is common, it is helpful to note for seniors that engaging in physi- cal activity may increase appetite and gastrointestinal motility.46


Anthropometric


Measurements Anthropometry, the measurement of body size, weight, and proportions, is another tool used to eval- uate the nutritional status of older adults. The RDN should ensure that the methods used to weigh and measure are reliable, as accurate height and weight data are imperative and are often used as primary screening and monitoring indicators. Staff should measure and record height annually or per facility policy and procedure. RDNs should review weight documentation, and any notable weight loss or gain should be evaluated. Major benefits of using height and weight measurements over other nutrition assess- ment procedures are the ease with which measure- ments can be taken, along with their relatively low cost and noninvasive nature.47


However, the ability


to obtain adequate and reproducible data depends on being able to obtain accurate measurements. Obesity is common among nonambulatory older adults whose energy expenditure is low; however, obesity prevalence decreases after age 80 years.48 Although overweight and obesity increases morbid- ity and mortality for the general population, this relationship has been suggested to decline over time. Weight loss in older adults who are overweight may contribute to negative outcomes, including loss of


muscle mass and decreased bone mineral density.49 The optimal BMI range for older adults is 31 to 32 for females and 27 to 28 for males.50


Changes in body weight can substantially affect the nutritional health of older adults; therefore, achieving and maintaining a stable usual body weight is gener- ally the preferred standard. Low body weight, when associated with illness or injury, increases the risk of morbidity. If weight loss is desired, the appropriate protocol is to use a regimen with moderate energy restriction and to limit fat intake to no more than 30% of total energy. The diet should be well balanced and include a variety of fruits and vegetables and sup- plemental vitamin D if levels are below 100 nmol/L. Evidence supports the benefits of physical activity for older adults, and this should be a part of the planned weight loss intervention.51


Standard Measures Stature


In older adults, height measurements alone do not reflect current nutritional status but can be used for calculating BMI, estimating energy needs, and deter- mining appropriate body weight. Height is often measured incorrectly or not at all. For consistency, long-term care facilities should have a written pro- tocol for establishing a standard method for taking and recording measurements. Height should be mea- sured at admission and then yearly. Self-reporting of height is not an acceptable method of obtaining this measurement. Height measurements can be obtained using direct indirect


or measurements. Direct measurements


use a stadiometer, and the individual must be able to stand or lie flat. Indirect methods include taking knee-height measurements, arm span, or recumbent length using a tape measure. Indirect measurements are a good option for individuals with muscular dys- trophy, contractures, paralysis, or limited mobility or who are bedridden. Recumbent height measurements are made with a tape measure while the individual is lying in bed and may be appropriate for those who are comatose, critically ill, or unable to be moved. How- ever, this method should not be used if the person has musculoskeletal deformities or contractures.


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