What a doctor should know and do, when facing an elderly with manultrition?

What a doctor should know and do, when facing an elderly with manultrition?Identifying Risk Factors : A nutrition history is recommended for every elderly patient; a review should occur when a change in nutrition related factors is suspected. The presence of one key factor should alert the clinician to systematically assess the patient's history and physical, social, and economic status. Screening Tools :Screening tools aid the clinician in obtaining information on nutrition, functional status, and the patient's ability to provide for his or her nutritional needs. The Nutrition Screening Initiative (NSI) has developed easy-to-use forms; the forms help assess when further evaluation is indicated or community service is appropriate. The forms can be self-administered or completed by caregivers or clinicians in minutes. The patient education sheet accompanying this article is based on an NSI form.NSI materials for clinicians include forms for three levels of screening and comprehensive monographs. The forms and monographs guide clinicians in understanding and evaluating malnutrition and instituting interventions. The Council for Nutritional Clinical Strategies in Long-Term Care has developed a two-part clinical guide, The Clinical Guide to Prevent and Manage Malnutrition in Long-Term Care.' The guide recommends interventions; its use is not limited to the institutional setting. Clinical Evaluation of the Patient :Presenting Complaints, Signs, and Symptoms In the elderly, presentation of problems may be vague, global,or evidenced in other organ systems (for example, confusion, self-neglect, new onset of Ming, new onset of incontinence, apathy, anorexia, dyspnea, or tiredness).

Anthropometry :Weight is the most sensitive malnutrition indicator. Instructions and interpretations for accurate anthropometric measurement techniques on ambulatory patients, bed-bound patients, and for situations that preclude the use of conventional measurement are provided in Nutritional Assessment of the Elderly through Anthropometry. Lower values are indicative of malnutrition.Medications :Drugs are known to have a significant impact on appetite, mental status, intestinal upset, and drug absorption. A thorough drug history includes prescription drugs, over-thecounter (OTC) drugs, and herbal and nutritional supplements. Because of its narrow therapeutic range, digoxin is the most problematic drug. Other drugs having an association with malnutrition include thyroid drugs, diabetes drugs, cardiovascular drugs, anticholinergics, psychotropics, antiseizure drugs, antibiotics, theophylline, pain medications, NSAID, metoclopramide, Hz receptor blockers, laxatives, and antacids.Functional level determines the ability of patients to support their nutrition. Small changes in physical and mental function can have a significant impact on independence and nutritional status. Functional changes also may be the presenting symptom of an active medical condition or malnutrition, because global or nonspecific presentations of illness are common in the elderly. Knowing a patient's baseline functional status provides the clinician with a comparison tool for measuring functional change. Mental function impairment is not a normal component of the aging process. If mental function is overlooked, so are other correctable conditions such as depression, delirium, cranial space-occupying lesions, adverse drug reactions, and metabolic imbalances. Depression is a common cofactor of malnutrition.