nutrition assessment for the older adult - chapter 16

Nutrition Assessment for the Older Adult

Chapter 16

Nutritional Status

• Older adults are at nutritional risk due to a number of factors– Poor dietary intake– Chronic medical

conditions– Variety of physical,

economic, and social factors

Nutritional Risk Factors for Older Adults

Nutritional Status

• Assessment of nutritional status• Nutritional screening• Detection of risk for malnutrition and early

intervention

Nutrition Screening

• Process of identifying characteristics known to be associated with nutritional problems

• Purpose– To identify individuals who are at nutritional risk

or who are malnourished

• Nutrition screening tools for older adults– The Nutrition Screening Initiative– Mini-Nutrition Assessment

Nutrition Screening

• Goals of Nutrition Screening– Keep older adults at home and in community-

based settings – Facilitate the prevention and early detection of

nutrition-related complications – Contribute to positive health outcomes

• Identify and treat nutritional risk factors

Nutrition Screening

• Goals of Nutrition Screening– Characteristics of a screening process

• Completed in any setting• Facilitates the completion of early intervention

goals• Includes the collection of relevant data on risk

factors• Determines the need for a nutrition assessment• Is cost-effective

Nutrition Screening

• Nutrition Screening Instruments– A diverse coalition of more than 25 national

health, aging, and medical associations– Goal

• To promote routine nutrition screening and intervention for older adults as a cost-effective strategy to improve the health of older Americans

Nutrition Screening

• Nutrition Screening Instruments– DETERMINE

• A self-assessment screening tool to increase older adults’ awareness of their nutritional status

• Promotes routine nutritional screening• Low scores indicate low risk of poor nutritional

status• Based on DETERMINE checklist, a more in-

depth assessment is performed

Nutrition Screening

• Nutrition Screening Instruments– Mini Nutrition Assessment

• “Gold standard” • Quick, economical, and noninvasive method for

assessing the nutritional risk of frail older persons

• Useful in clinical practice• Used in community and clinical setting• Does not require biochemical tests

Nutrition Screening

• Nutrition Screening Instruments– Mini Nutrition Assessment identifies

• Prevalence and risk of malnutrition in community-dwelling older adults

• Prevalence of undernutrition in outpatient and home care older adults

• Prevalence of undernutrition and the risk of malnutrition in hospitalized and institutionalized older adults

Nutrition Screening• Nutrition Screening Instruments

– Mini Nutrition Assessment uses• Community based individuals before they enter

nursing facility• In hospital and long-term care facilities

–Screening and assessment–Monitoring changes in nutritional status

over time • Distinguishing between levels of nutrition• Reassessing and monitoring nutrition status• A guide for a successful nutritional intervention

Nutrition Screening• Other Nutrition Screening Methods

– The Nutrition risk Index• Identifies those in need of nutritional

interventions and more in-depth assessment– SCALES

• Identifies those at nutritional risk

Nutrition Screening

Nutrition Screening

• Other Nutrition Screening Methods– Subjective Global Assessment

• Identifies those at risk of nutrition-associated complications and death

Nutrition Screening• Other Nutrition Screening Methods

– Additional Assessment Tools• SNAQ

– Identifies those at risk for anorexia-related weight loss

• MUST–Screen for risk of malnutrition

• Nutrition Risk Screening (NRS 2002)–Used for hospitalized patients who need

nutrition support

Nutrition Assessment

• Definition and Purpose– To interpret and expand on data from the

nutrition screening process– See Table 16-2 for Nutrition assessment methods,

purpose and components, and methods


• Components of Nutritional Assessment– Anthropometrics– Biochemical– Clinical – Dietary– Psychosocial– Economic– Functional– Mental health status– Oral health status


• Components of Nutritional Assessment– Used as a guide to help establish a history or

evidence of risk factors – Used to determine the client’s risk level


• Components of Nutritional Assessment– Four primary components

• Anthropometric measurements• Biochemical parameters• Clinical assessment• Dietary history


• Anthropometry– Measurement of body size, weight, and

proportions– Helps establish protein-energy reserve– Used to monitor the appropriateness and

effectiveness of nutrition intervention– Body weight, height, various circumferences,

skinfold thickness


• Weight– Most routinely collected measure– Rough estimate of energy stores– Indicators should be recorded– Weight changes

• Peaks during 40s and 50s• Holds steady until about age 60• Predictor of negative health outcomes• Change in body composition


• Weight– Weight for Height

• Used to compare to standards most representative of the population being evaluated


• Height– Should be measures annually– Surrogate Measures of Height

• When not able to obtain a standing height– Arm Span– Total Arm Length– Knee Height


Segmented Measurements of an Older Adult

Chernoff R. Geriatric Nutrition. 3rd ed. Sudbury, MA: Jones & Bartlett; 2006, p. 437. Reproduced with permission.

Nutritional Assessment

• Body Mass Index– Correlates significantly with body fatness– Does not consider the variable height loss with age


• Height– Body Composition

• Evaluate changes in muscle and fat

– Circumference Measurements• Evaluate changes in muscle and fat

– Waist-to-Hip Ratio• Association between fat distribution and health

outcomes


• Height– Arm Circumference

• Monitors for measurement changes

– Calf Circumference• More sensitive indicator of the loss of total body

muscle mass

– Skinfolds• Correlates to body fatness


• Height– Bioelectrical Impedance Assessment

• Measures body composition

– Creatinine Height Index• Assesses total body skeletal muscle mass or body

composition

– Dual-energy X-ray Absorptiometry (DXA)• Determines body fat, fat distribution, and bone density


• Biochemical Measures/Laboratory Data– Factors that Influence Biochemical Markers


• Biochemical Measures/Laboratory Data– Protein Status

• Predict protein-energy-malnutrition– Albumin

• Measures visceral protein status– Serum Transferrin

• A sensitive marker of protein status– Prealbumin

• Useful indicator of nutritional status


• Biochemical Measures/Laboratory Data– Total Lymphocyte Count

• Indicator of immunocompromise– Cholesterol

• Assess risk of cardiovascular disease– Iron Status/Anemias

• Screen for malnutrition• Iron deficiency anemia


• Biochemical Measures/Laboratory Data– Hemoglobin

• Used to detect iron deficiency anemia– Hematocrit

• Used to evaluate iron status– Mean Corpuscular Volume

• Indicates some types of anemia


• Biochemical Measures/Lab Data– Folate Status

• Evaluate hemolytic disorders and detect megaloblastic anemia

– Vitamin B12• Used to identify pernicious anemia and

megaloblastic anemia

Clinical Assessment

• Physical Assessment– Refer to Table 16-6 for Clinical Signs of Nutritional

Deficiencies– Goal of Clinical Assessment

• To reveal information about one’s current state of health

– Oral Status• Can be the cause or result of poor nutrition

Clinical Assessment

• Clinical Assessment– Medication Use

• May decrease appetite or alter metabolism– Alcoholism

• Often hard to detect• Alcohol intake replaces consumption of

nutrient-dense foods and beverages

Physical Disabilitiesand Functional Status

• Functional Declines– Often considered to be a natural consequence of

the aging process• Functional Dependence

– Dependence• Requiring assistance with an activity most of

the time– Independence

• The activity can be performed without assistance

Physical Disabilitiesand Functional Status

• Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)– Inability to perform the nutrition-related ADLs and

IADLs suggest increased risk for poor nutritional status

– Goal to identify difficulties early so that treatments can be implemented

Cognitive and Psychological Function (Mental Status)

• Depression– Leading cause of unexplained weight loss in older

adults– Recognized as a treatable cause of weight loss– Medication side effects

• Assessment of Mental Status– Screening tools used to detect dementia

Social, Psychological,and Economic Factors

• Income– Low-income adults have low intakes of many

nutrients– Food assistance programs available

• Social Isolation– Absence of social interactions

• Cultural Factors, Food Preferences, and Religious Beliefs

Dietary Assessment

• Purpose of Dietary Assessment– Provide insight into past and current food-intake

behaviors

• Classifications– Retrospective

• 24-Hour Recall• Food Frequency Questionnaires• Dietary History

Dietary Assessment

• Classifications– Prospective Methods

• Record of food intake obtained at the time the food is consumed

– Food Security• A person has access to enough food for an

active, healthy life at all times

Conclusion

• Nutrition screening and assessment can be used as the basis for initiating a plan of care for the older adult

• It is important to consider each older adult as a unique individual with individual nutritional needs and concerns

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