Review of nutrition screening methods in elderly persons - adapted from the Journal of the American

Date: Oct, 1995

A large percentage of older persons are overweight or malnourished. In a recent national survey, approximately 30 to 40 percent of elderly persons reported caloric and vitamin intake at levels less than two-thirds the recommended dietary allowance. Malnutrition, particularly in hospital and nursing home settings, is associated with increased length of hospital stay, hospital readmission and mortality. Approximately 25 percent of men and 40 percent of women over the age of 65 are overweight. Although overweight is associated with heart disease, diabetes, cholelithiasis, gout and arthritis, some recent evidence suggests that mild obesity may be protective against hip fracture and may pose less of a health risk in older persons than in younger persons. Reuben and colleagues examine the efficacy of currently available nutrition screening methods in elderly persons.

Current nutrition screening tests include self- or interviewer-administered questionnaires, subjective assessment by health professionals, and anthropometric measures and biochemical tests. Low income, social isolation and illness, and food security have been identified as important risk factors for poor nutrition. Food security (defined as stable sufficient access in socially acceptable ways to enough food of sufficient quality to lead to a healthy life) is a priority concern in the evaluation of dietary quality among elderly persons.

The authors note that energy and nutrient intake can be assessed quickly (in less than 20 minutes) during an office visit by completing a 24-hour diet recall, although a more reliable estimate of caloric intake requires calculating an average of data covering one to two weeks. A more structured dietary history and food frequency questionnaire may take up to an hour and requires a nutritionist, dietitian or other trained personnel to administer.

The authors describe the tiered approach to nutrition screening, developed by the American Academy of Family Physicians, the American Dietetic Association and the National Council on Aging. This method relies first on a checklist to identify older persons at higher nutritional risk. Persons at risk are then screened for a 10-lb weight gain or weight loss within six months, eating habits, living environment, and functional and cognitive status. Medication and drug use are also included in the assessment. Anthropometric measures, including body mass index, mid-arm circumference and triceps skinfold, and laboratory measures, such as serum albumin and cholesterol, are also factors to consider m this approach to determining nutritional status in elderly persons. The authors call for the continued pursuit of improved nutrition screens for use in this population. (Journal of the American Geriatrics Society, April 1995, vol. 43, p. 415.)

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