The Role of Nutrition in Maintaining Health in the Nation's Elderly Evaluating Coverage of Nutrition Services for the Medicare Population (2000) / Chapter Skim
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2 Overview: Nutritional Health in the Older Person
2 Overview: Nutritional Health in the Older Person
Pages 46-58
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From page 46... ...
Although this overview focuses on older persons, other Medicare beneficiaries, particularly those with end-stage renal disease, also have high rates of nutritional disorders. When considering the importance of nutrition in the health of Medicare beneficiaries, both the primary prevention of malnutrition and the role of nutrition in the management of health conditions prevalent in this population (secondary prevention)
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From page 47... ...
For example, changes in serum proteins among hospitalized older persons may be more reflective of inflammation and the acute-phase reaction than of malnutrition per se, whereas such changes may be more likely to indicate proteinenergy undernutrition in community-dwelling persons. In addition, nursing home residents may have chronic inflammation, which complicates both the diagnosis and the management of malnutrition.
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From page 48... ...
Conditions of energy undernutrition include adult marasmus (energy undernutrition) , in which normal serum proteins are maintained, and adult kwashiorkor (protein-energy undernutrition)
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From page 49... ...
(Corti et al., 1994~. In the MacArthur Studies of Successful Aging, which enrolled older persons who had little or no functional impairment at the study's onset, those with albumin levels less than or equal to 3.8 g/dL had an adjusted relative risk of 3-year mortality of 1.8 (Reuben et al., 1999~.
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From page 50... ...
Undernutrition in the nursing home is a particularly complex issue because of the burden of chronic disease and medications affecting nutritional status in this population and logistical difficulties in providing adequate food intake, in large part due to staffing issues (Kayser-Iones and Schell, 1997~. A review of 14 surveys of nutritional status conducted among chronically institutionalized older persons concluded that only 5 to 18 percent of nursing home residents had energy intakes below their
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From page 51... ...
Data from 26 VA nursing homes indicated that 12 percent of residents had body weights less than 80 percent of standard, and 28 percent had albumin levels less than 3.5 g/dL (Abbasi and Rudman, 1993~. Several emerging concepts of nutritional disorders of older persons have been identified that fall outside the traditional classifications of malnutrition.
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From page 52... ...
However, the Nutrition Screening Initiative's Determine Your Nutritional Health Checklist has received wide attention and has been incorporated into screening instruments in many health care settings. The Mini-Nutritional Assessment and Subjective Global Assessment have also received increased attention.
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From page 53... ...
Using the same cut point, the sensitivity, specificity, and positive predictive value for identifying perceived fair or poor health status were 46, 85, and 56 percent, respectively. When examining individual items, the strongest predictors of inadequate nutrition were "not enough money," "eating fewer than two meals per day," and "eating few fruits and vegetables." The only items significantly associated with fair or poor perceived health were "taking three or more drugs per day" and "having changed one's diet because of illness." A longitudinal study found that several individual items of the Determine Checklist predicted 8- to 12-year mortality, but the summary score for the entire instrument had a considerably lower predictive value than the individual items (Sahyoun et al., 1997~.
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From page 54... ...
combines weight change, dietary intake, gastrointestinal symptoms, functional capacity, and physical examination findings to classify individuals as well nourished, moderately malnourished or severely malnourished (Detsky et al., 1987b, 1994~. The SGA has demonstrated predictive validity in the identification of patients at risk for postoperative complications (Detsky et al., 1987a; VA TEN Cooperative Study Group, l991~.
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From page 55... ...
1987b. What is subjective global assessment of nutritional status?
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From page 56... ...
1993. Serum albumin and prealbumin as predictors of clinical outcomes of hospitalized elderly nursing home residents.
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1991. Protein-energy undernutrition and the risk of mortality within 1 y of hospital discharge in a select population of geriatric rehabilitation patients.
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From page 58... ...
1995. Involuntary weight loss in older outpatients: Incidence and clinical significance.
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