The Role of Nutrition in Maintaining Health in the Nation's Elderly Evaluating Coverage of Nutrition Services for the Medicare Population (2000) / Chapter Skim
Currently Skimming:
4 Undernutrition
4 Undernutrition
Pages 63-92
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 63... ...
Section I} The Role of Nutrition in the Management of Disease
|
From page 64... ...
Schell E, Porter C, Paul S Reliability of percentage figures used to record the dietary intake of nursing home residents.
|
From page 65... ...
2. Syndromes of Undernutrition · Body composition changes with aging or sarcopenia · Cachexia · Wasting · Protein-energy undernutrition · Failure to thrive None of these markers or syndromes (except poor nutritional intake)
|
From page 66... ...
In the nursing home, the definition of weight loss has usually followed that included in the Omnibus Budget Reconciliation Act (OBRA) regulations of 1987.
|
From page 67... ...
in Medicare-certified nursing homes to ensure prompt identification and response to problems in nursing home residents. (The MDS is a functionally based assessment tool; RAPs utilize MDS assessment information to flag potential problem and risk areas in nursing home residents.)
|
From page 68... ...
Among nursing home residents, reversible factors such as poor oral intake, feeding dependency, chewing problems, depressive symptoms or behavior, medications, and swallowing disorders were related to observed weight loss in two cross-sectional studies (Blaum et al., 1995; Morley and Kraenzle, 1994~. In hospital settings (defined here as short-stay, acute care hospitals)
|
From page 69... ...
A case-series of persons who had lost at least 20 percent of their body weight or at least 10 percent in 3 months demonstrated improvement in nutritional parameters, including serum albumin, after being hospitalized in a nutritional support unit and receiving enteral nutrition via a nasogastric tube which provided approximately three times the measured energy expenditure for 4 weeks (Hebuterne et al., 1995~. In nursing home settings, many residents who sustain weight loss do so because they are not adequately fed, in part due to limitations of nursing resources (see discussion of "poor nutritional intake" below)
|
From page 70... ...
With aging, a smaller proportion of total body fat is subcutaneous; therefore, skinfold thickness is less likely to indicate total body fat in older compared to younger persons. Nevertheless, in community-dwelling older persons, low corrected arm muscle area and low TSF predict subsequent 40- to 46-month ageadjusted mortality.
|
From page 71... ...
Assessment methods for abnormal anthropometric measures are similar to those used for weight loss. Approaches to Treatment and Treatment Outcomes Anthropometric measures have been used as entry criteria in some clinical trials of nutritional supplementation in hospitalized older persons (Bestow et al., 1983; Gariballa et al., 1998~.
|
From page 72... ...
Approaches to Treatment and Treatment Outcomes A randomized clinical trial of nutritional supplements for demented patients with low BMI (15.1-19.9) who were admitted to a psychiatric hospital and who received a 600 kcal oral supplement demonstrated significant increases in weight (3.7 versus 0.6 kg)
|
From page 73... ...
Two studies have documented that nursing home staff significantly overestimate nutritional intake of nursing home residents (Kayser-Iones et al., 1997; Pokrywka et al., 1997~. In summary, efforts to develop assessment tools for use with elderly have not yet been able to identify aspects of health and status that can be monitored and evaluated objectively in older individuals with varying stages of functional capability that will accurately discriminate between those at risk and those not.
|
From page 74... ...
In one study, 26 percent of nursing home residents met the MDS criterion for poor oral intake and 9 percent met the criterion for hunger (Blaum et al., 1997~. Potentially Treatable Contributing Factors and Assessment Methods In hospitalized older persons, diagnostic testing and other reasons for a "nothing by mouth" restriction may contribute to poor nutritional intake beyond the burden of their acute illness.
|
From page 75... ...
Biochemical Markers of Malnutrition Visceral Proteins Although the relationship between serum albumin and nutritional intake is not well established, hypoalbuminemia is commonly considered a sign of malnutrition. However, low serum albumin levels may be a better measure of inflammation and associated decrease in albumin synthesis, increase in albumin degradation, and transcapillary leakage than of malnutrition (Rothschild et al., 1988~.
|
From page 76... ...
, may be responsible for acquired hypocholesterolemia (Ettinger et al., 1995~. A variety of demographic and nutrition-related variables were considered as potential predictors of 1-year mortality in a prospective cohort study at a Department of Veterans Affairs nursing home (Rudman and Feller, 1989~.
|
From page 77... ...
Individualized assessment and intervention are therefore necessary. The aging process is associated with notable changes in body composition.
|
From page 78... ...
Potentially Treatable Contributing Factors and Assessment Methods Possible causal factors for sarcopenia include age-related accelerated muscle loss or changes in muscle accretion or responsiveness to trophic hormonal or neurologic factors. Decline in endogenous growth hormone production, altered cytokine regulation, decreased androgen and estrogen production, and loss of alpha motor neurons in the spinal column have been suggested as factors (Roubenoff et al., 1997~.
|
From page 79... ...
Fiatarone and colleagues (1994) conducted a randomized, placebo-controlled trial of resistance exercise and/or multinutrient supplementation for over 10 weeks in 100 frail nursing home residents.
|
From page 80... ...
Life is not sustainable when body cell mass falls below 60 percent of usual levels (Kotler et al., 1989; Winick, 1979~. Potentially Treatable Contributing Factors Diseases or injury states in which cachexia is present at varying degrees include rheumatoid arthritis, congestive heart failure, chronic obstructive pulmonary disease, human immunodeficiency virus (HIV)
|
From page 81... ...
The common feature of wasting conditions is poor dietary intake that results in weight loss. Potentially Treatable Contributing Factors Disorders in which wasting is a clinically observable component include marasmus, cancer, advanced AIDS with opportunistic infection, critical illness without nutrition support, and chronic organ failure syndromes (i.e., renal, hepatic, lung)
|
From page 82... ...
Community-dwelling older persons who are homebound appear to be at particular risk for hypoalbuminemia; 19 percent had serum albumin levels less than 3.5 g/dL in one survey (Ritchie et al., 1997~. In the nursing home setting, approximately 28 percent of residents have albumin levels less than 3.5 g/dL (Abbasi and Rudman, 1993~.
|
From page 83... ...
Among nursing home residents who were hospitalized, one prospective cohort study found that severe hypoalbuminemia predicted mortality (Ferguson et al., 1993~. Low serum albumin has been predictive of 1-year mortality in male nursing home residents (Rudman et al., 1987~.
|
From page 84... ...
Approaches to Treatment and Treatment Outcomes Among hospitalized older persons, the most relevant research has been that aimed at poor nutritional intake (summarized above and in chapter 2~. There have been no randomized clinical trials of specific treatments for PEU or hypoalbuminemia in community-dwelling older persons, but a small case-series indicated that a nurse-administered, in-home assessment may uncover remediable problems that contribute to hypoalbuminemia (Reuben et al., 1999~.
|
From page 85... ...
Undernutrition among nursing home residents is also common. Inadequate numbers of qualified staff and resulting feeding problems are major contributors.
|
From page 86... ...
This evaluation should include some or all of the following: food security food-related functional status appetite and dietary intake depressive symptoms swallowing ability medications that might be associated with decreased appetite cognitive impairment disease-related dietary restrictions. · Adequacy of feeding assistance in nursing home and hospital settings should be a performance standard for licensing.
|
From page 87... ...
1995. Factors associated with low body mass index and weight loss in nursing home residents.
|
From page 88... ...
1993. Serum albumin and prealbumin as predictors of clinical outcomes of hospitalized elderly nursing home residents.
|
From page 89... ...
1997. Reliability of percentage figures used to record the dietary intake of nursing home residents.
|
From page 90... ...
1997. Accuracy of patient care staff in estimating and documenting meal intake of nursing home residents.
|
From page 91... ...
Protein-calorie undernutrition in the nursing home. J Am Geriatr Soc 37:173-183.
|
From page 92... ...
1994. Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomized single-blind trial.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.