Midsummer is a great time to consider the importance of nutritional health, as there is an abundance of fresh fruits and vegetables in markets and roadside stands. As professionals, we are aware of associations found between eating a healthy diet and well-being. The season provides a perfect backdrop for us to renew our commitment to eat more healthy foods and to promote the nutritional health of the older people we serve.

Remember these old sayings: “We are what we eat” or “An apple a day . . .” etc. These well-known truisms continue to spur many people to make conscious decisions to eat a healthy diet even though the ease of high fat, cholesterol-laden fast foods provide ever-present temptations. Promoting nutritional health becomes critical as we age because of the significant impact that natural changes exert on dietary intake. For example, the status of oral health, dentition, digestion, absorption, and medication interactions may converge to negatively impact our diet and lead to a poor diet or malnutrition.

As professionals, we know that many diseases are linked with unhealthy nutrition which increases the vulnerability of older adults to develop chronic illnesses such as cancer, diabetes, coronary heart disease, and stroke. We also understand aging involves inherent social, cultural, and financial issues that may exert influence on nutritional health. The combination of chronic illness and additional age-related challenges that people experience has the potential to increase nutritional risk. We have a responsibility to include routine nutritional health screening and promotion to help maintain and optimize the overall health of older people.

Nutritional Screening Tools

Several nutrition screening tools are available for use by professional health providers. Here are two screening instruments for your consideration:

1. DETERMINE- Your Nutritional Health Checklist: Developed by the Nutritional Screening Initiative (NSI), a collaborative effort by several health, medical, and aging organizations, this mnemonic highlights warning signs and risk factors that may indicate the potential for unhealthy nutrition in older people.

    

   There are also 10 questions that an older person or someone who is caregiver for the person answers. Each question is scored 1-4 under a “yes” column and totaled for a nutritional risk score: 0-2=good; 3-5=moderate risk, 6 or more=high nutritional risk.2

   Disease
   Eating poorly
   Tooth loss, mouth pain
   Economic hardship
   Reduced social contact
   Multiple medicines
   Involuntary weight loss or gain
   Need for assistance in self-care
   Elderly (age>80 years)

2. Mini Nutritional Assessment (MNA): A two-part validated tool that helps professionals identify older people at risk for or experiencing malnutrition. This instrument is designed to take three minutes to administer and assesses food intake, mobility and BMI, weight loss, psychological stress, acute disease, dementia or psychological conditions.

Based on good evidence, the U.S. Preventive Services Task Force (USPSTF) recommends educational counseling as beneficial to older adults at increased risk for chronic illness as they age. Outcomes of counseling interventions indicate that older people made changes in their nutrition when the counseling was focused on diet-related chronic illnesses.³ The literature provides abundant nutritional guidelines for older adults along with many recommendations on dietary interventions.

References:

1. Aging in New York, State Plan on Aging Available online January 12, 2009, Center for Aging with Dignity.
2. Mauk, K. (2006). Gerontological Nursing: Competencies for Care. Boston: Jones & Bartlett.

GERO GEMS are a monthly publication of the Center for Aging with Dignity. Compiled by Evelyn Fitzwater, Gero Gems is designed to raise awareness of aging and related issues impacting health care professionals and our society as a whole.

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