Recommendations Summary
UWL: Assessment of Nutritional Status 2009
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
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Recommendation(s)
UWL: Assessment of Nutritional Status
The Registered Dietitian (RD) should ensure that the nutrition assessment of older adults with unintended weight loss includes (but is not limited to) the following:
- Anthropometric measurements (e.g. height, weight, weight change)
- Biochemical data, medical tests and procedures
- Client history (e.g. cognitive decline, depression, neurological disease, hydration status, presence of infection and pressure ulcers, recent hospitalization, admission to healthcare communities and female gender)
- Food/nutrition-related history (e.g. loss of appetite, swallowing problems, eating dependency, low physical activity level, decreased activities of daily living)
Assessment of the above factors is needed to effectively determine nutrition diagnoses and plan the nutrition interventions; all of these are associated with adverse health effects in older adults.
Rating: Strong
ImperativeUWL: Instruments for Assessment of Nutritional Status
The Registered Dietitian (RD) should collaborate with other health care team members and policy makers to ensure that nutrition assessment tools have been validated in the older population. The Mini-Nutritional Assessment is the most widely studied and validated in this population; several other nutrition assessment instruments have also been developed but not validated.
Rating: Strong
Imperative-
Risks/Harms of Implementing This Recommendation
None.
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Conditions of Application
- The nutrition assessment is the professional responsibility of the Registered Dietitian (RD).
- The RD may direct other members of the health care team to gather data as appropriate, based on competencies and established protocols.
- If current data are not available, the RD should use professional judgment to request additional data
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Potential Costs Associated with Application
- Although medical nutrition therapy (MNT) costs and reimbursement vary, MNT is essential for improved outcomes.
- Accessibility and costs of biochemical parameter testing should be considered.
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Recommendation Narrative
- Regarding the UWL: Assessment of Nutritional Status recommendation, eight studies were evaluated regarding nutritional status and increasing age. Studies reported evidence or risk of malnutrition, declining nutritional status, and/or adverse health effects in elderly subjects; these were associated with female gender, cognitive decline, loss of appetite, swallowing problems, low activity level, eating dependency, recent hospitalization and admission to healthcare communities (Bedard et al, 2000; Laporte, Villalon and Payette, 2001; Laporte, Villalon and Thibodeau, 2001; Zuliani et al, 2001; Margetts et al, 2003; Bowman and Keller, 2005; Nakamura et al, 2006; Lou et al, 2007).
- Regarding the UWL: Assessment of Nutritional Status recommendation, twelve studies were evaluated regarding the association between underweight and/or weight loss and depression in adults over age 65. Four studies report an association between weight loss or poor nutritional status and depression (Thomas et al, 2002; Callen and Wells, 2005; Chen et al, 2005; Woods et al, 2005), while two studies report no association between low BMI and depression (Crogan and Pasvogel, 2003; Shum et al, 2005). Additional studies report that weight loss may be common in depressed individuals with Alzheimer's disease (Purandare et al, 2001; Starkstein et al, 2005), individuals who are recently widowed (Schulz et al, 2001; Shahar et al, 2001), demented individuals (Thomas et al, 2003), and individuals on antidepressant therapies (Rigler et al, 2001).
- Regarding the UWL: Assessment of Nutritional Status recommendation, seven studies that were evaluated report an association between underweight, weight loss and/or poor nutrition status and prevalence of infection in adults over age 65 (Langmore et al, 2002; van der Steen et al, 2002; Barreto et al, 2003; Rothan-Tondeur et al, 2003; Dambach et al, 2005; Paillaud et al, 2005; Schmaltz et al, 2005).
- Regarding the UWL: Assessment of Nutritional Status recommendation, eight studies were evaluated regarding the association between underweight or weight loss and decreased appetite in adults over age 65. Studies report an association between reduced appetite and poor protein and energy intake, resulting in weight loss and poor nutritional status (Shahar et al, 2001; de Castro, 2002; Mowe and Bohmer, 2002; Sullivan et al, 2002; Suzana et al, 2002; St. Arnaud-McKenzie et al, 2004; Knoops et al, 2005; Saletti et al, 2005).
- Regarding the UWL: Assessment of Nutritional Status recommendation, fifteen studies were evaluated regarding the association between underweight and/or weight loss and a decrease in the activities of daily living in adults over age 65. All studies report an association between poor nutritional status, frailty, underweight and/or weight loss with a decrease in the activities of daily living (Payette et al, 2000; Huang et al, 2001; Pearson et al, 2001; Richardson et al, 2001; Woo et al, 2001; Zuliani et al, 2001; Corbett et al, 2002; Janssen et al, 2002; Al Snih et al, 2005; Boyd et al, 2005; Kikafunda and Lukwago, 2005; Odlund Olin et al, 2005; Ottenbacher et al, 2005; Shum et al, 2005; Woods et al, 2005).
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Regarding the UWL: Assessment of Nutritional Status recommendation, twenty-six studies were evaluated regarding the association between underweight and/or weight loss and neurological disease in adults over age 65. All studies report an association between underweight and/or weight loss in patients who have cognitive impairment (Keller and Ostbye, 2000; Pearson et al, 2001; Shatenstein et al, 2001; Corbett et al, 2002; Brubacher et al, 2004; Keller and Ostbye, 2005; Odlund Olin et al, 2005), including Alzheimer's disease and other dementia disorders (Bedard et al, 2000; Purandare et al, 2001; Hu et al, 2002; Holm and Soderhamn, 2003; Wang et al, 2004; White et al, 2004; Buchman et al, 2005; Faxen-Irving et al, 2005; Guerin, Andrieu et al, 2005; Guerin, Soto et al, 2005; Kagansky et al, 2005; Knoops et al, 2005; Starkstein et al, 2005; Stewart et al, 2005; Johnson et al, 2006), Parkinson's disease (Chen et al, 2003; Lorefalt, Ganowiak et al, 2004; Lorefalt, Ganowiak et al, 2006), and stroke (Poels et al, 2006).
- Regarding the UWL: Instruments for Assessment of Nutritional Status recommendation, twenty studies were evaluated regarding the use of particular instruments for nutrition assessment of older adults with unintended weight loss. The Mini-Nutritional Assessment is the most widely studied and validated instrument in this population (Murphy et al, 2000; Saletti et al, 2000; Andrieu et al, 2001; Van Nes et al, 2001; Gerber et al, 2003; Magri et al, 2003; Ruiz-Lopez et al, 2003; Arellano et al, 2004; Soini et al, 2004; Kuzuya et al, 2005; Langkamp-Henken et al, 2005; Wojszel et al, 2006; Kulnik et al, 2008). Several other nutrition assessment instruments have also been developed but not validated (Donini et al, 2004; Norman et al, 2005; Nursal, Noyan, Tarim et al, 2005; Crogan and Alvine, 2006). Further validation research on these nutrition assessment instruments is needed (Bauer et al, 2005; Kucukerdonmez et al, 2005; Nursal, Noyan, Atalay et al, 2005).
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Recommendation Strength Rationale
- Conclusion Statements in support of the UWL: Assessment of Nutritional Status recommendation received Grades I and II
- Conclusion Statement in support of the UWL: Instruments for Assessment of Nutritional Status recommendation received Grade I
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Minority Opinions
Consensus reached.
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Supporting Evidence
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
What is the evidence regarding the use of particular instruments for nutrition assessment of older adults with unintended weight loss?
Is there a relationship between nutritional status and increasing age?
What is the evidence that underweight or weight loss is associated with depression in adults over age 65?
What is the evidence that underweight and/or weight loss is associated with prevalence of infection in adults over age 65?
What is the evidence that underweight or weight loss is associated with decreased appetite in adults over age 65?
What is the evidence that underweight or weight loss is associated with a decrease in the activities of daily living in adults over age 65?
What is the evidence that underweight and weight loss is associated with neurological disease in adults over age 65?-
References
Andrieu S, Reynish W, Nourhashemi F, Ousset PJ, Grandjean H, Grand A, Albarede JL, Vellas B. Nutritional risk factors for institutional placement in Alzheimer's disease after one-year follow-up. J Nutr Health Aging. 2001; 5(2): 113-117.
Arellano M, Garcia-Caselles MP, Pi-Figueras M, Miralles R, Torres RM, Aguilera A, Cervera AM. Clinical impact of different scores of the Mini Nutritional Assessment (MNA) in the diagnosis of malnutrition in patients with cognitive impairment. Arch Gerontol Geriatr Suppl. 2004; (9): 27-31.
Bauer JM, Vogl T, Wicklein S, Trögner J, Mühlberg W, Sieber CC. Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients. Z Gerontol Geriatr. 2005 Oct; 38 (5): 322-327. PMID: 16244816
Crogan NL, Alvine C. Testing of the Individual Nutrition Rx assessment process among nursing home residents. Appl Nurs Res. 2006; 19(2): 102-104.
Donini LM, De Bernardini L, De Felice MR, Savina C, Coletti C, Cannella C. Effect of nutritional status on clinical outcome in a population of geriatric rehabilitation patients. Aging Clin Exp Res. 2004; 16(2): 132-138.
Gerber V, Krieg MA, Cornuz J, Guigoz Y, Burckhardt P. Nutritional status using the Mini Nutritional Assessment questionnaire and its relationship with bone quality in a population of institutionalized elderly women. J Nutr Health Aging. 2003; 7 (3): 140-145.
Kucukerdonmez O, Koksal E, Rakicioglu N, Pekcan G. Assessment and evaluation of the nutritional status of the elderly using two different instruments. Saudi Med J. 2005; 26(10): 1,611-1,616.
Kulnik D, Elmadfa I. Assessment of the nutritional situation of elderly nursing home residents in Vienna. Ann Nutr Metab. 2008; 52 (suppl 1): 51-53.
Kuzuya M, Kanda S, Koike T, Suzuki Y, Satake S, Iguchi A. Evaluation of Mini-Nutritional Assessment for Japanese frail elderly. Nutrition 2005; 21(4): 498-503.
Langkamp-Henken B, Hudgens J, Stechmiller JK, Herrlinger-Garcia KA. Mini nutritional assessment and screening scores are associated with nutritional indicators in elderly people with pressure ulcers. J Am Diet Assoc. 2005; 105: 1,590-1,596.
Magri F, Borza A, del Vecchio S, Chytiris S, Cuzzoni G, Busconi L, Rebesco A, Ferrari E. Nutritional assessment of demented patients: a descriptive study. Aging Clin Exp. 2003; 15(2): 148-153.
Murphy MC, Brooks CN, New SA, Lumbers ML. The use of the Mini-Nutritional Assessment (MNA) tool in elderly orthopaedic patients. European Journal of Clinical Nutrition, 2000; 54: 555-562.
Norman K, Schutz T, Kemps M, Lubke HJ, Lochs H, Pirlich M. The Subjective Global Assessment reliably identifies malnutrition-related muscle dysfunction. Clin Nutr. 2005; 24 (1): 143-150.
Nursal TZ, Noyan T, Atalay BG, Köz N, Karakayali H. Simple two-part tool for screening of malnutrition. Nutrition. 2005 Jun; 21(6): 659-665.
Nursal TZ, Noyan T, Tarim A, Karakayali H. A new weighted scoring system for Subjective Global Assessment. Nutrition 2005; 21 (6): 666-671.
Ruiz-Lopez MD, Artacho R, Oliva P, Moreno-Torres R, Bolanos J, de Teresa C, Lopez MC. Nutritional risk in institutionalized older women determined by the Mini Nutritional Assessment test: What are the main factors? Nutrition 2003; 19 (9): 767-771.
Saletti A, Lindgren EY, Johansson L, Cederholm T. Nutritional status according to Mini Nutritional Assessment in an institutionalized elderly population in Sweden. Gerontology. 2000;46(3):139-145.
Soini H, Routasalo P, Lagstrom H. Characteristics of the Mini-Nutritional Assessment in elderly home care patients. Eur J Clin Nutr. 2004; 58 (1): 64-70.
Van Nes MC, Herrmann FR, Gold G, Michel JP, Rizzoli R. Does the Mini Nutritional Assessment predict hospitalization outcomes in older people? Age and Ageing. 2001; 30: 221-226.
Wojszel ZB. Determinants of nutritional status of older people in long-term care settings on the example of the nursing home in Bialystok. Adv Med Sci. 2006; 51: 168-173.
Bedard M, Molloy DW, Bell R, Lever JA. Determinants and detection of low body mass index in community-dwelling adults with Alzheimer's disease. International Psychogeriatrics. 2000; 12(1): 87-98.
Bowman JJ, Keller HH. Assessing nutritional risk of long-term care residents. Can J Diet Prac Res. 2005; 66: 155-161.
Laporte M, Villalon L, Payette H. Simple nutrition screening tools for healthcare facilities: Development and validity assessment. Can J Diet Pract Res. 2001 Spring; 62(1): 26-34.
Laporte M, Villalon L, Thibodeau J, Payette H. Validity and reliability of simple nutrition screening tools adapted to the elderly population in healthcare facilities. J Nutr Health Aging. 2001; 5 (4): 292-294.
Lou MF, Dai YT, Huang GS, Yu PJ. Nutritional status and health outcomes for older people with dementia living in institutions. J Adv Nurs. 2007; 60(5): 470-477.
Margetts BM, Thompson RL, Elia M, Jackson AA. Prevalence of risk of undernutiriton is associated with poor health status in older people in the UK. Eur J Clin Nutr. 2003; 57: 69-74.
Nakamura H, Fukushima H, Miwa Y, Shiraki M, Gomi I, Saito M, Mawatari K, Kobayashi H, Kato M, Moriwaki H. A longitudinal study on the nutritional state of elderly women at a nursing home in Japan. Intern Med. 2006; 45(20): 1,113-1,120.
Zuliani G, Romagnoni F, Soattin L, Leoci V, Volpato S, Fellin R. Predictors of two-year mortality in older nursing home residents. The IRA study. Aging Clin Exp Res. 2001; 13: 3-7.
Callen BL, Wells TJ. Screening for nutritional risk in community-dwelling old-old. Public Health Nurs. 2005;22(2):138-146.
Chen CC, Chang CK, Chyun DA, McCorkle R. Dynamics of nutritional health in a community sample of American elders: A multidimensional approach using Roy Adaptation Model. ANS Adv Nurs Sci. 2005; 28 (4): 376-389.
Crogan NL, Pasvogel A. The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol A Biol Sci Med Sci. 2003; 58 (2): 159-164.
Purandare N, Burns A, Craig S, Faragher B, Scott K. Depressive symptoms in patients with Alzheimer's disease. Int J Geriatr Psychiatry. 2001; 16 (10): 960-964.
Rigler SK, Webb MJ, Redford L, Brown EF, Zhou J, Wallace D. Weight outcomes among antidepressant users in nursing facilities. J Am Geriatr Soc. 2001; 49(1): 49-55.
Schulz R, Beach SR, Lind B, Martire LM, Zdaniuk B, Hirsch C, Jackson S, Burton L. Involvement in caregiving and adjustment to death of a spouse: Findings from the Caregiver Health Effects Study. JAMA. 2001; 285(24): 3,123-3,129.
Shahar DR, Schultz R, Shahar A, Wing RR. The effect of widowhood on weight change, dietary intake, and eating behavior in the elderly population. J Aging Health. 2001; 13 (2): 189-199.
Shum NC, Hui WW, Chu FC, Chai J, Chow TW. Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital. Hong Kong Med J. 2005; 11(4): 234-242.
Starkstein SE, Jorge R, Mizrahi R, Robinson RG. The construct of minor and major depression in Alzheimer's disease. Am J Psychiatry. 2005; 162 (11): 2,086-2,093.
Thomas P, Hazif-Thomas C, Clement JP. Influence of antidepressant therapies on weight and appetite in the elderly. J Nutr Health Aging. 2003; 7(3): 166-170.
Thomas DR, Zdrowski CD, Wilson MM, Conright KC, Lewis C, Tariq S, Morley JE. Malnutrition in subacute-care. Am J Clin Nutr. 2002; 75: 308-313.
Woods NF, LaCroix AZ, Gray SL, Aragaki AA, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB. Frailty: Emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. J Am Geriatr Soc. 2005; 53 (8): 1,321-1,330.
Barreto SM, Passos VM, Lima-Costa MF. Obesity and underweight among Brazilian elderly: The Bambui Health and Aging Study. Cad Saude Publica. 2003; 19(2): 605-512.
Dambach B, Salle A, Marteau C, Mouzet JB, Ghali A, Favreau AM, Berrut G, Ritz P. Energy requirements are not greater in elderly patients suffering from pressure ulcers. J Am Geriatr Soc 2005;53:478-482.
Langmore SE, Skarupski KA, Park PS, Fries BE. Predictors of aspiration pneumonia in nursing home residents. Dysphagia. 2002; 17(4): 298-307.
Paillaud E, Herbaud S, Caillet P, Lejonc JL, Campillo B, Bories PN. Relations between undernutrition and nosocomial infections in elderly patients. Age and Ageing. 2005; 34: 619-625.
Rothan-Tondeur M, Meaume S, Girard L, Weill-Engerer S, Lancien E, Abdelmalak S, Rufat P, Le Blanche AF. Risk factors for nosocomial pneumonia in a geriatric hospital: A control-case one-center study. J Am Geriatr Soc. 2003; 51: 997-1,001.
Schmaltz HN, Fried LP, Xue QL, Walston J, Leng SX, Semba RD. Chronic cytomegalovirus infection and inflammation are associated with prevalent frailty in community-dwelling older women. J Am Geriatr Soc. 2005; 53(5): 747-754.
van der Steen JT, Ooms ME, Mehr DR, van der Wal G, Ribbe MW. Severe dementia and adverse outcomes of nursing-home acquired pneumonia: evidence for mediation by functional and pathophysiological decline. J Am Geriatr Soc. 2002; 50 (3): 439-448.
de Castro JM. Age-related changes in the social, psychological and temporal influences on food intake in free-living, healthy, adult humans. J Gerontol A Biol Sci Med Sci. 2002; 57 (6): M368-M377.
Knoops KTB, Slump E, de Groot LCPGM, Wouters-Wesseling W, Brouwer ML, van Staveren WA. Body weight changes in elderly psychogeriatric nursing home residents. J Gerontol A Biol Sci Med Sci. 2005; 60 (4): 536-539.
Mowe M, Bohmer T. Reduced appetite. A predictor for undernutrition in aged people. J Nutr Health Aging. 2002; 6 (1): 81-83.
Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg K, Cederholm T. Nutritional status and a 3-year follow-up in elderly receiving support at home. Gerontology, 2005; 51 (3): 192-198.
Shahar DR, Schultz R, Shahar A, Wing RR. The effect of widowhood on weight change, dietary intake, and eating behavior in the elderly population. J Aging Health. 2001; 13 (2): 189-199.
St. Arnaud-McKenzie D, Paquet C, Kergoat MJ, Ferland G, Dube L. Hunger and aversion: drives that influence food intake of hospitalized geriatric patients. J Gerontol A Biol Sci Med Sci 2004;59(12):1304-1309.
Sullivan DH, Morley JE, Johnson LE, Barber A, Olson JS, Stevens MR, Yamashita BD, Reinhart SP, Trotter JP, Olave XE. The GAIN (Geriatric Anorexia Nutrition) Registry: The impact of appetite and weight on mortality in a long-term care population. J Nutrition Health and Aging. 2002; 6 (4): 275-281.
Suzana S, Earland J, Suriah AR, Warnes AM. Social and health factors influencing poor nutritional status among rural elderly Malays. J Nutr Health Aging 2002;6(6):363-369.
Al Snih S, Raji M, Markides K, Ottenbacher K, Goodwin J. Weight change and lower body disability in older Mexican Americans. J Am Geriatr Soc. 2005; 53: 1,730-1,737.
Boyd CM, Xue QL, Simpson CF, Guralink JM, Fried LP. Frailty, hospitalization, and progression of disability in a cohort of disabled older women. Am J Med. 2005; 118: 1,225-1,231.
Corbett CF, Crogan NL, Short RA. Using the minimum data set to predict weight loss in nursing home residents. Applied Nursing Research. 2002; 15 (4): 249-253.
Huang Y, Wueng S, Ou C, Cheng C, Su K. Nutritional status of functionally dependent and nonfunctionally dependent elderly in Taiwan. J Am College Nutr. 2001; 20: 135-142.
Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc. 2002; 50: 889-896.
Kikafunda JK, Lukwago FB. Nutritional status and functional ability of the elderly aged 60 to 90 years in the Mpigi district of central Uganda. Nutrition 2005; 21 (1): 59-66.
Odlund Olin A, Koochek A, Ljungqvist O, Cederholm T. Nutritional status, well-being and functional ability in frail elderly service flat residents. Eur J Clin Nutr. 2005; 59: 263-270.
Ottenbacher KJ, Ostir GV, Peek MK, Snih SA, Raji MA, Markides KS. Frailty in older Mexican Americans. J Am Geriatr Soc. 2005; 53(9): 1,524-1,531.
Payette H, Coulombe C, Boutier V, Gray-Donald K. Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population. Journal of Clinical Epidemiology. 2000; 53: 579-587.
Pearson JM, Schlettwein-Gsell D, Brzozowska A, van Staveren WA, Bjornsbo K. Life style characteristics associated with nutritional risk in elderly subjects aged 80 - 85 years. J Nutr Health Aging. 2001; 5 (4): 278-283.
Richardson J, Bedard M, Weaver B. Changes in physical functioning in institutionalized older adults. Disabil Rehabil. 2001; 23(15): 683-689.
Shum NC, Hui WW, Chu FC, Chai J, Chow TW. Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital. Hong Kong Med J. 2005; 11(4): 234-242.
Woo J, Ho SC, Sham A. Longitudinal changes in body mass index and body composition over three years and relationship to health outcomes in Hong Kong Chinese age 70 and older. J Am Geriatric Soc. 2001; 49: 737-746.
Woods NF, LaCroix AZ, Gray SL, Aragaki AA, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB. Frailty: Emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. J Am Geriatr Soc. 2005; 53 (8): 1,321-1,330.
Zuliani G, Romagnoni F, Volpato S, Soattin L, Leoci V, Bollini MC, Buttarello M, Lotto D, Fellin R. Nutritional parameters, body composition, and progression of disability in older disabled residents living in nursing homes. J Gerontol A Biol Sci Med Sci. 2001; 56(4): M212-M216.
Bedard M, Molloy DW, Bell R, Lever JA. Determinants and detection of low body mass index in community-dwelling adults with Alzheimer's disease. International Psychogeriatrics. 2000; 12(1): 87-98.
Brubacher D, Monsch AU, Stahelin HB. Weight change and cognitive performance. Int J Obes Relat Metab Disord. 2004; 28(9): 1,163-1,637.
Buchman AS, Wilson RS, Bienias JL, Shah RC, Evans DA, Bennett DA. Change in body mass index and risk of incident Alzheimer disease. Neurology. 2005; 65(6): 892-897.
Chen H, Zhang SM, Hernan MA, Willett WC, Ascherio A. Weight loss in Parkinson's disease. Ann Neurol. 2003; 53(5): 676-679.
Corbett CF, Crogan NL, Short RA. Using the minimum data set to predict weight loss in nursing home residents. Applied Nursing Research. 2002; 15 (4): 249-253.
Faxen-Irving G, Basun H, Cederholm T. Nutritional and cognitive relationships and long-term mortality in patients with various dementia disorders. Age Ageing. 2005; 34(2): 136-141.
Guerin O, Andrieu S, Schneider SM, Milano M, Boulahssass R, Brocker P, Vellas B. Different modes of weight loss in Alzheimer disease: A prospective study of 395 patients. Am J Clin Nutr. 2005; 82: 435-441.
Guerin O, Soto ME, Brocker P, Robert PH, Benoit M, Vellas B, REAL.FR Group. Nutritional status assessment during Alzheimer's disease: Results after one year (the REAL French Study Group). J Nutr Health Aging. 2005; 9(2): 81-84.
Holm B, Soderhamn O. Factors associated with nutritional status in a group of people in an early stage of dementia. Clin Nutr. 2003; 22: 385-389.
Hu X, Okamura N, Arai H, Higuchi M, Maruyama M, Itoh M, Yamaguchi K, Sasaki H. Neuroanatomical correlates of low body weight in Alzheimer's disease: A PET study. Prog Neuropsychopharmacol Biol Psychiatry. 2002; 26(7-8): 1,285-1,289.
Johnson DK, Wilkins CH, Morris JC. Accelerated weight loss may precede diagnosis in Alzheimer disease. Arch Neurol. 2006; 63(9): 1,312-1,317.
Kagansky N, Berner Y, Koren-Morag N, Perelman L, Knobler H, Levy S. Poor nutritional habits are predictors of poor outcome in very old hospitalized patients. Am J Clin Nutr. 2005; 82: 784-791.
Keller HH, Ostbye T. Do nutrition indicators predict death in elderly Canadians with cognitive impairment? Can J Public Health. 2000; 91(3): 220-224.
Keller HH, Ostbye T. Body mass index (BMI), BMI change and mortality in community-dwelling seniors without dementia. J Nutr Health Aging. 2005; 9 (5): 316-320.
Knoops KTB, Slump E, de Groot LCPGM, Wouters-Wesseling W, Brouwer ML, van Staveren WA. Body weight changes in elderly psychogeriatric nursing home residents. J Gerontol A Biol Sci Med Sci. 2005; 60 (4): 536-539.
Lorefalt B, Ganowiak W, Palhagen S, Toss G, Unosson M, Granerus AK. Factors of importance for weight loss in elderly patients with Parkinson's disease. Acta Neurol Scand. 2004; 110(3): 180-187.
Lorefalt B, Ganowiak W, Wissing U, Granerus AK, Unosson M. Food habits and intake of nutrients in elderly patients with Parkinson's disease. Gerontology. 2006; 52: 160-168.
Odlund Olin A, Koochek A, Ljungqvist O, Cederholm T. Nutritional status, well-being and functional ability in frail elderly service flat residents. Eur J Clin Nutr. 2005; 59: 263-270.
Pearson JM, Schlettwein-Gsell D, Brzozowska A, van Staveren WA, Bjornsbo K. Life style characteristics associated with nutritional risk in elderly subjects aged 80 - 85 years. J Nutr Health Aging. 2001; 5 (4): 278-283.
Poels BJ, Brinkman-Zijlker HG, Dijkstra PU, Postema K. Malnutrition, eating difficulties and feeding dependence in a stroke rehabilitation centre. Disabil Rehabil. 2006; 28(10): 637-643.
Purandare N, Burns A, Craig S, Faragher B, Scott K. Depressive symptoms in patients with Alzheimer's disease. Int J Geriatr Psychiatry. 2001; 16 (10): 960-964.
Shatenstein B, Kergoat MJ, Nadon S. Anthropometric changes over five years in elderly Canadians by age, gender and cognitive status. J Gerontol A Biol Sci Med Sci. 2001; 56(8): M483-M488.
Starkstein SE, Jorge R, Mizrahi R, Robinson RG. The construct of minor and major depression in Alzheimer's disease. Am J Psychiatry. 2005; 162 (11): 2,086-2,093.
Stewart R, Masaki K, Xue QL, Peila R, Petrovitch H, White LR, Launer LJ. A 32-year prospective study of change in body weight and incident dementia: The Honolulu-Asia Aging Study. Arch Neurol. 2005; 62: 55-60.
Wang PN, Yang CL, Lin KN, Chen WT, Chwang LC, Liu HC. Weight loss, nutritional status and physical activity in patients with Alzheimer's Disease: A controlled study. J Neurol. 2004; 251: 314-320.
White HK, McConnell ES, Bales CW, Kuchibhatla M. A six-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer's disease subjects. J Am Med Dir Assoc. 2004; 5: 89-97. -
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
The Role of Nutrition in Pressure Ulcer Prevention and Treatment: National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel, 2009. Accessible at www.npuap.org.
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References