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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.


  • 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
    Imperative

    UWL: 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.

    • 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  

    • 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.

    • 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).
      • 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).  

    • 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

    • Minority Opinions

      Consensus reached.