Page 345 - Nutrition Essentials for Nursing Practice

C H A P T E R 1 3 Nutrition for Older Adults 333

Nutrition Screening for Older Adults

Nutrition screening to identify presence or risk of malnutrition is appropriate in any setting
where older adults receive services or care, such as in hospitals, long-term care facilities,
community-based care, home health, and physician offices (Kamp, Wellman, and Russell,
2010). Screening is often the responsibility of the nurse.

A widely used quick and easy tool for screening older adults is the Mini Nutritional
Assessment–Short Form (MNA-SF) (Fig. 13.3). It is the newest version of a nutrition
screening tool designed and validated as a stand-alone tool to identify PCM in people
65 years and older (Skates and Anthony, 2012). It consists of six questions with a maxi-
mum possible score of 14. A score from 12 to 14 indicates normal nutritional status, 8 to
11 indicates at risk for malnutrition, and 7 or less indicates malnutrition. Scores less than
12 warrant further assessment by a dietitian.

NUTRITION-RELATED CONCERNS IN
OLDER ADULTS

Overall goals of nutrition therapy for older adults are to maintain or restore maximal in-
dependent functioning and health and to maintain the client’s sense of dignity and quality
of life by imposing as few dietary restrictions as possible. Nutrition therapy for older adults
should consider the individual’s physiologic, pathologic, and psychosocial conditions.

Arthritis

An estimated 50 million American adults have some form of doctor-diagnosed arthritis
(Cheng, Hootman, Murphy, and Helmick, 2010). Osteoarthritis (OA), the most common
form of arthritis, can lead to joint degeneration, chronic pain, muscle atrophy, impaired
mobility, and poor balance. Arthritis is the leading cause of disability (Centers for Disease
Control and Prevention [CDC], 2007).

OA is associated with aging and normal “wear and tear” on joints; the knee is the
most commonly affected joint. Excess body weight, which creates chronic mechanical
stress on the weight-bearing joints, is a well-established risk factor; 66% of adults with
doctor-diagnosed arthritis are overweight or obese (CDC, 2011). Other risk factors for OA
include genetics, age, gender, occupation, exercise, trauma, and muscle weakness (Arthritis
Foundation, 2012). Symptoms of OA usually appear after the age of 45 years.

The objective of treatment is to control pain, improve function, and reduce physical limi-
tations. Currently, there is no diet or specific food or food component known to effectively
prevent or treat arthritis (Bernstein and Munoz, 2012). However, weight loss and appropriate
exercise seem to have a positive effect on preventing and treating OA (Greenstone, 2007). Data
from the Arthritis, Diet, and Activity Promotion Trial (ADAPT) study of overweight and obese
older adults with OA of the knee showed that the combination of a weight loss diet and exercise
improved both subjective and objective measures of physical function and quality of life, and
the benefits were greater than when either diet or exercise was used alone (Messier et al., 2004).
Losing weight reduces strain on the weight-bearing joints; exercise improves strength, mobility,
and joint stability and may also reduce pain and improve function (Roddy et al., 2005).

Osteoporosis

Throughout life, bone tissue is constantly being destroyed and rebuilt, a process known
as remodeling. In the first few decades of life, net gain exceeds net loss as bone mass and