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August 2003, Volume 33 Number 8 , p 70 - 71





  • What's behind the problem

  • More protein needed

  • Nutrition assessment tests

  • Tools for nutrition screening


  • ELDERLY PEOPLE with nutritional deficiencies have higher rates of bone fractures, are more likely to experience prolonged hospitalization and poor wound healing, and have less successful treatment outcomes. Chronic illness can cause or compound malnutrition.

    All patients need more energy to heal, but because elderly patients may heal more slowly, we'll focus on them.

    A hospitalized elderly patient can be compromised by poor nutrition long before clinical or physical signs of malnutrition are apparent. Weight loss, usually considered the benchmark of nutritional decline, is actually a late sign.

    Nutritional screening and assessment should be part of regular care for all patients over age 65. (See Tools for Nutrition Screening.) Physical signs of chronic malnutrition may include dull, thin, or brittle hair; nail irregularities such as fissures or ridges, gums that are enlarged and bleed easily, glottitis, skeletal muscle wasting, and significant weight loss (defined as an unintentional loss of more than 5% of total body weight in 30 days or more than 10% in 180 days).

    You also may notice skin problems such as poor turgor, dryness, and flaking. These skin problems put the elderly patient at greater risk for pressure ulcers and for skin injuries from friction, shearing, and tearing forces.

    What's behind the problem

    Many factors can contribute to malnutrition in the elderly.

    * The gastrointestinal tract slows down with aging , so even if the patient is eating correctly, he may not be absorbing enough protein, vitamins, and minerals.

    * Tooth and mouth problems , common in older adults, may limit his food choices. For example, he may stop eating high-protein food ...

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