Nutritional assessment of the elderly in a long-term care facility
Bowen, Barbara L.
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The average life expectancy is increasing each year and thus there is a rapid influx of population over 65, creating the need for more long-term care facilities. The elderly in long-term care facilities are likely to have complex chronic illness, physical impairments, malnutrition, and psychosocial factors which influence their nutritional status and possibly lead to protein-caloric malnutrition (PCM). The primary goal of the dietetic service in a facility is to improve or at least maintain the health of its residents. Thus, a study was conducted to determine the adequacy (RDA) of food served as well as the adequacy (RDA) of food intake in a specific long-term care facility and its relationship to the resident's present protein-calorie nutritional status. Elderly residents, 70 - 96 years old, with Organic Brain Syndrome, were involved in the Nutritional Assessment Program. Comparisons of residents' anthropometric measurements (weight, height, tricep skinfold [TSF], mid-arm-circumference [MAC], mid-arm-muscle-circumference [MAMC]), serum albumin (SA), and calorie-protein intake were included in this study. The general menu in this facility met the RDA for calories and 11 nutrients: protein, calcium, phosphorus, iron, sodium, potassium, vitamin A, thiamin, riboflavin, niacin, and vitamin C. In fact, the calorie mean of the menu was higher than the calorie mean required by the RDA. However, calories consumed by residents were inadequate in 27 percent of the cases while protein intake was more than adequate. Mild to severe malnutrition (PCM) did exist even though nutritionally adequate food was available on menu and eaten by the majority (73 percent) of residents. Nutritional status showed no relationship to food served or eaten when tested statistically with chi square. It is possible that the present norms for the RDA or anthropometric measurements are not applicable for the elderly with multiple medical diagnoses. Residents in this study have multiple medical diagnoses and require nursing care. This study indicates that nutritional care must be an individual concern since the complex aging process, illness, physical impairment, psychosocial forces are all unique to each specific person. It is suggested a series of inservices be given to residents, residents' families, and staff at this specific long-term care facility, on the complexity of the aging elderly, the possible nutritional involvement, as well as the nutritional recommended daily allowances. The food served in a specific long-term care facility should be evaluated and it should be determined how the calories on the menu can be lowered and still meet the RDA in all the nutrients- In the future, it may be advantageous to determine the percentage of the residents' daily nutrient intake falling within the Basic Four Food Groups. This may assist in determining accepted or non-accepted foods as well as types of foods lacking within the specific facility.