A nurse is assessing nutritional status in an 82-year-old client during an annual wellness visit. The client lives alone and reports decreased appetite over the past 3 months. Which actions reflect evidence-based geriatric nutritional assessment? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Use a validated older-adult nutrition screen such as the MNA or MNA-SF (Choice 1). Assess recent unintentional weight loss because 5% in 1 month or 10% in 6 months is a major warning sign (Choice 3). Identify barriers such as dental problems, medication effects, food insecurity, isolation, depression, and dysphagia so interventions address the cause (Choice 5). Bed rest and activity restriction worsen deconditioning and sarcopenia (Choice 2). BMI alone can miss low muscle mass or fluid-related weight changes and must be combined with weight trends and functional assessment (Choice 4). Routine severe protein restriction is not appropriate for every older adult and can worsen sarcopenia; intake should be individualized for renal function, illness, and activity (Choice 6).
Memory Tip "5/10 weight loss rule": ≥ 5% in 1 month or ≥ 10% in 6 months = significant.
Caution Routine protein restriction is harmful unless specific medical indication (advanced CKD without dialysis). Sarcopenia prevention is more important than feared kidney load in most older adults.
Scenario82 y.o., living alone, annual visit. Reports decreased appetite × 3 months. Spouse died 6 months ago. Wears partial dentures, complains they hurt while eating. Takes 8 medications. Weight 58 kg (was 64 kg 6 months ago — 9% loss). BMI 21.
MNA-SF Today1. Food intake decreased moderately = 12. Weight loss > 3 kg = 03. Mobility OK = 24. No acute disease = 25. Mild dementia (cognitive screen Q) = 16. BMI 21 = 2Total = 8 → at risk for malnutrition
Intervention Plan- Dental referral for denture adjustment- Pharmacist medication review (drug-induced anorexia/dry mouth)- Depression screen (PHQ-2 first, then PHQ-9)- Refer to community meal program (Meals on Wheels) for social and nutritional support- Dietitian referral for individualized plan, protein 1.2 g/kg/day target- Oral nutritional supplement BID between meals- Follow-up weight in 4-6 weeks
Avoid- Routine protein restriction- Bed rest recommendations- BMI alone as marker
Mini Nutritional Assessment (MNA) — Validated nutritional screening tool specifically for adults 65 and older. Full version 18 items, short form (MNA-SF) 6 items. Screens recent food intake, weight loss, mobility, stress/disease, cognitive/psychological status, and BMI. Score categories: 12-14 normal nutrition, 8-11 at risk for malnutrition, 0-7 malnourished. MNA-SF is endorsed by ESPEN.
Significant unintentional weight loss — Important malnutrition warning sign in older adults: ≥ 5% body weight loss in 1 month, or ≥ 10% in 6 months, when not intended. Triggers nutritional assessment, evaluation for underlying disease (cancer, depression, hyperthyroidism, infection), medication review, and intervention plan.
Sarcopenia — Age-related loss of skeletal muscle mass and strength, accelerated by inactivity, inadequate protein intake, and acute illness. Increases fall risk, disability, and mortality. Prevention/treatment: resistance exercise, adequate protein 1.0-1.2 g/kg/day (1.2-1.5 with acute illness or established sarcopenia), vitamin D adequacy. BMI does not detect; check grip strength and gait speed.