Nutrition: From Assessment to Intervention

Written by Ide-Marie Venter

Optimal nutrition is essential to ensure best possible health and quality of life for older adults. Specialised individual nutritional care plays a vital role in the prevention, management and improvement of a variety of conditions and diseases.

The prevalence of malnutrition in care facilities around the world is alarmingly high. Nearly 40% of hospitalised older people are malnourished and up to 67% of elderly in nursing homes and 38% of older people living in the community are malnourished or at risk of malnutrition.

“Malnourished older people are at increased risk of falls, lengthy
hospital stay and rehabilitation, postoperative complications,
infections, pressure ulcers, poor wound healing, impaired muscle
and respiratory function and death.”

– D Harris et al, 2005

There are a variety of increased risks associated with malnutrition as indicated above. Therefore a trans-disciplinary approach to pool expertise through a holistic view is essential for early detection and prompt treatment. Diagram 1 shows the process to be followed to ensure optimal nutritional status of residents.

Nutrition_1

Diagram 1


 

Nutritional Assessment:

The trans-disciplinary team doing the assessment should ideally consist of a nursing professional, careworkers, dietitian, catering manager, occupational therapist and the resident (plus any other professionals involved). Diagram 2 summarises factors with examples that should be taken into account when assessing an individual in order to compile a nutritional diagnosis.

Nutrition_2

Diagram 2


 

Nutrition Diagnosis:

All data collected through these assessments are necessary for the dietitian/nursing team to make an appropriate nutrition diagnosis.

Nutrition_3
 
Planning/Nutrition interventions:
The dietitian/nursing team must select person specific nutrition interventions that are directed to the cause (or etiology) of the nutrition problems identified and aimed at alleviating the signs and symptoms of the diagnosis.


 
Evaluation/monitoring
The final steps of the process are monitoring and evaluation, which the team use to determine if the resident has achieved, or is making progress toward, the planned goals.

  • Daily monitoring of the following systems are necessary:
  • Does the catering team comply with the nutrition interventions?
  • Does the serving team ensure the correct interventions are served to the correct individuals?
  • Does the care team monitor the intake and effectiveness of these interventions?


 
Re-assessment
This is a continuous process and should form part of formal daily communication as well as set nutrition care meetings.

 

Conclusion
70-80% of older people admitted to hospital who are malnourished are not identified as such. Health care facilities needs to be aggressive in providing adequate training to all staff involved, ensuring continuous formal assessments with validated screening tools and instituting processes to ensure intervention strategies are correctly applied and monitored. Only then can we ensure optimal nutrition resulting in best possible health and quality of life for older adults.

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