How can I assess the nutritional status of elderly patients in my practice, and what interventions are recommended?

Assessment of Nutritional Status in Elderly Patients:

• Screen elderly patients at initial registration and when there is clinical concern such as unintentional weight loss, poor appetite, muscle wasting, or prolonged illness.
• Use screening tools like the Malnutrition Universal Screening Tool (MUST) which assesses body mass index (BMI), percentage of unintentional weight loss, and duration of reduced nutrient intake.
• Calculate BMI as weight in kilograms divided by height in metres squared.
• Consider screening also during other opportunities such as health checks or flu vaccinations.

Criteria Indicating Malnutrition or Risk:

• BMI less than 18.5 kg/m².
• Unintentional weight loss greater than 10% within the last 3 to 6 months.
• BMI less than 20 kg/m² with unintentional weight loss greater than 5% within the last 3 to 6 months.
• Reduced or no food intake for more than 5 days or likely to continue.
• Conditions causing poor absorption, high nutrient losses, or increased nutritional needs.

Recommended Interventions:

• For patients who can swallow safely and are malnourished or at risk, consider oral nutrition support including fortified foods, snacks, oral nutritional supplements, altered meal patterns, and dietary advice.
• Ensure oral nutrition support provides a balanced mixture of protein, energy, fibre, electrolytes, vitamins, and minerals.
• If micronutrient intake is inadequate, consider a complete oral multivitamin and mineral supplement, guided by a healthcare professional trained in nutrition support.
• For patients with inadequate or unsafe oral intake but a functional gastrointestinal tract, consider enteral tube feeding.
• Coordinate care through a multidisciplinary team including dietitians, nurses, and other relevant professionals.
• Monitor nutritional intake, weight, BMI, and gastrointestinal tolerance regularly to adjust interventions as needed.