Page Submenu

add to knowledge bank

print

email to a friend

CONSIDER: MEALTIME DIFFICULTIES

Overview
While aging alone does not predispose an individual to problems with nutrition and hydration, many older people should be considered at high risk for nutritional problems. These people include those who:

• Require assistantce with meals ranging from simple cuing or reminding to actual spoon-feeding.
• Have any unplanned loss or gain of 5% of body weight that signals a significant change in condition and requires immediate assessment and intervention.
• Have multiple chronic illnesses, poor oral health, and altered metabolism or elimination that place them at higher risk for health problems related to altered intake of food and fluids
• Are dependent on caregivers to assist with meals because of conditions such as cognitive impairment or a stroke.

Definitions

• Feeding: The concept of feeding is defined as, "the process of getting the food from the plate to the mouth. It is a primitive sense without concern for social niceties"( Katz, Downs, Cash, & Grotz, 1970, p. 22).
• Eating: Feeding is differentiated from eating, which is defined as "the ability to transfer food from plate to stomach through the mouth"(Siebens et al., 1986, p. 193).
• Feeding behavior: an environmental and contextual approach to examining the interaction between the person being fed and the caregiver, as well their separate actions (Amella & DiMaria, 2001).

Atypical Presentation
Elderly persons often present with anorexia, change in appetite, or decline in ability to eat due to underlying medical problems. Any change in baseline eating or feeding should be evaluated for medical causes. (See Table: Common Underlying Causes and Interventions of Feeding and Eating Problems)

Assessment/Screening Tools
The nurse needs to assess if weight loss/gain is occurring and probable causes. To do this, an assessment tool is required that addresses nutritional problems across institutions and sites of care.

Mini Nutritional Assessment(MNA®): This tool is the only one that has been tested in acute care, long-term care, and in the community and shown to be both predictive of who is at risk and assist in planning care. The first portion of the MNA® has six (6) questions that predict risk and include the calculation of the Body Mass Index (BMI). The score on this section has a maximum of 16 points; if the score is 12 or greater, there is no risk and the assessment is complete. The second section has more in-depth questions and the assessor is asked to measure both mid-arm and calf circumference. This second section has a maximum of 30 points. If the scores on the two sections together is 23.5 or greater, no further intervention is needed except for monitoring every three months. Scores between 23.5 - 17 require intervention by a dietician and will probably resolve if addressed immediately. Scores 17 and less indicate probable protein-energy malnutrition and immediate interdisciplinary intervention is required. The MNA® has been translated into six languages and can be found here.

Assessing Ability to Feed: the Edinburgh Feeding Evaluation in Dementia (EdFED) Scale (See Dr. Roger Watson's website at The University of Hull - under downloadable document: EdFed)

Nursing Care Strategies

Amella EJ, DiMaria RA (2001). Feeding behavior. In GL Maddox, RC Atchley, JG Evans, RB Hudson, RA Kane, EJ Masoro, MD Mezey, LW Poon, IC Siegler (eds.). The Encyclopedia of Aging (3rd ed.) (pp. 389 - 391). New York: Springer

Katz S, Downs TD, Cash HR, Grotz RC. (1970). Progress in the development of the Index of ADL. The Gerontologist, 10, 22.

Siebens H, Trupe E, Siebens A, Cook F, Anshen S, Hanauer R, Oster G. (1986). Correlates and consequences of eating dependency in institutionalized elderly. Journal of the American Geriatric Society, 34,193.

Last updated - February 2005