Journal of Gerontological Nursing

Try This: Best Practices in Nursing Care to Older Adults 

Nutrition and Hydration

Cora Zembrzuski

Abstract

WHY

Nutrition and hydration in older adults are under-researched areas relative to their significance to clinical implications for older adults. Current literature suggests that normal age-related changes include decrease in total body water; thirst response; muscle mass; overall food and fluid intake and metabolic rate; and redistribution of fat to the abdomen, upper arms, and thighs. It is hypothesized that the causes for these changes are partially due to aging but can be dramatically delayed or offset by positive lifestyle changes. In-depth assessment of hydration and nutritional status will provide the information needed for nursing interventions aimed at maximizing wellness and identifying problems for treatment.

BEST TOOLS

Assessment instruments vary in format and in content, reflecting the diversity and debate surrounding the factors that contribute to nutritional and hydration status in older adults. Two are recommended - the Nutritional Screening Initiative Checklist (NSI) and the Hydration Assessment Checklist. See tools on page 7.

TARGET POPULATION

The NSI is a self-administered, scored checklist aimed at nutritional awareness of the non-institutionalized older adult. The Hydration Assessment Checklist is a lengthy, in-depth assessment designed to screen for hydration problems. Older adults both in the community as well as in the nursing home are grossly underhydrated, ingesting on average less than l,000cc/daily, which is substantially lower than recommended. Of the l,000cc, few take in water - an essential element supporting cellular and organ health; electrolyte balance; medication absorption and distribution; and kidney, bladder, and integumentary functioning.

VALIDITY/RELIABILITY

These instruments have been used clinically in the field yet psychometric testing has been conducted only on the NSI with reported acceptable levels of validity and reliability. Further testing is needed on both instruments.

STRENGTHS AND LIMITATIONS

The NSI is not clinically diagnostic, yet it is brief and may be self-administered by the older adult. The Hydration Assessment Checklist is lengthy and requires access to a client's laboratory results, history, and intake/output for 3 days.

MORE ON THE TOPIC

Dwyer, J.T. (1991). Screening older American's nutritional health: Current practices and future responsibilities. Washington D.C., Nutritional Screening Institute.

Dwyer, J.T., Gallo, JJ. & Reichel, W. (1993). Assessing nutritional status in elderly patients. American Family Physician, 47(3), 613-620.

Posner, B.M.Jette, A.M., Smith, K.W. & Miller, D.R. (1993). Nutrition and health risks in the elderly: The Nutritional Screening Initiative. American Journal of Public Health, 83(7), 972-978.

Zembrzuski, CD. (1997). A three-dimensional approach to hydration of elders: Administration, clinical staff, and in-service education. Geriatric Nursing, 18(1), 20-26.

Table

NSI CHECKLIST TO DETERMINE YOUR NUTRITIONAL HEALTH

HYDRATION ASSESSMENT CHECKLIST…

WHY

Nutrition and hydration in older adults are under-researched areas relative to their significance to clinical implications for older adults. Current literature suggests that normal age-related changes include decrease in total body water; thirst response; muscle mass; overall food and fluid intake and metabolic rate; and redistribution of fat to the abdomen, upper arms, and thighs. It is hypothesized that the causes for these changes are partially due to aging but can be dramatically delayed or offset by positive lifestyle changes. In-depth assessment of hydration and nutritional status will provide the information needed for nursing interventions aimed at maximizing wellness and identifying problems for treatment.

BEST TOOLS

Assessment instruments vary in format and in content, reflecting the diversity and debate surrounding the factors that contribute to nutritional and hydration status in older adults. Two are recommended - the Nutritional Screening Initiative Checklist (NSI) and the Hydration Assessment Checklist. See tools on page 7.

TARGET POPULATION

The NSI is a self-administered, scored checklist aimed at nutritional awareness of the non-institutionalized older adult. The Hydration Assessment Checklist is a lengthy, in-depth assessment designed to screen for hydration problems. Older adults both in the community as well as in the nursing home are grossly underhydrated, ingesting on average less than l,000cc/daily, which is substantially lower than recommended. Of the l,000cc, few take in water - an essential element supporting cellular and organ health; electrolyte balance; medication absorption and distribution; and kidney, bladder, and integumentary functioning.

VALIDITY/RELIABILITY

These instruments have been used clinically in the field yet psychometric testing has been conducted only on the NSI with reported acceptable levels of validity and reliability. Further testing is needed on both instruments.

STRENGTHS AND LIMITATIONS

The NSI is not clinically diagnostic, yet it is brief and may be self-administered by the older adult. The Hydration Assessment Checklist is lengthy and requires access to a client's laboratory results, history, and intake/output for 3 days.

MORE ON THE TOPIC

Dwyer, J.T. (1991). Screening older American's nutritional health: Current practices and future responsibilities. Washington D.C., Nutritional Screening Institute.

Dwyer, J.T., Gallo, JJ. & Reichel, W. (1993). Assessing nutritional status in elderly patients. American Family Physician, 47(3), 613-620.

Posner, B.M.Jette, A.M., Smith, K.W. & Miller, D.R. (1993). Nutrition and health risks in the elderly: The Nutritional Screening Initiative. American Journal of Public Health, 83(7), 972-978.

Zembrzuski, CD. (1997). A three-dimensional approach to hydration of elders: Administration, clinical staff, and in-service education. Geriatric Nursing, 18(1), 20-26.

Table

NSI CHECKLIST TO DETERMINE YOUR NUTRITIONAL HEALTH

NSI CHECKLIST TO DETERMINE YOUR NUTRITIONAL HEALTH

Table

HYDRATION ASSESSMENT CHECKLIST

HYDRATION ASSESSMENT CHECKLIST

NSI CHECKLIST TO DETERMINE YOUR NUTRITIONAL HEALTH

HYDRATION ASSESSMENT CHECKLIST

10.3928/0098-9134-20001201-04

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