NUTRITION
A Vital Sign
Nutrition BY PEGGY
KLOSTER Y E N ,
RD,MPH
ulse rate, respirations, temperature~nutritional stap tus? That last item does not fit in the list of vital signs nurses know. But making nutritional status an eldercare vital sign is the goal of a new aging initiative. The Nutrition Screening Initiative, a 5-year project of the A m e r i c a n A c a d e m y of F a m i l y Physicians, The American Dietetic Association, and the National Council
on Aging, hopes to make screening the elderly for signs of nutrition problems a part of every aging program and service. They have even developed a screening tool elders can use themselves to make periodic checks on their nutritional health.
Why Nutrition Screening? Poor nutritional status leads to longer and therefore more expensive hospital stays and greater risk of compli-
34/1/36622
Level 1 Screen
BodyWeight Measure height to tile nearest inch and weight to the nearest i pound. Record the values below and mark them on the Body .Mass Index (BMI) scale to the right. Then use a straight edge (ruler) to connect the two points and circle the spot where this straight line crosses the center line (body mass index). Record the number below. l leahhy older adults should have a BMI between 24 and 27. ileight (in): Weight (lbs): Body Mass Index: (number from center eolunm)
m
A t~
:
................
3,
a_e__c-Z-P-~r~" .J.
Check any boxes that are true the individual: ltas lost or gained 10 pounds (or more) in the past 6 months. [ ] Bodymass index 27 ~ior tile remaining sections, please ask the indMdual which of the statements (if any) is true for hinl or her and place a cheek by each that applies.
52 Geriatric Nursing January/February 1992
P i n p o i n t Risk Before P r o b l e m s Arise The Warning Signs o f poor nutritional health are often overlooked. Use this checklist to f i n d out i f you or someone you know is at nutritional risk. Read the statements below. Circle the number in the yes column for those that apply to you or someone 'ou know. For each yes answer, score the number in the box. Total your nutritional score.
I ha~e an ~lnessor ~
DETERMINE YOUR NUTRITIONAL HEALTH
that made me change the kind and/or amount of food l ~
I eat fewer than 2 meals per da):
~S 2 3
I eat few fruits or vegetables, or milk prelects.
2
[ have 3 or more drinks of beer, liquor or wine almost every day.
2
! have tooth or mouth problems that make it hard for me to eat.
2
! don't always have enough money to buy the food I need. I eat alone most of the time.
4 1
I take 3 or more different prescribed or over.the-counter drugs a day.
1
Without wanfng to, I have lost or gained 10 pounds in the last 6 mooths.
2 2
I am not always ph.~sieally able to shop, cook and/or feed mysdf. TOIAt
t o t a l Your N u t r i t i o n a l S c o r e .
If It's
--
10-2
Goodt Recheck your nutritional score in 6 months.
141
You are at merlin-ate md~lUmml fllatt. See what can be done to improve your eating habits and !ifestyle. Your office on.aging, s e ni or nutrition p r o g r a m , s e m o r citizens
center or health depmamentcan help. Recheck your nutritional score in 3 months. | o¢ m o t ,
e
YOu me at high nutlitlomd Hilt. Bring this checklist the next time you see your doctor, dietitian or other qualified health or social service professional. Talk v,ith them about any problems you may have. Ask for help to impro~'eyour nutritional health.
TItew ~ d a h de,*loped a~d d*smb~lea by the N,a,) ~ $ ¢ ~ . a . x I~iti~h¢, a p m i e a o1"
O
A-MERICANACADEMY OFFAMILYPHYSICIAXS
K
"[HEA~ILRICAN DI~/X"~CASSOC~XaO~ NATIONALCO~NCIL ON"l~dEAGING.INC.
Rememberthat ~.andag , ~ s .',af,t ~ t H.-.k,but do n t I'~-i:,n.~t diagnosis of an'y.cmulltlox. Tam Ibe page le kam mcoealert I1~ ~ m l n g Signs of poo¢ autrili~ml health.
cations during hospitalization. "Nutrition screening remains an unmet health monitoring and surveillance need among aging Americans today," according to Johanna T. Dwyer, DSC, RD, Director of the Frances Stern Nutrition Center at Tufts University in Boston. Dr. Dwyer is a member of the Initiative's technical committee, the group developing the " D E T E R M I N E Your N u t r i t i o n a l Health" Checklist for older people to use themselves. Each letter in DETERMINE represents a word or phrase reminder of the checklist items. For example, T stands for tooth loss/mouth pain, a factor in some elders' poor eating habits. A simple scoring system on the Checklist categorizes nutritional risk as high, moderate, or minimal. Single copies of the Checklist are available free of charge,* and larger quantities are available at minimal expense. The Checklist is backed by data from the National Center for Health Statistics and a validation study on people 70 years of age and older conducted by Boston University. *For single copies of the Checklist or other information contact: Nut r i t i o n S c r e e n i n g I n i t i a t i v e , 2 6 2 6 P e n n s y l v a n i a A v e n u e N W , S u i t e 301, Washington, DC 20037; (202) 625-1662.
Taking screening a step further, the Initiative's level I screening tool guides health professionals in identifying preventive measures before older adults become malnourished. The four sections of the one and one half page level I screen are body weight, eating habits, living environment, and functional status. Height and weight are recorded on a simple graph (called a nomogram) included on the screening form. The body mass index (BMI) can be found by using a ruler to draw a line between the height and weight points on the graph scale. Healthy older adults should have a BMI between 24 and 27. A BMI greater than 27 indicates obesity; less than 24 indicates underweight. An additional question about recent weight gain or loss helps to identify elders whose eating habits, activity, or living situation have recently changed, possibly affecting nutritional status. By encouraging referrals to social agencies, nutritionists, and physicians, the screening tool can help caregivers stop nutrition problems before they begin. W h a t ' s New? Dietitians have been promoting nutrition assessment for years, and that makes these nutrition screening tools sound like familiar information. But they are the first screening tools designed just for the elderly that have such a broad consensus of agreement behind them. Also, the Checklist is unusual because it is self-administered, a boon to busy professionals. An up-to-date technical and research basis supports the screening tools as relevant indicators of nutritional problems in the older population. Consensus and research do not count if screening tools are unused. Barriers to screening--limited time and funds and skepticism about the importance and effectiveness of screening--can keep nurses from using these important tools. Health professionals need to know that many of the causes of malnutrition can be addressed by simple, available interventions such as Meals on Wheels and the Nutrition Program for the Elderly. Preventive health services grants earmarked for the states and funded by the Older Americans Act of 1991 (Part F) must include provisions for the nutrition screening of older participants, a step toward encouraging the use of these tools. For those screening in medical settings, a Level II screening form adds clinical measurements. A manual, workshops, and a slide presentation, available from the Initiative, will help professionals apply these clinical measurements in an eldercare setting. Get yourself copies of all three screening tools and use them routinely. Doing so is the best way to ensure the nutritional health of America's elderly people.
Geriatric Nursing
J a n u a r y / F e b r u a r y 1992
53
PROFESSIONAL OPPORTUNITIES
[Health]line
1992 RATES Rates Per Issue:
1 Time
Same Ad 3 Times
30 words or less Each additional word
$96.00 2.40
$81.00 2.00
Count all words, including abbreviations. Initials and numbers count as one word. "Box 000" counts as 2 words. Box Service--S7.00 first insertion only. Payment must accompany insertion order.
Set within a ruled border: $55.00 additional per issue. Forms close 27th of month previous to month of issue. Send your ad to: GERIATRIC NURSING Journal Advertising Department Mosby-Year Book, Inc. 11830 Westline Industrial Dr. St. Louis, MO 63146-3318 Only professional advertisements for Opportunities Available or Fellowships will be accepted.
HEALTHLINE is a monthly, 16-page publication offering up-to-date information on a wide variety of health issues of concern to your patients. Presented in an attractive, two-color format, HEALTHLINE features a concise, easy-to-read style that's ideal for patient education. HEALTHLINE makes excellent waiting room literature. • Provides the latest news on disease prevention, nutrition, exercise, mental health, aging, child health, and other topics of interest. • Alerts your patients to warning signs and symptoms requiring professional attention. • Presents reliable, readable articles written by a national network of doctors, nurses, psychologists, and other health professionals. Edited by Paul M. Insel, PhD, and Walton T. Roth, MD, of the Stanford University School of Medicine. Mosby-Year Book offers a special subscription rate on multiple-copy orders of HEALTHLINE, for waiting room use or for handouts (see chart). Use the attached coupon to place an order or to request a sample issue. Or call toll-free to order: 1-800-325-4177, ext. 4351. Outside the U.S., call (314) 453-4351.
OPPORITINII~AVAH~ABLE
Number of subscriptions
Price per subscription
10-25 26-50 51-100 101-500 501-1000 More than 1000
S18.00 16.80 14.40 12.00 9.60 Contact Publisher
Start my individual subscription to HEALTHLINE. (12 issues per }'ear). F l o r i d a - - L a k e l a n d R e g i o n a l M e d i c a l Center, a 650+bed regional referral center in Central Florida, is seeking applicants for a Gerontology Specialist position to act as a role model, consultant and educator in the care of elderly patients. Successful candidate must have a Graduate Degree with emphasis in Gerontology and a minimum of 3 years acute care experience. Interested candidates should contact Elizabeth Allen, Coordinator, Nurse Recruitment, Lakeland Regional M e d i c a l Center, P.O. Box 95448, Lakeland, F L 33804 or call collect (813) 687-1207. cue
1992 rate: S24.00 U.S./S37.68 Canada/S36.00 Int'l.
UI I'm placing a multiple-copy order for HEALTHLINE. Number of subscriptions: Price per subscription: D Please send me a sample issue of HEALTHLINE. M e t h o d of P a y m e n t (please check one): O MasterCard El Check enclosed
Fj MC Int'l El Bill me
Credit card #
El VISA Exp. date _
_
Signature Name Institution Address
M o n t a n a - - R e g i s t e r e d and Licensed P r a c t i c a l N u r s e s - Looking to relocate? We have positions available in our 60 bed non-profit, long-term care facility in northeastern Montana. These positions include Social Services, Head nurse, evenings and day shift. We offer competitive wages, excellent benefits and flexible work schedule. Call DNS at 406-653-I 400 or send resume to Faith Lutheran Home I000 6th Avenue North Wolf Point, MT 59201. EOE
City
State
ZIP
Specialty J2912FZA
Return to: Mosby-Year Book, Inc. Journal Subscription Services 1 t830 Westffne Industrial Drive St. Louis, MO 63146 U.S.A.
T4 Mushy ~arBook
A Vital Sign
Nutrition BY PEGGY
KLOSTER Y E N ,
RD,MPH
ulse rate, respirations, temperature~nutritional stap tus? That last item does not fit in the list of vital signs nurses know. But making nutritional status an eldercare vital sign is the goal of a new aging initiative. The Nutrition Screening Initiative, a 5-year project of the A m e r i c a n A c a d e m y of F a m i l y Physicians, The American Dietetic Association, and the National Council
on Aging, hopes to make screening the elderly for signs of nutrition problems a part of every aging program and service. They have even developed a screening tool elders can use themselves to make periodic checks on their nutritional health.
Why Nutrition Screening? Poor nutritional status leads to longer and therefore more expensive hospital stays and greater risk of compli-
34/1/36622
Level 1 Screen
BodyWeight Measure height to tile nearest inch and weight to the nearest i pound. Record the values below and mark them on the Body .Mass Index (BMI) scale to the right. Then use a straight edge (ruler) to connect the two points and circle the spot where this straight line crosses the center line (body mass index). Record the number below. l leahhy older adults should have a BMI between 24 and 27. ileight (in): Weight (lbs): Body Mass Index: (number from center eolunm)
m
A t~
:
................
3,
a_e__c-Z-P-~r~" .J.
Check any boxes that are true the individual: ltas lost or gained 10 pounds (or more) in the past 6 months. [ ] Bodymass index 27 ~ior tile remaining sections, please ask the indMdual which of the statements (if any) is true for hinl or her and place a cheek by each that applies.
52 Geriatric Nursing January/February 1992
P i n p o i n t Risk Before P r o b l e m s Arise The Warning Signs o f poor nutritional health are often overlooked. Use this checklist to f i n d out i f you or someone you know is at nutritional risk. Read the statements below. Circle the number in the yes column for those that apply to you or someone 'ou know. For each yes answer, score the number in the box. Total your nutritional score.
I ha~e an ~lnessor ~
DETERMINE YOUR NUTRITIONAL HEALTH
that made me change the kind and/or amount of food l ~
I eat fewer than 2 meals per da):
~S 2 3
I eat few fruits or vegetables, or milk prelects.
2
[ have 3 or more drinks of beer, liquor or wine almost every day.
2
! have tooth or mouth problems that make it hard for me to eat.
2
! don't always have enough money to buy the food I need. I eat alone most of the time.
4 1
I take 3 or more different prescribed or over.the-counter drugs a day.
1
Without wanfng to, I have lost or gained 10 pounds in the last 6 mooths.
2 2
I am not always ph.~sieally able to shop, cook and/or feed mysdf. TOIAt
t o t a l Your N u t r i t i o n a l S c o r e .
If It's
--
10-2
Goodt Recheck your nutritional score in 6 months.
141
You are at merlin-ate md~lUmml fllatt. See what can be done to improve your eating habits and !ifestyle. Your office on.aging, s e ni or nutrition p r o g r a m , s e m o r citizens
center or health depmamentcan help. Recheck your nutritional score in 3 months. | o¢ m o t ,
e
YOu me at high nutlitlomd Hilt. Bring this checklist the next time you see your doctor, dietitian or other qualified health or social service professional. Talk v,ith them about any problems you may have. Ask for help to impro~'eyour nutritional health.
TItew ~ d a h de,*loped a~d d*smb~lea by the N,a,) ~ $ ¢ ~ . a . x I~iti~h¢, a p m i e a o1"
O
A-MERICANACADEMY OFFAMILYPHYSICIAXS
K
"[HEA~ILRICAN DI~/X"~CASSOC~XaO~ NATIONALCO~NCIL ON"l~dEAGING.INC.
Rememberthat ~.andag , ~ s .',af,t ~ t H.-.k,but do n t I'~-i:,n.~t diagnosis of an'y.cmulltlox. Tam Ibe page le kam mcoealert I1~ ~ m l n g Signs of poo¢ autrili~ml health.
cations during hospitalization. "Nutrition screening remains an unmet health monitoring and surveillance need among aging Americans today," according to Johanna T. Dwyer, DSC, RD, Director of the Frances Stern Nutrition Center at Tufts University in Boston. Dr. Dwyer is a member of the Initiative's technical committee, the group developing the " D E T E R M I N E Your N u t r i t i o n a l Health" Checklist for older people to use themselves. Each letter in DETERMINE represents a word or phrase reminder of the checklist items. For example, T stands for tooth loss/mouth pain, a factor in some elders' poor eating habits. A simple scoring system on the Checklist categorizes nutritional risk as high, moderate, or minimal. Single copies of the Checklist are available free of charge,* and larger quantities are available at minimal expense. The Checklist is backed by data from the National Center for Health Statistics and a validation study on people 70 years of age and older conducted by Boston University. *For single copies of the Checklist or other information contact: Nut r i t i o n S c r e e n i n g I n i t i a t i v e , 2 6 2 6 P e n n s y l v a n i a A v e n u e N W , S u i t e 301, Washington, DC 20037; (202) 625-1662.
Taking screening a step further, the Initiative's level I screening tool guides health professionals in identifying preventive measures before older adults become malnourished. The four sections of the one and one half page level I screen are body weight, eating habits, living environment, and functional status. Height and weight are recorded on a simple graph (called a nomogram) included on the screening form. The body mass index (BMI) can be found by using a ruler to draw a line between the height and weight points on the graph scale. Healthy older adults should have a BMI between 24 and 27. A BMI greater than 27 indicates obesity; less than 24 indicates underweight. An additional question about recent weight gain or loss helps to identify elders whose eating habits, activity, or living situation have recently changed, possibly affecting nutritional status. By encouraging referrals to social agencies, nutritionists, and physicians, the screening tool can help caregivers stop nutrition problems before they begin. W h a t ' s New? Dietitians have been promoting nutrition assessment for years, and that makes these nutrition screening tools sound like familiar information. But they are the first screening tools designed just for the elderly that have such a broad consensus of agreement behind them. Also, the Checklist is unusual because it is self-administered, a boon to busy professionals. An up-to-date technical and research basis supports the screening tools as relevant indicators of nutritional problems in the older population. Consensus and research do not count if screening tools are unused. Barriers to screening--limited time and funds and skepticism about the importance and effectiveness of screening--can keep nurses from using these important tools. Health professionals need to know that many of the causes of malnutrition can be addressed by simple, available interventions such as Meals on Wheels and the Nutrition Program for the Elderly. Preventive health services grants earmarked for the states and funded by the Older Americans Act of 1991 (Part F) must include provisions for the nutrition screening of older participants, a step toward encouraging the use of these tools. For those screening in medical settings, a Level II screening form adds clinical measurements. A manual, workshops, and a slide presentation, available from the Initiative, will help professionals apply these clinical measurements in an eldercare setting. Get yourself copies of all three screening tools and use them routinely. Doing so is the best way to ensure the nutritional health of America's elderly people.
Geriatric Nursing
J a n u a r y / F e b r u a r y 1992
53
PROFESSIONAL OPPORTUNITIES
[Health]line
1992 RATES Rates Per Issue:
1 Time
Same Ad 3 Times
30 words or less Each additional word
$96.00 2.40
$81.00 2.00
Count all words, including abbreviations. Initials and numbers count as one word. "Box 000" counts as 2 words. Box Service--S7.00 first insertion only. Payment must accompany insertion order.
Set within a ruled border: $55.00 additional per issue. Forms close 27th of month previous to month of issue. Send your ad to: GERIATRIC NURSING Journal Advertising Department Mosby-Year Book, Inc. 11830 Westline Industrial Dr. St. Louis, MO 63146-3318 Only professional advertisements for Opportunities Available or Fellowships will be accepted.
HEALTHLINE is a monthly, 16-page publication offering up-to-date information on a wide variety of health issues of concern to your patients. Presented in an attractive, two-color format, HEALTHLINE features a concise, easy-to-read style that's ideal for patient education. HEALTHLINE makes excellent waiting room literature. • Provides the latest news on disease prevention, nutrition, exercise, mental health, aging, child health, and other topics of interest. • Alerts your patients to warning signs and symptoms requiring professional attention. • Presents reliable, readable articles written by a national network of doctors, nurses, psychologists, and other health professionals. Edited by Paul M. Insel, PhD, and Walton T. Roth, MD, of the Stanford University School of Medicine. Mosby-Year Book offers a special subscription rate on multiple-copy orders of HEALTHLINE, for waiting room use or for handouts (see chart). Use the attached coupon to place an order or to request a sample issue. Or call toll-free to order: 1-800-325-4177, ext. 4351. Outside the U.S., call (314) 453-4351.
OPPORITINII~AVAH~ABLE
Number of subscriptions
Price per subscription
10-25 26-50 51-100 101-500 501-1000 More than 1000
S18.00 16.80 14.40 12.00 9.60 Contact Publisher
Start my individual subscription to HEALTHLINE. (12 issues per }'ear). F l o r i d a - - L a k e l a n d R e g i o n a l M e d i c a l Center, a 650+bed regional referral center in Central Florida, is seeking applicants for a Gerontology Specialist position to act as a role model, consultant and educator in the care of elderly patients. Successful candidate must have a Graduate Degree with emphasis in Gerontology and a minimum of 3 years acute care experience. Interested candidates should contact Elizabeth Allen, Coordinator, Nurse Recruitment, Lakeland Regional M e d i c a l Center, P.O. Box 95448, Lakeland, F L 33804 or call collect (813) 687-1207. cue
1992 rate: S24.00 U.S./S37.68 Canada/S36.00 Int'l.
UI I'm placing a multiple-copy order for HEALTHLINE. Number of subscriptions: Price per subscription: D Please send me a sample issue of HEALTHLINE. M e t h o d of P a y m e n t (please check one): O MasterCard El Check enclosed
Fj MC Int'l El Bill me
Credit card #
El VISA Exp. date _
_
Signature Name Institution Address
M o n t a n a - - R e g i s t e r e d and Licensed P r a c t i c a l N u r s e s - Looking to relocate? We have positions available in our 60 bed non-profit, long-term care facility in northeastern Montana. These positions include Social Services, Head nurse, evenings and day shift. We offer competitive wages, excellent benefits and flexible work schedule. Call DNS at 406-653-I 400 or send resume to Faith Lutheran Home I000 6th Avenue North Wolf Point, MT 59201. EOE
City
State
ZIP
Specialty J2912FZA
Return to: Mosby-Year Book, Inc. Journal Subscription Services 1 t830 Westffne Industrial Drive St. Louis, MO 63146 U.S.A.
T4 Mushy ~arBook
