Elderly Health Service

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Carers' Corner

Understanding Nutrition Screening Indicators

It is important for elders to have an adequate intake of nutrients. The carers of residential care homes should conduct regular nutrition screening on the residents and keep a record of the findings. Nutrition screening is an invaluable aid for monitoring the progress of elders who are on nutrition support. Moreover, it can help to screen out elders with nutritional problems, so that early intervention can be instituted.

The followings are commonly used nutrition screening methods and indicators of nutritional status:

1) Anthropometric Measurements

The residents should be weighed monthly, and the body weight should be compared with that in the previous month. Unintentional weight loss of 5% or more over a month or a loss of 10% or more over the past 6 months may indicate nutritional problems or even underlying diseases such as cancer. On the other hand, unintentional weight gain may also indicate health-related problems.
Body mass index (BMI) is an indicator to define the degree of obesity according to the relationship of weight to height.

BMI =	Body weight (kg) Height (m) x Height (m)	Classifications	BMI (kg/m 2 )
		Underweight	< 18.5
		Normal	18.5-22.9
		Overweight	23-24.9
		Obesity	25

Waist circumference (WC) measurement can help to determine if excessive abdominal fat is present, indicative of health risk associated with obesity.

Proposed WC cut-offs* indicative of health risk associated with obesity	Male	Female
	90 cm	80 cm

* These are the proposed cut-offs for adult Asians. The validity of these recommendations still await confirmation by further clinical and epidemiological studies. (Reference: WHO Asia-Pacific Consensus 2000)

2) Food Intakes

To ensure an adequate intake of nutrients, the carers of residential care homes should observe the daily food intakes of the residents to determine if they are eating the portions as recommended by the Food Guide Pyramid.

An adequate fluid intake by the residents is essential. It is important to identify if there is an over reliance on nutrition supplements that may impede the appetites for regular meals or snacks.

3) Appetities

Any change in food intakes should be noted, eg., any change in appetite that has led to inappropriate food intakes and a subsequent weight loss or weight gain. If the increase or decrease in food intake has persisted for a few days, the causes of appetite change should be sought.

4) Picky Eating

The carers of residential care homes should observe if picky eating behaviours exist among the residents which may result in limited food choices and imbalances in nutrient intakes.

5) Bowel Habits

Residents who have irregular bowel habits or constipation may have poor appetite. Constipation may imply that they have insufficient dietary fibre or fluid intakes.

6) Chewing and Swallowing Abilities

Chewing or swallowing problems may affect the food intakes of elders, resulting in poor nutritional status.

The carers of residential care homes should monitor the oral health status of the residents and identify any chewing and swallowing problems that may impair food and fluid intakes.

7) Special Diets

The carers of residential care homes should observe if the provision of special diets such as texture-modified diets and vegetarian diets are too monotonous and bland. Meals that limit food choices for these residents may also impair nutrient intakes.

8) Self-feeding Abilities

The carers of residential care homes should observe residents who are partially or totally dependent on others for feeding to determine if their debilitated conditions have affected their appetites and food intakes.

In addition, the carers of residential care homes should consider the medical history of the residents such as history of chronic diseases and gastro-intestinal surgeries as well as biochemistry test results and make use of relevant data to assist with nutrition screening.

Records of nutrition screening should be kept so that follow-up actions can be taken accordingly and the data can act as a baseline for future comparison. If the residents are found to suffer from poor nutritional status, the carers of residential care homes should identify the underlying causes and provide appropriate nutrition interventions. For example, residents with underweight problems can be served with small, frequent nutritious meals and snacks. Advice from health care professionals or dietitians should be sought before giving nutrition supplements to the elders. Otherwise, nutrient imbalances or overweight may result. If in doubt, the health care professionals should be consulted for assessments.

09/08/06
Elderly Health Services
Department of Health