Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Underweight (BMI <20 kg/m2) is typically present in 10-40% of patients admitted to hospital, but malnutrition risk is even greater.
In the general population, it is estimated that one in seven subjects aged 65 years and over has a medium or high risk of malnutrition, but the prevalence is higher in subjects who are institutionalised than those who are free living (i.e. living in their own homes).
The progression to malnutrition is often insidious and often undetected, causing malnutrition to be under-recognised and under-treated.
It leads to disease, delays recovery, increases visits to GP and increases the frequency and length of hospital stay.
While poor nutrition is not a natural concomitant of aging, older adults are at risk for malnutrition due to physiological, psychological, social, dietary, and environmental risk factors.
Body Mass Index calculator
Calculator embedded into this CGA Toolkit Plus for accurate BMI determination.
Mini Nutritional Assessment - Short Form
Identify individuals age 65 and above who are malnourished or at risk of malnutrition.
Malnutrition Universal Screening Tool
Detection of over-nutrition (overweight and obesity) as well as undernutrition, with link to a flexible care plan, which varies according to healthcare setting, patient group, and local resources.
Malnutrition predisposes to disease, delays recovery from illness, and adversely affects body function, well-being and clinical outcome.
There is no formal economic evaluation of disease-related malnutrition but it is estimated that the cost is greater than that of obesity.
The incidence of obesity (body mass index (BMI) >30 kg/m2) is increasing in both adults and children, and currently affects one in five adults. It predisposes to many health problems, including heart disease, diabetes, high blood pressure and osteoarthritis, with an estimated annual cost to the economy of over £2 billion, of which £0.5 billion represents a direct cost to the National Health Service.
Any assessment of frailty should include some key questions about diet, appetite and weight, as these can indicate specific problems related to nutrition as well as being markers of other underlying medical conditions.
Red flags for malnutrition are:
Involuntary weight loss (more than 5% over the last month or more than 10% over the last six months)
BMI less than 20 for elderly (≥ 65y)
Decreased appetite or reduced food intake
Basic tools such as the weight (or change in weight), Body Mass Index (BMI) or Mini Nutritional Assewssment (MNA) can be used to screen nutritional status. These tools are non-specific but reasonably sensitive.
Where indicated, the lengthier and more detailed five-step Malnutrition Universal Screening Tool (MUST) may be used.
Laboratory analyses should include blood tests for thyroid function, B12, serum folate and albumin.
Some patients will have a raised BMI due to excess body fat, but this neither rules out frailty nor poor nutritional status since protein/energy deficiency and sarcopenia are common in older people including those with raised BMI (in fact body fat can make significant loss of muscle bulk difficult to detect).
Unintentional weight loss is an important marker of nutritional problems or undiagnosed systemic illness such as malignancy or heart failure.
The Nutrition Assessment is one of 5 sub-domains of the
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The Medical Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
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