Nutrition and nutritional requirements for the older adult.

Establishing reliable nutrient requirements for individuals over the age of 65 years is a difficult task. Research on nutrient requirements in the aged is sparse and often contradictory. However, there are important clues in the literature suggesting that requirements for certain nutrients are altered with age and that preventable nutrient deficiencies exist. Energy expenditure and caloric intake typically decline with age. Unless nutrient density of the diet improves, a parallel decline in vitamin and mineral intake is inevitable. Deficiencies or suboptimal intakes of water-soluble vitamins, vitamin D, calcium, zinc, copper, chromium, and water are reported in groups of older adults. Marginal nutrient deficiencies in this population may easily go undetected and contribute to morbidity.

Malnutrition in the institutionalized older adult.

Most older adults in the United States live at home and are well nourished. Approximately 5% to 6% reside in nursing homes, and this segment of the older population typically suffers from multiple diseases that contribute to a high incidence of malnutrition. Forty percent of hospital beds are occupied by older persons. This article addresses the causes of malnutrition in older persons institutionalized in long-term and acute-care facilities. The causes include changes in nutrient requirements secondary to disease processes and drug modalities in combination with low or marginal dietary intake. Infections are common and result in anorexia, poor dietary intake, and malnutrition, which predispose the patient to another infection. Occurrence of decubitus ulcers is related to nutritional status and presents a serious risk for older persons with limited mobility. Depression and dementia are commonly seen in older persons and are major contributors to poor appetite and malnutrition. Cancer cachexia accounts for about half of the cases of malnutrition in older institutionalized persons. Physiologic changes that occur with age and multiple drug use place older persons at a high risk for adverse drug reactions. Less body water in the older individual influences and complicates many aspects of treatment. Standards, methods, and interpretation of nutritional assessment measurements in older persons differ from those in younger adults. The nutrition care provider must carefully consider many complex physical, medical, and psychosocial factors to deliver individualized nutrition care.

Education, research, and practice: bridging the gap.

The purpose of this study was to identify the research activities that were part of dietetic internship and coordinated undergraduate programs. Data about required research courses, research-related experiences, curriculum competencies, student publications, and faculty needs were obtained from 79 dietetic internship and 46 coordinated undergraduate program directors. Research courses were required in 60% of the programs and most often included basic statistics and review of the literature. Attendance at research conferences and observation of research dietitians were the most frequent learning experience activities. A wide variety of research projects were required by 71% of the programs, but there were few student opportunities to participate in faculty-sponsored research. The ability to evaluate literature critically, knowledge of research concepts, and application of research findings to dietetic practice were the most frequently cited competency statements. Less than 2% of graduates in a 3-year period had published in professional journals. Faculty members believed they needed more time, money, educational materials, professional development, and access to research facilities to improve the research component of the program. These findings suggest that research competencies may need to be prioritized differently in view of changing needs in dietetic practice.

Enteral nutrition practices: similarities and differences between dietitians and physicians in Connecticut.

There has been little evaluation of attitudes, beliefs, and practices of health professionals involved in the provision of enteral nutrition support. A study was undertaken to define and describe enteral feeding practices of registered dietitians (R.D.s) and physicians (M.D.s) in Connecticut. Survey questionnaires were returned by 74.5% of R.D.s and 53.3% of M.D.s. Data were analyzed for 195 respondents. Overall, there were more similarities than differences between R.D.s and M.D.s. Malnutrition was the most frequent indication for tube feedings. Dietitians and physicians selected formulas on the basis of nutrient needs of the patients, but R.D.s gave significantly more weight to formula design and nutrient composition than did M.D.s. Lactose-free low-residue, high-calorie high-nitrogen, and elemental diets were considered to be the most desirable products to include in a hospital formulary. Dietitians more frequently monitored nutrition-related parameters, whereas M.D.s followed metabolic parameters of patients on tube feeding. Physicians relied on R.D.s to recommend formulas and to provide them with enteral nutrition information. The results from this study may be useful in planning nutrition education programs, evaluating standards for enteral nutrition practice, and improving utilization of enteral nutrition therapy.

Making accountability less painful: program evaluation in allied health education.

Information from a program review can stimulate program change and document program effectiveness in times when retrenchment is of concern to administrators and faculties in higher education. The School of Allied Health Professions at the University of Connecticut conducted a comprehensive program evaluation of its undergraduate programs in physical therapy, medical technology, and clinical dietetics. In this paper the evaluation process is described as well as a model that appears to meet the unique needs of postsecondary programs in allied health fields.