Nutrition support for the elderly.

The increasing size and longevity of the geriatric patient population dictates that all health care practitioners become more cognizant of the unique requirements for nutritional assessment and support of the elderly. This review summarizes recent advances in the understanding of the nutrition support needs of the old and oldest-old patients requiring enteral or parenteral feeding. When a nutrition support formula individualized for the geriatric patient is being developed, there is a fine line between excess and deficit, requiring the involvement of the entire support team in monitoring the success of feeding. Indications for choosing enteral or parenteral feeding are considered excessively invasive by some and necessarily "heroic" by others. The patient and his or her family should be part of the decision-making process.

Weight loss and senile dementia in an institutionalized elderly population.

The purpose of this study was to determine whether patients with Alzheimer's disease or senile dementia have a higher incidence of underweight and weight loss than non-demented patients. In a retrospective study, the admission weight and height and the current weight of 36 patients with Alzheimer's disease and senile dementia of the Alzheimer's type were compared with those of 31 non-demented patients. Patients with Alzheimer's disease or senile dementia were significantly (p less than .05) further below minimum acceptable body weight on admission and were significantly (p less than .05) further below minimum acceptable body weight after an average of 17 months in the institution in comparison with the control group. Additional research is needed to determine whether the weight loss seen in patients with Alzheimer's disease or senile dementia is due to a metabolic aberration inherent in the disease or to management issues in feeding those patients.

Association of food frequency questionnaire estimates of vitamin A intake with serum vitamin A levels.

To assess the validity of nutrient intake estimates from a food frequency questionnaire, the authors compared estimates of intake of preformed retinol (dietary plus supplements), beta-carotene, other active carotenoids, and total vitamin A computed from questionnaire responses with serum retinoid and carotenoid concentrations. Data were obtained from 302 male and female current or former smokers, participants in a lung cancer chemoprevention trial at the Fred Hutchinson Cancer Research Center in Seattle, Washington, during 1985-1986. Both serum beta-carotene and serum alpha-carotene were associated, although weakly, with food frequency estimates of total vitamin A intake, dietary vitamin A, beta-carotene, other carotenoids, and total carotenoids (0.18 less than or equal to r less than or equal to 0.26). Serum retinol was associated with supplementary vitamin A intake (r = 0.16). Nondietary factors were also associated with serum nutrient concentrations--in particular, cigarette smoking, alcohol intake, and body mass index. Cigarette smoking emerged as an important modifying factor of the relation between serum beta-carotene and dietary beta-carotene (r = 0.14 for current smokers, r = 0.30 for former smokers).

Use of op site as an occlusive dressing for total parenteral nutrition catheters.

A retrospective study of standard hyperalimentation catheter dressing compared to the use of Op Site has demonstrated that Op Site is cost and time effective and is efficacious for attaining a low catheter sepsis rate. It is easy for nursing personnel to apply and comfortable for the patients to wear. Op Site may be contraindicated in diaphoretic patients.

Implementation of attractive dialogues in nutritive analysis and clinical dietetics information systems.

The implementation and evaluation of a system providing both extensive nutritive-analysis calculations and interactive capabilities are described. The extensive calculating ability of the system arose from the historic need for nutrient intake estimates in clinical investigation and nutritional research. The availability of computer-aided instruction (CAI) system software lead to adoption of the interactive style originating at Ohio State University. Capabilities evolved into an extended interactive processor utilizing an extensive data-base. The interactive processor functions either directly, for immediate response, or as a preprocessor for the more extensive processing system. Use of this capability by a dietetics consortium in the Pacific North-west has lead to definitions of effective and desirable styles of interaction by dietitians with a food and nutrient data-base. Hosting the PILOT CAI language with a high-level language, SAIL, allowed convenient and flexible dialogue creation as well as computational power. The central data-base was restructured on two occasions to accommodate the required characteristics for foods and their nutrients. The lack of interfaces between medical-information packages, and between languages, presently limits the growth of this system into a fully integrated component of the health-care information domain.