Nestle Supplement 2

NUTRITION AND THE OLDER PERSON TABLE 5. Appetite questionnaire to predict weight loss in older persons — SNAQ (Simplified Nutritional Appetite Questionnaire) 1. My appetite is: A. very poor B. poor C. average D. good E. very good 2. When I eat: A. I feel full after eating only a few mouthfuls B. I feel full after eating about a third of a meal C. I feel full after eating over half a meal D. I feel full after eating most of the meal E. I hardly ever feel full 3. Food tastes: A. very bad B. bad C. average D. good E. very good 4. Normally, I eat: A. less than 1 meal a day B. 1 meal a day C. 2 meals a day D. 3 meals a day E. more than 3 meals a day Instructions: Complete the questionnaire by circling the correct answers and then tally the results based upon the following numerical scale: A=1, B=2, C=3, D=4, E=5 Scoring: If the mini-SNAQ is less than 14, there is a significant risk of weight loss the American Diabetes Association no longer recommend therapeutic diets in institutionalized older persons. There is a need to increase the awareness of older persons and physicians concerning the dangers of weight loss with age. Older persons should be offered a varied diet of preferred foods. Protein intake should be relatively high (at least 1.2 g/kg). Supplements, when used, should not be given with meals but rather at least 2 hours before the next meal. Alcohol in moderation has been shown to stimulate appetite and appears to have positive effects on the aging process. Orexigenic drugs, such as megestrol acetate and dronabinol, should be utilized when other methods fail to slow weight loss. Problems with dysphagia should be identified and treated appropriately as described in another article in this series. The use of pre- and probiotics may decrease cytokine production from the gastrointestinal tract and, as such, ameliorate some of the effects of cytokines on appetite. SCREENING FOR ANOREXIA Anorexia independently predicts mortality with a hazard ratio16 of 2.9 (1.1–7.4). As such, it is important to screen for anorexia and attempt to reverse its occurrence. The Simplified Nutritional Assessment Questionnaire (SNAQ— pronounced “snack”) has been shown to significantly predict future weight loss15 in both community-dwelling persons and residents of nursing homes (Table 5). If the SNAQ is positive, a person’s nutritional status should be followed with the MiniNutritional Assessment (MNA),17 which has been well validated (Table 6). Two other useful screening tests are the Seniors in Community Risk Evaluation for Eating and Nutrition (SCREEN II), which was developed in Canada,18 and the Malnutrition Universal Screening Tool (MUST), which was developed in England.19 The MUST utilizes 3 simple screens via the body mass index (BMI) score, weight loss score, and acute disease effect score.The SCREEN II is more complex with 17 items. Another test, SCALES, has been used in physician offices. It has 6 elements: Sadness Cholesterol (< 160 mg/dL) Albumin (< 3.5 mg/dL) Loss of 5% body weight Eating problems Shopping and/or food preparation problems. Persons with cognitive problems often develop weight loss. For this reason, a cognitive screen is recommended as part of the nutritional screen. The SLUMS screen20 is recommended as the cognitive screen of choice (Table 7). In addition, all older persons at nutritional risk should be occurring in over 30% of older persons losing weight. Cancer is a cause of less than 10%. Many medications lead to anorexia. Dysphagia results in weight loss in about 5%. Therapeutic diets appear to have little utility for treating diabetes and cholesterol in older persons but result in weight loss in around 5% of older persons. Both the American Dietetic Association and 26 • DECEMBER 2007

Table of Contents Feed for the Digital Edition of Nestle Supplement 2

Nestle Supplement Table of Contents Introduction to Weight Loss in Older Persons Diagnosis and Management of Oropharyngeal Dysphagia in the Elderly The Danger of Weight Loss in the Elderly Nutrients and Frailty

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