Objectives
    Outline the ACOVE indicators for malnutrition for 
     community-dwelling and hospitalized older 
     persons
    Understand the physiologic changes that 
     contribute to the problem
    Identify the risks of malnutrition in the elderly 
     patient
    Discuss nutritional screening 
      and assessment tools
   Objectives
   Review basic nutritional requirements for 
     the older patient
    Discuss options for nutritional intervention
    Review the ethical considerations for 
     replacement of nutrition and hydration of 
     the older patient
   Identify nutritional syndromes
   Definition
    Malnutrition is the condition that develops when 
     the body does not get the right amount of 
     vitamins, minerals, and other nutrients it needs to 
     maintain healthy tissues and organ function. The 
     condition may result from an inadequate or 
     unbalanced diet, digestive difficulties, absorption 
     problems, or other medical conditions.  However, 
     there is no universally accepted clinical definition.
      “Malnutrition is not something 
           observed only in third-world countries.”1
      “Older persons suffer a burden of malnutrition that spans the 
           spectrum from under- to overnutrition.”2
      “Malnutrition in the elderly is one of the greatest threats to 
           health, well-being, and autonomy….”
      1.  Kiseljak-Vassiliades, K., et al.  Basic Nutrition for Successful Aging: Part 1.  Clinical Geriatrics, Vol. 14(4); April 2006   
      2.  Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine, Sixth Edition (GRS6); American Geriatrics 
           Society 2006    
      3.  Francesco, VD, et al. The Anorexia of Aging.  Digestive Diseases 25(2); 2007                                                                
                        
    ACOVE - 3
    Quality indicators for Malnutrition
     ACOVE-3 indicators are comprised of IF-THEN-
      BECAUSE statements
     Apply to community-dwelling AND hospitalized older 
      persons
     8 quality indicators covering 4 domains
     Indicators are not supported by RCTs (except one) 
      because most all studies have been small and involved 
      persons who met “narrow” entry criteria or which lacked 
      the highest quality of methodological rigor.
     Indicators are a product of literature review and expert 
      panel consideration.