Long-Term Care Nutrition Assessment

The nutrition assessment sets the groundwork for the overall nutrition care of a resident.

It determines the nutrition diagnosis, the nutrition interventions for the diagnosis, and how you monitor and evaluate the success of your interventions.

The components of the nutrition assessment are the same regardless of the setting in which you work.

However, there are some components of the nutrition assessment to which you should pay more attention when working in long-term care.

This article explains everything you need to know about completing the nutrition assessment in long-term care and provides a form you can use in your own practice.

Why the nutrition assessment is important

The nutrition assessment is the first of four steps in the nutrition care process (NCP).

It lays the groundwork for the remaining three steps, which include (1):

• Nutrition diagnosis: The diagnosis or specific problem you identified based on the data you collected in the nutrition assessment.
• Nutrition intervention: The specific strategy or actions you take to alleviate the signs and symptoms of the diagnosis by addressing the root cause.
• Nutrition monitoring/evaluation: The action of monitoring, measuring, and evaluating the outcomes or indicators relevant to the diagnosis and nutrition intervention.

Without a comprehensive nutrition assessment, you can’t appropriately assign or prioritize the nutrition diagnosis, allowing the remaining NCP steps to crumble.

The information you collect during the nutrition assessment falls into four domains or categories:

• Food- and nutrition-related history: Obtain information on dietary intake, nutrition route, medications, supplements, ability to access or purchase food, physical activity, and knowledge or beliefs as they relate to food.
• Anthropometric measurements: Obtain information on height, weight, body mass index, and weight history.
• Biochemical data, medical tests, and procedures: Obtain information on lab data and relevant tests like a swallow study.
• Nutrition-focused physical findings: Examine each body region physically to obtain data on body composition and fluid and micronutrient status. To learn how to conduct a nutrition-focused physical exam in long-term care, click here.

From the data you collect, you can identify the best nutrition diagnosis, recommend appropriate nutrition interventions, and monitor and evaluate the effectiveness of the intervention based on the outcomes you established.

The nutrition assessment in long-term care

Conducting a nutrition assessment in long-term care is no different than conducting one in a different setting like an acute-care hospital.

However, because older adults comprise most of the population living in long-term care, it helps to understand the various factors that impact their nutritional status.

Factors affecting the nutritional status of older adults include (2, 3, 4):

• Chronic diseases: Aging is associated with several chronic diseases, including cardiovascular disease, cancer, dementia, pulmonary diseases, renal disease, and stroke.
• Medications: Medications commonly prescribed to treat or manage chronic diseases adversely affect nutritional status by decreasing appetite and increasing protein needs, among other ways.
• Anorexia of aging: Aging is associated with various physiological changes that decrease appetite.
• Swallowing: Swallowing muscle strength weakens with age. Many chronic diseases and medications can also adversely affect swallowing.
• Dental status: While not a normal sign of aging, poor dental health is common among older adults, contributing to pain and discomfort with eating. Dentures may also not fit well, causing discomfort.
• Eating ability: A decline in fine motor skills and certain conditions like dementia increase some older adults’ reliance on others for help with eating and drinking.
• Body composition: Aging is associated with sarcopenia, the progressive loss of muscle mass and function that reduces mobility.
• Bowel and bladder function: Illness, injury, and changes in bowel habits make it more difficult for some older adults to control their bowels and bladder.

Collectively, these factors put older adults — especially those living in long-term care — at a greater risk of malnutrition.

As such, you should — at a minimum — collect information on these factors through interviews with the resident and appropriate staff or family members as well as from a chart review.

You can use screening tools that are validated for identifying malnutrition in older adults like the Mini Nutritional Assessment (MNA), but you cannot use these tools to diagnose malnutrition.

You can only diagnose malnutrition through a comprehensive nutritional assessment.

Include the information you collect in your documentation.

Generally, state regulations require that you complete a nutritional assessment on:

• each new resident upon admission
• any resident having a significant change in diet, eating ability, or nutritional status
• a monthly basis for any resident receiving tube feedings
• an annual basis

As good as your memory may be, it never hurts to document your assessment findings on paper and then use the information to craft your note in the resident’s medical chart.

This is especially true if you are completing multiple resident nutrition assessments consecutively.

If you don’t already have a form, you can download the one I use for free:

The bottom line

The nutrition assessment is the foundation for the nutrition care process.

From the information you gather from the nutrition assessment, you can assign a nutrition diagnosis, implement appropriate nutrition interventions, and monitor and evaluate the success of the interventions based on specific outcomes or goals.

The components of the nutrition assessment are the same, regardless of the setting in which you work.

However, because older adults comprise most of the population living in long-term care, it’s important to know the factors that affect their nutritional status so you can focus on them with your nutrition assessment.