Nutrition and Hydration in Aging Services

On April 13, 2016, the National Pressure Ulcer Advisory Panel (NPUAP) announced a change in terminology for the commonly used term "pressure ulcers." NPUAP suggests using the term "pressure injuries" instead. The term "pressure injuries" is used throughout this guidance article.

Poor nutritional status is not a normal part of aging and may result in adverse outcomes such as increased risk of developing and delayed healing of pressure injuries, decline in function, dehydration, and increased risk of death (CMS "Revisions to SOM"). Causes of low food and drink intake and impaired nutritional status include depression, inability to eat independently, chewing and swallowing difficulties, medications that inhibit appetite, and cognitive and functional impairments. Healthcare organizations that do not take steps to identify the causes of nutritional problems and ensure residents' or patients' adequate nutrition and hydration put them at severe risk of adverse outcomes and leave the organization prone to liability and citations for regulatory noncompliance.

Healthcare organizations that offer continuing care services (e.g., skilled nursing facilities, assisted living, memory care units) should ensure that the organization takes steps to improve residents' nutritional status. Such organizations can accomplish this by conducting nutritional assessments, by developing individualized care plans that focus on improving nutrition and hydration, by implementing appropriate interventions, and by monitoring interventions for effectiveness.

This guidance article discusses the nutrition and hydration needs of older adults and describes steps healthcare organizations that provide aging services can take to improve the nutritional status of residents or patients. Although organizations must take steps to assess patients or residents and implement interventions whenever a patient or resident gains or loses a significant amount of weight, this guidance article focuses mainly on weight loss and impaired nutritional status because such conditions are of particular concern for frail older adults and may result in significant adverse consequences for such individuals.

Adequate nutrition and hydration are essential for the body's overall functioning and for the maintenance and repair of cells and organs. Typically, older adults require 30 kcal/kg of body weight, adjusting for weight loss or gain, with a daily protein intake of 0.8 to 1.0 g/kg of body weight per day and no more than 30% of calories coming from fat (DiMaria-Ghalili). Older adults also require foods fortified with calcium and vitamin D to prevent osteoporosis and folic acid and vitamin B to maintain cardiovascular health (National Institute on Aging).

Overall, consuming a diet rich in nutrients may help older adults avoid the onset of certain chronic diseases and conditions. For example, one 2009 study found that older adults who adhered to a Mediterranean-type diet (i.e., a diet characterized by high amounts of fruit, vegetables, legumes, and cereals; moderate amounts of fish and monounsaturated fat; and low...