SIMPLE approach to Nutritional Care in Elderly Patients

The essence of this approach is that, rather than requiring a highly specialized nutritionist, a systematic assessment on the part of all the disciplines that are interacting with the patients can achieve what is needed for the nutritional care of the older patient with a fragility fracture, regardless of setting or healthcare provider.

S – Screen for nutritional risk

• 2 step process
  • First pass screening (can be done by anybody with minimal training) – skipped in high risk settings like acute hip fractures due to low sensitivity
    • Mini Nutrition Assessment – Short Form
    • Malnutrition Screening Tool
    • Malnutrition Universal Screening Tool
  • Detailed assessment (done by a qualified health professional) – for patients screened as “at risk” by Step 1

I – Interdisciplinary assessment (ABCDEF mnemonic)

• Anthropometry and body composition
• Biochemical markers
• Clinical assessments and measures
• Diet and medication history
• Environmental and psycho-social factors
• Functional measures

M – Make the diagnosis (es)

• Subjective Global Assessment
• Mini Nutritional Assessment – Short Form
• Global Leadership on Malnutrition Criteria
• ESPEN Criteria
• ICD-10AM Criteria

P – Plan with the patient

A comprehensive nutrition care plan should consider:

1. Short- and long-term nutritional goals with the patient
2. Nutrient and fluid requirements
3. Patient education and instructions for how to implement the nutrition intervention
4. Estimated duration of the nutrition therapy
5. Clinician re-assessment and monitoring parameters
6. Discharge planning, continuity of care
7. Contacts and further information sources

L – impLement interventions

• Improving access for nourishing foods and fluids, both in health care settings and for those living at home
• Oral nutrition supplements
• Nutritional support (enteral/parenteral nutrition)
• Prescription and Deprescription of medications and therapies
• Nutrition education, counselling and psychosocial support
• Coordination of nutrition care interventions

Nutrition care plan is included in handover and discharge documentation, and is transferred to the next setting and health care provider/s.

E – Evaluate ongoing care requirements

• Patients with or at risk of a nutrition-related diagnosis will routinely require nutrition monitoring or re-assessment strategies. Processes for re-screening should also be considered for those not currently at risk.

Further reading:

• English – FF-Education
• 2021_Book_Orthogeriatrics.pdf