The role of the dietitian in an acute — Care eldercare service

Abstract

Deaconess ElderCare is an interdisciplinary consult service that follows and coordinates care of high-risk elderly patients during hospitalization. Goals of the service are to optimize care and functional capability, coordinate discharge planning, and when possible, to prevent readmission to the hospital. Members of the team include geriatricians, gerontological nurse practitioners, social work gerontologists, a pharmacist and a clinical dietitian. The team meets regularly for care planning, problem solving, and coordination of care. The ElderCare dietitian conveys the team plan to dietitians on the patient care units. In order to identify the nutritional status and appropriate nutrition interventions for the population, we retrospectively reviewed 30 patients' medical records. Patients were admitted between 10/91 & 9/92. Mean age was 82 years (range 69–92). Thirteen of 30 patients (43%) had evidence of malnutrition. Of these, six had kwashiorkor, five had marasmus, and two had mixed marasmus-hypoalbuminemia. Two patients also had pressure sores. Most patients lived alone (37%) or with their family (43%); only 20% lived in nursing facilities. Common barriers to adequate dietary intake were found, including impaired cognition; depression; impaired dentition; difficulty preparing meals; and need for feeding assistance. ElderCare patients received interventions including nutrition education (13%), modified diets (17%), oral supplements (27%), enteral nutrition (13%), and parenteral nutrition (7%). ElderCare patients were at significant nutritional risk; the nature and frequency of malnutrition, and the types of nutrition interventions given illustrate the need for dietitians on ElderCare teams, and the skills needed in this high risk patient population.