Effective provision of comprehensive nutrition case management for the elderly.

Health care systems have not effectively incorporated routine nutrition screening, assessment, intervention, and case management into the delivery of services. Health programs are just beginning to recognize that the provision and maintenance of adequate nutrition can reduce health care cost and improve quality of life. Many of America's elderly are documented to be at nutritional risk because of their life-styles, functional ability, and physical and mental health status (1-3). The Nutrition Screening Initiative (NSI) has reported that 24% of the elderly are at high nutritional risk and 38% are at moderate nutritional risk (4,5).

Patients whose nutritional status is adequate have better health outcomes. Conversely, patients with a compromised nutritional status have three times the number of major complications, stay in the hospital two thirds longer, incur several thousand dollars more in charges per hospital stay, and are three times more likely to die (6). The 1988 Surgeon General's Workshop on Health Promotion and Aging recommended that a nutrition assessment be completed on all older patients admitted to health care institutions or community-based health services (7).

This is an opportune time for registered dietitians (RDs) to take a leading role in effectively educating the health care team about the importance of nutrition assessment in combination with case management in health promotion and disease prevention. Through nutrition assessment/case management, the true effect of maintaining or restoring nutritional status can be documented and a comprehensive nutrition case management (CNCM) service is developed.

Who on the health care team is better educated and qualified to provide CNCM than the RD? Yet if RDs are to be recognized as the providers of CNCM, they will need to take responsibility for examining the processes for routine nutrition services in both the clinical and community setting.

CNCM for the elderly is the process of assessing, planning, arranging, coordinating, and monitoring service delivery for patients at nutritional risk to ensure the delivery of appropriate, high-quality nutrition services in a timely and cost-effective manner. Nutrition case management is a series of activities that integrate nutrition screening/assessment findings with multiple health and community services for …