FNOA: Considerations for Weight Management in the Older Adult

Regardless of age, the registered dietitian (RD) should consider the following when assessing the need for weight management through modifications in dietary intake and physical activity in older adults:

• Classification of overweight or obesity
• Presence of comorbidities
• Physical function
• Cognitive function
• Attitude toward longevity
• Lifestyle
• Personal choice
• Quality of life

While studies have demonstrated varying associations between assessment indicators of overweight or obesity and physical function and mortality in the older adult, the need for weight loss should be based on input from the physician or geriatrician, RD, qualified exercise specialist and other members of the health care team and will ultimately be the personal decision made by the older adult.

Fair, Imperative

FNOA: Use Multiple Assessment Indicators for Classification of Overweight/Obesity

Regardless of age, the RD should use more than one of the following assessment indicators when classifying overweight or obesity:

• Weight change (and weight history)
• Current (and past) weight, height and body mass index (BMI)
• Waist circumference
• Body composition

More than one assessment indicator should be used, due to the potential limitations of each indicator in the older adult, such as gender and ethnic differences in their application. In addition, studies demonstrated that muscle mass generally decreases and fat mass generally increases over time, even when weight is stable.

Fair, Imperative

Recommendation Strength Rationale

• Conclusion statements are Grades I and II.

FNOA: United States Department of Agriculture (USDA) and Older Americans Act (OAA) Nutrition Service Programs for Older Adults

FNOA: Screen for USDA and OAA Program Eligibility

The RD should screen all older adults for eligibility (or refer for screening) in USDA programs and the OAA Nutrition Service Program and identify potential barriers to participation, such as disability, functional impairment, attitude toward program utilization and income level. Research reported racial and ethnic differences in program participation, as well as in subjects with vision or hearing difficulties, special dietary needs, functional limitations or disabilities.

Fair, Imperative

FNOA: Encourage Participation in USDA and OAA Programs

The RD should encourage eligible older adults to apply for and participate in the following USDA and OAA programs:

USDA

• Supplemental Nutrition Assistance Program (SNAP)
• Senior Farmer’s Market Nutrition Program (SFMNP)
• Child and Adult Care Food Program (CACFP)
• Emergency Food Assistance Program
• Commodity Supplemental Food Program (CSFP)

OAA Programs

• OAA Congregate Nutrition Program
• OAA Home Delivered Nutrition Program

Research reported that participation in USDA and OAA programs improved food and nutrient intake, increased fruit and vegetable consumption, stimulated interest in healthy foods, improved quality of life and improved nutritional status. However, some subjects felt that they did not need food assistance and some participants did not know that they were eligible or how to apply.

Fair, Conditional

Recommendation Strength Rationale

• Conclusion statements are Grades II and III.

FNOA: Antioxidant Consumption and Age-Related Macular Degeneration and Cognitive Function in Older Adults

FNOA: Encourage Dietary Reference Intakes (DRI) for All Older Adults

For all older adults, the RD should encourage food intake meeting the Dietary Reference Intakes (or other recommended levels) for antioxidant vitamins and minerals and recommend a multi-vitamin if food intake is low. Studies regarding antioxidant intakes below recommended levels reported an association with cognitive decline, however, research regarding age-related macular degeneration was inconclusive.

Strong, Imperative

FNOA: Collaborate with Others Regarding Treatment of Diagnosed Age-Related Macular Degeneration

• For older adults with diagnosed age-related macular degeneration, the RD should collaborate with others on the inter-professional team (such as physicians, ophthalmologists, pharmacists and other healthcare professionals) to determine whether an older adult would benefit from high-dose supplementation of antioxidants, as some formulations have side-effects and contraindications.
• Studies have found a beneficial effect of antioxidant (beta-carotene, vitamin C and vitamin E), lutein/zeaxanthin and zinc and copper from diet or supplementation on delaying progression of advanced age-related macular degeneration. However, other studies report inconclusive findings.

Strong, Conditional

FNOA: Advise against Antioxidants for Treatment of Diagnosed Cognitive Impairment/Alzheimer’s Disease

• For older adults with diagnosed cognitive impairment or Alzheimer’s disease, the RD should advise against antioxidant supplementation, as it has not been shown to have an effect and some formulations have side effects and contraindications.
• Findings from studies of antioxidant intake above recommended dietary allowance (RDA) levels in subjects with diagnosed cognitive impairment or Alzheimer’s disease demonstrated no difference in the delay of cognitive decline. These findings were substantiated by one systematic Cochrane review.

Strong, Conditional

Recommendation Strength Rationale

• Conclusion statements are Grade II.

Definitions:

Conditional vs Imperative Recommendations

Recommendations can be worded as conditional or imperative statements. Conditional statements clearly define a specific situation, while imperative statements are broadly applicable to the target population without restraints on their pertinence. More specifically, a conditional recommendation can be stated in if/then terminology (e.g., If an individual does not eat food sources of omega-3 fatty acids, then 1g of EPA and DHA omega-3 fatty acid supplements may be recommended for secondary prevention).

In contrast, imperative recommendations “require,” or “must,” or “should achieve certain goals,” but do not contain conditional text that would limit their applicability to specified circumstances. (e.g., Portion control should be included as part of a comprehensive weight management program. Portion control at meals and snacks results in reduced energy intake and weight loss).

Overall Objective

To provide evidence-based recommendations on three topics related to food and nutrition for older adults promoting health and wellness

Specific Objectives

• To define evidence-based nutrition recommendations for registered dietitians (RDs) that are carried out in collaboration with other healthcare providers
• To guide practice decisions that integrate medical, nutritional and behavioral strategies
• To reduce variations in practice among RDs
• To provide the RD with data to make recommendations to adjust medical nutrition therapy (MNT) or recommend other therapies to achieve desired outcomes
• To develop guidelines for interventions that have measurable clinical outcomes
• To define the highest quality of care within cost constraints of the current healthcare environment

Older adults (aged 60 years and older)