1. Evaluation of Pre-operative Status Karen E. Hall, M.D., Ph.D. GRECC, Ann Arbor VA Health System University of Michigan Health System Hydration and Nutrition Before and After Surgery

2. Overview

3. Case

4. Malnutrition

5. Caloric requirements

6. Protein requirements

7. So, in practical terms…?

8. Is Diet Adequate in Older Adults?

9. Is Aged Diet Adequate?

10. Mode of LivingPrevalence of Malnutrition Community2-7 % Hospital22-59 % Nursing Home30-85 % *Cederholm and Hellerstrom. Gerontol 38:105, 1992 Some Aged are Malnourished

11. Malnutrition Risks in Community-Dwelling Elders

12. Other Indices of Malnutrition

13. Nutrition Assessment Tools

14. Nutrition Screening Initiative

15. Mini Nutritional Assessment*

16. Mini Nutritional Assessment

17. MNA predicts outcome

18. MNA vs MNA-Short Form

19. Mini Nutritional Assessment-Short Form* MNA “impractical” due to length: 10-15 minutes MNA-SF: Very high correlation (r = 0.985) with MNA No anthropomorphic measurements except BMI Only 6 questions *Rubenstein et al. J Gerontol 56: M366, 2001

20. MNA-SF

21. MNA-Short Form

22. Micronutrient Deficiencies in Aging

23. Calcium Deficiency

24. Vitamin D Deficiency

25. Vitamin C Deficiency

26. Case

27. Pre-Operative Assessment in 5 Minutes

28. FEED THEM!