Among my RDNs posed this question Lately Associated with BMI levels for older adults:
I have been seeing transfer notes in the hospital along with other nursing homes with diet/nutrition histories where RDNs are charting that BMIs of less than 23 is underweight. By way of example, 1 note documented a BMI of 21.3 was underweight”for age” for a guy who was 92. State surveyors are also requesting a list of people who have BMI under 21 and wanting to find interventions on them. The MDS doesn’t trigger for a very low BMI until under 19. Do we must adapt our practices?
Classification – Normal
Classification – Overweight
Classification – Obesity
Classification – Obesity
BMI (kg/m2) – > 40
BMI is translated according to age, health history, usual body weight, and weight history.
Adults should be evaluated for signs of nutritional status and decrease using body mass index (BMI) as one of several things. Data suggests that a higher BMI range could be protective in older adults and the criteria for ideal weight (BMI of 18.5 to 25) may be overly restrictive in the elderly. A lower BMI might be considered detrimental to older adults because of association with decreasing nutrition status, possible pressure ulcers, infection and other complications. A BMI of 19 or less may indicate nutritional deficiencies, while a BMI of 30 or above indicates obesity.
In the literature, there’s a whole lot of conversation about a BMI of 21-23 (instead of 18/19) as considered on the low side for older adults. At exactly the exact same time, there’s a whole lot of conversation about the”obesity paradox” stating a greater BMI may be protective against some diseases and death. There’s still lots of controversy concerning the effectiveness of BMI for older adults, irrespective of what is considered”too low” or”too high”.
To our knowledge, there are no firm recommendations from any source on BMI cutoffs for elderly adults. The MDS activates a CAA if BMI is < 18.5, although as mentioned above a greater BMI are likely to be considered too low for older adults.
In clinical practice, the BMI number isn’t as important as how it pertains to an individual’s history. Tracking changes over time is what’s important.
If state surveyors question if everybody with a low BMI requires an intervention, consider explaining that if a low BMI was normal with this individual’s life history, then we wouldn’t try to fix it – although interventions may be put in place for different reasons (bad intake, weight loss, wounds, etc.). And for an older person with a high BMI of 35 who was overweight their entire life, it’s highly possible that habits and lifestyle are put and weight loss would likely not be necessary or successful at older age.