From the Mayo Clinic: Older adults are at risk of inadequate nutrition - malnutrition - as a result of inappropriate dietary choices, low income, difficulty obtaining food, and various physical and mental health conditions. Additional causes of inadequate nutrition:

• Changes in taste, smell and appetite generally decline with age making it more difficult to enjoy eating and keep regular eating habits.
• Difficulty chewing or swallowing, poor dental health, or limited ability in handling tableware can contribute to malnutrition.
• Dementia. Behavioral or memory problems from Alzheimer's disease or a related dementia can result in forgetting to eat, not buying groceries or other behavioral side effects of confusion.
• Medications. Some medications can affect appetite or the ability to absorb nutrients.
• Restricted diets. Dietary restrictions for managing medical conditions — such as limits on salt, fat or sugar — might also contribute to reduced caloric intake.
• Reduced social contact. Older adults who eat alone might not enjoy meals as before and lose interest in cooking and eating.
• Alcoholism. Too much alcohol can interfere with the digestion and absorption of nutrients and cause poor eating habits.

Symptoms of Malnutrition

• Weight loss
• Muscle weakness and fatigue
• Complaints of feeling tired all day and lack of energy
• Ongoing infections
• Prolonged healing of small wounds and cuts
• Irritability
• Dizziness & lightheadedness
• Dry/brittle skin & hair 

Patient Teaching for Prevention of Malnutrition 

• Eat/drink small meals every 3-4 hours. Avoid going long periods of time without eating. Your stomach will shrink.
• Gradually eat more food each day...Your stomach will expand over time.
• Keep a food and beverage diary. Learn when, what, and how much you eat and drink.
• Snack! Snacks may help if you are having trouble eating enough at mealtimes.
• Exercise! It will help you build muscle and increase your appetite. Your body may compensate or even overcompensate for the calories that you burn exercising.
• Eat a variety of different foods – vegetables, dairy, protein, fruit, carbohydrates and/or fats at mealtime.
• Keep your pantry, fridge, and freezer well stocked with foods you like to eat. It's tough to gain weight when there’s no food - you like - around.
• Choose high-calorie, high-nutrient foods that are less filling: dried fruit, bananas, nuts and seeds, potatoes, peas, and corn.
• Try to eat more quickly. It takes a few minutes for your stomach's signals of fullness to register. Try to put more food on your fork. Avoid putting your fork down in between bites.
• Use larger cups, plates, bowls, et cetera. You will probably be able to eat more without really thinking about it.
• Make meals social events. Drop by during mealtime or invite the older adult to your home for occasional meals. Go out to eat at a restaurant with senior discounts. Encourage participation in social programs where members of the community can eat together.

Home Health Coding: Medicare Do's & Don'ts under PDGM

Does Your Home Health Orientation Include These 11 Policies?