Family physicians, managed care organizations and health planners are becoming increasingly aware of the value of good nutrition in the prevention and treatment of disease. Our focus as a health care system will shift from individual disease-oriented office visits to concern for maintaining and improving the health of our citizens. Nutrition education, nutrition screening for the elderly and the therapeutic use of medical foods will become more important to practicing physicians and family practice educators.

The American Academy of Family Physicians, in partnership with the American Dietetic Association and the National Council on Aging, has promoted the Nutrition Screening Initiative (NSI). The NSI has succeeded in raising the level of awareness of physicians, politicians and the public to the importance of nutrition in the elderly.

The NSI commissioned a study¹ by the Barents Group to estimate the cost savings that could be achieved if our elderly citizens were systematically screened for nutritional deficiency. The study documented compelling evidence that older patients who are admitted to the hospital in a compromised nutritional state had longer lengths of stay and increased rates of complications than well-nourished patients. Moreover, the investigators estimated that the total cost of poor nutrition for Medicare over the next six years would be $1.3 billion, primarily in increased hospital costs.

All too often, older patients are admitted for medical or surgical diagnoses and placed on intravenous fluids for days with no nutritional support. The great majority of these patients have a normal bowel that could be used for enteral nutrition from the time of admission. Family physicians must become more aware of the nutritional needs of our elderly patients. Reviews on implementing enteral nutrition are available.² We encourage family physicians to improve their knowledge and skills in enteral nutrition.

The NSI has developed a simple screening tool that may be self administered or graded by any health care professional or family member (see figure on page 934). We encourage all family physicians to screen their older patients using this simple tool and recommend interventions when necessary. Community efforts that aid in meal procurement or preparation, coupled with nutritional supplements and enteral nutrition when indicated, will go a long way to improving the health and well-being of our senior citizens. The cost savings to our ailing Medicare system are clearly documented in the Barents study.¹ For more information about the Nutrition Screening Initiative, contact the NSI, 1010 Wisconsin Ave., Ste. 800, Washington, D.C. 20007-3603; telephone: 202-625-1662.