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Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

The Role of Nutrition in Maintaining Health in the Nation’s Elderly

Evaluating Coverage of Nutrition Services for the Medicare Population

Committee on Nutrition Services for Medicare Beneficiaries

Food and Nutrition Board

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, DC

Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

NATIONAL ACADEMY PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This project was funded by the U.S. Department of Health and Human Services, Health Care Financing Administration Contract No. 500-98-0275. Any opinion, findings, conclusions, or recommendations expressed in this publication are those of the Institute of Medicine committee and do not necessarily reflect the view of the funding organization.

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Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

THE NATIONAL ACADEMIES

National Academy of Sciences

National Academy of Engineering

Institute of Medicine

National Research Council

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

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Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

COMMITTEE ON NUTRITION SERVICES FOR MEDICARE BENEFICIARIES

VIRGINIA A. STALLINGS (Chair),

Division of Gastroenterology and Nutrition, The Children’s Hospital of Philadelphia, Pennsylvania

LAWRENCE J. APPEL,

Welch Center for Prevention, Epidemiology and Clinical Research, John Hopkins School of Hygiene and Public Health, Baltimore, Maryland

JULIA A. JAMES, Principal,

Health Policy Alternatives, Washington, D.C.

GORDEN L. JENSEN,

Division of Gastroenterology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee

ELVIRA Q. JOHNSON,

Clinical Nutrition Services, Cambridge Health Alliance, Massachusetts

JOYCE K. KEITHLEY,

Rush University College of Nursing, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois

ESTHER F. MYERS,

60th Diagnostics and Therapeutics Squadron/ SGOD, United States Air Force, Travis Air Force Base, California

F. XAVIER PI-SUNYER,

Division of Endocrinology, Diabetes, and Nutrition, St. Luke’s/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York

HAROLD POLLACK,

Health Management and Policy, University of Michigan, Ann Arbor

CAROL PORTER,

Nutrition Services and Dietetic Internship, University of California at San Francisco

DAVID B. REUBEN,

Division of Geriatrics, University of California, Los Angeles

ROBERT S. SCHWARZ,

Division of Geriatrics Medicine, University of Colorado, Denver

ANNALYNN SKIPPER,

Nutrition Consultation Service, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois

LINDA G. SNETSELAAR,

Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City

Staff

ROMY GUNTER-NATHAN, Study Director

GERALDINE KENNEDO, Project Assistant

CARMIE CHAN, Project Assistant

EDEN RAUCH, Intern (June to August 1999)

Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

FOOD AND NUTRITION BOARD

CUTBERTO GARZA (Chair),

Division of Nutrition, Cornell University, Ithaca, New York

JOHN W. ERDMAN, JR. (Vice-Chair),

Division of Nutritional Sciences, College of Agricultural, Consumer and Environmental Sciences, University of Illinois at Urbana-Champaign

LARRY R. BEUCHAT,

Center for Food Safety and Quality Enhancement, University of Georgia, Griffin

BENJAMIN CABALLERO,

Center for Human Nutrition, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland

FERGUS M. CLYDESDALE,

Department of Food Science, University of Massachusetts, Amherst

ROBERT J. COUSINS,

Center for Nutritional Sciences, University of Florida, Gainesville

JOHANNA T. DWYER,

Frances Stern Nutrition Center, New England Medical Center and Tufts University, Boston, Massachusetts

SCOTT M. GRUNDY,

Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas

CHARLES H. HENNEKENS,

Boca Raton, Florida

ALFRED H. MERRILL, JR.,

Department of Biochemistry, Emory Center for Nutrition and Health Sciences, Emory University, Atlanta, Georgia

LYNN PARKER,

Child Nutrition Programs and Nutrition Policy, Food Research and Action Center, Washington, D.C.

ROSS L. PRENTICE,

Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington

A. CATHARINE ROSS,

Department of Nutrition, The Pennsylvania State University, University Park

ROBERT M. RUSSELL,

Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts

ROBERT E. SMITH,

R.E. Smith Consulting, Inc., Newport, Vermont

VIRGINIA A. STALLINGS,

Division of Gastroenterology and Nutrition, The Children’s Hospital of Philadelphia, Pennsylvania

STEVE L. TAYLOR,

Department of Food Science and Technology and Food Processing Center, University of Nebraska, Lincoln

Staff

ALLISON A. YATES, Director

GAIL E. SPEARS, Administrative Assistant

GARY WALKER, Financial Associate

Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

Acknowledgments

Appreciation is due to the many individuals and groups who were instrumental in the development of this report. First and foremost, many thanks are extended to the committee who volunteered countless hours to the research, deliberations, and preparation of the report. Their dedication to this project and to a very stringent time line was commendable, and the basis of our success.

Many consultants also provided assistance and reviewed drafts of specific chapters. In particular, appreciation and thanks are extended to Rowan Chlebowski, MD, Division of Medical Oncology and Hematology, Harbor UCLA Medical Center, Torrance, CA; Bess Dawson-Hughes, MD, Calcium and Bone Metabolism Laboratory, Tufts University, Boston; Rosanna Gibbons, MS, RD, Consultant Dietitian in Home Care, Baltimore, Maryland; Talat Alp Ikizler, MD, Division of Nephrology, Vanderbilt University Medical Center, Nashville; John Kostis, MD, University of Medicine and Dentistry of New Jersey; and Andrew S. Levey, MD, Division of Nephrology, New England Medical Center, Boston.

The report was also independently reviewed in its entirety by many individuals who were chosen for their diverse perspectives and technical expertise to assure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. These individuals included Bruce R. Bistrian, MD, PhD, Division of Clinical Nutrition, Beth Israel Deaconess Medical Center, Boston; Ronni Chernoff, PhD, RD, FADA, Geriatric Research Education and Clinical Center, John L. McClellan Memorial Veterans Hospital, Little Rock; Cutberto Garza, MD,

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

PhD, Vice-Provost, Cornell University; Stanley Gershoff, PhD, Professor of Nutrition, Emeritus, Tufts University, Boston; Margaret M. Heitkemper, PhD, RN, FAAN, Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle; Jerome P. Kassirer, MD, Editor in Chief Emeritus, New England Journal of Medicine, Boston; Penny Kris-Etherton, PhD, RD, Department of Nutrition, Pennsylvania State University, University Park; Lauren LeRoy, PhD, Grantmakers in Health, Washington, DC; John E. Morley, MD, Division of Geriatric Medicine, St. Louis Veterans Affair Medical Center; Henry Riecken, PhD, Professor of Behavioral Sciences, Emeritus, University of Pennsylvania, Philadelphia; Louise B. Russell, PhD, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Jersey; and Philip J. Schneider, RPh, MS, College of Pharmacy, The Ohio State University, Columbus.

Many individuals also volunteered significant time and effort to address and to educate the committee at its workshop and public meeting. Workshop speakers included Bess Dawson-Hughes, MD and Ernest Schaefer, MD of Tufts University, Boston; Linda Delahanty, MS, RD of the Massachussets General Hospital, Boston; V. Annette Dickinson, PhD of the Council for Responsible Nutrition, Washington DC; Marion Franz, MS, RD of the International Diabetes Center, Minneapolis; Samual Klein, MD of Washington University, School of Medicine, St. Louis; William Mitch, MD of Emory University, Atlanta; Tom Prohaska, PhD of the University of Chicago; Dennis Sullivan, MD of the University of Arkansas, Little Rock; and Mackenzie Walser, MD of Johns Hopkins University, Baltimore.

In addition, organizations that provided either oral or written testimony to the committee included the American College of Health Care Administrators; the American College of Nutrition; the American Dietetic Association; the American Society for Clinical Nutrition; the American Society for Enteral and Parenteral Nutrition; Fresnisus Medical Care, North America; and the National Kidney Foundation.

Other individuals who deserve special thanks are Tate Erlinger, PhD of Johns Hopkins University for his special assistance with the NHANES III database, Lisa Prosser, MS of Harvard University for sharing her prepublication data on cost analysis of dietary interventions, Marilyn Field, PhD of the Health Care Services Division, Institute of Medicine for her guidance throughout the report process, and Joan DaVanzo, PhD, Allen Dobson, PhD, and Namrata Sen, MHA of The Lewin Group for their patience and number-crunching abilities.

So, it is apparent that many individuals from a variety of clinical and scientific backgrounds provided timely and essential support for this project. Yet, we would have never succeeded without the efforts, skills,

Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

and grace that was provided in large measure by Romy Gunter-Nathan, MPH, RD, our study director for this project, from Geraldine Kennedo, Project Assistant, and from Allison Yates, PhD, RD, Director, Food and Nutrition Board, Institute of Medicine.

Lastly, as the chair, may I express my sincere appreciation to each member of this committee for your extraordinary commitment to the project and for the wonderful opportunity to work with you on this important task for the medical and nutrition community and for the Medicare beneficiaries whose care we were asked to consider.

Virginia A. Stallings, MD

Chair

Committee on Nutrition Services for Medicare Beneficiaries

Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

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Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

SECTION III
NUTRITION SERVICES ALONG THE CONTINUUM OF CARE

 

 

9

 

NUTRITION SERVICES IN THE ACUTE CARE SETTING

 

165

   

 Medicare Reimbursement in Acute Care, Short-Stay Hospitals,

 

165

   

 Role of the Nutrition Professional,

 

166

   

 Effects of Undernutrition on Functional Status in the Elderly,

 

170

   

 Future Areas for Research,

 

171

   

 Summary,

 

171

   

 Recommendations,

 

171

10

 

NUTRITION SUPPORT

 

173

   

 Literature Review,

 

175

   

 Indications for the Use of Nutrition Support,

 

175

   

 Gastrointestinal Diseases,

 

175

   

 Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome,

 

180

   

 Cancer and Bone Marrow Transplantation,

 

183

   

 Acute Renal Failure,

 

185

   

 Critical Illness,

 

187

   

 Perioperative Nutrition Support,

 

189

   

 Limitations of Nutrition Support Evidence,

 

194

   

 Delivery of Nutrition Support,

 

195

11

 

NUTRITION SERVICES IN AMBULATORY CARE SETTINGS

 

213

   

 Reimbursement for Nutrition Therapy in Ambulatory Care,

 

213

   

 Accreditation Standards for the Ambulatory Setting,

 

215

   

 Nutrition Services in Ambulatory Settings,

 

216

   

 Effectiveness of Nutrition Therapy in Ambulatory Settings,

 

220

   

 Future Areas of Research,

 

221

   

 Summary,

 

221

   

 Recommendations,

 

222

12

 

NUTRITION SERVICES IN POST-ACUTE, LONG-TERM CARE AND IN COMMUNITY-BASED PROGRAMS

 

225

   

 Emerging Trends,

 

226

   

 Skilled Nursing Facilities and Nursing Homes,

 

227

   

 Home Health Agencies,

 

235

   

 Community-Based Benefits,

 

241

   

 Future Areas of Research,

 

244

   

 Summary,

 

244

   

 Recommendations,

 

246

Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

SECTION IV
PROVIDERS AND COSTS OF NUTRITION SERVICES

 

 

13

 

PROVIDERS OF NUTRITION SERVICES

 

257

   

 Terms and Definitions,

 

257

   

 Tiers of Nutrition Services,

 

258

   

 Education and Skills Necessary for the Provision of Nutrition Therapy,

 

259

   

 Licensure in the Practice of Dietetics,

 

260

   

 Health Care Professionals Specializing in Nutrition,

 

260

   

 Other Health Care Professionals,

 

266

   

 Who Is Qualified to Provide Basic Nutrition Education or Advice?

 

270

   

 Who Is Qualified to Provide Nutrition Therapy?

 

271

   

 Summary,

 

271

   

 Recommendations,

 

271

14

 

ECONOMIC POLICY ANALYSIS

 

274

   

 Evaluation Methodologies,

 

275

   

 Cost Estimates,

 

277

   

 Economically Significant Averted Costs,

 

289

   

 Summary,

 

304

15

 

OVERALL FINDINGS AND RECOMMENDATIONS

 

310

   

 Medicare Coverage of Nutrition Therapy,

 

311

   

 Administrative Recommendations Regarding the Provision of Nutrition Services,

 

317

   

 Economic Policy Analysis,

 

321

   

 Concluding Remarks,

 

322

APPENDIXES

 

 

A

 

Acronyms

 

327

B

 

Glossary

 

331

C

 

Workshop Speakers, Organizations Contacted, and Consultants to the Committee

 

338

D

 

State Licensure Laws for the Practice of Dietetics (as of June 1999)

 

340

E

 

The American Dietetic Association Foundation Knowledge and Skills and Competency Requirements for Entry-Level Dietitians

 

342

F

 

Advanced-Level Credentials in Nutrition

 

352

G

 

U.S. Preventive Services Task Force Rating of Professionals to Deliver Dietary Counseling

 

355

H

 

Summary of Cost Estimation Methodology for Outpatient Nutrition Therapy

 

357

I

 

Committee Biographical Sketches

 

361

Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

The Role of Nutrition in Maintaining Health in the Nation’s Elderly

Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×

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Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R3
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R4
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R5
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R6
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R8
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R9
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R10
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R11
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R13
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R14
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R15
Suggested Citation:"Front Matter." Institute of Medicine. 2000. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: The National Academies Press. doi: 10.17226/9741.
×
Page R16
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Malnutrition and obesity are both common among Americans over age 65. There are also a host of other medical conditions from which older people and other Medicare beneficiaries suffer that could be improved with appropriate nutritional intervention. Despite that, access to a nutrition professional is very limited.

  • Do nutrition services benefit older people in terms of morbidity, mortality, or quality of life?
  • Which health professionals are best qualified to provide such services?
  • What would be the cost to Medicare of such services? Would the cost be offset by reduced illness in this population?

This book addresses these questions, provides recommendations for nutrition services for the elderly, and considers how the coverage policy should be approached and practiced. The book discusses the role of nutrition therapy in the management of a number of diseases. It also examines what the elderly receive in the way of nutrition services along the continuum of care settings and addresses the areas of expertise needed by health professionals to provide appropriate nutrition services and therapy.

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