An 87-year-old female previously independent comes to the ER with 2 days of difficulty swallowing, productive cough, and dyspnea. History includes hypertension and atrial fibrillation. She has a low-grade fever and increased blood pressure.
Physical examination and chest radiography are consistent with consolidation in left lower lobe. On bedside testing, she immediately sputters and coughs after drinking a small amount of water from a cup. There are no other neurological signs. Labs: Mild dehydration and WBC increased. MRI reveals a new small brain-stem infarction and mild generalized cerebral atrophy. Treatment for aspiration pneumonia is instituted. Five days later a speech therapy consult was ordered to evaluate swallowing. No improvement has been noted and formal evaluation shows aspiration with most consistencies of food and liquid. Which of the following is the best recommendation?
A. Careful oral feeding
B. Hospice
C. Gastrostomy feeding
D. Nasogastric feeding
Question 2
Which of the following nutritional indicators is not an indication of poor nutritional status in an older person?
A. Albumin of <3.5 g/dl
B. Body mass index of 24
C. Total cholesterol <150 mg> D. Loss of 5-10 body weight in 180 days
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