The Great BMI Debate

One of my RDNs posed this question recently related to BMI levels for older adults:

I’ve been seeing transfer notes from the hospital and other nursing homes with diet/nutrition histories where RDNs are charting that BMIs of less than 23 is underweight. For example, one note documented that a BMI of 21.3 was underweight “for age” for a man who was 92. State surveyors are also asking for a list of residents with BMI under 21 and wanting to see interventions on them. The MDS does not trigger for a low BMI until under 19. Do we need to adapt our practices?

The National Institute of Health classification of overweight and obesity by body mass index (BMI) is as follows:

Classification – Normal

Obesity Class – None

BMI (kg/m2) – 18.4-24.9

Classification – Overweight

Obesity Class – None

BMI (kg/m2) – 25.0-29.9

Classification – Obesity

Obesity Class – I

BMI (kg/m2) – 30.0-34.9

Classification – Obesity

Obesity Class – II

BMI (kg/m2) – 35.0-39.9

Classification – Extreme Obesity

Obesity Class – III

BMI (kg/m2) – > 40

BMI is interpreted based on age, health history, usual body weight, and weight history.

Adults should be assessed for indicators of nutritional status and decline using body mass index (BMI) as one of many factors. Data suggests that a higher BMI range may be protective in older adults and that the standards for ideal weight (BMI of 18.5 to 25) may be too restrictive in the elderly. A lower BMI may be considered detrimental to older adults due to association with declining nutrition status, potential pressure ulcers, infection and other complications. A BMI of 19 or less may indicate nutritional depletion, while a BMI of 30 or above indicates obesity.

In the literature, there is a lot of conversation about a BMI of 21-23 (rather than 18/19) as considered on the low side for older adults. At the same time, there is a lot of conversation about the “obesity paradox” saying a higher BMI might be protective against some diseases and death. There is still a lot of controversy regarding the efficacy of BMI for older adults, regardless of what is considered “too low” or “too high”.

To our knowledge, there are no firm recommendations from any source on BMI cutoffs for older adults. The MDS triggers a CAA if BMI is < 18.5, although as stated above a higher BMI can probably be considered too low for older adults. In clinical practice, the BMI number is not as important as how it compares to an individual's history. Monitoring changes over time is what is important. If state surveyors question whether everyone with a low BMI needs an intervention, consider explaining that if a low BMI was normal for this person's life history, then we would not attempt to correct it - although interventions might be put in place for other reasons (poor intake, weight loss, wounds, etc.). And for an older person with a high BMI of 35 who had been overweight their whole life, it is highly likely that lifestyle and habits are set and weight loss would probably not be necessary or successful in older age. The new Academy/ASPEN criteria for diagnosing malnutrition does not use BMI - it uses unintended weight loss, body fat, muscle mass loss (as determined by nutrition focused physical assessment and/or handgrip strength in the case of severe malnutrition) and other factors. The National Quality Forum Measure #128 (NWF 0421) Preventive Care and Screening uses >23 and <30 for those over the age of 65. There are several reference articles on BMI in the elderly which all suggest higher BMIs for those over 65: - Flicker et al JAGS 2010; 68: 234. - Bell et al JAMDA 2013; 14: 94-100. - Winter J et al Am J Clin Nutri 2014; 99:875-890 Sorkin, J Am J Clin Nutri 2014; 99: 759-760. - Winter J, MacInnis R, Wattanapenpaiboon N and Nowson C. BMI and all-cause mortality in older adults: a meta-analysis. First published January 22, 2014, doi: 10.3945/​ajcn.113.068122. Am J Clin Nutr.

Uses Of Essential Oils

Essential oil is a hydrophobic liquid which is generally extracted from leaves, stems and elements of a plant. You cannot consider it as oil because generally oil contains the fatty acids, which are not found in this. Its aromatic fragrance can even help to lift your mood and make you feel refreshed and relaxed. It has antioxidant and anti-inflammatory properties which make it beneficial in aromatherapy, cleaning, cosmetic and natural beauty products.

From the ancient time, this can be used in traditional medicine and cosmetic products. So before purchasing this, just make sure that the product you are going to buy is certified pure and therapeutic grade. This can be used in many ways, as you can apply it on your skin, diffused in the air, added to your bath, used in aromatherapy, used to add flavor to food and drink and in medical products as well. Some of its uses are as follows.

Use for cleaning home: This oil has various uses and properties which make it all-rounder and highly demanded in the market. Apart from its health or skin benefits, this can be also used to clean your home in several ways. You can use this as a bathtub scrubber, carpet cleaner, use to remove burnt pans, bathroom freshener, fridge purifier, dish cleaner and also helps to eliminate the smell of smoke and so on. Nowadays, this is a must for every household to make their home clean and fresh, and this is the best product to use.

Use for Spa relaxation: Its aromatic fragrance is very helpful to release the stress of your body and mind. You can use this in a lot of ways like as a massage therapy, detox bath, foot bath, yoga and Pilates, sauna therapy, lip balm, body lotion and much more. Its aroma will definitely helps to energize your body and soul.

Use for skin and beauty: This is very skin-friendly and your skin can easily absorb it. You just need to add a few drops in your beauty products to make them skin-friendly. You can also use this oil to reduce wrinkles, strengthen nails, heal dry cracked feet, get natural skin, and for scrubbing your face, remove dandruff and in many more ways.

Use for medicine: One of the major things which attract numerous customers toward this natural oil is that it is traditionally used to get relief from various health issues. You can use this to get relief from migraine, sinus, heal burns, toothache, sunburn and many other diseases.

The Different Players Needed for Patient Care

Diseases and injuries affecting the ligaments, nerves, tendons, joints, and bones receive treatment from orthopedics specialists. Careers in this field include more than just the doctors. Each person in this team plays a vital role in patient care.

Orthopedic Nurse

Nurses who take care of people with musculoskeletal diseases fall under the umbrella of orthopedics. These skilled nurses may assist in the operating room or could work a special ward in the hospital. While many work with patients who have had joint replacement surgery or corrective procedures for broken bones, they also help patients suffering from arthritis. As with other nursing fields, these nurses may be a registered nurse (RN) or licensed practical nurse (LPN). Registered nurses go to school for two to four years to obtain their associate’s or bachelor’s degree. On the other hand, LPNs only go to school for about one year in order to obtain their certificate.

Advance Practice Nurses

In addition to having LPNs and RNs on the team, some doctors employ advanced practice nurses. These nurses have completed either their master degree or earned their doctorate in the nursing field. Due to their extensive education and experience, advanced practice nurses, also known as Nurse Practitioners, are able to perform doctor-like tasks. They are capable of ordering lab tests and x-rays, diagnosing injuries and diseases and can prescribe medication. While these nurses may perform direct patient care, they often manage a healthcare for a group of patients just like a physician. Nurse practitioners must be licensed and, in some states, certified in order to work in this field.


At the center of most teams is the surgeon. These doctors spend about half their time in the operating room. Despite the amount of time spent in operation, these doctors also use physical, medical, and rehabilitative methods to treat their patients. Doctors specializing in orthopedics complete the traditional medical track of an undergraduate degree, medical school, and residency. After their residency, they may need to spend several years as a general surgeon before moving into an orthopedic practice. As with all physicians, these specialists are required to obtain a license and certification for their state.


All physicians need assistants while they are in the operating room or in their office. While nurses do the bulk of the assisting, there are technologists who play a role in patient care. These techs work with patients by managing those who are in traction, assisting during operations, and applying or removing casts. Unlike physicians or nurses, these skilled workers are not required to have a license or certification. However, most offices will not employ someone as a technologist unless they have received an associate degree or certificate in the field. This ensures that the worker has had some training and education.

A team of orthopedics specialists work together to care for patients suffering from musculoskeletal ailments. Due to the unique job each person performs, it is difficult for a team to operate without one of the members.

Does Holding Your Pee Affect You?

The human bladder can hold up to 0.5 liters of liquid. A normal person taking 8 glasses of water a day takes 64 ounces (1.9 liters), hence the need to constantly get rid of the excess water. The bladder stores this excess liquid and when half full, sends signals to the brain to let one know that they should pee. This however, is bearable and one may decide to hold the pee for longer.

But how long is long, well it varies with different people. Others can hold it for so long while others can’t hold it in for long. It is however advisable that you hit the head as soon as the urge to do so comes.

While holding it for a short period has no effect apart from the difficulty to concentrate on anything else than your desire to pee, doing so for long and too many times is harmful. It may lead to infections and other numerous side effects. The bacteria on the genital surface is not being flushed out, hence it can enter through the ureter and migrate in to the bladder. The accumulation of these bacteria may cause lower urinary transmitted infection (UTI). In rare cases, the bacteria may walk its way up the ureter, reaching the kidney, causing pyelonephritis, a kidney ailment, whose symptoms include a fever, back pains. If this goes untreated, the bacteria will enter the blood stream causing a systemic disorder that is extremely life threatening.

For pregnant women, these bacteria spread faster, there are other infections that may arise from this. They include:

Kidneys stones a condition where tiny stone like develop in the kidneys due to excess accumulation of calcium and sodium salts along the tract. The stones make it difficult to pass urine as the pain that comes along is unbearable since the stones will be large compared to the tract size.

Cystitis an inflammation of the bladder walls mostly experienced by women. Its symptoms are: pain in the pelvis, burning and pain when urinating and swelling of the bladder.

Voiding dysfunction this occurs mostly in children. It is the inability to retain urine as the sphincter muscles have been weakened and are unable to relax.
The bladder may also swell since it is holding more than its capacity. Too much swelling may call for a surgery.

Other possible diverse effects are anxiety, cramps, shivers and stomach pains.

Effective Ways to Get Rid of Acne

Acne and acne scarring are quite common skin conditions that trouble many teenagers, some, well into their young adult age. Some people with hormonal disorders may also face acne-related problems throughout their life. Recurring acne problems don’t just cause irreparable damage to the skin sometimes but also affects the emotional and psychological health of the sufferer.

In addition to painful breakouts, recurrent acne also leaves unsightly scars even after the acne has healed. Atrophic scars, ice pick scars, redness and inflammation, as well as deformation and disfigurement of tissues surrounding the acne are all common problems that many acne sufferers have to deal with even after they have recovered from an outburst.

While poor hygiene may contribute to acne conditions, acne primarily originates from a hormonal imbalance in the body. The male reproductive hormone, androgen is a key causal factor behind the condition. As a result of the imbalance in this particular hormone, sebaceous glands start to over-produce oil or sebum, making the skin pores clog with all the extra oil and dead cells on the skin. Blocked, oily pores encourage the growth of bacteria, which is essentially the start of acne.

In most cases, acne dries out on its own, leaving behind minimal markings or scarring, which usually heal effectively over time. However, deep-rooted scars from constant acne breakouts can remain on the skin for years and can only be removed using medication and active treatment. Fortunately for acne sufferers, there are many dermatologically approved methods that can help reduce and even get rid of acne for good. Ask your local aesthetic/skin clinic about the following procedures and techniques:

• Medical Therapy
• Laser Techniques
• Radiofrequency Techniques
• Dermarollers and Cryorollers
• Microdermabrasion
• Chemical Peels
• Topical Treatments
• Homecare remedies

It is imperative for an acne patient to determine the root cause of the acne problem. A proper dermatologist or skin specialist can help you figure out exactly what is causing your outbreaks by means of your medical history and some laboratory testing. You may also be advised to be tested for other health conditions that may cause acne outbreaks if treatment options don’t seem to be working their course. When it comes to scarring, laser techniques and microdermabrasion are highly recommended for those who want to deal with their minor to their deep rooted acne scars. Chemical peels are also effective in expediting the shedding of dead skin layers, but they should only be administered by experienced and knowledgeable experts.