Meals That Heal Kathy Cope Helps Care-Givers Recognize That Many Elderly Patients Suffer From Poor Diets

Kathy Cope’s mother would dish out spoonfuls of cod liver oil at the front door before school. Her motto: “You are what you eat.”

Cope’s mother died of cancer years ago, but her red-haired daughter has never forgotten her words. From them Cope carved a career and a life’s mission.

Cope, Washington’s only certified nurse nutritionist, has fought a nationwide campaign to make nutrition screening as important a vital sign as blood pressure or pulse. She’s testified before the U.S. Senate, served on the White House Conference on Aging and lobbied the managed-care industry.

“It’s the biggest missing vital sign in health-care practice,” Cope says.

She wrote a manual called “Malnutrition in the Elderly: A National Crisis” published this year by the U.S. Administration on Aging.

“Many people don’t know that tea and toast isn’t a meal,” Cope says. “They think they’re eating right. (Malnutrition) is slow and insidious.”

It begins with skipped meals, fatigue and weakness. Unchecked, it may hinder the immune system and lead to illness and even death.

Dr. Elizabeth Sundberg, a Spokane nephrologist and chairperson of Sacred Heart Medical Center’s nutrition support committee, estimates that one-third of her kidney patients and at least 1 in 5 elderly hospital patients suffer from malnutrition.

“It’s underrecognized,” Sundberg says. “Many physicians and many people in the community don’t think to look for it. They expect the elderly to be frail and thin.”

Cope, the recipient of Sacred Heart’s nursing excellence award in 1993, works part time as a critical-care nurse. She spends endless hours, and approximately $10,000 a year of her own money, advocating for nutrition screening.

“She’s nationally recognized as an expert on malnutrition,” says Chisato Kawabori, the regional administrator for aging. Kawabori asked Cope to write the manual.

Schools of medicine and nursing as well as public health groups have quickly placed orders for it.

“It’s just a fantastic piece of work,” Kawabori says.

On this afternoon, a bowl of plump shiny fruit - red delicious apples, green and purple grapes, strawberries and bananas - sits in the center of Cope’s dining room table. She piles report after report, document after document, around the bowl.

Cope’s smile lines crease deeply and her hazel eyes crinkle. She beams, argues, explains. The documents mount. The fruit nearly disappears.

She produces statistics: 35 to 55 percent of elderly acute-care patients are malnourished; 85 percent of older Americans have chronic diseases that could be helped by nutritional intervention.

For malnutrition, Cope has an endless font of energy.

“It comes,” she says, tears springing to her eyes, “from feeling so helpless in closing the eyes in death of so many people who should not have died.”

Patients arrive at the hospital malnourished. They undergo tests requiring no food by mouth for hours at a stretch. They subsist on low-calorie IVs or undergo energy-draining surgery. If their protein levels and other nutrition indicators aren’t closely monitored, they may go home more depleted.

Physicians, who don’t study nutrition in medical school, may fail to notice. Managed-care limitations compound the risk.

“Patients are coming into the hospital and going out so fast we hardly even have time to find out why they got there,” Cope says.

Occasionally, a patient dies before the signs of malnutrition can be reversed.

“It attacks the immune system and it’s just as deadly as AIDS,” Cope says.

The costs, she says, can be catastrophic.

Dr. Larry Bernstein, a Connecticut clinical chemist who introduced a laboratory test for malnutrition called the prealbumin, estimates the costs of malnutrition for hospitalized patients at $60 billion per year.

The causes are varied: depression, ill-fitting dentures and dementia. Difficulty driving to the grocery store. Poor eyesight. Drug or alcohol abuse.

Kidney or heart disease leads to restricted diets. Daily concoctions of numerous prescription drugs can depress the appetite or hamper the body’s ability to assimilate nutrients.

An assortment of health-care workers - dietitians, pharmacists, dentists and social workers - have the remedies. They may include services such as daily meal delivery, transportation to the grocery store, treatment for depression, nutrition advice, alcohol treatment or denture repair.

The trick is to detect poor nutrition early. Cope believes the Nutrition Screening Initiative can help.

It’s a cooperative project of the American Academy of Family Physicians, the American Dietetic Association and the National Council on the Aging.

The initiative has created a simple test that can be performed by volunteers at churches, community centers and clinics.

The test is so simple, Cope says, that people can memorize it just like the seven warning signs of cancer.

“The people themselves have got to know,” Cope says. “They’re the ones who are going to ask the questions.”

Three warning signs: losing or gaining 10 pounds without trying within the last six months, lacking money to buy food, taking three or more medicines per day.

Cope spells out the details in her manual.

Dr. Gordon Jensen, who has conducted research on nutrition screening at Geisinger Medical Center in Danville, Pa., admires her work.

“I think it’s tremendous,” Jensen said. “She’s really put a lot of effort into it and done a lot in the state of Washington to put this manual together.

“It’s the kind of broad vision that is needed here to have any long-lasting opportunity for success.”

During the last four years, Cope has prodded Washington state governors to issue proclamations about nutrition screening. She’s hounded the American Medical Association. She’s tackled the National Committee for Quality Assurance, which sets standards for health-care insurance programs throughout the country, fuming that its latest drafts don’t address nutrition.

Change comes achingly slow.

“Hippocrates said, ‘Food is your best medicine,”’ Cope says impatiently. “So why do we have a health system that does not address this?”

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MEMO: This sidebar appeared with the story: To send for a manual To order a copy of Kathy Cope’s manual, “Malnutrition in the Elderly: A National Crisis,” send $6.50 to the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402. For more information about the Determine Your Health Checklist and a manual for health-care professionals, call (202) 625-1662. Cope may be reached by fax (509) 468-1026, or e-mail at kcope@onramp.ior.com