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Knowledge Point Articles   

March 2006

Unintentional Weight Loss

The objectives of the nursing home survey protocol for unintended weight loss are to determine if a resident’s weight loss was avoidable or unavoidable and to determine whether the facility’s response to the weight loss was adequate. For an older adult who is in a compromised state of health, unintentional weight loss can lead to a hazardous downward spiral of malnutrition, increased risk of infection, development of pressure ulcers, poor wound healing, weakness leading to falls and more.

There are many things we can do to avoid this dangerous decline:

1. Implement Systems for Identification of Risks: A good understanding of the regulations and survey expectations will help to determine which systems you need to have in place for early identification of problems. Accurate tracking of weights and food intakes, participation in nutrition-at-risk and weight team or care plan meetings can all assist in identifying residents with potential problems.

2. Implement a Good Dining Program: A well planned dining program can help encourage food and fluid intake and help assure mealtime is special. For many residents, mealtime is the highlight of the day. Offer residents as many choices as possible at mealtime, including what to eat, when to eat and who to eat with. Provide great customer service and a pleasant atmosphere, including positive opportunities for socialization. Make it as easy as possible for staff to document food intake percentages, meal replacements and supplement/ nourishment acceptance so their time is spent caring for the resident and not
on paperwork.

3. Implement Proper Menus and Improve Food Quality: Take a close look at your kitchen and make improvements in food preparation and presentation. Well-balanced and thought out menus with the appropriate (liberalized) special diet extensions are essential. Most importantly, food must be well prepared, eye-appealing, tasty and presented with a smile.

4. Implement Nutrition Interventions that Work: Implement nutrition interventions at the first sign of risk for weight loss. Aggressive nutrition intervention systems will help you respond appropriately and adequately. Every bite counts, so pick the resident’s favorite foods and pack in more nutrients per bite by enhancing favorite foods with extra calories and protein. Utilize nutritional supplements as appropriate. If needed, the team should discuss alternate nutrition and hydration therapy for those unable to tolerate oral nutrition interventions. These discussions should take place early on.

5. Implement Good Communication and Teamwork Systems: Each discipline plays a role when it comes to preventing weight loss. Good communication between team members is essential. This can be accomplished through regular meetings, use of clinical pathways and protocols and regular reassessment and follow-up.

Unintentional weight loss need not lead to a downhill battle. Early risk identification, a good dining program with proper menus and food quality, nutrition interventions that work, teamwork, communication and sound facility systems can help your residents stay healthy and happy.

For more information on this subject, please review Becky Dorner & Associates’ book, Healthy Weights: Preventing and Treating Unintentional Weight Loss.

Becky Dorner, RD, LD
Becky Dorner & Associates, Inc.

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