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Evidence-Based Practices for the Prevention of Weight Loss in Nursing Home Residents

Weight loss is a very common issue among residents of nursing homes. Although it may seem to have a simple solution given the availability of food, malnutrition is actually a very serious, multifaceted problem because it is a direct cause of increased morbidity and mortality and poorer quality of life. A recent article, titled “Evidence-Based Practices for the Prevention of Weight Loss in Nursing Home Residents,” published in the 2011 volume of the Journal of Gerontological Nursing reports that 35-85% of elder adults living in nursing homes suffer from malnutrition.

Unintentional weight loss, which is a consequence of malnutrition, occurs in 27% of adults over the age of 65, and is defined as a loss of 10 pounds in 6 months, 5% per month, or 1% to 2% per week. The three main causes of weight loss are starvation or wasting, cachexia, and sarcopenia.

Starvation or wasting is the result of calorie deprivation. It is often seen in conjunction with a critical illness without adequate nutritional support, advanced AIDS, end-stage renal disease, end-stage liver disease, and marsmus. While starvation results in a loss of fat tissue, cachexia leads to a loss of muscle tissue. Cachexia is often a result of a critical illness with adequate nutritional support, congestive heart failure, liver disease, early renal failure, rheumatoid arthritis, HIV infection without opportunistic infection, and protein-calorie or protein-energy malnutrition.

Sarcophenia entails a decrease in muscle mass and strength that occurs during normal aging and results in physical frailty, increased risk of falling, and decreased ability to perform activities of daily living. Because it is possible to simultaneously have multiple types of weight loss or to progress from one to the next, it is essential to determine if your loved one suffers from unintentional weight loss, especially if he or she also suffers from any of the aforementioned illnesses.

Often, unintentional weight loss is a result of poor communication. Cognitive impairments prevent residents from feeding themselves. Consequently, nurses assist the residents in eating and often have difficulty interpreting the residents’ behavior and wishes. Even when residents are still able to feed themselves, they sometimes have trouble identifying their food and understanding the purpose of silverware.

Dental and oral health issues that are prevalent in elderly adults can also contribute to weight loss. Many residents of nursing homes need dentures but do not have them, while others who do have them are using defectives ones. These issues were discovered to be more common in adults who were dependent than those who were only semi-dependent, suggesting that many adults who are dependent are not receiving adequate care. A study has shown that a resident who received over three hours of care by a certified nursing assistant (CNA) per day had a 17% decreased probability of weight loss and those receiving over 4.1 hours got better feeding assistance. It is important to ensure that your loved one’s nursing home is not understaffed and that your loved one is receiving sufficient care from caregivers.

If you are unsure about your loved one’s health, nutritional assessments exist to determine whether or not he or she is suffering from unintentional weight loss. The most common indicator of weight loss is body mass index (BMI), which is weight divided by the square of height. Specialists say that a BMI between twenty-four and twenty-seven is acceptable. A lower mortality rate and best functional ability have been observed in women with a BMI between twenty-two and thirty and men with a BMI between twenty-three and thirty. If your loved one has a BMI between nineteen and twenty-three, he or she may be at risk of malnutrition. Additional assessments include the Mini Nutritional Assessment (MNA), the Council on Nutrition Appetite Questionnaire (CNAQ), the Simplified Nutritional Appetite Questionnaire (SNAQ), and the Minimum Data Set (MDS) administered by the U.S. Department of Health and Human Services.

There are many simple solutions to weight loss. Supplement intake may help prevent weight loss, as long as residents are continuing to consume the additional calories needed to gain or maintain weight. Food fortification allows residents to consume more nutrients without increasing the volume of food eaten. Feeding assistance from volunteers or family members can provide a positive social environment during mealtimes that also increase nutritional intake. Positive social engagement also helps wandering residents who tend to wander from the table during mealtimes.

Although the physiological aspects of weight loss are quite complex, prevention is much simpler, so there is absolutely no reason that your loved one should not be receiving proper care. In fact, your loved one is entitled to patients’ rights that require proper nutrition. If you feel that your loved one’s rights are being violated and he or she is suffering from weight loss as a result, contact us today to see how we can help obtain the care to which your loved one is entitled.