Chapter 7 Unintended Weight Loss

BOX 7.1 Frequent Causes of Weight Loss in Long-Term Care Setting

● Advanced dementia (23) ● Cancer

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Chronic infections or inflammatory condi- tions (eg, AIDS, rheumatoid arthritis)

● Chronic obstructive pulmonary disease ● Depression

● Uncontrolled diabetes ● Hyperthyroidism

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Malabsorption syndromes (eg, pancreatic insufficiency, gluten enteropathy)

● Oral disease (including poor dentition) ●

● Swallowing disorders ● Therapeutic diets

Source: American Medical Directors Association. Altered Nutritional Status in the Long-Term Care Setting: Clinical Practice Guideline. Columbia, MD: American Medical Directors Association; 2010.

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Polypharmacy (including anorexigenic medications)

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which is a brief, simple appetite assessment tool that predicts anorexia-related weight loss in both community- dwelling adults and those in long term-care facilities (28). Figure 7.3 (page 118) shows the Council of Nutrition Appetite Questionnaire (CNAQ) (28).

NUTRITION ASSESSMENT The RDN should ensure that the comprehensive nutri- tion assessment of older adults with UWL includes (but is not limited to) the following factors to effec- tively determine nutrition diagnoses and plan the nutri- tion interventions (21):

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Food/nutrition related history: food and nutrient intake, routine medications, loss of appetite, eating dependency, swallowing problems, food and nutri- ent administration (diet order, diet experience, eating environment, enteral and parenteral nutrition administration), meal and snack patterns;

Biochemical data, medical tests, and proce- dures: altered nutrition–related lab data (elec- trolytes, glucose/HbA1c, lipid panel, comprehensive metabolic panel) and swallow- ing evaluation;

Anthropometric measurements: height, weight, weight history, usual weight, BMI;

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BOX 7.2 How to Estimate and Evaluate Current Weight as Percentage of Usual Body Weight

To estimate percentage of UBW, compare a person’s current weight with the weight that the person generally maintains:

% UBW = (Current Weight)/(Usual Weight) × 100

For example, if a man loses 35 lb during illness and his usual weight is 185 lb, his current weight would be 150 lb. These values can be incorporated into the equation below.

% UBW = 150/185 × 100 = 81.8%

As noted previously, the rate of weight loss should be considered as well as the amount; for example, an unintended weight loss of more than 10% within a six-month period suggests risk of protein-energy malnutrition.

Source: American Medical Directors Association. Altered Nutritional Status in the Long-Term Care Setting: Clinical Practice Guideline. Columbia, MD: American Medical Directors Association; 2011.

Nutrition-focused physical findings: overall appearance, muscle and fat wasting, oral cavity evaluation, skin condition, and vital signs; and

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Client history: age, race/ethnicity, treatments, gender, medical history and surgical history, social history, supplement usage, cognitive decline, depression, hydration status, presence of infections, pressure ulcers, and recent hospitalizations.

For further info on nutrition assessment, see Chapter 6.

Key Measurements and Calculations for Nutrition Assessment

Weight: When accurately measured, weight is a primary screening and monitoring indicator. Body weight is one of the most important measurements used in assessing nutritional status and estimating energy expenditure (see Table 7.1 on page 110). Because of this, the organization must have a strong and detailed policy/protocol on exactly how weights should be taken.

Height: In adults, height measurements alone do not reflect current nutrition status but are used for estimat- ing an individual’s energy needs. In some instances, a standing height cannot be measured accurately because