112

Part II Nutrition Assessment, Consequences, and Implications TABLE 7.2 cont. Agents Associated with Involuntary Weight Loss Drug

Nitroglycerin NSAIDs Opiates

Penicillamine Potassium Propranolol Quinidine Selegiline SSRIs Statins

Terbinafine Theophylline Tricyclics

Anorexia Dry Mouth Dysguesia, Dysosmia

x x

x x x x

x x x x x

x x

x x

Environmental Considerations ●

● x x Nutrition Support

Involve older adults in menu planning to satisfy their personal preferences.

Individualize the person’s meal plan to include small, medium, or large portions. Allow the indi- vidual to make choices of what to eat, where to eat, and what time to eat.

●

Provide participation in creative dining styles: restaurant or buffet or open dining styles and 24-hour room service. Offer selective menus with daily, always available food items.

●

Provide a dining ambiance that is well lighted, clean, and safe.

●

Allow the person to eat at his or her own pace, with dining assistance and cueing available to those requiring it.

●

Invite families to bring in the individual’s favorite foods and dine with the person.

●

Provide snacks and beverages 24 hours a day. Stock the cabinet/cart with both healthy snacks and those most often requested by the individuals and their families.

●

Serve foods in the dining room that are colorful, tasty, and palatable, at recommended temperatures.

Enteral feedings may be considered for older adults who are undernourished or at risk of undernutrition when other reasonable interventions have failed (30,31, 38). Probable indications for use of a feeding tube include severe dysphagia preventing intake of adequate calories, severely underweight and requires supple- mental feedings, and choking that prevents ingestion of a meal (30,31). Continued weight loss often necessi- tates a discussion with the individual, family member, or responsible party about whether an enteral feeding is desired. The physician needs to understand the per- son’s wishes and advance directives concerning pro- longing life and maximizing function and comfort. The RDN or IDT must explain to the individual, family, or responsible party the risks and benefits of providing enteral feedings. Studies have shown that tube feedings in older adults with dementia do not promote weight gain, prevent aspiration, or lengthen life, even when adequate calories are provided (39).

Use of Appetite Stimulants (Orexigenic Drugs)

Older adults tend to have multiple risk factors that can lead to UWL. A review of clinical literature highlights a relative lack of efficacy and increased risk of adverse events when using appetite stimulants in the elderly (40-42). Currently no drug has received US Food and

x x x

x x

Dysphagia

Nausea and Vomiting

x x x