Chapter 7 Unintended Weight Loss

BOX 7.3 Nutrition Diagnosis Terms and Sample PES Statements for UWL in Older Adults

Intake ● ●

● ● Inadequate (or suboptimal) oral intake

Inadequate (or suboptimal) energy-protein intake

Inadequate (or suboptimal) enteral or paren- teral nutrition infusion

Limited food acceptance

● Decreased nutrient needs (specify) ● Malnutrition

● Inadequate (or suboptimal) energy intake

Clinical ●

Unintentional weight loss ● Underweight

● Swallowing difficulty ● Altered GI function

Impaired nutrient utilization ● Food medication interaction

●

Behavioral/ Environmental ●

Self-feeding difficulty

● Limited access to food or water ●

Impaired ability to prepare foods/meals ● Excessive physical activity, dementia ● Physical inactivity; no appetite Inability to manage self-care

●

Examples of Possible Nutrition Diagnostic (PES) Statements

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Unintended weight loss related to impaired nutrient intake as evidenced by recent bowel resection, GI pain, and 20 lb weight loss.

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Inadequate energy intake related to intake not meeting calculated needs as evidenced by significant weight loss of 8 lb over 30 days (5%); BMI less than 16.

●

Unintended weight loss related to swallowing difficulty as evidenced by intake less than calculated energy and nutrient need; weight loss of 13 lb (10%) in 6 months; refusal of pureed diet; depression; and social isolation.

●

Inadequate oral food and beverage intake; related to lack of appetite as evidenced by a 9 lb (10%) weight loss in last 7 days; less than 30% meal intake; 20% fluid intake.

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Drug Administration (FDA) approval for geriatric anorexia. Although facilities vary in development of protocols for use of appetite stimulants due to their controversial natures, many physicians agree that orex- igenic drugs should be considered after all standard food and nutrition interventions have failed (42). Some medications have been identified that may stimulate the appetite and promote weight gain in the older adult with UWL. However, the long-term effect of appetite stimulants on quality of life is unknown. Table 7.3 lists a comparison of medications used to stimulate the appetite (see pages 120–121) (43).

Ethical Issues

Health care professionals are legally obligated to protect life, but there comes a time when end-of-life issues must be considered (see Chapter 19). In Ethical and Legal Issues in Nutrition, Hydration and Feeding, the Academy supports an individual’s right to request or refuse nutrition and hydration as medical treatment (44). When an older adult is in end stages of a terminal disease, including dementia, more invasive and advanced interventions may not be appropriate. There may be a time when UWL cannot be halted and is an expected part of the disease progression. The individ- ual, family, and IDT should be in agreement as to what food and fluid interventions are appropriate; it may include only providing favorite and comfort foods, allowing the individual to enjoy whatever he or she likes. The RDN, along with the IDT, should continue to provide support by helping the individual, family, and responsible party understand what may transpire in the future (ie, continued weight loss and dehydration). All discussions of this nature must be documented in the medical record so all caregivers are aware of the wishes and directions of the individual, family, or legal representative.

NUTRITION MONITORING AND EVALUATION

The RDN should monitor and evaluate the nutritional status of older adults with UWL based on the method- ology initially used during assessment. Select outcome markers that are relevant to individually defined needs, nutrition diagnosis, nutrition goals, and disease state. The monitoring and evaluation outcomes for UWL may include but are not limited to the following (36):

●

anthropometric measurements: weight, weight changes;

● food/nutrition-related history; ➤

loss of appetite, swallowing problems, eating dependency, low physical activity level, decreased activities of daily living and