Chapter 7 Unintended Weight Loss

Figure 7.4 Guide to Prevent and Manage Unintended Weight Loss in Older Adults Guide to Prevent and Manage Unintended Weight Loss in Older Adults

Screening Tool Trigger Conditions • Appetite change r/t chewing/swallowing/digestive problems

• Unintended weight loss ≥5% in 30 days; ≥10% in 180 days

• Body mass index (BMI) <18.5* • Diagnosis of under-nutrition/malnutrition • Decline in mobility • Psychological stress or acute disease • Neuropsychological problems (i.e., dementia)

Utilize a validated screening tool (i.e., MNA-SF, DETERMINE)

Dietitian to Assess Utilizing a Comprehensive Assessment Tool

Food /Nutrient- Related History ◆ Diet and/or enteral/parenteral nutrition order ◆ Medications/herbal complimentary products ◆ Average

intake

◆ Medical food supplements ◆ Nutrition related activities of daily living

Nutrition-Focused Physical Findings ◆ Mental status ◆ Skin condition ◆ Oral/dental status ◆ Ambulation ◆ Dehydration risk factors

Anthropometric Measurements ◆ Current weight/height ◆ Usual body weight ◆ Body mass index (BMI) ◆ Weight change/lost or gained

Client History (medical/ health history) ◆ Interview older adult and/or care giver

Access and Document

Nutrition Risk

Comparative Standards (Estimate Nutrient Needs) ◆ Calories ◆ Protein ◆ Fluid

Determine Nutrition Diagnosis

Food/Nutrient Delivery Considerations ◆ Provide preferred

119

(i.e., cultural, ethnic, religious) No Yes

◆ Individualize diet to least restrictive ◆ Incorporate nutrient- dense foods at meals ◆ Provide medical food supplements between meals ◆ Vary the type of supplements offered to prevent taste fatigue ◆ Consider a vitamin/mineral supplement, if intake is poor ◆ Collaborate with other health care professionals and offer at appropriate texture for condition

◆ Collaborate with physician to consider altering/stopping drugs that cause anorexia

Monitor Status Quarterly

Improve Weight Status

◆ Collaborate with physician to evaluate and treat depression ◆ Recommend physician consider appetite stimulant, if weight continues to decline

◆ Evaluate for irreversible causes (ie, terminal illness) ◆ Collaborate with physician to consider alternative method of

Reassess Document at least quarterly

feeding and if consistent with older adult’s advance directives/wishes and goals of therapy: 1. Provide tube feeding to meet needs per assessment 2. Appropriate products provided and tolerance maintained

3. Provide alternate parenteral nutrition when gut is non-functioning to meet needs per assessment 4. Consider palliative/hospice care

Environmental Considerations ◆ Consider the older adult’s involvement in menu planning ◆ Provide positive dining atmosphere (ie, well lighted, clean, safe)

◆ Encourage creative dining programs (ie, selective menus, buffets)

◆ Collaborate with staff to ensure surroundings are quiet and calm with prompt service and assistance

◆ Encourage staff to direct conversation to the older adult at meal time

◆ Provide opportunity for the older adult to dine with compatible companions

◆ Collaborate with staff to offer assistance with meals based on the older adult’s ability

Source: Unintended Weight Loss in Older Adults Evidence-Based Nutrition Practice Guideline Toolkit. Academy of Nutrition and Dietetics. Copyright © 2013. All rights reserved.