Weight Loss

In the nursing home setting, significant weight loss is defined as loss of 5% or more in the last 30 days or 10% or more in the last 180 days. Much weight loss can be prevented in the nursing home with proper care.

What are the risk factors for weight loss?

• Required assistance to eat or drink
• Choking/swallowing problem
• Refusals of food and fluids
• Decreased meal consumption
• Visual impairments
• Poor condition of teeth that may cause pain with eating and problems chewing
• Poor fitting dentures
• Dementia/delirium
• Depression
• Chronic pain
• Constipation
• Medication side effects and interactions
• Infections
• Swallowing difficulties
• Taste alterations
• Smells of urine and stool in the nursing home

What can the nursing home do to reverse weight loss?

• Encourage foods based on resident’s likes and dislikes
• Request order for nutritional supplements that are calorie-dense
• Schedule weekly weights
• Encourage a relaxed mealtime where intake is not rushed
• Request dietitian consultation
• Initiate intake and output monitoring (if not eating, probably not drinking, and some weight loss may be due to fluid loss)
• Evaluate and document all meal consumption
• Update the care plan with new nursing interventions
• Request a dental evaluation, if necessary to treat poor condition of teeth or dentures, which may resolve chewing difficulties
• Request social services to consult if depression is a likely cause
• If medication side effects are a likely cause, consult with the physician or consultant pharmacist

Questions you can ask the nursing home regarding weight loss:

• How does the nursing home determine the cause of weight loss in residents?
• How flexible is the nursing home in tailoring meals and foods to individual preferences?
• Does the nursing home have a program to rapidly and correctly notice changes in nutrition?
• How does the nursing home address issues that may affect the eating environment?

Resources

Evaluating and Treating Unintentional Weight Loss in the Elderly

Department of Health and Human Services – Emerging Practices in Nursing Homes

Comprehensive Multidisciplinary Assessment of the Demented Nursing Home Resident with Weight Loss