Anorexia is an overall decline
in appetite leading to decreased food intake, and consumption of inadequate
calories. It is the major cause of weight loss and poor nutritional status in
elderly persons[i]. Malnutrition and dehydration are associated
with susceptibility to infections, cognitive impairment, poor skin and bone
integrity, pressure sores and hip fractures. These serious consequences along
with co-morbidities from chronic illness, often lead to mortality[ii].
A protocol to screen and assess elderly
residents for nutritional risk is essential in establishing early interventions
to diminish serious health effects of malnutrition.
A
research group called the Collaborative Studies of Long Term Care, initiated in
1997 a series of multi-state projects that studied almost 5,000 residents in
more than 350 retirement and assisted living communities published their
findings in a special issue of the Gerontologist.[iii] Findings showed that low food intake was
common in 54% of the participants and low fluid intake is prevalent among 51%
of those studied in Long Term Care, particularly those with cognitive
impairment. They found that residents who were closely monitored by staff during
meal times are significantly less likely to have low food and fluid
intake. Similarly, residents who eat
their meals in a central dining area are much less likely to have low intake
than those dining in their bedrooms. Often, in large facilities meal times are set
and residents have limited time to consume their food. Pressured with time limits, staff can
mistakenly assume that the resident is not hungry and removes much of the
uneaten food before the resident is able to finish.
Physical examination can point
to clear, visible signs of weight loss.
Pronounced indentations at the temporal lobes commonly referred to as
temporal wasting, loss of muscle mass, loose elastic skin, and decreased
functional ability to perform activities of daily living (ADL’s) are all early
indicators. Causes of weight loss are numerous and can include: swallowing
difficulties, poor dentition, mouth pain, psychological disorders, depression,
impaired mobility, and loss of appetite. Residents
who begin to lose 5% of their weight in one month, or 10% over 6 months, or
those who eat less than 75% of their food at meal times should be considered
for a complete nutritional evaluation by a Registered Dietitian.
Operators
should routinely evaluate body weight at the time of admission, and monthly
thereafter. Use of the Body Mass Index[iv] (BMI) can help establish
a baseline, and subsequent measures can point to clear trends of weight maintenance
or decline. Residents who are determined to be high risk for weight loss can be
identified in their chart and with a silicon bracelet. Staff will then notify and involve a
registered dietitian who intervenes with an individualized food plan. Angela G. Sullivan MS RD consultant dietitian
for Potomac Homes suggests, “The specific nutritional recommendations we make are
in addition to a liberalized menu,
offering favorite foods, and routine mealtime practices”. “The strategies and protocols for the
resident at risk address prevention of continued weight loss and dehydration.” The
emphasis is to make sure food and fluid are optimized at each meal, snack and
hydration opportunity[v]. “Simply adding supplements is not enough to
prevent weight loss”, she warned. Recommendations might include adequate
texture changes for residents who have difficulty swallowing. Cutting up food,
adding sauces and gravy to add extra moisture, and delaying the need to puree
food are all strategies that focus on taste and appearance, and address quality
of life. “Allowing residents additional time to complete their meal, offering
assistance with feeding, using words of encouragement in addition to
nutritional supplements and calorie dense snacks are protocols that can really make
a difference,” She concludes.
Researchers
followed weight loss trends of 1000 nursing home residents across the United
States. They found many of elderly
residents to be undernourished. During a six month period, 30% of those
residents who continued to lose weight died.
The study also found that 16-18% of elderly living in communities
consume less than 1000 calories per day.
Clearly
elderly that are at risk for weight loss who are treated with additional
emphasis during meal times and throughout the day can greatly benefit, even
avoid the early onset of nutritionally triggered catastrophic health
failures. By recognizing at-risk
residents early, operators can have a significant impact on the overall quality
of life of their residents and help manage the acuity of care in their homes.
[i] Thomas, D.R., MD,
Morley, J.E. Regulation of
appetite in older adults. Clinical Strategies in LTC, a Supplement to Annals
of Long-Term Care. July, 2002. Page 4.
[ii] Thomas, D.R. Progress Notes: Nutrition and Chronic Wounds.
Supplement to Annals of Long-Term Care.
November, 2004. Page 1-12.
[iii] Reed, Peter S.,
Zimmerman, Sheryl, Sloane, Philip, Williams, Christianna, and Boustani, Malaz.
Characteristics Associated with Low Food Intake in Long-Term care residents
with Dementia. The Gerontologist. Vol. 45 . October 2005. Page 74-80.
[iv] BMI uses a
mathematical formula that takes into account both a person's height and weight.
BMI equals a person's weight in kilograms divided by height in meters squared.
(BMI=weight
kg/height m2). Mahan K. L., Escott-Stump S., Food Nutrition & Diet Therapy, 9th edition, Saunders., 1996, Appendix
18 pg 950-951
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