Several key factors that can lead to negative nutritional status include starvation (the withholding of food by oneself or by others); anorexia (loss of appetite, including loss of interest in seeking and consuming food); sarcopenia (refers to the loss of muscle mass due to causes that include decreased activity and mobility, atherosclerosis and increased pro-inflammatory cytokines); cachexia (refers to a state of loss of body fat, muscle atrophy, wasting, malnutrition and poor health caused by chronic conditions (such as cancer, advanced dementia, arthritis); serious acute medical illness (such as cerebrovascular accidents, hip fractures, and pneumonia); as well as advancing age. Hypermetabolism (the body’s need for excessive calories, protein and other nutrients) can occur with wounds, trauma, fractures, surgery, injury and infections— including pneumonia, urinary tract infections, sepsis and others. This leads to catabolism – the breakdown of proteins and lean body mass. Sufficient calories and protein in the diet are needed to prevent catabolism and promote anabolism (tissue building and repair).

The nutritional assessment, done by the qualified dietetics professional, www.eatright.org will focus on the risk factors that may contribute to UWL—including current weight status; BMI 19 or less; chronic and acute medical issues and cognitive impairments; functional impairments—especially those in self feeding and drinking; difficulty in chewing and/or swallowing; psychosocial factors which may include depression and anxiety; the resident’s own goals and wishes; potential side effects of medications that can decrease or increase appetite, weight, and nutrient absorption or requirements; poor intakes of foods and fluids and intakes that do not meet estimated needs; in-depth evaluation of laboratory values; and food history.

The nutritional assessment should include a calculation of the resident’s calorie, protein and fluid needs; is the resident’s current weight acceptable considering usual body weight, prognosis, age, overall condition and resident expectations or can improvement be anticipated and practical; whether the altered nutritional status or concerns may be secondary to underlying medical conditions (i.e., possible medication side effects, infection status, impaired kidney function, possible gastroenteropathies, the effects of altered mood states).

The care plan must be individualized and consistently implemented; developed in the context of the resident’s overall condition and prognosis and related causes and risks; updated in a timely fashion as conditions change or interventions are determined to be ineffective; modified as needed (not just every 3 months) and identifying additional nutrition-related problems as they become apparent and revising goals and approaches as needed.