Unintentional weight loss has been a prevalent concern among the elderly population in long term care. Residents who are experiencing unplanned weight loss may be at high risk for developing pressure sores, infections, muscle wasting, malnutrition, and increased health complications including death. For this reason, the facility heath care team must collaborate to prevent any incidence of unintentional weight loss.

Weight loss is significant when it is greater or equal to 5% within one month, 7.5% or greater within three months and 10% or greater within 6 months and, therefore, must be addressed by the facility.  Insidious weight loss (or unplanned gradual, progressive weight loss over time) is also  a serious concern and therefore must be addressed as well.  Multidisciplinary interventions that are consistent with resident’s needs, goals, and acceptable standards of practice must be in place and reviewed periodically.

According to a study, psychiatric disorders including depression,  are the most common cause of weight loss in nursing home patients.  Other leading causes are cancer, gastrointestinal diseases, pulmonary diseases, cardiac disorders, and medications.  Other factors likely to result to weight loss include physical limitations such as impaired swallowing and chewing, mouth problems (including poor fitting dentures, mouth sores, or loss of teeth), tremors, impaired cognitive status, and poor vision which may likely alter a resident’s feeding skills.

The first step in preventing weight loss is to identify residents who may be at high nutrition risk. A simple nutrition risk screening form may be utilized at the time of admission. Once identified, weekly weights must be monitored and interventions in place. Monthly review of current resident's weights over the last six months to assess for any significant or insidious weight loss is also crucial. A weight committee meeting is used to identify possible causes of poor intakes leading to weight loss and to exchange ideas for resolving issues and concerns.  A nutritional assessment must be completed by the dietitian for any residents found to have unintentional weight loss for further review and recommendations.

There are various and creative ways facilities can engage in to prevent unplanned weight loss among residents.  Although some can be practical and inexpensive, others require a long commitment and may be labor-intensive and costly. 

• Liberalize diets to improve food palatability, allowing  residents varied food options and choices. Diabetic residents with poor intake may be placed on less restrictive or a general diet as long as blood sugar is monitored regularly.
• Review recipes to make sure foods are seasoned well. Many times salt is omitted in some recipes including general diets. Pureed foods are frequently not salted or seasoned properly. Check for food variety, seasonal food items and color combination.  Garnish plated foods at serving to enhance aesthetic appearance.
• Provide on-going education to dietary staff regarding menu compliance, food portions and appropriate use of serving scoop sizes to guarantee nutritional adequacy of meals served,  particularly pureed and other textured diets.
• Avoid serving oral supplements like fortified health shakes during meals. Residents tend to feel full once a supplement is consumed at the beginning of meal, therefore, will not attempt to eat the food served.
• Offer fortified foods to residents who are losing weight to increase their caloric intake.  Additional butter or margarine, sour cream, or cheese may be added to certain foods, for example, potatoes, pastas, or vegetables.  Substitute whole milk with meals instead of 2%.
• Offer oral supplements, snacks or nourishments in between meals.  A recent study shows that supervised delivery of additional foods and fluids between meals (10 a.m., 2 p.m., and 7 p.m.) resulted to significant increase of food and fluid intake to 90% of residents with low intake. A snack and hydration cart that looks enticing can be wheeled around and made accessible to residents.
• Provide proper assistance to residents during meals. The same study as above showed that residents who received an average of 42 minutes of assistance during meals had significant increase in total daily caloric intake and maintained or gained weight.
• Start a complimentary ice cream shop to be open to residents daily to encourage socialization. This can be run by volunteers.
• Develop a creative, fun “shake program” for high risk residents or residents with poor intakes.  Activity staff can get a small group of residents together in the afternoon and blend healthy, nutritious shakes.
• Encourage resident participation in menu planning at least once a month to incorporate their favorite foods or choices. Keep the Resident Food Committee active.
• Review and update meal delivery or system to promote a home-like dining or meal experience to residents that may arouse some familiarity of how meals used to be at their own home.
• Encourage physical activity or exercise, if possible, to promote appetite and increase oral intakes. Residents often complain of not having appetite because “they are not doing anything”.

Preventing weight loss in the elderly is undoubtedly an enormous challenge for every health care member in long term care facility. It is not an option; it is a mandatory commitment for each team member to be involved with for the well-being and improved quality of life of each resident.