Approximately 50-60% of elders in nursing homes experience unintentional weight loss (Dodd, 2020). Weight loss and malnutrition is associated with delayed wound healing, decline in functional and cognitive status, immunodeficiency, impaired muscle function, anemia, decreased bone mass, delayed surgical recovery, increased hospital readmission rates, and mortality (Shilpa, 2015). The leading causes of unintended weight loss for older adults are depression, cancer (particularly lung and gastrointestinal malignancies), cardiac disorders, and benign gastrointestinal diseases (Shilpa, 2015). Due to COVID-19 limited or restricted visitation guidance, our residents are at an even greater risk for depression and weight loss. However, early identification, assessment, and interventions to manage weight loss and nutritional deficiencies may prevent unintended weight loss.
Quality Measure: Percent of Residents Who Lose Too Much Weight (Long Stay)
The measure captures the percentage of long-stay residents who had a weight loss of 5% or more in the last month or 10% or more in the last 6 months who were not on a physician prescribed weight-loss regimen noted in an MDS assessment during the selected quarter.
Best Practices for Facility Monitoring
- If unintentional weight loss is identified, ensure thorough IDT clinical assessment and development of specific short-term care plan to implement interventions to meet the specified care plan goal.
- Identify risk factors and perform complete nutritional assessment.
- Perform re-weight. Notify physican, family & dietitian.
- Review accuracy of MDS coding.
- Ensure dietician or dietary manager understand the RAI coding definitions.
- Review planned weight-reduction programs are ordered by physician to treat a specified condition, supported by documentation and care planned.
- Designate staff member(s) to perform weights that is knowledgeable regarding facility policies and procedures to obtain weights (i.e. same weight scale, subtracting wheelchair weight, removing pressure reduction cushion, how to calibrate the scale prior to weighing the resident, etc.)
- Perform weight proficiency competencies.
- Complete Nutritional At-Risk weekly meetings.
- Implement restorative eating programs to restore or maintain the resident’s current level of function.
- Ensure adequate staffing to assist with meals and consider “All Hands-on Dining Program” or Paid Feeding Assistants.
References
- Centers for Medicare & Medicaid Services. (2020, October 19). Quality Measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures
- Dodd, K. (2020, October 5). The Geriatric Dietitian. Preventing Unintentional Weight Loss in Older Adults. https://www.thegeriatricdietitian.com/weight-gain-smoothies-stopping-unintended-weight-loss-in-older-adults/
- Dorner, B. & Friedrich, E. (2018, April 1). Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care, Post-Acute Care, and Other Settings. Journal of the Academy of Nutrition and Dietetics, 118(4), 724-735. https://doi.org/10.1016/j.jand.2018.01.022
- Shilpa, A., Kalyani, S. & Manisha, S. (2015, September). Changes During Aging and Their Association with Malnutrition. Journal of Clinical Gerontology and Geriatrics, 6(3),78-84. https://doi.org/10.1016/j.jcgg.2015.05.003
Blog by Kristen Walden, MSN, RN, RAC-CT, Proactive Medical Review
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