The COVID-19 Pandemic has impacted rates of weight loss in long-term care facilities both directly and indirectly. Prior to the onset of the pandemic, the Quality Measure ‘Percent of Residents Who Lose Too Much Weight’ was 5.8% at the national average (QIES Database for October 31, 2019). From March 1, 2020 through February 28, 2021, the national average increased to levels of up to 8.9%. As a reminder, the weight loss measure is triggered for long-stay residents who had an unplanned weight loss of 5% or more in the last month or 10% or more in the last 6 months.
Common signs of COVID-19 infection include fever, insistent cough, and shortness of breath. However, seniors may not display any of these routine signs, but instead exhibit early symptoms of sleeping more than usual, loss of appetite, or new/worsening confusion. Any or all of these indicators can lead to poor nutritional intake and weight loss. The onset and duration of symptoms vary according to severity of illness and comorbidities. In addition, loss of taste and smell is often noted following COVID infection. Interestingly, while widespread in younger adults, loss of taste and smell is less common in those over age 65, occurring in only about 50% of the senior population. As people age, they naturally lose a portion of olfactory nerve fibers in combination with a tendency toward reduced taste bud sensitivity. Fortunately, for those residents who experience an exacerbated loss of smell or taste due to COVID, symptoms usually resolve within a few weeks.
Under the direction of The Centers for Medicare & Medicaid Services, based on Centers for Disease Control and Prevention recommendations, nursing facilities implemented new and revised infection prevention and control practices with the onset of the COVID-19 pandemic. As part of these directed practices, group dining/activities and non-essential visits were stopped. A study completed in a 240-bed suburban Chicago facility from December 2019 through April 2020 and published in JAMDA found that 67% of residents lost weight from February to April, with 23% losing more than 5% of their body weight. The overall weight loss average was 3.68 lbs after the implementation of the social distancing measures compared to the 3 months beforehand (Danilovich et al).
Researchers suggested that the following factors may have had an effect on the residents’ food intake:
- Residents requiring assistance ate at staggered times as nursing assistants could only help in one room at a time. Because of this, Intervals between meals were uneven, resulting in reduced appetite and consumption as compared to when meals were closer together than usual.
- Group activities ceased, and residents were encouraged to stay in their rooms. These changes reduced mealtime conversation and social interaction, which are known to support meal consumption.
- Family visits ceased, so residents did not receive outside food.
Where to go from here:
- The interdisciplinary team and attending physician should work closely together to identify and treat any underlying causes for decline in appetite and/or weight loss. Also involve the resident, clarifying his/her goals and expectations.
- The RD should assess to identify risk factors of unintended weight loss and risk of malnutrition. Implement individualized approaches such as updated likes/dislikes list, liberalized diet, portion size, meal frequency, dietary supplements and fortified foods based on assessment findings.
- Involvement of therapy staff may include OT to screen for beneficial adaptive utensils, SLP to evaluate for appropriate diet to facilitate safe intake, and OT/PT for appropriate meal time seating, positioning and activity tolerance.
- The consultant pharmacist can review the current medication regimen for medications that might cause weight loss or loss of appetite.
- If the resident wears dentures, a licensed nurse to perform an oral exam and interview resident to determine if dentures fit correctly and do not cause pain or discomfort while eating. Nursing should also determine that resident is provided the proper amount of assistance with meals and adequate time to consume.
- Assessment for Restorative Dining program referral as indicated.
In addition, consider these potential non-COVID related causes of poor food intake or decreased appetite in older adults:
- Depression and other psychiatric conditions
- Gastrointestinal disease
- Thyroid imbalances, diabetes, and other types of endocrine disorders
- COPD and other respiratory diseases
- Neurological or musculoskeletal disorders (including those that interfere with swallowing)
- Cardiovascular diseases
- Lack of social atmosphere for eating
- Decreased sense of smell/taste
- Decreased mobility/physical activity
- Dental issues
- Unappetizing food (restricted diets)
Contact Proactive for assistance in reviewing and overcoming weight loss or other quality measure challenges as part of your COVID-19 recovery plan.
- Nursing Home Resident Weight Loss During Coronavirus Disease 2019 Restrictions (jamda.com)
 *Screening residents for malnutrition / risk for malnutrition:
The MNA® is a validated nutrition screening and assessment tool that can identify geriatric patients age 65 and above who are malnourished or at risk of malnutrition. The MNA® was developed nearly 20 years ago and is the most well validated nutrition screening tool for the elderly. Originally comprised of 18 questions, the current MNA® now consists of 6 questions and streamlines the screening process. The current MNA® retains the validity and accuracy of the original MNA® in identifying older adults who are malnourished or at risk of malnutrition. The revised MNA® Short Form makes the link to intervention easier and quicker and is now the preferred form of the MNA® for clinical use.