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As weight loss is a marker for mortality in older persons, aggressive treatment is essential. Tables 4 and 5 review our guidelines for the treatment of weight loss in nursing home residents [30]. There is a need for controlled trials to more clearly delineate the appropriate management of weight loss in the elderly.

Table 4. Clinical guide to prevent and manage malnutrition in long-term care. The information in this table is aimed at nursing staff, dietary staff. and dietitians, and follows the strategy evaluate, document, and treat

Clinical Guide to Prevent and Manage Malnutrition in Long-Term Care

For Nursing Staff and Dietary Staff and Dietitians (Evaluate, Document and Treat)

The American Dietetic Association supports the Clinical Guide to Prevent and Manage Malnutrition in Long-Term Care. Representatives from the American Dietetic Association were instrumental in its development.

These Guidelines were developed by the Council for Nutrition.

A special committee of The Gerontological Society of America (GSA) served as critical reviewers and provided input and modification of the final Guidelines. While GSA does not endorse specific clinical measures, we support the principles underlying these Guidelines and their potential to improve nutrition in the nursing home.

Trigger Conditions

Involuntary 5% weight loss in 30 days or 10% in 180 days or less or BMI < 21 or

Resident leaves 25% or more of food uneaten at two thirds of meals (Assess over 7 days, based on 2000 cal/day)

Put on weekly weight monitoring program/ Proceed with documentation utilizing Nursing Nutritional Checklist

Quality indicator conditions: • Fecal impactions, Infection (UTI, URI, pneumonia, GI) • Tube feeding, decline in ADL's or pressure ulcer on low risk resident

Check hydration status minimum 1500 cc fluid/day unless contraindicated (For tube feeding patients, approximately 75% of the total tube feeding volume should be considered free fluid)

Inform physician/dietitian

Food/environmental considerations

Needs feeding assistance

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