Weight Loss Complications in the Elderly

Residents in long-term nursing home care frequently lose weight, especially during the first month at a facility, but weight-loss usually stabilizes. Persistent weight loss is not normal, however, and can lead to multiple complications. Weight loss accompanied by changes in protein and vitamin intake causes complications throughout the body.

Symptoms of Weight Loss to Look Out For

It is best to be proactive and to take weight loss seriously. Residents with malnutrition may develop:

• reduced muscle mass
• personality and behavior changes
• weakness
• fatigue, advancing to complete exhaustion
• depression
• weakened immune system
• apathy and lack of initiative
• increased risk of pressure sores
• increased risk of falls
• abnormal laboratory values
• death

Signs of Weight Loss

Signs and symptoms of weight loss due to malnutrition include:

• loss of appetite
• dull, dry or thinning hair
• red, swollen gums and lips; the corners of the mouth may be cracked
• dry mouth with fissures
• red or purple, inflamed tongue, smooth in appearance

Cause of Weight Loss

Some medical conditions may cause unavoidable weight loss. These include:

• refusal to eat
• terminal illness
• cancer
• chemotherapy or other cancer therapies
• alcohol and drug abuse
• end-stage renal disease
• gastrointestinal disease
• diarrhea, nausea, and vomiting that do not respond to treatment
• medical conditions that require increased calorie intake, such as wandering, Parkinson's disease, and Huntington's disease.

Preventing Weight Loss

• Talk to the resident about food preferences. Relate any changes in taste to staff members.
• Encourage and remind the resident to eat.
• Bring snacks approved by the facility's dietician. Advise staff members as to how much the resident eats.
• Help the resident eat if necessary.

Nursing Homes and Weight Loss Prevention

• Ensure that a resident maintains acceptable nutritional levels.
• Provide sufficient fluids to maintain proper hydration and health.
• Have available adequate substitutes for the main components of each meal.
• Monitor and record a resident's food intake. Notations should be made of:

(a) deviations from normal food and fluid intake
(b) snacks or supplemental feedings
• Compare the resident's current weight against a baseline weight. Six months is a good interval over which to compare.
• Check skin for new pressure sores
• Ensure proper solution in tube-feeding apparatus
• Notify the physician of 5% weight loss within the past 30 days or 10% within past 6 months.
• Notify the family or responsible party in cases of sudden or dramatic weight loss
• Determine if the resident will benefit from occupational therapy, speech therapy or restorative nursing feeding programs

Weight Loss Preventative Measures

• Though residents are usually weighed monthly, residents who have had weight-loss problems should be re-weighed weekly.
• Determine if the resident would benefit from a different diet or larger portions.
• Provide supplements and snacks.
• If the resident can eat without assistance, determine if he or she:
(a) can see the food; maybe glasses would help
(b) has dental problems that make eating problematic
(c) gets full breaths while eating
(d) is distracted by noise or other environmental conditions
(e) has difficulty swallowing
(f) is wandering instead of eating
(g) has tremors that make it hard to hold utensils
(h) is high enough or close enough to the table
(i) has depression that saps the resident's appetite