Weight loss is common in older people. In our weight-obsessed society weight loss is usually seen as a good thing. But in older people any unplanned weight loss is bad, even if they are overweight.
5 reasons we should care about the weight loss in our residents
1. Weight loss may signal underlying illness. Alert the resident’s GP so this can be investigated further.
2. The resident may be losing weight because he is not eating enough, and becoming malnourished. Malnourished residents are more likely to develop:
• pressure injuries
• pneumonia and other infections
• low mood
3. When a resident loses weight they will also lose valuable muscle mass, which increases the risk of:
• falls
• broken bones
• pressure injuries
4. Weight loss can lead to increasing frailty and:
• a decline in mental and physical function.
• decreased independence
• needing more nursing cares
5. Older people with unplanned weight loss are more likely to die within one year
How about the resident who is overweight?
Unplanned weight loss is a concern, even if the resident is overweight. We need to find out why they are losing weight. Bear in mind that overweight residents can also become malnourished.
How do we know when a resident is losing weight?
The simple answer is to weigh all residents regularly. But, how often is ‘regularly’?
The following groups of residents should be weighed weekly:
• Underweight residents
• Residents who have been losing weight
• Residents who consistently eat less than 75% of their meals
• The doctor may ask for daily or weekly weights for medical reasons e.g. fluid overload.
All other residents should be weighed at least once a month.
Record weight on a weight chart, so that you can identify the residents weight pattern over time. See example of graphical weight chart below.
When does weight loss become a concern?
Weight loss becomes a concern when a resident has lost:
• 5% of their body weight over a three month period
• 10% of their body weight over six months or longer
What to do if resident has lost weight ?
• Start food charts so you can identify problem areas.
Offer extra snacks and milk drinks.
We will cover this topic in a future blog.
Alert the Doctor that your resident is losing weight
• Refer to a Dietitian if your resident has lost more than 5% weight in the past month (or 10% over six months); and extra foods / drinks have not reversed weight loss.
Possible causes of unplanned weight loss in Aged Care Residents
Diet and eating:
- Poor appetite
- Restrictive diets e.g. low fat
- Quality of meals
- Change in diet when moving into facility
- Inability to self-feed
- Difficulty chewing or swallowing food
- Taste changes
- Dry mouth
Psychological
- Low mood
- Bereavement
- Confusion
Disease related
- Acute illness e.g. a chest or urinary tract infection
- Chronic disease such as heart failure, emphysema or Parkinson’s disease
- Cancer
- Dementia
- Delirium
- Bowel problems e.g. nausea,constipation, diarrhoea,
- Chronic pain
Medications
Many medications can contribute to weight loss. Side-effects include dry mouth, nausea and constipation, which may reduce the resident’s appetite.
Many drugs can alter nutrient absorption and / or use.
Seek the advice of a Pharmacist when a resident has these side effects.
Find out more about referring a resident to one of our Dietitians.