Weight Monitoring in Aged Care

We all know the importance of maintaining good nutrition in our residents. A simple but effective way to check residents’ nutritional status is to track weight over time. Unplanned weight loss is linked to poor clinical outcomes, including: malnutrition, pressure injuries, hip fractures and death. Therefore, monitoring for unplanned weight loss is an important quality indicator in Aged Care.


How often should residents be weight?
All residents should be weighed on admission and at least once a month.
A resident at increased nutritional risk should be weighed more frequently.

By tracking your resident’s weight you can identify weight trends. The best way to do this is to record on a weight chart.

weight-chart

(Email us if you would like a complimentary copy of our weight chart).


When does weight loss become a concern?
• As a rule of thumb, we would consider a weight loss of 3 kilograms or more over a three month period to be significant. So, if Ben weighed 75kg in January, and by April his weight was down to 71.5kg, we should find out why.
• Another way is to calculate percentage weight loss. A 5% weight loss over 3 months is significant. (Our Cheat Sheet takes the hard work out of calculating percentage weight loss. Cheat sheet) For instance, Mary weighed 60kg in May and was down to 56.9kg in August – the cheat sheet shows us that she has had a weight loss of more than 5% .
• If the resident is consistently losing weight over time. Even a small monthly weight loss adds up. It is always a good idea to look back at the admission weight. When Susan was admitted 3 years ago she weighed 75kg and her weight is now down to 63kg. Although Susan is still in the ‘healthy weight range’ she has been steadily losing weight since admission and we need to find out why.


Practical tips
• Many residents are unsteady on their feet and are not able to stand on a scale. A chair scale is a safe and reliable option for weighing older people. A hoist may be needed for residents who are not able to transfer safely to the chair scale. Another option is a wheelchair scale, which provides a convenient and safe method of weighing residents while they remain seated on their wheelchair.

• Train care staff responsible for weighing residents to ensure that standardised procedures are followed.

• It is important to calibrate the scale regularly (follow manufacturer’s guidelines).

• Although it is ideal to weigh first thing in the morning, this is not always practical. The important thing is to always weigh residents at the same time of day.

• Establish a routine for weighing residents e.g. the first Sunday of the month. Make sure that this recorded in the calendar, and any weight changes need to be followed up by senior staff.

• Weigh residents in light clothing, preferably no shoes or jackets.

• If there is a large unexplained weight gain, consider the following:
o measurement error – reweigh the next day
o fluid overload or oedema – alert the GP
o change in medication (e.g. diurectics)
o has the resident had subcut fluids charted?

• If there is a large unexplained weight loss, consider the following:
o measurement error – reweigh the next day
o dehydration
o change in medication (e.g. diurectics)


What to do if resident has lost weight ?
o Alert the Doctor that resident is losing weight.
o Refer to a Dietitian has lost more than 5% weight in the past month .

Contact us for more information

5 steps to manage weight loss in residents

In our previous blog, we discussed why weight loss is a concern for residents in aged care facilities. In this blog we discuss 5 simple steps to manage weight loss. Too often when a resident has lost weight, the immediate reaction is to prescribe nutritional supplements. In our view, while supplements have their place, there are many things we can try in the first instance.


5 steps to manage weight loss in residents

1. ‘Make every mouthful count ‘
Loss of appetite is common in older people. Eating can becomes a struggle and weight loss follows. When residents can only eat a small amounts, it is important that meals are high in energy and protein. We can ‘sneak in’ extra calories (kilojoules) by:

  • Adding extra cream, cheese and margarine / butter to food
  • Using full cream milk (rather than skimmed or low fat)
  • Serving rich and tasty sauces and gravies with meals
  • Using high fat salad dressings and mayonnaise

 

To make sure that protein needs are met:

  • Serve a high protein food with each meal, for instance: eggs, yoghurt, legumes, meat, fish or chicken.
  • Add skim milk powder to milk, porridge and sauces. (Or use a plant based protein powder).
  • Make peanut butter freely available as a spread.

2. Serve delicious and appealing meals
Nobody wants to eat ‘yuck’ food, and definitely not if they already have a poor appetite! Bear in mind that ‘food is only nutritious if it is eaten’. So we need to make sure that meals are:

  • Appealing and well presented. After all, we ‘eat with our eyes’! Taking a little bit of extra effort when dishing up can make the meal look much more appealing. Use garnishes to add colour, add a swirl of cream to soup – use your imagination!

 

  • Tasty and flavoursome. A common misconception is that older people need bland foods. Nothing can be further from the truth! Old people often complain of loss of taste , so we should serve well seasoned and flavoursome meals. Another frequent complaint is the lack of salt (in porridge and cooked foods). Using salt in moderation makes food taste better, and residents are more likely to enjoy their meals.

 

  • There has been a lot of negative publicity about sugar in recent years. Some facilities still use artificial sweeteners / sugar substitutes in desserts and baking, which is now a No-No. Baking with artificial sweeteners can taste awful and is likely to be rejected by the residents. Sensible use of sugar helps food taste good and also boosts calorie intake. So, continue to allow residents to enjoy their sweet treats if they choose.

3. Tailored meals to the their tastes. We all have our unique food preferences. Research shows that residents eat better when they have more choice with their meals. For instance, if Mary has a poor appetite, ask her what she feels like eating. It could be something simple like poached eggs on toast. Serving Mary the foods she likes can improve her intake and help to combat weight loss.


4. Eat little and often –The thought of sitting down to a huge meals is particularly daunting to older people with a poor appetite. The secret is to serve small, fortified meals with nutritious between meal snacks and drinks. (More on this in future blogs)


5. Check weight regularly – if your resident has a poor appetite and is losing weight it may be time to put them onto weekly weights. This way you can keep a close eye on weight changes. Make sure the GP is aware of the weight loss. If their weight continues to drop then it’s time to call in the dietitian.


For more information contact admin@dietitianz.com