Weight loss in elderly is a daily task to prevent and treat for Dietitians. Here I give you the top tips on how to get to the root cause of weight loss in elderly and how to treat it! Read on to find the list of factors that contribute to weight loss in elderly!

Tracking Weight Loss in Elderly

You likely discover many of your residents are losing weight through your monthly weight audits, or if you’re lucky you get consults when Nursing discovers a resident is losing weight.

No matter how you find out, it’s important to address it for the benefit of the resident and for the Standards/Audits that come to LTC homes. Auditors are looking at whether weight loss has been noted in the charting and whether anything has been done about it. It’s in the best interest of the resident and your job that you take care of it.

Weight loss can be complex and can have many factors contributing to it. It’s important that we look into why weight loss is happening in order to help prevent that.

I’ll preface the next part of the blog post by saying that weight loss may not be preventable in all residents. With some residents I have tried everything I can to stop/prevent further weight loss but they keep losing.

In some scenarios, it’s their body’s way of shutting down. Sadly it happens in some of our patients, but we still need to try all we can. Dying is inevitable in all our patients, our job is to reduce their discomfort in the journey.

If you’re looking for the nutrition process at end of life, or if you think a patients weight loss is related, read this article.

Assessing Weight Loss in Elderly

Step 1

Develop a weight tracking spreadsheet and audit process.

You can read an article here on getting weights recorded in your facility. If you need a weight tracking spreadsheet, you can download this one for free.

Every month once you have collected the weights, highlight the residents that have lost the significant weight amounts (5% in 30 days/1 month, or 10% in 180 days/6 months).

I also take a quick browse of all the residents names, in a different colour highlighter I note the residents that are having slow but progressive weight loss. These ones may not stand out in significance BUT over a year you may note that a resident has gone from 50 kg – 40 kg, it won’t be flagged as significant if it’s slow over time.

Now you have your list of residents that have lost significant weight that you need to follow up with.

Step 2

Develop a policy or review your current one.

Your facility should have a policy similar to: “If a resident has a noted weight loss that is significant; +/- 5% in 30 days or +/-10% in 180 days, an automatic reweighs will be completed by Care Aides and Nursing Staff.”

This is a very important policy for a couple reasons:
A resident may have noted 10 kg in 1 month…But it is VERY unlikely that is true. Unfortunately though, it’s been documented now in their chart that they have lost 10 kg in 1 month and no one is doing anything about it because both you and nursing know it’s not an accurate weight.

Well your Auditor will come in, see that and ask why no one did anything about it? I promise you that if your answers are, “Well we knew it wasn’t accurate”, you will get an auto fail.
This is where a reweighs comes in. Within 1 week Nursing/Care Aides need to have a reweigh completed and documented in the chart.

Now that you have the original weight and the reweigh in, determine if the new weight qualifies for a significant weight loss still. If it doesn’t, you can cross them off your list and move on. If the reweigh confirms they have lost significant amounts of weight, time to keep examining.

Step 3

Perform a chart review.

There are a couple sections that you are going to look at.

Medication Changes:
Within the time period that the weight change has happened. Have they been put on an antibiotic? This would cue you in that they have an illness or infection. Look for medication interactions that may be slowing them down, nutrient interactions, appetite suppressant etc…

Physician Notes:
(Most charts will have an area where they document), have they noted any changes in the resident? Next look at the general charting, I will always take a quick browse to see if anything is standing out, are they being treated for a wound/pressure injury (Read this article for a thorough breakdown on nutrition and wound care!).

Have they had a recent hospitalization or infection? Infections essentially take as many nutrients that they can to help the body heal, this can cause weight loss because their caloric needs are increased.

Last thing in the chart I look at is their intake records. Browse at least 2 months worth of records. You don’t need to do a deep dive into this but take note of if their intake has decreased, if they’re skipping any meal, which meals they are eating the best at, has their intake been consistent over the past 6 months, are they on nutrition supplement drinks.

These are all things to note.

Step 4

Talk to the Nurse/Care Aides taking care of them.

Ask about the changes that have occurred, they will be able to give you some insight about what’s going on. It is possible that the residents Dementia/Cognitive Impairment is progressing, this can impact intake, a significant amount of our population has some level of CI and it progresses.

Another aspect to ask about is if the resident is sleeping more. Residents that sleep more, or sleep in, sleep through meals, will have less intake of calories. If this is the case, you need to find ways to work with Nursing to ensure that a resident does not miss meals.

There is no issue with a resident choosing to sleep in, that is their right in their home, but they need to be offered some type of breakfast when they wake up. If the resident is skipping certain meals (most residents prefer a lighter lunch, or no lunch at all), the calories need to be increased other times of the day.

Look at offering that resident increased calorie snacks, higher calorie drinks, increase the calories at the meals that they do eat.

The Nurse and Care Aides are good resources as they will know the residents eating habits and what could be contributing to their weight loss.

Step 5

Talk to the patient and/or their loved ones.

This step happens in 2 processes as follows:

A) Do a meal observation. You can find a free meal observation screen template here!

Sit in the dining room where the resident may not notice you, and observe their meal.

You can review all the aspects of the meal observation screen. This will give you the best insight into any issues that may be impacting their intake.

B) Go speak with the resident.

Ask first if they have time to talk about their eating as you are concerned that they are losing some weight. If they give you permission start by explaining how you have noted they’ve been losing some weight and that you think it would be a good idea if we can prevent further weight loss.

Ask if they have noticed any difference, if their clothes are fitting different (something light – not too heavy of a conversation). Ask if there is anything about the meals that they don’t enjoy. Are there any favourite foods that you can add to their menu to increase their intake.

Is there anything that they can think of that is making them lose weight. Residents can give you really good insight into why they may be losing weight, not always but you want to get their input too.

If the resident is non verbal or cannot communicate why they aren’t eating or why they’re losing weight, have a conversation with their family/power of attorney.

They may have noted the same thing as you. Find out what type of foods they really don’t enjoy, and foods/drinks that they loved. They can give you some good tips that you may be able to use to add to their menu.

Nutrition Interventions

Step 6

Time to look at nutrition interventions.

This approach will change based on what you have found!
Use your findings to guide your nutrition interventions.

I’ll give some examples of how to correct:

Nutrition Problem: They don’t like the menu.
Nutrition Intervention: Add foods that they enjoy to their daily intake, and remove items that they don’t.

Nutrition Problem: They can’t independently feed themselves, or struggle during your meal observation.
Nutrition Intervention: Speak with Nursing and update their care plan that they need assistance at meals to eat. Try to give the resident as much independence as they are able to handle. They may be having trouble grasping a fork, this doesn’t mean that they need assistance right away, try an adaptive/wide handled utensil, this may solve the problem. The cups may be too thin for them to handle, try giving their drinks in a mug with handles. Always check with the resident first that you’re doing this.

Nutrition Problem: They skip breakfast.
Nutrition Intervention: Organize for them to have a late morning snack with adequate calories and fluids. Space it out far enough from lunch that they will still eat their lunch. Look as well at adding higher calorie items to their lunch and supper as well. Adding an extra scoop of potatoes at supper, or gravy onto their potatoes.

Nutrition Problem: They don’t like sitting with other people at meals.
Nutrition Intervention: Try to find a seating arrangement where they can eat either at a table by themselves, or with someone else who doesn’t like to talk during meals.

Once you have worked through all of the above, you need to document document document. You need to chart that you have noted the weight loss, the steps you have taken to examine the cause, what are your interventions going to be, and what your follow up plan is.

Sample Chart Note for Weight Loss in Elderly

A sample chart note could be something like this (note this will depend what type of charting is required in your facility), I’ll use ADIME charting for an example:

A – RD noted that resident has lost a significant amount of weight over previous 6 months, weight has changed from 60.0 kg to 45.0 kg in 6/12. Nutrition related lab values remain within normal range. Food and fluid intake over 2/12 reviewed, resident skips lunch on average 50% of the time, all other meals intake is approximately 50%. Resident stated upon interview that they have difficulty seeing their plate at meals and trouble holding utensils. No medication changes. Resident noted to have a stage 2 wound to coccyx, that has been there for 3/12 and has not improved as per Nurse (C.U.). Residents caloric needs 2,500 calories/day, 75 grams protein, and 1500 ml fluid minimum.

D – Unintentional weight loss related to inadequate food intake related to decreased vision, inability to eat independently at all times, and possible wound increasing caloric/protein needs.

I – RD has spoken with Nursing, Care Aides will be offering resident assistance at meals with adaptive cutlery now being trialed. Resident will have increased protein given at meals, larger portions of protein source at supper, and eggs given at breakfast starting this evening. Increased protein and calories will be equal to approximately 14-21 grams and 300 calories daily. Resident will also be given a sandwich at lunch as she states that she only wants an egg salad sandwich. Resident has agreed to the changes above. RD has also spoken with residents daughter/POA and she has been made aware of the above concerns and nutrition interventions.

M/E – RD will monitor residents weight monthly, and will follow up to evaluate intake records in 3-4 weeks. RD will repeat meal observation in 3-4 weeks. RD will also follow up to wound healing progression in 3-4 weeks. RD available for consult further as needed.

I know that is A LOT of information to take in! I tried to cover as much as I can because weight loss in elderly is so incredibly important to evaluate and get to the root cause.