How to Identify and Stop Weight Loss in Long-Term Care

Unplanned weight loss is a significant problem that plagues long-term care residents nationwide.

It increases the risk of malnutrition, pressure injuries, and falls, among other adverse health outcomes.

The good news is that you can treat and prevent unplanned weight loss by focusing on risk factors and the underlying cause.

This article highlights the causes of unplanned weight loss in long-term care and how you can treat and prevent it.

What is unplanned weight loss?

Unplanned weight loss is any weight loss that occurs unintentionally or unplanned.

The Centers for Medicare and Medicaid Services (CMS) — the federal agency that regulates nursing homes — has established parameters for evaluating unplanned weight loss (1).

These parameters include:

Time period	Significant loss	Severe loss
1 month	5%	> 5%
3 months	7.5%	> 7.5%
6 months	10%	> 10%

To calculate weight loss percentage, divide the amount of weight loss by their usual body weight, then multiply that by 100.

For example, say a resident weighed 150 pounds three months ago but currently weighs 135 pounds.

Divide 15 (150 subtract 135) by 150 to calculate a 10% weight loss in three months.

Having lost more than 7.5% of their body weight in 3 months, this resident has severe weight loss based on CMS’s parameters.

Causes of unplanned weight loss

Anyone can experience unplanned weight loss, but it’s especially prevalent in older adults living in long-term care settings.

Consequently, unplanned weight loss increases the risk of various adverse health outcomes, including (2):

• malnutrition
• falls and fractures
• pressure injuries
• hospitalizations and readmissions
• death

One or multiple factors can cause unplanned weight loss.

Factors associated with unplanned weight loss in long-term care include:

• certain medications
• conditions like or cancer or bowel diseases
• chewing or swallowing difficulties
• eating dependencies
• strict therapeutic diets
• loneliness or depression
• missed meals

These factors are all similar in that they decrease appetite or make it more difficult to eat enough calories.

How to treat and prevent unplanned weight loss

There are many nutrition interventions for treating unplanned weight loss in long-term care.

However, the nutrition intervention should focus on treating the underlying cause or causes of the unplanned weight loss.

A dietitian can identify the underlying cause by conducting a comprehensive nutrition assessment, which includes a nutrition-focused physical exam.

Under some circumstances, such as hospice care, preventing unplanned weight loss may not be possible.

In developing the nutrition intervention, remember to involve the resident and — if appropriate — their representative to ensure the intervention meets the resident’s needs, preferences, and goals.

Of course, the best way to treat unplanned weight loss is to prevent it in the first place.

This involves identifying nutrition risk factors early and implementing appropriate nutrition interventions that you document in the resident’s care plan.

Nutrition interventions for unplanned weight loss

Conducting a comprehensive nutrition assessment can help you identify causes or risk factors for unplanned weight loss.

Here is a list of nutrition interventions and when they might be appropriate:

• Identify food likes and dislikes: Learn what foods each resident likes and dislikes, and reassess at least once per year as food preferences may change.
• Allow flexible meal times: Offer residents who prefer to eat outside of typical meal times the choice of eating earlier or later.
• Liberalize diet: Therapeutic diets can limit food choices and reduce the joy of eating.
• Fortify foods: Add extra protein and high-calorie ingredients to foods like soups, casseroles, and sandwiches.
• Assist with dining: Some residents may need assistance or cueing at meals from staff, and others could benefit from adaptive eating devices.
• Consult speech therapy: Speech therapy can determine whether a resident would benefit from a change in diet texture and recommend appropriate feeding techniques.
• Consult pharmacy: More than 250 commonly prescribed medications can negatively interfere with appetite. A pharmacist can identify alternatives for medications that may be decreasing appetite or causing taste changes (3).
• Try supplements: Supplements like Ensure or Boost can be effective for increasing calorie and protein intake, but they can be costly and disliked by some residents.
• Recommend an appetite stimulant: Some appetite stimulant drugs are effective for older adults with weight loss who are also experiencing depression.
• Consider aggressive interventions: Some residents may need more aggressive interventions like tube feeding — either temporarily or permanently — to get enough nutrition.

Remember to regularly assess the effectiveness of nutrition intervention and update the resident’s nutrition care plan accordingly with any change in intervention.

Long-term care weight monitoring

Weight monitoring is important for identifying unplanned weight loss and assessing the effectiveness of nutrition interventions for treating unplanned weight loss.

However, weight monitoring is only effective if the weights are taken accurately and on time.

Unfortunately, scale inaccuracies, user error, and inconsistent weighing conditions lead to weight inaccuracies.

In some instances, care team members may input a false weight or no weight at all if there are time constraints or out of carelessness.

Collectively, these issues can prevent the early identification of unplanned weight loss or draw unnecessary attention from state surveyors in instances where weights are recorded inaccurately or falsified.

As such, always request a reweigh if you believe a weight is inaccurate and discuss the importance of obtaining accurate and timely weights with other members of the interdisciplinary health care team.

Residents with unplanned weight loss and those identified as at risk for unplanned weight loss should be weighed weekly under the same conditions.

The bottom line

Unplanned weight loss in long-term care is a significant risk factor for malnutrition, pressure injuries, and even death.

Identifying the root cause of unplanned weight loss is key to determining the best nutrition intervention.

The nutrition intervention should be consistent with a resident’s goals and preferences, regularly monitored for effectiveness, and adjusted as needed.

Accurate and timely weighing is essential for the early identification of residents at risk for unplanned weight loss and for assessing the effectiveness of nutrition interventions for treatment.