Treating weight changes in long-term care

Preventing and addressing resident weight changes in long-term care can pose significant challenges. When a resident experiences unplanned weight loss or gain, all eyes are on the dietitian. How should you address weight changes? And what strategies can be implemented to keep weights stable?  

Preventing weight changes

Thorough initial nutrition assessment 

In your initial assessment, be sure to identify anything that may result in weight changes including poor appetite, fluid overload, or history of weight gain and/or loss. You should also confirm the accuracy of the admission weight by asking the resident their usual body weight. Anything that stands out as a potential reason that weight changes could occur should be documented and an intervention should be ordered immediately. For example, if you suspect an admission weight is erroneous, request an immediate re-weight, rather than waiting for next week’s weight.  

Maximize mealtimes  

In addition to your initial nutrition assessment, ensure the patient is set up for success when it comes to meal consumption. There are several strategies you can employ to maximize nutritional intake at mealtimes: 

• Obtain food preferences and communicate them with the kitchen.  
• Visit residents at mealtime to assess for potential need of adaptive equipment or food consistency change. Communicate with occupational, physical, and speech therapists to ensure residents have what they need right from the start.  
• Ask the resident about the type of eating environment they enjoy. Some prefer to eat in a dining room, while others would rather eat in their rooms alone. Always encourage residents to eat somewhere other than their bed if they are medically able to. 
• Find out if residents were taking an oral nutrition supplement at home and if they would like to continue receiving it at the facility. If they were not, explain what supplements are available and see if they would like to try any.  

Determine a baseline weight 

If possible, document the resident’s baseline weight. For example, if the resident had maintained a weight of 150 lbs for the last five years and they are now 135 lbs following a surgery, document this information. A baseline weight is similar to a usual body weight. It can be obtained from the medical record or verbally reported by the resident or their family member. 

Establish a weight day 

Work with nursing on establishing a weight day, where all the residents can be weighed on the same day. In some facilities, a “weight team” can help tremendously with efficiency and accuracy. Calibrate your scales monthly and keep a record of this on file. When all weights are taken and recorded, review any significant changes with the team so that your nutrition plan can be interdisciplinary, which is often more effective. If a weight value suggests an error was made in obtaining or recording, request a re-weight and follow up within a day or two. 

Addressing weight changes when they occur

Inevitably, weight changes will occur. Even the best laid plans for prevention are not always effective. The important thing is that your documentation is timely and accurate.  

Documentation should be clear and detailed 

Be sure that a progress note or a weight evaluation is completed for any weight change that is deemed significant by your facility policy. According to the MDS, weight change is defined as  

• greater than or equal to 5% loss/gain in a 30-day time frame 
• greater than or equal to 7.5% gain/loss in a 90-day period  
• greater than or equal to 10% loss/gain in 180 days.  

When a weight change occurs, the physician and resident’s next of kin should be notified. In most cases, the nursing staff will inform the resident’s next of kin. However, there are plenty of cases where direct communication from the dietitian is best practice. If you hold a weight meeting, invite your medical director or nurse practitioner. This serves as physician notification and can be documented as such.  

Update the nutrition plan of care  

Any time a nutrition intervention is ordered or discontinued, the nutrition plan of care should reflect the current status of the resident. This helps keep everyone on the same page. A nutrition intervention is only effective when it is implemented. Be sure to communicate any changes to the nutrition plan of care with nursing and other clinical staff. 

High-risk residents require more frequent documentation 

If a resident’s weight change is unintentional or unexpected, they should be placed on your high-risk list until their weight stabilizes. This allows for the resident to stay on your radar and receive more frequent follow up. Most nutrition interventions are more effective if they are established early and reinforced frequently. 

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