Important tips for aged care providers

This article originally appeared on Aged Care Today Summer 2023 (stock photo only)

Commonwealth-subsidised residential aged care homes across Australia are governed by the National Aged Care Mandatory Quality Indicator (QI) Program where homes must measure and report on five quality indicators, one of which is unplanned weight loss.  

For older people, having regular weigh-ins is a fundamental part of their healthcare journey. Weight loss can be the first, and sometimes the only indicator of poor health.

The Cause of Unintentional Weight Loss and Malnutrition

Unintentional weight loss may stem from a number of factors:

  • Anorexia – as we age, the body experiences sensory changes which can impair appetite. Reduced physical activity, disease, pain and an overall physiological reduction in energy needs can also reduce one’s appetite.
  • Physical illness – residents may experience nutrition-impact symptoms (such as nausea, vomiting, diarrhoea, fatigue or reflux) which can impact their oral intake, while illnesses and diseases can carry a higher demand for nutrients, such as cancer, cardiac or respiratory failure or poor healing wounds.
  • Cognitive illness – dementia and cognitive decline are determinants of oral intake as residents may be unable to identify hunger or fullness cues, mealtimes and how to feed themselves. They may also be active wanderers who find it difficult to sit down and eat at mealtimes. 
  • Dependence on others – a physical or cognitive decline in health can increase the dependence on others to help with feeding. 
  • Poor oral intake due to dislike – although menus at residential aged care homes are diverse, it is impossible to please all individual tastes and preferences at each meal. Food refusal due to dislike of the food is common, which in turn prevents residents from meeting their daily nutrition needs. 
  • Swallowing and chewing impairments  – a lack of dentition, ill-fitting dentures, refusal to wear dentures and impaired swallowing (dysphagia) may require a resident to transition to a modified texture diet or fluids.  

Screening for Unintentional Weight Loss and Malnutrition

If a resident is no longer being weighed, there are other ways we can assess their nutrition status: 

  • Food and Fluid Charting – If a resident has had a decrease in their daily food intake, is refusing food, not attending the dining room for meals, complains of poor appetite or is unable to complete their meal, mark these as red flags and report them to your dietitian. 
  • Clothing – If you notice a loose watch band or ring, having to tighten a notch on a belt, a baggy jumper or pants that won’t stay up, these are all signs of weight loss and should be reported to the dietitian. 
  • Calf Circumference – Measuring calf circumference is a good way to assess muscle mass which can be quick to deplete in malnourished residents. A circumference less than 35cm for males and 34cm for females is indicative of muscle loss and should be reported. 
  • Functionality – A decline in residents’ mobility, pace, strength, independence (unable to feed or shower themselves anymore) and alertness can be signs of muscle loss. You may want to ask your physiotherapist or occupational therapist to conduct strength tests such as the chair-stand test, arm curl test or a hand grip strength test. 
  • Nutrition impact symptoms – Identify any nutrition impact symptoms that may be impacting the resident’s oral intake such as nausea, vomiting, reflux, diarrhoea, mouth sores, poor fitting dentures, poor appetite, fatigue and dry mouth.

How to Improve Malnutrition Rates and Prevent Unintentional Weight Loss

Staff of aged care homes have a major role to play in combatting malnutrition – whether through ensuring routine weight recording and malnutrition screening is completed, preparing and providing nutrient-rich foods and fluids, identifying non-weight weight loss indicators, or appropriately assisting residents with feeding. 

An OSCAR Care Group Dietitian can assist with ongoing staff training about food fortification techniques, malnutrition screening and assessment, creating a positive mealtime environment and nutrition support to combat nutrition impact symptoms and poor appetites. 

In addition, we undertake seasonal menu reviews to ensure the meals provided are not only delicious and inviting, but also meeting nutrition targets to minimise the risk of residents losing weight.

Dietetics Team, OSCAR Care Group