Unplanned Weight Loss in Aged Care

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Published: 05 April 2021

What is Unplanned Weight Loss?

Unplanned weight loss occurs when a client experiences an unintentional reduction in body mass. In these cases, there is no written strategy or ongoing record detailing planned weight loss (DoH 2020).

According to the National Aged Care Mandatory Quality Indicator Program, there are two categories of unplanned weight loss:

  1. Significant unplanned weight loss, where the client loses three or more kilograms within three months.
  2. Consecutive unplanned weight loss, where the client loses any amount of weight every month for three months in a row.

(DoH 2020)

It is possible for clients to experience both categories of weight loss simultaneously (DoH 2020).

For example:

Consider a client who initially weighed 80kg.

  • After one month, they weigh 78.5kg.
  • After two months, they weigh 78kg.
  • After three months, they weigh 77.5 kg.

(DoH 2020)

The client lost three kilograms within three months and lost some amount of weight for three consecutive months. Therefore, they have experienced both significant unplanned weight loss and consecutive unplanned weight loss (DoH 2020).

Note: Generally, an older adult is considered underweight if they have a body mass index (BMI) of under 18.5 (VIC DoH 2018).

Causes of Unplanned Weight Loss in Older Adults

Weight loss often occurs when daily nutritional requirements are not being met. This could be due to food quality, difficulties with eating or the food failing to meet clients’ cultural or religious needs - up to 68% of aged care clients are malnourished (Royal Commission into Aged Care Quality and Safety 2021).

In some cases, weight loss is caused by an underlying health condition, even among clients who are eating healthy and nutritious diets (My Aged Care 2019, 2020).

Unplanned weight loss may also be associated with age-related changes to the body such as:

  • Loss of taste, smell or sight
  • Changes to the digestive system
  • Swallowing difficulties
  • Oral hygiene issues (e.g. missing or decayed teeth, poorly fitting dentures)
  • Feeling full more quickly
  • Decreased appetite
  • Decreased capacity to store water
  • Frailty.

(My Aged Care 2019)

Other specific factors that may be associated with weight loss include:

  • Dementia
  • Dementia-related behaviours (e.g. pacing, wandering, difficulty recognising food, forgetting to eat or how to eat, difficulty feeding oneself, impaired communication skills, paranoia related to food, aversive feeding behaviours)
  • Polypharmacy
  • Protein-energy malnutrition
  • Sarcopenia
  • Depression
  • Chronic illness
  • Social isolation
  • Pain
  • Factors related to the client’s physical or organisational environment
  • Staffing challenges (lack of availability to provide meal assistance, poor knowledge of nutritional care, failure to identify or communicate clients’ nutritional needs, inadequate support).

(VIC DoH 2015; My Aged Care 2019, 2020)

Sometimes (in approximately 10 to 36% of cases), there is no known cause of weight loss in older adults (Hartford Institute for Geriatric Nursing, cited in My Aged Care 2019).

Consequences of Unplanned Weight Loss

unplanned weight loss fall
Unplanned weight loss may increase the risk of a hip fracture.

Unplanned weight loss is associated with several adverse health effects among older adults, including:

  • Increased risk of hip fracture
  • Impaired wound healing
  • Impaired strength and mobility
  • Malnutrition
  • An overall decrease in quality of life
  • Death.

(DoH 2020)

Unplanned Weight Loss as a Quality Indicator

Being able to detect and manage unplanned weight loss in your clients is essential.

Unplanned weight loss is common among older adults and poses serious risks. For this reason, it is a key quality indicator under the National Aged Care Mandatory Quality Indicator Program (DoH 2020).

The QI program outlines specific indicators that all government-subsidised aged care facilities are required to meet in order to measure the quality and safety of their services and facilitate continuous improvement (My Aged Care 2020).

Under this program, all clients receiving residential aged care must be weighed every month, except for:

  • Absent clients (e.g. those who are currently in hospital)
  • Clients receiving palliative care
  • Clients receiving respite care.

(DoH 2020)

In order to ensure measurements are accurate, clients should wear clothes of a similar weight every time they are weighed. Furthermore, the same weighing device should be used (DoH 2020).

Raw data about each client’s weight must be submitted to the My Aged Care service provider portal every quarter (except for those clients who opt out from having their data included) (My Aged Care 2019).

Weighing Clients

The following strategies will help ensure that weight data is as accurate as possible:

  • Weigh each client at a similar date and time of day every month
  • Ensure clients wear clothing of a similar weight every month, and deduct the weight of the clothing from the total
  • Use the same weighing device every month, and calibrate it regularly
  • Ensure any mathematical calculations are correct
  • If unplanned weight loss or gain is recorded, consider weighing the client again the next day in case this is a normal daily fluctuation
  • Consider taking alternative measurements such as mid-arm or calf circumference if weighing the client is unfeasible (e.g. it causes them pain or distress).

(VIC DoH 2015)

Standardised Care Process for Unplanned Weight Loss

Note: This is the standardised care process for Victoria. Other jurisdictions may differ.

  • Conduct a nutritional assessment of all clients upon admission. This should comprise:
    • Dietary history
    • Medical history
    • Physical examination
    • Mini Nutritional Assessment (MNA)
    • Social factors
    • Functional ability.
  • Recognise any signs of weight loss. Intervene if:
    • Weight loss has been detected or the client’s BMI is under 18.5
    • The client leaves over one-quarter of their food uneaten for two out of three meals for a seven day period
  • Determine appropriate interventions.
  • Refer the client to relevant specialists if required (e.g. general practitioner, dietitian, speech pathologist, occupational therapist, pharmacist, dentist).
  • Ensure the client is being weighed monthly as per the QI Program. Reweigh the client frequently if weight loss is detected.
  • Routinely assess whether interventions are working effectively.
  • Discuss the client’s food and mealtime preferences. Provide them with information about nutrition and maintaining nutritional status.
  • Ensure staff are appropriately trained in regards to:
    • Nutrition in older adults
    • Malnourishment risk factors
    • How to create a positive dining environment
    • How to assist clients with eating and drinking
    • Religious and cultural food preferences and choices.

(VIC DoH 2018)

Preventing Unplanned Weight Loss in Older Adults

unplanned weightloss meals

By regularly monitoring clients’ weight, staff should be able to promptly identify and address weight changes (My Aged Care 2020).

Interventions for preventing weight loss may include:

Food-related interventions
  • Ensuring meals are tasty, nutritious, visually appealing and served at the right temperature
  • Intensifying the smell and taste of food in order to stimulate appetite
  • Reheating meals for clients who eat slowly to ensure they remain at a palatable temperature
  • Taking clients’ food preferences into consideration and providing them with meal options
  • Providing nutritious snacks, finger food and water throughout the day
  • Providing aids for eating utensils
Dietary interventions (as guided by a dietitian or other appropriately qualified health professional)
  • Modifying food and fluid textures
  • Increasing calorie or protein intake
  • Limiting dietary restrictions on salt, sugar, fat etc.
  • Providing nutritional supplements if (upon consultation with the client’s general practitioner and dietitian)
  • Developing nutrition care plans together with clients
Environmental interventions
  • Ensuring the dining environment is relaxed and sociable (e.g. reducing interruptions, encouraging clients to eat together or with family members)
  • Adjusting the eating environment (e.g. reducing visual and auditory stimulation, improving lighting, increasing the contrast between table linen and crockery so that it is more visible)
  • Consider background music or focal points (e.g. an aquarium) to make the dining environment more intimate
  • Ensure seating and seating arrangements are comfortable
  • Allowing visitors to bring meals and eat within the facility
Staff interventions
  • Weighing clients who are experiencing unplanned weight loss more frequently
  • Allocating sufficient staff to assist clients
  • Assisting clients to eat if required (e.g. opening packages, reaching food, feeding)
  • Assisting clients with oral hygiene
  • Monitoring fluid intake
  • Referring clients to a general practitioner, dietitian, dentist, occupational therapist, pharmacist or speech pathologist if required in order to address any underlying issues
  • Ensuring dentures fit properly
  • Reviewing clients’ medicines for possible side effects
  • Identifying and treating any underlying conditions
  • Encouraging adequate exercise

(My Aged Care 2019, 2020; VIC DoH 2018)

Additional Resources


References

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Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date. See Educator Profile