Significant unplanned weight loss, where the client loses three or more kilograms within three months.
Consecutive unplanned weight loss, where the client loses any amount of weight every month for three months in a row.
It is possible for clients to experience both categories of weight loss simultaneously (DoH 2020).
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.
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:
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)
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.
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 portalevery quarter (except for those clients who opt out from having their data included) (My Aged Care 2019).
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:
Mini Nutritional Assessment (MNA)
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
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:
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
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
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