Unintended Weight Loss in Older Adults

UWL: Scope of Guideline (2009)

Below, you will find a list of characteristics that describe the scope of this guideline.

Guideline Category  

Assessment of Therapeutic Effectiveness, Counseling, Evaluation, Management, Rehabilitation, Treatment

Clinical Specialty

Cardiology, Colon and Rectal Surgery, Critical Care, Endocrinology, Family Practice, Gastroenterology, Geriatrics, Hematology, Nephrology, Neurological Surgery, Neurology, Nursing, Nutrition, Oncology, Orthopedic Surgery, Pharmacology, Physical Medicine and Rehabilitation, Psychiatry, Psychology, Surgery, Thoracic Surgery

Intended Users

Registered Dietitians, Advanced Practice Nurses, Health Care Providers, Nurses, Occupational Therapists, Pharmacists, Physical Therapists, Physician Assistants, Physicians, Psychologists/Non-physician Behavioral Health Clinicians, Social Workers, Speech-Language Pathologists, Students

Guideline Objective(s)

• To provide medical nutrition therapy (MNT) guidelines for older adults with unintended weight loss (UWL) to increase energy, protein and nutrient intakes, improve nutritional status and improve quality of life.

• To define evidence-based UWL nutrition recommendations for registered dietitians (RDs) that are carried out in collaboration with other healthcare providers
• To guide practice decisions that integrate medical, nutritional and behavioral strategies
• To reduce variations in practice among RDs
• To provide the RD with data to make recommendations to adjust MNT or recommend other therapies to achieve desired outcomes
• To develop guidelines for interventions that have measurable clinical outcomes
• To define the highest quality of care within cost constraints of the current healthcare environment.

Target Population

Aged (65 to 79 years), Male, Female

Target Population Description

Older adults with unintended weight loss.

Interventions and Practices Considered

• Nutrition Assessment
• Nutrition Diagnosis
• Nutrition Intervention
• Nutrition Monitoring and Evaluation.

I.  Referral to a Registered Dietitian
II. Medical Nutrition Therapy

A.     Nutrition Assessment

Below you will find the nutrition assessment terms related to unintended weight loss care from International Dietetics & Nutrition Terminology Reference Manual. Standardized Language for the Nutrition Care Process. Third Edition. 

• Food and nutrient intake
• Diet history
• Diet order
• Diet experience
• Eating environment
• Energy intake
• Food and beverage intake
• Fluid/beverage intake
• Food intake
• Enteral/parenteral intake
• Protein intake
• Vitamin intake
• Mineral/element intake
• Medication and herbal supplements
• Food and nutrition knowledge
• Beliefs and attitudes
• Adherence
• Mealtime behavior
• Food/nutrition program participation
• Safe food/meal availability
• Food and nutrition-related supplies availability
• Physical activity and function
• Nutrition-related ADLs and IADLs
• Physical activity
• Nutrition quality of life
• Anthropometric measurements (height, weight, usual body weight, weight change)
• Biochemical data, medical tests and procedures (metabolic rate profile, nutritional anemia profile, protein profile, vitamin profile)
• Nutrition-focused physical findings (overall appearance, extremities, skin)
• Personal history (physical disability, mobility)
• Patient/client/family medical/health history (integumentary)
• Social history (living/housing situation)
• Energy needs
• Macronutrient needs (estimated protein needs)
• Fluid needs
• Micronutrient needs.  

• Increased energy expenditure
• Inadequate energy intake 
• Inadequate oral food/beverage intake
• Inadequate intake from enteral/parenteral nutrition
• Inappropriate infusion of enteral/parenteral nutrition
• Inadequate fluid intake
• Increased nutrient needs
• Malnutrition
• Inadequate protein-energy intake
• Inadequate protein intake
• Inadequate vitamin intake (vitamin D)
• Inadequate mineral intake 
• Swallowing difficulty
• Biting/chewing (masticatory) difficulty
• Altered GI function
• Impaired nutrient utilization
• Altered nutrition-related laboratory values
• Food-medication interaction
• Underweight
• Involuntary weight loss 
• Food- and nutrition-related knowledge deficit
• Harmful beliefs/attitudes about food- or nutrition-related topics
• Not ready for diet/lifestyle change
• Limited adherence to nutrition-related recommendations
• Undesirable food choices
• Physical inactivity
• Excessive physical activity
• Inability or lack of desire to manage self-care
• Impaired ability to prepare foods/meals
• Poor nutrition quality of life
• Self-feeding difficulty
• Intake of unsafe food
• Limited access to food.

C.     Nutrition Intervention (Planning and Implementation)

Individualized prescription based on:

 

1.      Food/nutrition Intervention

2.      Physical activity Interventions

3.      Behavioral Interventions

4.      Pharmacotherapy, when indicated.

• Meals and snacks
• Enteral/parenteral nutrition
• Medical food supplements
• Vitamin and mineral supplements
• Feeding assistance
• Feeding environment
• Nutrition-related medication management
• Nutrition education
• Nutrition counseling
• Coordination of nutrition care.

D.    Monitoring and Evaluation  

• Eating environment
• Energy intake
• Fluid/beverage intake
• Food intake
• Enteral/parenteral intake
• Protein intake
• Food and nutrition knowledge
• Beliefs and attitudes
• Adherence
• Mealtime behavior
• Physical activity and function
• Nutrition-related ADLs and IADLs
• Physical activity
• Anthropometric measurements (height, weight, usual body weight, weight change)
• Biochemical data, medical tests and procedures (metabolic rate profile, nutritional anemia profile, protein profile, vitamin profile)
• Nutrition-focused physical findings (overall appearance, extremities, skin)
• Personal history (physical disability, mobility)
• Patient/client/family medical/health history (integumentary)
• Social history (living/housing situation)
• Energy needs
• Macronutrient needs (estimated protein needs)
• Fluid needs
• Micronutrient needs.