UWL: Benefits and Risks/Harms of Implementation (2009)
Benefits and Risks or Harms of Implementing the Recommendations
Safety issues must be reviewed carefully for each older adult. General benefits and risks associated with implementation of the guideline are addressed for each recommendation.
- Although medical nutrition therapy (MNT) costs and reimbursement vary, MNT is essential for improved outcomes
- A primary goal of implementing these recommendations includes improving an older adult's ability to increase energy, protein and nutrient intakes, improve nutritional status and improve quality of life
- Following these guidelines will increase the likelihood of meeting regulatory requirements.
Risk or Harm Considerations
When using these recommendations:
- To prevent potential adverse outcomes due to overconsumption of a particular nutrient, use clinical judgment
- Patient denial or misclassification of the necessary dysphagia diet may result in aspiration pneumonia due to poor swallowing function
- Use clinical judgment in applying the guidelines when evaluating older adults with unintended weight loss (UWL)
- Failure to make a nutrition diagnosis of involuntary weight loss may lead to lack of treatment and increased risk of mortality
- Continued involuntary weight loss may lead to potential for litigation
- Standard weighing procedures must be followed or weights may be inaccurate
- In some individuals, resting metabolic rate (RMR) estimation may be inadequate or excessive and clinical judgment should be used
- Sufficient feeding assistance may not be available
- Appetite stimulants may result in side effects
- Inadvertent misplacement of the enteral feeding tube
- Overfeeding, underfeeding and social isolation may contribute to greater risks of complications over time.
In addition to the above, a variety of barriers may hinder the application of these recommendations.