UWL: Benefits and Risks/Harms of Implementation (2009)
Benefits and Risks or Harms of Implementing the Recommendations
- 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
- 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.