TMC Excellence in Action: March 2022

Understanding the Increased Risks of Weight Loss for Individuals with Dementia

Weight Loss is often an area of risk for our long-term care residents, made evident by the fact that CMS measures the percentage of long-stay individuals who have experienced weight loss as a quality measure of resident care. Research has also shown that weight loss occurs frequently in the early stage of Dementia and becomes more pronounced as the illness progresses. There are several potential reasons for this connection between weight loss and Dementia, including decreased intake related to memory and attention deficits, increased need for assistance with self-feeding, and decreased levels of alertness.

Upon evaluation and observation by our Rehab Team, one of our Pittsgrove, New Jersey residents was noted to be eating less than 25% of her food and required increased assistance at meals, related to a diagnosis of Dementia, thus increasing her weight loss risk.

SLP Erin saw this and used root cause analysis to determine why this was happening. Utilizing the Cognitive Leveling resources available in TMC’s Clinical Resources she established that the patient’s cognitive level was “Yellow” – consistent with a Level 6 on the Global Deterioration Scale – a Moderate cognitive deficit. Through Erin’s training and knowledge regarding Cognitive abilities, she recognized that individuals functioning at this level often require cueing and assistance with all ADLs, requiring supervision for all activities. Additionally, she made the decision to downgrade the patient’s diet to Mech Soft from regular, as individuals functioning at this level are often unable to cut and manage their own foods, but typically retain the ability to chew and swallow a less restrictive diet texture. The day following these changes, the resident ate 100% of her meals, and has been consistently tolerating more of her meals than previously consumed. The CNAs and Nurses on the long-term care unit were thrilled to see the patient eating again!

The resident continues working with SLP to determine her best ability to function and to ensure that she is receiving the least restrictive diet to maximize oral intake and prevent further weight loss. Additionally, the facility care team has been empowered to help to minimize weight loss risks in this resident and many others who are living with Dementia, through the tips and interventions provided by SLP Erin and our entire Rehab Team!

Here are a few tips for reducing weight loss risk for individuals with Dementia and cognitive impairment:

• Incorporate food likes and avoid dislikes – Interview the patient (if able) and/or family members to determine food preferences and work with the kitchen staff to incorporate them into the patient’s diet plan.  Additionally, giving the person even one food item on their plate that they do not enjoy may result in a responsive behavior, or in the person refusing to eat the entire meal.
• Maximize self-feeding skills – As Dementia progresses, the individual may lose the ability to self-feed without assistance. Work with the patient to determine remaining abilities, teach them to the facility staff, and collaborate together to maximize each patient’s self-feeding abilities.
• Reduce overstimulation and distractions at mealtimes – Sometimes, patients’ ability to tolerate mealtimes is limited by excessive distractions and stimulation in the dining room. Music, TVs, and staff conversations should be limited during mealtimes. Sometimes, it can be as simple as turning the person’s back to the rest of the dining room to reduce distractions, that can make a big difference!
• Offer high calorie snacks between meals or try 5-6 small meals per day, instead of 3 larger meals – Many times, individuals cannot attend to a meal long enough to tolerate a large portion. Offering several small meals per day can help to ensure that the individual receives appropriate nutrition while limiting time spent in the dining room. Also, if the individual tends to walk excessively in the facility, offering several high-calorie snacks throughout the day can offset the calories being burned by their walking. You may also try over-flavoring foods or adding high-calorie additives (i.e., butter, heavy cream, etc.) to foods to enhance caloric intake.
• Ensure that foods are presented in the person’s visual field – As Dementia progresses, a person’s visual field decreases. If staff simply places the food on the person’s bedside table and leaves the room, the individual may not even realize that the food tray is there!
• Promote physical activity to increase hunger – Keeping the individual as physically active as possible can enhance their appetite.

Providing person-centered care that is focused on each patient’s remaining abilities is a huge part of TMC’s ‘Why’, and in Pittsgrove, NJ we are ALL IN for reducing patients’ risks and improving their quality of life by helping them function to the best of their abilities!