Preventing Weight Loss in Nursing Home Residents

Preventing Weight Loss in Nursing Home Residents

Preventing Weight Loss in Nursing Home Residents

Weight loss in nursing home residents is linked to poor outcomes, including higher rates of hospitalization and death. But a crossover study of residents with low oral intake at four nursing homes shows that assistance with meals or snacks can prevent weight loss. Preventing Weight Loss in Nursing Home Residents

Of 148 residents, those with low intake (who leave at least a quarter of most meals) were identified by observing their eating and drinking over two days. They then underwent two-day tests of assistance with all three meals or with three daily snacks (usual snack frequency was less than one per day). Those whose intake increased by 15% or more with either intervention were considered responders; 34 (all residents at two nursing homes) became the control group and 35 (at two other facilities), the intervention group. They were “moderately to severely cognitively impaired,” had been residents for nearly three years, and were mostly female and white; the average age was 82 years.

For 24 weeks controls received usual care; the intervention group received the assistance—with either snacks or meals—that had most increased their caloric intake during the test period. Assistance included one-to-one help and prompting, allowing residents to dine where they liked, and permitting food substitution and extra helpings.

At the end of the first 24 weeks, the intervention group’s average caloric intake had jumped 302 calories, from 1,237 to 1,539, while the control group’s average intake had increased by 127 calories. The facilities then switched protocols for another 24 weeks (the crossover phase); all 148 residents were assessed, and 64 participated in the next phase (30 receiving one of the interventions and 34 receiving usual care). After the crossover phase, the average caloric intake of the control group, formerly the intervention group, had fallen by 181 calories. The new intervention group’s average intake had increased by 379 calories, from 1,204 to 1,583.

Over the 48 weeks, 56% of the two intervention groups maintained or gained weight, as did 28% of the two control groups. Residents with a diagnosis of depression lost more weight than others, so the authors recommend combining feeding assistance with treatment for depression.

Of course, such assistance requires time. In this study, usual care per person averaged five minutes for meals and less than one minute for snacks; the intervention took an average of 42 minutes per person for meals and 13 minutes for snacks.

The good news is that most participants responded best to the less-time-consuming snack intervention, said the study’s lead author, Sandra Simmons. Because many residents have poor appetites and eat small amounts at a time, she told AJN, “the real key is doubling the number of opportunities a day where residents get a chance to eat.”

Tammy Worth


Hypertension is predictive of retinopathy in teens with type 1 diabetes, report the authors of a study of 1,869 adolescents with a median age of 13.4 years and a median disease duration of five years. Their only treatment was insulin. During the study, 36% developed retinopathy, defined as the presence of at least one microaneurysm or one hemorrhage. High blood pressure, both systolic and diastolic, increased the risk of retinopathy independently of other risk factors, such as elevated glycosylated hemoglobin, a longer duration of diabetes, or compromised kidney function. The authors urge providers to closely monitor blood pressure in all adolescents with type 1 diabetes. They also suggest conducting interventional trials on the risks and benefits of lowering blood pressure with medication in normotensive adolescents with type 1 diabetes.

Simmons SF, et al. J Am Geriatr Soc 2008; 56(8):1466–73.
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