Clinical Indicators Associated with Unintentional Weight loss and Pressure Ulcers in Elderly Residents of Nursing Facilities

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Abstract

Objective To monitor adults older than 65 years living in nursing facilities and who experience unintentional weight loss of more than 10% of actual body weight in 6 months or more than 5% in 1 month or who have stage II, III, or IV pressure ulcers.

Subjects We reviewed 290 medical records for unintentional weight loss and 265 for pressure ulcers.

Design Two data-collecting instruments were used: one for pressure ulcers and one for unintentional weight loss. Indicators for each instrument were selected to monitor clinical conditions that tend to be problem-prone areas for these two populations.

Statistical analysis Descriptive statistics were used to calculate the frequency of each indicator for each population.

Results Of the 24 indicators for unintentional weight loss, the 6 indicators present most often, in descending order, were reduced functional ability, intake of 50% or less of food served for the past 3 consecutive days, chewing problems, serum albumin level less than 35 g/L with normal hydration status, cholesterol level less than 4.1 mmol/L, and refusal of 50% or more of food replacement for the past 7 days. For the residents with pressure ulcers, the indicator present most often was scrum albumin level less than 35 g/L with normal hydration status. The three highest intervention indicators were receives 1.2 g protein per kilogram of actual body weight, receives 120 mg or more of vitamin C daily, and receives 112 times the energy required based on goal body weight. When serum albumin level was documented in the medical record, it was a valid indicator for both diagnoses.

Conclusions Inappropriate dietary intake, disease, and disability place residents in nursing facilities at risk for malnutrition. Thus, it is important to obtain laboratory values when assessing elderly residents and determining their nutritional status. J Am Diet Assoc. 1995; 95:984-992.

Section snippets

Methods

The CD-HCF and DNS Quality Management Committee developed a plan for a geographically distributed, multicenter study of nursing-facility residents and home-care clients to field-test indicators related to unintentional weight loss and pressure ulcers. Unintentional weight loss and pressure ulcers were selected because of the severity of their effect on clients’ health. The study monitored two target populations. One population comprised adults older than 65 years living in nursing facilities

Unintentional Weight Loss

Two hundred ninety medical records met the criteria for unintentional weight loss, and these records were reviewed by the 45 auditors. The numbers and percentages of residents’ medical records in which the indicators were present, missing, or not applicable to the problem are shown in Table 1. For these residents (n=290), the most frequently occurring indicators were reduced functional ability, intake of 50% or less of food served for the past 3 consecutive days, and chewing problems—the

Implications

This multicenter study was initiated to field-test indicators related to unintentional weight loss and pressure ulcers in the elderly population. Our results indicate that dietitians who work with this population must assess nutrient intake and acceptance and tolerance of supplements and monitor and recommend serum albumin and cholesterol levels. Dietitians’ assessment of residents’ chewing and swallowing abilities is also important, because this can lead to evaluation by a specialist in

Applications

This study identified the indicators associated with unintentional weight loss and pressure ulcers in the elderly living in nursing facilities. Reassessment by a dietitian is suggested when unintentional weight loss or pressure ulcers trigger a new minimum data set or a significant change.

Inappropriate dietary intake, disease, and disability place many residents in nursing facilities at risk for malnutrition. The prevalence of unintentional weight loss and pressure ulcers challenges dietitians

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