Unintentional Weight Loss in Long-term Care: Predictor of Mortality in the Elderly

Ryan, Charles W.; Bryant, Elizabeth; Eleazer, Paul D.; Rhodes, Anne E.; Guest, Katherine

doi:10.1097/00007611-199507000-00005

Cited by 86 publications

(54 citation statements)

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“…When energy requirements are not met owing to difficulties in self-feeding, poor mobility (Berkhout et al, 1998), dementia (Stewart et al, 2005) or reduced appetite (Mowe and Bohmer, 2002), body weight declines. Loss of body weight and muscle mass have been associated with risk of hip fracture (Patterson et al, 1992;Langlois et al, 1996Langlois et al, , 1998, reduced mobility (Bannerman et al, 2002;Schmid et al, 2003) and increased mortality (Dwyer et al, 1987;Ryan et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

Nutrient intake and plate waste from an Australian residential care facility

Grieger

Nowson

2006

Eur J Clin Nutr

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Objective: To determine the plate waste, energy and selected-nutrient intake, from elderly residents living in a high-level care (HLC) and low-level care (LLC) facility. Design: Three, single, whole day assessments of plate waste, energy, and selected nutrients, using a visual rating plate waste scale. Setting: Long-term residential care establishment. Subjects: One hundred and sixty-nine (93 HLC and 76 LLC) individual daily intakes. Main findings: The mean energy wasted throughout the whole day was 17%. The energy wasted from main meals (16%) was significantly less than the energy wasted at mid-meals (22%, P ¼ 0.049). The lowest mean energy wastage occurred at breakfast (8%) compared to lunch (22%) and dinner (25%, Po0.001). The mean (s.d.) daily energy served and consumed was 8.1 (2.0) and 6.6 (2.2) MJ, respectively. There was no difference in energy served or consumed between HLC and LLC residents. On the observation day, 60% of residents consumed less than their estimated energy requirement. The mean calcium intake was 796 (346) mg, and the median (inter-quartile range) vitamin D intake was 1.78 (2.05) mg. Conclusion: On 1 day, more than half the residents surveyed were at risk of consuming an inadequate energy intake, which over-time, may result in body weight loss. Although wastage was not excessive and energy served was adequate, the amount of food eaten was insufficient to meet energy and calcium requirements for a significant number of residents and it is not possible to consume sufficient vitamin D through food sources.

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Section: Introductionmentioning

confidence: 99%

Nutrient intake and plate waste from an Australian residential care facility

Grieger

Nowson

2006

Eur J Clin Nutr

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“…In the past, researchers had assessed significant weight loss as 5% in one month, 7.5% in three months, and 10% in six months. According to Ryan et al (1995), changes in weight over time are easy to track and may aid in identification of individuals in need of nutritional intervention. Research bears credence to the fact that continued unintentional weight loss is one of the key indicators of mortality in long-term care.…”

Section: Discussionmentioning

confidence: 99%

“…Beers and Berkow (1999) determined weight loss of 4% over one year is a significant amount of weight loss. Ryan et al (1995) conducted a study that affirmed those subjects who lost at least 5% total body weight in one month were 4.6 times more likely to die within a year. According to Morley (2007), nursing home residents who continue to lose weight have a 30% increase of mortality within a six-month period.…”

Section: Unplanned Weight Lossmentioning

confidence: 99%

A Randomized Clinical Trial Comparing Liberalized Diets and Therapeutic Diets in Long-Term-Care Residents

Black

Tidwell

Worthy

et al. 2011

Journal of the American Dietetic Association

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The population of elderly people in the United States is predicted to increase in large numbers within the next few decades. Many of them will be admitted to long-termcare centers in the waning years of their lives. Health care professionals will need to be prepared for this influx of the elderly into these institutions and for their demands of improved quality of life in these centers. Unplanned weight loss has become one of the major predictors of mortality in long-term-care residents. The purpose of the study was to compare the use of liberalized diets with the traditional therapeutic diets long advocated in long-term-care facilities in the United States. The objectives were to conduct a randomized clinical trial with a treatment group (subjects who consumed liberalized diets) and a control group (subjects who continued with their usual therapeutic diets), and to compare outcomes between the two groups. The randomized clinical trial was conducted for 18 weeks from April to August 2009 at a long-term-care facility in rural North Mississippi. Twenty-two persons ranging in age from 54 to 100 years were approved by their physicians for participation in the trial. All of these persons participated and completed the trial. Eleven of the participants received their prescribed therapeutic diet and 11 participants received a liberalized diet for the length of the trial study. At the end of the study, there were no significant differences (p>0.05) in mean body weights and laboratory values between the two groups. However, there was a trend of weight loss in the therapeutic diet group (mean weight loss of 2% (1.4 kg) during the 18-week trial), and although it was not significant (p>0.05), this supports the growing belief of those who advocate liberalized geriatric diets to improve quality of life and prevent unintentional weight loss. Participants in the liberalized diet group did not experience weight loss and gained 0.5 kg by the end of the study.

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“…Evidence suggested that subjects who lost 15% or more of their maximum weight had over twice the mortality risk of those who lost less than 5% [11] and Locher et al indicated that unintentional weight loss was a greater mortality threat to older adults than was obesity or intentional weight loss [12]. Retrospective record review showed that elder people whose weight lost more than 5% within one month were 4.6 times more likely to die within 1 year [13]. After weight loss occurred, mortality could be as high as 16% during the first year [9].…”

Section: Introductionmentioning

confidence: 99%