Nursing Home Quality Improvement Initiative

Quality Measure Fact Sheet:
Percent of Chronic/Long Term Care Residents Who Lose Too Much Weight

Why residents may lose too much weight despite good care:
Long term care residents commonly have conditions associated with weight loss; these may include dementia/delirium, depression, chronic pain, constipation, medication side effects and interactions, chronic infections, end-stage major organ system disease, and terminal illness. Other conditions that may contribute to weight loss in the elderly include lack of ability to feed oneself, swallowing/chewing/digestive difficulties, upper-extremity impairments of mobility and coordination, and taste alterations. Hospitalizations are often associated with weight loss due to illness and poor intake.

Upon admission to the nursing home, an evaluation is done to identify swallowing and chewing difficulties. Swallowing problems are sometimes resolved by offering foods that are naturally of a pureed consistency, such as oatmeal, mashed potatoes and pudding. Chewing difficulties may be improved with dental treatment. Changing the menu to include individual food preferences, and altering the environment where the meals are served sometimes improves the intake of food. But sometimes the cause of the weight loss may not be due to inadequate food intake; some patients have malabsorption disorders and other may have increased metabolic needs due to medical conditions. Even with good nursing care including feeding assistance and treatment of medical conditions, some patients will continue to lose weight (for example, patients with terminal conditions or patients with swallowing difficulties whose advance directives prohibit the use of feeding tubes).

What conditions exclude a resident from this measure: (Risk adjustment)
Residents who have been recently admitted to the facility and patients who are receiving hospice care are omitted from this measure.

Questions you can ask the facility if they are rated high in this measure: How does the facility determine the cause of weight loss in patients? How flexible is the facility in tailoring meals and foods to individual preferences? Does the facility have a program to rapidly and correctly notice change in nutrition? How does the facility address issues that may affect the eating environment in the nursing facility? Do the health care providers ensure that decisions concerning tube feedings reflect the patient's preferences as far as they can be known, balanced by a realistic appraisal of the patient's progress?