Clinical Practice Guideline (CPG): Altered Nutritional Status (ANS)
Weight has emerged as a principal screening and monitoring indicator in long term care (LTC) because it is easy to measure and the measurement is reasonably accurate and reproducible, noninvasive, acceptable to most patients, and relatively inexpensive to obtain. Change in weight is common among patients of LTC facilities. Among patients who remain in LTC for at least 2 years, 50 to 60% experience weight change; equal numbers of patients gain and lose weight.
Unplanned weight change that occurs quickly or continues to occur over an identified period of time may have negative clinical implications; the degree of concern warranted usually is proportional to the rate and degree of change. Weight may change in either direction, but the implications of weight loss are markedly different from those of weight gain. Among LTC patients, unintended weight may be a significant clinical indicator of worsening health status, but not necessarily remediable.
This CPG has been developed to help interdisciplinary teams evaluate and manage nursing home patients who are at risk for or who have experienced a significant change in weight. The guideline offers a structured approach to the recognition, assessment, treatment, and monitoring of ANS that acknowledges the ethical implications of this condition for patients, their families, and the staff of LTC facilities. It is hoped that this guideline will also be helpful to those who develop and determine institutional policies and procedures and the survey processes at the federal and the state levels.
This guideline recognizes that failure to identify or to correct a remediable cause of weight loss can have profound implications for the patient’s prognosis and the facility’s regulatory and legal liability. Therefore, it is essential to clearly define unavoidable clinical decline and include palliative and end-of-life care as part of the facility’s spectrum of clinical responsibilities.
For additional information, visit the Clinical Corner on Nutrition & Hydration.
Product Code: CPG14R
Member Price: $15
Non-member Price: $35
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