Is Weight Loss in the Nursing Home a Reversible Problem?

Abstract

Weight loss in the nursing home is a common problem and is the resultant symptom of complex interactions of multiple disease states and medication reactions, but it can be the instrumental symptom in a downward spiral leading to increasing morbidity and death. 1 For this reason, weight loss requires immediate assessment, and its multifactorial nature can make the causes difficult to tease out and difficult to treat. A concerted effort by a multidisciplinary team to investigate the etiology of unintentional weight loss and to develop a plan to deter further weight loss is essential. The minimum data set (MDS), a Centers for Medicare and Medicaid Services mandated resident assessment instrument for the nursing home, defines unintentional weight loss as a 5% loss in actual body weight in 30 days or a 10% loss in 180 days. 2 One early study 3 in an academic nursing home at a Veterans Administration (VA) medical center found that 60% of 130 patients surveyed had lost weight from admission to time of survey (at least 6 months) and 43% had lost weight during the initial month of institutionalization. Additionally, 70% of nursing home residents lost more than 10 pounds, nearly 40% had lost over 20 pounds, and 4% had lost over 40 pounds at some point during their nursing home stay. In a large crosssectional study of factors associated with low body mass index and weight loss in 6832 nursing home residents using information collected from the MDS, Blaum et al 2 found that weight loss, as defined by MDS criteria, occurred in 9.9% of the sample. Weight loss may result in adverse health outcomes in nursing home residents, including increased mortality. Wallace et al 4 noted that an annual weight loss of greater than 4% of body weight was associated with a higher mortality rate over a 2-year follow-up period in community-dwelling male veterans older than 65 years. In a retrospective record review, 5 subjects with weight loss of more than 5% of body weight in 1 month were 4.6 times more likely to die within 1 year. Murden and Ainslie 6 reported that residents in an intermediate-care nursing facility who had a weight loss of 10% of body weight over 6 months had an odds ratio for death in the next 6 months of 14.7. Weight loss of more than 10% over the 3-year study period was also associated with functional decline in another retrospective study. 7