Weight Loss Prevention
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FOR BEST RESULTS, INDIVIDUALIZE FEEDING ASSISTANCE
They said it couldn't be done, but findings from our most recent research suggest that nursing homes can improve feeding assistance and increase food and fluid intake among residents without hiring more workers. The key to success is using existing staff more efficiently and creatively. To do that, however, nursing home staff must first determine which of two possible feeding assistance interventions works best for residents who typically under-eat.
Over the years, we've worked in numerous nursing homes and not one of them, without considerable urging from us, has ever assessed nutritionally at-risk residents to determine whether in fact they would eat more if offered proper feeding assistance. Staff forego these assessments largely because they believe they're unnecessary: There's a strong assumption bordering on faith that more and better feeding assistance will inevitably prompt poor eaters to consume more. This belief is at the heart of the Bush Administration's recent rule change allowing part-time "feeding assistants" to help residents during busy mealtimes. The idea is that more workers equals more feeding assistance, which in turn equals greater food and fluid intake among residents who would otherwise under eat.
The problem with this equation is that it doesn't add up to success for a lot of residents at risk for undernutrition. Our studies show that not all residents respond equally well to mealtime feeding assistance; in fact, only about half of residents who typically under eat will increase their intake of food and fluids when offered adequate, high quality feeding assistance at mealtimes (1). Most "unresponsive" residents, however, will eat more when offered between-meal snacks (2).
These findings underscore the need to individualize feeding assistance in nursing homes; one size, it turns out, does not fit all. Failure to determine which intervention--mealtime or snack--works best for which resident can lead to costly staff inefficiencies and poor clinical outcomes for residents. Nurse aides waste time trying to feed residents who are unlikely to respond to their help. Meantime, these residents remain at risk for undernutrition and weight loss because they don't get the assistance and snacks between meals that they really need.
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