Weight Loss Prevention
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MEALTIME INTEVENTION PROTOCOL
A mealtime feeding assistance trial can be accomplished in two days (six meals), and any resident who eats less than 75% of most meals (see Step 1: Resident Assessment) should undergo this further assessment.
As a practical matter, the two-day feeding assistance trial should be conducted with groups of three residents. Our research shows that most residents who increase their intake in response to one-on-one feeding assistance maintain that increase when the help is provided to small groups of three (1). All residents should be medically stable at the time of assessment.
A nurse or nurse aide should provide continuous feeding assistance to the group for a total of six meals, preferably breakfast, lunch, and dinner, on two days within the same week. Be forewarned: This critical assessment step requires considerable staff time to complete. Plan on spending about 45 minutes per meal to assess a group of three residents and another 10-12 minutes per resident if a snack-intervention assessment is required. But take heart: These are one-time assessments for most residents. Finish them and your staff can move on.
Staff should follow procedures in our Mealtime Feeding Assistance Protocol to conduct the two-day trial. Briefly, the intervention protocol calls for the following:
- The staff person should casually converse or otherwise socially interact with the residents throughout the meal.
- Residents should be properly positioned to eat; that is, they should be sitting upright.
- Residents should have their dentures, glasses, and hearing aides, if needed.
- Resident requests for substitute food and fluid items should be honored (and substitutes should be offered by staff if a resident doesn't seem to like the served meal).
- If a resident entirely consumes a particular food or beverage, offer a second helping, even if the food is a dessert. Most experts agree that the primary goal here is to increase caloric intake for residents at risk of weight loss. It is helpful to coordinate the availability of substitutions and second helpings with the kitchen staff such that these items (e.g., sandwiches, fruit plates, desserts) are available on the unit and do not require the staff member who is providing feeding assistance to make a trip to the kitchen.
- Residents should have access to their trays for up to 1 hour per meal (the average is about 45 minutes and the absolute minimum is 30 minutes). Feeding assistance ends when each resident has refused all food and fluid items on his or her tray multiple times.
- An oral nutritional supplement should be offered at the end of the meal only to those residents who refused all other food and fluid items on their tray, consumed less than 75% of their meal, or requested a supplement.
- The nurse or nurse aide should follow our graduated prompting protocol (see our Mealtime Feeding Assistance Protocol) to encourage residents to feed themselves. This standardized procedure instructs staff members to try nonverbal and verbal prompts to encourage residents to eat before offering physical guidance or assistance.
Taken together, these intervention components enhance independence, support individual preferences, and characterize optimal feeding assistance quality, according to multiple experts (5-9).
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