Weight Loss Prevention
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DETERMINE RESIDENT RESPONSIVENESS TO THE SNACK INTERVENTION
Follow these procedures to determine a resident's responsiveness to the snack intervention:
- Calculate the resident's average daily total calories consumed during the two-day trial (count all meals plus snacks).
- Compare this total to the resident's average daily intake as determined in the Step 1 assessment.
- Residents are considered responsive if they show at least a 15% gain in average daily calories or an increase of 300 or more calories a day (2).
Our nutrition software program can determine residents' responsiveness to the snack intervention if you enter each resident's food and fluid intake estimates for each condition: the Step 1 assessment and the two-day trial of snacks.
In effect, you are looking for a gain in total daily calories wherein mealtime intake remains approximately the same but the resident also consumes roughly 100 calories during each of three daily snack periods.
Responsive residents should continue to receive the snack intervention daily--ideally, three times per day but a minimum of twice per day.
Our research indicates that about 80% of the residents who receive the snack intervention will prove responsive to it (2).
Once you have determined who is responsive to either the mealtime intervention or the snack intervention you can re-deploy staff to achieve the maximum benefit for residents in the most time-efficient manner (see Step 3 or use our nutrition software to project staffing needs).
Residents who prove to be unresponsive to both interventions should receive a follow-up evaluation from their primary care physician and consultation with respective family members, if appropriate. For these residents, a two-day trial of mealtime feeding assistance and between-meal snacks provides the nursing home staff with important medical record documentation consistent with federal care practice guidelines that these interventions were attempted in an effort to prevent unintentional weight loss.
Double-Duty Assessments:
The two days of assessment for the mealtime and snack interventions are an opportune time to collect, with almost no extra effort, additional information required on the MDS and critical to improving nutritional care. For each resident assessed, consider recording this information:
- Symptoms of mood disturbance (e.g., repetitive health complaints, negative self-statements)
- Behavioral problems that interfere with eating or the provision of feeding assistance (e.g., agitation, resident refusal of food or staff assistance)
- Need for assistive devices during meals (large-handled utensils, plate guards)
- Evidence of swallowing or chewing difficulties, including problems with dentures
- Food preferences and complaints
Use the information you collect to further individualize feeding assistance for at-risk residents.
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