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WEIGHT LOSS AND MORTALITY Powered By Docstoc                                                             06/17/2005 11:36 AM

 By: Hazel Dickinson RN BSN

 About the Author:
 Ms. Dickinson RN BSN is a graduate student at the University of Mobile in Alabama. She has worked in long term care for the past
 ten years and six of those years she served as the Assistant Director of Nursing at Twin Oaks Nursing in Mobile, Alabama.


 The purpose of the study was to explore the relationship between rapid unintentional weight loss and
 mortality in nursing home residents. The study consisted of 82% African American residents. Rapid
 unintentional weight loss was defined as two or more pounds (of body weight) every week for one month,
 five or more pounds (of body weight) or 10% (of body weight) in six months. A retrospective chart review
 was conducted by using resident discharge charts. Data analysis was performed using weight report tool,
 descriptive statistics, and T test.


 Weight loss is an important nutritional assessment parameter for elders in nursing homes (Matthews, 1989).
 The nutritional status of institutionalized adults significantly affects their quality of life (Silver & Morley,
 1988). Keller (1991) reported that as many as 45% of the elderly in long term care facilities are
 undernourished. The nutritional status of older adults is difficult to assess because marginal deficiencies of
 some nutrients mimic signs of the aging process (Holecroft, 1988)

 Any change in weight may signal illness. Unexplained weight loss is a danger signal of acute illness (Yen,
 1994 & Verdery, 1990). Weight gain may be a sign of congestive heart failure or kidney failure (Morrison
 & Edwards, 1991). Holdcroft (1988) found that involuntary weight loss occurs for a variety of reasons
 including cancer, sepsis, diabetes and chronic obstructive pulmonary disease (COPD). Anorexia is often
 documented in charts of residents in long term care facilities, and it has been speculated to be the result of
 decreased metabolic rate and decreased nutrients required for energy (Holt, 1991 & Sullivan & Walls,

 The rapidity of weight loss or gain is an important clue to the severity of the problem Indirect inferences
 and qualitative descriptions have limited value. Only a series of regular measurements will distinguish
 sudden dramatic change or a steady change from a change that occurred several months or years ago
 (Mansouri & Morton 1994). This study used rapid weight loss to determine if weight loss predicts mortality.

 Weight loss and gain are being used by providers as indicators of the quality of care provided in long term
 care facilities (Litchford, 1993). This study was designed to determine if a correlation existed between rapid
 weight loss and mortality, and to provide data to assist long term care workers in the early identification and
 intervention in weight change cases.


 The nature of weight loss and weight gain in a nursing home population of chronically ill elders has been
 studied in selected subpopulations (Chaing, Katz & Ambrose, 1990 & Fischer &Johnson, 1987). Diagnosis                                                                      Page 1 of 6                                            06/17/2005 11:36 AM

 of dementia or infection and weight loss were linked in a mortality study of senescence (Weinberg,
 Engingro, & Miller, 1989). One study found that residents with Alzheimer's disease weighed 21% less than
 nondemented residents and that residents with Alzheimer's disease weighed 14% less than residents with
 multiinfarction dementia (Singh & Mulley, 1987). Depression has also been associated with both weight loss
 and weight gain (Fischer & Johnson, 1987).


 The setting for this study was a 140 bed skilled long term care facility. 56 residents were studied through a
 retrospective records review. The records were reviewed for a twelve month period (March, 1995 through
 February, 1996). Each resident's weight record for a twelve month period was reviewed and a follow up
 review of subjects with weight loss up to six months after the last documented weight change was
 conducted. All records reviewed were confirmed to have used the same type of scales for weighing during
 the twelve months of the study. The residents selected had a minimum of one weighing each month.
 Residents identified as having a significant change were weighed every week until weight was regained or
 stabilized. The residents' significant change status were also brought to the attention of the care planning
 team so that immediate interventions could be initiated. Rapid unintentional weight loss was defined in this
 study as two pounds or more every week for one month, five pounds or more weight loss in one month or
 less, or ten percent or more loss in six months. A baseline weight was determined on all residents at the
 beginning of the study. The data were collected by the author and two certified nursing assistants and
 recorded on a weight monitoring sheet. The data were analyzed using the weight report tool (See Appendix
 1).                                                     Page 2 of 6                                              06/17/2005 11:36 AM


 There were fifty-six residents selected for this study. Thirty-nine (70%) experienced a significant weight
 loss. Twenty-three (59%) of the residents that experienced a significant weight loss died within one year.
 Seventeen (30%) of the residents did not experience a significant weight loss during the study. Two of the
 residents that did not experience a significant weight loss died during the study. Of the thirty-nine residents
 who did experience a significant weight loss, twenty-six (67%) did not respond to the facility's weight loss
 interventions, twenty-one (81%) of the twenty-six died within one year. Thirteen (33%) of the thirty-nine
 residents who experienced a significant weight loss were stabilized or regained weight as a result of the
 facility's interventions, two of these residents died within one year. Most of the weight loss residents died
 within 0-3 months of significant weight loss. ( See Table 1 for the percentages and the length of time.) The
 majority of the residents that died were between the ages of 85 and 94 (See Table 2).                                                       Page 3 of 6                                           06/17/2005 11:36 AM


 The design for this study, a retrospective chart review of weight loss/gain data recorded over a one year
 period had limitations. Although the procedures for weighing residents in the facility did not change, some
 of the weight variations might have been due to measurement techniques. This study demonstrated that
 weight loss of more than five pounds in one month is associated with a significant increase in mortality. The
 results suggest that weight loss is a strong predictor of mortality in long term care residents in nursing
 homes. Zone tail T test also indicated results were significant (P>.01).                                                    Page 4 of 6   06/17/2005 11:36 AM

 CONCLUSION:            Page 5 of 6                                                                  06/17/2005 11:36 AM

 There is a positive correlation between significant weight loss and mortality in nursing home residents. This
 study provides information that could be useful in identifying residents who require aggressive interventions
 to reverse the weight loss. However, the large number of residents who had appropriate interventions and
 still died might indicate that in some cases, interventions would be useless. Additional studies need to be
 conducted on the type of interventions used to correct weight loss and their effectiveness.


 Chang, J.L., Katx, P.R. & Ambrose, P. (1990). Weight loss in nursing home patients: Prognostic implications. Journal of family
 Practice 30 (6). 671-674.

 Fischer, J. & Johnson, M.A. (1987). Low body weight and weight loss in the aged. Journal of the American Dietetic Association 90.

 Holdcroft, C. (1988). Evaluating weight loss in older adults. Nurse Practitioner 13, 599-605.

 Holt, P.S. (1991). Anorexia in the elderly. Geriatric Nursing Today, 10, 34-43.

 Keller, H.H. (1991). Malnutrition in institutionalized elderly: How and why. Journal of the American Geriatric Society, 41. 1212-

 Litchford, M.D. (March, 1993). Respecting nutrition-ulcer link crucial in treatment. Provider, 63-64.

 Mansouri, A. & Marton, K.I. (March 30, 1994). Pinpointing the cause of unexplained weight loss Patient Care, 28 (6). 43-59.

 Matthews, L.E. (1989). Monitoring weight changes in nursing home residents. Journal of Nutrition in the Elderly, 9, 67-72.

 Morrison, W.L, & Edwards, R.H. (1991). Cardiac cachexia. Boston Medical Journal, 302, 301-304.

 Silver, A.J. & Morley, J.E. (1988). Nutritional status in a geriatric nursing home. Journal of the American Geriatric Society, 36, 487-

 Singh, Ss. & Mulley, G.P. (1988). Why are Alzheimer's patients thin? Age and Aging, 17, 21-28.

 Sullivan, D.H. & Walls, R.C. (1991). Protein-energy undernutrition and the risk of mortality within 1 year of hospital discharge in a
 selected population of geriatric rehabilitation patients. American Journal of Clinical Nutrition, 53, 599-605.

 Verdery, R.B. (19990) "Wasting away" of the old: Can it--and should it--be treated? Geriatrics, 46 (6), 26-31.

 Weinberg, A.D. Engingro, P.F. & Miller, L.L. (1989). Death in the nursing home: Senescence, infection and other causes. Journal of
 Gerontological Nursing 15 (4), 12-16.

 Yen, P.K. (1994). Weight and body shape. Geriatric Nursing, 50-52.                                                                            Page 6 of 6

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