It’s time to change how we manage unintentional weight loss in senior communities.
This year, use of prescription appetite stimulants or high calorie supplements for older adults made the top 10 list of healthcare “don’ts” for the elderly. In the second half of their Choosing Wisely® recommendations, the American Geriatrics Society said:
“Avoid using prescription appetite stimulants or high-calorie supplements for treatment of anorexia or cachexia in older adults; instead, optimize social supports, provide feeding assistance and clarify patient goals and expectations.”
According to the recommendations, high-calorie supplements can increase weight, but “there is no evidence that they affect other important clinical outcomes, such as quality of life, mood, functional status or survival.” Prescription drugs show similar dismal results when used only to promote weight gain. 
Although rates vary depending on the study you read, unexpected weight loss in adults over 65 is a significant problem, especially for people who are already sick or frail. Elderly people who lose weight unintentionally are at higher risk for disease, depression, and death. To make matters more complicated, depression, especially in residents of long-term care facilities, and disease are the leading causes of involuntary weight loss. A multi-disciplinary approach with doctors, dietitians, nurses, and pharmacists working together to manage unintended weight loss, has been the recommendation for many years. 
Now, additional critical components of preventing unwanted weight loss are gaining recognition, as evidenced by the wording of these new recommendations:
- Improving social support
- Providing appropriate assistance
- Honoring the choices and expectations of the person receiving care
In other words, we need to balance our traditional, clinical focus, with a more holistic approach.
Resident-Centered Weight Loss Management
Meeting the American Geriatrics Society recommendations—as well as the new industry, regulatory, and resident expectations—requires de-institutionalizing food service and empowering residents like never before:
Make Breakfast, Lunch, and Dinner Bonding Experiences
Mealtime has never been simply about the food. In our own homes, and in senior communities, people come to the table to nourish their hearts and minds as well as their bodies. One of the primary reasons residents look forward to meals is because they want to get out of their rooms and socialize. If they eat in an environment that fosters interaction and community bonding, they naturally stay at the table longer, eat more, and anticipate the next meal with pleasure. Train dining servers to welcome and introduce diners, spark conversation, and create a hospitable ambiance in the dining room.
As physical and cognitive function declines, adaptive tools or assistance may be required, but we need to be respectful about how we help. Too often, staff members barely look at or speak to residents they are spoon feeding; residents are subjected to embarrassing, infantilizing treatment; and unnecessary interventions are implemented that are more about making things easy for employees than helping residents. On the other hand, sometimes declining function isn’t noticed and residents are left to struggle when help is needed. Look for ways to help residents feed themselves whenever possible, but if hands-on help is necessary, teach staff how to assist discreetly and respectfully while also providing social support. Avoid missing signs of a resident needing help by encouraging staff to interact with residents as often as possible, getting to know them as individuals, and communicating even subtle changes to the right staff person, such as an RD, DTR, CDM.
Provide and Respect Resident Choices
For many residents, deciding what they will and will not eat is one of the last independent decisions they have left. After decades of calling their own shots as competent, respected adults, they are often not happy to find their options curtailed after moving to a senior community. I don’t blame them. Food choices are very personal. Nobody wants to be told when and what and where to eat; having a say in what we ingest is basic to maintaining our dignity. Find ways to offer choice, even if the best you can do is a few modest alternatives, and ensure all staff understand why and how to honor resident choices appropriately.
Although it will take some time to develop a truly resident-centered dining program, you may start seeing positive changes in weight management outcomes faster than you expected. When mealtimes are happy, social occasions, residents eat better because they want to, which naturally reduces unexpected weight loss.
Originally published in July 2014 Kind Dining® Connection. If you would like informational articles like this one delivered to your inbox–for free–subscribe today.
 ABIM Foundation. Choosing Wisely® Website. http://www.choosingwisely.org/doctor-patient-lists/american-geriatrics-society/. Accessed June 4, 2014.
 Huffman, G.B. (2002). Evaluating and Treating Unintentional Weight Loss in the Elderly. American Family Physician, 15:65(4), 640-651.