Altered Nutritional Status in the Long-Term Care Setting
American Medical Directors Association. (2011).
Columbia (MD): American Medical Directors Association, 36.
This guideline provides recommendations for management of nutritional status in nursing home residents who are at risk for weight change, including individuals with dementia. The target audience of this guideline is "members of the interdisciplinary team in long-term care facilities-the administrator, medical director, director of nursing, attending physician, nursing staff, certified nursing assistant, consultant pharmacist, and other professionals such as various therapists, social workers and dietitians who care for long-term care patients" (p. ii). The guideline recommendations were developed using a consensus-based process based on expert opinion and relevant scientific literature.
American Medical Directors Association
A skilled practitioner (e.g., speech pathologist, physician, registered nurse) should perform a bedside clinical evaluation to determine if the patient in a lon-term care setting has dysphagia.
Within three to five days of admission to a long term care setting, a staff member should observe the patient eating and note any difficulty swallowing foods or liquids.
Intervention to improve intake may involve altering the eating environment, tailoring meals and foods to the individual's preferences, reconsidering dietary restrictions, supplements, appetite stimulants, and tube feeding. The effectiveness of any implemented intervention in long term settings should be monitored.
A fluoroscopic or fiberoptic study in a long-term care setting may be ordered if appropriate and agreed upon by the interdisciplinary team, patient, and family.
For patients in long term care settings whose food intake is inadequate, screen for functional impairments, social and environmental factors, dietary restrictions and food preferences, and medical conditions associated with anorexia or dehydration.
Patients in long term care settings should be monitored regularly for changes in weight or food intake.
