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A very weighty issue

Failing to thrive should not be considered a normal part of ageing, writes Karyn Matterson.

Although the term is viewed by some as rather dated, geriatric failure to thrive (GFTT) is a syndrome that is characterised by a loss of vitality in life, a process of functional decline, progressive apathy and a loss of willingness to eat and drink, eventually leading to death. GFTT should not be considered a normal part of ageing, a descriptor for dementia symptoms, nor a consequence of chronic disease or acute illness.

There are four areas that contribute to diagnosing the syndrome. They are impaired physical functioning, malnutrition, depression and cognitive impairment.

Screening of all of these areas is beneficial to preventing GFTT. As a healthcare community looking after the aged, we need to recognise the inter-relationships that these four areas have. Lack of attention to any or all of them will contribute to a diminished quality of life for our elderly.

Malnutrition is an independent predictor of mortality in the elderly. The high prevalence of malnutrition in acute care facilities and residential aged care facilities is well documented. Malnutrition affects the ability of the individual to recover from acute illness or accident and contributes additional costs to the community, specifically to the healthcare system.

There are different degrees of malnutrition, ranging from severe to mild. In the International Classification for Disease, 10th Revision (ICD-10), moderate to mild malnutrition in adults is characterised by a Body Mass Index (BMI) <18.5 kg/m2 or unintentional loss of weight (5 to 9 per cent) with evidence of suboptimal intake resulting in severe loss of subcutaneous fat and/or severe muscle wasting. A person may have protein-energy malnutrition (a deficit of total protein and energy that is required for maintaining optimal nutritional health) or they may have micronutrient malnutrition. Micronutrient malnutrition is a deficit of the essential vitamins and minerals that enable a person to function properly each day. For example, a deficit of vitamin D, calcium or vitamin B12 is quite common for the elderly in residential aged care in Australia. It is evident that the root cause of malnutrition is unintentional weight loss, and the answer to preventing malnutrition lies within identifying the risk of unintentional weight loss before it occurs. What is unintentional weight loss? Unintentional weight loss is, unfortunately, a common condition in the aged. It is measured by a clinically significant weight loss of at least 5 per cent of body weight within three months or 10 per cent in six months. Unintentional weight loss predicts the occurrence of malnutrition better than a BMI measurement or a weight taken at any single point in time. Regular weighing of residents is essential to ensure an accurate weight history is maintained in the facility and weight history can be assessed correctly. It ensures that any clinically significant weight loss is identified and an appropriate referral to an accredited practising dietitian (APD) follows. For new residents it is often difficult to accurately assess how much weight loss may or may not have occurred in the previous six months, or more. Documentation from GPs, hospitals or other healthcare providers can provide us with weights, but it is virtually impossible to look back on a new resident’s weight history with any degree of certainty. More so the case when we have non-communicative residents or residents that have had little or no family or friend support. It is often the case that dietitians are called in once weight loss has already occurred, or a resident is identified as losing their appetite. But dietitians can also implement clinical nutrition interventions that can be used as a preventive measure to guard against unintentional weight loss, and the subsequent malnutrition. So the challenge lies in identifying at-risk residents, prior to significant weight loss actually occurring. Improving nutrition care There are tools that can reliably alert you to the risk of unintentional weight loss, and one of these tools is the simplified nutritional assessment questionnaire (SNAQ). SNAQ is made up of four questions that take under two minutes to ask. This questionnaire will signal that the resident is at risk by targeting appetite as an independent predictor for this weight loss. These questions can easily be incorporated into any new admissions assessment or a survey throughout your facility can be done quite efficiently to identify those residents that might be at risk. The SNAQ tool can be performed by any of your care staff and the appropriate referral to an APD can follow. SNAQ assesses the risk of at least 5 per cent weight loss within six months. By assessing a persons risk of weight loss SNAQ can identify if a person will also be at risk of malnutrition. The World Health Organisation advocates protection of nutrition as a basic human right. As healthcare providers, we must be vigilant in guarding against malnutrition that sneaks up in our residents in the form of unintentional weight loss. Karyn Matterson is an accredited practising dietitian and accredited nutritionist. Article written on behalf of the Dietitian’s Association of Australia (DAA) Rehabilitation and Aged Care Interest Group. To find an APD in your local area go to www.daa.asn.au or call 1800 812 942.

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