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Nutritional Management in Long-Term Care

Development of a Clinical Guideline

^a Division of Geriatric Medicine, Saint Louis University School of Medicine, Missouri
^b Programs in Medicine, Newton Square, Pennsylvania
^c Donald W. Reynolds Center on Aging, UAMS Medical Center, Little Rock, Arkansas

David R. Thomas, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Boulevard, M238, St. Louis, MO 63104 E-mail: thomasdr{at}slu.edu.

Decision Editor: Laurence Z. Rubenstein, MD, MPH

Background. Involuntary weight loss resulting from malnutrition is a major problem among residents in long-term care facilities. Although body weight is easily measured, the evaluation of unintended weight loss in long-term care facilities is difficult.

Methods. The Council for Nutritional Clinical Strategies in Long-Term Care, an expert panel of interdisciplinary thought leaders representing academia and the medical community, derived a structured approach aimed at improving management of malnutrition in long-term care settings, using literature review and consensus development. The Clinical Guide to Prevent and Manage Malnutrition in Long-Term Care is based on a best-evidence approach to the management of nutritional problems in long-term care.

Results. The Clinical Guide is divided into two parts, one designed for nursing staff, dietary staff, and dietitians, and a second directed to physicians, pharmacists, and dietitians.

Conclusions. A structured approach to the management of unintended weight loss or malnutrition in long-term care is intended to ensure a comprehensive resident evaluation. While the Clinical Guide is presented in a linear fashion, many of the considerations can be done simultaneously and the order varied dependent on the individual resident's needs. Further research to validate the effectiveness of using the algorithm in long-term care settings will be required.

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