Case Studies
Resident Care
Problem
Betty is an 82-year-old lady who lives in a nursing home. She used to be a very good eater, but in recent months her appetite has decreased. Secondary to this, her weight has decreased 5kg in the past 2 months. There seems to be no medical reason for her loss of appetite; the doctor equates it to the ageing process and referred her to the dietitian.
Process
On meeting Betty, she seemed bright, aware and happy to talk about her food, the meals and her appetite. She was well able to give a detailed account of what she used to eat and her likes and dislikes. Her intake of late has, however, been only very small amounts of odd meals, depending on whether she likes them. She reported to be put off by the large meals that the kitchen serves.
In making recommendations to Betty, she was encouraged to eat meals high in protein and high energy, in the distribution of small frequent meals. A list of foods that Betty likes and dislikes was noted. This was given to the kitchen so that they could provide alternatives to allow Betty to select an appealing and nourishing meal choice. The kitchen was also able to supply smaller and more frequent meals to her.
Betty was seen by the dietitian again after two weeks. She reported that she was eating a little more, as the meals were now more appealing to her. Her weight over this time had been stable, but it was still in the “underweight” category. Because of Betty’s weight still being low, Betty agreed to try and start drinking on sustagen twice a day, at morning and afternoon tea. These drinks were kept to small volumes of 150ml but were made with full cream milk and the full dose of sustagen to ensure Betty received the necessary nutrition and calories but that these extra drinks did not curb her appetite.
Results
Betty continued to be seen by the dietitian at regular intervals and started to slowly regain some weight. Once she was back into the healthy weight range for her height, her Sustagen intake was reduced to one each day. Fortunately this was enough to keep her weight stable. Betty reports to continue to enjoy her food and is finding eating pleasurable again.
Further benefits for the facility- During the process of requesting various foods for Betty and setting up small frequent meals for her the kitchen staff took on a lot of informal education / information form the dietitian regarding the nutrition needs for the residents. The kitchen staff then took the initiative to start providing other residents with nourishing small frequent meals.
Preparing for Accreditation
Problem/Issue
A small aged care facility in Melbourne had noted an increase in dietitian referrals for unintentional weight loss and was worried that they were failing to provide adequate nutrition and hydration to residents, a requirement of the Aged Care Standards. With accreditation only six months away the facility contacted Melbourne Dietetic Centre for assistance.
Process
Melbourne Dietetic Centre provided the facility with a dietitian, highly experienced in aged care to assess the situation. Upon entering the facility it was clear to the dietitian that there were numerous underlying causes of the high levels of weight loss, including: nutritionally inadequate menu and poor weight tracking systems.
To address the issues the dietitian conducted a comprehensive menu review and nutrition and hydration audit, looking in detail at all systems related to nutrition within the facility (including kitchen, clinical processes and policies). The individual residents that had been referred were also assessed and action plans formed to prevent further weight loss and optimize nutritional status.
Recommendations arising from the menu review and audit were then presented to key staff: facility manager, catering manager and clinical team, at a facility Nutrition & Hydration meeting where areas for improvement could be addressed.
Results