As nursing home residents and staff get vaccinated, it’s clear we still won’t be returning to crowded dining halls and ice cream parties anytime soon. But milkshakes, sundaes, bananas, soft pretzels and other snacks will be more than fun treats; they may be lifesaving.
Being immobile and isolated for months isn’t conducive to healthy nutrition. Particularly in long-term care settings, socializing is a big part of meals. Deprived of that, many residents may have been eating less. At the same time, fewer visits and busier staff mean that any weight loss and poor eating habits may not be recognized right away.
Add other factors such as oral health issues and medications that interfere with appetite, digestion and nutrition, and this patient population is at great risk for malnutrition.
For residents who have had COVID-19, there may be an additional challenge. According to a new study, these individuals may lose their sense of smell and taste for several months after they recover. This can keep them from eating or drinking enough.
Whatever the cause for malnutrition, these residents are more likely to have a weakened immune system (which increases the risk of infections), poor wound healing, a higher risk of hospitalization and an increased risk of frailty or even death.
Malnutrition also causes muscle weakness and decreased bone mass, which can lead residents to experience a harmful fall. In fact, in one study, malnourished patients were almost 8 times more likely to have an injurious fall than those their non-malnourished counterparts, regardless of age and/or body mass index. This is of particular concern as residents get more active with pandemic restrictions easing.
Like everything else we’ve done during the pandemic, we need a team approach to keep residents nourished and maintain healthy weights:
- We all scream for ice cream. Yes, ice cream played a major part in surviving COVID-19 in this population. As COVID-19 dramatically increases the development of anosmia and ageusia (loss of sense of smell and taste) in residents who already have sensory loss associated with dementia, ice cream is something they still will be attracted to eating due to its temperature, texture and sweetness. These senses tend to be preserved during COVID-19 infection and in those with dementia, hence their interest in eating it. Ultimately, getting calories into these patients has been demonstrated to make a drastic difference in survival and long-term outcomes.
- Get all hands on deck for feeding residents. Administrators, human resources staff, therapists, nurses and others can be engaged in helping to feed residents at mealtimes. Consider the use of assistive devices that may make it easier for residents with physical disabilities to feed themselves. For instance, Meal Lifter, is an aide that makes dining easier for those challenged with feeding themselves. Specifically, it is designed to enable people to eat better by increasing the visibility of the dinner plate and reducing the arm and hand movement required to self-feed.
- Remind staff to offer drinks. Everyone from frontline workers to housekeeping and maintenance staff should offer residents something to drink whenever they go into someone’s room. Encourage them to report to a nurse or other practitioner if they notice that someone isn’t eating or drinking.
- Make sure foods are well-seasoned for taste, but not with salt. Nonetheless, if residents want a salty food, such as potato chips, let them have it (in moderation). Most experts do not recommend dietary restrictions for nursing home residents, particularly when they are underweight, losing weight or at risk for malnutrition. This includes letting diabetic residents have a cookie or ice cream.
- Make eating fun. During the pandemic, some facilities have had staff dressed in costumes deliver classic take-out foods such as burgers, fries, milkshakes and pizza. Others have had days with special themes such as a “trip to Italy” with pastas and other Italian foods, music and decorations. Movie nights with films shown outdoors where residents can watch from their windows or patios can be augmented with popcorn and other movie snacks delivered to their rooms.
- Involve families. Even where visitation is still limited, engage family members to find out what foods might be most appealing to their loved one. Encourage them to bring meals, treats or desserts to the facility (even if they can’t eat with their family members because of restrictions).
- Make sure everyone knows to watch for signs of malnutrition. Those include a lack of interest in food or drink, tiredness and irritability, inability to concentrate, always feeling cold, depression, loss of fat/muscle mass/body tissue, longer healing times for wounds and/or complications after surgery.
Assessing frailty is key to identifying those individuals who may be at greatest risk for weight loss, malnutrition and falls. As facilities open up, make sure these residents have access to nutritional supplements, assistive devices and physical therapy that can help keep them safe as life gets back to a semblance of normal.
March is National Nutrition Month, so this is the perfect opportunity to promote the importance of maintaining healthy weights and nutritional status. And don’t forget the power of ice cream!
Steven Buslovich, M.D., is a New York-based geriatrician and co-founder/CEO of Patient Pattern, which develops software and other tech tools to bridge the gap between complex healthcare and technology.