Malnutrition is highly prevalent among cancer patients today, and is one of the leading causes of readmission for long-term care residents. But, studies show that better nourished residents have improved prognoses and better outcomes. With the proper diagnosis of malnutrition, clinical decisions can be steered toward using personalized nutritional intervention.
Outlined below are the signs and symptoms of malnutrition to look out for, as well as some helpful ways long-term care staff members can further personalize patient care to optimize the nutrition of their residents.
Malnutrition and readmission rates
HemOnc Today named malnutrition an “epidemic,” affecting up to 80% of cancer patients.
The Healthcare Cost and Utilization Project states that malnourished patients have over 50% higher rates of readmission within 30 days compared to those more well-nourished patients. Malnutrition prior to cancer treatment means an increased risk of complications and unintended weight loss, resulting in treatment breaks and dose reductions, both of which affect outcomes.
Lower body mass prior to treatment increases rates of toxicity during treatment which leads to readmission, higher costs and perpetually worsening complications for the residents and their families. The most effective way of reducing readmission rates due to malnutrition is to focus on personalized nutrition support for long-term care residents.
The Academy of Nutrition and Dietetics defines malnutrition as a “physical state of unbalanced nutrition,” with the greatest risk being placed on head and neck, pancreatic, lung, and gastroesophageal cancer patients. Symptoms commonly coinciding with malnourished long-term care residents undergoing cancer treatment are taste and smell changes, loss of appetite, dysphagia, nausea and diarrhea, fatigue, depression and mouth sores.
With or without symptoms, long-term care staff should use the following guidelines to screen residents for malnutrition. Two or more of the following are needed for a formal diagnosis of malnutrition:
- Unintentional significant weight loss of 5%
- Intake of less than 75% of nutrient needs for the last month
- Mild muscle loss based on a nutrition focused physical exam
- Mild fat loss based on a nutrition focused physical exam
Personalized care can translate directly to better treatment outcomes, ultimately lowering readmission rates. Understanding the resident’s needs is key to solving some of the emotional and physical challenges they face, especially as they pertain to food and nutrition.
Strategies for preventing malnutrition
Long-term-care staff can personalize the long-term care resident’s nutrition care by considering the following tactics to help prevent malnutrition:
- Involve the Registered Dietitian. Registered Dietitians are the nutrition professionals and including them in multidisciplinary care decisions is important. The dietary department will understand and accommodate specific food needs, both clinically and culturally and tailor recommendations specific to the individual.
- Help the resident manage side effects of treatment. Nutrition-related side effects of cancer treatment will impact what the resident can and will eat, as well as the desire to eat. Understand their side effects, work with the staff dietitian, adapt food offerings to the patient’s needs, and provide ongoing encouragement to maintain adequate oral intake. Frequent mealtimes and snack offerings may also help manage decreased appetite and promote improved oral intake.
- Ensure that the resident is able to meet their nutritional needs. Providing adequate calories and protein, including oral nutrition supplements, and encouraging all staff to monitor intake both for malnourished residents as well as those at nutritional risk, are important steps in the care process.
- Bring the comforts of home to the hospital. The first step is to converse with the resident and their family members to find out what ‘home’ means to them. It is normal for residents to have emotional attachments to food, so meet them where they are. Have the dietitians speak to them about their favorite ‘comfort’ foods, and make small adjustments depending on their side effects and treatment regimen to provide these comforts. Creating a more positive and enjoyable mealtime environment can help improve appetite and nutritional intake.
- Actively listen to the resident. Active or reflective listening during family care meetings will build mutual trust. Trust leads to respect, and can translate to better nutrition and more knowledge of personal preferences which can help both the registered dietitian and the long-term care staff members.
- Monitor weight. If the resident has plans for treatment, make sure to proactively address the importance of nutrition before, during and after cancer treatment. A proactive approach can help reduce complications, prevent weight loss and manage side effects.
- Consider creating portable malnutrition reference cards for the staff. The cards will list off the diagnosis parameters for chronic and acute malnutrition, and can help in the screening process as well as enhance continued monitoring and evaluation strategies.
Providing a proactive and personalized approach to nutrition is the best way to care for long-term care residents. This strategy will translate to reduced readmission rates and save the healthcare system and the resident significant time and cost. Long-term care staff have extensive involvement in successful care strategies, and have the most control in implementing them. Successful prevention of malnutrition means recognizing and diagnosing common symptoms as early as possible and following through with early and ongoing nutritional intervention. Finally, it is important to personalize the meal delivery process to promote optimal nourishment during vital times of care for vulnerable patients. Optimizing nutrition in a personal way can help to prevent readmission, enhance quality of care, and most importantly, improve quality of life.
Jessica A. Iannotta is a registered dietitian and certified specialist in oncology nutrition and the COO of Savor Health. Susan Bratton, a former Wall Street banker, is the CEO and Founder of Savor Health.