Contents
Introduction
3
Required knowledge and skills
4
Section One: Knowledge and skills for all nurses
and care staff
6
Section Two: Knowledge and skills for registered
and enrolled nurses
12
Section Three: Quiz
18
Introduction
The weight loss framework consists of the following components:
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guidelines;
flowchart;
pamphlet;
food & fluid intake form;
weight loss & BMI chart;
supporting information.
Listed below are the knowledge and skills you should expect your nurses and care staff
to have to enable them to provide effective care for residents with advanced dementia
at risk of weight loss, and suggestions for training if an individual is not competent to
provide care.
Timely assessment and management of symptoms is a major component of a palliative
approach to dementia care. All nurses and care staff have a responsibility to ensure
they are able to assess and manage weight loss problems experienced by residents,
within their scope of practice.
This manual is to be used in conjunction with the ‘Weight loss decision-making
framework for nurses and care staff caring for people with advanced dementia’,
‘Guidelines’ and ‘Supporting Information’.
It is recommended that training be offered regularly, so that all nurses and care staff
are able to master the required knowledge and skills within three months of
commencing employment in the facility.
Palliative Care Australia resources
Palliative Care Australia have developed a number of resources to assist with training
in a palliative approach to care. Use the resources (available from
www.pallcare.org.au) to supplement this training package.
We recommend that as many staff as possible complete the two competency-based
modules in a palliative approach to care:
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CHCPA01A: Deliver care services using a palliative approach;
CHCPA02A: Plan for and provide care services using a palliative approach.
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Page 3 of 22
Required knowledge and skills
All nurses and care staff
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have a basic understanding of the physiological changes that occur due to ageing
that can affect appetite and eating;
have a basic understanding of the causes of weight loss among older people,
including depression, pain, dysphagia and using therapeutic diets;
have a basic understanding of what a BMI measurement is;
know some of the causes of undernutrition and the adverse effects on an
undernourished person;
understand what the common causes of undernutrition among residents in aged
care facilities are;
have a basic understanding of the weight loss that occurs throughout the dementia
trajectory, and the effects of the weight loss on mortality and morbidity;
have a basic understanding of the reversible causes of weight loss among residents;
understand that weight loss due to metabolic disturbance (cachexia) in advanced
disease is irreversible despite excellent care;
know that aversive feeding behaviours commonly occur in residents in the final
stages of dementia, and be able to complete an EdFED-Q scale for aversive feeding
behaviour;
know the signs and symptoms associated with dysphagia, and how and to whom to
report swallowing problems;
understand that aspiration of food & fluids commonly occurs during the final
stages of dementia;
know the correct procedures for feeding a resident, and be able to accurately
complete a food intake chart;
know how much fluid a resident needs to drink each day to prevent dehydration,
and be able to accurately complete a fluid intake chart;
understand the benefits and burdens associated with using dietary supplements for
residents;
know how to weigh a resident and accurately record the weight, and how to
estimate the BMI from a table and accurately record the BMI;
have sufficient knowledge to be able to identify when environmental and social
factors are limiting the food consumed by a resident, and be able to participate in
discussions related to resolving the issues.
Enrolled nurses and registered nurses
* NB a care staff member (eg Assistant in Nursing) may have sufficient knowledge and
skills to undertake some of the tasks associated with weight loss assessment and
management within this section.
All of the above knowledge and skills, and:
• be competent in completing a history of eating, swallowing and weight loss; and
develop a nutrition care plan based on the resident’s history, cultural needs and
preferences;
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Page 4 of 22
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understand the consequences of undernutrition, describe what a healthy BMI is
for an older person, and why a low BMI is dangerous; and complete a Mini
Nutritional Assessment form;
have sufficient clinical reasoning skills to be able to calculate the height of a
resident who is unable to stand;
be able to calculate the BMI of a resident;
state the 4 criteria for weight loss that when found should trigger further
assessment of the causes of weight loss;
know the side effects of medications that might affect oral intake;
understand the uses of therapeutic diets and the benefits and burdens to
resident’s with advanced dementia;
have sufficient clinical reasoning skills to know when an assessment for
possible dehydration is needed;
know the reversible causes of weight loss due to medical conditions, and have
sufficient clinical reasoning skills to implement initial assessment for the
conditions before seeking advice from the general practitioner;
understand that cachexia is an irreversible cause of weight loss in residents with
advanced disease; and have sufficient knowledge and skills to be able to discuss
cachexia with general practitioners, family members and care staff, and direct
the care of a resident with cachexia;
know the signs and symptoms of dysphagia, and be able to direct care staff to
observe for and report the symptoms;
have sufficient clinical reasoning skills to know when an assessment for
dysphagia is needed, and be able to either assess, or refer to a speech
pathologist, according to the facility policy;
know the benefits and burdens of medical interventions to provide nutrition in
end stage dementia;
have sufficient knowledge and skills to be able to discuss tube feeding a resident
with the family members;
know the basic interventions that can be implemented to potentially increase
the weight of a resident;
be able to collaborate with the general practitioner, speech pathologist, dietitian
and/or dentist to address issues related to eating and weight loss;
understand the role of the nurse in family conferences and be able to participate
in a multidisciplinary family conference for a resident receiving a palliative
approach to care, including determining the goals of care for the resident.
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Page 5 of 22
SECTION ONE: KNOWLEDGE and SKILLS
All Nurses and Care Staff
The basic knowledge and skills required to enable all nurses and care staff to understand the assessment and management of weight
loss in residents with advanced dementia are listed below. A video ‘Alzheimer’s Disease: Natural Feeding Techniques’ 1 is useful to
show to all staff as part of inservice education regarding feeding and weight loss.
Organise inservice education as required. Suggested topics are listed below. Ensure all registered and enrolled nurses are aware of
the correct reporting and recording requirements for weight monitoring within the facility, so they can adequately supervise the work
of the care staff.
Can every nurse and care staff member:
Name up to 5 physiological changes due to ageing
that affect appetite and eating?
Yes
Name up to 5 common causes of unintentional
weight loss in older people?
Say what a BMI measurement is, and why a low BMI
is a cause for concern?
Name up to 5 causes of undernutrition in older
people, and say what the effects of undernutrition on
an older person are?
No
If no, then:
Refer to pages 6-7 of the ‘Supporting Information’. Conduct a
short inservice education session if required. Stress that
changes to appetite, senses, gastric motility and oral health
can impact on appetite and eating in older people.
Refer to pages 8- 18 of the ‘Supporting Information’. Conduct
a short inservice education session if required. Stress that
many medications; co-morbid conditions, pain, and even
using therapeutic diets can cause unintentional weight loss in
older people.
Refer to pages 6 & 10 of the ‘Supporting Information’. Conduct
a short inservice education session if required. Emphasise that
as the BMI drops, the likelihood of the death of a resident
rises.
Refer to pages 11-12 of the ‘Supporting Information’. Conduct
a short inservice education session if required. Stress that
multiple factors that affect the emotional, biological and social
1
Alzheimer’s Disease: Natural Feeding Techniques was produced by the US Department of Veterans Affairs. To order, visit the Training Health & Educational Media Pty Ltd
website: http://www.themedia.com.au
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Page 6 of 22
Can every nurse and care staff member:
Yes
Name 5 causes of undernutrition among residents in
aged care facilities.
Discuss weight loss associated with dementia?
Name 4 conditions that are reversible that are known
to cause weight loss among residents?
Understand what the term cachexia means, and what
care a resident with cachexia requires?
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No
If no, then:
domains, as well as medical conditions, can all cause
undernutrition in an older person. The effects can include
slower healing of wounds, less cognitive ability and death.
Refer to pages 12-14 of the ‘Supporting Information’. Conduct
a short inservice education session if required. Emphasise that
not identifying swallowing problems and treating them; not
identifying and treating oral health problems; using pureed
food; not correctly positioning residents; and not providing
food that the person likes all contribute to undernutrition and
weight loss among residents.
Refer to pages 21-22 of the ‘Supporting Information’. Conduct
a short inservice education session if required. Emphasise that
weight loss occurs throughout the dementia trajectory, and the
causes are unclear, but having a diagnosis of dementia makes
every resident at high risk of weight loss, and these residents
require careful monitoring.
Refer to page 32 of the ‘Supporting Information’, and pages
18-19 of the ‘Guidelines’. Conduct a short inservice education
session if required. Stress that eating will be affected by pain,
constipation, infections and depression, and these can be
treated so that the resident eats more and maintains weight.
Also making sure the resident drinks enough will assist with
keeping weight stable.
Refer to pages 19-20 of the ‘Supporting Information’; pages
28-29 of the ‘Guidelines’; and the pamphlet ‘Weight loss in
advanced dementia’. Conduct a short inservice education
session if required. Stress that residents with cachexia no
longer need to have their weight monitored; they do not feel
hungry; that care staff should continue to offer food & fluids of
any type that the resident enjoys and can safely swallow,
without forcing the resident to eat, or worrying about the
nutritional balance of the diet. Feeding in this way will
Page 7 of 22
Can every nurse and care staff member:
Yes
Describe 3 aversive feeding behaviours that are seen
in advanced dementia?
Demonstrate that they can complete an EdFED-Q
scale of aversive feeding behaviours?
List 5-7 signs and symptoms that may indicate a
swallowing disorder?
Know to whom and how to report signs and
symptoms associated with swallowing disorders?
Describe in his/her own words the consequences to a
resident of aspirating food and fluids.
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No
If no, then:
continue until a family conference results in a decision to stop
all feeding, or until the resident becomes comatose.
Refer to pages 23-24, & 36-37 of the ‘Supporting Information’,
and page 37 of the ‘Guidelines’. Conduct a short inservice
education session if required. Emphasise that aversive feeding
behaviours are cumulative, and once a resident is displaying a
behaviour on the EdFED-Q scale, he or she will also display all
the behaviours before it (eg if displaying no 6, will also be
displaying no’s 1-5). This scale can be used to assess feeding
problems and track changes in feeding, and will be useful
when discussing feeding problems with family members and
the general practitioner. Have the staff members complete an
EdFED-Q scale on one resident, and verify its accuracy.
Refer to pages 24, 25 & 39 of the ‘Supporting Information’,
and page 33 of the ‘Guidelines’. Conduct a short inservice
education session if required. Emphasise that residents with
swallowing disorders are at risk of aspiration and repeated
chest infections and death; that swallowing disorders generally
occur late in the dementia trajectory; and that referral to a
speech pathologist is required to determine the best feeding
position for the resident, and consistency of food and fluids.
Refer to pages 24-27 & 39-42 of the ‘Supporting Information’.
Conduct a short inservice education session if required.
Emphasise that aspiration may be ‘silent’ and that staff feeding
residents must be vigilant for signs of aspiration such as
coughing or moist-sounding breath. Discuss with the nurses
and care staff that in some residents aspiration is unavoidable,
and that in these cases a family conference to consider
whether to keep feeding, and whether to transfer the resident
to hospital for intravenous antibiotics, is necessary. Further
emphasise that if feeding is discontinued, then the resident’s
goals of care are end of life (terminal) care and that mouth
Page 8 of 22
Can every nurse and care staff member:
Yes
Describe in his/her own words the correct
procedures for feeding a resident with advanced
dementia and feeding problems;
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Demonstrate the correct procedures for feeding a
resident with advanced dementia and feeding
problems?
Accurately complete a food intake chart?
Accurately complete a fluid intake chart?
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No
If no, then:
care should be attended very regularly.
Conduct a short inservice education session if required, based
on pages 34-40 of the ‘Supporting Information’. Show the
video ‘Alzheimer’s Disease: Natural Feeding Techniques’ if
available. Stress to the nurses and care staff that they need to
make sure the resident is comfortable, correctly positioned,
has his/her dentures, spectacles and hearing aide in place, and
that the care staff member sits facing the resident, within eye
contact, to undertake the feed. Position the resident so he/she
does not choke. If the speech pathologist has recommended a
particular position for feeding to avoid choking and aspiration
then it MUST be followed at every meal and when fluids are
given.
Conduct a short inservice education session if required, based
on page 29 of the ‘Supporting Information’.
1. Use a plate of food served to residents and vary the
quantity of food on it. Have the nurses and care staff
estimate how much has been ‘eaten’. A series of
photographs could also be used for this exercise. OR
2. Have participants complete a food chart on one resident
after a meal. An example is on page 36 of the ‘Guidelines’.
Verify its accuracy by having a second person complete a
chart on the same resident at the same meal. Compare the
two completed charts. If the charts are very different,
check the food remaining on the plate. Provide additional
education to the nurses and care staff until their
estimations are accurate. Ensure they know when to
report uneaten meals (any time that >50% of food has
been left) and how to report the uneaten meals.
Conduct a short inservice education session if required. Bring
the usual glasses, cups and mugs that residents use in the
facility, and a jug for measuring liquids. Measure how much
Page 9 of 22
Can every nurse and care staff member:
Yes
Understand and discuss the importance of resident’s
drinking adequate amounts of fluids each day to
prevent dehydration?
Understand the benefits and burdens associated with
using dietary supplements for residents
Accurately record a resident’s weight on a weight &
BMI chart?
Accurately record BMI on the weight & BMI chart?
Name five environmental and social factors that
could limit the amount of food eaten by a resident
that leads to weight loss?
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No
If no, then:
fluid each container holds when full, using any fluid such as
water, cordial or cold tea. Take a varying amount of fluid out,
to simulate when a resident does not drink a full cup or glass
of fluid, and have the participants estimate how much fluid
has been ‘drunk’ by the resident. Measure the amount
remaining and verify the accuracy of participants’ estimations.
Discuss accurately filling in a fluid intake chart with the nurses
and care staff. Have them practice estimating the amount of
fluid consumed by part-filling the containers, until they are
accurate with their estimations. Make a chart to display on the
wall showing the capacity of cups and glasses used in the
facility, as a reminder to the care staff. Have the care staff
Conduct a short inservice education session, based on page 32
of the ‘Guidelines’. Stress the importance of the care staff
regularly offering residents fluids throughout the day, unless
medically contraindicated.
Refer to pages 37 & 38 of the ‘Supporting Information’, and
information about fluid supplements from the ‘Guidelines’ (3rd
and 4th line interventions). Conduct a short inservice
education session if required. Emphasise that the burdens
associated with supplements, that is, reducing the appetite,
not being liked by residents, the costliness of supplements,
may be outweighed by the benefit to the resident, particularly
for residents with cachexia.
Refer to page 30-31, 35, & 33-34 of the ‘Guidelines’. Conduct a
short inservice education session if required. Ask the
participants to complete the charts based on the results from
one resident. Check the accuracy of the entries on the Weight
& BMI chart.
Refer to page 34 of the ‘Supporting Information’. Conduct a
short inservice education session if required. Emphasise that
providing a pleasant environment for eating can be difficult in
Page 10 of 22
Can every nurse and care staff member:
Yes
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No
If no, then:
an institution, but that a relaxed atmosphere, using quiet
music, and having residents eat together can improve appetite
and the amount of food eaten.
Page 11 of 22
SECTION TWO: KNOWLEDGE and SKILLS
Registered and Enrolled Nurses
All registered and enrolled nurses are expected to have knowledge and skills as outlined in Section One. In addition, they should
demonstrate more comprehensive knowledge and skills relating to weight loss assessment and management as outlined in this
section. Organise inservice education as required. NB a care staff member (eg Assistant in Nursing) may have sufficient knowledge
and skills to undertake some of the tasks associated with weight loss assessment and management within this section.
9 To assess knowledge, ask every registered nurse and enrolled nurse to complete all 20 questions of the Quiz (page 22 of this
document) to provide a baseline measure before undertaking education relating to weight loss;
9 correct the quiz questions, and provide a short inservice education session relating to any topic that a number of nurses found
difficult, or responded to incorrectly;
9 for an individual nurse having difficulty with a specific topic area, discuss the problem with him/her and refer to the relevant
sections of the ‘Guidelines’ and ‘Supporting Information’ for review. Advise the staff member that he/she will be asked to
repeat the Quiz in one month;
9 repeat the Quiz questions with the individual nurse. If the nurse still cannot correctly respond to a question(s), review the
problem topic again with him/her. Discuss the issue with facility management if there is a likelihood that the knowledge
deficit will impact negatively on the care of the residents, so the nurse’s performance can be monitored appropriately.
Can every registered nurse (RN) and enrolled
nurse (EN):
• Undertake and record a history of eating,
swallowing and weight loss for a new
admission, or a review of a resident?
• Describe where to record the history?
• Develop a nutrition care plan based on the
resident’s history, cultural need and
Yes
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No
If no, then:
Refer the nurse to pages 28 & 29 of the ‘Supporting
Information’; and pages 6-8 of the ‘Guidelines’. Use the
facility nutrition management record form and care plan.
Conduct an education session if necessary. Stress the
importance of regularly updating the care plan to reflect the
goals of care relating to nutrition and weight loss.
Page 12 of 22
Can every registered nurse (RN) and enrolled
nurse (EN):
preferences?
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Yes
List 5 adverse effects of undernutrition;
Describe what a healthy BMI is for an older
person, and why a low BMI is dangerous;
Complete a Mini Nutritional Assessment
form;
Answer questions 8,10,13, 14, & 19 correctly?
Calculate the height of a resident unable to stand?
Provide the RN/EN with a calculator and tape
measure, and have him/her calculate the height of
one resident in the facility who is unable to stand to
be measured. The formula for calculating height is on
page 30-31 of the ‘Supporting Information’; or page
30 of the ‘Guidelines’.
• Calculate the BMI of a resident, and correctly
document it?
Provide the RN/EN with a calculator, and have
him/her calculate the BMI of one resident in the
facility. The formula for calculating BMI is on page
31 of the ‘Supporting Information’; or page 31 of the
‘Guidelines’. The BMI can also be calculated via the
internet, or using the calculator table provided on
pages 43-44 of the ‘Guidelines’ to estimate the BMI. .
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No
If no, then:
Refer the RN/EN to pages 6, 10-14, &31 of the ‘Supporting
Information’. Conduct a short inservice education session if
required. Stress that undernutrition, (not eating enough
protein and energy), affects at least 1 in 5 residents with
dementia in aged care facilities, with another 1 in 2 being at
risk; that undernutrition increases the risk of dying; makes
cognitive function worse; makes healing of wounds slower;
and that undernutrition can be prevented by paying careful
attention to feeding of residents. Once residents become
cachectic however, weight loss will occur despite providing
enough food & fluids. Stress that if using the MNA all
residents with advanced dementia will screen as being at high
risk of weight loss.
Conduct a short inservice education session if required.
Provide the RN/EN with other examples to practice, using the
formula on 30-31 of the ‘Supporting Information’; or page 30
of the ‘Guidelines’. Stress that the height is needed to calculate
the BMI, and that people shrink after age 30 so memory
cannot be relied on.
Conduct a short inservice education session if required.
Provide the RN/EN with other examples to practice
calculating the BMI, using either the formula, internet or table
provided. Refer to the weight loss flowchart for information
relating to interventions. Stress that the BMI is a measure of
body fat that is useful when deciding if a resident is
underweight. A slow decline in the BMI requires assessment to
locate the cause.
Page 13 of 22
Can every registered nurse (RN) and enrolled
nurse (EN):
• Describe what action to take if a BMI is not
within an acceptable range for an older
person.
• List the 4 criteria for weight loss that when
found should trigger further assessment;
• State when the assessment should commence;
• State how often residents with advanced
dementia should be weighed and their BMI
calculated.
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Yes
List 5 side effects of medications that might
affect oral intake;
Answer questions 1, 3, & 9 of the Quiz
correctly?
Describe the benefits and burdens associated
with the use of therapeutic diets for residents
with advanced dementia.;
Answer question 5 of the Quiz correctly?
Describe the amount of fluids a resident needs
to drink daily to prevent dehydration?
List 4 signs of dehydration?
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No
If no, then:
Refer the RN/EN to page 33 of the ‘Supporting Information’,
or page 9 of the ‘Guidelines’, and the weight loss flowchart.
Conduct a short inservice education session if required. Stress
that constant monitoring, with weighing and BMI calculation
monthly, is required for all residents with advanced dementia
due to their high risk of undernutrition. If one of the criterion
is met then that should trigger an assessment within 3 days.
Weighing and BMI calculation should continue until the goals
of care state otherwise.
Refer the RN/EN to pages 8, 15-16 of the ‘Supporting
Information’. Conduct a short inservice education session if
required. Stress that many medications have side effects that
may affect oral intake and thus weight loss, and these
medications should be avoided or or the use of them
minimized whenever possible.
Refer the RN/EN to page 16 of the ‘Supporting Information’.
Conduct a short inservice education session if required. Stress
that therapeutic diets are frequently tasteless and not
pleasurable for the resident, and contribute to weight loss
because the resident will not happily eat them. The resident is
unlikely to benefit from being maintained on many types of
therapeutic diet. The RN/EN should discuss these diets with
the general practitioner, and have the GP document the reason
for the diet if it is to be continued. This should be reviewed
when the goals of care are discussed
Refer the nurse to pages 16- 17 of the ‘Supporting
Information’. Conduct a short inservice education session if
required. Stress the importance of supervising and
Page 14 of 22
Can every registered nurse (RN) and enrolled
nurse (EN):
• Answer questions 4 & 5 of the Quiz correctly?
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Yes
List 5 causes of weight loss that are potentially
reversible;
State what assessments can be undertaken
prior to contacting the general practitioner to
assess further for these conditions;
Answer questions 4 & 6 of the Quiz correctly.
List 5 signs and symptoms of cachexia;
Describe under what circumstances the
general practitioner should be consulted to
diagnose cachexia;
Describe how family members of residents
with cachexia can be supported;
Describe what instructions they would expect
care staff to adhere to if feeding a cachectic
resident;
Answer question 7 of the Quiz correctly?
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No
If no, then:
encouraging the care staff to offer sufficient fluids each day, to
prevent dehydration and associated conditions such as
constipation, fluid and electrolyte imbalance, and urinary tract
infections.
Refer the RN/EN to page 32 of the ‘Supporting Information’,
and pages 17-19 of the ‘Guidelines’. Conduct a short inservice
education session if required. Stress that pain, constipation,
fluid and electrolyte imbalance, depression, chronic infections,
metabolic disorders are all potentially treatable, and if treated
may stop further weight loss. Treatment will depend on the
goals of care for the resident. Excellent feeding techniques are
also required.
Refer to pages 19-20 of the ‘Supporting Information’; pages
28-29 of the ‘Guidelines’; and the pamphlet ‘Weight loss in
advanced dementia’. Conduct a short inservice education
session if required. Conduct a short inservice education
session if required. Provide information about cachexia, and
the opportunity for participants to role-play discussing
difficult topics such as prognosis and death from
cachexia/dehydration. Have available a copy of the
communication best practice guidelines (see Annotated
Bibliography entry page 62 of the ‘Supporting Information’).
Stress that between 1 in 2 or 1 in 3 residents with advanced
dementia will die of cachexia; that residents with cachexia do
not feel hungry; that care staff should continue to offer food &
fluids of any type that the resident enjoys and can swallow,
without forcing the resident to eat, or worrying about the
nutritional balance of the diet. Feeding in this way should
continue until a family conference results in a decision to stop
all feeding, or until the resident becomes comatose; that the
GP should be consulted to confirm the diagnosis of cachexia if
Page 15 of 22
Can every registered nurse (RN) and enrolled
nurse (EN):
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Yes
List 5-7 signs and symptoms that may indicate
a swallowing disorder?
Describe when to seek referral to a Speech
Pathologist;
Describe how the recommendations from the
Speech Pathologist are relayed to the care staff
and food service staff, so that the correct food
& fluids, and best practice feeding techniques,
are employed;
Answer questions 2 & 18 of the Quiz correctly?
List the benefits and burdens of medical
interventions to provide nutrition in end stage
dementia;
State what action the nurse would take if a
family member wished to discuss tube feeding
a resident;
Answer question 17 on the Quiz correctly.
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No
If no, then:
the person responsible is insistent that this occurs; and that
the family members will need constant reassurance that
everything possible is being done to provide food in this final
stage of life. If the RN/EN is uncomfortable talking about
issues relating to death with the family members, consider
providing additional training in communication skills, or
approaching a social worker, pastoral care worker, or
counselor to provide additional training and support.
Refer the RN/EN to pages 24-26 & 39-42 of the ‘Supporting
Information’, and page 33 of the ‘Guidelines’. Conduct a short
inservice education session if required. Stress that
approximately 93% of residents with dementia will develop
swallowing problems, and as a ‘rule of thumb’ once swallowing
problems start the resident probably has a prognosis of 6
months or so. Stress that a system should be used in the
facility to make sure that all care and kitchen staff know the
correct consistency of food & fluids, and correct feeding
technique needed for an individual resident to limit the chance
of aspiration.
Refer the RN/EN to pages 24-27 & 40-42 of the ‘Supporting
Information’. Have a copy of the booklet ‘Making Choices’
available (see the Annotated Bibliography, page 62 of the
‘Supporting Information’ for access information). Conduct a
short inservice education session if required. Stress that in
almost every case, the burdens associated with tube feeding in
advanced dementia outweigh the benefits. A family conference
to discuss feeding issues is of benefit if tube feeding is being
considered, and the general practitioner needs to be invited to
participate. Note that emotional support of staff may be
required when feeding issues are being discussed; and
communication skills training to assist staff discuss difficult
Page 16 of 22
Can every registered nurse (RN) and enrolled
nurse (EN):
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Yes
List 5-7 basic interventions that can be
implemented to potentially increase the
weight of a resident;
Answer questions 11, 15 & 20 of the Quiz
correctly.
Describe the 3 categories of ‘goals of care’ that could
apply to any resident.
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No
If no, then:
issues would be beneficial.
Refer the RN/EN to the flowchart and sections of the
‘Guidelines’ relating to interventions. Conduct a short
inservice education session if required. Stress that
interventions include addressing environmental and social
factors; providing enough time & assistance for the resident to
eat; feeding the resident when he/she is most alert; offering
food and fluids that take into consideration the individual
preferences and needs of the resident; using the correct
feeding techniques; and addressing medically reversible
conditions that cause weight loss.
Refer the nurse to page 6 of the ‘Guidelines’ for information
relating to goals of care. Conduct a short inservice education
session if required.
Page 17 of 22
SECTION THREE: QUIZ
QUIZ ANSWERS
For questions 1 – 4 please circle the correct response:
1. Which of the following are causes of weight loss in older people?:
a)
depression;
b)
dental problems;
c)
multiple medications;
d)
wandering and other dementia-related behaviours;
e)
all of the above.
See page 8 of the “Supporting Information’
2. Which of the following is NOT a sign of swallowing difficulties?:
a)
coughing;
b)
clearing the throat;
c)
leaning into the table;
d)
protruding tongue movements.
See page 25 of the “Supporting Information’
3. In residential aged care facilities, which of the following factors diminish residents’
food intake?:
a) pureed food;
b) incorrect positioning;
c) not enough trained staff;
d) b and c;
e) a,b and c.
See page 12 of the “Supporting Information’
4. Reversible causes of weight loss include:
a)
depression;
b)
chronic infections;
c)
metabolic disorders;
d)
fluid and electrolyte imbalance;
e)
all of the above;
f)
none of the above.
See page 32 of the “Supporting Information’
Decision-making frameworks in advanced dementia: Links to improved care project
Weight Loss Framework Train the Trainer Manual
Page 18 of 22
For questions 5 – 20 please place a tick in the box to indicate whether the
statement is true or false.
True
False
5
Residents with dementia and co-morbid
False. See
conditions should be maintained on therapeutic
p. 16 of the
diets for as long as possible.
‘Supporting
Information’
6
Pain and constipation are common causes of lack True. See p.
of appetite in residents.
32 of the
‘Supporting
Information’
7
Offering small, frequent high protein meals and
False. See
fluids can reverse weight loss due to cachexia.
p. 19 of the
‘Supporting
Information’
8
A resident who develops pressure ulcers may be
True. See p.
undernourished.
12 of the
‘Supporting
Information’
9
Residents being given anti-psychotic medication
True. See p.
are likely to lose weight.
15-16 of the
‘Supporting
Information’
10
A resident with a body mass index of 27 is
False. See p.
overweight.
6 of the
‘Supporting
Information’
11
Family members think the first line intervention
True. See p.
for weight loss should be to improve the quality of 34 of the
food offered.
‘Supporting
Information’
12
An older person has the same senses of taste and
False. See p.
smell as a younger person.
7 of the
‘Supporting
Information’
13
Residents who are undernourished will lose fatty True. See p.
tissue before they lose muscle tissue.
11 of the
‘Supporting
Information’
14
Residents with dementia due to Alzheimer’s
True. See p.
disease are more likely to be undernourished than 12 of the
residents with vascular dementia.
‘Supporting
Information’
15
Using soothing music in the dining room can help True. See p.
residents to eat more.
34 of the
‘Supporting
Information’
16
Residents with a urine specific gravity of less than
False. See p.
1.020 are dehydrated.
17 of the
‘Supporting
Decision-making frameworks in advanced dementia: Links to improved care project
Weight Loss Framework Train the Trainer Manual
Page 19 of 22
17
Residents with advanced dementia who have
feeding tubes (eg PEG tube) are less likely to
aspirate.
18
A resident with dysphagia who develops a fever
may have ‘silent’ aspiration.
19
A resident with advanced dementia and a low
BMI is more likely to benefit from nutrition
supplements than a resident with a higher BMI.
20
Residents being given antipsychotic medication
need extra sauces and gravies to moisten their
foods.
Decision-making frameworks in advanced dementia: Links to improved care project
Weight Loss Framework Train the Trainer Manual
Information’
False. See p.
41 of the
‘Supporting
Information’
True. See p.
26 of the
‘Supporting
Information’
False. See p.
38 of the
‘Supporting
Information’
True. See p.
36 of the
‘Supporting
Information’
Page 20 of 22
WEIGHT LOSS QUIZ
For questions 1 – 4 please circle the correct response:
1. Which of the following are causes of weight loss in older people?:
c)
d)
c)
d)
e)
depression;
dental problems;
multiple medications;
wandering and other dementia-related behaviours;
all of the above.
2. Which of the following is NOT a sign of swallowing difficulties?:
a)
b)
c)
d)
coughing;
clearing the throat;
leaning into the table;
protruding tongue movements.
3. In residential aged care facilities, which of the following factors diminish residents’
food intake?:
a)
b)
c)
d)
e)
pureed food;
incorrect positioning;
not enough trained staff;
b and c;
a,b and c.
4. Reversible causes of weight loss include:
a)
b)
c)
d)
e)
f)
depression;
chronic infections;
metabolic disorders;
fluid and electrolyte imbalance;
all of the above;
none of the above.
For questions 5 – 20 please place a tick in the box to indicate whether the
statement is true or false.
True
False
5
Residents with dementia and co-morbid
conditions should be maintained on therapeutic
diets for as long as possible.
6
Pain and constipation are common causes of lack
of appetite in residents.
Decision-making frameworks in advanced dementia: Links to improved care project
Weight Loss Framework Train the Trainer Manual
Page 21 of 22
True
7
Offering small, frequent high protein meals and
fluids can reverse weight loss due to cachexia.
8
A resident who develops pressure ulcers may be
undernourished.
9
Residents being given anti-psychotic medication
are likely to lose weight.
10
A resident with a body mass index of 27 is
overweight.
11
Family members think the first line intervention
for weight loss should be to improve the quality of
food offered.
12
An older person has the same senses of taste and
smell as a younger person.
13
Residents who are undernourished will lose fatty
tissue before they lose muscle tissue.
14
Residents with dementia due to Alzheimer’s
disease are more likely to be undernourished than
residents with vascular dementia.
15
Using soothing music in the dining room can help
residents to eat more.
16
Residents with a urine specific gravity of less than
1.020 are dehydrated.
17
Residents with advanced dementia who have
feeding tubes (eg PEG tube) are less likely to
aspirate.
18
A resident with dysphagia who develops a fever
may have ‘silent’ aspiration.
19
A resident with advanced dementia and a low BMI
is more likely to benefit from nutrition
supplements than a resident with a higher BMI.
20
Residents being given antipsychotic medication
need extra sauces and gravies to moisten their
foods.
Decision-making frameworks in advanced dementia: Links to improved care project
Weight Loss Framework Train the Trainer Manual
False
Page 22 of 22