Combating Significant Weight Loss in Seniors: A TASTEFUL Case Study

About RiverSpring Living

RiverSpring Living is recognized as one of the best nursing homes in the country, RiverSpring pushes the boundaries of what’s possible in skilled nursing care. Innovative programs like vision care, therapeutic activities, college courses, memory care, and exercise programs are underscored by individual attention and passion for their residents which makes a real difference in their quality of life.

The Impact of COVID-19

Research has demonstrated the negative nutritional impact of COVID-19 due to the clinical manifestations and psychosocial effects. Specifically, Registered Dietitian Nutritionists (RDN) have seen increased weight loss trends during upticks in the COVID-19 virus over the past few years. Therefore, as an organization, RiverSpring Living took a deeper dive into what specifically were contributing factors in addition to the actual virus itself along with historical weight loss statistics.

Weight Loss Statistics & Social Isolation

Increased isolation and decreased activity levels due to infection control restrictions, such as visitor limitations and dining hall closures, likely also contribute to increased weight loss. Weight loss in older adults has been associated with mortality overall and is a common feature of other geriatric syndromes. The study found weight loss among both COVID-positive and COVID-negative residents. In addition, the study’s findings support the call to proactively address COVID–19–associated weight loss as part of a COVID-19 management strategy within skilled nursing facilities. The study notes that “creative strategies and policies are needed to ensure residents receive adequate mealtime support, symptom management, weight monitoring, and comprehensive nutrition assessments”.

Unintentional Weight Loss in Older Adults

Monitoring weights within senior living is crucial as unintentional weight loss in people older than 65 years is associated with increased morbidity and mortality. Nonmalignant diseases are more common causes of unintentional weight loss in this population than malignant causes. However, malignancy accounts for up to one-third of cases of unintentional weight loss.

What follows is a list of diverse causes that may be at the root of unintentional weight loss in seniors:

Medical Causes

• Dementia. As dementia progresses, challenges with mobility, chewing, memory, confusion, suspicion, and appetite decline can lead to weight loss.
• Gastrointestinal disorders. Disorders of the digestive tract can affect nutrient absorption and appetite.
• Cancer. Cancers can affect the body in different ways, sometimes hijacking energy the body would otherwise need or affecting appetite and the way the body processes nutrients, leading to weight loss.
• Endocrine disorders. Thyroid disorders, diabetes, and other hormone-related disorders can affect metabolism, digestion, and nutrient absorption.
• Difficulty chewing and swallowing. Various medical conditions, including neurological disorders, can affect an aging adult’s ability to chew and swallow.

Psychiatric Causes

• Depression. Depression may cause loss of appetite and be connected with isolation, loss of independence, grief, and other underlying medical conditions.
• Anxiety. Anxiety disorders can have far-reaching consequences for an older adult’s health and sense of well-being.

Social Causes

• Poverty. Financial difficulties can become a major barrier to adequate nutritious food intake.
• Inaccessibility and food insecurity. Mobility issues or lack of local options can impose limitations on the nutritious food that is available for seniors when they can’t manage shopping on their own or quality stores are too far away.
• Loneliness and isolation. When an aging adult spends more time alone, they may lose touch with regular eating habits and lose interest in eating altogether.
• Independent abilities. If an individual is unable to regularly prepare healthy meals on their own and they do not have assistance, their diet and nutrition will suffer.

Physical Challenges with Eating

• Ill-fitting dentures. Eating can become a hassle with dentures or nearly impossible when they don’t fit or adhere well.
• Teeth or jaw pain. Dental problems or jaw tension can make eating painful.
• Altered taste or nausea. Perhaps as a side effect of medications or natural developments of aging, changes in taste or bouts of nausea can disrupt an older adult’s desire and tolerance for eating.

The non-communal dining mandates throughout COVID-19 supported a more isolated dining experience within senior living facilities including RiverSpring Living. Not only were residents eating alone or separated from their peers but also many were eating all their meals in their rooms which may have contributed to an increased feeling of isolation, reduced appetite, or decreased desire to request assistance or alternates at meals. In addition, RiverSpring had put many of its communal food-related programs on hold such as monthly birthday celebrations, barbeques, or festive celebratory meals.

COVID – 19 Weight Loss – A Team Approach at RiverSpring Living

The NEXDINE Hospitality nutrition team led by Jennifer Flood Sukhdeo developed a QAPI, which stands for Quality Assurance and Performance Improvement. The team consisted of representatives from administration, quality assurance, dining and nutrition, and nursing, who worked to identify areas that were negatively impacting weight trends within the organization during monthly meetings.

According to the American Geriatric Society, their recommendation was to optimize social opportunities, discontinue medication interactions, offer appealing food, and provide the needed feeding assistance. Therefore, as the COVID-19 regulatory restrictions began to lift, the facility did everything possible to create a meal-like environment that fostered communal dining and festive meal celebrations like what residents remember prior to the pandemic.

Next, the team ensured that staff in all the neighborhoods were aware of ‘high-risk’ residents and developed a communication tool that allowed staff on all shifts to be alerted to those residents that may have changes in appetite or weight trends. Lastly, they fostered the help of other staff members to develop a program called ‘Hands on the Hudson’. The program empowers all staff within the organization to give one hour of their time weekly to a program or task outside of their daily workflow that supports resident care, such as assisting staff at meals, bringing residents off units or outdoors, or increasing the number of one-on-one visits.

Introduction of TASTEFUL Plus

Another goal for the RiverSpring team was to implement TASTEFUL Plus, a NEXDINE Hospitality signature program encompassing enriched foods as a replacement for commercial supplementation. The goal was to reduce supplement utilization at RiverSpring Living and provide the residents with a delicious product that supports weight maintenance and prevents weight loss through additional calories and protein.

TASTEFUL Plus is NEXDINE’s signature food program for individuals with increased caloric and protein needs. Made up of enriched foods and smoothies, the program is designed to successfully promote weight gain or weight maintenance in our residents and patients. TASTEFUL Plus enriched foods are natural foods (not artificial supplements) that are enhanced with calorically dense ingredients and protein sources. NEXDINE’s blended smoothies can also help increase the intake of quality ingredients, including assorted fruits, whole milk, and yogurts, to provide additional calories and protein in an enjoyable way. Smoothies make for a simple, economical alternative to commercial supplements. The program’s goal is to deliver the same great-tasting food but with a focus on the density of calories and protein.

There are many benefits to the TASTEFUL Plus program, two of the most being NEXDINE’s culinary integrity and the variety of items available. Most enriched food programs focus on a limited number of items. While easier from a production standpoint, the patient or resident often tires quickly of the lack of variety and no longer readily consumes the items provided. The TASTEFUL Plus program is different. It utilizes a wide range of ingredients and food items, promoting sustained program success by decreasing the potential for repetition and declining patient/resident interest. Additionally, the recipes created specifically for TASTEFUL Plus were carefully curated. The items include traditional favorites such as oatmeal, muffins, macaroni and cheese, cream soups, cookies, and other rich desserts. TASTEFUL Plus smoothies also reflect the NEXDINE approach to menu building: ingredients and recipes change with the seasons to keep flavors fresh and exciting.

Implementing TASTEFUL Plus

First, the RiverSpring team conducted a pilot group for the TASTEFUL Plus program to ensure they were able to follow a specific group of nutritionally at-risk residents throughout a six-week pilot program. The commercial supplement orders for Ensure and Boost were discontinued, and a house-made TASTEFUL Plus shake or smoothie was provided instead.

• Total weight gain of 43.1 pounds, weight loss 13.7 pounds with an overall net gain of 29.7 pounds
• Gained weight (any amount of weight gain): 10/15
• Stable (within two pounds of baseline weight): 3/15
• Weight loss: 2/15

*Two of the residents who lost weight during the audit were COVID-positive during part of the pilot which could have negatively impacted their appetite and intake of supplements.

There were a few recipe modifications during the pilot and flavor introductions which makes TASTEFUL Plus unique, you can’t customize commercial supplements to resident preferences. After a successful six-week pilot the team decided to go house-wide with TASTEFUL Plus, expanding the program to 107 skilled nursing residents. They replaced commercial supplements like Ensure and Boost with house-made shakes.

Utilizing the Casper Reporting at RiverSpring, the team was able to analyze metrics to track the success of the program. The Casper Report results for excess weight loss for the time of 2/1/22 – 7/31/22 was 9.6 %. Comparatively, the results for the period 1/1/23 – 6/30/23 were 7.2% for long-stay residents. This represents a decline of 2.4 % for the comparative six-month period review.

Financial Impact

Creating excitement around mealtimes with themed events and entertainment, enhanced resident engagement by making dining more of a social experience. Additionally, given the high cost of commercial supplements, the opportunity to replace them with a high-quality, customized food-first program that is less expensive is a significant value-add.

The addition of TASTEFUL Plus allowed the team to further impact oral intake by providing whole foods versus commercial supplements. RiverSpring is saving around $5,000 per month through the utilization of the TASTEFUL Plus shakes twice per day for an annual savings of around $60,000.

Conclusion

An interdisciplinary approach to designing a data-driven performance improvement plan was instrumental in having a clinically meaningful effect on RiverSpring Living residents. Residents are enjoying more of the special food-related programs and staff are feeling rewarded by the experiences they share with residents. RiverSpring’s Vice President of Rehabilitation and Quality Assurance; “I agree with the many cultures that believe healing the belly ultimately heals the body!” Thus, furthering the NEXDINE Culinary Commitments we embrace as an organization.

For more information about NEXDINE’s TASTEFUL Plus program, contact us today.

 

Written by: Rebecca McCullough, MS RD CDP, SVP Nutrition Health & Wellness, NEXDINE Hospitality

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References:
Gaddey HL, Holder KK. Unintentional Weight Loss in Older Adults. Am Fam Physician. 2021 Jul 1;104(1):34-40. PMID: 34264616. Martinchek M, Beiting KJ, Walker J, Graupner J, Huisingh-Scheetz M, Thompson K, Gleason LJ,
Levine S. Weight Loss in COVID-19-Positive Nursing Home Residents. J Am Med Dir Assoc. 2021 Feb;22(2):257-258. doi: 10.1016/j.jamda.2020.11.031. Epub 2020 Nov 28. PMID: 33352194; PMCID: PMC7699303