1. WEIGHT GAIN AND PROTEIN MAINTENANCE IN DEBILITATED NURSING HOME ELDERLY Y. LEVINSON, T. DWOLATZKY, A. EPSTEIN, B. ADLER, L. EPSTEIN NEVE SIMCHA GERIATRIC HOSPITAL AND HADASSAH MEDICAL ORGANIZATION

2. Nutritional Maintenance in Nursing Homes Previous studies have shown a general inability to maintain weight and protein status of elderly nursing home patients Previous studies have shown a general inability to maintain weight and protein status of elderly nursing home patients

3. Nutritional Maintenance in Nursing Homes “ Uncontrolled weight loss is almost inevitable in later stages (of Alzheimer ’ s disease ) despite quality of care ” “ Uncontrolled weight loss is almost inevitable in later stages (of Alzheimer ’ s disease ) despite quality of care ” JADA 89: 392, 1989

4. Nutritional Maintenance in Nursing Homes “ Adequate energy and protein were provided, but (elderly) subjects lost weight and had severe depletion of lean and fat body mass … weight loss was associated with longer time on tube feeding and more pressure ulcers ” “ Adequate energy and protein were provided, but (elderly) subjects lost weight and had severe depletion of lean and fat body mass … weight loss was associated with longer time on tube feeding and more pressure ulcers ” J. AMER. COLL. NUTR. 11: 309, 1992

5. The Nutritional Management of Elderly in Nursing Homes Problems Weight loss Worsening of protein status Pain and weakness Pressure sores Severe appetite loss Solution Nutritional support Formula feeding

6. In-house formulas In-house formulas Commercial formulas Commercial formulas

7. In-house low cost formula Description Description high protein, milk-based high protein, milk-based 250 cc/ serving 250 cc/ serving 380 calories 380 calories 15 grams protein 15 grams protein Available as Available as Milkshake Milkshake Pudding Pudding Tube feeding Tube feeding

8. Nutritional Maintenance in Nursing Homes

9. In-house formula study patient characteristics 143Number of patients 61/39Gender women/men (%) 60 - 103Age range (years) 83Mean age (years) 26.6 %Age group 60 – 79 (years) 55.9 %Age group 80 – 89 (years) 17.5 %Age group 90 + (years)

10. In-house formula study patient characteristics %Diagnosis 66Dementia 43CVA 37Heart disease 20Diabetes 22Fractures Patients may have more than 1 diagnosis

11. In-house formula study

12. In-house formula study all available weights

13. In-house formula study only subjects with all weights

14. In-house formula study

17. In-house formula study summary of results Overall increase of 5 kg in mean weight Overall increase of 5 kg in mean weight Mean serum albumin maintained above 4 g% Mean serum albumin maintained above 4 g%

18. In-house formula study conclusions  It is possible to increase weight and maintain protein status of debilitated elderly in nursing homes

19. Nutritional Maintenance in Nursing Homes Questions ?