On the alert.

Initiative will help fight malnutrition in nursing homes

FRONTLINE CAREGIVERS AND OTHERS ARE now equipped with a new set of tools to combat malnutrition in elders. A coalition of health care and government groups developed the tools, called Nutrition Care Alerts, to help volunteers, nursing assistants, family members, medical directors, nurses, and other health professionals identify and correct common nutritional concerns. The alerts were unveiled in September.

According to Ann Gallagher, RD, president of the American Dietetic Association, the most prevalent nutritional problems among older Americans are dehydration, unintentional weight loss, pressure ulcers, and complications with tube feedings. "The care alerts highlight easily observable warning signs of each of these conditions and practical steps to address them," she says.

The alerts are provided on a single, folded, two-sided 8-1/2" x 14" sheet of paper. Each of the four conditions is allotted one panel, which lists its most predictive warning signs and indicates which residents may be at risk. Each panel also offers two lists of clear, concrete and specific action steps: one for nursing assistants and one for interdisciplinary teams including physicians, nurses, dietitians, and pharmacists.

The alerts were developed by the Nutrition Screening Initiative, led by the American Dietetic Association, American Academy of Family Physicians, and National Council on Aging. Members also include the American Association of Homes and Services for the Aging (AAHSA), American Health Care Association (AHCA), American Medical Directors' Association, National Citizens' Coalition for Nursing Home Reform, National Association of Directors of Nursing in Long Term Care, and the National Gerontological Nurses Association. HCFA and the U.S. Senate Special Committee on Aging support the initiative.

Last year, following inquiries begun in 1997, the Senate Aging Committee and General Accounting Office reported alarming levels of malnutrition, pressure ulcers and dehydration in facilities. Many residents faced high risk for such conditions prior to admission, from disease, depression, immobility, finances, and other factors.

In response, the NSI decided to create a tool for caregivers, basing it on a review of scientific literature and HCFA's minimum data set and resident assessment protocols. The final draft was site-tested by members and consultant dietitians. HCFA is developing an assessment tool to test its effectiveness.

Facility managers can decide whether and how to use the alerts. The NSI recommends giving copies to each nursing assistant to carry for ready reference, posting alerts at nursing stations, and using them in staff in-services.

At press time, NSI was developing a Web site and planning distribution channels for mid-September, but had not yet determined pricing for multiple copies and camera-ready art that facilities can use to print their own.

Copies and/or camera-ready art will be available from sponsor Ross Products' sales forces, HCFA offices, survey agencies, AAHSA, and AHCA.