ecall Clara. A history, physical exam, and lab tests fail to find an underlying pathology for her weight loss. When questioned about her usual food intake, Clara admits that she has lost interest in cooking and shopping and that her appetite isn't what it used to be. Her family reveals that her intake has decreased, as evidenced by the spoiled food they find in her refrigerator and out of date items in her pantry. What percentage of weight has Clara lost over the last 6 months? What is an appropriate intervention to recommend at this point? Clara, 74 years old, lives alone in her own home. A home health aide visits 2 hours per week to help Clara with light housekeeping. Clara is relatively healthy. Her only medication is an occasional antacid for gastroesophageal reflux disease. She is 5 ft 5 in, and for all of adult life, she has weighed 135 pounds, giving her a body mass index (BMI) of 22.5. At her most recent doctor visit, she was down7 pounds from the previous visit 6 months ago. She lives alone, has lost weight, and has lost interest in preparing food . She tried going to the senior center for noon time meals but told her family she "quit" because they give her food she doesn't like-too much meat, milk, and vegetables and not enough sweets. She also got lost driving there one day and fears she may be developing dementia. She agrees to more extensive help in the home. What criteria should the in-home health aide be monitoring regarding Clara's intake? What suggestions would you give the aide to promote Clara's intake? In hindsight, her loss of interest in shopping and cooking were early signs of declining cognitive ability. Her symptoms are characteristic of the progressive decline in function seen in adults with Alzheimer disease. She is admitted to a memory care facility and diagnosed as frail. What interventions may help improve Clara's intake? A nutrition screen revealed malnutrition. Clara is consuming < 50% of her food at each meal. She pushes food around her plate and hides it under the plate. She also prefers wandering the halls to sitting. Clara has a health-care proxy who explicitly states she does not want artificial food or fluids should there be no hope of recovery. What strategies may help improve her intake?

Recall Clara. A history, physical exam, and lab tests fail to find an underlying pathology for her weight loss. When questioned about her usual food intake, Clara admits that she has lost interest in cooking and shopping and that her appetite isn't what it used to be. Her family reveals that her intake has decreased, as evidenced by the spoiled food they find in her refrigerator and out of date items in her pantry. What percentage of weight has Clara lost over the last 6 months? What is an appropriate intervention to recommend at this point? Clara, 74 years old, lives alone in her own home. A home health aide visits 2 hours per week to help Clara with light housekeeping. Clara is relatively healthy. Her only medication is an occasional antacid for gastroesophageal reflux disease. She is 5 ft 5 in, and for all of adult life, she has weighed 135 pounds, giving her a body mass index (BMI) of 22.5. At her most recent doctor visit, she was down7 pounds from the previous visit 6 months ago. She lives alone, has lost weight, and has lost interest in preparing food . She tried going to the senior center for noon time meals but told her family she "quit" because they give her food she doesn't like-too much meat, milk, and vegetables and not enough sweets. She also got lost driving there one day and fears she may be developing dementia. She agrees to more extensive help in the home. What criteria should the in-home health aide be monitoring regarding Clara's intake? What suggestions would you give the aide to promote Clara's intake? In hindsight, her loss of interest in shopping and cooking were early signs of declining cognitive ability. Her symptoms are characteristic of the progressive decline in function seen in adults with Alzheimer disease. She is admitted to a memory care facility and diagnosed as frail. What interventions may help improve Clara's intake? A nutrition screen revealed malnutrition. Clara is consuming < 50% of her food at each meal. She pushes food around her plate and hides it under the plate. She also prefers wandering the halls to sitting. Clara has a health-care proxy who explicitly states she does not want artificial food or fluids should there be no hope of recovery. What strategies may help improve her intake?