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EBP Compendium: Summary of Clinical Practice Guideline

American Medical Directors Association (AMDA); Abbott Nutrition
Altered Nutritional Status in the Long-Term Care Setting

American Medical Directors Association. (2010).
Columbia (MD): American Medical Directors Association, 32 pages.

AGREE Rating: Recommended with Provisos


This guideline provides recommendations for management of nutritional status in nursing home residents who are at risk for weight change, including individuals with dementia. The target audience of this guideline is "members of the interdisciplinary team in long-term care facilities-the administrator, medical director, director of nursing, attending physician, nursing staff, certified nursing assistant, consultant pharmacist, and other professionals such as various therapists, social workers and dietitians who care for long term care patients" (p. ii).


  • Assessment/Diagnosis
    • Assessment Areas
      • Swallowing
        • Within 3 to 5 days of admission, a staff member should observe the patient eating and note any difficulty swallowing foods or liquids.
        • A skilled practitioner (e.g., physician, registered nurse, or speech pathologist) should perform a bedside clinical evaluation to determine if the patient has dysphagia.
        • A fluoroscopic or fiber optic study may be ordered if appropriate and agreed upon by the interdisciplinary team, patient, and family. Patients should be monitored regularly for changes in weight or food intake.
        • For patients whose food intake is inadequate, screen for functional impairments, social and environmental factors, dietary restrictions and food preferences, and medical conditions associated with anorexia or dehydration.
  • Treatment
    • Swallowing
      • Diet Modification & Tube Feeding - Intervention to improve intake may involve altering the eating environment, tailoring meals and foods to the individual's preferences, reconsidering dietary restrictions, supplements, appetite stimulants, and tube feeding. The effectiveness of any implemented intervention should be monitored.

Keywords: Swallowing Disorders; Dementia

Access the Guideline

Added to Compendium: October 2011

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