Signs you're a lousy cook: Your husband refers to the smoke detector as the oven timer.
 

In the day to day business of nutrition consulting in long term care, it's not uncommon to run across residents that despite your best efforts, stubbornly refuse to gain weight, resolve pressure ulcers and/or improve visceral protein status.  As RD's we are geared to fix problems with careful assessment and application of needed nutrients. But what happens when that's clearly not working?

One possible scenario to consider is the presence of Sarcopenia. This metabolic, age related syndrome appears to result from decreases in anabolic hormone production, Interleukin mediated "withdrawals" from lean body mass and overall decrease in muscle quality. At present, from a nutrition standpoint, it's unclear if anything can be done about it. There's ongoing debate and research to determine if supplementation of metabolites such as beta-hydroxy-beta-methylbutyrate (HMB) may be useful, but the jury is still out. What does appear to be consistently successful in the research is strength building through resistance training.

So where does that leave us? RD's are in a unique position to help identify residents who don't appear to be responding to adequate provisions of calories and protein. We can help these residents by:

• Communicating findings to the care team and helping to construct more individualized plans of care that may include increased and targeted physical activity supported by adequate nutrition.

Interestingly, Abbott Nutrition has just launched their new Ensure product: Ensure Clinical Strength with "Revigor", their trademarked name for HMB. While Sarcopenia is not specifically named in the marketing materials, Abbott states ECS is designed to "help rebuild muscle and strength naturally lost over time" with its target audience of people "over 40".