Marlene is an 86-year-old white female resident in a skilled nursing facility wi

Marlene is an 86-year-old white female resident in a skilled nursing facility with unintentional weight loss. She was admitted 3 months ago from the hospital after a hip fracture. She had been residing in an independent living facility for several years. She reports she has been eating poorly because of difficulty moving around, being generally uncomfortable, and states, “If I am not active, I don’t need to eat so much.” Intake is less than 50% of regular diet. No problems chewing or swallowing are noted after a speech language pathologist’s evaluation. Admission weight was 112 pounds; current weight is 95 pounds. Self-reported height is 5’ 3”; Hgb/Hct is normal; total cholesterol is 135; and Mini Nutrition Assessment score is 5. Hip scans show slow fracture healing and no improvement in bone density; currently she is being supplemented with calcium 1000 mg/day and vitamin D 600 IU/day. Blood pressure is 128/80 with furosemide (Lasix); other medications are lorazepam (Ativan), fentanyl transdermal patch (Duragesic), senna (Senokot-S), docusate (Colace), and mirtazapine (Remeron)

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