Elderly and infirm residents of nursing homes are at an increased risk for malnutrition and dehydration for a myriad of reasons, most significantly because they frequently cannot monitor their own intake of food and water.
A study done in 2000 by the Commonwealth Fund found that at least 1/3 of our nation's nursing home residents suffer from malnutrition and dehydration. The Commonwealth Fund is a private foundation that supports research to promote improvements in health care.
"The extent of malnutrition and dehydration in some American nursing homes is comparable to that found in many poor, developing countries where inadequate food intake in compounded by repeated infection." Jeanie Kayser-Jones, co-author of the study and professor of physiological nursing and medical anthropology in the School of Medicine at the University of California at San Francisco.
What should family members and caregivers be looking for?
Because nursing home residents frequently need assistance with eating and drinking, families should be ever-vigilant for obvious signs of inadequate staffing and high staff turnover rates. Typically, a nurse aide is assigned to 7-10 residents during the day shift and is required to provide meal-time assistance ranging from positioning the resident to eat, setting up trays, opening containers, cutting food, buttering bread - these tasks are time consuming; however, this same aide is often required to feed many of these resident, slowly and carefully due to a range of medical conditions including cognitive impairment and difficulty swallowing. Simply placing plate in front of a resident is a futile activity unless the facility provides sufficient staff to supervise, assist and in some cases feed the resident.
Inadequate nutritional intake can lead to severe medical complications including increased confusion, muscle weakness, bedsores, pneumonia, urinary tract infection, and other bacterial and viral infections. These conditions are far more difficult to treat than to prevent.
Families and caregivers must be on the constant lookout for some of the physical signs and symptoms of malnutrition and dehydration:
1. Increased weakness, confusion, disorientation;
2. Diarrhea;
3. Reduced urine output;
4. Dry, cracking skin;
5. Sores in the mouth, cracking lips;
6. Sunken eyes
What can families do?
- Request a speech therapist consult if your loved one experiences new or increased difficulty swallowing;
- For bed bound patients, make sure fluids and meals are within reach of the patient;
- Visit at mealtimes and observe if there is staff present to assist. Ask to speak to the director of nursing if your loved one is not being assisted with meals;
- Request a dietary consult from a registered dietician and request a copy of the report;
- Attend care planning conferences and request your loved one's weight charts, charts containing meal consumption percentages, and recordation of fluid intake and output;
- Contact the physician and request his/her input on your loved ones' nutritional status.
The active involvement of families, coupled with observation and frequent visits are cornerstones in preventing many of the problems and conditions associated with malnutrition and dehydration in nursing home residents.
Posted by: Denise A. Platt, RN, JD with Law Offices of Jody C. Moore, APC
