Malnutrition and Dehydration: The Nursing Home's Silent Killers
Malnutrition and dehydration: two completely avoidable nursing home situations that take numerous lives annually. Sadly, studies show that approximately 40% of nursing home residents are malnourished. Many of these individuals receive their nutrition via tube feeding, which is the sole responsibility of the nursing home. It is simply inexcusable for a resident who receives nutrition via tube to become malnourished.
Malnutrition and dehydration can be caused by numerous physical and psychological problems, such as:
- Chronic illness, such as congestive heart failure and chronic lung or kidney diseases
- Adverse drug effects, such as nausea, vomiting, or diarrhea
- Food and drug interactions which decrease the body's ability to absorb vitamins and minerals;
- Depression
- Mouth problems or swallowing disorders, such as improperly fitting dentures, mouth sores and/or pain
- Tremors, dementia, or agitation, which decreases the resident's ability to feed themselves
Sometimes, malnutrition and dehydration can be caused by environmental factors, such as:
- Lack of assistance eating or drinking when needed
- Lack of individualized care, such as staff uneducated about the proper way to assist residents with eating and/or drinking
- Reliance on liquid supplements instead of ensuring residents eat and drink
- Failure to provide appropriate diet
- Unadministered tube feedings
- Chaotic dining environment
- Absence of fresh water
- Failure to open drink cartons for residents or cartons left out of reach of the residents
PINPOINTING MALNUTRITION OR DEHYDRATION
If you suspect your loved one might be malnourished or dehydrated, watch for these signs:
- Loosely fitting clothing or other obvious weight-loss signs
- Cracks around the mouth
- Pale lips and mouth
- Complaints of ill-fitting dentures
- Thinning hair
- Confusion (not in cases of Alzheimer's or dementia residents)
- Skin breakdown
- Sunken eyes
- Wounds taking long time to heal
If you find your loved one exhibiting at least two of these signs, then ask yourself the following questions:
- Can my loved one feed him/herself?
- Does it take a long time for him/her to eat?
- Does he/she feel rushed through meals or unable to finish meals?
- Does he/she eat more if someone is there at mealtime to assist?
- Is he/she uninterested in food or have no appetite?
- Is the facility food appetizing and tasty? Served at the proper temperature?
- Has he/she begun a new medication or been put on a special diet?
WHAT SHOULD YOU DO?
First, tell the nursing home staff what you have determined. Make sure that you mention any physical symptoms that you found, such as sunken eyes, cracked lips, or dry skin. Make sure that facility employees follow up on your observations and assess the resident. Be sure to follow up with the facility on what they did to alleviate the problem. Second, ask your loved one's physician for a blood test to check for dehydration or nutritional deficiencies.
Next, request an immediate care planning meeting with nursing home staff and the Administrator. In the meeting, tell the staff of your discoveries and ask them if facility staff determined that your loved one was suffering from dehydration or malnutrition. These problems should be noted in your loved one's chart. Ask what is on your loved one's meal plan and who assists with meals, if that is necessary. Does the resident have problems swallowing? If so, request a dental and dysphasia (difficulty or inability to swallow) exam. Find out if water is readily available and if your loved one is able to lift the glass or cup. Are straws provided? Find out if your loved one has recently been assessed for depression, as both weight loss and loss of appetite are signs of depression. Also, ask for a physician or pharmacist to review your loved one's medications for possible interactions.
After the care planning meeting, carefully watch to see if any recommendations made during that meeting are implemented. Keep monitoring your loved one for weight loss or gain.
If, after taking all these steps, your loved one continues to lose weight or is still dehydrated, contact your local ombudsman. An ombudsman is an individual who advocates for nursing home residents and their families and will know exactly how to assist you.
The Terry Law Firm is experienced in handling cases of nursing home abuse and neglect. Please contact us with any questions or concerns at www.nursinghomejustice.com.
