Malnutrition

Malnutrition, or lack of proper nutrition, can be a serious, life-threatening medical problem for older adults. Malnutrition means more than not having enough to eat. It means not getting enough vitamins and minerals into your body. Malnutrition can lead to a variety of serious health problems, including:

• Confusion and memory loss
• Weakness, resulting in immobility, falls, bedsores, and pneumonia
• Inability to fight off sickness
• Inability to recover from an existing illness
• Loss of muscle mass
• Impairment of organ function
• Infection
• Anemia
• Death

Negligence Related to Malnutrition and Dehydration

Two out of five nursing home residents suffer from malnutrition, and dehydration is the most common fluid and electrolyte disorder of frail older people. Malnutrition in nursing home residents can occur for a variety of reasons, including the resident's inability to process food and ill-fitting dentures. Dehydration can occur for a variety of reasons as well, including diarrhea and the effects of medication. Unfortunately, malnutrition and dehydration can also occur due to a nursing home's negligence in a variety of situations, including:

• Failure of the nursing home to employ adequate staff, which results in the staff's inability to properly feed the residents
• Failure of the staff members to pay adequate attention to those residents needing assistance with eating
• Failure of the nursing home to properly educate the staff on nutrition and feeding methods
• Failure of the nursing home to provide proper supervision over those who provide nutritional services
• Reliance on liquid supplements as opposed to making sure each resident eats enough food to get necessary vitamins, minerals, protein, and calories

If you notice that your loved one has signs of malnutrition or dehydration or if you think that they are not getting enough food or fluids at the nursing home, you should immediately notify the nursing staff and the physician to prevent potentially serious, life-threatening consequences.

Effects of Understaffing

Government statistics show that 47% of residents in nursing homes need assistance with eating. 21% of residents are completely dependent for help. In addition, patients in nursing homes often need more water than the average person because of the medications they are taking. If the nursing home is understaffed, then there may not be anyone available to take the time to see that the patient has had enough to eat or to drink.

Tips to prevent malnutrition and dehydration

• Make sure your loved one in a nursing home drinks plenty of water. Eight glasses a day is recommended, unless there is a medical reason for restricting fluids. In addition to water, your loved one should drink plenty of juice.
• Insist on a pitcher of water and cups in the room. Make sure the resident can handle the pitcher and cups. If needed, insist on oversized cups with lids and built-in straws.
• Make sure your loved one eats three well-balanced meals per day.
• Insist on a daily weigh-in with accurate record keeping. Review weight records to monitor gain or loss.
• Make sure the resident's food tray hasn't been placed too far away so that it is difficult to reach.

Signs that may indicate that your loved one is suffering from malnutrition and/or dehydration:

• Weight loss
• Cracks around the mouth
• Pale lips and mouth
• Complaints that dentures no longer fit
• Unexplained confusion
• Mouth sores
• Thinning hair
• Loose, flappy skin
• Dry skin
• Sunken eyes
• Urinary tract infection
• When the resident eats or drinks more when a friend or family member assists with feeding
• If you observe patients being fed in a circle by one nurse's aide. This could indicate that there is not enough staff to properly ensure all residents are eating enough food and drinking enough liquids.

If your loved one shows even one of these signs, you should:

• Immediately inform the doctor and staff members of your observations
• Immediately request a care planning conference with the physician to discuss possible causes for the symptoms and to set up a plan for meals and feeding assistance
• Monitor the situation. If it does not improve within days, you should contact authorities

If you even remotely suspect the situation may be life-threatening, take immediate steps to get your loved one to a hospital emergency room.

Legal evaluation of malnutrition claims

Nursing home residents should not suffer unnecessarily from malnutrition which can be prevented with proper care.

Potential signs and symptoms of malnutrition are:

• Pale skin
• Dull eyes
• Swollen lips
• Swollen gums
• Swollen and/or dry tongue
• Poor skin turgor (when you pinch the skin, it stays indented and doesn't go back to normal quickly)
• Swelling in lower legs
• Weight loss
• Muscle wasting

Risk factors for malnutrition are:

• Poor teeth or poor oral hygiene
• Depression or dementia
• Difficulty swallowing
• Slow eating pace resulting in food getting cold or in the staff removing the tray before the resident has finished eating
• Cancer
• Stroke resulting in paralysis that renders the resident unable to feed themselves

We will evaluate the records to look for evidence that the resident was being provided proper nutrition. The first thing that should be done when a resident is admitted to the nursing home, is a nutrition assessment. An appropriate diet should be ordered, including any supplements such as snacks or ensure, if necessary. Persons at risk for malnutrition should be identified and a proper plan of care to assure that the resident receives sufficient nutrition should be implemented. The care plan should not only be implemented, it must be re-evaluated and changed when necessary based on changed in the residents food intake, weight, or laboratory values that may show evidence of malnutrition. We will assess whether the staff's concerns regarding signs and symptoms of malnutrition are clearly documented, along with consistent efforts to communicate concerns to the dietary department and to the physician.

We will look for documentation that the nursing staff was fulfilling their responsibilities, if warranted, of assisting the resident with meals, documenting the amount of food the resident is eating at each meal and offering food substitutes based on patient preference. We will also look for documentation that the resident's nutritional status was being monitored by checking for:

• Weight gain or weight loss
• Laboratory values - a simple blood test can be done to check the residents nutritional status. If some levels are below normal range, such as the protein or albumin level, it may be an indication of malnutrition.

In some cases, it may not be possible to provide adequate nutrition because the resident may be very sick and have some of the following medical conditions:

• The resident may refuse to eat due to depression or other reasons
• The resident may have advanced cancer and treatments such as chemotherapy and radiation may cause severe nausea, vomiting, and lack of appetite
• Advanced kidney disease
• Alcohol and drug abuse, chronic blood loss, hyperthyroidism
• Gastrointestinal surgery

If your loved one refuses to eat or is unable to eat due to a serious medical condition, talk with the physician and determine what alternatives are appropriate, such as supplements or tube feedings.