Signs of Malnutrition in Nursing Home Residents

No two nursing home neglect cases are alike. While injuries such as pressure sores, falls, and wandering occur often, the legal impact of each incident depends on specific details, including caregiver conduct, decisions by administrators, and the resident’s unique vulnerabilities. Families rely on Legal guidance for injury claims in Chicago to evaluate these factors and pursue accountability.

Nursing home laws require caregivers to complete an individual assessment of each resident who is admitted into the home. This individual assessment should then lead to the creation of a tailored care plan that takes the resident’s particularized needs into account. This ensures that there is no “one size fits all” approach to eldercare.

Unfortunately, caregivers often cut corners and provide a less-than-thorough initial assessment. This paves the way for poor care that can prove deadly.

Consider the scourge of malnutrition among the elderly in nursing homes. The Nutritional Institute reports that malnutrition and aging go hand in hand for numerous reasons, including:

• Decreased sense of smell and taste can affect appetite
• Poor oral health can lead to difficulty or even painful eating
• Mobility problems can lead to lack of access to nutrition
• Educational deficits may lead to poor diets lacking in proper nutrients

It is hard to overestimate the consequences of progressive malnutrition. Poor nutrition can lead to decreased muscle mass, resulting in mobility problems and an increasing dependence on others. Malnourishment has also been associated with deteriorating cognitive conditions. With Alzheimer’s and dementia already a prominent problem among seniors, every possible step must be taken to keep mental functioning as high as possible in nursing home residents.

Risks of malnutrition in elderly nursing home residents

Understanding the Leading Signs and Symptoms of Malnutrition

To help you protect your loved one against malnutrition and its potentially deadly consequences, we’ve compiled this list of the top nine signs of undernourishment in nursing home residents:

• Weight loss: Rapid or severe weight loss is the number one sign that your loved one may not be getting the proper nutrition. Keep your eyes open for clothes that start hanging more loosely than normal.
• Fatigue: Exhaustion and fatigue are commonplace among undernourished nursing home patients. A balanced diet with appropriate levels of nutrients helps to keep energy levels up. Without those nutrients, the body starts to shut down.
• Dizziness: If your loved one mentions feeling lightheaded when standing or difficulty sitting up, this could be a sign of malnutrition, as lightheadedness and dizziness commonly follow from lack of nutrition and hydration.
• Constipation: If your loved one’s daily diet does not include enough fiber, he or she can become constipated.
• Reduced muscle mass: Protein and vitamin D play a large role in maintaining a good level of muscle mass. Without a balanced diet that includes these nutrients, however, muscle mass can deteriorate quickly.
• Dental problems: Poor nutrition leads to poor dental health. Poor dental health, including swollen and/or bleeding gums and tooth decay, can also cause low food intake and malnutrition. Make sure your loved one receives the proper dental care he or she needs by working it into the daily care plan.
• Extended recovery time: Elderly individuals who suffer from malnutrition take more time to recover from illnesses and infections. They are also more susceptible to infections, which only makes a bad situation worse.
• Slow healing time: Like the sign listed above, it takes malnourished individuals longer for their bruises and wounds to heal. Malnourishment also increases the likelihood that more wounds, such as bed sores, will appear.
• Mood changes: Lack of proper nutrition quickly leads to a deteriorating outlook on life. Common mood changes include irritability, irrationality, and even depression. If you notice a significant mood change in your loved one that doesn’t go away after a few days, ask his or her care providers to look into potential causes.

Types of Malnutrition

Many people think that malnutrition is simply not getting enough food to eat. However, there are actually many different types of malnutrition, such as protein deficiency and vitamin and mineral deficiencies. Specifically, protein-energy, or protein-calorie, malnutrition refers to situations in which an individual does not consume enough protein and/or calories to sustain the body.

There are two main types of protein-energy malnutrition that lie on a spectrum with one another, namely marasmus, which is the consumption of too few calories to remain healthy, and kwashiorkor, which is the consumption of too little protein to properly maintain essential body functions. Usually, when a person is malnourished, he or she presents symptoms that are somewhere between the marasmus and the kwashiorkor type of malnutrition.

Marasmus Malnutrition

Marasmus malnutrition is effectively the wasting away of a person. A person having this type of malnutrition generally appears emaciated due to a reduction in body weight because the muscle and other tissues waste away. Marasmus malnutrition occurs because there is a lack of all nutrients; it is basically the byproduct of starvation.

Kwashiorkor Malnutrition

When a person does not consume enough protein, he or she can develop kwashiorkor malnutrition. It is an extreme form of malnutrition that is characterized by anorexia, edema, and ulcerating dermatoses. Cases of kwashiorkor malnutrition in the United States are very rare but do happen, mostly in small children.

However, as mentioned above, most cases of protein-energy malnutrition are somewhere between healthy and malnutrition. Kwashiorkor and marasmus are extreme cases of malnutrition that usually result in death, even if treatment is begun because the body is too far gone to recover. Many cases of malnutrition in nursing homes across the United States are identified before they become fatal, but they still point to serious abuse or neglect. When this happens, a nursing home abuse attorney can help hold those responsible accountable.

Restricted Diets Can Promote Malnutrition

Sometimes elderly individuals are placed on restrictive diets for one reason or another. The individual’s doctor may have prescribed a restrictive diet to help combat some sort of health issue, such as to aid in weight control or promote heart health. This can lead to the resident being prescribed a salt-free diet, slimming diet, or a diabetic or cholesterol-reducing diet.

While the intention of these diets is for the good of the resident, the change can impact the nutrients that he or she is getting. For example, changing the resident’s diet may not be in alignment with what the resident wants to eat. The resident may refuse food altogether rather than succumb to the food he or she finds not pleasurable to eat.

A good, hypothetical illustration of how a protein-energy deficiency could occur would be if a male resident who has been a steak-and-potatoes kind of man his whole life suddenly has a heart attack. He survives but is instructed by his doctor to change his diet or suffer the consequences. He is placed on a low-cholesterol diet, which consists of more green leafy vegetables than the man is used to. Two things play into this man developing a protein deficiency. First, he has had a high-protein diet most of his life. He will need to be weaned down to a lower but safe level of protein in his diet. His body is used to processing a lot of protein, so greatly reducing the amount in his diet suddenly is not good for his body. Second, if the man does not like green, leafy vegetables and is not used to eating them, he is likely to eat less of them.

What Kinds of Diseases Pose a Risk of Malnourishment?

Nursing home residents who have gastrointestinal diseases, such as inflammatory bowel disease (IBD), Crohn’s disease (a type of IBD), or celiac disease (which is triggered by gluten), have a significantly higher risk of becoming malnourished because these diseases are all known to cause pain when a person eats certain foods.

Because people with these conditions often experience pain when they eat, they are less likely to eat at every meal, or may eat less than is healthy in order to avoid pain. Each one of these conditions can be managed in its own way: celiac disease can be managed by avoiding foods that contain gluten; IBD can usually be managed with anti-inflammatory drugs; and although there is no universal treatment for Crohn’s disease, many individuals are helped by taking anti-inflammatory drugs.

Certain cancers, and more specifically certain cancer treatments, can trigger malnutrition in nursing home residents. Many of the steroids that are used in cancer treatment suppress appetite. A specific example can be seen in lung cancer patients. Nearly three-fourths of lung cancer patients suffer from malnutrition due to vitamin and/or mineral deficiencies.

A number of neurological conditions can also cause malnutrition because residents are unable to remember whether they have eaten or may be unable to comprehend that they need to or should eat food. Furthermore, certain psychological conditions, such as depression, can suppress a resident’s appetite to such an extent that it causes malnutrition. Certain residents who have survived a stroke or other brain injury may have a limited or depressed sense of taste or reduced sense of hunger due to damage in certain areas of the brain.

Malnutrition and Nursing Home Staffing Issues

Weight loss, malnutrition, and dehydration remain some of the most serious issues affecting nursing homes nationwide. Many facilities limit food choices at mealtime, with menus set in advance. Staffing shortages also lead to rushed meals, so residents fail to eat enough to maintain their health.

Federal law has been enacted that addresses the issues of malnutrition and dehydration in nursing homes and long-term care facilities. The law is codified as the Nursing Home Reform Act of 1987 (NHRA). As the law pertains to the issue of hydration, a nursing home facility must provide the residents with sufficient fluid consumption to maintain proper hydration and health.  Similarly, regarding nutrition, the law requires that each resident be provided with adequate nutrition to maintain acceptable body weight and protein levels unless the resident has a clinical condition that makes maintaining such levels impossible.

There are some diseases, whether pre-existing conditions or conditions that are newly developed after being admitted to the nursing home, that may interfere with the resident’s ability to be adequately nourished, despite being provided with plenty of food and water.  For example, cancer and kidney or liver damage can cause malnutrition, as well as the resident’s refusal to intake food or water provided to them. When a resident has a condition that interferes with the resident’s ability to be properly nourished or hydrated, the nursing home staff is required to administer the appropriate treatment and services for the condition.

Nursing homes are required to provide residents with a therapeutic diet when needed to address nutritional issues, and staff must assist those who are unable to feed themselves. When these basic duties are not met, seeking nursing home abuse legal representation can help protect your loved one’s rights and well-being.

Inadequate Staffing Can Spur Dehydration and Malnutrition

When staffing levels are not sufficiently adequate in the nursing home to provide proper care, dehydration and malnutrition cases are all too common.  When too few staffers are on hand, staff may sometimes cut corners or take shortcuts in their duties, such as rushing residents through meals or merely placing meal trays in rooms, but not providing assistance to residents with the acts of eating and drinking. These shortcuts are more frequently taken with care provided to residents who have cognitive impairments (i.e., dementia or Alzheimer’s disease), as these residents are unlikely or unable to complain or notify anyone of the mistreatment.

Sometimes the inadequacy isn’t a matter of low numbers of staffers, but rather the quality of the care provided by the staff.  Lack of training or a deficiency in the number of available licensed professionals can be the source of staff inadequacy. For example, certified nursing assistants (CNAs) are required to be supervised by licensed professionals, such as licensed practical nurses (LPNs), licensed vocational nurses (LVNs), or registered nurses (RNs).  The poor management of staff and the rate of staff turnover are also identifiable inadequacies.

Preventing Malnutrition

We know what needs to be done to prevent malnutrition: ensure seniors eat a healthy diet. But time and again caregivers fail to ensure proper nutrition, and the main reason is simple–they do not identify which residents need help at the outset.

Prevent malnutrition in elderly Nursing Home Residents

A comprehensive study this year on the benefits of malnutrition screening from the National Institutes of Health showed that it is critical for seniors to be tested on different variables on a consistent basis to check for malnutrition. By measuring residents based on body-mass index, weight loss, and food intake, researchers were able to develop a clear tracking system to identify which seniors were already malnourished or at heightened risk of malnourishment. The test itself also verified the prevalence of the problem, with over 60% of nursing home test subjects chosen at random experiencing either malnutrition or heightened risk of malnutrition.

The scientists explained that this method of screening and tracking seniors must be adopted by elder caregivers to ensure that intervention steps were taken to prevent seniors from suffering long-term harm from nutrition problems.

The Four Steps to Fighting Malnutrition

To better combat malnutrition, nursing home staff need to be alert to this issue and take steps to prevent malnutrition before it occurs.

Staff Education and Training to Better Identify the Signs and Symptoms of Malnutrition

It would serve the residents greatly if nursing staff were to be trained to identify residents who are having difficulty eating on their own. Picking up on visual cues and other clues is crucial to successfully prevent malnutrition since there are many reasons why a resident may not directly express their need for such assistance. The resident may be in pain or have trouble swallowing and may not want to bring attention to his or her difficulties.

Similarly, the resident may have poor motor control, and thus may have difficulty lifting cutlery to his or her mouth. A resident could be embarrassed about his or her diminishing ability to feed him or herself and may rather not eat than draw attention to him or herself.  Staff should be trained to recognize residents who are exhibiting any sort of lack of enthusiasm for eating and should ask the resident what the problem is.

Staff Need to Keep Track of Which Residents Eat, When They Eat, and How Much Food They Consume

Tracking what each resident eats, the frequency of eating, and assessing how much the resident eats of each meal can go a long way towards preventing malnutrition. A computer could be used to keep track of this type of information and could also be used to identify any changes in a resident’s diet based on previously recorded data.

Staff Must Provide Assistance to Residents Who Need Help With Eating

Federal law, codified as the Nursing Home Reform Act of 1987, requires that each nursing home resident shall be provided with adequate nutrition to maintain acceptable body weight unless a medical condition would make maintaining an acceptable body weight impossible. This law places a responsibility on nursing home staff to provide residents with physical assistance when eating if the residents require such assistance. This could include cutting up food for the resident, providing special cutlery, dishware, or straws, or preparing a meal in a liquid form for easier consumption.

Staff Should Conduct Regular Nutrition Assessments

Regular nutrition assessments help catch problems early. The Nursing Home Reform Act of 1987 requires staff to complete these evaluations when a resident enters a facility and every three months after. Staff must follow this schedule and document any concerning changes or patterns. When this process fails, families often seek a personal injury consultation in Evanston to address the oversight.

What is a malnutrition nursing care plan for the elderly

Legal Accountability

It is never acceptable for a nursing home to allow a resident to become malnourished. When a senior suffers medical complications due to poor nutrition, it may point to serious neglect and grounds for legal action. An experienced Illinois nursing home abuse law firm can help you hold the facility accountable and protect your loved one’s well-being. For help understanding your legal rights, feel free to contact Robert Rooth today.