Many Nursing Home Residents Dying from Malnutrition
In a special health feature, the Los Angeles Times reports that "thousands" of seniors in the nation's 17,000 nursing homes often "wast[e] away from too little food or water." According to the Times, about 35% to 85% of the nation's 1.7 million nursing home residents may suffer from malnutrition and dehydration, even at some of the "'best' --or costliest -- facilities." Elderly patients often "won't eat" because of a "dull" sense of taste or hunger, illness, disability, a "dislike of institutional food" or understaffed nursing homes that "can't provide enough individual attention for residents." In nursing homes, where "low-wage, overworked" nurses and nursing assistants "typically feed from five to 20" residents in about an hour, University of California-Los Angeles researchers found that "it takes an average of 40 minutes for just one nursing home resident to finish a meal." A recent UC-San Francisco study of 100 residents with eating problems at nursing homes in the Pacific Northwest found that inadequate staffing, "lack of attention to food preferences" and medical problems "all were factors in why people weren't eating." According to UCSF nursing professor Jeanie Kayser-Jones, the lead researcher in the study:
- Nursing home staff members "often were so rushed" that they "'shoveled' food into residents' mouths, causing choking and coughing";
- Nursing homes often served food, although "healthful," in "unappetizing form" -- "doled out in indistinguishable scoopfuls or pureed and mixed into a glass of milk";
- Residents often left food trays "untouched" and failed to consume nutritional supplements;
- Nursing assistants placed water pitchers "out of reach" or failed to open drink containers for residents with arthritic hands;
- Only one of 40 residents received the minimum fluid requirement -- at least six glasses daily.
In addition, some residents "went without liquids" for up to 24 hours, Kayser-Jones said, adding that some nursing assistants "avoided giving liquids to incontinent residents so that they wouldn't have to change clothes and bedding as often."
In 1998, Senate hearings on problems in nursing homes and a General Accounting Office report attributing the deaths of some California nursing home residents to poor nutrition and dehydration prompted HHS in 1999 to institute new guidelines that "dictate how nursing home investigators should evaluate weight loss, malnutrition and dehydration." Investigators must review nursing home records, interview health professionals and family members and "personally observe" at least two meals. Although advocates for nursing home residents "blame" the problem on short staffing, many experts on aging argue that nutrition and hydration problems "aren't solved merely by mandating that a nursing aide is responsible for fewer people." While researchers from UCLA's Borun Center on Aging "tried to encourage poor eaters," only about half "ate more than they had before," Sandra Simmons, lead author of a study on feeding assistance slated to appear in a gerontology journal, said. Borun Center Director Jack Schnelle said that the findings suggest that inadequate staffing or poor quality care "are not the only explanations for why some elderly patients won't eat"; sometimes, patients "just don't want the food." The Times reports that residents' "refusal or inability" to eat or drink places nursing home staff "in a difficult position" with "no easy answers." Researchers at the Borun Center are studying "different approaches," such as more frequent but smaller meals and an improved variety of food, but caution that "nothing is simple" with elderly patients (Allen, Los Angeles Times, 4/2).