Malnutrition and Dehydration

The importance of nutritional care of nursing home residents cannot be overstated. A nutritional diet is important for the resident’s physical and mental health. The elderly typically have decreased appetites. This can be compounded by physical and mental limitations, which make it difficult, if not impossible, for residents to feed themselves. Significant weight loss can suppress the immune system, decrease strength and reduce a resident’s ability to respond to stress.

Likewise, staying hydrated is very important to the resident’s overall health and well-being. Water is the most abundant and vital source in the human body. Adequate fluid intake is critical for all of the body’s processes. Unfortunately, dehydration is all too common in nursing home residents. Physical and mental limitations can make it very difficult for nursing home residents to maintain adequate hydration independently.

Clinical Signs of Malnutrition

1. Weight loss;
2. Dull eyes;
3. Pale skin;
4. Swollen lips and gums;
5. Swollen and/or dry tongue with a scarlet or magenta hue;
6. Poor skin turgor;
7. Cachexia (weak, emaciated condition); and
8. Muscle wasting.

Risk Factors for Malnutrition

1. Drug therapy that may contribute to nutritional deficiencies;
2. Poor oral health or hygiene, eyesight, motor coordination or taste alterations;
3. Depression or dementia;
4. Therapeutic or mechanically altered diet;
5. Lack of access to culturally acceptable foods;
6. Slow eating pace resulting in food becoming unpalatable, or in staff removing the tray before the resident has finished eating; and
7. Swallowing difficulties e.g. dysphagia.

Weight loss is a guide in determining nutritional status. There are suggested parameters for evaluating the significance of unplanned weight loss. They are as follows:

Federal Regulations and Guidelines

42 CFR §483.25(i) Nutrition – Based on a resident’s comprehensive assessment, the facility must ensure that a resident (1) maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident’s clinical condition demonstrates that this is not possible; and (2) receives a therapeutic diet when there is a nutritional problem.

Clinical Signs of Dehydration

1. Thirst;
2. Dry skin;
3. Dry mucous membranes and/or cracked lips;
4. Poor skin turgor;
5. Fever; and
6. Abnormal laboratory values (e.g., elevated hemoglobin and hematocrit, potassium, chloride, sodium, albumin, transferrin, blood urea nitrogen (BUN)).

Risk Factors for Dehydration

1. Dementia in which the resident forgets to drink or forgets how to drink;
2. Fluid loss and increased fluid needs (e.g., diarrhea, fever, uncontrolled diabetes);
3. Fluid restriction secondary to renal dialysis;
4. Functional impairments that make it difficult to drink, reach fluids, or communicate fluid needs (e.g., dysphagia, aphasia);
5. Decreased sensory perception; and
6. Refusal of fluids.

Federal Regulations and Guidelines

42 CFR §483.25(j) Hydration – The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health.

If you or someone you love has suffered from malnutrition or dehydration while residing in a nursing home, contact a nursing home abuse lawyer at Suthers & Harper. For a FREE consultation, please contact us online through our confidential evaluation form or call us toll free at 1.800.320.2384.