As of late, our nation has concerned itself with the widespread nature of obesity; however, this has resulted in inadequate attention to the problem of malnutrition or under-nutrition. Unfortunately, protein under-nutrition and malnutrition is regularly plaguing elderly residents of nursing facilities in California. A recent article by John E. Morley MB, BCh’s entitled “Undernutrition: A Major Problem in Nursing Homes,” in the May 2011 issue of Journal of the American Medical Directors Association, addresses this often neglected issue, describing in detail the various causes of and solutions to under-nutrition.
According to Morley, for every form of malnutrition, there are proven steps that nursing homes can take toward countering such grave and life threatening injuries. For example, Anorexia, as a form of under-nutrition, causes elderly individuals to be more susceptible to losing weight when illness strikes. Morley found that by improving food quality and environments, nursing homes can help prevent depression, which is a major cause of this form of weight loss. Cachexia can also result from anorexia, but exercise, creatine, and vitamin D can aid in the fight against this form of malnutrition. Additionally, poor cognition can arise from under-nutrition, but a well balanced diet can easily combat this tendency.
Morley’s research indicates that nursing homes have the solutions for further under- nutrition deficiencies, including low Vitamin D, Vitamin B12, and zinc levels, as well as dehydration. To increase Vitamin D levels, nursing homes simply need to ensure that their residents are exposed to more sunlight. For those with Vitamin B12 deficiencies, basic injections or inhalations of Vitamin B12 can bring their levels to a healthy state. Zinc replacement is the proven method for treating patients with low zinc levels. Finally, dehydration is common for elderly people because they do not know when they are thirsty, but nurses making “fluid rounds” consistently can make sure that patients are staying hydrated.
Morley’s research touches on an often overlooked but tragically common form of neglect in Bay Area nursing homes. According to California’s Elder Abuse Act, codified under California Welfare and Institutions Code sections 15610 et seq, “Abuse” of an elder or dependent adult can mean, among other things, (1) “neglect” or other treatment with resulting physical harm or pain or mental suffering; or (2) the deprivation by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering. (For access to the Welfare and Institutions Code and other California Statutes, visit Find California Code.)
Neglect is specifically defined by the code to include failure by any person having the care or custody of an elder or dependent adult to assist in personal hygiene or in the provision of food, clothing, or shelter, failure to provide medical care for physical and mental health needs, and failure to prevent malnutrition or dehydration. (Welf. & Inst. Code § 15610.57(b)(1)-(4).) The inability of many nursing home residents to properly feed or hydrate themselves, coupled with the decision by many nursing home operators to staff their facilities with the minimum level of direct care-givers, poses a grave risk to our elderly population.
There is a pressing necessity for adequate nutritional supplements in nursing homes to combat the issue of malnutrition, as well as for research and nutritional risk assessment. But a key component to providing such supplements and keeping dependent adults properly nourished and hydrated is adequate staffing, both in quantity and quality. Based on the information given, the steps are laid out: they simply must be taken.
The article “Undernutrition: A Major Problem in Nursing Homes” is available online at Pubmed.