Malnutrition and Dehydration
I was hired by the son of a man admitted to a Providence nursing home because of dementia. The father was at increased risk for dehydration because of his dementia and medications he was taking. The nursing home failed to prepare a care plan to address the risk of dehydration. The nursing staff did not systematically offer the resident fluids, provide him with assistance in drinking, monitor his fluid intake and output, or order lab tests such as a urinalysis to see if he was getting sufficient fluids. He became unresponsive and died from acute renal failure due to dehydration.
Malnutrition and dehydration are serious health conditions among the elderly. The elderly have a reduced sense of taste, appetite and thirst. Proactive steps may be required to prevent physical decline and wrongful death due to malnutrition and dehydration.
Causes and Risk Factors for Malnutrition and Dehydration
An individualized care plan should be in place to promote adequate nutrition and hydration based upon identifying risk factors such as:
- Risks for wandering, such as dementia, Alzheimer's disease, and medications that cause confusion
- Prior history of wandering and forgetting whereabouts.
Wandering Off and Elopement - Care Planning
Nursing Homes and assisted living residence are required to develop a care plan for residents who are at increased risk for wandering or elopement. The nursing home or assisted living residence should take precautionary measures that include:
- Inadequate food intake
- Poor food choices (since the elderly often eat less, it is more important to eat nutritional food)
Illness - Poor nutrient absorption
- Depressions
- Decreased sense of taste
- Alzheimer's, or other dementia
- Diabetes
- Stroke
- Urinary incontinence
- History of dehydration
- 4 or more chronic conditions
- Medications such as diuretics, antidepressants, psychotropics, or anti-anxiety medications
- Acute medical conditions such as colds and flues
Signs of Elderly Malnutrition and Dehydration
Keep a lookout for the following signs:
- Unintentional weight loss
- Dizziness, lethargy, weakness
- Dry eyes, mouth or skin
- Changes in behavior
- Fever
- Nausea, vomiting
- Small amount of concentrated urine
- Sunken eyes
- Skin that lacks its normal elasticity and sags back into position slowly when pinched up into a fold
Preventing Elderly Malnutrition and Dehydration
Assuring adequate nutrition for the elderly requires proactive measures, which may include the following:
- Increase protein intake by adding meat or peanut butter
- Offer liquid nutritional supplements between meals
- Change medication that causes a lack of appetite
- Treat conditions such as depression that cause a lack of appetite
- Offer a more liberal diet
- Offer frequent small meals
- Offer nutritional foods
- Offer flavor enhancers
- Make sure nursing home residents drink enough every day
- Offer residents fluids at meals and between meals, such as snack times
- Use fans or air conditioners to cool rooms during hot weather
- Monitor fluid intake and output
- Weigh residents, periodically
Liability for Malnutrition and Dehydration
In almost all cases, elderly malnutrition and dehydration are caused by neglect. Nursing home dietitians are required to assess the nutritional needs of their residents, calculate how much fluid each resident should receive on a daily basis and plan healthy meals and snacks. The nursing home is supposed to monitor food and fluid intake and take steps to encourage the eating of healthy foods. Nursing home staffs rarely provide residents with the recommended daily amount of hydration, which is typically between 1,500 cc and 2,500 cc of water a day. In some cases, nursing aides do not want to give nursing home residents fluids because then they will need help going to the bathroom.