Malnutrition in Nursing Homes

Malnutrition among seniors is a pressing, often overlooked issue. It can affect individuals at any age, but older adults are particularly vulnerable, including those in nursing homes or other skilled nursing facilities.

Understanding the causes, symptoms, and treatment options for malnutrition in older adults is a crucial component in the fight against elder neglect and abuse. Early intervention can significantly improve a senior’s health, quality of life, and longevity.

Malnutrition can involve:

• Insufficient caloric intake
• Deficiencies in essential nutrients, vitamins, or minerals
• Imbalances in nutrient consumption

A person may be malnourished if they experience involuntary weight loss due to inadequate calorie intake. A lack of protein, vitamin C, or other essential nutrients can contribute to malnutrition. One of the most common forms among seniors is protein-energy malnutrition.

It’s important to note that malnutrition can affect people regardless of their body weight. Even those who appear to be at a normal weight or are overweight may be sufferinf from malnutrition.

Common Causes and Risk Factors

Aging naturally brings changes to body composition and metabolic processes, often leading to reduced muscle mass and increased body fat. Despite a decreased caloric need, older individuals remain at high risk for malnutrition due to age-related factors.

A major contributing factor is the “anorexia of aging,” which refers to a reduction in appetite and food intake among the elderly. This phenomenon is often linked to frailty rather than a specific disease. Additional factors that complicate nutrition in seniors include chronic health conditions, medication side effects, financial constraints, bereavement, depression, and environmental influences.

Malnutrition in older adults is rarely caused by a single issue; rather, multiple interconnected factors contribute to it. Some of the most prevalent causes are known collectively as the ‘nine D’s’ of geriatric weight loss: dementia, depression, dentition, dysphagia, dysgeusia, diarrhea, dysfunction, drugs, and disease. Let’s take a look at each in turn.

Dementia

Dementia affects not only memory but also posture, physical function, and eating habits. Weight loss is common before and during dementia progression, with many patients experiencing swallowing difficulties or forgetting to eat altogether. Research indicates that malnutrition can accelerate functional decline in dementia patients.

Depression

Depression is prevalent among seniors, especially those in nursing homes or requiring home health care. Causes include chronic pain, financial hardship, social isolation, and bereavement. Depression often leads to a reduced appetite, increasing the risk of malnutrition.

Dentition

Tooth loss, gum disease, and ill-fitting dentures can limit food choices and impair chewing ability. Poor oral health can contribute to malnutrition, and malnutrition can worsen oral health conditions.

Dysphagia

Dysphagia – or difficulty swallowing – affects around 15% of seniors. It can lead to malnutrition and dehydration. Causes include loss of throat muscle function, medication side effects, stroke, dementia, neuromuscular disorders, and throat or mouth cancer.

Dysgeusia

Taste changes are common in older adults, leading to diminished appetite and reduced food intake. Dysgeusia may result from medication side effects, smoking, oral health problems, or neurological disorders. By age 50, taste bud cells regenerate less frequently, further impacting food perception.

Diarrhea

Persistent diarrhea can lead to weight loss, dehydration, and nutrient deficiencies. Causes include colorectal cancer, inflammatory bowel disease, irritable bowel syndrome, and medication side effects.

Dysfunction

Malnutrition can stem from reduced gut function, leading to impaired nutrient absorption. Weakened immune systems also contribute to frequent infections and poor wound healing. Additionally, seniors with mobility impairments may struggle to prepare or access food.

Drug Interactions/Medication Side Effects

Seniors often take multiple medications, increasing the risk of nutrient absorption issues, appetite suppression, and dry mouth. Common drug classes that affect nutrition include gastrointestinal medications, beta blockers, pain relievers, diuretics, blood pressure medications, and statins.

Disease

Many health conditions increase nutritional requirements while making it harder to meet them. Conditions such as stroke, COPD, heart disease, and diabetes can exacerbate malnutrition. Malnutrition can also worsen existing conditions, creating a vicious cycle of declining health.

Signs of Malnutrition

Malnutrition is frequently overlooked, even by healthcare professionals. Some common signs include:

• Unintentional weight loss (5% or more of body weight)
• Weakness and reduced strength
• Hand grip weakening
• Unsteady gait
• Loose clothing or dentures
• Decreased meal intake
• Slow wound healing
• Frequent illness
• Swelling in the abdomen, ankles, or legs
• Persistent diarrhea, vomiting, or nausea

Treating Malnutrition

Intervention strategies may include exercise, nutrititional supplements, oral health assessments and denture adjustments, and social and psychological support.

Timely intervention can reverse malnutrition, though recovery may take several months. Left untreated, malnutrition leads to higher hospitalization rates and lengthier stays, increased fall risk, and fatalities.

If you suspect a loved one is malnourished due to neglect or abuse in a nursing home or assisted living facility, an experienced elder abuse lawyer can help you determine if you have a case.