Passed in 1987, the Nursing Home Reform Act (NHRA) addresses the prevention of among other things, malnutrition. Section (4)(A)(iv) of the Act specifies that skilled nursing facilities must provide “dietary services that assure that the meals meet the daily nutritional and special dietary needs of each resident”.
Malnutrition is defined as poor nutrition resulting from an insufficient or poorly balanced diet or from defective digestion or defective assimilation of food.
Malnutrition is often the result of lipid disorders, protein/energy undernutrition (PEU), or vitamin and mineral deficiencies. Nursing home residents with dementia, poor oral health, dysphagia (difficulty swallowing) or who take medications that irritate the stomach, are especially susceptible to malnutrition. The risk of malnutrition increases with the aging process.
Of the 1.7 million nursing home residents in the United States, 35-85% are malnourished, and 30-50% have substandard body weights.
Inadequate nutrition, although a problem unto itself, has far-reaching effects in the elderly. It can result in infections (including urinary tract infections and pneumonia), pressure ulcers, anemia, hypotension, confusion and impaired cognition, decreased wound healing, hip fractures, weakness, fatigue, apathy, depression, and inability to get out of bed.
Malnourished residents require longer stays when hospitalized for an acute illness and are five times more likely to die in the hospital than their well-nourished counterparts.
In addition, malnutrition can contribute to decreased quality of life.
Malnutrition in nursing home residents is most often caused by poor environment, lack of individualized care, inadequate staffing, high turnover, and lack of professional supervision of nurse’s aides. Even when nutritious meals are offered, cultural and ethnic food preferences are often ignored.
Nurse’s aides typically assist 12-15 residents during the evening meal, and residents are often fed quickly or forcefully, and sometimes not at all. Nurse’s aides have a 93% turnover rate per year.
In addition to an often impossible workload, new aides are often unprepared to care for residents who are at risk for malnutrition.
People who must be fed because of functional or cognitive impairments are at an increased risk of malnutrition.
The NHRA prompted the implementation of the federally mandated Resident Assessment Instrument (RAI), a comprehensive health assessment that must be performed upon the admission of each resident and at least annually. The RAI focuses on residents’ physical, cognitive, and psychosocial functioning, including malnutrition, weight loss, and the ability to feed oneself, and must be completed at least annually, including when a significant change in health status occurs.
Adequate staffing and training, careful monitoring, and the preparation of appealing and nutritious meals are an important first step to preventing malnutrition among nursing home residents.