These and other signs are symptoms of ongoing malnutrition or dehydration.

It should be common sense that a nursing home would satisfy the nutritional needs of the seniors who live there. And federal laws—including the Nursing Home Reform Act—demand that they do. And yet, behind their walls and inside their dining rooms, malnutrition and dehydration are becoming an epidemic among their elderly residents.

And according to one study supported by The Commonwealth Fund, they affect at least one-third of the 1.6 million residents living in our nursing homes… and as much as 85%.

While conditions that are common in old age (including dementia and tremors) can make it harder for seniors to feed themselves, malnutrition among nursing home residents is not inevitable.

Why It Happens

For most of us, it’s simple. When we’re hungry, we eat. When we’re thirsty, we drink. But for nursing home residents, meeting the body’s basic needs depends on many (often interconnected) factors. Some are big, some small... and without total diligence, breakdowns can happen anywhere. These factors include:

Staffing:

Nursing home staffs may lack sufficient education and training, turn over too rapidly to ensure quality care, or find themselves stretched too thin (sometimes because the facility wants to maximize profits). When a nursing home operates under these conditions, the staff may be unable to properly monitor three vital factors: your loved one’s weight, calorie intake, and intake of fluids. The staff may also overlook assessing the overall nutritional needs of your loved one—even though federal law requires them to do every three months.

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Assistance:

Different residents have different abilities and needs. Overworked or simply inattentive staffers may make food or liquids available to residents, but not provide the help they need to consume them. Something as simple as failing to open a carton or make sure that food is not only on the table, but also within reach can mean the difference between juice, milk, or a meal actually nourishing the body and sitting unused, waiting to be thrown out. Also, a staff that cuts corners may over-rely on liquid supplements. These are easier to deliver, but may not deliver all the nutrients of actual food.

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Medications:

Some drugs, especially diuretics, may require the resident to drink even more liquids than usual to prevent dehydration. Also, adverse reactions to medications can wreak havoc on a resident’s interest in, or ability to, ingest food and liquids. These reactions include nausea, but also sleepiness, cognitive impairment, and even a decreased ability to absorb vitamins and minerals. Even staff members who are attentive when it comes to medications and nutrition separately must also be mindful of the connection between the two.

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Mouth & Throat:

Tooth loss, difficulty swallowing (a common problem for Alzheimer’s sufferers), and even poorly fitting dentures may decrease a resident’s motivation to eat and drink, even though their dietary needs have not changed.

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Engagement:

Depression, loneliness, lack of physical activity, or an absence of mental stimulation can all lead to a diminished appetite.

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Dining:

It may be the food: with no taste, texture, or variety. It may be the dining room: too loud and chaotic. But whether it’s one of these or both, these factors can cut into a resident’s ability to get the proper nourishment. And while some people simply might not expect much from nursing home food, federal law does—specifying that nursing homes must provide residents with “a well-balanced, palatable meal” that is served at the right temperature.