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Nursing homes to be taught about elderly malnutrition

A new campaign will tell workers what to look for and what to do for the estimated 40 percent of residents who aren't eating or drinking enough.

As many as 40 percent of the nation's 2-million nursing home residents are malnourished, experts estimate, and a coalition of health care professionals and advocates is taking a first step to fight that.

The group plans to use educational materials to build the nutrition expertise of certified nursing assistants in the nation's 16,700 nursing homes to help them do a better job spotting such problems. It also hopes to provide this assistance for other nursing home professionals.

Malnutrition in nursing homes is a vexing problem because many seniors there lose their appetites and must be coaxed to eat. Nursing assistants are the health workers most in contact with residents and are likely to be aware of any eating difficulties.

Malnourished nursing home residents are prone to more infections and diseases, their injuries take longer to heal, surgeries carry more risk and hospital stays are longer and more expensive, health experts say.

In the end, those weakened by poor diet are more likely to die.

The campaign to attack malnutrition is being launched by the Nutrition Screening Initiative and a broad coalition of health care groups led by the American Academy of Family Physicians, American Dietetic Association and National Council on Aging. The Senate Special Committee on Aging and the Health Care Financing Administration support the effort.

The groups plan for the educational guides to lead nursing assistants and other nursing home staff through steps to recognize and correct nutrition-related problems.

The effort was applauded Thursday by Sen. Ron Wyden, D-Ore., a long-term care advocate who sits on the Senate committee on aging.

"America is at ground zero in its fight against (nursing home) malnutrition," he said. "Today, we begin an effort that can improve the health and lives of hundreds of thousands of older Americans."

Wyden said it was "morally repugnant" that nursing home residents are malnourished, particularly in a country with abundant wealth and resources.

The Nutrition Care Alerts guide offered by the groups includes warning signs and steps that can be taken by nurses, administrators and doctors to deal with four of the most common and "observable" malnutrition risk factors: weight loss, dehydration, pressure ulcers and tube feeding complications.

The estimate that two in five nursing home residents are malnourished came in a May study in the Journal of the American Geriatric Society. An earlier survey, sponsored by the Nutrition Screening Initiative in 1993, had a similar result.

James Firman, executive director of the National Council on Aging, applauded the new effort to tackle a problem that "has gone unaddressed for far too long."

It took an advisory board _ made up of 12 organizations representing physicians, nutritionists, regulators and the nursing home industry _ nine months to come up with the Nutrition Care Alerts.

Ann Gallagher, a dietitian and president of the American Dietetic Association, representing 68,000 food and nutrition professionals, called the guide a "great step forward" in helping aides recognize signs of nutrition-related problems.

Beyond simple loss of appetite, malnutrition can arise because of advancing disease, immobility or high turnover of nursing home staff, Gallagher noted.

And it doesn't always start in the nursing home, she added. About 50 percent of residents are already malnourished when they arrive.

Janice Zalen, director of special programs with American Health Care Association, representing more than 12,000 national long-term care facilities, said the guide is a "very practical and great" tool that will help caregivers in their fight against malnutrition.

"It's difficult making sure residents eat properly," especially when they are severely ill or suffer from depression, she said. "People are not aware of how serious this problem is or that nursing homes have to play catch-up."

Hattie Rawlings, who has been a certified nursing assistant for almost 30 years, said St. Elizabeth's Rehabilitation and Nursing Center in Baltimore began using the Nutrition Care Alerts on a pilot basis a month ago. When Rawlings first received the guide, she was skeptical. But after reading it, she keeps it in her pocket for quick reference.

"It really is useful," she explains. "It has helped a lot of us become more aware of warning signs and the suggestions help us to deal with the problems."

Eric Tangalos, chair of the division of Community Internal Medicine at the Mayo Clinic and former president of the American Medical Director's Association, said he hoped the initiative would also help educate the public about the seriousness of malnutrition among elderly people.

The experts hope the guide will help spur nursing home workers to come up with individualized meals and nutritional plans for each resident.

The Nutrition Screening Initiative will work with its partners to distribute the Nutrition Health Alerts to nursing homes, hospitals and other long-term facilities nationwide over the next few months.

This fall, the Health Care Financing Administration will begin testing the guide to assess whether it is useful and effective, said James F. Coan, a health insurance specialist with the agency. The program's supporters hope to use the tests _ to be held in about 10 nursing homes _ to hear from caregivers.

Nutritional needs of older people

Researchers have recommended a "food pyramid" similar to the familiar USDA guidelines, but adapted to the needs of older people.


Fats, sweets, caffeinated beverages

Grain products, bread, pasta

Fruits, vegetables

Dairy foods, meat and high-protein foods


Supplements: Calcium, vitamins D and B-12

Fats, sweets (small amounts)

Fruit (2 servings)

Meat, poultry, fish, beans, eggs, nuts (2)

Dairy foods (3)

Vegetables (3)

Whole-grain, enriched or fortified grain foods (6 or more)

8 glasses of water daily (Older people tend to lose their sensation of thirst)

Sources: Journal of Nutrition, Tufts Univ. Human Nutrition Research Center on Aging.