Dehydration and Malnutrition from Ohio Nursing Home Abuse

Dehydration and malnutrition in nursing homesElderly dehydration is a frequent cause of hospitalization. In fact, it is one of the ten most common admitting diagnoses according to Medicare’s Health Care Financing Administration and it is one of the main forms of elder abuse and neglect associated with assisted living facilities. Sometimes dehydration has a big effect on a senior’s body, but at other times symptoms are more subtle and there are only small telltale signs that a life-threatening situation could be close at hand.

Dehydration is an excessive loss of body fluid—the person is losing more water than they are taking in and this disrupts the body’s normal functioning. Everyone’s body is in a constant state of losing water and everyone has a normal state of body water that relates to their weight. Anything below that normal state is dehydration—fluids aren’t replaced at an adequate rate and the body eventually does not have enough water to perform its natural functions.

Mild dehydration is defined as losing two percent of your body weight. It can affect your health if you already have cardiac or kidney problems. Severe dehydration occurs with four percent or greater body weight loss and can cause cognitive impairment and put a greater strain on the heart trying to pump with less fluid. If diagnosis of dehydration is missed the following may result:

  • Weakened immune system
  • Loss of muscle mass
  • Anemia
  • Worsened dementia
  • Bedsores
  • Pneumonia
  • Deadly electrolyte balances
  • Seizures
  • Kidney failure
  • Swelling in the brain
  • Loss of consciousness
  • Other organ failure
  • Coma
  • Death

The elderly need about half an ounce of fluid per pound of body weight each day. Therefore, a 150-pound person needs about 75 ounces of fluid per day.

What makes dehydration so common in the elderly?

There are several reasons dehydration may occur, but these are some of the most frequent:

  • Decreased thirst sensation and decreased fluid intake. A person’s sense of thirst becomes less acute with age, or with certain illnesses such as dementia. In other cases, frail seniors have a hard time getting up to get a drink when they are thirsty, or they may rely on caregivers who are unaware of their need for fluids.
  • Nursing home support staff may have limited training or experience in providing adequate hydration to residents and there is often a high level of employee turnover making care inconsistent. The staff may also lack a high level of supervision and may miss or avoid opportunities to provide fluids to elderly patients or fail to recognize the signs and symptoms of dehydration.
  • Side effects of medications. It is not uncommon for the elderly to be on several medications at any given time. Some of these may have a diuretic effect (help the body to get rid of water) and others may cause patients to sweat more or have increased medication concentration in the bloodstream resulting in development of toxicity.
  • Physiological changes in the body such as decreased kidney function. As we age our bodies lose kidney function and we are less able to conserve fluid and concentrate urine.
  • Illness which causes increased fluid loss. Vomiting or diarrhea can cause rapid dehydration in the elderly. Residents with cold or flu are especially at risk for increased dehydration.
  • Trouble swallowing due to dementia, stroke, Parkinson’s disease and other neurological diseases that affect 40 to 60 percent of nursing home residents.
  • Other risk factors for dehydration include: Chills, fever, infection, intake of food up to 80% fluid, impaired ability to consume fluid without assistance, warm environmental temperature, depression, flushing of skin (red face), excessive wound drainage, highly concentrated tube feedings, uncontrolled diabetes, and shortness of breath.

Those at highest risk for dehydration are bedridden females over age 85 who have four or more chronic illnesses and take four or more medications and also have at least one acute illness such as an urinary tract infection.

The following symptoms usually indicate an early stage of dehydration:

  • A dry, sticky mouth, dry brown tongue or dry mucus membranes
  • Thirst
  • Dry, inelastic skin or sores in the mouth or cracks around the lips
  • Decreased urination or concentrated dark urine

More severe symptoms include:

  • Sunken eyes or sunken cheeks
  • Rapid breathing or rapid heart rate
  • Low blood pressure or increased drop in blood pressure when changing positions
  • Inability to sweat
  • Confusion and irritability
  • Delirium or unconsciousness

In potentially dehydrated patients, one should also be alert to weight loss, difficulty walking, elevated temperature, weakness especially in the upper body which may be causing fall fractures, constipation, decreased appetite, headache, dizziness and nausea.

If you suspect hydration in an elderly loved one, check for a decrease in skin turgor by pulling up the skin on the back of their hand for a few seconds. If it does not return to normal almost immediately, the patient is probably dehydrated. You can also check if your loved ones is eating foods with water content such as fruit, vegetables and soups.

How can dehydration be prevented by the nursing home?

  • The staff should identify those at risk for dehydration and daily monitor their intake of fluids and their weight.
  • The staff should monitor intake and output measurements in those who are determined to be at especially high risk for dehydration. This includes those receiving tube feedings, those with catheters, residents ordered to restrict or encourage fluids, and those receiving intravenous fluids. If output is greater than intake, the risk of dehydration is higher.
  • Have a hydration program in place that includes assisting residents with drinking, offering a variety of beverages and provides drinks between meals as well as at mealtime.
  • Encourage residents to drink even when they are not thirsty.
  • Tell staff to check the color of the patient’s urine. Dark urine or infrequent output is a classic sign of dehydration.
  • The resident should be reassessed if his physical condition or mental state changes.
  • Obtain laboratory tests (from a physician) if signs of dehydration are noted. Dehydration can be indicated by low potassium, high sodium, elevated blood urea nitrogen and elevated creatinine. You can also speak to your loved one’s doctor and ask if these laboratory tests have been ordered for your loved one and if so, what the results were.

Does malnourishment affect nursing home residents?

Nutritional well-being is an important part of the healthy process and a core issue in the health of Ohio’s nursing home patients. Following dehydration, malnutrition is the next leading area of neglect found among nursing home residents. Although federal law requires nursing homes to meet residents’ nutritional needs, as many as 85 percent of the nearly 17,000 elderly living in the nation’s nursing homes are believed to be malnourished. Some 30 to 50 percent are underweight.

When your loved one is admitted to the nursing home, he or she should be evaluated for dietary and nutritional needs. Based on the nutritional assessment, the facility should take steps to ensure that the resident maintains adequate fluids and is provided with well-balanced, palatable meals.

How do people become malnourished?

Malnutrition is a condition that results from eating an unbalanced diet that lacks the proper amount of nutrients or has too many of a certain kind of nutrient.

Some nursing home patients suffer from depression and loss of appetite that causes them to eat less food. Others have dental problems, tooth loss, or ill-fitting dentures which make it difficult to eat certain kinds of foods.

Once a person has lost his ability to feed himself, the incidence of malnutrition often increases. In some nursing homes, the overwhelmed nursing assistant must feed seven to nine residents during the day and as many as 12 to 15 at the evening meal. One nursing assistant for every two or three residents who require assistance with eating is the preferred situation.

Cognitive impairment and side effects of prescription drugs and treatments are other causes of a failure to eat. Sixty to seventy percent of nursing home residents are cognitively impaired and cannot eat on their own. Each year those who are nourished by feeding tubes face the problem of improper tube insertion. According to the Center for Medicare and Medicaid Services (CMS), hundreds of nursing homes are cited for feeding tube problems on an annual basis.

Swallowing disorders due to dementia, stroke, Parkinson’s disease, and other neurological diseases affect another 40 to 60 percent of residents and affect their nutrition status.

Symptoms of malnutrition

These are some of the most commons signs of malnutrition:

  • Weight loss
  • Fatigue and dizziness
  • Swollen and/or bleeding gums or tooth decay
  • Fragile bones, muscle loss or weakness
  • Mental decline and memory loss
  • Decreased organ function
  • Bloated abdomen
  • Dry skin
  • Confusion and disorientation
  • Bedsores
  • Anemia
  • Urinary tract infections
  • Pneumonia

If your loved one suffers from two or more of these symptoms, you may need to take a closer look at how his nutritional needs are being provided. Try to discover:

  • If the patient is able to feed himself
  • If it takes a long time for the patient to eat
  • If the patient is rushed through meals or is unable to finish
  • If any special diet is being properly administered
  • If the patient eats better when someone is there to help with the meal
  • If the patient seems uninterested in food or seems to have lost his or her appetite?
  • Can the patient choose from a menu and does the meal schedule fit likes and dislikes?
  • Are snacks readily available?
  • Has the patient started any new medications or had any sudden weight loss?

Where to turn for further help

It is estimated that at least a third of the 1.6 million nursing home residents in the U.S. suffer from dehydration or malnutrition—conditions that, if not caught in the early stages, can aggravate and cause severe medical problems which can be life-threatening. Without proper hydration and nourishment, most elderly citizens can’t fight off infections.

If your loved one has been a victim or nursing home abuse or neglect involving dehydration or malnourishment or any form of nursing home abuse or neglect, you should contact a nursing home abuse lawyer. At Slater & Zurz LLP we have experienced attorneys who specialize in cases related to residents in nursing homes and we can help assure your loved ones are properly cared for. There is a good chance if your loved one is experiencing any of the symptoms described in the above article, he or she is being neglected in other ways. We will begin to assess your case immediately and offer you a free initial consultation. Please call us at 1-888-534-4850 or visit our webpage, slaterzurz.com.

We have offices in Akron, Canton, Cleveland and Columbus, Ohio.

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