Nutrition is major focus at many nursing facilities because it is often linked to medical conditions. Malnutrition and dehydration, in particular, are recurring issues at nursing facilities, especially because they can lead to falls, the development of pressure injuries and/or cognitive impairment.

Nutritional Assessment and Dietary Planning

Assessing a nursing home patient’s nutritional health is a highly individualized process that must include measuring food intake levels. Patients are typically assessed shortly after admission. Subsequent nutritional reviews should occur at regular intervals—usually quarterly and annually if a patient is not showing signs of nutritional issues. Similarly, patients should be weighed monthly, or more frequently if nursing staff notices sudden weight gains or losses.

Next, the nursing facility’s dietician should evaluate the nutritional assessments and create a dietary plan recommending the number of calories the patient should consume. To provide proper nutrition for a patient, it is important to consider each patient’s individual circumstances. Nursing staff observations should be noted and all information should be carefully documented.

10 Considerations for Nutritional Health in Elderly Patients

The nursing facility’s team, including staff, dieticians, and oral therapists, should consider the following factors:

• Ability to eat: There are multiple factors that may impede a patient’s ability to eat. This could include issues chewing or swallowing, as well as a lack the strength to cut food or to properly use utensils.
• Constipation: A patient who frequently suffers from fecal impaction may have a suppressed appetite, or may choose not to eat to avoid discomfort.
• Dentures or oral pain: The patient may have ill-fitting dentures or cavities that cause pain while eating, or may need dentures to properly chew food.
• Diet: The person’s diet may be unappetizing, whether it’s due to sodium restrictions for high blood pressure treatment, or reduced sugar intake because of diabetes maintenance.
• Depression: Some patients refuse to eat because they are depressed. In these situations, the nursing home may want to order a psychological intervention, or determine whether the presence of the patient’s family may encourage them to eat.
• Disease processes: Patients with certain medical conditions may experience weight changes depending on the stage of their disease. Some patients may gain weight because of fluid retention, then rapidly lose it after being placed on a diuretic. Nursing staff should be aware of a patient’s medications and treatment history, and how they may impact weight fluctuations.
• DNRs: The nursing home should know whether patients or their families have a do-not-resuscitate (DNR) order in place. DNRs may prevent the implementation of certain nutritional interventions, such as the placement of a feeding tube.
• Lifestyle habits: Sometimes patients’ culture or religion influences their diet. Patients who traditionally didn’t eat pork may not be able to vocalize their reason for refusing to eat pork chops at dinner. In some cases, it may be appropriate for the patient’s family to bring food that has cultural or traditional significance.
• Mobility: Patients who are more active will generally need to consume more calories to maintain their weight compared to patients who are largely sedentary.
• Pressure injuries: Patients with pressure injuries will need a higher caloric intake to facilitate the healing process.

For patients whose weight changes significantly in either direction—i.e., more than 5% in a month, or more than 10% in 180 days—the nursing facility should consider a variety of interventions. This may include a physician ordering a feeding tube, whether as a supplementary or sole source of nutrition. Alternately, the nursing home could provide the patient with protein supplements, or with “enhanced food” that contains additional nutrients.

Another option is providing the patient food that has a consistency compatible with the patient’s chewing and swallowing ability. The patient may require assistance at meal times, whether in the form of plates with raised edges, modified utensils, or manual feeding. For patients with Parkinson’s disease, ALS, or other conditions that cause tremors, the nursing facility may want to provide the patient with “finger foods” that are easy to grasp.

Ultimately, many factors contribute to a nursing home patient’s nutrition and health. A defense attorney’s ability to demonstrate that a nursing facility properly assessed and provided for a patient’s individual needs depends on familiarity with nutritional considerations in elderly populations. Click here for more information on how to obtain assistance in this process.