At least a third of the 1.6 million nursing home residents in the United States may suffer from malnutrition or dehydration, conditions that can aggravate or cause more severe medical problems such as tooth decay, broken bones, anemia, and low blood pressure—or in some cases even death—according to a new study supported by The Commonwealth Fund. "Much of this problem could be alleviated by increasing the number of overall staff and trained professional nurses at nursing homes so they can make sure residents are getting enough to eat and drink," said Sarah Greene Burger, executive director of the National Citizens' Coalition for Nursing Home Reform and lead author of the study, Malnutrition and Dehydration in Nursing Homes: Key Issues in Prevention and Treatment. Despite federal laws—including the Nursing Home Reform Act of 1987—that require nursing homes to meet residents' nutrition needs, one study cited in the report found as many as 85 percent of the elderly living in some of the nation's more than 17,000 nursing homes are malnourished. And in some nursing homes, from 30 to 50 percent are underweight. "The extent of malnutrition and dehydration in some American nursing homes is comparable to that found in many poor, developing countries where inadequate food intake is compounded by repeated infections," said study coauthor Jeanie Kayser-Jones, professor of physiological nursing in the School of Nursing, and professor of medical anthropology in the School of Medicine, at the University of California, San Francisco. "Undernourished residents suffer from any number of ailments that could easily be prevented if they were properly nourished. Unless action is taken, the incidence of malnutrition and dehydration is likely to become an even more serious problem as more Americans live longer." Malnutrition and dehydration have a variety of causes. Inadequate staffing, a lack of individualized care, high nurse aide turnover, and other structural factors within the nursing home setting contribute to the problem. The understaffing situation at nursing homes is underscored by the fact that one certified nursing assistant (CNA) typically must help seven to nine residents eat and drink during the daytime, and as many as 12 to 15 during the evening meal. Ideally the ratio should be one CNA for every two or three residents who require eating assistance, the study says. Compounding the problem is the profession's 93 percent yearly turnover rate, which leads to inconsistent care. Chronic conditions such as depression and cognitive impairment—and the side effects of treatments for these conditions—are also a major factor. Residents suffering from depression, for example, are more likely to experience weight loss, the study says. Another obstacle to good nutrition is that nursing home residents commonly have a limited choice in what they eat, with their cultural and ethnic food preferences frequently ignored. Poor dental health also contributes to inadequate nutritional intake. "Malnutrition, dehydration, and weight loss in nursing homes constitute one of the largest silent epidemics in this country," said Karen Davis, president of The Commonwealth Fund. "As this report suggests, we can address this problem by promoting changes in public policy, seeking creative solutions from providers and professionals, undertaking further research on key issues, and enforcing existing standards." Coauthoring the report was Julie Prince Bell, community resource developer with the Piedmont Triad Council of Governments Area Agency on Aging in Greensboro, North Carolina. Kayser-Jones' research was supported in part by the National Institute on Aging, National Institutes of Health. The full report is available on the Fund's website at www.commonwealthfund.org.