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Malnutrition and Dehydration in Nursing Homes: Key Issues in Prevention and Treatment

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, national experts on nutrition in nursing homes conclude in a new report.

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 report, Malnutrition and Dehydration in Nursing Homes: Key Issues in Prevention and Treatment, was written by Sarah Greene Burger and Julie Prince Bell of the National Citizens' Coalition for Nursing Home Reform, and Jeanie Kayser-Jones, a professor of nursing at the University of California, San Francisco.

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 report 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 report 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.

The report describes a range of potential solutions, noting that changes in public policy, further research on key issues, seeking creative solutions from providers, and enforcing existing standards could help begin to solve the problem.

Facts and Figures
  • It is estimated that 43 percent of all Americans who turned 65 in 1990 will spend some time in a nursing home during their lifetimes.
  • Anywhere from 35 percent to 85 percent of nursing home residents are malnourished. Sixty to 70 percent of nursing home residents are cognitively impaired; many of them require assistance with eating.
  • Swallowing disorders (dysphagia) due to dementia, stroke, Parkinson's disease, and other neurological diseases affect from 40 percent to 60 percent of nursing home residents.

Publication Details



Malnutrition and Dehydration in Nursing Homes: Key Issues in Prevention and Treatment, Sarah Greene Burger, Jeanie Kayser-Jones, and Julie Prince, National Citizens' Coalition for Nursing Home Reform, The Commonwealth Fund, July 2000