Elderly Starved of Nutrition in Homes

By Adam Cresswell and Kellie Bisset, The Australia

Australia

April 22, 2006

Nursing homes are allowing some residents to turn into living skeletons weighing as little as 28kg, potentially leading to scurvy, pressure ulcers, pneumonia, falls and delirium.

Experts say malnutrition of the elderly often goes unrecognised in nursing homes, hospitals and by relatives and that it is common for patients to shed more than 20kg before the problem is spotted and steps are taken to help them. 

One dietitian told The Weekend Australian that some nursing homes did not become alarmed if an elderly resident's weight dipped because that made them "easier to lift". 

Another expert, Peter Lipski, a staff specialist in geriatric medicine at Gosford Hospital on the NSW central coast, called on carers to give elderly people high-energy snacks like Mars bars and party pies between meals, saying it was a myth that it was normal for elderly people to lose 20kg to 30kg. 
"There is too much emphasis on low-fat diets and low salt for patients with heart disease and diabetes ... their food is bland and they don't eat it," Dr Lipski said. "You can't treat an 80-year-old diabetic the same as a 15-year-old. 

"Instead of removing scrambled eggs and chocolate biscuits (from their diets), give them a KitKat or Mars bar for afternoon tea." 
Estimates for the extent of malnutrition vary. A new study of elderly patients admitted to Williamstown Hospital in Melbourne has revealed that 62 per cent of the 75 patients assessed were either at risk of malnutrition (41 per cent) or actually malnourished (21 per cent). Of those, 20 out of 47 had previously been in other hospitals or nursing homes. 

But another expert, Michael Woodward, director of aged and residential care services at Melbourne's Austin Health, said 70per cent of those in residential care, and 40 per cent of elderly hospital patients, were receiving inadequate nutrition. "Loss of 20 or more kilos in residential care is common," the associate professor said. 

The official accreditation guidelines for aged-care facilities say that residents should "receive adequate nourishment and hydration". But a Senate select committee report on aged care heard evidence last year that this did not always happen. One aged-care advocate told senators one resident "spent two days on just mashed potatoes". 

Federal Minister for Ageing Santo Santoro said he would "seek out the results" of the Williamstown study and would ask his department "to fully consider its findings and any recommendations". "Any indication of malnourishment amongst older Australians is of concern to me and to the Government," he said. 
He said aged-care homes had to have processes to monitor residents' weight and general health for signs of malnutrition or dehydration. Residents or relatives who felt these requirements were being breached should complain first to the facility's management, he said. 

Aranka Nenov, a dietitian and co-author of the Williamstown study, called for screening of patients to pick up signs of malnutrition. 
"It's easier for someone to put back 3kg or 4kg than to find them a year or so later when they have lost 24kg," she said. 

Mifanwy McConville, 92, is one of the lucky ones. She was admitted to Williamstown on March 27 after falling in her hostel and breaking her hip and shoulder. On admission she weighed just 47kg, but has since gained 3kg after being given a daily high-energy, high-protein drink to supplement her meals. 
"She's a small eater ... she gets halfway through her meal, and she's had enough," Mrs Nenov said. "With that, over a period of time, she would become deconditioned and lose weight, as she has done."