Food and Nutrition in Nursing Homes
Castellanos, Victoria Hammer, Generations
Approximately 1.5 million older adults currently reside in skilled nursing facilities, or nursing homes, in the United States. With the nursing home's own unique culture and challenges, a number of factors set apart the delivery of nutrition care in this setting compared to others.
WHAT IS UNIQUE ABOUT NURSING HOME NUTRITION?
Nutrition care in nursing homes is unique in both the challenges and opportunities it provides. First, in the nursing home environment, in particular, the facility is die resident's home, and many residents will live out the remainder of their lives there. second, die residents of nursing homes tend to be both very elderly and quite frail, often suffering from a host of chronic and acute diseases and conditions. Third, the residents' physical ability to eat enough food is greatly reduced because of aging and disease processes. And, fourth, nutrition care is both driven and hindered by the regulatory environment. In sum, the characteristics of skilled nursing facilities and those who reside in them make nutritional well-being difficult to achieve but also present a rare opportunity for the nutrition professional to significantly affect both the health outcomes and quality of life of a significant number of older people.
The facility as home. Both regulations and ethics require nursing facilities to meet the nutritional needs of residents while maintaining their dignity and quality of life (American Health Care Association, 2003). After all, the long-termcare facility is "home" for this population of older adults. Unlike a stay in a hospital, residence in a nursing home is not a short-term situation in which limited choice and reduced quality of life are justified by short-term clinical goals. But, as in a hospital, decisions in nursing homes are made facility-wide regarding the menu and die exact nature of meal and snack service. The implications of this situation for the nursing home residents are that each food, dining environment, and staffing decision made at die facility level will serve to either limit or expand the nutrition and eating pleasure available to them for a significant portion of their remaining life.
Again, although such decisions bring with them significant responsibility, they also afford tremendous opportunity for the care provider. That is to say that the nursing home has both the infrastructure and consistency of client contact that make it possible to move beyond a reactive, medical model and instead adopt a proactive, prevention-focused approach to nutrition care for large numbers of people.
Illness and advanced age. The nutritional needs of nursing home residents are likely to be affected by both illness and advanced age. In recent years increased attention has focused on the role of nutrition in healthy aging. While it certainly is a worthy goal to help people retain their vitality and productivity in their later years, many people will nevertheless suffer a sharp decline in their health near the end of their lives and will require some type of skilled nursing care. Most nursing home residents are medically frail, with at least five chronic health conditions and intermittent bouts of acute illnesses such as infection and diarrhea. These conditions and incidents tend to increase nutritional needs. Further, some aspects of institutional living itself may affect nutritional needs. For example, too little exposure to sunlight makes residents highly dependent upon dietary and supplemental sources of vitamin D.
Nursing home residents also tend to be very old. Today's nursing home resident is typically older than age 7$, and many are in their pos or older. Some nutritional needs can increase with age. For example, as people age, their kidneys are less able to concentrate urine, and so more water may be needed to replace water loss through urination (Chidester and Spangler, 1997). Also, physiological changes commonly associated with aging can decrease absorption of some nutrients, including vitamin Biz and calcium (Institute of Medicine, 1998,2001). …