Introduction

Nursing home residents have many special needs, perhaps none more important than nutrition. A person's appearance, mood, resistance to illness and self-esteem can be improved through good general nutrition, the lack of which is overtly obvious to a skilled health practitioner.

What does it take to provide good nutrition for a nursing home resident? The people responsible for providing care or overseeing the well-being of elderly residents spend a great deal of time assessing and measuring the effectiveness of their dietary programs. Dietitians, cooks, food servers, nursing staff, therapists, doctors, family members and administrators all have a hand in making the meal plan successful.

Of course, having a "good meal" means more than eating a lot of calories. Here lies the key to the problem—eating is more than filling one's stomach or maintaining weight. When we partake in a meal, we fulfill physical, social and psychological needs. Missing out on one of these categories can greatly diminish the value of the meal.

Documentation

The amount of food consumed at each meal must be documented for each meal that records whether a resident consumes 25, 50, 75, or 100% of the meal. By documenting intake, special needs can be addressed such as the need for supplementation.

A resident who cannot feed himself must be evaluated for partial or total assistance. Special spoons and forks, as well as plates with plate guard are available and may be of assistance. It is important to remember that eating is a social activity and people need to feel socially adept when participating in mealtime activity. Humiliation for not being independent can bring forth anger and depression and further complicate matters. People with visual or hearing impairments may need adaptive devices; hearing aids must be turned on, dentures cleaned and eyeglasses polished before meal time. Remember that a resident who doesn't see well may have an exaggerated sense of smell—allow that resident to utilize this special ability to their advantage by seasoning their foods prior to consumption.

In most nursing facilities at least fifty percent of the resident population requires some help with meals, whether opening milk cartons and salt packets or actually hand feeding the resident, cleanliness is the first priority. Hand washing is necessary for both the resident and the helper. Positioning the feeder so that a direct line of conversation with the resident can be established is also important. Ideally the staff member, relative or visitors can be helpful in this process and should sit at the resident's eye level. Providing plenty of time for chewing and swallowing is also important—communicate a relaxed atmosphere and allow pauses in feeding and conversation.

Noise levels are often much too intense in general, but are especially bothersome when food is being served. Staff available for meal time has to be aware of and regulate noise and other environmental levels in the dining area. There is no harm in providing quiet music, but having a TV blaring the news in the background ground or watching "Soaps" at lunch time is distracting and counterproductive. Staff conversation must be limited to the resident's need— shouts of greeting between staff members or phone calls are inappropriate at meal time.

Dehydration is a problem that occurs when fluid output exceeds intake or the amount of fluid needed is not met by fluid intake. As a general rule, two liters of fluid a day are required for normal body functions. As with solid food, individual needs may vary widely and have to be assessed on an individual basis. Dehydration may be precipitated by loose bowels or excessive sweating or fever. Signs of dehydration include dry skin, poor skin turgor, thirst or fever.

Residents with dementia are at risk for dehydration if they cannot help themselves to water. At times they may be unable to communicate the need for a drink. Ensuring all residents are provided with beverages at meals can help deflect the onset of dehydration. A well established 'water pitcher' program and offering of supplemental fluids between meals can go a long way towards preventing dehydration in the geriatric nursing home patient.

In conclusion it can be said that meeting the nursing home resident's dietary requirements is an essential part of long term care. Whether there is a problem with food intake or fluid imbalance, care planning must identify and address the problem. People who have come to an advanced stage of life have the potential for multiple physical as well as psychological disorders—all disposed to interfere with their nutritional intake. As long term care professionals, we are obligated to be alert to the needs of our residents, whether they are dietary or quality of life issues.