Dehydration And Malnutrition In Nursing Homes

Across all age groups, nutritional well-being is critical to the quality of life. Yet, many older adults living in nursing homes are at risk of  inadequate nutrition and dehydration due to abuse and neglect. As such, dehydration and malnutrition remains a complex and widespread issue that affects the nutritional well-being of older adults, despite the numerous guidelines and reforms that are in place.

Studies show that nearly 40% of residents in nursing homes are malnourished and dehydrated, which can lead to severe health problems, and possibly death 1 . Though the Nursing Home Reform Act of 1987 mandates that nursing home facilities and providers need to continually assess the nutritional needs of their residents, and provide substitutes where necessary, dehydration and malnutrition deaths in nursing homes are on the rise 1,2 . The causes seem straightforward; however, it can be challenging to detect at the early stages, especially if the residents are under inadequate care.


Dehydration usually occurs when there’s an imbalance between fluid intake and production. According to the Mayo Clinic, dehydration occurs when fluids that have been used and lost during day-to-day activities––sweating and urination––are not replaced in a timely manner3. Here, the body is unable to function properly. This condition is particularly dangerous for older adults. For example, older people might be taking medicine that lowers the volume of water in their bodies, thereby doubling the risk of dehydration4

In nursing homes, the leading cause of dehydration is inadequate attention from staff–– refusal or forgetting to provide this basic necessity. Due to this lack of attentiveness, physical and physiological causes of dehydration might go unnoticed and unchecked, leading to an elevation in health problems. 

Due to the sheer number of nursing homes residents who are physically unable to fetch their own drinks, inadequate staff attention can lead to dehydration. Also, these residents might be unable to pinpoint any dehydration-related symptoms as they occur. Studies show that acts such as the absence of fresh water within the resident’s reach and failing to open containers or bottles are very common in nursing homes2.

What to look out for

  • Extreme thirst*
  • Reduced Urination
  • Dark-colored Urine
  • Restlessness
  • Confusion 
  • Dizziness
  • Chills

*For many people, thirst isn’t always a reliable indicator of dehydration3

Life-threatening symptoms include seizures, vomiting, and hyperventilation, and should be treated immediately they occur. 


The Mayo Clinic describes malnutrition as caused by the consumption of a little food, or an unbalanced diet lacking in nutrients4. Nursing home facilities are mandated to address issues that contribute to the heightened risk of nutritional deficiencies and to carry out the necessary corrective measures to improve their residents’ quality of life. However, according to a study conducted by Carol Evans, nutritional deficiencies in nursing home residents are common5. This problem can be linked to a combination of several social, psychological and physical issues.

Studies show that the most common misconception about malnutrition is that nutritional deficiencies in older people are expected and that any interventions are minimally effective5. This misconception has led to numerous cases of nursing home neglect. Here, the typical go-to corrective measure is to supplement food with liquids, special diets, or pureed food instead of ensuring that nursing home residents get the minerals and vitamins they need to function adequately1.

In nursing homes, the lack of individualized care is a primary cause for malnutrition. Simple acts such as––exercises, exposure to fresh air, mental and sensory stimulation, eating with others––can lead to an elevation of negative moods such as depression, and consequently an increased appetite. However, this is not the case. According to Carol Evans, depression is unrecognized in older adults, which leads to the misconception that such individuals are comfortable eating and being alone5. The reality is that reduced social contact with others can lead to loneliness and a loss of interest in eating4

Another reason that can cause malnutrition in nursing home residents is the inability to feed oneself, coupled with inadequate oral health care––before and after meals. According to the Mayo Clinic, general oral healthcare can be a deterrent to the consumption of nutritious food4. Issues such as difficulty swallowing or chewing, and an increased inability when handling cutlery can lead to inadequate food intake.   

What to look out for

  • Weak Immune System
  • Weight Loss
  • Easily Bruised
  • Poor Wound Healing
  • Memory Loss
  • Weakness
  • Fatigue
  • Confusion
  • Loose Clothing
  • Dry Skin

We are here to help

Dehydration and malnutrition are serious and life-threatening illnesses that need immediate attention. By law, nursing home facilities are mandated to apply a holistic approach when managing the nutritional well-being of their residents; encompassing the interactivity and social side of things as well. Without the mandated care, the immune system is weakened, and severe conditions can manifest, leading to a decrease in quality of life. 

If you notice anything out of the ordinary, report the problem immediately so that your loved one gets the medical attention that they need. Additionally, if you have witnessed, or your loved one has experienced abuse and neglect while under the care of a nursing home provider, contact a nursing home abuse lawyer immediately. Nursing home abuse lawyers specialize in nursing home maltreatment and abuse and can provide up-to-date guidance and support. Nursing home abuse lawyers continue to help victims reclaim their dignity and the respect they deserve through the justice system. Call us today for a free consultation. 


National Consumer Voice for Quality Long-Term Care. (2016) www.theconsumervoice.org

2  U.S Title 42 section 1395i–3; Requirements for, and assuring quality of care in, skilled nursing facilities (U.S. Code § 1395i–3).  https://www.law.cornell.edu/uscode/text/42/1395i-3 (Accessed 30th June 2020).

3  Mayo Clinic | Diseases and Conditions https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086 

4  Mayo Clinic | Senior health: How to prevent and detect malnutrition. https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/senior-health/art-20044699   (Accessed 30th June 2020). 

5  Carol Evans “Malnutrition in the Elderly: A Multifactorial Failure to Thrive.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396084/ (Accessed 30th June 2020). 

If you or a loved one suspect physical or sexual abuse, please contact our attorneys immediately.