Malnutrition
Many elderly people don’t eat well, for many reasons. Taste sensations are not as vibrant, food aromas are not as pleasant anymore, dentures don’t fit well. CNA’s can do much to help the nursing home resident eat better. Malnutrition is a costly and tragic occurrence. Nutritional well-being is an important part of successful aging. Improper nutrition or malnutrition can lead to infections, confusion, and muscle weakness resulting in immobility and falls, pressure ulcers, pneumonia, and decreased immunity to bacteria and viruses. Malnutrition lowers the quality of nursing home residents’ lives, and is often avoidable.
When a resident enters a facility for the first time, a nutritional assessment should be done by the dietitian. Based on this assessment, the facility must take steps to ensure that the resident maintains good nutritional health and must provide residents with a well-balanced, palatable meal.

There are several causes of malnutrition. Here are a few:
Physical Causes:
· Illness
· Adverse drug effects such as nausea, vomiting, diarrhea, cognitive disturbances, or sleepiness
· Food and drug interactions which decrease the ability of the body to absorb vitamins and minerals
· Depression
· Swallowing disorders
· Mouth problems such as tooth loss, dentures that do not fit properly, mouth sores, and mouth pain
· Tremors, which affect the residents’ ability to feed themselves
· Residents’ toileting needs not addressed before meals

Environmental Causes:
· Inadequate attention from staff for residents who need assistance eating
· Staff who are uneducated about malnutrition and proper ways to feed residents who need help
· Reliance on liquid supplements
· Special diets
· Loud, busy dining rooms with too much stimulation (staff talking to each other, yelling, dinner wear banging about ect)

What can a CNA do?
Several things. First, make sure your residents have been toileted before each meal (would you be able to eat while needing to GO badly?) or make sure residents are dry; encourage/do oral care before meals (I know this seems silly and time wise impossible, but it works). Also, make sure the dining room doesn’t have loud music playing- rather- play soft music from your resident’s generation; make sure your residents are seated correctly (buttocks all the way back in chairs, hips straight, neck/back aligned properly).
Next, make sure the food is edible. Seriously, if food comes down that is cold or smells bad- send it back to the kitchen for a replacement. Unappetizing foods are one of the biggest reasons WE don’t eat- our elderly are no different. Make sure the foods are culturally appropriate and honor religious values of the residents. Never force residents to eat food they strongly object to. Offer condiments- salt, pepper, catsup, mayo, ect. Nothing is a bad as eating a hamburger without the works—. Only offer supplements after residents have eaten a decent portion of their meal. Doing otherwise will only increase resident’s dependence upon the supplements. Foods that have been ground and pureed lose their appeal; dress up these foods with condiments. Make sure this food is at correct temperatures as well. Another important thing to consider: Many elderly prefer to eat in their rooms. Of course we staff always seem to not like this idea, but we are not the “Bosses” of the residents. If it means they will eat better, than let them eat where they want! Same with meal times- if a resident wants to sleep in and eat at 10am, let them. They can have their meals at whatever time they want. Never rush meals. Especially for the residents who depend upon us to feed them- we must take our time (after all we are being paid for this time). When we rush the resident senses this and almost always looses interest in eating. Getting families to help is an option too. Food likes and dislikes should be known by all staff who have anything to do with meals. Substitutions should be made readily available, and should be offered. Snacks should also be around. Making sure they are enough fluids with each meal is important too.