THE USE OF DIETARY RESTRICTIONS IN MALNOURISHED NURSING-HOME PATIENTS

OBJECTIVE: To evaluate the dietary prescriptions of nursing home patients who show evidence of malnutrition. DESIGN: A descriptive chart review. SETTING: Four chronic care facilities in Milwaukee, Wisconsin. PATIENTS: h total of 336 charts were randomly selected from the four facilities. Analysis was done on the 217 charts that included a recorded serum albumin. MAIN OUTCOME MEASURES: Serum albumin, height, most recent weight, weight recorded 6 months previously, major diagnoses, and current diets were recorded. Average weight change per month and body mass index were calculated. RESULTS: In 109 of the 217 patients, the serum albumin was less than 3.5 g/dL. 75.2 percent of the hypoalbuminic patients were on some sort of dietary restriction, including caloric restriction in 18% and sodium restriction in 35%. Sixty-six of the 217 patients had an average weight loss of greater than 1 pound per month, and 59% of this group were on dietary restrictions, with 21% on sodium restriction and 20% on limited calories. CONCLUSIONS: Malnutrition is a common problem in the nursing home population. A restricted diet is one possible factor that might contribute to this. While this study does not prove a causal relationship between a restricted diet and malnutrition, it would seem inappropriate that most patients with evidence of malnutrition are on diets that might discourage nutrient intake.