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Tuesday, May 30, 2006

Neglect of the Elderly

There was much controversy a few weeks ago about a photo essay of the care of elderly residents in a nursing home. This was published in a nursing magasine and included shots of emaciated and naked residents being bathed and toileted. Without discussing the ethics of this photographic exercise, it was interesting to note that some of these photos were indistinguishable from pictures one might see of a starving refugee or a concentration inmate.

These photos beg the question of what factors are at play with many frail elderly: is the obvious emaciation the direct result of their ailments, or is it secondary? How much of their poor physical condition is due to chronic protein, vitamin and mineral deficiencies, lack of mental stimulation and insufficent exercise?

If you have not already done so, you might like to read my newsletter "Another Horror Story". One of the cases referred to in this article demonstrates just how quickly an elderly person can deteriorate and die if their nutrition and mental stimulation are neglected.

When you are in your 80"s, what do you intend to be doing?

I am convinced that a nutrient rich diet and stimulating physical and mental challenges are the foundations of a long and satisfying life. Sure, heredity has a lot to do with it; but we have no control over who each of our ancestors chose to mate with!


Anonymous said...

I feel better then I have in Years.

Anonymous said...

Hi Gary
The story was not about neglect of the elderly, it was to support a pay claim. I agree entirely with your comments about the lack of ethics in publishing the photos. I also agree with nurses that the workforce in residential care is underpaid and undervalued. However to imply that the photos show neglect goes too far for me. People are very sick and / or frail by the time they go into residential care these days. The people photgraphed were near to death. Good food keeps them living, but will not get them up and about again. There are strict standards around diets. No-one (apart from you!)has suggested that the people photographed were not getting good care. I have no doubt that there are bad residential providers out there (I closed a few when I worked for the Ministry!). But the vast majority provide really good care to people who are nearing the end of their lives, and yes people do get emaciated, for many it's part of the natural process of dying...

Gary Moller said...

Fair comments. I sometimes worry, when writing these articles, that the need for brevity is often at the risk of appearing unreasonable or "two one-eyed".

I was tempted to comment about the appalling wages these workers receive for what is a trying occupation. These people do it as much for love and with much compassion as for anything else. The wages are a joke. My ex-wife manages a nursing home and must deal daily with illness, death and grief. She lives on site and is on call 24/7. I do not know how she manages.

On your point about nutrition, I agree that emaciation is part and parcel of the dying process and this is not disputed. However; there is ample published evidence that dietary malnutrition is widespread in elderly populations and much of this can be prevented or alleviated. I would argue that the more ill a person, the greater the need for a nutrient rich diet - even if bed-ridden or terminal. Even a daily chocolate milk drink improves the health status of some elderly populations - evidence itself of just how poor general nutrition can be. My ex commented that many of her new residents arrive in a malnourished state due to their not coping at home for some time, living off white bread and little else in some cases.

I appreciate that aged care institutions are closely monitored to ensure that strict food standards are maintained, including having dietary plans for residents, such as diabetics. But this is flawed:
A diet that meets WHO RDA's is still inadequate in times of ill health, because RDA levels will only serve to maintain current nutritional status, which may be perilously low. Besides; many commonly prescribed medications, and treatments like chemotherapy, can have significant effects on digestion and nutrient requirements.

An extra $5 a day spent on ensuring a diet that well exceeds RDA's will be beneficial for institutionalised elderly. Ideally, this should include an array of tests to assess their actual nutritional status and repeated regularly to monitor progress of a diet plan that is tailored to need. I wonder; are vitamin D, folate, magnesium etc levels ever assessed?

Finally, we urgently need to improve the training, wages and conditions of the dedicated workers who provide aged care services.

Anonymous said...

Aye Gary, fair comment back..certainly worthy of dicussion! Thanks

Gary Moller said...

As a matter of interest, my partner was in hospital overnight not long ago. The staff were fantastic as per usual and the food looked good with the meat, fresh salad and so on. However, what counts is what actually goes down the gizzard and how it is digested and the nutritional satus of the person concerned. Anaemia for example, may require several months of deliberate attention to build body stores of iron in the bones organs and muscles to optimum.

Ill and heavily medicated people tend to eat little and much of what is served is returned on the plate. In may cases, poor dental care or ill-fitting dentures exacerbate the problem.

We have our own private joke that my partner will make sure that I have my food blender with me when she finally checks me in when I'm old and decrepit.

Incidentally, our 6 year old refused to eat the desert that was served in the hospital. It was a pink instant pudding and he screwed his nose up. I ate it and felt very guilty for several weeks after!