The authors of this article state that malnutrition, dehydration, and weight loss in nursing homes constitute one of the largest, silent epidemics in this country. According to studies using a variety of measurements and performed over the last five to 10 years on different nursing home subgroups have shown that from 35 percent to 85 percent of U.S. nursing home residents are malnourished. Thirty to 50 percent are substandard in body weight. In fact, according to the authors, the level of malnutrition and dehydration in some American nursing homes is similar to that found in many poverty-stricken developing countries where inadequate food intake is compounded by repeated infections. The consequences of these conditions for elderly nursing home residents are potentially serious.

The authors hypothesize that most cases of malnutrition and dehydration can be prevented or reversed, if they occur, with the use of an interdisciplinary approach. Physicians, nurses, speech pathologists, dietitians, dentists, administrative nursing home personnel, and CNAs must collaborate in resolving these problems.

Higher staff-to-resident ratios, both at mealtime and 24 hours a day, are imperative. CNAs must be taught how to assist residents with eating, and knowledgeable registered nurses must supervise them during mealtimes. Not only may malnutrition and dehydration result in readmission to the acute hospital—a stressful event for frail elders—but they also contribute to a decreased quality of life, morbidity, and mortality. In addition to these physiological, psychological, and pathological consequences, nursing home residents who do not receive adequate nutritionand hydration during the last months or years of their lives are denied one of life’s greatest pleasures—the enjoyment of food and drink of their choice in a pleasant, social environment.

From the Foreword:

When medications are prescribed for patients, the intent is to improve the patient’s quality of life by curing a disease, reducing or eliminating the symptoms of a disease, arresting or slowing a disease process, or preventing a disease or its symptoms from appearing in the first place (Hepler and Strand, 1990).

But a medication is a two-edged sword; it can cut both ways. The same dose of a medication given to two different people may cure one and harm the other. In recent years there has been a growing recognition in clinical literature, in the popular press, and in health policy circles that misuse of medications is creating serious health problems, disabilities, and death at an alarming rate. This "silent epidemic" can appear in a variety of situations – when a person is prescribed the wrong medication for his or her medical condition or age, the right medication in the wrong dose, or two or more medications that interact with dangerous, unintended side effects. Eight general categories of medication-related problems have been identified (table 1). The resulting physical and mental effects can make people feel worse instead of better, less functional, more confused, and less able to care for themselves. Medication-related problems occur most often in older people and are generally more severe.

From the Foreword:

This is the Alliance’s third report to the nation on the  shortage of health professionals trained to care for the nation’s older patients. This study, however, is different from the earlier reports in three fundamental ways.

 • This report focuses on the health professions team, not on physicians or geriatricians only. Appropriate care of the elderly requires a team of health professionals. The shortages we document are equally severe in nursing, pharmacy, social work, and indeed all the allied health professions.

 • By no means do we say that every elderly individual should receive care from a geriatric specialist. We do, however, suggest that every health care provider who treats elderly patients requires some specialized training.

 • Time is running out. Baby Boomers, who begin to turn 65 in a decade, will make a serious problem today practically impossible to solve in a few years.

 This report identifies 10 reasons why our nation has not yet addressed this critical issue. Behind these barriers are three inconvertible facts:

 • The numbers of older Americans have never been greater, and are about to soar.

 • The numbers of health professionals with some formal training in caring for the elderly are woefully inadequate even for today’s population.

 • The American people expect this problem to be fixed for themselves and their families. A recent survey conducted for the Alliance by Opinion Research Corporation shows that three out of every four Americans feel it is very important that their healthcare providers have some specific training to care for the elderly.

The first section of the report, The Health of Older Americans, presents data that illustrate changes that have taken place during the past two decades in several important measures of older Americans' health. Five key measures show trends in life expectancy, death rates, chronic disease, disability, and self-related health status.

The second and third sections present the national and state-by-state Report Card on Healthy Aging. The Report Card includes 10 indicators divided into three groups:

* Health Behaviors

* Preventative Care and Cancer Screening

* Fall-Related Deaths and Injuries

The Report Card grades the nation and the states based on targets set for the older population in Healthy People 2000, a national effort to improve health by establishing health targets and measuring progress. The Report Card uses a "Pass" or "Fail" grading system based on whether the nation and states met, or failed to meet, a target.

The fourth section or the report, Mental Health and Aging, presents challenges in treating mental illness among the elderly. The section focuses on the treatment of depression in later life, because most research on mental health services and the management of mental disorders relates to depressive disorders.

The fifth section, Training the Health Care Workforce--Present and Future, focuses on the growing gap between older Americans' health care needs and the knowledge of health professionals who care for them.

This article, from the American Dietetic Association (ADA), states the association’s position that the quality of life and nutritional status of older residents in long-term care facilities may be enhanced by liberalization of the diet prescription. The Association advocates the use of qualified dietetics professionals to assess and evaluate the need for medical nutrition therapy according to each person's individual medical condition, needs, desires, and rights.

 Nutrition care in long-term settings must meet two goals: maintenance of health and promotion of quality of life. This article explores the need for assessment of nutritional status through development of an individualized nutrition intervention plan. The Association stresses the need to balance medical needs and individual desires and maintain quality of life. The Association also stresses the need to consider that food is an essential component of quality of life. Balancing risks vs benefits of therapeutic diets is important. If the food is bland, unacceptable, or unpalatable, this can create risks for poor food and/or fluid intake, resulting in risk of weight loss and undernutrition and a spiral of negative health effects. Allowing the elderly to participate in diet-related decisions can increase their quality of life, and reduce the risks of weight loss and undernutrition and a spiral of negative health effects.