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Neglect of malnourished condition compromises patient’s recovery

It is universally recognized that malnutrition in the elderly is an ominous sign.  It can lead to increased hospital length of stay and reduce the prognosis for recovery.  Without aggressive intervention, it substantially increases the risk of a cascade of complications, including skin breakdowns, pneumonia and even death.  It is irrefutably established that proper nourishment is essential to the recovery of the injured brain.   

Even though MAHC was aware at admission that our mother was suffering from malnutrition, it took anything but an aggressive approach to treating that condition.  A test that was recommended to assess nutritional status at admission was never carried out.  Other tests considered to be essential in monitoring the malnourished patient, such as glucose testing, were never conducted.  In a staggering departure from evidence-based protocols, the hospital did not bother to weigh our mother until the fifth week of her stay, by which time she had lost more weight. Even that came about only after a family intervention where we expressed grave concerns about our mother’s frail and emaciated appearance.  Enhanced nutrition formulas and supplements recommended in the treatment of malnourished patients were not acted upon or tried.  In fact, MAHC’s nutrition service notes do not even acknowledge her malnourished condition.  Repeated errors were made in the amount of nutrition delivered.  Required procedures to minimize, and test for, the risk of aspiration, which is often a life-threatening condition in the brain-injured elderly, and especially those on enteral support, were omitted on hundreds of occasions according to the chart.  

None of the physicians treating our mother, or any other member of her care team, advised us that she was malnourished or alerted us to the risks this presented.  Had they done so, we would have immediately questioned whether all available means were being pursued to treat this condition.  They clearly were not, as our extensive review of the literature on the subject has since informed us.

Ultimately, this neglect led to our mother being discharged from MAHC weighing less than when she arrived.  By this time, she had lost some 28 percent of her pre-injury weight. This placed her in the category of being severely malnourished.  It is a telling indication of the hospital’s standards that it would discharge a patient in this state and still declare that she received “appropriate care.”

This condition, like others, was never disclosed to the family, and its adverse effects on our mother’s cognitive and physical recovery lasted long after her discharge home.

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