Dehydration and malnutrition – is neglect always involved?

By Savi Hensman
December 2, 2013

Over the past decade in England and Wales, over two thousand people have died in care homes or hospitals while dehydrated or malnourished. Charities and politicians have expressed outrage. Some of these deaths are due to neglect, which should end – but unjustly blaming staff or managers when patients die for other reasons should also be avoided.

“More than 1,000 care home residents have died of thirst or while suffering severe dehydration over the past decade,” the Daily Telegraph reported after making a Freedom of Information request. “Elderly and vulnerable patients were left without enough water despite being under the supervision of trained staff in homes in England and Wales.”

“How can we call ourselves civilised when people are left to starve or die of thirst?” an Alzheimer’s Society director was quoted as saying. “It is an utter disgrace that they are ever left without the most basic care.”

“Norman Lamb, the care and support minister, said the deaths from thirst and starvation were ‘entirely unacceptable’,” wrote journalist Ben Riley-Smith. “He added that new CQC rules would allow it to intervene more effectively, and ministers would act to make company directors personally responsible for the care their organisation provides.” A Labour spokesperson also called for better care.

Other newspapers too picked up the story. “More than 2,000 people have died of dehydration or malnutrition while in a care home or hospital in the last decade,” the Guardian reported. “The figures show the ‘underlying cause of death’ in 2,162 recorded cases since 2003 was dehydration or malnutrition. They do not include the death toll in 2013.”

Understaffing is a serious problem in numerous hospital wards and care homes, and this can put wellbeing and indeed survival – especially of frail older and other disabled people – at risk. Overstretched community health and social care services also often fail patients in their own homes. And lack of training can mean that staff are not aware of service users’ need for physical assistance or prompting to eat and drink.

To tackle this effectively, it is important to address common causes, including underfunding linked to skewed social priorities, badly-designed systems and prejudice. Blaming staff or institutions for deaths they cannot avoid will only get in the way, and may have damaging consequences for residents and patients.

“Problems with chewing and swallowing are common in the later stages of dementia due to the person's muscles and reflexes no longer working properly,” points out one of the Alzheimer’s Society’s own factsheets. “Nutritional specialists can advise on a special diet or, if the person is unable to eat or drink normally, they can carry out an assessment to see whether or not having foods or liquid through a tube would be beneficial.”

Tube-feeding can be unpleasant, carries risks and may not always be in a patient’s best interests. And if a person’s organs are failing, pumping in fluid which the body cannot process can have nasty consequences.

What is more, if someone has capacity to decide they do not want to eat, drink or be artificially hydrated or nourished – for instance a person with end-stage cancer who has lost their appetite and is now ready to die – it is unlawful to force them. If the government were to change the law, this might cruelly limit people’s freedom and cause unnecessary suffering.

Watchdogs should indeed make checks when dehydration or malnutrition are listed on hospital or care home death certificates. But as the Office for National Statistics explained in notes accompanying the statistics on such deaths, “There are many explanations as to why someone becomes malnourished: for example they may have cancer of the digestive tract, which means they can't eat properly or can't absorb nutrients; they may have suffered from a stroke or have advanced dementia which can cause difficulties chewing and swallowing; or they may abuse alcohol and so not eat properly. The deceased may have been malnourished before they went into hospital… and perhaps only have been in hospital a very short time and the malnutrition may have nothing to do with not being fed properly in hospital.”

Threatening to punish hospitals and care homes even if deaths are not their fault may lead to falsification of death certificates or victimisation of frontline staff for providing end-of-life or emergency care. Worse still, attempts may be made to force patients to eat or drink when it is not in their best interests or they have made an informed decision not to do so.

To protect the human rights of care home residents and hospital patients, neglect should be tackled more effectively, while showing respect for individuals’ needs and choices and acknowledging the sometimes distressing realities of illness and dying. It is important to take account of the complex realities behind headline-grabbing statistics.

* The statistics can be found at:


© Savitri Hensman is a regular Christian commentator on politics, economics, society, welfare and religion. She is an Ekklesia associate and works in the equality and care sector.

Although the views expressed in this article do not necessarily represent the views of Ekklesia, the article may reflect Ekklesia's values. If you use Ekklesia's news briefings please consider making a donation to sponsor Ekklesia's work here.