The most common nutritional problems in
nursing home residents are
weight loss and concomitant
protein energy
undernutrition. Although the causes of
weight loss in these patients can usually be treated, they are rarely identified in the
nursing home. Depression and adverse
drug effects are the most common causes of
weight loss. We discuss the appropriate use of feeding tubes in the
nursing home and the early use of
enteral feeding to prevent the development of severe
protein energy
undernutrition.
Vitamin deficiencies, especially
folate and
pyridoxine deficiencies, frequently develop in
nursing home residents.
Hip fractures are often associated with
vitamin D deficiency.
Trace mineral deficiencies (for example,
zinc deficiency) can aggravate immune deficiency and slow wound healing. Inadequate fluid intake leads to
dehydration,
hypotension, and, in persons with
diabetes mellitus, hyperosmolarity. Finally, food intake itself can cause postprandial
hypotension (which in turn may precipitate falls), produce
electrolyte shifts, and result in
aspiration pneumonia. Physical activity programs are an important component of
nursing home care that may have an effect on nutritional status, and simple, cost-effective programs may be as beneficial as high-technology programs. Careful attention to the nutritional intake of
nursing home residents is both a clinical and a quality-of-life issue.