NUTRITIONAL ISSUES IN NURSING-HOME CARE

The most common nutritional problems in nursing home residents are wei ght loss and concomitant protein energy undernutrition. Although the c auses of weight loss in these patients can usually be treated, they ar e rarely identified in the nursing home. Depression and adverse drug e ffects are the most common causes of weight loss. We discuss the appro priate use of feeding tubes in the nursing home and the early use of e nteral feeding to prevent the development of severe protein energy und ernutrition. Vitamin deficiencies, especially folate and pyridoxine de ficiencies, frequently develop in nursing home residents. Hip fracture s are often associated with vitamin D deficiency. Trace mineral defici encies (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 hi gh-technology programs. Careful attention to the nutritional intake of nursing home residents is both a clinical and a quality-of-life issue .