Morley J E, Silver A J
St. Louis University School of Medicine, Missouri, USA.
Ann Intern Med. 1995 Dec 1;123(11):850-9. doi: 10.7326/0003-4819-123-11-199512010-00008.
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.
疗养院居民中最常见的营养问题是体重减轻以及随之而来的蛋白质能量营养不良。尽管这些患者体重减轻的原因通常是可以治疗的，但在疗养院中却很少能被识别出来。抑郁症和药物不良反应是体重减轻最常见的原因。我们讨论了疗养院中饲管的合理使用以及早期使用肠内营养以预防严重蛋白质能量营养不良的发生。维生素缺乏，尤其是叶酸和维生素B6缺乏，在疗养院居民中经常出现。髋部骨折常与维生素D缺乏有关。微量矿物质缺乏（例如锌缺乏）会加重免疫缺陷并延缓伤口愈合。液体摄入不足会导致脱水、低血压，对于糖尿病患者还会导致高渗状态。最后，食物摄入本身会导致餐后低血压（进而可能导致跌倒），引起电解质紊乱，并导致吸入性肺炎。体育活动计划是疗养院护理的重要组成部分，可能会对营养状况产生影响，而且简单且经济高效的计划可能与高科技计划一样有益。密切关注疗养院居民的营养摄入既是一个临床问题，也是一个生活质量问题。
