Basic energy and nutrient needs
The incidence of dysphagia, or difficulty in swallowing, increases with age. Dysphagia results from conditions such as stroke, Alzheimer's or Parkinson's disease, multiple sclerosis, or physiological changes such as loss of teeth or poorly fitting dentures. Inadequate dietary intake as a result of dysphagia can lead to weight loss, dehydration, and nutritional deficiencies.
Dehydration is the most common cause of fluid and electrolyte disturbances in older adults. Reduced thirst sensation and fluid intake, medications such as diuretics and laxatives, and increased fluid needs during illness contribute to dehydration. Adequate water-intake guidelines are 1 ml water/kcal energy consumed, or 25-30 ml/kg of weight for most individuals.
Skin breakdown is a common problem, particularly in bedridden or immunologically impaired people. The most common skin breakdown is the pressure ulcer, which occurs in 4-30% of hospitalized patients and 2-23% of residents of skilled-care nursing homes. Pressure ulcers are graded or staged to classify the degree of tissue damage.