Nutrition as a risk for mortality and functionality in critically ill older adults

Abstract

Background There is no specific recommendation for nutrition therapy for critically ill older adults. However, targeting energy and protein balance and avoiding fasting could improve outcomes in this population with high‐risk nutrition outcomes. This study aimed to evaluate the associations between nutrition and mortality/functionality in critically ill older patients. Methods A single‐center retrospective observational study of critically ill patients aged 65 years or older was conducted. We extracted data from the dietitian evaluations on energy, protein, and the type of diet (fasting, oral, enteral, or parenteral) prescribed in the first week of intensive care unit admission. Primary outcomes were intrahospital mortality and independence and functional capacity evaluated after hospital discharge. Results Of the 2043 patients screened, 533 were included in the study. Most patients were men (52.1%), with a median age of 73 (68–78) years. Overall, the intrahospital mortality rate was 53.8%. Simplified Acute Physiology Score 3 (SAPS 3), serum albumin and C‐reactive protein levels, and surgical patients were independently associated with fasting in a multivariate analysis. The multivariate regression analyses showed that SAPS 3, serum albumin level, and fasting were independently associated with mortality. Each fasting day increases the risk of mortality by 16.7%. Also, independence and functional capacity were not related to nutrition prescription. Conclusion Older adults (65 years or older) constitute a fragile population in whom nutrition breaks were associated with increased hospital mortality. Furthermore, a prospective clinical trial is necessary to establish the best strategy to feed this population.

The mode and timing of administrating nutritional treatment of critically ill elderly patients in intensive care units: a multicenter prospective study

“…The study by Agarwal et al evaluated 3,122 patients with a mean age of 64.6 ± 18 years and concluded that participants suffering from malnutrition were 41% ( 4 ). In critically ill elderly patients, malnutrition was higher with poor outcomes, increased rates of infections, length of hospital stay, and mortality risks ( 5 ). More data are required to evaluate nutrition in critically ill elderly patients.…”