Nutrition therapy in the older critically ill patients: A scoping review

Abstract

Introduction: There is a lack of guidelines or formal systematic synthesis of evidence for nutrition therapy in older critically ill patients. This study is a scoping review to explore the state of evidence in this population. Method: MEDLINE and Embase were searched from inception until 9 February 2022 for studies that enrolled critically ill patients aged ≥60 years and investigated any area of nutrition therapy. No language or study design restrictions were applied. Results: Thirty-two studies (5 randomised controlled trials) with 6 topics were identified: (1) nutrition screening and assessments, (2) muscle mass assessment, (3) route or timing of nutrition therapy, (4) determination of energy and protein requirements, (5) energy and protein intake, and (6) pharmaconutrition. Topics (1), (3) and (6) had similar findings among general adult intensive care unit (ICU) patients. Skeletal muscle mass at ICU admission was significantly lower in older versus young patients. Among older ICU patients, low muscularity at ICU admission increased the risk of adverse outcomes. Predicted energy requirements using weight-based equations significantly deviated from indirect calorimetry measurements in older vs younger patients. Older ICU patients required higher protein intake (>1.5g/kg/day) than younger patients to achieve nitrogen balance. However, at similar protein intake, older patients had a higher risk of azotaemia. Conclusion: Based on limited evidence, assessment of muscle mass, indirect calorimetry and careful monitoring of urea level may be important to guide nutrition therapy in older ICU patients. Other nutrition recommendations for general ICU patients may be used for older patients with sound clinical discretion. Keywords: Critical care nutrition, geriatric patients, intensive care medicine, older adults, scoping review

ICU nutrition: Bracing for the silver tsunami

“…Hence, it is timely that in this issue of the Annals, Lee et al performed a scoping review to examine the extent of the research publications related to the nutrition therapy of older critically ill patients, summarised the key research findings, and identified research gaps in this area. 7 The authors identified 6 areas of interest: nutrition screening and assessments; muscle mass assessment; route or timing of nutrition therapy; determination of energy and protein requirements; energy and protein intake; and pharmaconutrition. One of the key findings was the paucity of large randomised control trials (RCTs) in elderly patients that could inform decision-making for the ICU team.…”