Advertisement

Preoperative Nutrition in Elderly Patients and Postoperative Outcome

  • Julia van Wissen
  • Nathalie Bakker
  • Colin Heus
  • Alexander P. J. Houdijk
Reference work entry

Abstract

Malnutrition is a frequent problem in elderly patients, especially in the nursing home population. The cause of malnutrition is often multifactorial and includes biological, physiological, and psychological changes due to aging. The nutritional status of elderly people has a great effect on their general health and outcome after hospital admission and surgery. Malnutrition, resulting in loss of fat-free mass, loss of muscle mass, and vitamin deficiencies, is associated with significantly increased morbidity and mortality. The elderly surgical patient represents an increasing part of the total surgical population. Elderly patients are more at risk to develop postoperative complications because of an altered physiology, higher risk of malnutrition, and more comorbidities. Emergency operations are more common in elderly patients and of all operations the most riskful. There are different methods available to determine nutritional status, including questionnaires, anthropometric measurements, biochemical parameters, devices to measure body composition, and measures of muscle strength.

There are different strategies to improve the nutritional status, including complete nutrition such as enteral and parenteral feeding and supportive measures like carbohydrate drinks, vitamin supplementation, enriched protein drinks, and immunonutrition.

The nutritional status of the elderly surgical patient should be assessed by a combination of methods, including questionnaires and devices to measure body composition in order to be specific. With an adequate nutritional status, surgical outcome is easier to predict and malnutrition can be treated accurately. There is a need for more research with elderly surgical patients in the field of perioperative nutritional support on predictive measures of nutritional status.

Keywords

Nutritional Status Pressure Ulcer Mini Nutritional Assessment Handgrip Strength Malnutrition Universal Screen Tool 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations

ARDS

Acute respiratory distress syndrome

ASPEN

American Society of Parenteral and Enteral Nutrition

BIA

Bioelectrical impedance analysis

BMI

Body mass index

COPD

Chronic obstructive pulmonary disease

CT

Computed tomography

DEXA

Dual-energy X-ray absorptiometry

Elderly patient

≥65 years of age

Immunonutrition

Interventions with specific nutrients that have potential to modulate the activity of the immune system

Malnutrition

The condition that develops with a diet in which certain nutrients are lacking, in excess or in the wrong proportions, to maintain healthy tissue and organ function

MNA

Mini Nutritional Assessment

MUST

Malnutrition Universal Screening Tool

Pressure ulcer

Localized injury to the skin and/or underlying tissue that usually occurs over a bony prominence as a result of pressure or pressure in combination with shear and/or friction

Refeeding syndrome

In significantly malnourished patients, the initial stage of oral, enteral, or parenteral nutritional replenishment causes electrolyte and fluid shifts that may precipitate disabling or fatal medical complications. The refeeding syndrome is marked by hypophosphatemia, hypokalemia, hypomagnesemia, vitamin and trace mineral deficiencies, volume overload, and edema

SNAQ

Short Nutritional Assessment Questionnaire

References

  1. Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging. 2010;5:207–16.PubMedPubMedCentralGoogle Scholar
  2. Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev. 2010;1:CD001880.Google Scholar
  3. Bozzetti F. Surgery in the elderly: the role of nutritional support. Clin Nutr. 2001;20:103–16.CrossRefPubMedGoogle Scholar
  4. Buijs N, van Bokhorst-de van der Schueren MA, Langius JA, Leemans CR, Kuik DJ, Vermeulen MA, van Leeuwen PA. Perioperative arginine-supplemented nutrition in malnourished patients with head and neck cancer improves long-term survival. Am J Clin Nutr. 2010;92:1151–6.CrossRefPubMedGoogle Scholar
  5. Cerantola Y, Hubner M, Grass F, Demartines N, Schafer M. Immunonutrition in gastrointestinal surgery. Br J Surg. 2011;98:37–48.CrossRefPubMedGoogle Scholar
  6. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22:235–9.CrossRefPubMedGoogle Scholar
  7. Ellinger S, Stehle P. Efficacy of vitamin supplementation in situations with wound healing disorders: results from clinical intervention studies. Curr Opin Clin Nutr Metab Care. 2009;12:588–95.CrossRefPubMedGoogle Scholar
  8. Ferrari AU. Modifications of the cardiovascular system with aging. Am J Geriatr Cardiol. 2002;11:30–3.CrossRefPubMedGoogle Scholar
  9. Finucane TE. Evidence-based nutrition guidelines for critically ill adults. JAMA. 2009;301:1543–4.CrossRefPubMedGoogle Scholar
  10. Ftouh S, Morga A, Swift C. Management of hip fracture in adults: summary of NICE guidance. BMJ. 2011;342:d3304.CrossRefPubMedGoogle Scholar
  11. Harris D, Haboubi N. Malnutrition screening in the elderly population. J R Soc Med. 2005;98:411–4.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Kagansky N, Berner Y, Koren-Morag N, Perelman L, Knobler H, Levy S. Poor nutritional habits are predictors of poor outcome in very old hospitalized patients. Am J Clin Nutr. 2005;82:784–91.PubMedGoogle Scholar
  13. Kenney WL, Chiu P. Influence of age on thirst and fluid intake. Med Sci Sports Exerc. 2001;33:1524–32.CrossRefPubMedGoogle Scholar
  14. Kruizenga HM, Seidell JC, de Vet HC, Wierdsma NJ, van Bokhorst-de van der Schueren MA. Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ). Clin Nutr. 2005;24:75–82.CrossRefPubMedGoogle Scholar
  15. Marshall TA, Stumbo PJ, Warren JJ, Xie XJ. Inadequate nutrient intakes are common and are associated with low diet variety in rural, community-dwelling elderly. J Nutr. 2001;131:2192–6.PubMedGoogle Scholar
  16. Mauskopf JA, Candrilli SD, Chevrou-Severac H, Ochoa JB. Immunonutrition for patients undergoing elective surgery for gastrointestinal cancer: impact on hospital costs. World J Surg Oncol. 2012;10:136.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Mazess RB, Barden HS, Bisek JP, Hanson J. Dual-energy x-ray absorptiometry for total-body and regional bone-mineral and soft-tissue composition. Am J Clin Nutr. 1990;51:1106–12.PubMedGoogle Scholar
  18. Mikagi K, Kawahara R, Kinoshita H, Aoyagi S. Effect of preoperative immunonutrition in patients undergoing hepatectomy; a randomized controlled trial. Kurume Med J. 2011;58:1–8.CrossRefPubMedGoogle Scholar
  19. Miyatani M, Yang P, Thomas S, Craven BC, Oh P. Bioelectrical impedance and dual-energy x-ray absorptiometry assessments of changes in body composition following exercise in patients with type 2 diabetes mellitus. J Obes. 2012;2012:953060.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Morley JE. Anorexia of aging: physiologic and pathologic. Am J Clin Nutr. 1997;66:760–73.PubMedGoogle Scholar
  21. Mueller C, Compher C, Ellen DM. A.S.P.E.N. clinical guidelines: nutrition screening, assessment, and intervention in adults. JPEN J Parenter Enteral Nutr. 2011;35:16–24.CrossRefPubMedGoogle Scholar
  22. Nespoli L, Coppola S, Gianotti L. The role of the enteral route and the composition of feeds in the nutritional support of malnourished surgical patients. Nutrients. 2012;4:1230–6.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Norman K, Stobaus N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr. 2011;30:135–42.CrossRefPubMedGoogle Scholar
  24. Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate nutrition: an update. Curr Opin Clin Nutr Metab Care. 2001;4:255–9.CrossRefPubMedGoogle Scholar
  25. Perrone F, Silva-Filho AC, Adorno IF, Anabuki NT, Leal FS, Colombo T, da Silva BD, Dock-Nascimento DB, Damiao A, Aguilar-Nascimento JE. Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial. Nutr J. 2011;10:66.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Phillips RM. Nutrition and depression in the community-based oldest-old. Home Healthc Nurse. 2012;30:462–71.CrossRefPubMedGoogle Scholar
  27. Pichard C, Kyle UG, Morabia A, Perrier A, Vermeulen B, Unger P. Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay. Am J Clin Nutr. 2004;79:613–8.PubMedGoogle Scholar
  28. Pofahl WE, Pories WJ. Current status and future directions of geriatric general surgery. J Am Geriatr Soc. 2003;51:S351–4.CrossRefPubMedGoogle Scholar
  29. Potter J, Klipstein K, Reilly JJ, Roberts M. The nutritional status and clinical course of acute admissions to a geriatric unit. Age Ageing. 1995;24:131–6.CrossRefPubMedGoogle Scholar
  30. Ramos MA, Asensio VA, Nunez PA, Millan S. Prevalence and risk factors associated to malnutrition in elderly inpatients. An Med Interna. 2004;21:263–8.Google Scholar
  31. Rosa F, Bossola M, Pacelli F, Alfieri S, Doglietto GB. Malnutrition and postoperative complications in abdominal surgery. Ann Surg. 2011;254:666–7.CrossRefPubMedGoogle Scholar
  32. Rubin CD. Evaluation and management of hip fracture risk in the aged. Am J Med Sci. 2012;343:233–42.CrossRefPubMedGoogle Scholar
  33. Rudolph FB, Kulkarni AD, Fanslow WC, Pizzini RP, Kumar S, Van Buren CT. Role of RNA as a dietary source of pyrimidines and purines in immune function. Nutrition. 1990;6:45–52.PubMedGoogle Scholar
  34. Sanchez AC, Zabarte Martinez dA, Bordeje LL. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: gastrointestinal surgery. Nutr Hosp. 2011;26 Suppl 2:41–5.Google Scholar
  35. Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144:581–95.CrossRefPubMedGoogle Scholar
  36. Stableforth WD, Thomas S, Lewis SJ. A systematic review of the role of immunonutrition in patients undergoing surgery for head and neck cancer. Int J Oral Maxillofac Surg. 2009;38:103–10.CrossRefPubMedGoogle Scholar
  37. Tappy L, Berger MM, Schwarz JM, Schneiter P, Kim S, Revelly JP, Chiolero R. Metabolic effects of parenteral nutrition enriched with n-3 polyunsaturated fatty acids in critically ill patients. Clin Nutr. 2006;25:588–95.CrossRefPubMedGoogle Scholar
  38. Turnock A, Calder PC, West AL, Izzard M, Morton RP, Plank LD. Perioperative immunonutrition in well-nourished patients undergoing surgery for head and neck cancer: evaluation of inflammatory and immunologic outcomes. Nutrients. 2013;5:1186–99.CrossRefPubMedPubMedCentralGoogle Scholar
  39. van Stijn MF, Boelens PG, Richir MC, Ligthart-Melis GC, Twisk JW, Diks J, Houdijk AP, van Leeuwen PA. Antioxidant-enriched enteral nutrition and immuno-inflammatory response after major gastrointestinal tract surgery. Br J Nutr. 2010;103:314–8.CrossRefPubMedGoogle Scholar
  40. van Stijn MF, Korkic-Halilovic I, Bakker MS, van der PT, van Leeuwen PA, Houdijk AP. Preoperative nutrition status and postoperative outcome in elderly general surgery patients: a systematic review. JPEN J Parenter Enteral Nutr. 2013;37:37–43.CrossRefPubMedGoogle Scholar
  41. Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15:116–22.CrossRefPubMedGoogle Scholar
  42. Volgyi E, Tylavsky FA, Lyytikainen A, Suominen H, Alen M, Cheng S. Assessing body composition with DXA and bioimpedance: effects of obesity, physical activity, and age. Obesity (Silver Spring). 2008;16:700–5.CrossRefGoogle Scholar
  43. White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr. 2012;36:275–83.CrossRefPubMedGoogle Scholar
  44. Whitehead C, Finucane P. Malnutrition in elderly people. Aust N Z J Med. 1997;27:68–74.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Julia van Wissen
    • 1
    • 2
  • Nathalie Bakker
    • 1
    • 2
  • Colin Heus
    • 1
  • Alexander P. J. Houdijk
    • 1
    • 2
  1. 1.Department of SurgeryMedical Center AlkmaarAlkmaarThe Netherlands
  2. 2.Trial Center Holland HealthAlkmaarThe Netherlands

Personalised recommendations