Nutritional Assessment and Nutritional Support Therapy in Elderly Patients

Abstract

In order to study nutritional asessment and nutritional support therapy for elderly patients, we conducted energy supply therapy on 15 elderly (aged over 75) patients disabled with diseases such as cerebrobascular disease, pneumonia and heart failure. After recovery from acute phase, they were divided into 3 groups, and assigned to 3 different energy supply methods for 2 weeks: Six (3 males, 3 females) could take hospital diet, but only could absorb about 50% of the energy, amounting only 1,000 to 1,400 kcal/day. Additional 246 kcal was given by peripheral parental nutrition (PPN). Five (2 males, 3 females) were unable to take nutrition orally. Therefore, they were given high caloric nutrients by total parental nutrition (TPN). giving (1,222 kcal daily for a week), then 1,666 kcal for another week. Four (1 male, 3 females) also could not take meals orally, and had to be nourished by enteral nutrition (EN) with a nutrient preparation of 1,120 kcal for one week, then with 1,600 kcal for another week. In all 3 groups, the indeces of rapid turnover proteins (pre-albumin, retinol binding protein and transferrin), choline esterase and vitamin A significantly elevated after 2 weeks of therapy, though the increase of pre-albumin and RBP in TPN group was slightly below the significant level. The increase in rapid turnover proteins and choline esterase was greater in the order of EN, TPN and PPN. Vitamin C, on the other hand, decreased significantly with treatment in alll the groups, while vitamin E remained unchanged. The other nutritional indices: such as body weight, triceps skinfold thickness, arm muscle circumference, total protein, albumin, serum lipids, aplipoproteins and branched amino acid contents did not change significantly during the period of this study. These results indicate that 1) for nutritional assessment, rapid turnover proteins, choline esterase and vitamins A and C are more sensitive even to the nutritional treatment for 2 weeks. 2) for nutritional improvement in the elderly, nutritional preparations closer to values of a balanced diet are preferable, and more effective when delivered via digestive tract. © 1993, The Japan Geriatrics Society. All rights reserved.