Resting energy expenditure and body composition in bedridden institutionalized elderly women with advanced-stage pressure sores

Abstract

Background. Our study investigated nutritional status, body composition, and resting energy expenditure (REE) in elderly patients with advanced-stage pressure sores (PS), in addition to researching any hypermetabolic condition and its relationship with PS size. Methods. The study involved 52 institutionalized bedridden elderly women (aged 83.7 ± 6.3 years), divided into two groups: 23 with advanced-stage (stage 3 and 4) PS and 29 without PS. Albumin, prealbumin, and retinol-binding protein were measured in all patients, and fat-free mass (FFM) and fat mass (FM) were obtained by dual-energy x-ray absorptiometry (DEXA). REE was measured by indirect calorimetry and predicted with the Harris-Benedict formula. PS area and volume were also measured. Results. The elderly women with and without PS were comparable in age, FFM, and FM. Mean albumin, prealbumin, and retinol-binding protein values were lower in cases with PS. Unadjusted mean REE was significantly higher in patients with PS (1212.3 ± 236.7 vs 1085.5 ± 161.3 kcal/d; p < .01). Hypermetabolism, i.e., a measured REE > 110% of the predicted REE, was seen in 74% of patients with PS and 38% of controls. The difference between measured and predicted REE (ΔREE) correlated with PS volume (r = 0.58; p < .01), but not with area. Conclusion. Advanced-stage PS in elderly women are associated with a hypermetabolic state that is influenced by the volume of the PS. Copyright 2007 by The Gerontological Society of America.