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Preoperative Nutrition in Elderly Patients and Postoperative Outcome

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Diet and Nutrition in Critical Care

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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.

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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

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Authors and Affiliations

  1. Department of Surgery, Medical Center Alkmaar, Wilhelminalaan 12, Alkmaar, 1815 JD, The Netherlands

    Julia van Wissen, Nathalie Bakker, Colin Heus & Alexander P. J. Houdijk

  2. Trial Center Holland Health, Alkmaar, The Netherlands

    Julia van Wissen, Nathalie Bakker & Alexander P. J. Houdijk

Authors
  1. Julia van Wissen
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  2. Nathalie Bakker
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  3. Colin Heus
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  4. Alexander P. J. Houdijk
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Corresponding author

Correspondence to Alexander P. J. Houdijk .

Editor information

Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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van Wissen, J., Bakker, N., Heus, C., Houdijk, A.P.J. (2014). Preoperative Nutrition in Elderly Patients and Postoperative Outcome. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_93-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_93-1

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  • Online ISBN: 978-1-4614-8503-2

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