ESPEN Guidelines on Parenteral Nutrition: Geriatrics

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2009, Vol.28 (4), p.461-466
• Main Authors: Sobotka, L, Schneider, S.M, Berner, Y.N, Cederholm, T, Krznaric, Z, Shenkin, A, Stanga, Z, Toigo, G, Vandewoude, M, Volkert, D
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Contraindications; Enteral Nutrition; Enteral nutrition in the elderly; Gastroenterology and Hepatology; Geriatrics - standards; Home Care Services; Home Nursing; Homes for the Aged; Humans; Malnutrition; Malnutrition - therapy; Malnutrition in the elderly; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Nursing Homes; Nutritional Status; Nutritional support in the elderly; Parenteral Nutrition - adverse effects; Parenteral Nutrition - standards; Parenteral nutrition in the elderly; Quality of Life; Subcutaneous fluid administration
• ISSN: 0261-5614; 1532-1983; 1532-1983
• DOI: 10.1016/j.clnu.2009.04.004

Summary Older subjects are at increased risk of partial or complete loss of independence due to acute and/or chronic disease and often of concomitant protein caloric malnutrition. Nutritional care and support should be an indispensable part of their management. Enteral nutrition is always the first choice for nutrition support. However, when patients cannot meet their nutritional requirements adequately via the enteral route, parenteral nutrition (PN) is indicated. PN is a safe and effective therapeutic procedure and age per se is not a reason to exclude patients from this treatment. The use of PN should always be balanced against a realistic chance of improvement in the general condition of the patient. Lower glucose tolerance, electrolyte and micronutrient deficiencies and lower fluid tolerance should be assumed in older patients treated by PN. Parenteral nutrition can be administered either via peripheral or central veins. Subcutaneous administration is also a possible solution for basic hydration of moderately dehydrated subjects. In the terminal, demented or dying patient the use of PN or hydration should only be given in accordance with other palliative treatments. Summary of statements: Geriatrics Subject Recommendations Grade Number Indications Age per se is not a reason to exclude patients from PN. C [IV] 1.1. PN is indicated and may allow adequate nutrition in patients who cannot meet their nutritional requirements via the enteral route. C [IV] 1.1. PN support should be instituted in the older person facing a period of starvation of more than 3 days or if intake is likely to be insufficient for more than 7–10 days, and when oral or enteral nutrition is impossible. C [IV] 1.1. Pharmacological sedation or physical restraining to make PN possible is not justified. C [IV] 1.1. PN is a useful and effective method of nutritional support in older persons but compared to EN and oral nutritional supplements are much less often justified. B [III] 1.2. Metabolic/physiological features in older subjects Insulin resistance and hyperglycaemia together with impairment of cardiac and renal function are the most relevant features. They may warrant the use of formulae with higher lipid content. C [IV] 2 Deficiencies in vitamins, trace elements and minerals should be suspected in older subjects. B [IIb] 2 The effect of nutritional support on restoration of depleted body cell mass is lower in elderly patients than in younger subjects. The oxidation capacity for lipi