Nutritional intervention in cognitively impaired geriatric trauma patients: a feasibility study

Abstract

Background: Most studies focusing on improving the nutritional status of geriatric trauma patients exclude patients with cognitive impairment. These patients are especially at risk of malnutrition at admission and of worsening during the perioperative fasting period. This study was planned as a feasibility study to identify the difficulties involved in including this high-risk collective of cognitively impaired geriatric trauma patients.

Patients and methods: This prospective intervention study included cognitively impaired geriatric patients (Mini-Mental State Examination <25, age >65 years) with hip-related fractures. We assessed Mini Nutritional Assessment (MNA), Nutritional Risk Screening (NRS 2002), body mass index, calf circumference, American Society of Anesthesiologists' classification, and Braden Scale. All patients received parenteral nutritional supplementation of 800 kcal/d for the 96-hour perioperative period. Serum albumin and pseudocholinesterase were monitored. Information related to the study design and any complications in the clinical course were documented.

Results: A total of 96 patients were screened, among whom eleven women (median age: 87 years; age range: 74-91 years) and nine men (median age: 82 years; age range: 73-89 years) were included. The Mini-Mental State Examination score was 9.5 (0-24). All patients were manifestly undernourished or at risk according to MNA and NRS 2002. The body mass index was 23 kg/m² (13-30 kg/m²), the calf circumference was 29.5 cm (18-34 cm), and the mean American Society of Anesthesiologists' classification status was 3 (2-4). Braden Scale showed 18 patients at high risk of developing pressure ulcers. In all, 12 patients had nonsurgical complications with 10% mortality. Albumin as well as pseudocholinesterase dropped significantly from admission to discharge. The study design proved to be feasible.

Conclusion: The testing of MNA and NRS 2002 was feasible. Cognitively impaired trauma patients proved to be especially at risk of malnutrition. Since 96 hours of parenteral nutrition as a crisis intervention was insufficient, additional supplementation could be considered. Laboratory and functional outcome parameters for measuring successive supplementation certainly need further evaluations involving randomized controlled trials.

Keywords: cognitive impaired geriatric trauma patients; elderly; malnutrition; perioperative nutrition management.

Figure 1

(A) Median albumin levels at admission; at days 2, 3, and 4 of nutritional supplementation; and at discharge. (B) Median PCHE = PCHE at admission and discharge. Notes: Data are given as median and quartiles. *P≤0.05. Abbreviation: PCHE, pseudocholinesterase.