Nutritional supplementation in elderly people during the course of catabolic illnesses

The benefit of nutritional support applied to elderly subjects during the course of catabolic illnesses is here discussed through the results of both a nutritional intervention study and a pragmatic prospective study. The early recognition of the nutritional risk is the basis of an adequate nutrition support. We have developed a visual method for estimating meal intake during hospitalisation. It permitted the exact quantification of energy and protein intake by a dietician or immediate but visual rough estimation by the nursing staff. These latter allowed classifying the patients according to the severity of the nutritional intake impairment. The oral nutritional intervention permitted to actually increase the mean dietary intake of critically ill elderly patients. This intervention was associated to a decrease in incidence rate of grade I pressure ulcer (erythema), but did not modify the death rate. On the other hand, the continuous training of the nursing staff for nutritional risk evaluation and oral nutritional support implementation led to significant improvements in practices. Such improvements in routine care were not followed by a significant decrease in inhospital adverse outcomes. However, in both studies the resulting average intake of these patients remained far from optimal and patients specific conditions played a critical role in adverse outcome rate. Thus, we propose to support the critically ill patients using oral supplementation (which is usually safe, when they are able to eat) on the basis of nutritional risk recognition.