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Nutrition and Critical Care in Very Elderly Stroke Patients

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Diet and Nutrition in Critical Care

Abstract

Most strokes occur in elderly people, and stroke incidence increases sharply with advanced age. Strokes in very elderly patients are generally more severe and have poorer outcomes than those in younger patients. Malnutrition after an acute stroke is a risk factor for poor prognosis, and very elderly acute stroke patients are at a high risk of malnutrition upon admission. In addition, their nutritional status tends to deteriorate after the occurrence of a stroke. Very elderly acute stroke patients have several risk factors for malnutrition, such as chronic diseases, dysphagia, and a bedridden state. Dysphagia is a major risk factor for malnutrition in acute stroke patients.

Nutrition support plays an important role in critical care nutritional management. However, evaluating nutrition status in elderly patients is difficult because of inadequate nutrition parameters. Body mass index is a useful marker of nutritional status in the absence of edema and dehydration. Serum albumin level can be a marker of nutritional status in the absence of edema, dehydration, inflammation, infection, renal dysfunction, and liver dysfunction. The most commonly used indicators for somatic protein status include creatinine height index and nitrogen balance. The Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment are nutrition assessment tools that allow the quick identification of malnourished stroke patients.

Nutritional support will depend on the severity and stage of the stroke. Except for minor strokes, the route of nutrient administration in the hyperacute stroke stage is peripheral parenteral nutrition. Hyperglycemia, uremia, electrolyte imbalance, edema, and dehydration are more frequent in very elderly patients. Blood glucose and serum electrolyte levels should be stringently monitored. In the subacute stage, the decision to administer either enteral or parenteral feeding routes is determined by the presence or absence of a functioning intestine, dysphagia, and consciousness disorders. Dysphagia occurs in many acute stroke patients and is a major risk factor for malnutrition. Stroke patients with dysphagia are at a high risk of aspiration pneumonia, which has deleterious effects on their nutritional status. Nutritional support should be considered under various factors (chronic diseases, complications, and dysphagia) and clinical status (severity, stage, activity, and nutritional status) in very elderly stroke patients. Monitoring and assessment should be performed daily in very elderly stroke patients during critical care. Appropriate nutritional support is effective in the prevention of malnutrition and stroke complications.

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Abbreviations

%IW:

Ideal body weight

BEE:

Basal energy expenditure

BMI:

Body mass index

CHI:

Creatinine height index

MAC:

Mid-arm circumference

MAMC:

Mid-arm muscle circumference

MNA:

Mini-Nutritional Assessment

MST:

Malnutrition Screening Tool

MUST:

Malnutrition Universal Screening Tool

NB:

Nitrogen balance

NIHSS:

National Institute of Health Stroke Scale

NRS-2002:

Nutritional Risks Screening 2002

PEG:

Percutaneous endoscopic gastrostomy

PG-SGA:

Patient-Generated Subjective Global Assessment

PPN:

Peripheral parenteral nutrition

REE:

Resting energy expenditure

RQ:

Respiratory quotient

SGA:

Subjective Global Assessment

TPN:

Total parenteral nutrition

TSF:

Triceps skinfold thickness

UUN:

Urinary urea nitrogen

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Authors and Affiliations

  1. Department of Nutrition Management, National Hospital Organization Miyagi National Hospital, 100 Kassenhara Aza Takase, Yamamoto-cho Watari-gun, 989-2202, Miyagi, Japan

    Hitoshi Obara & Natsuki Ito

  2. Department of Rehabilitation, National Hospital Organization Kamaishi National Hospital, 4-7-1 Sadanaicho, Kamaishi-shi, Iwate, 026-0053, Japan

    Mamoru Doi

Authors
  1. Hitoshi Obara
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  2. Natsuki Ito
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  3. Mamoru Doi
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Corresponding author

Correspondence to Hitoshi Obara .

Editor information

Editors and Affiliations

  1. Royal Free London Hospitals, Barnet General Hospital, London, UK

    Rajkumar Rajendram

  2. Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Rajkumar Rajendram

  3. King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

    Rajkumar Rajendram

  4. Department of Nutrition and Dietetics, Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Victor R. Preedy

  5. Department of Biomedical Sciences, Faculty of Science & Technology, University of Westminster, London, UK

    Vinood B. Patel

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Obara, H., Ito, N., Doi, M. (2015). Nutrition and Critical Care in Very Elderly Stroke Patients. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7836-2_31

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  • DOI: https://doi.org/10.1007/978-1-4614-7836-2_31

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