Parameters For Nutritional Status Monitoring In Critically Ill Older Adults: An Integrative Review

Abstract

This integrative review was conducted to identify alternative tools for nutritional screening/evaluation of critically ill elderly patients that might overcome the limitations of traditional parameters. Four databases were searched. The criteria for inclusion were original articles, with full text available, published in Portuguese and English between 2013 and 2017. The search terms were: “elderly AND critical ill AND nutritional assessment” and “elderly AND intensive care AND nutritional assessment”. Nine articles were selected and divided between those using conventional and those using alternative nutritional parameters. At the end of the article selection stage, we found that none of the included studies used bioelectrical impedance analysis (BIA). Thus, an additional search was conducted, using the keywords “bioelectrical impedance analysis”, “bioelectrical impedance vector analysis”, “phase angle”, and “intensive care”, and articles related to the topic of interest were included. Studies using the Nutrition Risk in Critical Ill (NUTRIC) score, which includes the Acute Physiology and Chronic Health Classification System II (APACHE II) and Sepsisrelated Organ Failure Assessment (SOFA) scores, as well as those using either of these scores alone, presented good results. Although the final SOFA value remained the same in the studies included in this review, this instrument may be promising. We suggest that future research should explore the use of BIA (and its derived parameters, such as phase angle and bioelectrical impedance vector analysis – BIVA) and combinations of the NUTRIC score with phase angle and/or BIVA in critically ill elderly patients with decreased level of consciousness and/or edema.

Keywords

• aging
• intensive care units
• nutrition assessment