Nutrition and the Elderly Surgical Patients

As the world’s population is living longer, there are increasingly more elderly patients requiring surgical intervention. Today, we do more surgeries for the elderly than we used to. The elderly patients receiving surgical treatment are more complex because of their diminished physiological reserve, background co morbidities, cognitive impairment and they are at higher risk of developing postoperative complications and the mortality rate is higher compared to the younger patients [1,2]. The elderly are predisposed to poor nutrition for multiple reasons [3]. Among the elderly surgical patients, prevalence of malnutrition was seen in over 50% and was more prevalent among the elderly admitted for urgent emergency operations than elective operations (69.6% Vs 34.1%). The presence of cognitive impairment was a major risk for malnutrition, and depression was not a major risk. The elderly patients who were malnourished tend to be more dependent in their instrumental activities of daily living [4]. Poor nutrition among the elderly surgical patients is associated with increased postoperative complications, prolonged length of stay and increased healthcare cost. The malnourished elderly with low preoperative body weight, documented weight loss and low serum albumin had a threefold higher mortality compared to the well-nourished group and the high mortality remained persistently high after 3 years [5]. There is a push to encourage early feeding among the elderly surgical patients to improve outcome by limiting postoperative catabolism, maintain immune response and improve wound healing [6]. This article aims to review the causes of poor nutrition among the elderly surgical patients, the metabolic changes which occur peri operatively and strategies to manage nutrition during the perioperative period for a better overall outcome.