Malnutrition in the older patients: Constructing knowledge, perceptions, and solutions for an intensive Care setting in Vietnam

Abstract

Background and aims: Malnutrition is common in critically ill older patients. The objectives of this study were to explore prevalence of malnutrition among older pateints admitted to an intensive care unit (ICU) and to evaluate the effectiveness of a nutrition education program (NEP).

Method: This prospective, non-blinded study was carried out in a 30-bed intensive care unit (ICU) of one general hospital in Vinh Long Province, Viet Nam. There were three phases. In the first phase, the malnutrition prevalence and the nutrition routinely care in ICU were studied in 250 newly admitted older patients along with their caregivers and all ICU staff were evaluated for nutrition-related knowledge, perception, self-efficacy, and practice. Phase two: CC cut-off points of the ICU older patients in phase one (normal nourished group = 224, malnourished group = 26) were examined for both genders. Phase three: another 32 patients and their caregivers, as well as the ICU staff (post-test) were enrolled and observed in an experiment group (EG) comparing with the matcthed control group (CG) along with their caregivers and the ICU staff (pre-test) deriving from phase one. Effectiveness of the NEP was evaluated by means of nutrition status, dietary and energy intakes, as well as clinical outcomes of the older ICU patients.

Results: The prevalences of malnutrition among the ICU older patients based on the mNutric, NRS2002, and SGA scores were 70.8%, 88.4%, and 88.8%, respectively. The CC cut-off points, based on BMI, for malnutrition in male and female older patients were 27.3 cm and 24.1 cm, respectively. The experiment and control groups did not differ in age, APACHE II score, gender, and nutritional status (p > 0.05) at baseline. The mean energy intake improved from the first day of admission and the discharge day in both group but the EG group had better improvement (EG 900.0±252.2 and 1,204.8±272.3, p< 0.000; CG 884.7±234.9 and 1007.9±332.5, p < 0.025). There were significant lower nutrition complications and days on mechanical ventilation in the experimental group (6.3% and 3.7±6.0 days) than the control group (28.1% and 7.3±6.3 days), p<0.05. However, these two groups did not significantly differ in ICU length of stay, hospital length of stay, and ICU mortality (p > 0.05).

Conclusion: Malnutrition is highly prevalent among older ICU patients. The nutrition education program was effective in enhancing nutrition carr process and improving clinical outcomes, particulary, decreasing nutrition complications and days on mechanical ventilation.

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