Older subjects are at increased risk of partial or complete loss of independence due to acute and/or
chronic disease and often of concomitant protein caloric malnutrition. Nutritional care and support
should be an indispensable part of their management. Enteral nutrition is always the first choice for
nutrition support. However, when patients cannot meet their nutritional requirements adequately via
the enteral route, parenteral nutrition (PN) is indicated.
PN is a safe and effective therapeutic procedure and age per se is not a reason to exclude patients from
this treatment. The use of PN should always be balanced against a realistic chance of improvement in the
general condition of the patient. Lower glucose tolerance, electrolyte and micronutrient deficiencies and
lower fluid tolerance should be assumed in older patients treated by PN. Parenteral nutrition can be
administered either via peripheral or central veins. Subcutaneous administration is also a possible
solution for basic hydration of moderately dehydrated subjects. In the terminal, demented or dying
patient the use of PN or hydration should only be given in accordance with other palliative treatments.
