Nutritional Assessment A Primary Component of the Multidimensional Geriatric Assessment in the Intensive Care Unit

The geriatric patient faces several nutritional challenges in the ICU and on the ward. Decreasing muscle mass, impaired mobility, malnutrition, comorbidities with attendant medications, and frailty make this patient population worthy of specialized knowledge and attention. The admission of a geriatric patient to the ICU should prompt early nutritional screening (see Fig. 1). Tools that may be particularly feasible to use at bedside include NRS2002 and NUTRIC. In patients identified as at risk for malnutrition, nutritional support is initiated, and assessment for malnutrition severity is indicated. Along with etiologic criteria, referencing the GLIM criteria of reduced muscle mass will also identify sarcopenia. Hence, consideration should be given to evaluating the muscle mass of patients who have undergone or would otherwise undergo a torso CT scan. For other patients, consider bedside ultrasound or bioimpedance evaluations. If these modalities are unavailable, handgrip strength can be assessed by way of an inexpensive dynamometer. Recognition of sarcopenia should prompt initiation of early mobility and muscle-strengthening programs. Confirmation of malnutrition should prompt nutritional support via an appropriate route (eg, oral, enteral, or parenteral) followed by reassessment. These determinations individually or in conjunction with the frailty evaluation can help in the assessment, outcome prognostication, and multidisciplinary management of the geriatric ICU patient. Attention to and prevention of worsening sarcopenia, malnutrition, and immobilization may be rewarded with lower morbidity and mortality.

Automated summary

Geriatric patients in the ICU and on the ward face several nutritional challenges, including decreased muscle mass, impaired mobility, malnutrition, comorbidities, and frailty. It is important to conduct early nutritional screening, assess for malnutrition risk using tools like NRS2002 and NUTRIC, and initiate nutritional support. Evaluating muscle mass and initiating early mobility and muscle-strengthening programs are essential for improving outcomes in geriatric ICU patients.