People unable to eat due to serious illness, kidney failure requiring dialysis, infection, injury or surgery or advanced dementia may require nutritional support through tube feedings or intravenous fluids. This assistance may come through tube feedings or intravenous fluids.
Nutrition support in elderly patients has only been the subject of limited clinical trials and its beneficial impacts on various outcomes remain mixed.
What Is It?
People unable to eat in their usual way may need artificial feeding tubes inserted directly into their stomach, bowel or bloodstream for nutrition support. This may last only temporarily until normal eating resumes again.
Nutritional support has been demonstrated to mitigate complications of malnutrition and produce clinical, functional and financial gains for those at risk for protracted semistarvation. It may prove particularly useful in this situation.
Nutrition support management is an intricate task requiring the expertise of multiple disciplines. Such teams usually consist of nurses, dietitians, pharmacists, physicians and advanced practice providers – along with any nutrition support professionals such as free-standing departments or departments that house multiple clinicians – as they assess, implement, monitor and educate patients on enteral and parenteral therapy treatments as well as review documentation such as orders, progress notes or any other documents used to guide care delivery.
What Is It Used For?
Many individuals need nutritional support because they are too sick to consume the foods they need or cannot absorb all the nutrients found in what they eat. Artificial feeding with nutrient mixtures typically uses tubes inserted directly into either their stomach or small intestine, or more commonly, directly into their bloodstream (known as Total Parenteral Nutrition [TPN]).
Family physicians should identify patients in need of nutritional support and use the Mifflin-St Jeor equation to estimate resting metabolic rate before consulting with a registered dietitian nutritionist on total energy needs and selecting an appropriate formula.
Evidence may be limited, but clinical trials demonstrate that nutrition support can reduce hospital length of stay and associated costs while improving quality of life. Some hospitals provide nutrition support teams composed of physicians, dietitians and nurses who collaborate together in caring for these patients while others may utilize free-standing nutrition support departments that operate under various models depending on institutional resources and policies.
How Is It Helped?
Nutritional support offers an effective means for those unable to eat or swallow safely to receive essential calories and nutrients they require, helping reduce complications related to inflammation catabolic states like low skeletal muscle mass or poor wound healing (see figure 10.1).
Nutritional support may help mitigate or improve some outcomes associated with critical illness. Skeletal muscle weakness, known as intensive care unit-acquired weakness (ICU-AW), is a major risk for these patients, contributing significantly to mortality while impeding recovery and quality of life.
While research into critical care outcomes measures is advancing quickly, surprisingly few studies exist which measure the effects of nutrition support on various outcomes. This should be addressed as soon as possible.
What Are the Signs of Malnutrition?
Malnutrition may be difficult to spot, but health care professionals can make identification easier through a nutritional assessment which takes into account overall appearance, appetite and any recent weight changes or fluctuations. X-rays, blood or urine tests may also be used to measure bone density or detect digestive issues or check for vitamin and mineral deficiencies.
Malnourished individuals typically display characteristics such as low body weight, prominent bones, brittle nails and poor skin tone. A 2023 study published in BMC Medicine also noted that malnutrition raised risks of serious illness and caused them to respond more poorly than expected to hospital treatments.
Nutrition support has long been studied as an intervention in medical settings, yet few randomized trial data exist for its use with polymorbid medical inpatients. Nonetheless, guidelines from clinical nutrition societies address this issue with instructions for providing nutrition support to individuals suffering malnutrition. They include monitoring tolerance to enteral and parenteral nutrition therapy as well as complications, adherence issues and any other concerns as a form of support.
