Nutritional support and rehabilitation in intensive care units for elderly and senile patients. Review
Introduction. The general aging of the population, which has been observed over the past two decades, leads to an increase in the number of elderly and senile patients hospitalized in intensive care units. The results of treatment of elderly patients are worse in comparison with younger patients due to the presence of comorbid pathology, including the syndrome of senile asthenia. The leading manifestation of the latter is nutritional insufficiency and sarcopenia. In the conditions of hypermetabolism-hypercatabolism, there is a progressive decrease in muscle mass, which worsens the results of treatment and increases its cost. Objectives. To show the need for a comprehensive approach in the treatment of elderly and senile patients in critical conditions on the basis of nutritional support and rehabilitation measures. Materials and methods. Out of more than 250 initially selected literature sources from various databases (Scopus, Web of science, RSCI, etc.), 52 sources were left for analysis, mainly for the last 5 years, and earlier publications were used while maintaining their relevance for clinicians. Results. The review presents data on the nutritional support of elderly and senile patients, taking into account the development of sarcopenia and anabolic resistance. It is emphasized that in order to prevent a decrease in muscle mass in such patients, it may be necessary to prescribe an increased amount of protein. In addition, nutritional support should be combined with rehabilitation activities. Conclusions. Modern approaches to the management of elderly and senile patients should take into account the presence of pronounced comorbid pathology and sarcopenia. The current recommendations on nutrition are developed without taking into account the age of patients. In patients with initial sarcopenia and progressive loss of muscle mass, the need for protein increases. The effectiveness of nutritional support increases with the inclusion of dosed physical activity and physical therapy in a comprehensive rehabilitation program.