(408) Personalized Nutrition in Critically Ill Older Adult Trauma Patients

Introduction: Malnutrition, prevalent in over half of critically-ill older adult trauma patients (age 60+), adversely affects their physical function, cognition, and quality of life post-discharge. This pilot study aims to address these concerns by personalizing and enhancing nutrition delivery using a Structured Nutrition Delivery pathway (SeND Home).

Methods: Older adult trauma patients tolerating oral nutrition were 3:1 randomized for the study. We assessed the feasibility, acceptability, and fidelity of SeND Home, along with physical function measures, muscle mass, and self-reported health. Indirect calorimetry (IC) was used to assess individual nutrition within 72 hours of admission and regularly until discharge. To augment enteral nutrition, supplemental oral nutrition was introduced upon tolerance of a full liquid diet.

Results: Over a span of six months, we enrolled 23 critically-ill older adult trauma patients, with no participant withdrawals and a single in-hospital mortality. The participants' mean age and BMI were 71 ± 2.1 and 30 ± 2, respectively. At admission, 43% were either malnourished or at risk, with a baseline sarcopenia index of 78 ± 9.7. Initial metrics included grip strength (20 ± 3), quadricep strength (12 ± 1), 6-minute walk distance (105 ± 26 meters), 4-meter walk time (19 ± 3 seconds) and sit-and-stand repetition within 30 seconds (5.8 ± 1). Caloric needs predicted using the Mifflin St. Jeor equation and IC, averaged 1477 ± 87 and 2183 ± 170, respectively. IC-guided intervention resulted in all patients receiving three daily supplements during their hospital stay and a month's supply at discharge.

Conclusions: This pilot study investigates the SeND Home program's impact on addressing malnutrition in older trauma patients, with the aim of restoring functional ability and resilience through personalized nutrition. Results from this study will guide a future randomized control trial for larger-scale evaluation.