Nutrition in the Geriatric Surgical Patient

The elderly population is particularly vulnerable to malnutrition due to a number of physiologic, psychologic, and socioeconomic changes associated with aging. Diagnosis is challenging and a number of screening modalities have been described. Reliance upon biochemical testing (albumin and prealbumin) alone is not recommended. Multiple screening tools such as Mini Nutritional Assessment (MNA), Nutrition Risk Index (NRI), Malnutrition Universal Screening Tool (MUST), and Nutritional Risk Screening-2002 (NRS-2002) have varying degrees of accuracy. Because malnutrition and “at risk for malnutrition” are strongly predictive of poor clinical outcomes, intervention is recommended, though reversal of malnutrition in the elderly is particularly difficult after significant lean body mass has been lost. Prehabilitation with nutrition and exercise begins in the preoperative stage, continuing through the perioperative period, and continues beyond the immediate postoperative period