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Sieber C.C.,Klinik fur Allgemeine Innere Medizin und Geriatrie | Sieber C.C.,IBA University
Internist | Year: 2017

A higher age is usually associated with multimorbidity due to chronic illnesses intermittently aggravated by acute disease and exarcerbation of pre-existing chronic illnesses. Physical and psychological diseases often coexist. Cure in the classical sense should not be the priority of diagnostic and therapeutic decision making, but more a prioritization of patient-oriented care. This includes polypharmacy which most often accompanies multimorbidity. Therapeutic actions and designated endpoints are therefore different from those in younger persons because preservation of functionality and independence is priority, not survival. Rehabilitative treatments are important in all settings that care for old and very old persons. Older adults and their care-givers also often express different time and treatment goals. © 2017, Springer Medizin Verlag Berlin.


Wirth R.,St Marien Hospital Borken | Wirth R.,IBA University | Smoliner C.,St Marien Hospital Borken | Jager M.,St Vinzenz Hospital | And 3 more authors.
Experimental and Translational Stroke Medicine | Year: 2013

Stroke is regularly accompanied by dysphagia and other factors associated with decreased nutritional intake. Dysphagia with aspiration pneumonia and insufficient nutritional intake lead to worse outcome after stroke.This guideline is the first chapter of the guideline " Clinical Nutrition in Neurology" of the German Society for Clinical Nutrition (DGEM) which itself is one part of a comprehensive guideline about all areas of Clinical Nutrition. The thirty-one recommendations of the guideline are based on a systematic literature search and review, last updated December 31, 2011. All recommendations were discussed and consented at several consensus conferences with the entire DGEM guideline group. The recommendations underline the importance of an early screening and assessment of dysphagia and give advice for an evidence based and comprehensive nutritional management to avoid aspiration, malnutrition and dehydration. © 2013 Wirth et al.; licensee BioMed Central Ltd.


Kemmler W.,Friedrich - Alexander - University, Erlangen - Nuremberg | Teschler M.,Friedrich - Alexander - University, Erlangen - Nuremberg | Weissenfels A.,Friedrich - Alexander - University, Erlangen - Nuremberg | Sieber C.,IBA University | And 2 more authors.
Osteoporosis International | Year: 2017

Summary: The relevance of sarcopenia and sarcopenic Obesity (SO) is rising in our aging societies. Applying recognized definitions to 965 community-dwelling Bavarian men 70 years+ resulted in a prevalence for sarcopenia between 3.7 and 4.9 and between 2.1 and 4.1% for SO. Despite this high consistency, the overlap between the definitions/approaches was <50%. Introduction: The relevance of sarcopenia and sarcopenic obesity (SO) is rising steadily in the aging societies of most developed nations. However, different definitions, components, and cutoff points hinder the evaluation of the prevalence of sarcopenia and SO. The purpose of this contribution was to determine the prevalence of sarcopenia and SO in a cohort of community-dwelling German men 70+ applying established sarcopenia (European Working Group on Sarcopenia in Older People, Foundation National Institute of Health, International Working Group on Sarcopenia) and obesity definitions. Further, we addressed the overlap between the definitions. Methods: Altogether, 965 community-dwelling men 70 years and older living in Northern Bavaria, Germany, were assessed during the screening phase of the Franconian Sarcopenic Obesity project. Segmental multi-frequency bio-impedance analysis (BIA) was applied to determine weight and body composition. Results: Applying the definitions of EWGSOP, IWGS, and FNIH, 4.9, 3.8, and 3.7% of the total cohort were classified as sarcopenic, respectively. When further applying body fat to diagnose obesity, SO prevalence in the total cohort ranged from 4.1% (EWGSOP + body fat >25%) to 2.1% (IWGS + body fat >30%). Despite the apparently high consistency of the approaches with respect to prevalence, the overlap in individual sarcopenia diagnosis between the sarcopenia definitions was rather low (<50%). Conclusion: The prevalence of sarcopenia and SO in community-dwelling German men 70 years+ is relatively low (<5%) independently of the definition used. However, consistency of individual sarcopenia diagnosis varies considerably between the three definitions. Since sarcopenia is now recognized as an independent condition by the International Classification of Diseases, a mandatory definition must be stated. Trial registration number: ClinicalTrials.gov: NCT2857660. © 2017 International Osteoporosis Foundation and National Osteoporosis Foundation


Bollwein J.,IBA University | Diekmann R.,IBA University | Kaiser M.J.,IBA University | Bauer J.M.,Geriatric Center Oldenburg | And 3 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2013

Background.The etiology of the geriatric syndrome frailty is multifactorial. Besides hormonal and inflammatory processes, nutritional influences may be of major relevance. In this cross-sectional study, the association between dietary quality and frailty was investigated.Methods.In 192 community-dwelling older volunteers (>75 years), an interview-based food frequency questionnaire was used to assess nutritional data. A Mediterranean diet (MED) score (maximum 9 points) was used to evaluate dietary quality. Frailty was defined as the presence of at least three and prefrailty as the presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength, and slow walking speed. Older adults without any of these attributes were defined as "nonfrail" Binomial logistic regression analysis was used to assess the risk of being frail (vs prefrail and nonfrail) in each quartile (vs lowest quartile) of the MED score.Results.The mean (SD) age of the participants was 83 (4) years; 41.1% were prefrail and 15.1% were frail. The risk of being frail was significantly reduced in the highest quartile of the MED score (OR 0.26; 95% CI 0.07-0.98).Conclusions.A healthy dietary pattern is associated with a lower risk of being frail. Larger, prospective and interventional studies are needed to clarify the association between dietary quality and frailty. © The Author 2012. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.


Smoliner C.,St Marien Hospital Borken | Smoliner C.,IBA University | Sieber C.C.,IBA University | Wirth R.,St Marien Hospital Borken | Wirth R.,IBA University
Journal of the American Medical Directors Association | Year: 2014

Objectives: Sarcopenia, a common syndrome in older individuals, is characterized by a progressive loss ofmuscle mass and muscle strength. Although data exist on the prevalence of sarcopenia in community-dwelling older individuals and nursing home residents, there has been no systematic research in hospitalized older patients according to newly developed criteria. Design: Cross-sectional study design. Setting: Acute geriatric ward of a general hospital. Participants: Geriatric inpatients. Measurements: Hand grip strength was measured with the Jamar dynamometer, skeletal muscle index was calculated from raw data obtained from the bioelectrical impedance analysis, and physical function was assessed with the Short Physical Performance Battery. Sarcopenia was defined according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP). Results: This study involved 198 patients from a geriatric acute ward. Mean age was 82.8 ± 5.9 years and 70.2% (n= 139) of the study participants were women. Thirteen patients (6.6%) were defined as sarcopenic and 37 (18.7%) were defined as severely sarcopenic. In a group comparison, patients with sarcopenia had a poorer nutritional status. In a binary logistic regression analysis, only body mass index was associated with sarcopenia, whereas gender, age, length of stay, cognitive function, and self-care capacity were not. Conclusion: The prevalence of sarcopenia in geriatric hospitalized patients is high and does not differ from those of other older individuals. Nutritional status is associated with sarcopenia. The predictive value of sarcopenia regarding outcome for older individuals still requires evaluation. © 2014 American Medical Directors Association, Inc.


Norman K.,Charité - Medical University of Berlin | Wirth R.,St Marien Hospital Borken | Wirth R.,IBA University | Neubauer M.,Charité - Medical University of Berlin | And 2 more authors.
Journal of the American Medical Directors Association | Year: 2015

Objectives: We investigated the impact of low phase angle (PhA) values on muscle strength, quality of life, symptom severity, and 1-year mortality in older cancer patients. Design: Prospective study with 1-year follow-up. Participants: Cancer patients aged >60years. Methods: PhA was derived from whole body impedance analysis. The fifth percentile of age-, sex-, and body mass index-stratified reference values were used as cut-off. Quality of life was determined with the European Organization of Research and Treatment in Cancer questionnaire, reflecting both several function scales and symptom severity. Muscle strength was assessed by hand grip strength, knee extension strength, and peak expiratory flow. Results: 433 cancer patients, aged 60-95years, were recruited. Patients with low PhA (n=197) exhibited decreased muscle strength compared with patients with normal PhA (hand grip strength: 22±8.6 vs 28.9±8.9kg, knee extension strength: 20.8±11.8 vs 28.1±14.9kg, and peak expiratory flow: 301.1±118 vs 401.7±142.6L/min, P<.001). Physical function, global health status, and role function from the European Organization of Research and Treatment in Cancer questionnaire were reduced, and most symptoms (fatigue, anorexia, pain, and dyspnea) increased in patients with low PhA (P<.001). In a risk-factor adjusted regression analysis, PhA emerged as independent predictor of physical function (ß:-0.538, P=023), hand grip strength (ß:-4.684, P<.0001), knee extension strength (ß:-4.548, P=035), and peak expiratory flow (ß:-66.836, P<.0001). Low PhA moreover predicted 1-year mortality in the Cox proportional hazards regression model, whereas grip strength was no longer significant. Conclusions: PhA below the fifth reference percentile is highly predictive of decreased muscle strength, impaired quality of life, and increased mortality in old patients with cancer and should be evaluated in routine assessment. © 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine.


Most organ systems display a normal aging process where the intestinal system due to its high regeneration potential does not usually lead to functional impairments. It is therefore a mistake to interpret gastrointestinal complaints as only being age-related as this can lead to an underuse of diagnostic procedures. The heavy burden of malnutrition in the elderly will be discussed in more detail which leads to loss of fat-free mass (sarcopenia) with the subsequent development of frailty leading to a high burden for both the persons affected and the health system as a whole. Due to the demographic shift, nutritional medicine will also impact more and more the daily work of gastroenterologists. © Springer-Verlag 2012.


Stange I.,IBA University | Bartram M.,University of Bonn | Liao Y.,University of Bonn | Poeschl K.,University of Bonn | And 5 more authors.
Journal of the American Medical Directors Association | Year: 2013

Objectives: Although oral nutritional supplements (ONS) are known to be effective to treat malnutrition in the elderly, evidence from nursing home populations, including individuals with dementia, is rare, especially with regard to functionality and well-being. A known barrier for ONS use among elderly is the volume that needs to be consumed, resulting in low compliance and thus reduced effectiveness. This study aimed to investigate the effects of a low-volume, energy- and nutrient-dense ONS on nutritional status, functionality, and quality of life (QoL) of nursing home residents. Design: Randomized controlled intervention trial. Setting: Six nursing homes in Nürnberg and Fuerth, Germany. Participants: Nursing home residents affected by malnutrition or at risk of malnutrition. Intervention: Random assignment to intervention (IG) and control group (CG), receiving 2×125mL ONS (600kcal, 24g protein) per day and routine care, respectively, for 12weeks. Measurements: Nutritional (weight, body mass index [BMI], upper arm and calf circumferences, MNA-SF) and functional parameters (handgrip strength, gait speed, depressive mood [GDS], cognition [MMSE], activities of daily living [Barthel ADL]) as well as QoL (QUALIDEM) were assessed at baseline (T1) and after 12weeks (T2). ONS intake was registered daily and compliance calculated. Results: A total of 77 residents (87±6y, 91% female) completed the study; 78% had dementia (MMSE<17) and 55% were fully dependent (ADL ≤30). Median compliance was 73% (IQR 23.5%-86.5%) with median intake of 438 (141-519) kcal per day. Body weight, BMI, and arm and calf circumferences increased in the IG (n=42) and did not change in the CG (n=35). Changes of all nutritional parameters except MNA-SF significantly differed between groups in favor of the IG (P<.05). GDS, handgrip strength, and gait speed could not be assessed in 46%, 38%, and 49% of participants at T1 and/or T2, because of immobility and cognitive impairment. In residents able to perform the test at both times, functionality remained stable in IG and CG, except for ADLs, deteriorating in both groups. From 10 QoL categories, "positive self-perception" increased in IG (78 [33-100] to 83 [56-100]; P<.05) and tendedtodecrease in CG (100 [78-100] to 89 [56-100]; P=06), "being busy" significantly dropped in CG (33 [0-50] to 0 [0-50]; P<.05). Conclusion: Low-volume, nutrient- and energy-dense ONS were well accepted among elderly nursing home residents with high functional impairment and resulted in significant improvements of nutritional status and, thus, were effective to support treatment of malnutrition. Assessment of function was hampered by dementia and immobility, limiting the assessment of functionality, and highlighting the need for better tools for elderly with functional impairments. ONS may positively affect QoL but this requires further research. © 2013 American Medical Directors Association, Inc.


Stange I.,IBA University | Poeschl K.,University of Bonn | Stehle P.,University of Bonn | Sieber C.C.,IBA University | Volkert D.,IBA University
Journal of Nutrition, Health and Aging | Year: 2013

Objectives: To identify nursing home residents with malnutrition or at risk of malnutrition by using different markers, determine if the Mini Nutritional Assessment (MNA®) is able to identify all residents at risk according to single risk markers and explore the relation between risk markers and functional impairment. Design: Cross-sectional study. Setting: Six German nursing homes. Participants: 286 residents (86±7y, 89% female). Measurements: Screening for malnutrition or its risk included low BMI (≤22 kg/m2), recent weight loss (WL), low food intake (LI) as single risk markers and MNA (<24 points, p.) as composite marker. Prevalence of single nutritional risk markers in different MNA categories was compared by cross-tables. Mental (cognition, mood) and physical function (mobility) were assessed by interviewing nursing staff and association of impaired status to nutritional risk markers determined by Chi2 test. Results: 32.9% of residents had a low BMI, 11.9% WL and 21.3% LI. 60.2% were categorized malnourished (18.2%) or at risk of malnutrition (42.0%) by MNA. 64% presented at least one of these nutritional risk markers. Of those classified malnourished by MNA, 96.2% also showed low BMI, WL or LI. In contrast, eleven residents (9.6%) considered well-nourished by MNA presented single risk markers (9 low BMI, 2 WL). Cognitive impairment, depressive symptoms and immobility was present in 59.0%, 20.8% and 25.5%, respectively. Functional impairment, and in particular severe impairment, was to a higher proportion present in residents at nutritional risk independent of the chosen marker (MNA<24 p.; low BMI, WL, LI). Conclusion: The high prevalence of nutritional risk highlights the importance of regular screening of nursing home residents. The MNA identified nearly all residents with low BMI, WL and LI. The close association between nutritional risk and functional impairment requires increased awareness for nutritional problems especially in functionally impaired residents, to early initiate nutritional measures and thus, prevent further nutritional and functional deterioration. © 2013 Serdi and Springer-Verlag France.


PubMed | IBA University
Type: | Journal: Der Internist | Year: 2017

In the course of dementia sooner or later nutritional problems appear, and the question arises which interventions are effective in ensuring adequate nutrition and thus may contribute to the maintenance of health, functionality and independence.This overview presents the state of knowledge regarding nutrition in dementia.This work is based on the present guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) on nutrition in dementia, which systematically investigated relevant available evidence.Nutritional interventions should be an integral component of dementia treatment. They should be based on aroutine screening for malnutrition, followed by assessment when appropriate, and periodic body weight control in order to recognize problems early. In all stages of dementia, adequate oral nutrition can be supported by attractive, high-quality food according to individual needs served in apleasant ambience, by adequate nursing support and treatment of underlying causes of malnutrition. If nutritional requirements are not met by usual or enriched food, oral nutritional supplements are recommended in order to improve nutritional status. Beneficial effects of energy and/or nutrient supplementation on cognitive abilities are however not proven. Artificial nutrition is only rarely indicated, namely after careful weighing of individual benefits and risks considering the patients (presumed) will. In patients with advanced dementia and in the terminal phase of life artificial nutrition is not recommended.

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