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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.

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.

Bollwein J.,IBA University | Diekmann R.,IBA University | Kaiser M.J.,IBA University | Bauer J.M.,Geriatric Center Oldenburg | And 3 more authors.
Nutrition Journal | Year: 2013

Background: To preserve muscle mass and therefore limit the risk of disability in older adults protein intake is seen as important factor. Besides the amount of protein, its distribution over the day is thought to affect protein anabolism. This cross-sectional study investigates the association between the amount and distribution of protein intake and frailty in older adults. Methods. In 194 community-dwelling seniors (≥75 years) amount of protein intake and its distribution over the day (morning, noon, evening) were assessed using a food frequency questionnaire. Unevenness of protein distribution was calculated as coefficient of variation (CV). Frailty was defined as the presence of at least three, pre-frailty as the presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength and slow walking speed. Results: 15.4% of the participants were frail, 40.5% were pre-frail. Median (min.-max.) daily protein intake was 77.5 (38.5-131.5) g, 1.07 (0.58-2.27) g/kg body weight (BW) and 15.9 (11.2-21.8) % of energy intake without significant differences between the frailty groups. The risk of frailty did not differ significantly between participants in the higher compared to the lowest quartile of protein intake. Frail participants consumed significantly less protein in the morning (11.9 vs. 14.9 vs. 17.4%, p = 0,007), but more at noon (61.4 vs. 60.8 vs. 55.3%, p = 0.024) than pre-frail and non-frail. The median (min.-max.) CV of protein distribution was highest in frail (0.76 (0.18-1.33)) compared to pre-frail (0.74 (0.07-1.29)) and non-frail (0.68 (0.15-1.24)) subjects (p = 0.024). Conclusions: In this sample of healthy older persons, amount of protein intake was not associated with frailty, but distribution of protein intake was significantly different between frail, pre-frail and non-frail participants. More clinical studies are needed to further clarify the relation between protein intake and frailty. © 2013 Bollwein et al.; licensee BioMed Central Ltd.

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.

Smoliner C.,St Marien Hospital Borken | Volkert D.,IBA University | Wirth R.,St Marien Hospital Borken | Wirth R.,IBA University
Zeitschrift fur Gerontologie und Geriatrie | Year: 2013

Introduction: Elderly hospitalized patients have a high risk for developing malnutrition. The causes for an impaired nutritional status in old age are various and the impact is far-reaching. Malnutrition is a comorbidity that is well treatable and various studies show the favorable effect of nutrition therapy on nutritional status and prognosis. In the past few years, several guidelines have been developed to improve nutritional management and to ensure standardized procedures to identify patients at nutritional risk who will benefit from nutrition therapy. However, it is still not clear to what extent nutrition management has been implemented in geriatric wards in Germany. Aim: This survey is intended to give an overview on the situation of the current diagnosis and therapy of malnutrition and nutritional management in geriatric hospital units for acute and rehabilitative care. Methods: In 2011, the task force of the German Geriatric Society ("Deutsche Gesellschaft für Geriatrie", DGG) developed a questionnaire which was sent out to 272 directors of geriatric hospital and rehabilitational units. Included were questions regarding the size and staffing of the hospital and wards, food provision, diagnosis and therapy of malnutrition, as well as communication of malnutrition and nutrition therapy in the doctor's letter. Results: A total of 38% of the questioned units answered. The following information was compiled: 31% of the geriatric facilities employed a doctor with training in clinical nutrition, 42% employ dieticians or nutritional scientists, and 90% speech and language pathologists. In 36% of the wards, a so-called geriatric menu is offered (small portions, rich in energy and/or protein, easy to chew). In 89% of the wards, snacks are available between meals. Diagnosis of malnutrition is mainly done by evaluation of weight and BMI. Validated and established screening tools are only used in 40% of the geriatric wards. Food records are carried out in 64% of the units when needed. Diagnosed malnutrition and nutrition therapy are underreported in the doctor's letter. Dental care beyond emergency care is rarely provided in 67% of wards and never in 23% of units. Conclusion: The use of validated screening instruments is clearly underrepresented and therapy algorithms are rarely implemented in German geriatric hospital units. There are a variety of nutrition interventions available, but it is unclear how patients at nutritional risk are identified. The data on the efficacy of nutrition therapy in elderly patients are very convincing and the integration of nutrition screening in the basic geriatric assessment seems sensible. The establishment of standardized procedures for nutrition intervention and therapy recommendations in the doctor's letter would be useful to ensure sustainability of nutrition therapy. © 2012 Springer-Verlag.

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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