Borken, Germany
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Wirth R.,St Marien Hospital Borken | Volkert D.,Friedrich - Alexander - University, Erlangen - Nuremberg | Rosler A.,Albertinen Haus | Sieber C.C.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bauer J.M.,Friedrich - Alexander - University, Erlangen - Nuremberg
Archives of Gerontology and Geriatrics | Year: 2010

Malnutrition is regularly associated with weight loss and changes in body composition, which lead to an increase in disability, complications and mortality. Bioelectric impedance analysis (BIA) is a simple and non-invasive bedside body composition analysis technique. In particular, bioelectric impedance phase angle (PA) has been shown to predict prognosis and mortality in several clinical conditions. The purpose of this study was to determine the relationship of BIA measurements and hospital mortality in multimorbid geriatric patients. The data obtained from the routine clinical admissions of 1071 consecutive patients (783 women and 288 men, age 81.4 ± 8.5 years) to a geriatric hospital unit was analyzed retrospectively. A significant difference of PA (50. kHz) between survivors (4.2 ± 1.1°) and non-survivors (3.6 ± 1.2°; p<. 0.001) of the hospital stay could be detected. Subjects with a PA below 3.5° showed a significant fourfold increased hospital mortality of 20% (95% CI = 15-24%) compared to all other subjects (5%; 95% CI = 4-7%). No calculated parameters of BIA reflecting body composition were associated with hospital mortality. Although the extent to which the PA may be regarded as a marker of nutritional state is still controversial, it was associated with hospital mortality in geriatric patients. © 2009 Elsevier Ireland Ltd.


Norman K.,Charité - Medical University of Berlin | Wirth R.,St Marien Hospital Borken | Neubauer M.,Charité - Medical University of Berlin | Eckardt R.,Charité - Medical University of Berlin | Stobaus N.,Charité - Medical University of Berlin
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 >60 years.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 60-95 years, 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 ± 8.9 kg, knee extension strength: 20.8 ± 11.8 vs 28.1 ± 14.9 kg, and peak expiratory flow: 301.1 ± 118 vs 401.7 ± 142.6 L/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. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. 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.


Wirth R.,St Marien Hospital Borken | Wirth R.,Friedrich - Alexander - University, Erlangen - Nuremberg | Sieber C.C.,Friedrich - Alexander - University, Erlangen - Nuremberg | Sieber C.C.,Nuremberg Hospital
Gerontology | Year: 2012

Background: The estimated life expectancy of older persons is an important component of medical decision-making. To date, no data are available on the accuracy of health care professionals in estimating the remaining life expectancy of older subjects. Methods: A survey estimating the mean remaining life expectancy of Germans of both sexes at the ages of 0, 70, 80 and 90 years was performed from September to November 2010. Results: Two hundred and six health care professionals underestimated the mean remaining life expectancy of older persons by 10%, on average, and with great variance (SD = 34%). Medical doctors, especially those not specialized in geriatrics, estimated worst. Conclusions: Underestimation of the remaining life expectancy of older people is prevalent in health care professionals and may lead to patients being managed inappropriately. This underscores the need for further studies and better training on this issue in health care education. Copyright © 2011 S. Karger AG, Basel.


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.


Wirth R.,St Marien Hospital Borken | Bauer J.M.,Friedrich - Alexander - University, Erlangen - Nuremberg | Willschrei H.P.,St Marienhospital Orsoy | Volkert D.,Friedrich - Alexander - University, Erlangen - Nuremberg | Sieber C.C.,Friedrich - Alexander - University, Erlangen - Nuremberg
Gerontology | Year: 2010

Background: Despite extensive discussion about percutaneous endoscopic gastrostomy (PEG) in nursing home residents, no prevalence data exist in most countries. Objective: This study aimed to determine the prevalence of PEG in German nursing homes, as well as nursing home characteristics that may influence this prevalence. Additionally, we documented the timing of PEG insertion, whether pre- or post-admission to the nursing home, and the proportion of residents receiving oral nutrition in addition to tube feeds. Methods: A 26-item questionnaire was sent to 6,995 German nursing homes. Responses were anonymous. Results: Of the 6,995 questionnaires sent out, 807 (11.5%) were completed and returned. Of the 66,507 total residents in the responding nursing homes, there were 4,390 residents with PEG (6.6%). The median PEG prevalence was 5.6% (5th-95th percentile 1.0-16.3%). Of all PEGs inserted, 55.3% were inserted before and 44.7% were inserted after nursing home admission. Oral beverage intake in addition to tube feeding was reported in 48.8% of residents with a PEG, and 43.5% of patients also received solid food. There were no significant differences in PEG prevalence between the federal states of Germany. The location (rural vs. urban) of the nursing home, its proprietor and food delivery method had no significant influence on PEG prevalence. With regard only to PEG tubes inserted after nursing home admission, all the factors stated above showed no significant influence on PEG prevalence. Weak positive correlations between PEG prevalence and the size of the nursing home as well as the number of total and certified nursing staff per resident could be detected, reflecting the heavy burden of care associated with residents requiring artificial nutrition. Conclusions: Compared to other countries, Germany can be assumed to have an average PEG prevalence in nursing home residents. No specific nursing home characteristics could be identified that affect PEG prevalence. Copyright © 2009 S. Karger AG, Basel.


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.


Wirth R.,St Marien Hospital Borken | Wirth R.,Friedrich - Alexander - University, Erlangen - Nuremberg | Voss C.,St Marien Hospital Borken | Smoliner C.,St Marien Hospital Borken | And 5 more authors.
Journal of the American Medical Directors Association | Year: 2012

Background: Generally, the high short-term mortality after percutaneous endoscopic gastrostomy (PEG) in geriatric patients is attributed to the severity of their underlying diseases. However, the procedure-related mortality in this group is unknown. Methods: This prospective multicenter observational study gathered information about 197 geriatric patients treated with PEG insertion, including the indication for PEG insertion and the prevalence of postprocedure complications and analyzed how these factors related to mortality. Results: Dysphagia (64%) and insufficient food intake (76%) were the most frequent indications for PEG insertion. Severe complications after PEG insertion occurred in 9.6% of patients. Mortality was 9.6% in hospital, as well as 18.4% at 1 month. Six months after PEG placement, with 81 patients lost to follow-up, mortality was 51.9%. Hospital mortality was significantly higher in patients with severe complications caused by PEG insertion (47.4% vs 5.6%; P <.001). A regression analysis that corrected for confounding factors revealed that severe complications in general (HR 6.9; 95% CI: 2.6-18.1; P<.001), peritonitis (HR 33.1; 95% CI: 3.7-293.2; P =.002), and severe wound infections (HR 6.9; 95% CI: 1.9-24.9; P =.003) were each independently associated with hospital mortality. Considering the prevalence of procedure-related complications and their association with early mortality after PEG insertion, the procedure-related mortality rate in geriatric patients was at least 2% in this study. Conclusion: Although the prevalence of complications after PEG in this study of multimorbid geriatric patients is within the expected range, the procedure-related mortality is higher than expected. © 2012 American Medical Directors Association, Inc..


Wirth R.,St Marien Hospital Borken | Wirth R.,Friedrich - Alexander - University, Erlangen - Nuremberg | Smoliner C.,St Marien Hospital Borken | Sieber C.C.,Friedrich - Alexander - University, Erlangen - Nuremberg | And 2 more authors.
Journal of Nutrition, Health and Aging | Year: 2011

Background: Most patients with dementia lose body weight over the course of the disease. Yet it is not known whether this weight loss is predominantly in the form of fat-free mass (FFM) or fat mass (FM), the latter of which one would expect if the weight loss were caused simply by a chronic decrease of energy intake. Objectives: To determine body composition and nutritional risk in geriatric patients and their association with cognitive function. Design: A retrospective, cross-sectional single-center database analysis. Methods: We analyzed 4,095 consecutive geriatric hospital patients for body composition, nutritional risk, need of care and cognitive function using bioelectric impedance analysis, NRS 2002, Barthel Index and Mini Mental State Examination. Results: Subjects with cognitive dysfunction showed significant lower body weight, body mass index (BMI), FM, fat mass index, FFM and fat-free mass index and a higher NRS score compared to cognitively intact subjects. Mean body weight decreased 10.2%, mean FM decreased 21.1%, mean FFM decreased 5.9% and mean NRS 2002 score increased from 2.1 to 3.0 points with increasing cognitive deterioration. A multivariate analysis revealed that cognitive dysfunction, age and female gender were all significant risk factors for a low body mass index and a low fat mass index. Age, male gender and need of care, but not cognitive dysfunction, were risk factors for a low fat-free mass index. Conclusion: Dementia patients seem to lose predominantly fat mass with weight loss. Female dementia patients are at a higher nutritional risk than male patients, presumably as a result of their different social situation in old age. That is why the nutritional state of female patients with dementia requires special attention. © 2011 Serdi and Springer Verlag France.


PubMed | Friedrich - Alexander - University, Erlangen - Nuremberg, St Marien Hospital Borken, Copenhagen University and Nutricia Research
Type: | Journal: Clinical nutrition (Edinburgh, Scotland) | Year: 2016

During the first days of tube feeding (TF) gastrointestinal (GI) complications are common and administration of sufficient nutrition is a challenge. Not all standard nutritionally complete formulas contain dietary fiber, fish oil or carotenoids, key dietary nutrients for health and wellbeing. The aim of this study was to investigate the effects of a fiber, fish oil and carotenoid enriched TF formula on diarrhea, constipation and nutrient bioavailability.A multi-center randomized, double-blind, controlled, parallel trial compared the effects of a dietary fiber, fish oil and carotenoid-enriched TF formula (test) with an isocaloric non-enriched formula (control) in 51 patients requiring initiation of TF. Incidence of diarrhea and constipation (based on stool frequency and consistency) was recorded daily. Plasma status of EPA, DHA and carotenoids was measured after 7 days.The incidence of diarrhea was lower in patients receiving the test formula compared with the control group (19% vs. 48%, p=0.034). EPA and DHA status (% of total plasma phospholipids) was higher after 7 days in test compared with control group (EPA: p=0.002, DHA: p=0.082). Plasma carotenoid levels were higher after 7 days in the test group compared with control group (lutein: p=0.024, -carotene: p=0.005, lycopene: p=0.020, -carotene: p=0.054).This study suggests that the nutrient-enriched TF formula tested might have a positive effect on GI tolerance with less diarrhea incidence and significantly improved EPA, DHA and carotenoid plasma levels during the initiation of TF in hospitalized patients who are at risk of diarrhea and low nutrient status.This trial was registered at trialregister.nl; registration number 2924.

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