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Aim: Older people are at increased risk of malnutrition and are frequently affected by malnutrition. In clinical practice, it is often unclear, which strategies are useful in specific situations for the persons concerned. The present guideline intends to provide comprehensive evidence-based recommendations for clinical nutrition in older persons, in order to prevent and/or adequately treat malnutrition. Methods: Existing guidelines of the German and European societies of nutritional medicine (DGEM, ESPEN) on enteral and parenteral nutrition in geriatrics were consolidated and in accordance with the principles of the AWMF and AEZQ revised and extended. Results: The present guideline comprises 60 consensus-based recommendations for nutritional care in the elderly having regard to basic principles of clinical nutrition, relevant indications (general indication, malnutrition and risk of malnutrition, frailty, dysphagia, hip fracture, depression, dementia, decubitus, delirium) as well as to specific structural and process needs for nutritional care in geriatric institutions. Generally, nutritional intervention is indicated in older persons with malnutrition or at risk of malnutrition in order to allow an adequate intake of energy and nutrients and to avoid the serious consequences of malnutrition. In this regard oral nutrition can be supported by cause oriented, nursing and dietary interventions. Enteral respectively parenteral nutrition should be initiated if oral respectively enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable (not in terminal stages of disease). Conclusion: Independent of the indication, the decision for or against specific interventions must always be made individually, after carefully weighing the particular risk-benefit relationship, taking the (assumed) patient will and prognosis into account. It is strongly recommended not to wait until severe malnutrition has developed but to start nutritional interventions early, as soon as nutritional risk becomes apparent. © Georg Thieme Verlag KG Stuttgart New York.

Wirth R.,Friedrich - Alexander - University, Erlangen - Nuremberg | Wirth R.,St. Marien Hospital Borken GmbH | Sieber C.C.,Friedrich - Alexander - University, Erlangen - Nuremberg
Aktuelle Ernahrungsmedizin | Year: 2011

Progressive weight loss is a frequent symptom in dementia. The reason for this weight loss, often preceding the onset of dementia, is not completely understood. Yet, the serious consequences of weight loss and malnutrition in dementia could be counteracted by an early detection of weight loss and an adequate therapy. Therefore, by the first diagnosis of dementia, a recent weight loss should be recognized and a regular screening of the nutritional state of all patients with dementia should be performed. Therapeutic interventions for malnutrition with a proven effect on weight loss in dementia are counselling of relatives and caregivers, optimising meal ambiance, help with oral intake, providing energy dense meals, between-meal snacks, finger-food, caloric enrichment of meals and the provision of oral nutritional supplements. © Georg Thieme Verlag KG Stuttgart · New York.

Leischker A.H.,Alexianer Krefeld GmbH | Busch E.W.,Evangelische Kliniken Gelsenkirchen GmbH | Dziewas R.,Universitatsklinikum Munster | Warnecke T.,Universitatsklinikum Munster | And 3 more authors.
Aktuelle Ernahrungsmedizin | Year: 2014

Many neurologic disorders lead to dysphagia. Complications of dysphagia include aspiration pneumonia and malnutrition. In this article, procedures for the screening (which may be conducted by qualified nursing staff) and assessment (which is usually performed by speech-language therapists or by physicians with special experience in dysphagia assessment) are described. In the second part of this article, the nutritional therapy for important neurologic diseases (Stroke, Parkinsons disease, Chorea Huntington, multiple sclerosis and epilepsy) are described. © Georg Thieme Verlag KG Stuttgart.

Rosler A.,Medizinisch Geriatrische Klinik | Lehmann F.,Medizinisch Geriatrische Klinik | Krause T.,Medizinisch Geriatrische Klinik | Wirth R.,St. Marien Hospital Borken GmbH | von Renteln-Kruse W.,Medizinisch Geriatrische Klinik
Archives of Gerontology and Geriatrics | Year: 2010

Malnutrition and dehydration are common in elderly. A simple, reliable instrument to assess nutritional and hydration status would be very helpful. Bioelectrical impedance analysis (BIA) has been promising in this context, but data of elderly persons and geriatric in-hospital patients are rare. Therefore, we first compared BIA measurements (resistance, reactance, phase angle and a resulting vectorgraph) with a clinical assessment in 31 community-dwelling women and 30 female nursing-home residents. The results of the BIA measurement correlated well to weight, hand grip strength, and calf circumference. We then compared BIA measurements with clinical judgement of hydration status in 103 acute geriatric hospital in-patients. Concordance between the results of clinical judgement and BIA measurements was only 43.7%. In assessing geriatric in-patients, there is little concordance between the clinical and the bioelectrical evaluation of the hydration status. © 2009 Elsevier Ireland Ltd. All rights reserved.

Purpose: Neurologic diseases can lead to swallowing disorders. This may cause aspiration during oral intake of food and fluid and involves a higher risk for malnutrition. The present guideline is supposed to give evidence-based recommendations for clinical nutrition in neurology. Acute stroke, Parkinsons disease, Chorea Huntington and Multiple Sclerosis were chosen because here nutrition can become an import issue. Methods: A systematic literature search about nutrition and the mentioned disease patterns was conducted. The results were discussed in an interdisciplinary working group that consisted of neurologists and physicians with expertise for nutritional medicine. On this basis the working group developed recommendations, which were presented, discussed and partly modified at the consensus conference on September 14 th, 2011. The revised form of these recommendations was passed at a second consensus conference on June 16th, 2012. Results: The guideline includes 75 recommendations for patients with neurologic diseases. If the existing disease leads to dysphagia, screening and assessment of dysphagia should be performed early. Nutritional intervention has to be adapted according to medical findings. This ranges from texture modification and tube feeding to necessity for parenteral nutrition. Patients with Morbus Parkinson and Chorea Huntington have a higher risk for malnutrition already in early stages of disease. Regular screening, assessment and, if needed, nutritional interventions are recommended to avoid malnutrition. When using L-Dopa-containing medication the interactions with food proteins have to be taken into account. There is no adequate scientific evidence for the application of specific diets or nutritional supplements in Multiple Sclerosis, therefore such interventions cannot be recommended in general. Conclusion: Nutrition for patients with neurologic diseases can be optimized by early screening and assessment of dysphagia and malnutrition. The texture modification of food and drinks, oral nutritional supplements, nutrition through a nasogastric tube, PEG tube, PEJ tube and parenteral nutrition are possible nutritional medical interventions. All indicated interventions shoud be introduced early.

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