Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE und der DGG

Zusammenfassung

Fragestellung: Ältere Menschen haben ein erhöhtes Risiko für Mangelernährung und sind häufig von Mangelernährung betroffen. Dabei besteht oft Unklarheit darüber, welche Maßnahmen in bestimmten Situationen für die Betroffenen von Nutzen sind. Ziel der vorliegenden Leitlinie ist es, evidenzbasierte Empfehlungen zur klinischen Ernährung älterer Menschen zu geben, um Mangelernährung so weit wie möglich zu vermeiden bzw. zu behandeln.

Material und Methodik: Die bestehenden Leitlinien der deutschen und europäischen ernährungsmedizinischen Fachgesellschaften (DGEM, ESPEN) zur enteralen und parenteralen Ernährung wurden zusammengeführt und in Einklang mit den Richtlinien der AWMF und des ÄZQ aktualisiert und erweitert.

Ergebnisse: Die Leitlinie beinhaltet 60 konsentierte Empfehlungen zur Ernährungsversorgung älterer Menschen hinsichtlich grundlegender Prinzipien klinischer Ernährung, relevanter Indikationen (allgemeine Indikation, Mangelernährung und Risiko für Mangelernährung, Gebrechlichkeit, Dysphagie, Hüftfrakturen, Depression, Demenz, Dekubitus, Delir) sowie spezifischer Struktur- und Prozessanforderungen für die Ernährungsversorgung in geriatrischen Institutionen. Generell sollen Ernährungsmaßnahmen bei älteren Menschen mit einem Risiko für Mangelernährung oder mit Mangelernährung ergriffen werden, um eine adäquate Zufuhr von Energie und Nährstoffen zu ermöglichen und die gravierenden Folgen von Mangelernährung zu vermeiden. Dabei kann die orale Ernährung durch ursachenorientierte, pflegerische und diätetische Maßnahmen gefördert werden. Enterale bzw. parenterale Ernährung sollten initiiert werden, wenn die orale bzw. enterale Nahrungsaufnahme unzureichend oder unmöglich und die Verlaufsprognose insgesamt positiv ist (nicht in terminalen Krankheitsstadien).

Schlussfolgerung: Unabhängig von der Indikation muss die Entscheidung für oder gegen bestimmte Maßnahmen immer individuell unter sorgfältiger Nutzen-Risiko-Abwägung, Berücksichtigung des (mutmaßlichen) Patientenwillens und der Prognose getroffen werden. Es wird empfohlen, Ernährungsmaßnahmen nicht erst bei schwerer Mangelernährung zu beginnen, sondern frühzeitig, sobald Hinweise auf Ernährungsrisiken vorliegen.

Abstract

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.

Schlüsselwörter

Leitlinie - Empfehlungen - Geriatrie - Ernährungsversorgung - Mangelernährung

Keywords

guideline - recommendations - geriatrics - nutritional care - malnutrition

^* DGEM Steering Committee: Bischoff SC, Lochs H, Weimann A, Adolph M, Ockenga J, Sieber C.

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