Download PDF
Arthritis und Rheuma 2018; 38(02): 97-102
DOI: 10.1055/s-0038-1649288
Geronto-Orthopädie
Schattauer GmbH

Mangelernährung bei geriatrischen Traumapatienten

Ein unterschätztes Problem?Malnutrition in geriatric trauma patientsAn underestimated issue?
D. Eschbach
1   Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Marburg, Marburg
,
C. Bliemel
1   Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Marburg, Marburg
,
R. Aigner
1   Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Marburg, Marburg
,
C. Rolfes
2   Abteilung für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Marburg
,
S. Ruchholtz
1   Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Marburg, Marburg
,
B. Buecking
1   Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Marburg, Marburg
› Author Affiliations
Further Information

Publication History



Publication Date:
27 April 2018 (online)

    Permissions and Reprints

Zusammenfassung

Die Inzidenz von Mangelernährung geriatrischer Patienten wird im Allgemeinen mit über 50 % angegeben. Mangelernährung bei geriatrischen Traumapatienten rangiert im Kollektiv der proximalen Femurfrakturen zwischen 30 und 50 %. Insgesamt erscheinen sowohl die angegebenen Häufigkeiten als auch die angewandten Messinstrumente inhomogen. Malnutrition führt zu einer Verschlechterung der Wundheilung, einer längeren postoperativen Immobilität, einem verlängerten Krankenhausaufenthalt sowie zu einer Steigerung der Mortalität. Unter Hinzuziehung bestehender Leitlinien erreichen das Mini Nutritional Assessment (MNA) sowie das Nutritional Risk Screening (NRS) eine ausreichende prädiktive Validität in diesem geriatrischen Patientengut, um ein Screening auf Mangelernährung durchzuführen. Bezüglich möglicher therapeutischer Interventionen ist die Studienlage limitiert: Vorhandene Studien zeigen oft eine geringe Patientenzahl und demente Patienten, die besonders häufig mangelernährt sind, wurden häufig ausgeschlossen. Eine Leitlinie explizit für dieses spezielle Patientengut existiert aktuell nicht. Ein suffizientes Screening des Ernährungszustandes sowie Daten zur Durchführbarkeit und Effizienz einer kurzfristigen perioperativen Nahrungsergänzung könnten einen wichtigen Beitrag zur Stabilisierung dieser oft multimorbiden und fragilen Patienten leisten.

Summary

The prevalence of malnutrition in geriatric hospitalized patients is reported with up to 57 % in Germany. The incidence of malnutrition in geriatric trauma patients, especially in those suffering hip-related fractures, ranges between 30 % and 50 %. Malnutrition has a strong negative impact on wound healing and is associated with a prolonged in-hospital stay, reduced post-traumatic mobility and daily activity, as well as a higher mortality. Without intervention, pre-existing malnutrition can further protract the in-hospital stay. Thus, nutritional risk screening and improvement of nutritional status could be a fundamental contribution to an optimised treatment of these multi-morbid, advanced-age patients. According to existing guidelines, Mini Nutritional Assessment (MNA) and Nutritional Risk Screening (NRS) showed a satisfying predictive validity for a nutritional screening. Studies focusing on the feasibility of therapeutic interventions are often limited by small subject numbers and do often exclude cognitively impaired patients. Due to a lack of sufficient studies, to date, a guideline targeting especially the malnourished geriatric trauma patient does not exist. The detection of malnutrition and as a consequence the therapeutic intervention in trauma patients shows a strong need for further investigations.

Schlüsselwörter

Geriatrisches Trauma - geriatrische Fraktur - Mangelernährung - Frailty

Keywords

Geriatric trauma - geriatric fracture - malnutrition - frailty
 

  • Literatur

  • 1 Vincent GK, Velkoff VA. The next four decades, the older population in the United States: 2010 to 2050. Current Population Reports. Washington, DC: U.S. Census Bureau; 2010: 25-1138.
    Google Scholar
  • 2 Keller JM, Sciadini MF, Sincalir E. et al. Geriatric trauma: demographics, injuries and mortality. J Orthop Trauma 2012; 26 (09) e161-e165.
    CrossrefPubMedGoogle Scholar
  • 3 The Eastern Association for the Surgery of Trauma. Geriatric trauma (update). Available at: http://www.east.org/resources/treatment-guidelines/geriatric-trauma(update) Accessed July 20, 2012
    PubMedGoogle Scholar
  • 4 Stephanie MDBonne, Douglas JE, Schuerer MD. Trauma in the Older Adult Epidemiology and Evolving Geriatric Trauma Principles. Clin Geriatr Med 2012; 29: 137-150.
    Google Scholar
  • 5 Pirlich M, Schutz T, Norman K. et al. The German Hospital malnutrition study. Clin Nutr 2006; 25: 563-572.
    CrossrefPubMedGoogle Scholar
  • 6 Lumbers M, Driver LT, Howland RJ. et al. Nutritional status and clinical outcome in elderly female surgical orthopaedic patients. Clin Nutr 1996; 15: 101-107.
    CrossrefPubMedGoogle Scholar
  • 7 Hanger HC, Smart EJ, Merrilees MJ, Frampton CM. The prevalence of malnutrition in elderly hip fracture patients. N Z Med J 1999; 112: 88-90.
    PubMedGoogle Scholar
  • 8 Ponzer S, Tidermark J, Brismar K. et al. Nutritional status, insulin-like growth factor-1 and quality of life in elderly women with hip fractures. Clin Nutr 1999; 18: 241-246.
    CrossrefPubMedGoogle Scholar
  • 9 Rolland YG, Abellan van Kan A, Bénétos H. et al. Frailty, osteoporosis and hip fracture: causes, consequences and therapeutic perspectives. J Nutr Health Aging 2008; 12: 335-346.
    PubMedGoogle Scholar
  • 10 Di Monaco M, Vallero F, Di Monaco R, Tappero R. Prevalence of sarcopenia and its association with osteoporosis in 313 older women following a hip fracture. Arch Gerontol Geriatr 2011; 52: 71-74.
    CrossrefPubMedGoogle Scholar
  • 11 Kondrup J, Rasmussen HH, Hamberg O. et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22: 321-336.
    CrossrefPubMedGoogle Scholar
  • 12 Braga M. et al. ESPEN Guidelines on Parenteral Nutrition: Surgery. Clinical Nutrition 2009; 28: 378-386.
    CrossrefPubMedGoogle Scholar
  • 13 Chang CC, Roberts BL. Feeding difficulty in older adults with dementia. J Clin Nurs 2008; 17: 2266-2274.
    CrossrefPubMedGoogle Scholar
  • 14 Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry 2001; 62 (Suppl. 21) 11-14.
    PubMedGoogle Scholar
  • 15 Gherini S, Vaughn BK, Lombardi AV, Mallory TH. Delayed wound healing and nutritional deficiencies after total hip arthroplasty. Clin Orthop Relat Res 1993; 293: 188-195.
    Google Scholar
  • 16 Russell L. The importance of patients’ nutritional status in wound healing. Br J Nurs 2001; 10 S42, S44-S49.
    CrossrefPubMedGoogle Scholar
  • 17 Koval KJ, Maurer SG, Su ET. et al. The effects of nutritional status on outcome after hip fracture. J Orthop Trauma 1999; 13: 164-169.
    CrossrefPubMedGoogle Scholar
  • 18 Foster MR, Heppenstall RB, Friedenberg ZB, Hozack WJ. A prospective assessment of nutritional status and complications in patients with fractures of the hip. J Orthop Trauma 1990; 04: 49-57.
    CrossrefPubMedGoogle Scholar
  • 19 Nematy M, Hickson M, Brynes AE. et al. Vulnerable patients with a fractured neck of femur: nutritional status and support in hospital. J Hum Nutr Diet 2006; 19: 209-218.
    CrossrefPubMedGoogle Scholar
  • 20 Thorsdottir IP, Jonsson V, Asgeirsdottir AE. et al. Fast and simple screening for nutritional status in hospitalized, elderly people. J Hum Nutr Diet 2005; 18: 53-60.
    CrossrefPubMedGoogle Scholar
  • 21 Guo JJ, Yang H, Qian H. et al. The effects of different nutritional measurements on delayed wound healing after hip fracture in the elderly. J Surg Res 2010; 159: 503-508.
    CrossrefPubMedGoogle Scholar
  • 22 Kondrup J, Allison SP, Elia M. et al. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr 2003; 22 (04) 415-421.
    CrossrefPubMedGoogle Scholar
  • 23 Jones JM. The Methodology of nutritional screening and assesment tools. J Hum Nutr Diet 2002; 15: 59-57.
    CrossrefPubMedGoogle Scholar
  • 24 Grashoff K. Den Ernährungszustand richtig beurteilen. http://www.aerztezeitung.de/extras/extras_specials/ernaehrung-wp/article/506941/2008.
    Google Scholar
  • 25 Murphy MC, Brooks CN, New SA, Lumbers ML. The use of the Mini-Nutritional Assessment (MNA) tool in elderly orthopaedic patients. Eur J Clin Nutr 2000; 54: 555-562.
    CrossrefPubMedGoogle Scholar
  • 26 Vellas B, Guigoz Y, Garry PJ. et al. The Mini Nutritional Assesment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999; 15: 116-122.
    CrossrefPubMedGoogle Scholar
  • 27 Isaia G, Mondino S, Germinara C. et al. Malnutrition in an elderly demented population living at home. Arch Gerontol Geriatr 2011; 53: 249-251.
    CrossrefPubMedGoogle Scholar
  • 28 Bastow MD, Rawlings J, Allison SP. Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial. BMJ 1983; 287: 1589-1592.
    CrossrefPubMedGoogle Scholar
  • 29 Delmi M, Rapin CH, Bengoa JM. et al. Dietary supplementation in elderly patients with fractured neck of the femur. Lancet 1990; 335: 1013-1016.
    CrossrefPubMedGoogle Scholar
  • 30 Schroeder D, Gillanders L, Mahr K, Hill GL. Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing. J Parenter Enteral Nutr 1991; 15: 376-383.
    CrossrefPubMedGoogle Scholar
  • 31 Meyenfeldt von M, Meijerink W, Roufflart M. et al. Perioperative nutritional support: a randomized clinical trial. ClinNutr 1992; 11: 180-186.
    PubMedGoogle Scholar
  • 32 Keele AM, Bray MJ, Emery PW. et al. Two phase randomized controlled clinical trial of postoperative oral dietary supplements in surgical patients. Gut 1997; 40: 393-399.
    CrossrefPubMedGoogle Scholar
  • 33 Sullivan DH, Nelson CL, Klimberg VS, Bopp MM. Nightly enteral nutrition support of elderly hip fracture patients: a pilot study. J Am Coll Nutr 2004; 23: 683-691.
    CrossrefPubMedGoogle Scholar
  • 34 Weimann A, Braga M, Harsanyi L. et al. ESPEN guidelines on enteral nutrition: surgery including organ Tnsplantation. Clin Nutr 2006; 26: 224-244.
    Google Scholar
  • 35 Simpson F, Doig GS. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med 2005; 31: 12-23.
    CrossrefPubMedGoogle Scholar
  • 36 Sobotka L, Schneider SM, Berner YN. et al. ESPEN Guidelines on Parenteral Nutrition: geriatrics. Clin Nutr 2009; 28: 461-466.
    CrossrefPubMedGoogle Scholar
  • 37 Eneroth M, Olsson UB, Thorngren KG. Nutritional supplementation decreases hip fracture-related complications. Clin Orthop Relat Res 2006; 451: 212-217.
    CrossrefPubMedGoogle Scholar
  • 38 Anbar R, Beloosesky Y, Cohen J. et al. Tight Calorie Control in geriatric patients following hip fracture decreases complications: A randomized, controlled study. Clin Nutr. 2013 Apr 3. [Epub ahead of print].
    PubMedGoogle Scholar
  • 39 Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev. 2010 CD 001880.
    PubMedGoogle Scholar
  • 40 Caplan JP, Chang G. Refeeding syndrome as an iatrogenic cause of delirium: a retrospective pilot study. Psychosomatics 2010; 51: 419-424.
    CrossrefPubMedGoogle Scholar
  • 41 Volkert D, Chourdakis M, Faxen-Irving G. et al. ESPEN guidelines on nutrition in dementia. Clin Nutr 2015; 34 (06) 1052-1073.
    CrossrefPubMedGoogle Scholar