Mangelernährung bei geriatrischen Traumapatienten

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

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