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Aktuelle Ernährungsmedizin 2004; 29(4): 198-225
DOI: 10.1055/s-2004-828309
Leitlinie Enterale Ernährung - Teil 2
© Georg Thieme Verlag KG Stuttgart · New York

Leitlinie Enterale Ernährung der DGEM und DGG:
Enterale Ernährung (Trink- und Sondennahrung) in der Geriatrie und geriatrisch-neurologischen Rehabilitation

DGEM and DGG Guidelines Enteral Nutrition: Enteral Nutrition (Oral Liquid Supplements and Tube Feeding) in Geriatric Patients and Geriatric-Neurologic RehabilitationD.  Volkert1 , R.  Lenzen-Großimlinghaus1 , U.  Krys1 , M.  Pirlich1 , B.  Herbst1 , T.  Schütz1 , W.  Schröer1 , W.  Weinrebe1 , J.  Ockenga1 , H.  Lochs1
  • 1Institut für Ernährungswissenschaft, Rheinische Friedrich-Wilhelms-Universität Bonn
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Publication History

Publication Date:
12 August 2004 (online)

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Zusammenfassung

Bei geriatrischen Patienten stellt die bedarfsgerechte Versorgung mit Flüssigkeit und Nährstoffen ein häufiges Problem dar. Enterale Ernährung mittels Trink- und Sondennahrung bietet die Möglichkeit, bei unzureichender Lebensmittelaufnahme die Nährstoffversorgung zu verbessern bzw. sicher zu stellen. Die vorliegende Leitlinie gibt evidenzbasierte Empfehlungen für den Einsatz von Trink- und Sondennahrung bei geriatrischen Patienten. Sie wurde, basierend auf den seit 1985 erschienenen themenbezogenen Fachpublikationen, in einer interdisziplinär besetzten Expertengruppe nach den Richtlinien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) und des Ärztlichen Zentrums für Qualität in der Medizin (ÄZQ) erarbeitet und im Rahmen einer Konsensuskonferenz verabschiedet. Enterale Ernährungstherapie in Form von Trinknahrung wird bei drohender oder manifester Mangelernährung, bei Multimorbidität und Gebrechlichkeit, nach Schenkelhalsfrakturen und orthopädisch-chirugischen Eingriffen empfohlen. Sie führt bei drohender oder manifester Mangelernährung zu Verbesserungen im Ernährungszustand, Verkürzung der Krankenhausaufenthaltsdauer und zu einer Verlängerung der Überlebenszeit sowie nach Schenkelhalsfrakturen und orthopädisch-chirurgischen Eingriffen zu einer Reduktion von Komplikationen. Sondenernährung ist eindeutig bei neurologisch bedingten Schluckstörungen indiziert und wird bei Depression zur Überbrückung der Phase der schweren Antriebs- und Essstörung empfohlen. Nicht indiziert ist Sondenernährung dagegen in finalen Krankheitsstadien einschließlich finalen Stadien der Demenz sowie zur Pflegeerleichterung oder Zeitersparnis. Unabhängig von der Indikation muss die Entscheidung für oder gegen Sondenernährung immer individuell unter Berücksichtigung des (mutmaßlichen) Patientenwillens, vorhandener Komorbiditäten, des Krankheitsgrades und der Prognose getroffen werden. Insgesamt wird dringend empfohlen, Ernährungstherapie nicht erst bei schwerer Mangelernährung zu beginnen, sondern frühzeitig, sobald Hinweise auf Ernährungsrisiken vorliegen.

Abstract

Nutrient and fluid intake is often compromised in elderly, multimorbid patients. Enteral nutrition by means of oral liquid supplements and tube feeding offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of oral liquid supplements and tube feeding in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. Enteral nutrition by means of oral liquid supplements is recommended for geriatric patients with malnutrition or at risk of malnutrition, in case of multimorbidity and frailty, and following femur fractures and orthopaedic-surgical procedures. In elderly people at risk of malnutrition oral liquid supplements may improve nutritional status, reduce length of hospital stay and lower mortality. After femur fractures and orthopaedic-surgery oral liquid supplements may reduce unfavourable outcome. Tube feeding is clearly indicated in patients with neurologic dysphagia and is recommended in case of depression in order to overcome phases of severe loss of motivation and refusal to eat. In contrast, tube feeding is not indicated in final disease states, including final dementia, and in order to facilitate patient care and to save time. Independent of the indication, the decision for or against enteral nutrition has to be made individually, in line with the (assumed) patient will and under consideration of comorbidities, severity of illness and prognosis. Altogether, it is strongly recommended not to wait until severe malnutrition has developed, but to start enteral nutrition therapy early, as soon as a nutritional risk becomes apparent.

Schlüsselwörter

Leitlinie - Empfehlungen - geriatrische Patienten - Mangelernährung - enterale Ernährung - Trinknahrung - Sondennahrung

Key words

Guideline - recommendations - geriatric patients - malnutrition - enteral nutrition - oral liquid supplementation - tube feeding

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PD Dr. Dorothee Volkert

Institut für Ernährungswissenschaft · Rheinische Friedrich-Wilhelms-Universität Bonn

Endenicher Allee 11 - 13

53115 Bonn

Email: d.volkert@uni-bonn.de