PDF herunterladen
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
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
12. August 2004 (online)

Auch verfügbar auf
    Lizenzen und Reprints

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

Literatur

  • 1 Bundesministerium für Familie, Senioren, Frauen und Jugend .Erster Altenbericht der Bundesregierung über die Lebenssituation älterer Menschen in Deutschland. Bonn; 1993
    Google Scholar
  • 2 Runge M, Rehfeld G. Geriatrische Rehabilitation im Therapeutischen Team. Stuttgart, New York; Thieme 1995
    Google Scholar
  • 3 Lochs H. Leitlinie Enterale Ernährung.  Aktuel Ernaehr Med. 2003;  28, Suppl 1 S1-S120
    PubMedGoogle Scholar
  • 4 Lorenz W. Das Leitlinien-Manual von AWMF und ÄZQ, Entwicklung und Implementierung von Leitlinien in der Medizin.  ZaeFQ. 2001;  95, Suppl 1 1-84
    PubMedGoogle Scholar
  • 5 Milne A C, Potter J, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2002; CD003288
    Google Scholar
  • 6 Volkert D, Hübsch S, Oster P, Schlierf G. Nutritional support and functional status in undernourished geriatric patients during hospitalization and 6-month follow-up.  Aging Clin Exp Res. 1996;  8 386-395
    PubMedGoogle Scholar
  • 7 Payette H, Boutier V, Coulombe C, Gray-Donald K. Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial.  J Am Diet Assoc. 2002;  102 1088-1095
    CrossrefPubMedGoogle Scholar
  • 8 Lawson R M, Doshi M K, Ingoe L E, Colligan J M, Barton J R, Cobden I. Compliance of orthopaedic patients with postoperative oral nutritional supplementation.  Clin Nutr. 2000;  19 171-175
    CrossrefPubMedGoogle Scholar
  • 9 Roebothan B V, Chandra R K. Relationship between nutritional status and immune function of elderly people.  Age Ageing. 1994;  23 49-53
    CrossrefPubMedGoogle Scholar
  • 10 Williams C M, Driver L T, Older J, Dickerson J WT. A controlled trial of sip-feed supplements in elderly orthopaedic patients.  Eur J Clin Nutr. 1989;  43 267-274
    PubMedGoogle Scholar
  • 11 Gray-Donald K, Payette H, Boutier V. Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly.  J Nutr. 1995;  125 2965-2971
    PubMedGoogle Scholar
  • 12 Larsson J, Unosson M, Ek A-C, Nilsson L, Thorslund S, Bjurulf P. Effects of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients - a randomized study.  Clin Nutr. 1990;  9 179-184
    CrossrefPubMedGoogle Scholar
  • 13 Norton B, Homer-Ward M, Donnelly M T, Long R G, Holmes G K. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke.  Br Med J. 1996;  312 13-16
    PubMedGoogle Scholar
  • 14 Park R H, Allison M C, Lang J. et al . Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia.  Br Med J. 1992;  304 1406-1409
    CrossrefPubMedGoogle Scholar
  • 15 Bastow M D, Rawlings J, Allison S P. Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial.  Br Med J. 1983;  287 1589-1592
    CrossrefPubMedGoogle Scholar
  • 16 Hartgrink H H, Wille J, Konig P, Hermans J, Breslau P J. Pressure sores and tube feeding in patients with a fracture of the hip: a randomized clinical trial.  Clin Nutr. 1998;  17 287-292
    CrossrefPubMedGoogle Scholar
  • 17 Sullivan D H, Nelson C L, Bopp M M, Puskarich-May C L, Walls R C. Nightly enteral nutrition support of elderly hip fracture patients: a phase I trial.  J Am Coll Nutr. 1998;  17 155-161
    CrossrefPubMedGoogle Scholar
  • 18 Norregaard O, Tottrup A, Saaek A, Hessov I. Effects of oral supplements to adults with chronic obstructive pulmonary disease (abstract).  Clin Resp Physiol. 1987;  23 388s
    PubMedGoogle Scholar
  • 19 Jensen M B, Hessov I. Dietary supplementation at home improves the regain of lean body mass after surgery.  Nutrition. 1997;  13 422-430
    CrossrefPubMedGoogle Scholar
  • 20 Bos C, Benamouzig R, Bruhat A. et al . Nutritional status after short-term dietary supplementation in hospitalized malnourished geriatric patients.  Clin Nutr. 2001;  20 225-233
    CrossrefPubMedGoogle Scholar
  • 21 Hübsch S, Volkert D, Oster P, Schlierf G. Möglichkeiten und Grenzen der Anwendung flüssiger Nährstoffkonzentrate in der Therapie der Mangelernährung geriatrischer Patienten.  Aktuel Ernaehr Med. 1994;  19 109-114
    PubMedGoogle Scholar
  • 22 Fiatarone Singh M A, Bernstein M A, Ryan A D, O'Neill E F, Clements K M, Evans W J. The effect of oral nutritional supplements on habitual dietary quality and quantity in frail elders.  J Nutr Health Aging. 2000;  4 5-12
    PubMedGoogle Scholar
  • 23 Meredith C N, Frontera W R, O'Reilly K P, Evans W J. Body composition in elderly men. Effect of dietary modification during strength training.  J Am Geriatr Soc. 1992;  40 155-162
    PubMedGoogle Scholar
  • 24 Wouters-Wesseling W, Hooijdonk C Van, Wagenaar L, Bindels J, Groot L de, Staveren W van. The effect of a liquid nutrition supplement on body composition and physical functioning in elderly people.  Clin Nutr. 2003;  22 371-377
    CrossrefPubMedGoogle Scholar
  • 25 Bourdel-Marchasson I, Joseph P A, Dehail P. et al . Functional and metabolic early changes in calf muscle occurring during nutritional repletion in malnourished elderly patients.  Am J Clin Nutr. 2001;  73 832-838
    PubMedGoogle Scholar
  • 26 Callahan C M, Haag K M, Weinberger M. et al . Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting.  J Am Geriatr Soc. 2000;  48 1048-1054
    PubMedGoogle Scholar
  • 27 Ciocon J O, Silverstone F A, Graver L M, Foley C J. Tube feedings in elderly patients. Indications, benefits, and complications.  Arch Intern Med. 1988;  148 429-433
    CrossrefPubMedGoogle Scholar
  • 28 Nair S, Hertan H, Pitchumoni C S. Hypoalbuminemia is a poor predictor of survival after percutaneous endoscopic gastrostomy in elderly patients with dementia.  Am J Gastroenterol. 2000;  95 133-136
    CrossrefPubMedGoogle Scholar
  • 29 Okada K, Yamagami H, Sawada S. et al . The nutritional status of elderly bed-ridden patients receiving tube feeding.  J Nutr Sci Vitaminol. 2001;  47 236-241
    CrossrefPubMedGoogle Scholar
  • 30 Paillaud E, Bories P N, Merlier I, Richardet J P, Jeanfaivre V, Campillo B. Prognosis factors of short and long-term survival in elderly hospitalized patients after percutaneous endoscopic gastrostomy.  Gastroenterol Clin Biol. 2002;  26 443-447
    PubMedGoogle Scholar
  • 31 Abitbol V, Selinger-Leneman H, Gallais Y. et al . Percutaneous endoscopic gastrostomy in elderly patients. A prospective study in a geriatric hospital.  Gastroenterol Clin Biol. 2002;  26 448-453
    PubMedGoogle Scholar
  • 32 Kaw M, Sekas G. Long-term follow-up of consequences of percutaneous endoscopic gastrostomy (PEG) tubes in nursing home patients.  Dig Dis Sci. 1994;  39 738-743
    CrossrefPubMedGoogle Scholar
  • 33 Panos M Z, Reilly H, Moran A. et al . Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs.  Gut. 1994;  35 1551-1556
    CrossrefPubMedGoogle Scholar
  • 34 Sitzmann J V. Nutritional support of the dysphagic patient: methods, risks, and complications of therapy.  J Parent Ent Nutr. 1990;  14 60-63
    PubMedGoogle Scholar
  • 35 Hébuterne X, Schneider S, Peroux J-L, Rampal P. Effects of refeeding by cyclic enteral nutrition on body composition: comparative study of elderly and younger patients.  Clin Nutr. 1997;  16 283-289
    PubMedGoogle Scholar
  • 36 Shizgal H M, Martin M F, Gimmon Z. The effect of age on the caloric requirement of malnourished individuals.  Am J Clin Nutr. 1992;  55 783-789
    PubMedGoogle Scholar
  • 37 Fiatarone M A, O'Neill E F, Doyle N, Clements K M, Roberts S B. et al . The Boston FISCIT Study: The effects of resistance training and nutritional supplementation on physical frailty in the oldest old.  J Am Geriatr Soc. 1993;  41 333-337
    PubMedGoogle Scholar
  • 38 Fay D E, Poplausky M, Gruber M, Lance P. Long-term enteral feeding: a retrospective comparison of delivery via percutaneous endoscopic gastrostomy and nasoenteric tubes.  Am J Gastroenterol. 1991;  86 1604-1609
    PubMedGoogle Scholar
  • 39 Vetta F, Gianni W, Ronzoni S. et al . Role of aging in malnutrition and in restitution of nutritional parameters by tube feeding.  Arch Gerontol Geriatr. 1996;  Suppl 5 599-604
    PubMedGoogle Scholar
  • 40 Peck A, Cohen C E, Mulvihill M N. Long-term enteral feeding of aged demented nursing home patients.  J Am Geriatr Soc. 1990;  38 1195-1198
    PubMedGoogle Scholar
  • 41 Golden A, Beber C, Weber R, Kumar V, Musson N, Silverman M. Long-term survival of elderly nursing home residents after percutaneous endoscopic gastrostomy for nutritional support.  Nurs Home Med. 1997;  5 382-389
    PubMedGoogle Scholar
  • 42 Unosson M, Larsson J, Ek A-C, Bjurulf P. Effects of dietary supplement on functional condition and clinical outcome measured with a modified Norton scale.  Clin Nutr. 1992;  11 134-139
    CrossrefPubMedGoogle Scholar
  • 43 Potter J M. Oral supplements in the elderly.  Curr Opin Clin Nutr Metab Care. 2001;  4 21-28
    CrossrefPubMedGoogle Scholar
  • 44 Woo J, Ho S C, Mak Y T, Law L K, Cheung A. Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective trial.  Age Ageing. 1994;  23 40-48
    CrossrefPubMedGoogle Scholar
  • 45 Espaulella J, Guyer H, Diaz-Escriu F, Mellado-Navas J A, Castells M, Pladevall M. Nutritional supplementation of elderly hip fracture patients. A randomized, double-blind, placebo-controlled trial.  Age Ageing. 2000;  29 425-431
    CrossrefPubMedGoogle Scholar
  • 46 Gariballa S E, Parker S G, Taub N, Castleden C M. A randomized, controlled, single-blind trial of nutritional supplementation after acute stroke.  J Parent Ent Nutr. 1998;  22 315-319
    CrossrefPubMedGoogle Scholar
  • 47 Wouters-Wesseling W, Wouters A E, Kleijer C N, Bindels J G, Groot C P de, Staveren W A van. Study of the effect of a liquid nutrition supplement on the nutritional status of psycho-geriatric nursing home patients.  Eur J Clin Nutr. 2002;  56 245-251
    CrossrefPubMedGoogle Scholar
  • 48 Faxen-Irving G, Andren-Olsson B, Geijerstam A af, Basun H, Cederholm T. The effect of nutritional intervention in elderly subjects residing in group-living for the demented.  Eur J Clin Nutr. 2002;  56 221-227
    CrossrefPubMedGoogle Scholar
  • 49 Saudny-Unterberger H, Martin J G, Gray-Donald K. Impact of nutritional support on functional status during an acute exacerbation of chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1997;  156 794-799
    PubMedGoogle Scholar
  • 50 Kwok T, Woo J, Kwan M. Does low lactose milk powder improve the nutritional intake and nutritional status of frail older Chinese people living in nursing homes?.  J Nutr Health Aging. 2001;  5 17-21
    PubMedGoogle Scholar
  • 51 Lauque S, Arnaud-Battandier F, Mansourian R, Guigoz Y. Protein-energy oral supplementation in malnourished nursing-home residents. A controlled trial.  Age Ageing. 2000;  29 51-56
    CrossrefPubMedGoogle Scholar
  • 52 Efthimiou J, Fleming J, Gomes C, Spiro S G. The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1988;  137 1075-1082
    CrossrefPubMedGoogle Scholar
  • 53 Cederholm T E, Hellström K H. Reversibiliy of protein-energy malnutrition in a group of chronically-ill elderly outpatients.  Clin Nutr. 1995;  14 81-87
    PubMedGoogle Scholar
  • 54 Katakity M, Webb J F, Dickerson J WT. Some effects of a food supplement in elderly hospital patients. A longitudinal study.  Hum Nutr Appl Nutr. 1983;  37A 85-93
    PubMedGoogle Scholar
  • 55 Abuksis G, Mor M, Segal N. et al . Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients.  Am J Gastroenterol. 2000;  95 128-132
    CrossrefPubMedGoogle Scholar
  • 56 Skelly R H, Kupfer R M, Metcalfe M E. et al . Percutaneous endoscopic gastrostomy (PEG): change in practice since 1988.  Clin Nutr. 2002;  21 389-394
    CrossrefPubMedGoogle Scholar
  • 57 Sanders D S, Carter M J, D'Silva J, James G, Bolton R P, Bardhan K D. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia.  Am J Gastroenterol. 2000;  95 1472-1475
    CrossrefPubMedGoogle Scholar
  • 58 Bourdel-Marchasson I, Dumas F, Pinganaud G, Emeriau J-P, Decamps A. Audit of percutaneous endoscopic gastrostomy in long-term enteral feeding in a nursing home.  Internat J Quality Health Care. 1997;  9 297-302
    PubMedGoogle Scholar
  • 59 Rudberg M A, Egleston B L, Grant M D, Brody J A. Effectiveness of feeding tubes in nursing home residents with swallowing disorders.  J Parent Ent Nutr. 2000;  24 97-102
    PubMedGoogle Scholar
  • 60 Mitchell S L, Kiely D K, Lipsitz L A. The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment.  Arch Intern Med. 1997;  157 327-332
    CrossrefPubMedGoogle Scholar
  • 61 Mitchell S L, Kiely D K, Lipsitz L A. Does artificial enteral nutrition prolong the survival of institutionalized elders with chewing and swallowing problems?.  J Gerontol A Biol Sci Med Sci. 1998;  53 M207-M213
    PubMedGoogle Scholar
  • 62 Sanders H, Newall S, Norton B, Holmes G T. Gastrostomy feeding in the elderly after acute dysphagic stroke.  J Nutr Health Aging. 2000;  4 58-60
    PubMedGoogle Scholar
  • 63 Weaver J P, Odell P, Nelson C. Evaluation of the benefits of gastric tube feeding in an elderly population.  Arch Fam Med. 1993;  2 953-956
    CrossrefPubMedGoogle Scholar
  • 64 Delmi M, Rapin C-H, Benoga J M, Delmas P D, Vasey H. Dietary supplementation in elderly patients with fractured neck of femur.  Lancet. 1990;  335 1013-1016
    CrossrefPubMedGoogle Scholar
  • 65 Tkatch L, Rapin C-H, Rizzoli R. et al . Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur.  J Am Coll Nutr. 1992;  11 519-525
    PubMedGoogle Scholar
  • 66 Schurch M A, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour J P. Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial.  Ann Intern Med. 1998;  128 801-809
    CrossrefPubMedGoogle Scholar
  • 67 Brown K M, Seabrock N A. Nutritional influences on recovery and length of hospital stay in elderly women following femoral fracture.  Proc Nutr Soc. 1992;  51 132A
    PubMedGoogle Scholar
  • 68 Avenell A, Handoll H H. Nutritional supplementation for hip fracture aftercare in the elderly. Cochrane Database Syst Rev 2000; CD001880
    Google Scholar
  • 69 Krondl M, Coleman P H, Bradley C L, Lau D, Ryan N. Subjectively healthy elderly consuming a a liquid nutrition supplement maintained body mass index and improved some nutritional parameters and perceived well-being.  J Am Diet Assoc. 1999;  99 1542-1548
    CrossrefPubMedGoogle Scholar
  • 70 Bannerman E, Pendlebury J, Phillips F, Ghosh S. A cross-sectional and longitudinal study of health-related quality of life after percutaneous gastrostomy.  Eur J Gastroenterol Hepatol. 2000;  12 1101-1109
    CrossrefPubMedGoogle Scholar
  • 71 Verhoef M J, Rosendaal G M van. Patient outcomes related to percutaneous endoscopic gastrostomy placement.  J Clin Gastroenterol. 2001;  32 49-53
    CrossrefPubMedGoogle Scholar
  • 72 Stratton R J, Green C J, Elia M. Disease-related malnutrition. An evidence-based approach to treatment. Oxon, UK; CABI Publishing 2003: p 461
    Google Scholar
  • 73 Meier D E, Ahronheim J C, Morris J, Baskin-Lyons S, Morrison R S. High short-term mortality in hospitalized patients with advanced dementia: lack of benefit of tube feeding.  Arch Intern Med. 2001;  161 594-599
    CrossrefPubMedGoogle Scholar
  • 74 Cowen M E, Simpson S L, Vettese T E. Survival estimates for patients with abnormal swallowing studies.  J Gen Intern Med. 1997;  12 88-94
    CrossrefPubMedGoogle Scholar
  • 75 Murphy L M, Lipman T O. Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia.  Arch Intern Med. 2003;  163 1351-1353
    CrossrefPubMedGoogle Scholar
  • 76 Croghan J E, Burke E M, Caplan S, Denman S. Pilot study of 12-month outcomes of nursing home patients with aspiration on videofluoroscopy.  Dysphagia. 1994;  9 141-146
    CrossrefPubMedGoogle Scholar
  • 77 Dwolatzky T, Berezovski S, Friedmann R. et al . A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people.  Clin Nutr. 2001;  20 535-540
    CrossrefPubMedGoogle Scholar
  • 78 Finucane P, Aslan S M, Duncan D. Percutaneous endoscopic gastrostomy in elderly patients.  Postgrad Med J. 1991;  67 371-373
    PubMedGoogle Scholar
  • 79 Horton W L, Colwell D L, Burlon D T. Experience with percutaneous endoscopic gastrotomy in a community hospital.  Am J Gastroenterol. 1991;  86 168-170
    PubMedGoogle Scholar
  • 80 Schneider S M, Raina C, Pugliese P, Pouget I, Rampal P, Hebuterne X. Outcome of patients treated with home enteral nutrition.  J Parent Ent Nutr. 2001;  25 203-209
    PubMedGoogle Scholar
  • 81 Mitchell S L, Tetroe J M. Survival after percutaneous endoscopic gastrostomy placement in older persons.  J Gerontol A Biol Sci Med Sci. 2000;  55 M735-M739
    CrossrefPubMedGoogle Scholar
  • 82 Lindemann B, Nikolaus P T. Outcomes of percutaneous endoscopic gastrostomy in dementia patients.  J Am Geriatr Soc. 2001;  49 838-839
    PubMedGoogle Scholar
  • 83 Quill T E. Utilization of nasogastric feeding tubes in a group of chronically ill, elderly patients in a community hospital.  Arch Intern Med. 1989;  149 1937-1941
    CrossrefPubMedGoogle Scholar
  • 84 Bussone M, Meaune S. Percutaneous endoscopic gastrostomy in old age patients.  Age Nutrition. 1992;  3 110-111
    PubMedGoogle Scholar
  • 85 Bussone M, Lalo M, Piette F, Hirsch J F, Senecal P. Percutaneous endoscopic gastrostomy: its value in assisted alimentation in malnutrition in elderly patients. Apropos of 101 consecutive cases in patients over 70 years of age.  Annales de Chirurgie. 1992;  46 59-66
    PubMedGoogle Scholar
  • 86 Markgraf R, Geitmann K, Pientka L, Scholten T. Ernährung über perkutane endoskopische Gastrostomie. Langzeitergebnisse bei polymorbiden geriatrischen Patienten.  Geriatrie Forschung. 1994;  4 123-129
    PubMedGoogle Scholar
  • 87 Raha S K, Woodhouse K. The use of percutaneous endoscopic gastrostomy (PEG) in 161 consecutive elderly patients.  Age Ageing. 1994;  23 162-163
    PubMedGoogle Scholar
  • 88 James A, Kapur K, Hawthorne A B. Long-term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke.  Age Ageing. 1998;  27 671-676
    PubMedGoogle Scholar
  • 89 Wanklyn P, Cox N, Belfield P. Outcome in patients who require a gastrostomy after stroke.  Age Ageing. 1995;  24 510-514
    PubMedGoogle Scholar
  • 90 Wijdicks E F, McMahon M M. Percutaneous endoscopic gastrostomy after acute stroke: complications and outcome.  Cerebrovascular Diseases. 1999;  9 109-111
    PubMedGoogle Scholar
  • 91 Clarkston W K, Smith O J, Walden J M. Percutaneous endoscopic gastrostomy and early mortality.  South Med J. 1990;  83 1433-1436
    PubMedGoogle Scholar
  • 92 Friedenberg F, Jensen G, Gujral N, Braitman L E, Levine G M. Serum albumin is predictive of 30-day survival after percutaneous endoscopic gastrostomy.  J Parent Ent Nutr. 1997;  21 72-74
    PubMedGoogle Scholar
  • 93 Kohli H, Bloch R. Percutaneous endoscopic gastrostomy: a community hospital experience.  Am Surg. 1995;  61 191-194
    PubMedGoogle Scholar
  • 94 Larson D E, Burton D D, Schroeder K W, DiMagno E P. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients.  Gastroenterol. 1987;  93 48-52
    CrossrefPubMedGoogle Scholar
  • 95 Light V L, Slezak F A, Porter J A, Gerson L W, McCord G. Predictive factors for early mortality after percutaneous endoscopic gastrostomy.  Gastrointest Endosc. 1995;  42 330-335
    PubMedGoogle Scholar
  • 96 Llaneza P P, Menendez A M, Roberts R, Dunn G D. Percutaneous endoscopic gastrostomy: clinical experience and follow-up.  South Med J. 1988;  81 321-324
    PubMedGoogle Scholar
  • 97 Markgraf R, Geitmann K, Pientka L, Scholten T. Long-term results of enteral nutrition by percutaneous endoscopic gastrostomy in multi-morbid internal medicine patients.  Z Gastroenterol. 1993;  31, Suppl 5 21-23
    PubMedGoogle Scholar
  • 98 Nicholson F B, Korman M G, Richardson M A. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome.  J Gastroenterol Hepatol. 2000;  15 21-25
    CrossrefPubMedGoogle Scholar
  • 99 Rabeneck L, Wray N P, Petersen N J. Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes.  J Gen Intern Med. 1996;  11 287-293
    CrossrefPubMedGoogle Scholar
  • 100 Rimon E. The safety and feasibility of percutaneous endoscopic gastrostomy placement by a single physician.  Endoscopy. 2001;  33 241-244
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 101 Sali A, Wong P T, Read A, McQuillan T, Conboy D. Percutaneous endoscopic gastrostomy: the Heidelberg Repatriation Hospital experience.  Aust N Z J Surg. 1993;  63 545-550
    PubMedGoogle Scholar
  • 102 Stuart S P, Tiley E H, Boland J P. Feeding gastrostomy: a critical review of its indications and mortality rate.  South Med J. 1993;  86 169-172
    PubMedGoogle Scholar
  • 103 Tan W, Rajnakova A, Kum C K, Alponat A, Goh P M. Evaluation of percutaneous endoscopic gastrostomy in a university hospital.  Hepato-Gastroenterology. 1998;  45 2060-2063
    PubMedGoogle Scholar
  • 104 Taylor C A, Larson D E, Ballard D J. et al . Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study.  Mayo Clin Proc. 1992;  67 1042-1049
    PubMedGoogle Scholar
  • 105 Wolfsen H C, Kozarek R A, Ball T J, Patterson D J, Botoman V A, Ryan J A. Long-term survival in patients undergoing percutaneous endoscopic gastrostomy and jejunostomy.  Am J Gastroenterol. 1990;  85 1120-1122
    PubMedGoogle Scholar
  • 106 Elia M, Stratton R J, Holden C. et al . Home enteral tube feeding following cerebrovascular accident.  Clin Nutr. 2001;  20 27-30
    PubMedGoogle Scholar
  • 107 Howard L, Malone M. Clinical outcome of geriatric patients in the United States receiving home parenteral and enteral nutrition.  Am J Clin Nutr. 1997;  66 1364-1370
    PubMedGoogle Scholar
  • 108 Sanders D S, Carter M J, D'Silva J, McAlindon M E, Willemse P J, Bardham K D. Percutaneous endoscopic gastrostomy: a prospective analysis of hospital support required and complications following discharge to the community.  Eur J Clin Nutr. 2001;  55 610-614
    CrossrefPubMedGoogle Scholar
  • 109 Potter J M, Roberts M A, McColl J H, Reilly J J. Protein energy supplements in unwell elderly patients - a randomized controlled trial.  J Parent Ent Nutr. 2001;  25 323-329
    PubMedGoogle Scholar
  • 110 Chandra R K, Puri S. Nutritional support improves antibody response to influenza virus vaccine in the elderly.  Br Med J. 1985;  291 705-706
    PubMedGoogle Scholar
  • 111 Wouters-Wesseling W, Wagenaar L W, Groot L C de, Bindels J G, Staveren W A van. Biochemical antioxidant levels respond to supplementation with an enriched drink in frail elderly people.  J Am Coll Nutr. 2003;  22 232-238
    PubMedGoogle Scholar
  • 112 Banerjee A K, Brocklehurst J C, Wainwright H, Swindell R. Nutritional status of long-stay geriatric in-patients: effects of a food supplement (Complain).  Age Ageing. 1978;  7 237-243
    PubMedGoogle Scholar
  • 113 Banerjee A K, Brocklehurst J C, Swindell R. Protein status in long-stay geriatric in-patients.  Gerontology. 1981;  27 161-166
    PubMedGoogle Scholar
  • 114 Beck A M, Ovesen L, Schroll M. Home-made oral supplement as nutritional support of old nursing home residents, who are undernourished or at risk of undernutrition based on the MNA. A pilot trial. Mini Nutritional Assessment.  Aging Clin Exp Res. 2002;  14 212-215
    PubMedGoogle Scholar
  • 115 Ek A-C, Larsson J, Schenck H von, Thorslund S, Unosson M, Bjurulf P. The correlation between anergy, malnutrition and clinical outcome in an elderly hospital population.  Clin Nutr. 1990;  9 185-189
    PubMedGoogle Scholar
  • 116 Hankey C R, Summerbell J, Wynne H A. The effect of dietary supplementation in continuing-care people: Nutritional, anthropometric and biochemical parameters.  J Hum Nutr Diet. 1993;  6 317-322
    PubMedGoogle Scholar
  • 117 McEvoy A W, James O FW. The effect of a dietary supplement (Build-up) on nutritional status in hospitalized elderly patients.  Hum Nutr Appl Nutr. 1982;  36A 374-376
    PubMedGoogle Scholar
  • 118 Bunker V W, Stansfield M F, Deacon-Smith R, Marzil R A, Hounslow A, Clayton B E. Dietary supplementation and immunocompetence in housebound elderly subjects.  Br J Biomed Sci. 1994;  51 128-135
    PubMedGoogle Scholar
  • 119 Bourdel-Marchasson I, Barateau M, Rondeau V. et al . A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients.  Nutrition. 2000;  16 1-5
    CrossrefPubMedGoogle Scholar
  • 120 Chandra R K, Joshi P, Au B, Woodford G. Nutrition and immunocompetence of the elderly: effect of short-term nutritional supplementation on cell-mediated immunity and lymphocyte subsets.  Nutr Res. 1982;  2 223-232
    PubMedGoogle Scholar
  • 121 Gray-Donald K, Payette H, Boutier V, Page S. Evaluation of the dietary intake of homebound elderly and the feasibility of dietary supplementation.  J Am Coll Nutr. 1994;  13 277-284
    PubMedGoogle Scholar
  • 122 Lipschitz D A, Mitchell C O, Steele R W, Milton K Y. Nutritional evaluation and supplementation of elderly subjects participating in a „meals-on-wheals” program.  J Parent Ent Nutr. 1985;  9 343-347
    PubMedGoogle Scholar
  • 123 Harrill I, Kunz M, Kylen A. Dietary supplementation and nutritional status in elderly women.  J Nutr Elderly. 1981;  1 3-13
    PubMedGoogle Scholar
  • 124 Welch P K, Dowson M, Endres J M. The effect of nutrient supplements on high risk long-term care residents receiving pureed diets.  J Nutr Elderly. 1991;  10 49-62
    PubMedGoogle Scholar
  • 125 Joosten E, Elst B Vander. Does nutritional supplementation influence the voluntary dietary intake in an acute geriatric hospitalized population?.  Aging (Milano). 2001;  13 391-394
    PubMedGoogle Scholar
  • 126 Brin M F, Younger D. Neurologic disorders and aspiration.  Otolaryngol Clin North Am. 1988;  21 691-699
    PubMedGoogle Scholar
  • 127 Daniels S K, Brailey K, Priestly D H, Herrington L R, Weisberg L A, Foundas A L. Aspiration in patients with acute stroke.  Arch Phys Med Rehabil. 1998;  79 14-19
    CrossrefPubMedGoogle Scholar
  • 128 Smithard D G, O'Neill P A, Parks C, Morris J. Complications and outcome after acute stroke - does dysphagia matter?.  Stroke. 1996;  27 1200-1204
    CrossrefPubMedGoogle Scholar
  • 129 Teasell R W, McRae M, Marchuk Y, Finestone H M. Pneumonia associated with aspiration following stroke.  Arch Phys Med Rehabil. 1996;  77 707-709
    CrossrefPubMedGoogle Scholar
  • 130 Odderson I R, Keaton J C, McKenna B S. Swallow management in patients on an acute stroke pathway: quality is cost effective.  Arch Phys Med Rehabil. 1995;  76 1130-1133
    CrossrefPubMedGoogle Scholar
  • 131 Smithard D G, Kenwick D, Martin D, O'Neill P. Chest infection following acute stroke: does aspiration matter?.  Age Ageing. 1993;  22, Suppl 3 24-29
    PubMedGoogle Scholar
  • 132 Axelsson K, Asplund K, Norberg A, Eriksson S. Eating problems and nutritional status during hospital stay of patients with severe stroke.  J Am Diet Assoc. 1989;  89 1092-1096
    PubMedGoogle Scholar
  • 133 Gariballa S E, Parker S G, Taub N, Castleden M. Nutritional status of hospitalized acute stroke patients.  Br J Nutr. 1998;  79 481-487
    CrossrefPubMedGoogle Scholar
  • 134 FOOD Trial Collaboration . Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial.  Stroke. 2003;  34 1450-1456
    CrossrefPubMedGoogle Scholar
  • 135 Bath P M, Bath F J, Smithard D G. Interventions for dysphagia in acute stroke. Cochrane Database Syst Rev 2000; CD000323
    Google Scholar
  • 136 Broadley S, Croser D, Cottrell J. et al . Predictors of prolonged dysphagia following acute stroke.  J Clin Neurosci. 2003;  10 300-305
    CrossrefPubMedGoogle Scholar
  • 137 Nyswonger G D, Helmchen R H. Early enteral nutrition and length of stay in stroke patients.  J Neurosci Nurs. 1992;  24 220-223
    CrossrefPubMedGoogle Scholar
  • 138 Taylor S J. Audit of nasogastric feeding practice at two acute hospitals: is early enteral feeding associated with reduced mortality and hospital stay?.  J Hum Nutr Diet. 1993;  6 477-489
    CrossrefPubMedGoogle Scholar
  • 139 Smithard D G, O'Neill P A, England R E, Park C L, Wyatt R, Martin D, Morris J. The natural history of dysphagia following a stroke.  Dysphagia. 1997;  12 188-193
    CrossrefPubMedGoogle Scholar
  • 140 Barer D H. The natural history and functional consequences of dysphagia in hemispheric stroke.  J Neurol Neurosurg Psychiatry. 1989;  52 236-241
    CrossrefPubMedGoogle Scholar
  • 141 Gordon C, Hewer R L, Wade D T. Dysphagia in acute stroke.  Br Med J. 1987;  295 411-414
    CrossrefPubMedGoogle Scholar
  • 142 Houwing R H, Rozendaal M, Wouters-Wesseling W, Beulens J W, Buskens E, Haalboom J R. A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients.  Clin Nutr. 2003;  22 401-405
    CrossrefPubMedGoogle Scholar
  • 143 Lawson R M, Doshi M K, Barton J R, Cobden I. The effect of unselected post-operative nutritional supplementation on nutritional status and clinical outcome of orthopaedic patients.  Clin Nutr. 2003;  22 39-46
    CrossrefPubMedGoogle Scholar
  • 144 Stableforth P G. Supplement feed and nitrogen and calorie balance following femoral neck fracture.  Br J Surg. 1986;  73 651-655
    CrossrefPubMedGoogle Scholar
  • 145 Carver A D, Dobson A M. Effects of dietary supplementation of elderly demented hospital residents.  J Hum Nutr Diet. 1995;  8 389-394
    PubMedGoogle Scholar
  • 146 Arens J, Zürcher G, Fietkau R, Aulbert E, Frick B, Holm M, Kneba M, Mestrom H J, Zander A. Leitlinie Enterale Ernährung: Onkologie.  Aktuel Ernaehr Med. 2003;  28, Suppl 1 S61-68
    PubMedGoogle Scholar
  • 147 Patel P H, Thomas E. Risk factors for pneumonia after percutaneous endoscopic gastrostomy.  J Clin Gastroenterol. 1990;  12 389-392
    PubMedGoogle Scholar
  • 148 Baeten C, Hoefnagels J. Feeding via nasogastric tube or percutaneous endoscopic gastrostomy. A comparison.  Scand J Gastroenterol. 1992;  194 95-98
    PubMedGoogle Scholar
  • 149 Peschl L, Zeilinger M, Munda W, Prem H, Schragel D. Percutaneous endoscopic gastrostomy - a possibility for enteral feeding of patients with severe cerebral dysfunctions.  Wien Klin Wochenschr. 1988;  100 314-318
    PubMedGoogle Scholar
  • 150 Leibovitz A, Plotnikov G, Habot B, Rosenberg M, Segal R. Pathogenic colonization of oral flora in frail elderly patients fed by nasogastric tube or percutaneous enterogastric tube.  J Gerontol A Biol Sci Med Sci. 2003;  58 52-55
    PubMedGoogle Scholar
  • 151 Gomes G F, Pisani J C, Macedo E D, Campos A C. The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia.  Curr Opin Clin Nutr Metab Care. 2003;  6 327-333
    CrossrefPubMedGoogle Scholar
  • 152 Ek A-C, Unosson M, Larsson H, Schenck H von, Bjurulf P. The development and healing of pressure sores related to the nutritional state.  Clin Nutr. 1991;  10 245-250
    CrossrefPubMedGoogle Scholar
  • 153 Bourdel-Marchasson I, Barateau M, Rondeau V. et al . A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d'Evaluation.  Nutrition. 2000;  16 1-5
    CrossrefPubMedGoogle Scholar
  • 154 Finucane T E. Malnutrition, tube feeding and pressure sores: data are incomplete.  J Am Geriatr Soc. 1995;  43 447-451
    PubMedGoogle Scholar
  • 155 Breslow R A, Hallfrisch J, Guy D G, Crawley B, Goldbert A P. The importance of dietary protein in healing pressure ulcers.  J Am Geriatr Soc. 1993;  41 357-362
    PubMedGoogle Scholar
  • 156 McCarter T L, Condon S C, Aguilar R C, Gibson D J, Chen Y K. Randomized prospective trial of early versus delayed feeding after percutaneous endoscopic gastrostomy placement.  Am J Gastroenterol. 1998;  93 419-421
    CrossrefPubMedGoogle Scholar
  • 157 Brown D N, Miedema B W, King P D, Marshall J B. Safety of early feeding after percutaneous endoscopic gastrostomy.  J Clin Gastroenterol. 1995;  21 330-331
    PubMedGoogle Scholar
  • 158 Choudhry U, Barde C J, Markert R, Gopalswamy N. Percutaneous endoscopic gastrostomy: a randomized prospective comparison of early and delayed feeding.  Gastrointest Endosc. 1996;  44 164-167
    CrossrefPubMedGoogle Scholar
  • 159 Dormann A, Stehle P, Radziwill R, Löser C, Paul C, Keymling M, Lochs H. Leitlinie Enterale Ernährung: Grundlagen.  Aktuel Ernaehr Med. 2003;  28, Suppl 1 S26-35
    Artikel in Thieme ConnectPubMedGoogle Scholar

PD Dr. Dorothee Volkert

Institut für Ernährungswissenschaft · Rheinische Friedrich-Wilhelms-Universität Bonn

Endenicher Allee 11 - 13

53115 Bonn

eMail: d.volkert@uni-bonn.de