Aktuelle ESPEN-Leitlinie Klinische Ernährung und Hydration in der Geriatrie

Malnutrition und Dehydration zählen zu den häufigsten geriatrischen Syndromen mit weitreichenden klinischen Folgen. Zudem gewinnt die Problematik der Adipositas auch im hohen Alter zunehmend an Bedeutung. Dieser Beitrag präsentiert zentrale evidenzbasierte Empfehlungen zur Prävention und Therapie der genannten Ernährungsprobleme aus der aktuellen europäischen ESPEN-Leitlinie.

Abstract

Malnutrition, dehydration and obesity are relevant health problems with far-reaching consequences for older people. Routine screening for malnutrition and dehydration should be carried out in order to identify vulnerable and affected persons at an early stage and to be able to take timely countermeasures. In many cases, adequate nutrition and hydration can be supported by simple nursing measures and optimisation of the food and drink supply. Nutritional advice, sip feed, enteral and parenteral nutrition are further effective measures for the prevention and therapy of malnutrition. An ingestion deficiency dehydration should be diagnosed on the basis of serum osmolality and requires a rapid compensation of the deficit by hypotonic fluids – depending on the severity, in the form of drinks, subcutaneously or intravenously. Weight loss in old age should only be considered in cases of obesity with associated health problems and should be achieved by moderate energy reduction in combination with physical exercise.

Schlüsselwörter

Leitlinie - Mangelernährung - Dehydration - Adipositas - Geriatrie

Key words

guideline - malnutrition - dehydration - obesity - geriatrics

Publication History

Article published online:
09 September 2020

• Literatur

• 1 Volkert D, Beck AM, Cederholm T. et al ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2019; 38: 10-47 . doi:10.1016/j.clnu.2018.05.024
• 2 Morley JE. Anorexia of ageing: a key component in the pathogenesis of both sarcopenia and cachexia. J Cach Sarc Muscle 2017; 8: 523-526
• 3 Cereda E, Pedrolli C, Klersy C. et al. Nutritional status in older persons according to healthcare setting: a systematic review and meta-analysis of prevalence data using MNA^® . Clin Nutr 2016; 35: 1282-1290
• 4 Hooper L, Bunn D, Jimoh FO. et al Water-loss dehydration and aging. Mech Ageing Dev 2014; 136–137: 50-58 . doi:10.1016/j.mad.2013.11.009
• 5 Hooper L, Bunn DK, Downing A. Which frail older people are dehydrated? The UK DRIE study. J Gerontol A Biol Sci Med Sci 2015; 71: 1341-1347
• 6 Gallus S, Lugo A, Murisic B. et al. Overweight and obesity in 16 European countries. Eur J Nutr 2015; 54: 679-689
• 7 Porter Starr KN, McDonald SR, Weidner JA. et al. Challenges in the management of geriatric obesity in high risk populations. Nutrients 2016; 8: 262
• 8 Bischoff SC, Singer P, Koller M. et al. Standard operating procedures for ESPEN guidelines and consensus papers. Clin Nutr 2015; 34: 1043-1051
• 9 Volkert D, Bauer J, Frühwald T. et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE und der DGG. Aktuelle Ernährungsmedizin 2013; 38: e1-e48
• 10 Volkert D, Berner YN, Berry E. et al. ESPEN guidelines on enteral nutrition: geriatrics. Clin Nutr 2006; 25: 330-360
• 11 Sobotka L, Schneider SM, Berner YN. et al. ESPEN guidelines on parenteral nutrition: geriatrics. Clin Nutr 2009; 28: 461-466
• 12 Cederholm T, Jensen GL, Correia MITD. et al GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr 2019; 38: 1-9 . doi:10.1016/j.clnu.2018.08.002
• 13 National Clinical Guideline Centre. Intravenous fluid therapy – Intravenous fluid therapy in adults in hospital. London: National Institute for Health and Care Excellence; 2013 https://www.ncbi.nlm.nih.gov/books/NBK247761/ ; Stand 13.01.2020