Download PDF
Osteologie 2014; 23(01): 5-10
DOI: 10.1055/s-0037-1620029
Alterstraumatologie
Schattauer GmbH

Mangelernährung bei geriatrischen Traumapatienten

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

Publication History

eingereicht: 17 November 2013

angenommen: 13 December 2013

Publication Date:
02 January 2018 (online)

Also available at
    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 ins-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.
    Search in 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.
    CrossrefPubMedSearch in Google Scholar
  • 3 The Eastern Association for the Surgery of Trauma. Geriatric trauma (update). Available at: http://www. east.org/resources/treatment-guidelines/geriatrictrauma (update). Accessed July 20, 2012.
  • 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.
    Search in Google Scholar
  • 5 Pirlich M, Schutz T, Norman K. et al. The German Hospital malnutrition study. Clin Nutr 2006; 25: 563-572.
    CrossrefPubMedSearch in Google 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.
    CrossrefPubMedSearch in Google 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.
    PubMedSearch in Google Scholar
  • 8 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.
    PubMedSearch in Google Scholar
  • 9 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.
    CrossrefPubMedSearch in Google Scholar
  • 10 Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry 2001; 62 (Suppl. 21) 11-14.
    PubMedSearch in Google Scholar
  • 11 Russell L. The importance of patients’ nutritional status in wound healing. Br J Nurs 2001; 10 S42, S44-S49.
    CrossrefPubMedSearch in Google Scholar
  • 12 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.
    CrossrefPubMedSearch in Google Scholar
  • 13 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.
    CrossrefPubMedSearch in Google Scholar
  • 14 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.
    CrossrefPubMedSearch in Google Scholar
  • 15 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.
    CrossrefPubMedSearch in Google Scholar
  • 16 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.
    CrossrefPubMedSearch in Google Scholar
  • 17 Kondrup J, Allison SP, Elia M. et al. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr 2003; 22 (04) 415-421.
    CrossrefPubMedSearch in Google Scholar
  • 18 Jones JM. The Methodology of nutritional screening and assesment tools. J Hum Nutr Diet 2002; 15: 59-57.
    CrossrefPubMedSearch in Google Scholar
  • 19 Grashoff K. Den Ernährungszustand richtig beurteilen. http://www.aerztezeitung.de /extras/ extras_specials/ ernaehrung-wp/article/506941/2008
  • 20 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.
    CrossrefPubMedSearch in Google Scholar
  • 21 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.
    CrossrefPubMedSearch in Google Scholar
  • 22 Isaia G, Mondino S, Germinara C. et al. Malnutrition in an elderly demented population living at home. Arch Gerontol Geriatr 2011; 53: 249-251.
    CrossrefPubMedSearch in Google Scholar
  • 23 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.
    CrossrefPubMedSearch in Google Scholar
  • 24 Delmi M, Rapin CH, Bengoa JM. et al. Dietary supplementation in elderly patients with fractured neck of the femur. Lancet 1990; 335: 1013-1016.
    CrossrefPubMedSearch in Google Scholar
  • 25 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.
    CrossrefPubMedSearch in Google Scholar
  • 26 Meyenfeldt von M, Meijerink W, Roufflart M. et al. Perioperative nutritional support: a randomized clinical trial. ClinNutr 1992; 11: 180-186.
    PubMedSearch in Google Scholar
  • 27 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.
    CrossrefPubMedSearch in Google Scholar
  • 28 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.
    CrossrefPubMedSearch in Google Scholar
  • 29 Weimann A, Braga M, Harsanyi L. et al. ESPEN guidelines on enteral nutrition: surgery including organ Tnsplantation. Clin Nutr 2006; 26: 224-244.
    Search in Google Scholar
  • 30 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.
    Search in Google Scholar
  • 31 Sobotka L, Schneider SM, Berner YN. et al. ESPEN Guidelines on Parenteral Nutrition: geriatrics. Clin Nutr 2009; 28: 461-466.
    CrossrefPubMedSearch in Google Scholar
  • 32 Eneroth M, Olsson UB, Thorngren KG. Nutritional supplementation decreases hip fracture-related complications. Clin Orthop Relat Res 2006; 451: 212-217.
    CrossrefPubMedSearch in Google Scholar
  • 33 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].
    PubMedSearch in Google Scholar
  • 34 Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev. 2010 CD 001880.
    PubMedSearch in Google Scholar
  • 35 Caplan JP, Chang G. Refeeding syndrome as an iatrogenic cause of delirium: a retrospective pilot study. Psychosomatics 2010; 51: 419-424.
    CrossrefPubMedSearch in Google Scholar