ESPEN GUIDELINESESPEN Guidelines on Enteral Nutrition: Geriatrics☆
Section snippets
Terminology
Geriatric patient—a biologically elderly patient who is at acute risk of loss of independence due to acute and/or chronic diseases (multiple pathology) with related limitations in physical, psychological, mental and/or social functions. The abilities to perform the basic activities of independent daily living are jeopardised, diminished or lost. The person is in increased need of rehabilitative, physical, psychological and/or social care to avoid partial or complete loss of independence.
Elderly
What are the aims of EN therapy in geriatrics?
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Provision of sufficient amounts of energy, protein and micronutrients.
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Maintenance or improvement of nutritional status.
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Maintenance or improvement of function, activity and capacity for rehabilitation.
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Maintenance or improvement of quality of life.
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Reduction in morbidity and mortality.
Therapeutic aims for geriatric patients do not generally differ from those in younger patients except in emphasis. While reducing morbidity and mortality is a priority in younger patients, in geriatric patients
EN in specific diagnostic groups
2.1. Is EN indicated in patients with undernutrition?
Undernutrition and risk of undernutrition represent essential and independent indications for EN in geriatric patients. ONS is recommended in order to increase energy, protein and micronutrient intake, maintain or improve nutritional status, and improve survival in patients who are undernourished or at risk of undernutrition (A). ONS and/or TF are recommended early in patients at nutritional risk (e.g. insufficient nutritional intake,
Special practical aspects of EN in geriatric patients
3.1. How should EN be delivered: by PEG or by NGT?
In elderly patients in whom EN is anticipated for longer than 4 weeks, placement of a PEG tube is recommended (A).
Comment: Five studies (four prospective, three randomised) comparing PEG with NGT, show the superiority of PEG (Table 7) in allowing the administration of greater amounts of energy and nutrients over longer periods, resulting in better nutritional status (Ib)11, 12 (IIa)86 The use of NGT is associated with more tube displacements86
References (174)
- et al.
Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial
J Am Diet Assoc
(2002) - et al.
Compliance of orthopaedic patients with postoperative oral nutritional supplementation
Clin Nutr
(2000) - et al.
Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly
J Nutr
(1995) - et al.
Effects of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients—a randomized study
Clin Nutr
(1990) The effect of a supplement which is nutrient dense compared to standard concentration on the total nutritional intake of anorectic patients
Clin Nutr
(1992)- et al.
Pressure sores and tube feeding in patients with a fracture of the hip: a randomized clinical trial
Clin Nutr
(1998) - et al.
Dietary supplementation at home improves the regain of lean body mass after surgery
Nutrition
(1997) - et al.
Nutritional status after short-term dietary supplementation in hospitalized malnourished geriatric patients
Clin Nutr
(2001) - et al.
The effect of a liquid nutrition supplement on body composition and physical functioning in elderly people
Clin Nutr
(2003) - et al.
Functional and metabolic early changes in calf muscle occurring during nutritional repletion in malnourished elderly patients
Am J Clin Nutr
(2001)
Role of aging in malnutrition and in restitution of nutritional parameters by tube feeding
Arch Gerontol Geriatr
The meaning of hypoalbuminaemia in clinical practice
Clin Nutr
Hypoalbuminemia is a poor predictor of survival after percutaneous endoscopic gastrostomy in elderly patients with dementia
Am J Gastroenterol
Effects of refeeding by cyclic enteral nutrition on body composition: comparative study of elderly and younger patients
Clin Nutr
Lack of adaptation to severe malnutrition in elderly patients
Clin Nutr
The effect of age on the caloric requirement of malnourished individuals
Am J Clin Nutr
Effects of dietry supplement on functional condition and clinical outcome measured with a modified Norton scale
Clin Nutr
Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures
Clin Nutr
Reversibiliy of protein-energy malnutrition in a group of chronically ill elderly outpatients
Clin Nutr
Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients
Am J Gastroenterol
Percutaneous endoscopic gastrostomy (PEG): change in practice since 1988
Clin Nutr
Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia
Am J Gastroenterol
Nutritional status and clinical outcome in elderly female surgical orthopaedic patients
Clin Nutr
Dietary supplementation in elderly patients with fractured neck of femur
Lancet
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
Quality of life in long-term home enteral nutrition patients
Clin Nutr
A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people
Clin Nutr
Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients
Gastroenterology
Nutritional support and functional status in undernourished geriatric patients during hospitalization and 6-month follow-up
Aging Clin Exp Res
Relationship between nutritional status and immune function of elderly people
Age Ageing
A controlled trial of sip-feed supplements in elderly orthopaedic patients
Eur J Clin Nutr
Exercise training and nutritional supplementation for physical frailty in very elderly people
N Engl J Med
A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke
Br Med J
Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia
Br Med J
Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial
Br Med J
Nightly enteral nutrition support of elderly hip fracture patients: a phase I trial
J Am Coll Nutr
Effects of oral supplements to adults with chronic obstructive pulmonary disease (abstract)
Clin Resp Physiol
Möglichkeiten und Grenzen der Anwendung flüssiger Nährstoffkonzentrate in der Therapie der Mangelernährung geriatrischer Patienten
Akt Ernähr -Med
The effect of oral nutritional supplements on habitual dietary quality and quantity in frail elders
J Nutr Health Aging
Body composition in elderly men: Effect of dietary modification during strength training
J Am Geriatr Soc
Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting
J Am Geriatr Soc
Tube feedings in elderly patients. Indications, benefits, and complications
Arch Intern Med
Percutaneous endoscopic gastrostomy in elderly patients. A prospective study in a geriatric hospital
Gastroenterol Clin Biol
Long-term enteral feeding: a retrospective comparison of delivery via percutaneous endoscopic gastrostomy and nasoenteric tubes
Am J Gastroenterol
Hypoalbuminemia in the elderly is due to disease not malnutrition
J Clin Exp Gerontol
Long-term enteral feeding of aged demented nursing home patients
J Am Geriatr Soc
Long-term survival of elderly nursing home residents after percutaneous endoscopic gastrostomy for nutritional support
Nurs Home Med
The nutritional status of elderly bed-ridden patients receiving tube feeding
J Nutr Sci Vitaminol
Prognosis factors of short and long-term survival in elderly hospitalized patients after percutaneous endoscopic gastrostomy
Gastroenterol Clin Biol
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For further information on methodology see Schütz et al.173 For further information on definition of terms see Lochs et al.174
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Dorothee Volkert had been employed at the Department of Nutrition Science, University of Bonn, until May 31, 2005; she was not industry employed during the development of the guidelines.
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The authors of the DGEM (German Society for Nutritional Medicine) guidelines on enteral nutrition in geriatrics are acknowledged for their contribution to this article.