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’………clinical interventions for weight loss have been used with modest succes’.
Bales CW, Ritchie CS. Sarcopenia, weight loss, and nutritional frailty in the elderly. Annu Rev Nutr 2002; 22: 309-23
5
Hvor er problemet?• Poulsen et al. J Nutr Health
Aging 2006; 10:84-90• Geriatric admission• 44 % BMI<22• Poor appetite, oral cavity
problems associated with undernutrition
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Hvorfor er problemet her? (Ernæringsrådet. Ernæring og aldring 2002)
0
10
20
30
40
50
21-30 31-40 41-50 51-60 61-70 70+
Alder (År)
Pct.
af s
amle
t kro
psvæ
gt
muskelmasse fedtmasse
10
Hvorfor er problemet her? (Ernæringsrådet. Ernæring og aldring 2002)
• RisikofaktorerSygehusopholdKroniske sygdommeBivirkninger til medicinTygge- og synkeproblemerNedsat fysisk funktionsevneDiæter med lavt fedtindholdOsv.
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OBS! (Janssen & Mark. Obes Rev 2007; 8: 41-59)
BMI 25-30 and mortality• All studies 1.00 (0.97-1.03)• No disease at baseline 1.04 (1.01-1.07)• Measured height and weight 0.89 (0.84-0.95)• Self-reported height and weight 1.03 (1.00-1.06)• Very old (75+) age ?
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OBS! (Janssen & Mark. Obes Rev 2007; 8: 41-59)
BMI 30+ and mortality• All studies 1.10 (1.06-1.13)• No disease at baseline 1.30 (1.24-1.37)• Measured height and weight 0.90 (0.84-0.95)• Self-reported height and weight 1.22 (1.16-1.27)• Very old (75+) age ?
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OBS! (Beck & Ovesen. Clin Nutr 1998; 17: 195-8) (Sygehus)
< 65 ÅR ≥
65 ÅR
Undervægt < 18.5 < 24.0
Normalvægt 18.5-24.9 24.0-29
Overvægt ≥
25 > 29.0
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OBS! (Beck & Damkjær. J Nutr Health Aging 2008; 12: 675-8) (Plejehjem)
BMI<24 BMI 24-29 BMI>29
Lav socialt engagement
74% 62% 46% ***
Hjælp til - Spisning- Personlig hygiejne- Toiletbesøg
34%73%56%
25%67%54%
18% *67% *48%
Engageret i livet 44% 54% 67% ***
Trives ikke med andre 9% 15% 6%
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OBS! (Beck & Damkjær. J Nutr Health Aging 2008; 12: 675-8) (Plejehjem)
BMI<24 BMI 24-29 BMI>29
> 1 livsstilssygdom 46% 48% 78% ***Indlagt - t=0-6- t=6-12
13%10%
10%8%
10%11%
Død t=6- >85 år- Øvrige
18%11%
10%7%
11%5%
Død t=12- >85 år- Øvrige
33%29%
24%13%
28%9% **
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’………clinical interventions for weight loss have been used with modest succes’.
Bales CW, Ritchie CS. Sarcopenia, weight loss, and nutritional frailty in the elderly. Annu Rev Nutr 2002; 22: 309-23
22
Andres konklusioner vedr. ernæring til ældre (Milne et al. Cochrane Library 2005, Ann Intern Med 2006; 144: 37-48)
• For geriatric patients who were given oral nutritional supplements (ONS), evidence suggested fewer complications (0.72 (CI 0.53 to 0.97) and reduced mortality (0.66 (CI 0.49 to 0.90))
• A reduction in mortality for older people in long-term care was almost statistical significant (0,65 (CI 0.41 to 1.02))
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Andres konklusioner vedr. ernæring til ældre (Volkert et al. ESPEN guidelines. Clin Nutr 2006; 25: 330-60)
• In geriatric patients who are undernourished or at risk of undernutrition use ONS to improve survival (A)
• In geriatric patients with severe neurological dysphagia use enteral nutrition (A)
• In geriatric patients after hip fracture and orthopaedic surgery use ONS to reduce complications (A)
• In frail elderly use ONS to improve or maintain nutritional status (A)
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Andres konklusioner vedr. ernæring til ældre (Sundhedsstyrelsen. Screening og behandling af patienter i ernæringsmæssig risiko)
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Andres konklusioner vedr. ernæring til ældre (Sundhedsstyrelsen. Medicinske patienters ernæringspleje. MTV 2005)
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Andres konklusioner vedr. ernæring (til ældre) (Europarådet. Resolution 2003)
• ’Proper nutrition is a human right’
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’………clinical interventions for weight loss have been used with modest succes’.
Bales CW, Ritchie CS. Sarcopenia, weight loss, and nutritional frailty in the elderly. Annu Rev Nutr 2002; 22: 309-23
’Because nutritional frailty rarely has only one cause, treatment requires a plan that includes several simultaneous interventions’.
30
Andres konklusioner vedr. ernæring til ældre (Milne et al. Cochrane Library 2005, Ann Intern Med 2006; 144: 37-48) (plejehjem)
• Change in functional status ?• Change in quality of life ?• Some problems with compliance with ONS• A minority (none ?) energy dense foods• A minority training• None focus on oral health or other risk factors
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OBS ny viden (plejehjem)
• Nijs et al. BMJ 2006; 332: 1180-4 (family-style meals) OK• Rosendahl et al. Aust J Physiother 2006; 52: 105-13 (ONS +
exercise) OK• Beck et al. Nutrition 2008; 24: 1073-80 (energy dense food,
exercise, oral care) OK• Smoliner et al. Nutrition 2008; 24: 1139-44 (energy dense
food)• Rydwik et al. Aging Clin Exp Res 2008;20:159-70 (dietician
+ exercise) OK• Zak et al. BMC Public Health 2009; 9: 39 (ONS + exercise)
OK
32
OBS ny viden (plejehjem)
• Beck AM, Ovesen L, Schroll M. Homemade 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. Aging Clin Exp Res 2002;14:212-5.
33
OBS ny viden Esmarck et al. 2001 *)• ”Early intake of an oral protein supplement after resistance
training is important for the development of hypertrophy in skeletal muscle of elderly (un-trained) men”
*) J Physiol 2001;535:301-11
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OBS ny viden (plejehjem)
Rydwik et al. 2004 *) (16 trials)• Improved muscle strength,
mobility• Improved range of motion ?• Gait, ADL, balance, endurance ?*) Age Ageing 2004;33:13-23
Rydwik et al. 2005 *)• Strength (moderate), mobility,
balance, endurance• Twice a week, 45-60 min., team,
10 w• Improved balance, mobility*) Arch Gerontol Geriatr 2005;40:29-
44
35
OBS ny viden (plejehjem)
• Ekstrand et al. plejehjemsbeboere *)• 31 deltagere → 16 (fra 2 til alle tænder) 81,6 år• Plaque fjernelse m.m. hver 14. dag v. tandplejer• I 8 måneder• Effekt på forekomst af plaque og tandsten *) Tandlægebladet 1998
36
OBS ny viden (plejehjem)
- 25 g chokolade/dag, - 450 ml varm chokolade/uge,
600 ml energidrik/uge, - 150 ml træningsdrik x 2/uge,
holdtræning x2/uge, - tandpleje x 1-2/uge)- 11 uger- Randomiseret, kontrolleret
37
OBS ny viden (plejehjem)
• Oldest participant
• N=200 invited• N=121 (61%) participants - 86 y (CI 85-88) - BMI 23.4 (CI 22.2-24.3)• N=62 in intervention group- 8 dead, 6 drop-outs (t=11)
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OBS ny viden (plejehjem)
Chocolate 68%
Homemade oral supplement
70%
Training 70%
Homemade ”training” supplement
69%
Oral health care
67%
39
OBS ny viden (plejehjem)
Intervention Control P-value
Weight change (t=0-11 w)
1,3% -0,6% 0.005
Weight change (t=0-27 w)
-0,5% -3,1% 0.019
Weight change(t=11-27 w)
-2,5% -3.1% 0.908
Energy intake change(t=0-11 w)
0,7 MJ -0,3 MJ 0.084
Habitual energy intake change (t=0-11 w)
0,5 - 0.066
Protein intake change(t=0-11 w)
5 g -2 g 0.012
40
OBS ny viden (plejehjem)
Intervention Control P-value
30-second chair stand 39 20 0.04
30-second arm curl 57 30 0.009
2-minute step 41 17 0.012
8-foot-up-and-go 39 15 0.01
Berg balance scale 53 19 0.001
Hand grip strenght 55 39 0.119
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OBS ny viden (plejehjem)
Konklusion• Det er muligt at gøre noget
ved ernæringsproblemer, som således ikke skal accepteres som en naturlig del af det, at blive beboere på et plejehjem
42
OBS ny viden (plejehjem)
• VELUX FONDENE• Helsefonden• TOMS• Arla• Tandex• Findus
Samt ikke mindst: Alle medvirkende