Ernæringsproblemer hos svækkede ældre. Anne Marie Beck, klinisk diætist, seniorforsker ambe@food.dtu.dk

Ernæringsproblemer hos svækkede ældre Anne Marie Beck, klinisk diætist, seniorforsker ambe@food.dtu.dk

2 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

Hvor er problemet? 3

4 Hvor er problemet? På sygehuse På plejehjem I hjemmepleje

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

Hvor er problemet? (Beck et al. Ugeskr Læger 2008; 170:749-52) (16 % BMI<18.5) 6

7 Hvorfor er problemet her? (Ernæringsrådet. Ernæring og aldring 2002) 50 Pct. af samlet kropsvægt 40 30 20 10 0 21-30 31-40 41-50 51-60 61-70 70+ Alder (År) muskelmasse fedtmasse

Hvorfor er problemet her? (Ernæringsrådet. Ernæring og aldring 2002) 8

Hvorfor er problemet her? (Ernæringsrådet. Ernæring og aldring 2002) 9

10 Hvorfor er problemet her? (Ernæringsrådet. Ernæring og aldring 2002) Risikofaktorer Sygehusophold Kroniske sygdomme Bivirkninger til medicin Tygge- og synkeproblemer Nedsat fysisk funktionsevne Diæter med lavt fedtindhold Osv.

OBS! 11

OBS! 12

OBS! 13

14 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?

15 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?

16 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

17 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 34% 25% 18% * - Personlig hygiejne 73% 67% 67% * - Toiletbesøg 56% 54% 48% Engageret i livet 44% 54% 67% *** Trives ikke med andre 9% 15% 6%

18 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 13% 10% 10% -t=6-12 10% 8% 11% Død t=6 - >85 år 18% 10% 11% - Øvrige 11% 7% 5% Død t=12 - >85 år 33% 24% 28% - Øvrige 29% 13% 9% **

OBS! 19

OBS! 20

21 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))

23 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)

Andres konklusioner vedr. ernæring til ældre (Sundhedsstyrelsen. Screening og behandling af patienter i ernæringsmæssig risiko) 24

Andres konklusioner vedr. ernæring til ældre (Sundhedsstyrelsen. Medicinske patienters ernæringspleje. MTV 2005) 25

26 Andres konklusioner vedr. ernæring (til ældre) (Europarådet. Resolution 2003) Proper nutrition is a human right

OBS! 27

OBS! Følg ordentligt hjem 28

29 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

31 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

34 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)

38 OBS ny viden (plejehjem) Chocolate 68% Homemade oral supplement 70% Training 70% Homemade training supplement Oral health care 69% 67%

39 OBS ny viden (plejehjem) Intervention Control P-value Weight change (t=0-11 w) Weight change (t=0-27 w) Weight change (t=11-27 w) Energy intake change (t=0-11 w) Habitual energy intake change (t=0-11 w) Protein intake change (t=0-11 w) 1,3% -0,6% 0.005-0,5% -3,1% 0.019-2,5% -3.1% 0.908 0,7 MJ -0,3 MJ 0.084 0,5-0.066 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

41 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

Ernæringsproblemer hos svækkede ældre clinical interventions for weight loss have been used with modest succes. IKKE OK! 43