Deutscher Kongress für Versorgungsforschung (20. : 2021 : Online) 20. Deutscher Kongress für Versorgungsforschung 2021 2021, insgesamt 1 Seite 1 Online-Ressource
activities of daily living; Barthel index; body mass index; fat mass; geriatric rehabilitation; long-term; obesity; waist circumference
The obesity pandemic has reached old age but the effect of obesity on functional recovery in geriatric rehabilitation patients has not been investigated to date. In this prospective cohort study, patients admitted into geriatric rehabilitation were consecutively included between September 2015 and September 2016, aged ≥70 years. Individual activities of daily living were documented by the Barthel index (BI, 0-100 points). Obesity was assessed by the measurement of body mass index (BMI, kg/m²), waist circumference (WC, cm) and percentage of body fat mass (%FM) based on triceps’ skinfold thickness at admission (t1), discharge (t2) and six months after discharge (t3). A total of 122 patients were included in the analysis. Prevalence of obesity according to BMI, WC and %FM was 33.6%, 83.6% and 71.3% respectively. Patients with a high WC and patients with a high BMI had lower BI values at t1, t2, t3 and the improvement in BI (t1-t2, t2-t3) was lower than in those with low WC and low BMI, but without statistical significance. In multiple regression analysis, BMI, WC and %FM were not associated with BI at t3 and improvement of BI (t2-t3). Obesity was highly prevalent in geriatric rehabilitation patients, but it was not associated with BI during the 6-month follow-up.
von Janneke Petra van Wijngaarden ; Julia Wojzischke ; Claudia van den Berg ; Aysun Cetinyurek-Yavuz ; Rebecca Diekmann ; Yvette C. Luiking ; Jürgen M. Bauer
Objectives - It has been recognized that nutritional interventions play a role in improving the nutritional and functional status of older persons. This systematic review summarizes the evidence on nutritional and functional outcomes of nutritional interventions alone or in combination with physical exercise in geriatric rehabilitation patients. - Design - Eight electronic databases were searched until July 1, 2019 to identify nutritional intervention studies in patients aged ≥60 years who were admitted to geriatric rehabilitation. A meta-analysis was performed to quantify intervention effects on serum albumin, muscle mass, and hand grip strength (HGS). - Results - A total of 1962 studies were screened and 13 included in the systematic review. Studies were heterogeneous in interventions (4 nutritional interventions, 6 physical exercise + nutritional intervention, 1 timing of protein provision, 1 exercise + dietary advice, 1 nutrition-related nursing care) and outcomes. Among the 9 interventions that tested oral nutritional supplements (ONS) with protein, with or without exercise, 7 studies reported protein intake and 6 showed increased protein intakes, 2 of 5 studies showed increased albumin levels, and 5 of 9 reported an improvement in functional outcomes (BI, Functional Independence Measure, mobility). Meta-analyses showed no significant intervention effects on albumin [standardized mean difference (SMD) 0.45, 95% confidence interval (CI) −0.14, 1.04 (4 studies)], muscle mass [mean difference (MD) 2.14 kg, 95% CI -2.17, 6.45 (3 studies)], and HGS [SMD -0.04, 95% CI -0.55, 0.63 (3 studies)], but was based on a very limited number of studies. - Conclusions and Implications - Only a limited number of studies with heterogeneous nutritional interventions and outcomes were available in the geriatric rehabilitation population. Studies that included ONS improved nutritional outcomes, especially protein intake and albumin levels. Functional outcomes improved in the majority of reporting studies. This indicates benefits of protein supplementation, with or without exercise, in this population. Future well-designed and well-powered clinical trials are needed to clarify existing controversial aspects.
American Medical Directors Association Journal of the American Medical Directors Association New York, NY : Elsevier, 2001 21(2020), 9, Seite 1207-1215.e9 Online-Ressource
Im höheren Lebensalter ist ein höherer Body Mass Index (BMI) mit der altersbezogen geringsten Mortalität assoziiert. Der BMI-Bereich von 25-30 kg/m2, der laut WHO als Übergewicht eingestuft wird - kann im Alter als Normalgewicht gelten. Dennoch ist Adipositas gerade im höheren Lebensalter mit einem gesteigerten Risiko für eine Verschlechterung der körperlichen Funktionalität und für Behinderung assoziiert. Auch für Frailty konnte diese Beziehung zur Adipositas nachgewiesen werden. Daher kann unter funktionellen Gesichtspunkten bei BMI-Werten über 30 kg/m2 eine Gewichtsabnahme sinnvoll sein. Eine diesbezügliche Entscheidung kann jedoch nicht allein auf Basis des individuellen BMI-Werts gefällt werden. Sie sollte den funktionellen Status, die Körperzusammensetzung, die Komorbiditäten und insbesondere die Lebensperspektive der Patientin bzw. des Patienten einbeziehen. Erfolgt eine Gewichtsreduktion, muss diese immer unter strenger ärztlicher Kontrolle mit optimierter Proteinzufuhr, sorgfältig kalkulierter moderater Kalorienreduktion und adäquatem körperlichem Training erfolgen. Bei chronisch kranken, älteren Patienten ist eine Gewichtsreduktion nicht indiziert. Restriktive Diäten jedweder Art sind im Alter prinzipiell kritisch zu werten, da bei auch temporär unzureichender Energiezufuhr ein beschleunigter Abbau an Muskel- und Knochenstruktur droht.
Zeitschrift für Gerontologie und Geriatrie Heidelberg : Springer Medizin, 1998 49(2016), 7, Seite 573-580 Online-Ressource
