Older people are at risk of malnutrition when living in the community, as well as in hospitals and in care homes. Malnutrition in older patients may arise from loss of appetite, dysphagia and neurological, digestive or metabolic impairments.1,2 The loss of body weight and muscle mass may also result in a cycle of frailty.3
When the required intake of energy and protein cannot be met by oral nutrition, then enteral tube feeding may bridge the gap and prevent the progression of frailty.4,5
Clinical summary: Presentation/Clinical history
Mrs A, 68 years, retired school teacher, bed-/chair-bound after an ischaemic stroke 2 years ago, weight 3 months ago: 65.1 kg (BMI: 24.2 kg/m2)
Current diagnoses: dysphagia, decubitus grade 3 with delayed wound healing, nausea
Due to dysphagia, Mrs A receives nutrition via a gastrostomy tube
Outcome: 3 months after change of feeding regime
Download the complete and detailed patient case here
Download the complete and detailed patient case here
Clinical summary: Presentation/Clinical history
Mr D, 78 years, living alone at home, current weight 70.1 kg (BMI: 24.0 kg/m2)
Symptoms before admission: Frailty, fall following 4–6 weeks of nausea and vomiting
Diagnosis: Hip fracture, corrective fixation surgery completed and under investigation for vomiting
Nutritional screening identified high nutritional risk due to poor intake and regular vomiting
Outcome: 6 weeks after start of enteral tube feeding
Download the complete and detailed patient case here
Download the complete and detailed patient case here
Clinical summary: Presentation/Clinical history
Mrs C, 70 years, housewife, current weight 55.4 kg (BMI: 21.1 kg/m2)
Symptoms before admission: Confusion, lethargy, shortness of breath
Diagnosis: Chest infection and exacerbation of COPD and possible aspiration pneumonia, commenced I.V. antibiotics
Nutritional screening and poor oral intake indicate high nutritional risk
Outcome: At discharge, 2 weeks after start of enteral tube feeding
Download the complete and detailed patient case here
Download the complete and detailed patient case here
Clinical summary: Presentation/Clinical history
Mrs E, 80 years, frail lady, living alone, current weight 38.7 kg (BMI: 16.1 kg/m2)
Symptoms before admission: Significant weight loss, urinary tract infection, low mood
Past medical history: depression, hypertension, history of falls, previous hip fracture
Nutritional screening: Very significant 24.3 % weight loss over past 5 years and BMI very low
Outcome: 8 weeks after start of enteral tube feeding
Download the complete and detailed patient case here
Download the complete and detailed patient case here
4 example cases illustrate how different patients in the geriatric field may benefit from tube feeding:
What Fresubin can do for your patients.
What Fresubin can do for your patients.
References:
1) Wells JL, Dumbrell AC. Nutrition and aging: assessment and treatment of compromised nutritional status in frail elderly patients. Clin Interv Aging. 2006;1(1):67–79.
2) Stratton RJ, Green CJ, Elia M. Disease-related malnutrition: An evidence-based approach to treatment. CABI Publishing, Wallingford, UK 2003.
3) Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN expert group. Clin Nutr. 2014;33(6):929–936.
4) Volkert D, Berner YN, Berry E, Cederholm T, Coti Bertrand P, Milne A, et al. ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr. 2006;25(2):330–360.
5) Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–397.
