Biomedical subjects
D Volkert
Publications and source records attributed to D Volkert.
[Nutrition in old age].
A balanced diet before one gets old is relevant for the prevention of the diseases of affluence in old age. With decreasing physical activity the energy requirement decreases, and foods with high nutrient density are required to still supply all essential nutrients. Thirst may become a poor guide to sufficient fluid intake, which should be maintained by good drinking habits. As a consequence of disease or functional impairments, malnutrition may develop. Weight loss and anorexia are warning signals. Risk factors for malnutrition should be known and, if possible, eliminated. A poor nutritional status in the elderly increases morbidity and mortality: good nutrition in the last decades, on the other hand, is an important determinant of the quality of life.
[Nutritional needs of the aged].
Increasing life-expectancy and the high prevalence of diseases in the elderly result in a rapidly growing number of people who are in need of help. There is overall agreement on the importance of nutrition in the care of old people and its influence on health and well-being. In contrast to the younger elderly, where overnutrition is still the main nutritional problem, undernutrition is quite common amongst the very old and ill. Physical and mental impairment, social and financial restriction affect food intake and nutritional status and are considered as risk factors for malnutrition. Food habits such as frequent use of tinned food, long cooking times or improper food storage promote the risk of nutritional deficiencies as well as the risk of bacterial contamination. Age- and nutrition-related changes in immune function lead to an increased susceptibility to infections in the elderly. Therefore special attention should be paid to the consumption of a variety of fresh foods with a high nutrient density and on careful food handling. Sufficient intake of fluid and fibre should also be emphasized.
Nutritional status of the very old: anthropometric and biochemical findings in apparently healthy women in old people's homes.
To obtain reference values for comparison with malnourished geriatric patients, the nutritional status of 50 apparently healthy women aged 75 or older living independently in two old people's homes in Heidelberg was examined. All women were able to walk, and were free from overt disease and signs of mental deterioration. Anthropometric measurements (body height and weight, triceps skinfold thickness, midarm circumference) and biochemical determinations of protein and vitamin status were performed. Anthropometric parameters were similar to those obtained in "younger" samples of healthy elderly, lower than those reported in younger adults, and markedly greater than those reported in geriatric patients. The majority of biochemical findings were within normal reference ranges established for healthy young adults. Only plasma retinol concentrations were below the reference limit in 8 women (16%). These findings show clearly that even in the very old, major alterations in biochemical indicators of nutritional status are rare. Neither advanced age nor institutionalization are associated with malnutrition. This obviously suggests that malnutrition in old age is mainly related to physical and mental disabilities.
Malnutrition in geriatric patients: diagnostic and prognostic significance of nutritional parameters.
Nutritional status was assessed in 300 geriatric patients aged 75 years or more using clinical, anthropometric, biochemical and immunologic methods. Relations between different assessment methods and their prognostic significance with regard to 18-month mortality were examined. For biochemical variables 10% (prealbumin, vitamin B6) to 37% (vitamins A and C) were below conventional limits. In 44% of the patients lymphocytes were diminished. 44% were anergic. Judgement of nutritional status by clinical impression resulted in 22% being deemed undernourished. Clinical diagnosis of undernutrition was associated with low anthropometric measurements (p less than 0.05 for all parameters) and a high prevalence of low biochemical values (p less than 0.05 for albumin, prealbumin, transferrin, vitamin A, vitamin B1). The mean values of all anthropometric variables, plasma proteins, vitamins A and C were significantly lower in patients who died within the following 18 months compared to survivors. The greatest prognostic significance was related to the clinical diagnosis of malnutrition. We conclude that clinical assessment is useful for the evaluation of nutritional status in geriatric patients and the best of numerous nutritional parameters to estimate risk of long-term mortality.
Drug-prescribing patterns in old age. A study of the impact of hospitalization on drug prescriptions and follow-up survey in patients 75 years and older.
A prospective drug surveillance study was undertaken in 300 elderly patients admitted to a geriatric clinic. Prescribing patterns were determined on admission, at discharge and 3.6 and 18 months after discharge. Patients referred from long-term care institutions were on significantly more drugs than non-institutionalized subjects. A 34% reduction in the number of medicines prescribed at discharge was accompanied by a significant decrease in the mean number of prescriptions per patient, from 4.3 to 2.8, irrespective of whether the patient was institutionalized. Polypharmacy, defined by 5 or more concomitant drugs, declined from 43 to 17%. Dosage schedules were simplified in the majority of patients, as expressed by a significant decrease in the mean number of daily doses to be taken from 6.7 on admission to 4.4 at discharge. Cardiovascular drugs, diuretics and psychotropic drugs accounted for 64% of all drug prescriptions. At discharge, prescription frequencies were reduced for most medication categories, except diuretics and gastrointestinal drugs, which were being taken more often. The prescribing frequency of cardiac glycosides, the single most frequently prescribed drug class, decreased from 60 to 33% of the patients. Three months after discharge, prescribing patterns and frequencies were found to be very similar to the pre-admission situation. Eighteen months after discharge, overall drug use had increased by 15% compared to admission, and polypharmacy was recorded in 54% of patients. It is concluded that a substantial reduction in drug prescriptions was possible in the majority of elderly patients, particularly if they are institutionalized, on admission to a geriatric clinic.(ABSTRACT TRUNCATED AT 250 WORDS)
[Malnutrition in old age--results of the Bethany nutrition study].
One of the nutritional problems in elderly people is undernutrition, which is multifactorial in origin: The causes cannot only be seen in poor nutrition. Physical handicaps such as problems with chewing and swallowing, difficulties to cut food, immobility and mental restrictions are responsible for reduced food intake and malnutrition. Psychic and socio-economic problems such as depression, life events and loneliness may reduce appetite; poverty also contributes to the risk of undernutrition. As a result of our investigations of 300 geriatric patients, physical handicaps with influence on nutrient intake such as immobility or chewing problems were found in nearly 50% of all cases; undernutrition was observed in 22% of the patient group. In a group of 50 apparently healthy women aged 75 or older, the frequency of risk factors as well as the frequency of malnutrition was remarkably lower. These results confirm the thesis that, in most of the cases, undernutrition is related to medical problems and to the simultaneous presence of several of the above-mentioned risk factors. As a conclusion, treatment and prevention of malnutrition have to consider individually the elderly person's complete life situation. Present risk factors have to be removed, if possible; even better would be to avoid them.
[Dietary habits of the aged--frequency of intake of foods of high nutritive value].
The high rate of malnutrition in the elderly suggests the need for increased availability of high nutrient density foods such as fruits, vegetables, milk, and whole grain products. An analysis of nutritional habits of 100 persons 75+ years showed that 75% had insufficient intake of whole grain products, 50% an insufficient intake of milk and dairy products, and 25% an insufficient intake of fruits and vegetables. Food intake was shown to be largely independent of such factors as sex, age, or life situation. Only for milk and dairy products could a better supply be shown for institutionalized persons than for independent-living persons. The results of the study emphasize the need for better nutritional information and education of the elderly regarding the importance of high nutrient density foods.
[Malnutrition in the aged--effect of physical, mental, psychological and social factors].
The elderly are considered a risk group for malnutrition, due not only to poor nutrition, but also to other aspects of daily life which affect food intake and nutritional status. In this study 11 factors of physical, mental, psychical, and social origin have been defined as risk-factors leading to malnutrition. Their appearance in a group of 100 geriatric patients above the age of 75 years has been examined. Immobility and difficulties with chewing were found in nearly 50% of the patients. Social problems were observed in 22%-31%. In contrast, there was usually a daily hot meal available to those studied. The relation between the number of risk factors and the nutritional status was obvious. None of the 23 underweight patients was without a risk factor. In 17 (74%) of these patients four or more risk factors were found. For an amelioration of the nutritional situation not only a well balanced diet should be available but the elderly person's complete life situation must be considered.
[Malnutrition in geriatric patients: the Bethanien nutritional study].
Demographic developments in the Federal Republic of Germany indicate a future marked increase in the aged population. With this, there will be an increase in elderly patients. Malnutrition can contribute to disease as well as result from it. While most urgent nutritional problems of the population in general reside in the areas of increased intakes of energy and certain nutrients, nutritional deficiencies are frequent in older citizens, and in particular, geriatric patients. These deficiencies may result from psycho-social factors such as isolation, depression, or chronic brain failure, as well as from clinical factors (diseases which increase nutritional requirements or utilization of nutrients, drug/nutrient-interactions, etc.). The following questions are addressed: 1) How frequent is malnutrition in geriatric patients and which forms of malnutrition can be found? 2) What are the causes of malnutrition? 3) What is the relationship between malnutrition and mortality? 4) Which strategies for prevention and treatment of malnutrition can be developed from the above findings? The study is performed in Bethanien-Hospital, Heidelberg, FRG, a geriatric hospital and day clinic. Three hundred patients aged 75 years or older (representative sample) were included. Nutrition and nutritional status are determined and related to health, drug therapy and other psycho-social conditions in the very old. The prospective part of the study is planned for 18 months and this will also be the duration of the intervention phase.