Bedeutung der Ernährungs- und Bewegungstherapie für den geriatrischen Patienten

Zusammenfassung

In Deutschland weisen in geriatrischen Abteilungen ca. 60% der Patienten ein Risiko für oder eine manifeste Mangelernährung auf. Nach Phasen der Unterernährung können ältere Menschen den Gewichtsverlust nicht ohne besondere therapeutische Unterstützung kompensieren. Je stärker die Mangelernährung im Alter ausgeprägt ist, umso mehr Muskelmasse geht verloren. Zum Wiederaufbau von Muskelmasse und -funktion benötigen alte Menschen significant mehr Energie und essenzielle Aminosäuren als junge. Der Energiebedarf zum Muskelaufbau steigt außerdem mit fallendem BMI. Bei krankheitsbedingter Immobilisierung verlieren ältere Menschen in 5 Tagen Bettruhe 4% ihrer Muskelmasse und 16% ihrer Muskelkraft. Daher muss es das Ziel einer medizinischen Behandlung geriatrischer Patienten sein, sowohl die Gesundung des Organismus zu erreichen als auch die Kraft und Funktion des muskuloskeletalen Systems zu erhalten. Dies wird im Alter nur durch gleichzeitige Bewegungs- und Ernährungstherapie erreicht. Bei Jungen reicht allein die Gabe von Proteinsupplementen zur Steigerung der muskulären Proteinsynthese nach Bettruhe, bei Alten müssen zusätzlich physiotherapeutische Maßnahmen erfolgen. Die Basis der funktionsorientierten Therapie ist die optimierte Ernährung des geriatrischen Patienten: Der tägliche Energiebedarf im Alter beträgt bei mäßiger Aktivität ca. 30 kcal/kg KG. Eine ausgeglichene Ernährung im Alter sollte 40–60% Kohlenhydrate, 15–20% Protein, 30–50% Fett umfassen, wobei der Proteinanteil durchaus höher sein kann und möglichst 1,5 g/kg KG betragen sollte. Störfaktoren der Ernährung im Alter sind vielfältig, müssen systematisch erfasst und multimodal behandelt werden. In der Geriatrie steht für dieses kombinierte Therapiekonzept das multiprofessionelle Team zur Verfügung.

Abstract

In Germany, about 60% of geriatric patients are at risk of protein-malnutrition or suffer from manifest malnutrition. After a period of undernutrition, weight loss and muscular weakness cannot be compensated in the elderly without individual support. The more malnutrition is present, the more difficult is the process of recovery. In the elderly, increase in muscle mass and function requires more intake of energy and essential amino acids than in youth. This process is even aggravated by lower BMI. During disease-associated immobilisation, elderly patients loose about 4% of muscle mass and 16% of muscle strength after 5 days of bed rest. The aim of medical treatment in the elderly must include strategies of healing and stabilising the functional capacity. Interventions in geriatric patients must combine exercise and nutritional support simultaneously. Daily energy requirements in the elderly with mild activity are about 30 kcal/kg body weight. Carbohydrates should be given at an amount of 40–60 %, proteins of 15–20% and fat by 30–50 %. Daily intake of proteins should be 1.5 g/kg body weight. Multidimensional factors which contribute to manifest malnutrition in the elderly should be systematically determined and – as far as possible – be modified by a multiprofessional geriatric team.

Schlüsselwörter

Ernährungstherapie - Bewegungstherapie - multimodales Therapiekonzept - Eiweiß-Mangelernährung im Alter

Key words

nutritional support - physical activity - multiprofessional therapy concept - protein energy malnutrition in the elderly

Publication History

Article published online:
14 June 2022

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