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Screening and Assessment for an Early Identification of Malnutrition in Older People Abstract: Malnutrition is common among older people and leads to numerous negative clinical consequences due to changes in body composition and body function. A prerequisite for successful prevention and treatment is the early identification of older persons with (risk of) malnutrition. Therefore, in geriatric settings, routine malnutrition screening with a validated tool (e.g., Mini Nutritional Assessment or Nutritional Risk Screening) is recommended at regular intervals. In case of a positive screening result, a subsequent nutritional assessment is performed to confirm the diagnosis, to clarify the causes and to determine the energy and protein deficit, in order to initiate a targeted nutritional therapy and to improve the nutritional status of the older persons and thereby the overall prognosis.

Malnutrition is widespread in older people and if not treated leads to numerous negative clinical consequences, such as functional decline and in-hospital complications as well as increased health care costs. Prerequisites for a successful prevention and therapy of malnutrition are the early identification of persons at risk or those affected and a detailed assessment of their nutritional situation. Based on the current literature, this article provides an overview of important aspects considered in the screening and assessment of malnutrition in older people, such as the use of malnutrition screening tools, the application of diagnostic criteria, the quantification of energy and protein deficiencies, the identification of potential causes of malnutrition and the determination of individual preferences and resources., Competing Interests: Vortragshonorar durch Nutricia., (© Georg Thieme Verlag KG Stuttgart · New York.)

Falls in older adults are a major public health problem with a high incidence and severe consequences for the older individual. The age-related loss of muscle strength as well as muscle mass and muscle function (sarcopenia) are i) risk factors for falling, ii) associated with physical function and iii) markers of the frailty syndrome. Muscle function appears to play a bigger role than muscle mass. The operationalization of sarcopenia using the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm is consistently associated with falling events. Structured physical exercise plays the key role in the prevention of falls and the management of functional decline caused by sarcopenia and frailty. The combined supplementation with proteins and vitamin D supports muscle protein synthesis in undersupplied persons and improves aspects of physical function.

In formulating his theory of action control, Kuhl (1983) proposed two motivational states: action orientation and state orientation. People who are action oriented are able to ignore all informations in concrete situations which are irrelevant with regard to the preferred goals. Persons who are state oriented tend to focus sooner on the outlast aspects of a special state. Kuhl introduced a questionnaire HAKEMP to record these tendencies. Further on, there occurs the general assumption that in a particular state of state orientation, people have only a limited processing capacity for given tasks. This hypothesis was tested in an experiment (n = 88) with a stimulus-reaction task. The conditions were varied by the type of the task (fixed or variable stimulus interval) and feedback for the subjects' ability to react. It was expected that for the fixed stimulus interval condition, state-oriented people would be less efficient than action-oriented subjects; with feedback there should be increasing results. The experiment however, shows no significant difference between the performance of state- and action-oriented subjects. These results are discussed in relation to modifications of the HAKEMP questionnaire.

In an Obstetric Department with approximately 2,000 deliveries yearly, offry third mother is delivered under epidural anesthesia. In a group of 600 maternity patients, the effectiveness, the side effects and the changes in the fetal cardiotocogram were examined during labour and delivery under epidural anesthesia. Evaluated were questionnaire to the mothers with mainly subjective impressions, the anesthetic protocol, and the protocol of labour and delivery including the internal cardiotocogram. 85% of the mothers would have a future delivery under an epidural anesthesia. The incidence of headaches and its independence of the type of obstetric analgesia and anesthesia is mentioned. The number of punctures, the technique of epidural anesthesia, the concentration of the local anesthetic used, failures and side effects are described. The incidence of cesarian sections, fetal morbidity and changes in the cardiotocogram are discussed in detail. The incidence of transilent silent decelerations and alarm dips in the cardiotocogram are mentioned. This study shows that epidural anesthesia is free of risks and a highly effective method for the conduct of obstetric analgesia.