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Ernahrungstherapie bei Mangelernahrung alter Menschen sollte nach Moglichkeit auf oralem Wege erfolgen. Sie stellt eine besondere Anforderung an Angehorige, Pflegende und Arzte dar. Aufgrund der individuellen Defizite mus fur jeden Patienten ein angepaster Therapieplan erstellt werden. Als Masnahmen stehen im engeren Sinne die Optimierung des Nahrungsangebotes, energiereiche und angereicherte Kost und flussige Nahrungssupplemente sowie im weiteren Sinn die Optimierung der Betreuung und des Umfeldes bei den Mahlzeiten zur Verfugung. Der Erfolg dieser Masnahmen hangt im wesentlichen von der Intensitat der jeweiligen Betreuung ab.

Im Rahmen der Sturzpravention wird u.a. eine routinemasige Uberprufung der Medikation gefordert. In einer Zufallsstichprobe von 276 uber 75jahrigen Krankenhauspatienten wurde untersucht, wie haufig Arzneimittel verordnet werden, die uber die mogliche Auslosung von Schwindel das Sturzrisiko erhohen konnen. Schwindelbeschwerden und Sturzereignisse wurden standardisiert erhoben. Patienten, die uber Schwindel klagten, gaben Sturze 10mal haufiger an als Patienten ohne Schwindel. Arzneimittel, die als mogliche Nebenwirkung Schwindel verursachen konnen, wurden sehr haufig verordnet. Neuroleptika, Antidepressiva und Hypnotika/Sedativa sowie Kombinationsverordnungen hypotensiv wirksamer Medikamente waren signifikant haufiger fur Patienten verordnet, die uber Schwindel klagten. Eine systematische Durchsicht der Medikation im Rahmen einer Sturzpravention erscheint sinnvoll, insbesondere bei Vorliegen von Mehrfachverordnungen.

The objective of this study, designed as a randomized controlled prospective intervention study, was to evaluate the effect of nutritional supplementation on functional status and need of care in undernourished geriatric patients during hospitalization, and up to 6 months after discharge. Participants consisted of 46 undernourished geriatric patients from a geriatric acute care hospital aged 75 years or older without malignant disease, or need for tube feeding or parenteral nutrition. Patients in the supplement group (SG, N = 20) were offered 400 mL (2100 kJ) daily of a liquid supplement during hospital stay and 200 mL (1050 kJ) per day for the following 6 months at home. Patients in the control group (CG, N = 26) had usual care without supplements. The main outcome measure was functional status based on the Barthel Activities of Daily Living score (ADL) at hospital admission, discharge and after 6 months, with higher scores indicating greater independence and a maximum score of 100 points. In supplemented patients with good acceptance (SG+, N = 11), a median improvement of 20 points was observed between admission and discharge, and a further improvement of 5 points at home. Median changes were 0 and -10 points in supplemented patients with poor acceptance (SG-, N = 9) and 5 and 2.5 points in CG, respectively. In SG+, the proportion of independent patients (> 65 points) increased continuously from 36% at admission to 63% at discharge, to 72% after 6 months, and was significantly higher compared to CG at discharge (63% vs 19%, p < 0.05) and after 6 months (72% vs 39%, p < 0.05). 64% of the patients in SG+ improved during hospitalization, compared to 23% in CG (p < 0.05). In the six months at home, 18% of SG+ improved; none of SG+ deteriorated in hospital or at home. In contrast, deterioration of the ADL score occurred in considerable proportions of SG- (22% in hospital, 22% at home) and CG (4% at hospital, 12% at home) patients. The proportion of patients who improved was smaller in SG- (44% at hospital, 22% at home) as well as in CG (23% at hospital, 35% at home), compared to SG+. In conclusion, a positive functional course was evident in supplemented patients with good acceptance during hospitalization, and further improvement was observed during the following 6 months at home. Nutritional support may contribute to reconvalescence and recovery of undernourished geriatric patients.

To determine predictors of death, nursing home placement and hospital admission, a prospective study was carried out in a university-affiliated geriatric hospital and a general practice. One hundred and thirty-five patients consecutively admitted from home to the geriatric hospital and discharged home again (site 1), and 144 patients, aged 70 years and over, of a general practice (site 2) were recruited for a comprehensive geriatric assessment program. At baseline, none was completely dependent on others, or severely demented. At follow-up after 18 months, 46 subjects (17%) had died, 20 subjects (7%) had been institutionalized, and 79 had been admitted to hospital (28 %) in the interim. Univariate analysis demonstrated a significant association between Barthel Activities of Daily Living (ADL), Lawton-Brody Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Balance and Gait Evaluation, Timed “Up and Go”, Timed Test of Money Counting, Grip-Strength and Williams Board Test, and death as well as nursing home placement. Barthel-ADL were significantly correlated with hospital admission. In a logistic regression analysis, Barthel-ADL were independent predictors for death; Barthel-ADL, Timed “Up and Go”, Timed Test of Money Counting, and Williams Board Test were independent predictors for nursing home placement. No independent predictor was found for hospital admission. It is concluded that self-report and performance-based measures of functional capabilities are useful instruments to identify patients at risk for nursing home placement and death. Factors contributing to hospital admissions are other than those measured by the applied tests.

Objectives: To examine medication problems during a stay in hospital and after discharge and to identify risk factors that contribute to poor compliance with medication a prospective observational study was carried out in an university-affiliated geriatic hospital and a patients' home. Patients: One hundred and nineteen patients admitted from home to the geriatric hospital underwent a comprehensive geriatric assessment. They were also tested in opening and removing tablets from various common medicine containers. Drug prescriptions before, during and after the hospital stay were recorded. Medication use at home was observed by a member of a hospital-based home intervention team. The patients' reports of their drug therapy was compared with those by their family doctors. Results: Of all tested patients 10.1% failed to open at least one container. This inability was associated with poor vision, impaired cognitive function and low manual dexterity. Compliance with prescribed medication was associated with cognitive function, ability to handle medication containers, number of prescribed drugs and recent changes in drug prescriptions. Of the patients only 39.5% had stable drug prescriptions during the 3-month study period. Doctor/patient agreement concerning drug therapy was low in all age groups. The agreement rate and patients' knowledge of their treatment was correlated with cognitive function and the number of prescribed drugs. Conclusion: Patients' ability to open and remove tablets from common commercial packages/containers should be tested routinely during a stay in hospital. Management of medication should be taught and supervised within the first few days after discharge from hospital.

The objective of the study was to compare compliance with and the hypocholesterolaemic effect of lovastatin given once daily as a morning or an evening dose. Twenty-four out-patients with familial hypercholesterolaemia were randomly assigned to receive placebo first, then lovastatin 20 mg, to be taken once daily for 4 weeks, either with the breakfast or evening meal, in a single-blind fashion. Drug compliance was assessed by pill counts and continuous electronic monitoring. Two compliance parameters were evaluated, consumption, defined as percentage of prescribed doses taken, and time compliance, the percentage of total dosing events recorded within defined intervals (6.00-10.00 h, and 17.00-21.00 h), for the morning and evening regimes. Both regimes satisfactorily reduced the total and LDL-cholesterol concentrations, and there was no significant difference in the extent of the reductions. Pill counts overestimated compliance, as revealed by the monitoring method. The times of actual consumption of doses by the patients often differed from that prescribed, predominantly in patients who were told to take the evening dose. Partial time compliance may have confounded the efficacy of the drugs. Electronic compliance monitoring appears to be particularly useful in chronopharmacological studies.

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.

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)

In the present investigation 238 randomly selected male individuals of the general population (age 19--41 years) and 42 age-matched male patients with recurrent renal stone formation (calcium oxalate and/or calcium phosphate) were studied under outpatient conditions without dietary restrictions. Urinary Na excretion was 207 +/- 82 mmol/24 h (range 55--570) in controls and 208 +/- 100 (range 76--575) in recurrent renal stone formers. Both in controls (r = 0.36; p less than 0.01) and in stone formers (r = 0.4; p less than 0.01) a significant correlation was observed between urinary excretion of sodium and calcium. Urinary sodium excretion was unrelated to systolic or diastolic blood pressure in normotensive or hypertensive individuals. This finding indicates that factors other than sodium are involved in the maintenance of hypertension. Urinary sodium, presumably an index of intake of nutrients, was significantly correlated to several coronary risk factors, e.g. fasting glucose, cholesterol and overweight. There existed a significant inverse relationship between fasting plasma phosphate and urinary sodium, but not between fasting plasma phosphate and serum iPTH or urinary cAMP. This finding points to some function of sodium excretion as one determinant of plasma phosphate.

Longterm treatment for 5 years of young patients with familial hypercholesterolemia was accompanied by monitoring of plasma levels of calcium, iron, sodium, parathyroid hormone and water- and fat soluble vitamins, since interference of the ion exchange resin with absorption of numerous substances as well as abnormal plasma levels of some of the above had been described in several studies. Treatment was effective in the group with good compliance (lowering of plasma cholesterol at the end of 5 years by 19% and, compared to the control group, by 23%). Adverse drug effects with respect to the above parameters were not found. Plasma levels of carotinoides and vitamin E were elevated in the patients according to elevated concentrations of lipoproteins which are carriers of these vitamins.

Alimentary lipemia was studied in 12 healthy young men with and without exercise. Three sets of experiments were performed. While continuous exercise of 90 min duration significantly reduced postprandial triglycerides by 26% (study I), this effect could not be observed when exercise was interrupted for 5 min after each 25 min (study II). Plasma free fatty acid concentrations, in the latter experiment, were significantly higher (by 311%) than during rest. When, in a third experiment continuous exercise was compared with intermittent physical activity, the latter condition significantly increased postprandial triglyceridemia, most probably due to precipitous rises of free fatty acids on each interruption of ergometry. It is concluded that in the third experiment the balance between triglyceride removal and triglyceride synthesis was shifted toward the latter. Whether exercise lowers, leaves unaltered, or raises plasma triglyceride levels may depend on subtle changes of experimental design.

In 20 children and adolescents with familial Type IIa hyperlipoproteinemia, serum lipids and lipoproteins were examined before and during treatment with polyanion exchange resins. The composition of LDL was compared to that of healthy siblings. The patients were given Colestyramine (0.6 g/kg body weight) and Colestipol (0.5 g/kg body weight) in a cross-over study for 8 weeks each, after they had been under dietary treatment for at least 12 months. In 6 children, drug treatment had to be stopped due to side-effects. The most common complaints were gastrointestinal discomfort and constipation.

The effect of nicotinic acid and several derivatives on the nocturnal level of free fatty acids was studied in 12 healthy young women and men. Free fatty acids are an important precursor of plasma triglycerides and their concentration is highest at night. The drugs used were nictinic acid, beta-pyridyl-carbinol, mesoinositol hexanicotinate and xantinol nicotinate. The highest plasma nicotinic acid level was observed with beta-pyridyl-carbinol, but significant reduction in free fatty acids during the entire night was only achieved with inositolhexanicotinate and xantinol nicotinate. There was no correlation between the plasm levels of free fatty acids and nicotinic acid at any sampling time. If prolonged reduction in free fatty acid concentration is desired in the therapy of hyperlipidemias, the inositol and xantinol esters of nicotinic acid appear to be superior to the other preparations.

The effect of i.v. LB-46 (Visken®), 0.6 mg, on blood concentrations of various parameters of carbohydrate (blood sugar, lactate, pyruvate) and lipid metabolism (free fatty acids, acetoacetate, β-hydroxybutyrate, triglycerides) has been studied in a double blind trial in 10 healthy subjects. There were small, but significant elevations of blood sugar and free fatty acids (p

Bei 6 Personen wurde die Wirkung einer intraduodenalen Instillation von 10 naval HCl/10 min und 1 E/kg Sekretin (Boots) auf die exokrine und endokrine Pankreasfunktion untersucht. Wahrend eine Stimulierung der exokrinen Pankreasfunktion sowohl wahrend der HCl-Instillation als auch unter exogener Sekretinzufuhr beobachtet werden konnte, war eine betacytotrope Wirkung, gemessen am Blutzucker und an der Plasmainsulinkonzentration im peripheren Venenblut nur nach exogener Sekretinstimulation nachweisbar. - Die intraduodenale Instillation von 2×3 mval HCl wahrend einer intraduodenalen Glucosebelastung mit 300 ml 5%iger Glucose/20 min bei 7 Personen fuhrte zudem zu keiner Steigerung der Glucoseutilisation oder des Insulinspiegels. Nach intraduodenalem Atherreiz (3 ml), welcher zur Stimulierung eines bicarbonat- und enzymreichen Pankreassaftes fuhrt, konnten keine Zeichen einer betacytotropen Wirkung beobachtet werden, so das eine endogene Sekretinfreisetzung fur die schnellere Glucoseassimilation und grosere Insulinsekretion nach oraler Glueosezufuhr im Vergleich zur intravenosen Glucosezufuhr keine grosere physiologische Bedeutung haben durfte.

Eine neue Methode der Lipoproteinelektrophorese in Agarose-Gel wird mit der nachLees u.Hatch (1963) modifizierten Methode der Papierelektrophorese an Hand von Seren mit typischen Lipoproteinmustern verglichen. Nach den bisherigen Erfahrungen bietet die Agarose-Gel-Elektrophorese gegenuber dem Verfahren auf Papier die Vorteile einer scharferen Trennung der einzelnen Lipoproteinbanden, einer schnelleren Durchfuhrung, reproduzierbarer Aussagen uber die relative elektrophoretische Mobilitat bestimmter Lipoproteinbanden und einer densitometrischen Auswertbarkeit.

Bei 5 Normalpersonen wurde der Einflus von 7µg/kg Glukagon (Novo) i. v. auf die exokrine und endokrine Pankreasfunktion im Vergleich zur Wirkung von 1 E/kg Korpergewicht/kg Secretin (Boots) untersucht. Blutzucker und Plasmainsulinkonzentration zeigten nach Glukagonzufuhr einen raschen Anstieg und einen tragen Abfall innerhalb 60 min. Die Bicarbonatsekretion und die Amylasesekretion wiesen wahrend dieses Zeitraumes keine Veranderungen im Vergleich zur Leerperiode auf. Die nachfolgende Secretininjektion verursachte eine signifikante Steigerung der Bicarbonatsekretion.

In tierexperimentellen Untersuchungen an adrenalektomierten Ratten wurde der Einflus von Glucagon (0,1 mg/kg) auf die Insulinsekretion und den Blutzucker nach Vorbehandlung mit 200 mg/kg Diazoxid untersucht. Bei normal gefutterten Tieren war die glucagoninduzierte Insulinsekretion nach Diazoxid stark vermindert, aber nicht vollig aufgehoben. Nach 24stundigem Fasten hatte Diazoxid keine hemmende Wirkung auf die glucagonstimulierte Insulinsekretion.