Schluckstörungen und Mangelernährung bei älteren Menschen im Krankenhaus

Zusammenfassung

Etwa 15 % aller älteren Menschen leiden an einer Schluckstörung. Die Anzahl der Betroffenen steigt parallel zum Alter sowie zur Frailty, daher erreicht die Prävalenz bei älteren, gebrechlichen Patienten im Krankenhaus bis zu 47 %. Patienten mit Schluckstörungen weisen eine hohe Morbidität und Mortalität auf, was v. a. auf die Entwicklung von negativen Konsequenzen wie Aspirationspneumonie, Mangelernährung und Dehydration zurückzuführen ist. Patienten mit Schluckstörung sind signifikant häufiger von Mangelernährung betroffen als Patienten ohne Schluckstörung. Im klinischen Alltag ist es daher von besonderer Wichtigkeit, Schluckstörungen frühzeitig zu erkennen und zusätzlich zur medizinischen und logopädischen Therapie eine ernährungsmedizinische Therapie einzuleiten. Besonders bedeutend ist dies bei Hochrisikopatienten wie z. B. bei neurologischen Patienten, jedoch auch allgemein bei älteren hospitalisierten Personen, da das Alter per se einen Risikofaktor für die Entstehung einer Schluckstörung darstellt. Die Erkennung, Diagnostik sowie Therapie von Patienten mit Schluckstörungen muss im multidisziplinären Team erfolgen. Einer der Hauptpfeiler in der Therapie von Schluckstörungen ist die kompensatorische Konsistenzadaptierung der Speisen und Flüssigkeiten. Laut derzeitig vorliegender Evidenz werden die Eindickung von Flüssigkeiten, die Anpassung der Nahrungskonsistenz sowie die individuelle Beratung der Betroffenen als ernährungstherapeutische Maßnahmen empfohlen. Im klinischen Alltag werden bei Patienten mit Schluckstörungen jedoch nicht immer adäquate ernährungsmedizinische Maßnahmen gesetzt, das zeigt u. a. die österreichische Pflegequalitätserhebung. Die Möglichkeiten der Ernährungstherapie sollten jedoch genutzt werden, um die beschriebenen negativen Folgen zu vermeiden und die Prognose sowie die Lebensqualität der Betroffenen zu verbessern.

Abstract

About 15 % of older adults suffer from dysphagia. The number of affected patients increases with age and frailty, therefore the prevalence in frail older hospitalized patients accounts for up to 47 %. Patients with dysphagia show high morbidity and mortality, which is mainly due to the development of negative consequences such as aspiration pneumonia, malnutrition and dehydration. Patients with dysphagia are significantly more frequently affected by malnutrition than those without. In clinical practice, it is therefore particularly important to identify dysphagia at an early stage and to initialize nutrition therapy by dietitians alongside medical and speech therapy. This is of particular importance for high risk patients, e. g. neurology patients, but also generally recommended for older hospitalized adults because age per se is a risk factor for the occurrence of dysphagia. A multidisciplinary team is an indispensable prerequisite for the detection, diagnosis and therapy of patients with dysphagia because various professions may contribute to adequate dysphagia management. One of the main interventions in the treatment of dysphagia is the compensatory adaptation of food/fluid consistency. According to current literature, there is evidence for the thickening of liquids, adjustment of food consistency and individual counseling by dietitians. These interventions are recommended as dietary therapeutic measures. Conversely, adequate nutritional interventions are not always conducted in patients with dysphagia in clinical practice, as shown by the data from the annual International Prevalence Measurement of Care Problems. Adequate nutritional therapy, however, should be used to avoid negative consequences and to improve the prognosis and quality of life of those affected by dysphagia.

Schlüsselwörter

Schluckstörung - Dysphagie - Mangelernährung - Screening - Ernährungstherapie - Ernährung

Keywords

swallowing disorder - dysphagia - malnutrition - screening - nutritional therapy - nutrition

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