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“More than 60 percent suffer from malnutrition.”

“More than 60 percent suffer from malnutrition.”

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  2. North Rhine-Westphalia

Nutrition screening for older patients has been carried out at the Dortmund clinic since 2019. Clinic director Thomas Reinbold (left) believes that a nationwide expansion makes sense. © Imago/Fabian Strauch

The issue of malnutrition is a relevant problem in German hospitals – especially among the elderly. Geriatric expert Thomas Reinbold calls for action.

Dortmund – The numbers are alarming: every fourth patient admitted to a German hospital for inpatient treatment suffers from malnutrition. The situation is worse among the elderly: here the nationwide average rate is more than 50, and often more than 60 percent, says Professor Thomas Reinbold, Head of the Department of Geriatrics at the Dortmund Clinic, in an interview with hurry He says.

Older people often eat poorly: ‘More than 60 percent are malnourished’

Reinbold and his team play a leading role in combating this phenomenon: of the 2,221 complex nutritional treatments performed in German hospitals last year, 378 were performed in the Dortmund clinic alone. Jens Greinke spoke to the clinic director about malnutrition.

64.53% of patients in the elderly ward of the Dortmund clinic were malnourished when they were admitted in the first half of 2023. A shockingly high number.

Yes. Most of the patients who come to our geriatric unit are over 80 years old. This is a very weak group. Many people suffer from multiple diseases at the same time. So we’re not talking about normal, decent old people here. But it is usually people who are seriously ill. This ensures that malnutrition worsens. On the other hand, there are other factors that play a major role. Such as social poverty. People don’t have much money anymore, and everything is more expensive.

I recently spoke with an elderly patient and asked him where he could save money. He told me: “Food.” It’s not just about quantity, but also about quality of food. This is a factor related to the phenomenon of malnutrition, and must be clearly explained. Another point is that these patients usually cannot drive to the supermarket by car or bike. Many people also don’t have a smartphone to order something from delivery services. They don’t know that. Nutrition then suffers as a result. By the way, many people are surprised when they hear from us that they suffer from malnutrition. Because they didn’t notice it themselves.

At Dortmund Hospital, the nutrition team takes care of geriatric patients: Professor Dr.  Thomas Reinbold (Head of the Geriatric Clinic), Dr.  Nina Günther (Chief Geriatrician), Lena Nierman (Enteral Nutrition Therapist), and Monica Brandau (Speech Therapist).
ham_vwd535e86b9edb1eaa2b2d23ff70a0d23be.jpg © Jens Greinke

What about the social component?

Many of their partners have died and their children live far away. These people say to me: “I’m alone, Mr. Reinbold. I don’t have a smartphone either, just a cell phone for the elderly. How am I supposed to organize to have decent food?” In these cases, after discharge, we actually organize home care through the outpatient care service.

Who pays for that?

If patients have a standard of care, the nursing care insurance company pays for it. If not, things often get tight. Then they finally have to pay for it themselves. Which brings us back to social poverty.

Invisible symptoms: “You can’t always see a patient’s malnutrition”

Please define the term malnutrition.

By definition, one is talking about malnutrition of the patient. Malnutrition can have different causes. You either eat or drink too little or too one-sided. Or they have an illness that means the food they eat cannot be used properly. What many people don’t take into consideration is that people who are obese, that is, overweight, can also suffer from malnutrition. The patient’s malnutrition is not always apparent, and in this case we are talking about invisible symptoms. This is often a problem when colleagues are not sufficiently knowledgeable about the topic and come to the conclusion that the patient could actually lose some weight. Because the patient’s malnutrition is not always obvious. That’s why you need to use these screening tools to find out if malnutrition is present. Body weight or BMI does not always play a role.

What are these tools?

We are talking about complex nutritional and medical treatment. To do this, we first perform a specific screening test for malnutrition and check, for example, how strong the patients are in their hands. We perform what is called a BIA measurement. This measurement is a relatively simple test that usually takes only five minutes and can be considered an EKG. We use it to measure body composition: how much fat, water and muscle mass is there? Based on the general medical history and these additional criteria, we then decide what the patient’s nutritional needs are. This is integrated into the individual nutrition plan that ensures the patient recovers more quickly.

“Three out of four patients suffer from vitamin D deficiency.”

What defects do you notice most frequently?

An important parameter, for example, is protein intake. We also generally determine for each patient how much vitamin D is in their body. This is not only important for bones, but also for treating muscle loss and muscular dystrophy. Three out of four of the patients we treat here at the clinic suffer from vitamin D deficiency. As people get older, they don’t go out as much, which is why the body’s production of vitamin D, which is stimulated by sunlight, decreases.

We have gradually introduced nutrition management here in Dortmund. This means that every patient is examined and treated appropriately for malnutrition. Because it can lead to a whole bunch of problems. Patients with malnutrition have a longer hospital stay. They have higher complication rates, which also prolongs, if not jeopardizes, recovery time. Wounds after operations in particular heal more quickly and without complications if there is no malnutrition. Respiratory ventilation in the lungs is also worse in malnourished patients. They can increasingly develop irregular heartbeats.

Eliminating malnutrition is of great help to both doctors and patients…

exactly. Let’s take muscle loss, which plays a major role in geriatrics: If you already have someone who is old and frail and you want them back on their feet in geriatrics according to instructions and they are malnourished and have muscle loss, you should also train . He receives intensive physical and occupational therapy. At the same time, this patient must also receive adequate nutrition for the muscle building process to take place. For elderly patients, we check how much energy and protein they need to consume and thus perform a requirement calculation. We can determine exactly how many calories, protein, fat, or carbohydrates a patient needs.

The clinic director from Dortmund calls for mandatory nutritional screening

What conclusions do you draw from the results collected here at the Dortmund Clinic?

We are in constant contact with specialized associations such as the German Society for Nutritional Medicine. We firmly believe that in Germany we need a mandatory nutritional examination for all patients who come to our hospital as inpatients. There was already a hearing in the German Bundestag this summer. I was invited there as an expert on the Health Committee. So politicians are putting this issue on their radar. But it’s clear: Anyone imposing mandatory screening is tying up staff and money. It’s a huge logistical and financial effort, no doubt.

However, is it worth it?

For me as a doctor, the first priority is the patient. By recognizing malnutrition, we can ensure much better care. And recovery is faster. Only five percent of hospitals in Germany currently have a nutrition team. We are in a much worse situation here compared to Switzerland and Austria. The background is that our current reimbursement system does not adequately refund the use of nutritional medicine as a resource.

In short: It’s not financially viable for many hospitals. But this will change at the beginning of 2024, because complex food processing will be revenue-related within the wage system. That’s why I expect many clinics to create nutrition teams in 2024. There are already many studies showing that this malnutrition costs hospitals and the health system a lot of money. However, anyone who identifies and treats malnourished patients is investing more than just covering the costs.