PROGRAM BOOK Best Practice Sharing: Tested nutritional solutions to support mobility and recovery The 36th ESPEN Congress Geneva, Switzerland Saturday, September 6, 2014 12:00-13:30 Geneva Convention Centre (PALEXPO), Halle 1, Room C
As Nutrition Screening as Visit: www.mna-elderly.com Malnutrition is associated with a 3 times higher infection rate and higher mortality rate 1,2 MNA : The GOLD standard in nutrition screening for the older adult Most validated tool for the elderly Quick, convenient and easy to use Identifies patients who need nutrition intervention Most commonly used nutrition screening tool by geriatricians 3 The new Self-MNA is valid for use by older adults 4 Mini Nutritional Assessment MNA Last name: First name: Sex: Age: Weight, kg: Height, cm: Date: Complete the screen by filling in the boxes with the appropriate numbers. Total the numbers for the final screening score. Screening Screen and intervene. Nutrition can make a difference. A Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties? 0 = severe decrease in food intake 1 = moderate decrease in food intake 2 = no decrease in food intake B Weight loss during the last 3 months 0 = weight loss greater than 3 kg (6.6 lbs) 1 = does not know 2 = weight loss between 1 and 3 kg (2.2 and 6.6 lbs) 3 = no weight loss C Mobility 0 = bed or chair bound 1 = able to get out of bed / chair but does not go out 2 = goes out D Has suffered psychological stress or acute disease in the past 3 months? 0 = yes 2 = no E Neuropsychological problems 0 = severe dementia or depression 1 = mild dementia 2 = no psychological problems F1 Body Mass Index (BMI) (weight in kg) / (height in m 2 ) 0 = BMI less than 19 1 = BMI 19 to less than 21 2 = BMI 21 to less than 23 3 = BMI 23 or greater IF BMI IS NOT AVAILABLE, REPLACE QUESTION F1 WITH QUESTION F2. DO NOT ANSWER QUESTION F2 IF QUESTION F1 IS ALREADY COMPLETED. F2 Calf circumference (CC) in cm 0 = CC less than 31 3 = CC 31 or greater Screening score (max. 14 points) 12-14 points: Normal nutritional status 8-11 points: At risk of malnutrition 0-7 points: Malnourished References 1.Vellas B, Villars H, Abellan G, et al. Overview of the MNA - Its History and Challenges. J Nutr Health Aging. 2006;10:456-465. 2.Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA- SF). J. Geront. 2001;56A: M366-377. 3.Guigoz Y. The Mini-Nutritional Assessment (MNA ) Review of the Literature - What does it tell us? J Nutr Health Aging. 2006; 10:466-487. 4.Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment Short-Form (MNA -SF): A practical tool for identification of nutritional status. J Nutr Health Aging. 2009; 13:782-788. Société des Produits Nestlé, S.A., Vevey, Switzerland, Trademark Owners Nestlé, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com 1. Sorensen J et al. Clin Nutr 2008; 27(3):340-349. 2. Schneider SM et al. Br J Nutr 2004; 92(1):105-111. 3. Vandewoude M et al. European Geriatric Medicine 2011; vol 2, issue 2:67-70. 4. Huhmann et al. J Nutr Health Aging 2013; 17(4):339-344.
Best Practice Sharing: Tested nutritional solutions to support mobility and recovery SATELLITE SYMPOSIUM Best Practice Sharing: Tested nutritional solutions to support mobility and recovery Saturday, September 6, 2014 12:00-13:30 Geneva Convention Centre (PALEXPO), Halle 1, Room C
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Best Practice Sharing: Tested nutritional solutions to support mobility and recovery PROGRAM SPEAKERS Speakers: New evidence for combined nutrition and exercise to improve physical function in pre-frail seniors Reto W. Kressig, MD (Switzerland) Caregiver tips to optimize adherence to prescribed nutritional supplements Sandra Simmons, PhD (USA) Effects of combined nutrition and exercise programs in frail institutionalized older adults: The ACTIVNES study Pedro Abizanda, MD, PhD (Spain) Chair: Matteo Cesari, MD, PhD (France) 5
Reto W. Kressig, MD SPEAKER BIOGRAPHY Reto W. Kressig, born in Zurich (Switzerland), is professor and chief of Geriatrics at the University of Basel, where he is directing the Acute Geriatrics Department, including the acute geriatrics division, the Memory Clinic, and the Basel Mobility Center. After graduation and dissertation at the Zurich University Medical School (1987), he specialized in internal medicine and geriatrics (St. Gallen and Geneva), followed by a postdoctoral fellowship at Emory University, Georgia Institute of Technology, and VA Rehab R&D in Atlanta, USA. In 2005, he obtained the academic degree of Private Docent at the University of Geneva, Switzerland, and in 2006 he was appointed Professor at the Medical Faculty of Basel University. His scientific work and interests include older adults gait biomechanics, physical activity, functional autonomy, and cognition in relation to principles of geriatric rehabilitation, nutrition and fall prevention. He is author of numerous original articles, reviews, letters and book chapters. Professor Kressig is Editorial- Member of several international geriatric journals, Associate Professor of Gerontology at the University of Luxemburg and former Secretary of the European Academy for Medicine of Aging. KEY MESSAGES The aging process is associated with progressive loss of muscle mass with lowered strength and physical endurance ( sarcoepenia ). Regular aerobic and resistance exercise programs have been shown to counteract most aspects of sarcopenia. However, only around half of European seniors are considered physically active and engaged into regular exercise programs. Further, simple resistance exercise alone and therefore increased muscle mass and muscle strength are not a guarantee for functional improvement and less falls in seniors. When designing and offering exercise programs for seniors, compliance factors such as fun and socializing, but also cognitive components for body coordination and balance control imperatively need to be considered. Protein nutrition in combination with exercise is considered optimal for maintaining muscle function. Using fast proteins such as whey in direct combination with physical training interventions seems to be feasible and practical in regard to compliance and most promising in regard to increasing muscle strength and muscle functionality. Adequate dietary protein intake (1.0 1.2g protein/kg body weight/day for healthy older people; 1.2 1.5g protein/kg body weight/day for malnourished and sarcopenic older people) and continuing exercise/ physical activity are important to healthy aging and should be undertaken by all older people, for as long as possible. 6
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Sandra F. Simmons, PhD SPEAKER BIOGRAPHY Sandra F. Simmons, PhD, is an Associate Professor of Medicine in the Division of General Internal Medicine and Public Health at Vanderbilt University. Her educational background is in clinical psychology and gerontology. Her current clinical appointments include staff member at the Vanderbilt Center for Quality Aging and the Geriatric Research, Education and Clinical Center (GRECC), Veterans Administration. Active in research as a Principal Investigator or Co-investigator, Dr. Simmons has been the recipient of numerous grants and fellowships to examine issues in gerontology from the National Institutes of Health and Aging, Agency for Healthcare Research & Quality, Veterans Health Administration and the National Alzheimer s Association. Specifically, her research foci include clinical interventions to improve quality of care and quality of life for older adults in a variety of care settings, in particular long term care. Complementing her research endeavors, Dr. Simmons writes for the medical literature and has more than 80 peer-reviewed articles to her credit, as well as numerous review articles, editorials and book chapters. Additionally, Dr. Simmons frequently speaks nationally and internationally on long-term care quality issues at professional and provider-oriented meetings. KEY MESSAGES Many older adults are at risk for under-nutrition and dehydration. Caregiver offers of a variety of supplements and snacks multiple times per day between regularlyscheduled meals is an effective way to increase caloric intake. Professional caregivers in the long-term care setting often do not provide consistent offers or adequate assistance. Both professional and lay caregivers can be trained to provide better quality assistance to enhance independence in eating and intake for older adults. 8
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Pedro Abizanda Soler, MD, PhD SPEAKER BIOGRAPHY Pedro Abizanda Soler, MD, PhD, is Chief of the Geriatrics Department at the Complejo Hospitalario Universitario de Albacete. He is Associate Professor in Geriatrics at the Medicine Faculty from Castilla-La Mancha University. His PhD degree was granted by the Universidad Autónoma de Madrid. He serves as President of the Ethics Research Committee from Albacete, and member of the Geriatrics Specialty National Commission. He is the author of books and publications in international journals covering issues among older persons in community and hospital settings. Focus areas include cognitive and physical function, frailty, and disability; validated clinical methods of assessment, and therapeutic interventions for rehabilitation. KEY MESSAGES The ESPEN Guidelines on Enteral Nutrition state that in frail elderly, oral nutritional supplements are recommended to improve or maintain nutritional status. It has also been demonstrated that physical exercise in frail older adults is associated with multiple benefits. With these premises we conducted the ACTIVNES Study. Our hypothesis was that a combined intervention of a hyperproteic, hypercaloric (HP/HC) oral nutritional supplement (ONS) (Resource Senior Activ, Nestlé Health Science) plus standardized physical exercise training in frail institutionalized older adults in Spain, would increase strength, functional status, and quality of life under ususal clinical practice conditions. The design was a multicentric prospective observational study in 4 institutions from Spain (n=97). The inclusion criteria were: Patients 70 years old, with 3 or more of Fried s frailty criteria, able to walk 50 meters, and already taking or who started to take a HP/HC nutritional formula with prebiotic fiber, vitamin D and calcium. The main conclusions of the study were: The study intervention (ONS + exercise) reveals an improvement in functional capacities, especially at 6 weeks. 50% of participants improved one or more points in SPPB at weeks 6 and 12. This improvement is more important in participants with more frailty criteria, lower functional level, lower Vitamin D levels and with poorer nutritional status. Participants also improved nutritional status, especially those with malnutrition, and their quality of life at weeks 6 and 12. It is important to highlight that over 90% of residents accomplished daily exercises, and over 80% accomplished an oral intake of more than 60% of ONS. The good results obtained after 6 weeks and the positive trend of many results at 12 weeks open a new research field in medical assistance. 10
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