Abstract Background Oropharyngeal dysphagia is common in geriatric patients and a major risk factor for pneumonia. Fiberoptic endoscopic evaluation of swallowing (FEES) can identify specific swallowing abnormalities; however, apart from aspiration, the relationship of these abnormalities to pneumonia risk is not well understood. This study aimed to identify FEES-based swallowing abnormalities associated with long-term pneumonia risk beyond airway invasion alone and to develop and internally evaluate a transparent multifeature risk score. Methods In this retrospective cohort study, 98 geriatric patients underwent FEES. Nine predefined FEES-derived swallowing features were analyzed using a clustering approach to identify a multifeature constellation associated with pneumonia. In addition, three methods were tested to develop a scoring system: clustering-based feature selection, penalized logistic regression, and a weighted ensemble of decision tree stumps, all assessed using fivefold cross-validation. Results The clustering approach revealed a swallowing pattern comprising prolonged oral phase (excluding bread), delayed swallow reflex, reduced whiteout intensity, repetitive swallowing (excluding bread), piriform sinus residue, and airway invasion at PAS ≥ 3. A simple scoring system assigning one point per feature yielded an area under the receiver operating characteristic curve of 0.73 (95% CI 0.61–0.82). Each additional deficit increased pneumonia risk (odds ratio 1.82, 95% CI 1.24–2.67). The optimal Youden-optimized cut-off was ≥ 4 deficits, yielding a sensitivity of 0.46 (95% CI 0.29–0.63) and specificity of 0.89 (95% CI 0.79–0.96). Conclusions and Implications Pneumonia risk in hospitalized geriatric patients with oropharyngeal dysphagia arises from the accumulation of functional swallowing impairments rather than isolated endoscopic findings. A transparent, exclusively FEES-based multifeature score provides a pragmatic framework for risk stratification.

Aufgrund von Begleiterkrankungen, Medikation, der geringeren fettfreien Masse und des im Alter oft nachlassenden Durstgefühls besteht bei älteren Menschen ein besonders hohes Risiko für die Entwicklung einer Dehydratation. Daher zählt die Dehydratation zu den häufigsten Diagnosen bei älteren Patienten. Trotz der hohen Prävalenz existieren keine einheitlichen diagnostischen Kriterien, sodass die Diagnosestellung oft mit einer erheblichen Unsicherheit behaftet ist. Alle diagnostischen Einzelkriterien weisen eine unzureichende Sensitivität und Spezifität auf, sodass die Diagnose nur in der Gesamtschau aller Symptome und gelegentlich auch erst nach einer erfolgreichen probatorischen Therapie gestellt werden kann. Die Symptome einer Dehydratation sind oft sehr unspezifisch, ihre Folgen können jedoch gravierend sein. Neben der unmittelbaren Symptomatik begünstigt die Dehydratation eine Vielzahl anderer Erkrankungen. Die Akuttherapie ist vergleichsweise einfach, während die verhaltenstherapeutischen Ansätze bei chronischem Flüssigkeitsmangel weniger bekannt und kaum evaluiert sind.

Abstract Background Few studies have assessed the full spectrum of potential causes of malnutrition in older hospitalized patients using a standardized framework. Applying the “Determinants of Malnutrition in Aged Persons” (DoMAP) model, this study aimed to quantify the prevalence of specified determinants and compare their distribution between malnourished and non-malnourished patients, thereby identifying the most important determinants. Methods This multicenter, cross-sectional, prospective, observational study was conducted in three geriatric acute care hospital units. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Potential causes of malnutrition were assessed using the DoMAP model. This study was registered in the German Clinical Trials Register with the DRKS-ID: DRKS00030850 on December 14, 2022. Results A total of 556 patients (mean age 82.5 ± 6.6 years; 67% women) were included. Malnourished patients exhibited a significantly higher prevalence of most determinants compared to non-malnourished patients, particularly low intake (89 vs. 49%), poor appetite (68 vs. 25%), inflammation (31 vs. 19%), gastrointestinal disease (29 vs. 11%), inflammatory disease (32 vs. 19%), and hospitalization (62 vs. 47%). The mean total determinants count was significantly higher in malnourished participants (12.5 ± 5.3) than in non-malnourished ones (10.1 ± 4.0; p < 0.001). Regression analysis revealed low intake as the strongest determinant at Level1; poor appetite, at Level2; gastrointestinal disease and oral pain at Level3, and anorexia of aging and hospitalization at Level4. Conclusion The DoMAP model provides a structured framework for capturing the diverse etiologies of malnutrition in older patients. This study emphasizes the multifactorial nature of malnutrition in hospitalized patients, with low intake and poor appetite emerging as predominant drivers.

Due to comorbidities, medication, lower fat-free mass and the often diminished sense of thirst in old age, older adults are at particularly high risk of developing dehydration. Therefore, dehydration is among the most common diagnoses in older patients. Despite its high prevalence, there are no uniform diagnostic criteria and the diagnosis often remains uncertain. All individual diagnostic criteria have insufficient sensitivity and specificity, so that the diagnosis can only be made by holistic consideration of all symptoms and sometimes only after successful trial treatment. The symptoms of dehydration are frequently nonspecific but its consequences can be severe. In addition to the immediate symptoms, dehydration promotes a variety of other illnesses. Acute treatment is relatively simple, while behavioral approaches for chronic dehydration are less known and barely evaluated.

La malnutrición (o desnutrición) y la deshidratación son frecuentes en las personas mayores, y la obesidad es un problema creciente. Sin embargo, faltan estrategias adecuadas y efectivas para contrarrestarlas en la práctica clínica.El objetivo de esta guía fue proporcionar recomendaciones para la nutrición clínica e hidratación en la población adulta basadas en la evidencia científica, con el fin de prevenir y/o tratar la malnutrición y la deshidratación. Además, se abordó si las intervenciones para perder peso en las personas mayores con sobrepeso u obesidad son adecuadas.Esta guía fue desarrollada según el procedimiento operativo estándar para las guías y documentos de consenso de ESPEN, con una búsqueda sistemática de la literatura basada en 33 preguntas clínicas en formato PICO (Población, Intervención, Comparación y Resultado). La calidad de la evidencia se evaluó con el sistema SIGN. Las recomendaciones fueron desarrolladas y consensuadas mediante un proceso compuesto por múltiples etapas.En cuanto a resultados se desarrollaron ochenta y 2 recomendaciones basadas en la evidencia para la atención nutricional en las personas mayores, cubriendo 4 temas principales: Cuestiones básicas y principios generales; recomendaciones para las personas mayores con riesgo de malnutrición o con malnutrición; recomendaciones para las personas mayores con enfermedades específicas y recomendaciones para prevenir, identificar y tratar la deshidratación. En general, se recomienda que a todas las personas mayores se les realice un cribado (o tamizaje) de malnutrición para identificar tempranamente un riesgo existente. La nutrición oral se puede apoyar mediante intervenciones de enfermería, educación, consejo nutricional, modificación de alimentos y el uso de suplementos (o complementos) nutricionales orales. La nutrición enteral debe iniciarse si la alimentación por vía oral es insuficiente o imposible. La nutrición parenteral debe iniciarse si la nutrición enteral es insuficiente o imposible y el pronóstico general es favorable. Se deben evitar las restricciones dietéticas; en las personas mayores con problemas de salud relacionados con la obesidad, las dietas para bajar de peso solo deben considerarse en combinación con el ejercicio físico. Se debe considerar a todas las personas mayores como en riesgo de deshidratación debido a una baja ingesta y se les debe animar a consumir suficientes líquidos. Por lo general, las intervenciones serán individualizadas, integrales y parte de un enfoque de equipo multimodal y multidisciplinar.Como conclusión existe una amplia variedad de intervenciones eficaces para respaldar una nutrición e hidratación adecuadas en las personas mayores, con el objetivo de mantener o mejorar el estado nutricional, el curso clínico y la calidad de vida. Estas intervenciones deben ser implementadas en la práctica clínica y utilizarse de manera sistemática.

BACKGROUND & AIMS:Dysphagia and malnutrition frequently co-occur and are associated with aspiration pneumonia, sarcopenia, increased mortality, reduced quality of life and restricted social participation. Yet foods and drinks for individuals with dysphagia and malnutrition are inconsistently specified and lack objective standards. This study aimed to develop a consensus-based, expert-derived framework for evaluating foods and drinks perceived suitable for individuals with dysphagia and malnutrition (FOOD-DM). METHODS:A two-round online modified Delphi study was conducted (October 2024-May 2025). International experts in medicine, speech-language pathology and nutrition were eligible with ≥5 years of clinical experience and a Hirsch-index ≥5. In round 1, participants rated nine prespecified items relating to texture, nutritional composition and labeling on a 9-point Likert scale. Consensus required ≥70% ratings at 7-9 (critically important) and <15% at 1-3 (not important). Round 2 provided aggregated results, item refinements and a comparison of the International Dysphagia Diet Standardisation Initiative (IDDSI) with quantitative texture measures expressed in the International System of Units (SI). RESULTS:Forty-eight experts participated in round 1. All nine items achieved consensus and were reaffirmed in round 2 (44/48; 92% retention). The final FOOD-DM framework comprises nine criteria across three domains: (1) Texture: availability of consistent textures, accuracy of texture descriptions (IDDSI and/or SI-based rheology), ability to customize texture, and ability to measure texture modifications (IDDSI and/or SI-based rheology); (2) Nutrition: availability of high-calorie options (e.g., 1.5-2.0 kcal/mL), flexibility to adjust calorie content, availability of high-protein options (≥20% energy from protein), and adaptable macronutrient composition; (3) Labeling: clear indications of suitability for dysphagia and malnutrition including detailed explanations of their specifics and composition. Overall, 91% of experts perceived the proposed measures as potentially helpful in improving access to appropriate nutrition; 61% favored a combined IDDSI-plus-SI model for texture description. CONCLUSIONS:Distinct from existing approaches focusing on texture or nutrition alone, FOOD-DM integrates standardized texture specification with nutritional optimization and labeling within a single framework. Implementation of the FOOD-DM framework may support standardized, customizable, and transparent nutrition and foster collaboration between clinical nutrition, dysphagia therapy, and the food industry.

Background: Dysphagia in geriatric patients is associated with adverse outcomes, but often remains under-recognized in routine care. Evidence from nationwide real-world geriatric cohorts is limited, particularly regarding in-hospital outcomes and discharge pathways. Methods: We conducted a retrospective nationwide cohort study using the Geriatric Minimum Data Set (GEM-IDAS Pro), including 1403,790 geriatric hospital admissions between 2006 and 2024. Dysphagia was defined by ICD-10-GM code R13 recorded as a main or secondary diagnosis. Endpoints were in-hospital mortality, in-hospital aspiration pneumonia, and discharge destination. Multivariable logistic regression models were adjusted for age, sex, functional status at admission (Barthel Index), stroke, and dementia. Results: ICD-coded dysphagia was documented in 6.4% of admissions. In-hospital mortality was higher in admissions with dysphagia than in those without dysphagia (9.8%vs 2.7%), as was in-hospital aspiration pneumonia (7.7%vs 0.3%). After full adjustment, dysphagia remained independently associated with in-hospital mortality (OR 1.77, 95% CI 1.72-1.82) and in-hospital aspiration pneumonia (OR 10.37, 95% CI 9.95-10.81). Among patients discharged alive, dysphagia independently predicted institutional discharge (OR 1.48, 95% CI 1.45-1.51). In patients admitted from private households, dysphagia remained independently associated with non-home discharge after full adjustment including stroke and dementia (adjusted OR 1.42, 95% CI 1.40-1.45). Conclusions: In this nationwide cohort of hospitalized geriatric patients, clinically documented, ICD-coded dysphagia was independently associated with in-hospital mortality, aspiration pneumonia, and adverse discharge pathways. These findings support interpreting clinically documented, ICD-coded dysphagia as a marker of systemic vulnerability and complex care needs within a geriatric-syndrome framework.

To evaluate the feasibility of implementing comprehensive geriatric assessment into routine care and multidisciplinary tumor boards in Germany within a bicentric feasibility trial. The implementation of comprehensive geriatric assessment in cancer care of older adults and integration of geriatric parameters into the multidisciplinary tumor boards was feasible and well appreciated by patients and cancer physicians. Integrating comprehensive geriatric assessment into routine care should be the standard-of-care for all older adults with cancer. A comprehensive geriatric assessment (CGA) followed by geriatric assessment-guided interventions was demonstrated to reduce treatment-related toxicities CTCAE III°–V° in older adults with cancer undergoing systemic cancer treatments, but implementation remains insufficient. Thus, we aimed to evaluate the feasibility of implementing CGA into routine care and multidisciplinary tumor boards (MDTs) in Germany within a bicentric feasibility trial (DRKS00035569; 19.12.2024). Patients ≥ 65 years with positive geriatric screening (G8 < 15 points) and all patients ≥ 70 years received CGA as part of their routine care. Results were presented during MDT discussions to derive treatment recommendations. After CGA, patients were asked for trial participation which included data analysis and a telephone follow-up after 3 months. Clinicians participating in the MDT were asked about the added value of CGA presentation. Primary endpoint was the estimation of patient’s willingness to participate with an accuracy of ± 7.5

Frailty ist ein häufiges geriatrisches Syndrom bei älteren Patient*innen mit Krebserkrankungen und beeinflusst die Prognose und Therapietoleranz in vielfacher Hinsicht. Außerdem bestehen einige gemeinsame Risikofaktoren für Frailty und Tumorerkrankungen, welche sich in den Schlüsselmerkmalen des Alterns finden. Ein onkogeriatrisches Assessment mit Management (GAME) bietet die Möglichkeit, die Frailty-assoziierte Vulnerabilität zu erkennen und soweit möglich zu kompensieren, sodass höhergradige therapieassoziierte Toxizitäten der onkologischen Therapien reduziert werden und die Therapiekomplettierungsraten sowie die Lebensqualität verbessert werden. Der vorliegende Übersichtsartikel stellt die Bedeutung der Frailty in der Onkologie und die Evidenz für ein GAME dar. Darüber hinaus werden erste Studienergebnisse für Frailty-adaptierte Therapiekonzepte vorgestellt.

OBJECTIVES:To examine the relationship between the Mini Nutritional Assessment Short Form (MNA-SF) screening for malnutrition and the Global Leadership Initiative on Malnutrition (GLIM) diagnosis and the difference between the globally agreed GLIM two-step approach with prior screening (GLIMs+) and the alternative one-step approach without prior screening (GLIMs-) in a large group of geriatric patients. DESIGN AND SETTING:Cross-sectional multicenter study in eight geriatric institutions in Germany. PARTICIPANTS:681 geriatric patients. MEASUREMENTS:Patient characteristics, MNA-SF and GLIM criteria were assessed in all patients using standardized questionnaires based on routine geriatric assessments. Malnutrition prevalence rates, Cohen's kappa and diagnostic test parameters were calculated to compare MNA-SF results with GLIMs- and GLIMs- with GLIMs+. RESULTS:88.1 % of all patients (83 ± 6.7 years; 68.0 % women) were MNA-SF positive (38.8 % malnourished, 49.3 % at risk). GLIMs- malnutrition was diagnosed in 44.6 %, GLIMs+ in 43.5 % of all patients. 8 patients (1.2 %) were normal according to MNA-SF and malnourished according to GLIMs- (false negative). Sensitivity of MNA-SF compared to GLIMs- was 0.97, specificity 0.19. Sensitivity of GLIMs- compared to GLIMs+ was 1.00, specificity 0.98. Cohen's kappa indicated slight agreement between MNA-SF and GLIMs- (κ = 0.153) and near-perfect agreement between GLIMs- and GLIMs+ (κ = 0.976). CONCLUSION:The very good agreement between GLIMs- and GLIMs+ may argue in favor of direct GLIM diagnosis without prior screening, but prior MNA-SF screening saved the effort of GLIM testing in 12 % of all patients with only very few false negatives and also identifies the large group of at-risk patients who may benefit from preventive interventions.

Track how often percutaneous endoscopic gastrostomy (PEG) tubes are used in German geriatric inpatient care (2006–2024), associated nutritionally relevant diagnoses and in-hospital mortality. Among 1,355,436 admissions (≥ 60 y; mean 83 y; 67

Background/Objectives: A comprehensive geriatric assessment (CGA) was demon-strated to reduce treatment-related toxicities CTCAE III-V° in older adults with cancer undergoing systemic cancer treatments. However, practical implementation of this important procedure is insufficient. To evaluate the feasibility of implementing CGA into routine care and multidisciplinary tumor boards (MDTs) in Germany, we per-formed this bicentric feasibility trial. Methods: Patients ≥65 years with positive geriatric screening (G8< 15 points) and all patients ≥70 years received CGA as part of their routine care. Results were presented during MDT discussions to derive treatment recommendations. After CGA, patients were asked for trial participation which included data analysis and a telephone fol-low-up after 3 months. Physicians participating in the MDT were asked about the added value of CGA presentation. Primary endpoint was the estimation of patient’s willing-ness to participate with an accuracy of ± 7.5% to inform design for a later effectiveness trial. Results: 75 patients received CGA. Of those, 72 (96%) agreed to participate (95% confi-dence interval, [0.8875; 0.9917]). With an accuracy of estimating the willingness to par-ticipate of < |7.5%|, the primary endpoint was reached. The median age was 76.6 years (range: 69-92 years). A member of the geriatric team attended 2/3 of the MDT meetings. Physicians rated the integration of CGA results predominantly as useful. Conclusions: Integration of CGA into routine care of older cancer patients is feasible but will likely require adequate geriatric staffing per center. A larger implementation study, evaluating efficacy and cost effectiveness in the German healthcare system, is necessary.

The patient population treated by vascular medicine is becoming older, which goes along with an increasing number of patients presenting with frailty syndrome. The level of frailty determines the outcomes after vascular surgery or interventions. This position paper written by the German Society for Vascular Surgery and Vascular Medicine, the German Society for Geriatrics, and the German Society for Angiology - Society for Vascular Medicine summarizes the current evidence on the impact of frailty on the outcome after treatment for vascular diseases, and calls for a closer collaboration between geriatrics and vascular medicine and an integration of geriatric assessment in the preoperative or preinterventional evaluation of patients. Concrete and practical demands and tasks are formulated aiming at increasing awareness of geriatrization of the patient population, promoting research on the impact of frailty on the treatment of vascular patients and improving patients' safety, reducing complications and enhancing quality of care of older vascular patients.

The rapid growth of digital health technologies has highlighted the importance of electronic health literacy (eHealth literacy), which is crucial for navigating health information and tools such as telemedicine and electronic health records. However, older adults often have reservations about digital technologies and face barriers due to cognitive, sensory, and motor impairments, which hinder their ability to effectively use digital health applications. Despite its relevance, research on eHealth literacy in older populations is limited, with a particular gap in understanding how self-assessments of eHealth literacy correlate with health characteristics. The study seeks to explore eHealth literacy among hospitalized geriatric patients in Germany. The main objective is to evaluate the eHealth literacy level within this particular group and identify the clinical and sociodemographic factors that may influence it. Data from this observational study were analysed to explore characteristics influencing eHealth literacy in hospitalized geriatric patients. The study included patients aged 60 or older, admitted to the Department of Geriatric Medicine at Marien Hospital Herne, and enrolled in the standardized early rehabilitation pathway. eHealth literacy was measured using the GR-eHEALS, a self-assessment tool. Sociodemographic and clinical data, including cognitive function (Montreal Cognitive Assessment – MoCA), frailty (Clinical Frailty Scale), and depression (Depression in Old Age Scale - DIA-S), were collected. Statistical analyses involved descriptive statistics, t-tests, chi-square tests, and regression analyses to examine the relationship between eHealth literacy and various factors. A total of 244 participants (aged 60-97, mean age = 77.2 years) were included in the analysis. Participants generally reported moderate eHealth literacy, with higher scores in "Information Seeking" (mean = 3.64) compared to "Information Appraisal" (mean = 3.32). Significant differences in eHealth literacy were observed by age, with older participants scoring lower on both subscales (p-values between 0.009 and 0.019). Frailty was a significant negative predictor for critical appraisal of online health information (B = -1.372, p = 0.023), suggesting that frail individuals struggle more with evaluating health information. No significant associations were found with other sociodemographic variables, including MoCA scores, education, or gender. While the findings suggest a positive self-reported ability to engage with digital health tools, the selective sample and reliance on self-assessment limits the accuracy of these results. The study also emphasizes the need for tailored interventions to support older adults in improving their eHealth literacy, particularly those with higher levels of frailty or cognitive impairment. Further research, including longitudinal studies and objective assessments, is essential to better understand and address the digital health needs of the geriatric population. German Clinical Trials Register (DRKS00032931, registered on 29/11/2023). Available from https://drks.de/search/de/trial/DRKS00032931.

Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. The objective of this guide was to provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. As a result we provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counselling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. As a conclusion a range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.