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Nutrionalsupportstrategyforprotein-energymalnutritionintheelderlyHAS/SRP/April20071CLINICALPRACTICEGUIDELINESGUIDELINESApril2007Nutritionalsupportstrategyforprotein-energymalnutritionintheelderlyNutrionalsupportstrategyforprotein-energymalnutritionintheelderlyHAS/SRP/April20072Thefullreport(inFrench)canbedownloadedfromwww.has-sante.frHauteAutoritédeSantéCommunicationsDepartment2avenueduStadedeFrance-F93218Saint-DenisLaPlaineCEDEXPhone:+33(0)155937000-Fax:+33(0)155937400ThisdocumentwasvalidatedbytheHauteAutoritédeSantéBoardinApril2007©HauteAutoritédeSanté–2007Nutrionalsupportstrategyforprotein-energymalnutritionintheelderlyHAS/SRP/April20073Sommaire1.Introduction...........................................................................................51.1Subjectandaimsoftheguidelines.........................................................51.2Patientsconcerned.................................................................................51.3Healthprofessionalsconcerned.............................................................61.4Assessmentmethod...............................................................................61.5Gradingoftheguidelines.......................................................................62.Protein-energymalnutrition:definition,epidemiology...................63.Whataretheriskfactorsformalnutritioninelderlypersons?.......73.1Riskfactorsunrelatedtoage..................................................................73.2Riskfactorsmorespecifictotheelderly.................................................74.Whattoolsmaybeusedtoscreenforanddiagnosemalnutritionintheelderly?Howisseveremalnutritiondiagnosed?.............................74.1Screeningformalnutrition......................................................................74.2Diagnosisofmalnutrition........................................................................94.3Diagnosisofseveremalnutrition............................................................105.Nutritionalsupportstrategy................................................................115.1Objectiveofnutritionalsupportinmalnourishedelderlysubjects..........115.2Methodsofnutritionalsupport................................................................115.3Choiceofmethodsofnutritionalsupport................................................116.125.4Roleofadjuvantmedication...................................................................125.5Prescriptionofmicronutrients.................................................................135.6Monitoringofmalnourishedelderlysubjects,periodicityofnutritionalassessmentandtools.......................................................................................135.7Limitsofterminalnutritionalsupport.......................................................146Practicalmethodsofnutritionalsupport...........................................146.1Oralnutritionalsupport...........................................................................146.2Prescriptionofenteralnutrition...............................................................167.Specialsituations.................................................................................177.1Alzheimer’sdisease................................................................................177.2Pressuresores......................