Zeitschrift Fur Gerontologie Und Geriatrie最新文献

Background: Proximal femoral fractures are severe injuries in geriatric patients. Additionally, geriatric patients are at a high risk of death due to coronavirus disease 2019 (COVID-19).

Objective: To identify predictors of mortality in geriatric patients with COVID-19 and concurrent proximal femoral fractures.

Material and methods: Patients who underwent surgical treatment for proximal femoral fractures and also tested positive for COVID-19 were included. The age, gender, the American Society of Anesthesiology (ASA) score and the admission from a nursing home were considered as variables. The rate of reoperations, the mortality at 3 months and discharge home were evaluated as outcomes.

Results: In this study 46 patients with COVID-19 (female/male 31/15, median age 87.0 years with an interquartile range [IQR] of 9.8 years) met the inclusion criteria. Of these, 32 patients (69.6%) had to be cared for in the intensive care unit and 26 patients (56.5%) had a severe course of COVID-19 with pneumonia. The median length of hospital stay for survivors was 19 (IQR 17.5) days and 4 of the patients (8.7%) required surgical revision. The in-hospital and 3‑month mortality were 40.0% (n = 17) and 43.5% (n = 20), respectively. The factors which influenced the in-hospital and 3‑month mortality rates were admission from a nursing home, the presence of pneumonia (increased the risk of death) and female gender (protective).

Conclusion: The occurrence of COVID-19 in patients with proximal femoral fractures has a high mortality. Admission from a nursing home and the presence of pneumonia increased the risk of death, whereas women were at lower risk.

Background: Anemia and deficiency of vitamin D (VDD) are frequently seen in seniors and an association is suspected. Approximately one third of the German population is affected by VDD, with a rising prevalence among seniors.

Aim: To analyze the association between anemia and VDD among German seniors aged ≥ 60 years.

Methods: Retrospective cross-sectional data analysis (n = 4008) in a nationwide working laboratory medical center (January-December 2019). Study parameters included amongst others: hemoglobin (Hb), calcifediol (25D) and calcitriol (1.25D), glomerular filtration rate (GFR) to assess the kidney disease outcomes quality initiative (KDOQI) state. The inclusion criteria were age ≥ 60 years, normal C‑reactive protein (CRP) and leucocyte levels.

Results: The 25D was estimated in 4008 patients and 1.25D only in 411 patients. Mean age 75 years (± 8.61 years; 60-99 years) with 30.6% males; mean GFR 62 ml/min/1.73 m³ (± 22.74); 20% of patients were anemic, 35% were deficient for 25D (< 50 nmol/l), with men > women (p = 0.014). Linear regression analysis revealed a significant effect of 25D values < 30 nmol/l on hemoglobin in males of KDOQI I-III and females of KDOQI I-IV (R2 = 0.052; p = 0.005; and R2 = 0.124; p < 0.001, respectively). For 1.25D a weak but significant effect on hemoglobin independent of KDOQI was only seen in women (R2 = 0.200; p = 0.005).

Conclusion: In this cohort deficiency of 25D and 1.25D was significantly associated with hemoglobin independent of renal function only in women but not in men.

The article demonstrates the contributions of the innovation program "D-Care Lab Baden-Württemberg 2023" to the development of innovative solutions for neighborhood care. The effects of the program are reconstructed on the basis of initial research findings pertaining to the innovation program. A distinctive aspect of the laboratory is its cross-sectoral collaborative structure. The levels of impact can be defined as follows: the acquisition of skills by the participants, the connection between skills acquisition and learning arrangement, the changes observed as a result of participation and the innovative solutions developed for care in the neighborhood. The initial results are presented in accordance with the theoretical research design and research methods previously outlined. The results demonstrate alterations in the competence profiles of the participants and the impact of the cooperative laboratory setting on the development of solutions. Based on these findings, the function of innovation programs becomes evident, thereby highlighting the necessity for mid-term to long-term impact analysis.

The increasing interruptions of nocturnal sleep with aging must be distinguished from actual sleep disorders. Morbidity and medication have an impact on sleep. The relationship between sleep and morbidity is mutual. Disturbed sleep modifies many clinical symptoms and diseases affect sleep and the ability to sleep. Geriatric syndromes such as falls, depression and dementia are modified by sleep disorders. Geriatric syndromes can be favorably influenced by the treatment of sleep disorders. Adequate diagnostics are important prerequisites. Coincidences of different sleep disorders are frequent. The medical history of patients and a sleep diary form the basis of the diagnostics. Sleep medicine provides further technical examination procedures. Older people should be examined in a sleep laboratory if the results have consequences that are accepted by the patient. This should be clarified in advance.

Background: With the continuous increase in the average age, the temporal perspective for the phase of old age is also significantly expanding. This results in an individual need for reorientation for the aging person with respect to a meaningful shaping of this long period of time, which as a progressive process leads to the end of life. In the context of the status passages to the third, fourth and fifth ages, there is a special relevance for this; however, the so-called care for older people (§ 71 Social Security Code, SGB XII) has so far largely ignored these important aspects. Rethinking in a needs-oriented way, the facilitation of the necessary reorientation of life in old age through learning and education must therefore be given greater consideration.

Aim of the article: The article gives a necessary update of the existing care for older persons, which takes greater account of a needs-oriented design of a society of long life. Furthermore, the role and significance of the necessary educational processes in the sense of geragogy are outlined and also how they can contribute to successful aging.

Material and methods: With reference to current research work and publications on the topic, the possibilities of geragogic support as a challenge and opportunity for new care for older persons are worked out.

Results and discussion: The learning and educational processes of the aging person can be aimed at various concerns, if nothing else differentiated according to the challenges associated with the social age categories, i.e., the third, fourth or fifth age; however, learning and educational processes also address very different dimensions, each focusing on the question of how older people can tackle and cope with such necessary adaptation and change processes.

Background: In the second half of 2023 the Senate for Science, Health and Nursing of Berlin commissioned an explicit gerontological expert report from the team of authors, which was intended to provide suggestions for the modernization and concretization of § 71 of the German Social Code Act (SGB) XII, i.e., the central social law basis for so-called care of older people. It was completed by the end of 2023. The objective of the report was to provide suggestions for a Berlin Assistance for Old People Structural Law that considers the differentiation and diversity of the life phase of old age by identifying, analyzing and describing the necessary individual services.

Aim of the article: The approach and the central results of the report are presented and discussed.

Material and methods: In a multistep procedure, combined with a multimodal research approach, various methods were combined in order to generate a comprehensive understanding of the current situation of so-called assistance for older people and gerontological justifications for its services. Critical and selective literature reviews, document analysis and qualitative guideline-based expert interviews were used.

Results and discussion: The expert report contains concrete recommendations for an age phase and life situation-orientated development of individual services according to § 71 SGB XII. This relates to approaches, forms and topics of counselling that enable and support successful ageing for all older people. The report also explicitly identifies objects of necessary cash and non-cash benefits, which, even in precarious situations in old age, aim to strengthen the ability for self-help and provide the opportunity to participate independently in community life.

Respect of human dignity is an unquestionable part of daily clinical routine as well as of evaluations in medical ethics. Some aspects of human dignity are a subject of transformation in the course of a lifetime. If the ability to form a will is reduced, it might be difficult to satisfy the individual perception of a dignified treatment, which is of particular interest in terminal care. As illustrated by the presented case report, moral problems can arise when the patient's present verbal or non-verbal expressions are opposed to what is documented or what is estimated by dependants to be the individual's will. In clinical decision-making processes, the determination of the will via an advance directive can be overstated, which can go so far that human dignity is reduced to autonomy. A concept of dignity reduced to autonomy misses the point not only of a dignity-centered medical care but also of shared decision-making. In situations at the end of life other aspects, such as authenticity or self-actualization should be considered when respecting the individual's dignity. Medicine should as such not marginalize death but provide a care based on principles that focus on human interaction and respect for a comprehensive concept of dignity.

Background: Life situation dimensions, such as financial resources, housing, health and social relationships, have a significant influence on the scope available to older people for coping with everyday life and participation and thus for a good life in old age.

Method: As a basis for identifying current and future challenges posed by precarious living conditions in old age, current publicly available data and study results on the income situation, housing, health and care are reported as central dimensions of the living conditions of people aged 65 years and over in Germany.

Results: The study results presented provide indications as to which groups of older people live in particularly precarious living situations, which provide starting points for municipal action. Inequalities exist in the availability of income, affordable and accessible housing, social networks, health opportunities and care support services. Particular importance is attached to the risk of poverty, which goes hand in hand with the risk of disadvantages in the other dimensions analyzed.