Zeitschrift Fur Gerontologie Und Geriatrie最新文献

Background: The prevention of postoperative delirium (POD) in older adults requires interprofessional collaboration among all healthcare professionals (HCP) involved in the continuum of care.

Objective: This study investigated the question of how HCPs experience the interprofessional prevention of POD in older adults within the continuum of care. Additionally, it examined the challenges and desired changes in the intersectoral communication and collaboration for prevention of POD.

Methods: This multicenter study was carried out with a qualitative research approach. To explore the experiences of HCPs a total of 21 semistructured expert interviews were conducted with general practitioners, geriatricians, anesthesiologists, surgeons and nurses across the 2 study regions Salzburg County and South Tyrol. The interviews were analyzed using content analysis.

Results: The results show that the interviewed HCPs already implement measures to prevent POD but these predominantly focus on identifying patients at risk in the inpatient sector. Information about risk factors is not systematically shared between disciplines or across the intersectoral continuum of care. Structures and processes for intersectoral communication and collaboration in the prevention of POD over the continuum of care are largely missing.

Conclusion: To improve the prevention of POD in older adults efforts should be made to enhance intersectoral and interprofessional collaboration and communication between the HCPs involved. The development of a shared instrument for the systematic identification and documentation of relevant risk factors across the continuum of care could support the prevention of POD.

Background: Violence in caregiving settings is a complex and increasingly prevalent issue, rooted in both structural and individual factors. To date, systematic analyses of police responses to such cases have been largely absent.

Objective: This study explores which risk factors and offense patterns are associated with abuse in care as well as the challenges faced by law enforcement agencies. The aim is to identify actionable strategies for improving the handling of violence in caregiving contexts.

Material and methods: The research is based on an analysis of 106 documented cases and 64 expert interviews across multiple disciplines. The findings were further discussed in interdisciplinary workshops to develop practical solutions for enhancing protection of care-dependent individuals. Various limitations reduce the significance and generalizability of the findings.

Results: Most victims were female (69%) with an average age of 80 years and equally represented in home and institutional care. In 73% of cases the perpetrators were professional caregivers. The offenses primarily involved physical violence and unlawful deprivation of liberty. The case dismissal rate was 89%, often due to limited testimonial capacity and insufficient legal documentation. Police procedures were optimized and the interdisciplinary network violence-free care was established.

Conclusion: Key insights of the network emphasize the need for cross-sectoral collaboration, ongoing awareness training and professional development. The network advocates clear reporting pathways, targeted protective services and structured case management for vulnerable care recipients.

Background and objective: Violence in nursing care is a frequent phenomenon both towards nurses and towards care recipients. In Germany, there is a lack of scientifically developed and evaluated interventions and concepts for the prevention of violence. The aim of this study is to analyze the implementation of the participative development and evaluation of a multimodal concept for violence prevention (PEKo) project in three settings.

Intervention and methods: The aim of the project is to develop and implement facility-specific measures by multiprofessional teams. To evaluate the success of the implementation, quantitative data from an employee survey and process data regarding implementation fidelity, dose and outreach of PEKo were analyzed.

Results: The PEKo was implemented between 2021 and 2023 in 42 nursing homes, 7 outpatient care services and 12 hospitals. All components were offered and were implemented in the majority of outpatient care services and hospitals and in approximately half of the nursing homes. A total of 91 measures were implemented in the facilities during the intervention period, 443 employees took part in the survey and reported more exchange and changes in dealing with violence.

Discussion: The PEKo appears to promote awareness and confidence in all settings. Limitations were observed in terms of fidelity in the long-term inpatient care. The results suggest that continuous external support is crucial for sustainable implementation. The active involvement of care recipients should be given greater consideration in interventions.

Background: Chronic pruritus (CP) is a prevalent condition in older adults, with a significant impact on the quality of life (QoL), yet data on CP in German geriatric inpatients are scarce.

Objective: The study provides descriptive data on the prevalence and severity of CP and its impact on QoL and psychological well-being in cognitively capable geriatric inpatients. Furthermore, the study appraises the feasibility and adherence of a 2-month lipid-enriched emollient treatment, as recommended in current guidelines, with a view to informing and optimizing care for this vulnerable group.

Material and methods: The present pilot study constitutes a prospective, single-center, observational study. Participants were recruited from a geriatric hospital ward in Germany. Over 2 months the cream was to be applied twice daily. Severity, QoL and psychological well-being were assessed before and after the intervention using three validated questionnaires, the Hospital Anxiety and Depression Scale (HADS), the Dermatology Life Quality Index (DLQI) and the Working Group Pruritus Research (Arbeitsgemeinschaft Pruritusforschung, AGP) questionnaire. The data on the geriatric assessment scores, medication and previous illnesses were taken from the medical records.

Results: Among 214 hospitalized patients, 8.4% had CP. After 2 months, all median scores improved: the HADS anxiety and depression from 6 to 3.5 or 4.5, the numeric rating scale (NRS) of the worst pruritus from 7 to 5.5 and the DLQI from 3 to 1.

Conclusion: Despite suboptimal scores in the geriatric assessment, the intervention led to an overall improvement in pruritus severity, QoL and psychological well-being.

Background: The increase in age-associated cognitive disorders presents particular challenges for inpatient care. An effective interprofessional collaboration is fundamental for patient care and is particularly crucial for the management of patients with delirium. Interprofessional education (IPE) can improve the understanding of other professions and one's own role during training.

Objectives: The development of an interprofessional teaching course (LV) in the interdisciplinary area (QB) 7 "Medicine of aging and elderly people" aims to introduce various healthcare professions to the care of older adults with dementia and delirium.

Methods: The development of the course is based on the National Competence-Based Learning Objectives Catalogue for Medicine (NKLM 2.0). The Interactive, constructive, active, passive (ICAP) model was used to structure the teaching methods. The evaluation was carried out using questionnaires consisting of 23 Likert-scaled items on the organization, structure, interprofessionalism and overall assessment of the course.

Results: An interprofessional course with a duration of 240 min for up to 40 participants from 5 professional groups was developed and implemented in 12 courses. A total of 358 students and trainees participated. Of the participants 281 (78.5%) completed the questionnaire. Based on the German grading system, the course received an overall grade of 2.0 ("good").

Discussion: The topic of "dementia and delirium" is well suited for IPE, as all participating professions care for this patient population and could enrich each other with their expertise. Structural optimization is needed regarding time management and didactics.

Background: Calcium is critically involved in bone metabolism and stability, nerve excitability and intercellular signal transduction.

Methods: In this retrospective study, calcium plasma concentrations of all patients treated in 2018 at our institution were evaluated. As approximately 50% of the plasma calcium is bound to plasma proteins, in particular albumin, additionally the respective plasma albumin concentration was determined and the albumin-corrected calcium plasma concentration was estimated.

Results: In 1246 of 1721 cases the plasma calcium concentration on admission was normal (2.15-2.55 mmol/l), in 421 cases hypocalcemia (< 2.15 mmol/l) and in 38 cases hypercalcemia (> 2.55 mmol/l) were detected. In 1226 of 1543 cases (79.5%) hypoalbuminemia was noted. After correction of the plasma calcium levels for plasma albumin by the modified Payne equation, the corrected plasma calcium was normal in 1272 cases (73.9%), decreased in 15 cases (0.9%), and elevated in 256 cases (14.9%). The frequency of hypercalcemia > 2.8 mmol/l requiring rapid clinical interventions without correction for plasma albumin was 6 of 1705 patients (0.4%), after correction for albumin 24 of 1543 patients (1.6%). In logistic regression analysis, higher albumin was strongly associated with a decreased mortality (odds ratio, OR = 0.88, 95% confidence interval, CI 0.83-0.94, p < 0.001), whereas the plasma calcium concentration had no independent influence on mortality.

Conclusion: Without correction for plasma albumin, approximately 25% of the patients were hypocalcemic on admission. After correction for plasma albumin, this rate fell to < 1%. We suggest that the determination of plasma albumin should be included in the clinical routine on admission in all geriatric patients.

Background: Central venous catheters (CVC) in the internal jugular vein are established in perioperative care; however, the incidence of catheter-associated thrombosis (CAT) and catheter-related thromboembolic complications (CTEC) remains insufficiently studied.

Objective: This study aimed to assess the incidence and characteristics of CAT with a focus on differences between geriatric and nongeriatric patients. Among the guiding questions were do the risk and incidence of CAT fundamentally differ between geriatric and nongeriatric patients and is the catheter dwell time associated with increased thrombotic risk?

Methods: In this 6‑month prospective study, consecutive patients from orthopedic, trauma and vascular surgery with CVC in the internal jugular vein were examined. Patients were categorized into a geriatric group and a non-geriatric group. Sonographic assessments were performed initially and weekly during which CATs were measured and analyzed.

Results: Out of 117 patients 90 (77%) developed CAT. No significant differences were found between geriatric (78.9%) and nongeriatric patients (76.7%, p = 0.767). The mean thrombus size was similar. A significant correlation existed between catheter dwell time and CAT incidence.

Discussion: The incidence of CAT was high regardless of the geriatric status. Catheter dwell time emerged as a relevant risk factor. Standardized and systematic sonographic monitoring and critical CVC indications should be considered.

Fluid therapy is an integral component of perioperative management in geriatric trauma surgery. Sufficient evidence-based medicine in perioperative fluid management in older patients is still lacking. Our aim is to present practical algorithms for the perioperative phases of fluid management reflecting the current state of scientific knowledge, expert opinions and best clinical practices. These algorithms follow the rules of practical applicability. The final assessment as the basis for the targeted fluid management is always a synoptic view of the clinical findings, medical history, laboratory findings and diagnostic tests. Ongoing and prospective evaluation of the presented criteria and procedures is necessary.