Zeitschrift Fur Gerontologie Und Geriatrie最新文献

Chronic obstructive pulmonary disease (COPD) is a frequent disease from which approximately 8% of individuals aged 40 years and above suffer. The prevalence increases up to fivefold as age advances. Following an introduction including the etiology, measurement, characteristic features and classification of COPD, this article presents the consensus recommendations of the German Working Group on Pneumology in Older Patients. These include statements on the screening for frailty, dysphagia, malnutrition and cognitive impairment. The results are summarized with the final conclusion that adequate treatment of COPD can also slow the progression of cognitive decline and could potentially prevent or delay the onset of dementia.

Background: Due to age-related changes the lung function decreases. At the same time there is an increase in pulmonary diseases that lead to restrictions in mobility and autonomy.

Research question: What are the underlying changes in lung ageing? To what extent do they affect lung function and are there factors that can be influenced?

Method: Literature search.

Results: Ageing of the lungs is associated with a loss of elasticity and distensibility. Senescence-associated factors play an important role at the molecular level. Accumulation of damaged DNA and proteins, oxidative stress and chronic inflammation are major factors. Avoidance of harmful environmental factors can reduce the disease burden.

Conclusion: Age-related pathophysiological changes lead to increased work of breathing with decreasing muscle strength. Patients should be encouraged to avoid inhaling noxious agents as these are associated with a diminution of lung function loss even in older age.

Background: The majority of people in need of care in Germany are cared for at home by relatives or other close individuals. Many informal caregivers are also in paid employment and face the challenge of juggling the demands of both areas of life. This can adversely affect the caregiver's own health.

Objectives: (1) To what extent is informal caregiving related to health complaints among people in paid employment? (2) Within the group of working caregivers, how are the amounts of informal care and work related to health complaints?

Material and methods: This secondary data analysis is based on the BIBB/BAuA employment survey 2018. To account for systematic differences between caregivers and non-caregivers in the analyses, propensity score matching was applied.

Results: Working caregivers more frequently experience psychosomatic and physical complaints compared to people in paid employment without caregiving responsibilities. The working hours and the extent of caregiving are interrelated and a high burden in both areas of life is associated with poorer health.

Conclusion: People who provide informal care in addition to their work are often burdened with health problems. Targeted health promotion interventions are therefore necessary to support this vulnerable group and improve their health.

Purpose: Polypharmacy is a widespread phenomenon in older patients. In particular, the anticholinergic burden of medication is an important risk factor for delirium due to age-related changes in the cholinergic system.

Methods: Preoperative medication, including the calculation of the anticholinergic burden (ACB), was recorded in a prospective study (421 patients) to identify potential risks associated with medication intake. Postoperative delirium screening was carried out daily.

Results: The study included 199 women (47.3%) and 222 men (52.7%) aged 80.8 ± 6.7 years and 78.8 ± 6.2 years, respectively. Antidepressants odds ratio (OR) 3.16 (95% confidence interval. CI, 1.51-6.64), antidiabetic drugs OR 2.53 (95% CI 1.27-5.03), neuroleptics OR 3.52 (95% CI 1.70-7.28) and Parkinson medication OR 5.88 (95% CI 1.95-17.7) showed a significantly higher risk for delirium. The ACB score revealed an anticholinergic burden in 43 patients (10.4%). The delirium rate was 25.6% (n = 11) and 11.0% (n = 40) had no anticholinergic burden. A significant correlation can be demonstrated with χ²(1) = 7.52, p = 0.006, Cramer's V = 0.136. There was a 2.79-fold higher risk of delirium (OR 2.79, 95% CI 1.31-5.97).

Conclusion: The standardized recording of medication is essential, especially when identifying patients at risk of suffering from delirium. The use of the ACB score to assess the anticholinergic burden is a simple and reliable screening tool and should be part of a preoperative geriatric assessment.

Background: Little is known about how younger and older hospitalized patients differ with respect to reasons for admission, comorbidities, diagnostics, treatment and intercurrent problems.

Objective: The aim of the study was to compare the previously named characteristics in the clinical profile of patients > 90 years old (nonagenarians) with a control group of patients 70-75 years old admitted to an emergency hospital department for internal medicine and cardiology.

Material and method: The study included all consecutive nonagenarians and gender-matched control patients who were admitted during 2011. The reason for admission, comorbidities, diagnostics, treatment, intercurrent problems and discharge medication were taken from the patient records. Data on 8‑year mortality were obtained by comparison of the death data.

Results: Nonagenarians (n = 117; 81 females) had a mean age of 92 ± 2.5 years and the control patients 72 ± 1.6 years. Nonagenarians were hospitalized more often because of neurological symptoms (19% vs. 7%), suffered more from kidney failure (85% vs. 67%), heart failure (35% vs. 21%), malignancies (29% vs. 8%), dementia (28% vs. 4%) and stroke (15% vs. 6%), developed confusion more often (27% vs. 7%) and fell more often (15% vs. 0%) than control patients. Control patients had a higher body mass index (29 ± 5.3 vs. 24 ± 4.1). Nonagenarians received fewer diagnostic measures (1.6 vs. 2.3), more often intravenous fluid (77% vs. 51%), diuretics (31% vs. 18%) and physiotherapy (24% vs. 8%). Polypharmacy (> 5 medications) in the discharge letter was frequent in both groups (67% vs. 75%). The yearly mortality of the nonagenarians was 27% and of the control group 6%.

Conclusion: Acute internal diseases in nonagenarians are frequently manifested with neurological symptoms. In hospitalized nonagenarians, prevention of falls and delirium are of clinical relevance. Polypharmacy is a relevant problem in nonagenarians as well as in control patients.

Background: Rehabilitative short-term care (REKUP) is aimed at geriatric patients in need of rehabilitation but not (yet) capable of rehabilitation after acute inpatient hospitalization with a positive rehabilitation prognosis. It was tested at two geriatric rehabilitation clinics from October 2020 to March 2022.

Objective: Qualitative process evaluation with respect to acceptance (service providers, health insurance), adoption (implementation at the start of the project), practicability (processes, contents, structures) and observed patient satisfaction.

Methods: A focus group and 14 semi-structured interviews with a total of 18 employees of both rehabilitation clinics and a health insurance provider were recorded, transcribed and qualitatively analyzed for content.

Results: The survey of service providers (acute care, model clinics) and the health insurance provider revealed a high level of acceptance and good practicability (processes, contents, structures). Due to the high level of acceptance and the familiar service content in the geriatric rehabilitation clinics, the implementation was feasible and patient satisfaction was rated as very good.

Conclusion: The acceptance of REKUP was high because the basic idea was easy to understand. Nevertheless, a careful patient selection is crucial. There is a risk that REKUP could be used as a quick discharge option to avoid capacity problems. The success of treatment perceived by the service provider is based on early exercises, psychosocial care and a longer period of time before rehabilitation, which avoids excessive demands and strengthens self-efficacy. Admission to the long-term nursing home sector is avoided, which has a positive psychological and motivational effect on patients. A transfer of REKUP to other geriatric rehabilitation clinics seems to be easily possible.

The geriatric assessment is a basic requirement and a key quality parameter in geriatric care. An increasing number of older patients are presenting to emergency or central admission departments and discharge units in hospitals. For this reason, and in view of the time-critical decision-making requirements in this setting, digital applications of basic geriatric assessment data are becoming increasingly more important for the high-quality follow-up care of geriatric patients.

The postoperative outcome of older people is significantly influenced by individual age-related risk factors. Therefore, factors such as frailty, cognitive impairment and functional dependency should be routinely included in the preoperative anesthesiological assessment of older patients. The approach recommended in the catalogue of criteria for geriatric trauma centers of the German Society for Trauma Surgery (DGU®) includes screening to identify geriatric patients, determination of frailty, assessment of cognitive impairment and delirium screening even in the emergency department. In addition, a basic geriatric assessment should be performed at the latest in the early postoperative phase to determine the need for further supportive therapy. Anesthesiologists work closely with geriatricians and trauma surgeons in the geriatric traumatological treatment. The recommendations for action and the nature of interdisciplinary collaboration are defined in standard operating procedures. It would be desirable to develop comparable concepts for the perioperative care of all older people beyond the field of geriatric traumatology.

Digitalization is transforming social life and relationships. New cultural ideas of care, cooperation and reciprocity are emerging that can create challenges for older people. These are particularly poignant for older people living alone, who use digital devices less frequently and rely on support to manage the increasing number of digital tasks (appointments, bookings, financial matters). This article explores the relationship between digitalization and care relationships among older people living alone using a critical document analysis approach according to Bacchi. This approach makes it possible to look at the understanding behind the terms living alone, care relationships, and digitalization, each in relation to older people and in interaction as well as to render gaps visible. The analysis of laws and social policies as well as of political and civil society orientated documents leads to two key findings: Firstly, an individual responsibility to deal with needs arising from gaining access to and handling of digitalization is expected of older people and their social networks. This is striking as digitalization is presented as a means of dealing with the large-scale social challenges, such as demographic change and shortage of care staff. Secondly, the analysis shows that legal documents that set out the structure for policies do not focus on digitalization in later life. With older people not being a target group of policy of digitalization, fewer strategies are put into practice.