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[Medication supply and polypharmacy in long-term care : An overview of possible interventions and the question of a functioning concept]. [长期护理中的药物供应和多重用药 :可能的干预措施概述和功能概念问题]。
IF 1.1 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-13 DOI: 10.1007/s00391-024-02340-1
Fabian Graeb, Bianca Berger, Frank Alf, Petra Reiber, Gundula Essig, Reinhold Wolke

Background: Polypharmacy and the resulting problems lead to considerable consequences for those affected. There are also considerable problems with the medication management.

Objective: Which interventions and programs for optimizing the supply of medication are available for nursing homes and which implementation problems can be expected?

Material and method: A literature search was carried out for interventional studies in nursing homes in Germany, with a focus on improving medication safety.

Results: A total of six programs were identified for which evaluation results are available. Despite a mostly multimodal approach with several pillars of intervention (e.g., medication reviews, further education and training, development of aids), the results are largely disappointing. The effects on the number of prescriptions in general, specific medication groups or outcome parameters such as hospital admissions could only be shown in one study, whereby, selection bias could also be at least partly responsible for this. Interdisciplinary collaboration and the implementation of medication recommendations formulated in reviews by the responsible physicians are the main problem areas. At the same time, too little attention is paid to the central role of nurses in the entire process and they are not actively promoted enough. This could be one of the reasons for the difficulties in implementation in practice.

Conclusion: There are nearly no significant changes as a result of the interventions implemented in the studies reviewed. In particular, interprofessional cooperation, especially the skills of nurses and the reluctance on the part of physicians, should probably be given more attention.

背景:多重用药及由此产生的问题给患者带来了严重后果。在药物管理方面也存在相当多的问题:材料与方法:对德国养老院的干预性研究进行了文献检索,重点是改善用药安全:结果:共发现了六项有评估结果的计划。尽管这些计划大多采用多模式方法,并有多个干预支柱(如用药审查、继续教育和培训、开发辅助工具),但结果大多令人失望。只有一项研究显示了对一般处方数量、特定药物组别或入院率等结果参数的影响,而选择偏差至少也是造成这种情况的部分原因。跨学科合作和负责医生执行审查中提出的用药建议是主要的问题所在。与此同时,人们对护士在整个过程中的核心作用关注太少,对她们的宣传也不够积极。这可能是在实践中难以实施的原因之一:结论:综述研究中实施的干预措施几乎没有带来重大变化。特别是跨专业合作,尤其是护士的技能和医生的不情愿,可能应得到更多关注。
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引用次数: 0
Psychosocial and biological pathways to aging : The role(s) of the behavioral and social sciences in geroscience. 衰老的社会心理和生物学途径:行为科学和社会科学在地球科学中的作用。
IF 1.1 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-10 DOI: 10.1007/s00391-024-02324-1
Paul Gellert, Enrique Alonso-Perez

While the biological hallmarks of aging are widely recognized as fundamental mechanisms of biological aging, more recently, there have been calls within geroscience to understand the aging process more comprehensively by adding a perspective of the social hallmarks of aging. Social and behavioral factors, such as socioeconomic status, life events or behavior and beliefs can alter the aging process per se and act in complex interactions with biological pathways. In addition, underlying biological pathways have been proposed for various psychosocial concepts, such as views on age and relationship quality. The aim of the present article is to provide narrative insights into theoretical and empirical developments between social and behavioral gerontology and geroscience or biogerontology. This article focuses on the potential of an interdisciplinary aging research but it also sets out the critical perspective that social gerontology provides.

虽然衰老的生物特征被广泛认为是生物衰老的基本机制,但最近,地球科学界呼吁通过增加衰老的社会特征来更全面地了解衰老过程。社会和行为因素,如社会经济地位、生活事件或行为和信仰,可以改变衰老过程本身,并与生物途径产生复杂的相互作用。此外,各种社会心理概念,如对年龄的看法和人际关系的质量,也提出了潜在的生物学途径。本文旨在就社会和行为老年学与老年科学或生物老年学之间的理论和实证发展提供叙述性见解。本文的重点是跨学科老龄化研究的潜力,但也阐述了社会老年学提供的批判性视角。
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引用次数: 0
[Prevention of ischemic stroke in old age]. [预防老年缺血性中风]。
IF 1.1 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-01 Epub Date: 2024-08-06 DOI: 10.1007/s00391-024-02336-x
Bernhard Iglseder, J Sebastian Mutzenbach

Stroke is one of the main causes of permanent disability and death and the risk increases with age. Primary and secondary prevention therefore have a high priority. The treatment of risk factors, such as high blood pressure, diabetes mellitus and hyperlipidemia is just as important as anticoagulation in atrial fibrillation, in addition to optimization of lifestyle and diet. Platelet function inhibitors play a role in the prophylaxis of recurrence, carotid surgery and stenting are used in selected patients. There is little study evidence for old people, individualized treatment planning takes functional status and comorbidities into account.

中风是导致永久性残疾和死亡的主要原因之一,其风险随着年龄的增长而增加。因此,一级和二级预防是重中之重。除了优化生活方式和饮食之外,高血压、糖尿病和高脂血症等危险因素的治疗与心房颤动的抗凝治疗同样重要。血小板功能抑制剂在预防复发方面发挥着作用,颈动脉手术和支架植入术可用于特定患者。针对老年人的研究证据很少,个体化的治疗计划需要考虑到功能状况和合并症。
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引用次数: 0
[Geroscience: possibilities and challenges for the healthcare system and the society of the future]. [老年科学:医疗保健系统和未来社会的可能性与挑战]。
IF 1.1 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-01 Epub Date: 2024-08-09 DOI: 10.1007/s00391-024-02335-y
M Cristina Polidori, Andreas Simm
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引用次数: 0
[Sarcopenia, physical activity and sedentary behavior among nursing home residents in Germany]. [德国养老院居民的肌肉疏松症、体力活动和久坐行为]。
IF 1.1 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-01 Epub Date: 2024-01-26 DOI: 10.1007/s00391-023-02275-z
Daniel Haigis, Silas Wagner, Rebekka Pomiersky, Leon Matting, Lea-Sofie Hahn, Gerhard W Eschweiler, Ansgar Thiel, Annika Frahsa, Gorden Sudeck, Andreas M Nieß

Background: Residents in nursing homes show a high prevalence of the musculoskeletal syndrome sarcopenia and tend not to achieve current physical activity recommendations.

Objective: The aim of this study is to identify differences in physical activity and sedentary behavior of sarcopenic residents compared with nonsarcopenic and presarcopenic residents.

Methods: Sarcopenia assessment was performed among 63 nursing home residents in Baden-Wuerttemberg (D) using the European Working Group on Sarcopenia in Older People 2 specifications. Structured activity sessions (per week), accelerometer-based physical activity (steps/day), and sedentary behavior (percentual/day) were examined. The group comparisons were determined with Kruskal-Wallis tests and Dunn-Bonferroni post hoc tests.

Results: Significant differences were found for number of steps (p = 0.005) and percentual sedentary behavior (p = 0.019). Moreover, steps per day presented significant results in group comparison for no sarcopenia (2824.4 [423-14275]) with probable sarcopenia (1703.9 [118-5663]) and confirmed/severe sarcopenia (1571.2 [240-2392]) (both p = 0.022; |r| = 0.34). Sedentary behavior demonstrated significant differences in groups with no sarcopenia (87.9% [69.1-94.3]) and with probable sarcopenia (91.7% [80.4-9835]) (p = 0.018; |r| = 0.35).

Conclusion: Nonsarcopenic residents demonstrated a higher number of steps and lower sedentary behavior compared with presarcopenic and sarcopenic residents. Increasing steps, reducing sedentary behavior and promoting activities of daily living can contribute to the prevention and treatment of sarcopenia in the nursing home setting.

背景:疗养院中的住院者肌肉骨骼综合症 "肌肉疏松症 "的发病率很高,而且往往达不到目前建议的体力活动量:本研究旨在确定肌肉疏松症患者与非肌肉疏松症患者和肌肉疏松症前期患者在体育活动和久坐行为方面的差异:在巴登-符腾堡州(D)的 63 名疗养院居民中,采用欧洲老年人肌肉疏松症工作组的 2 项规范进行了肌肉疏松症评估。对结构化活动次数(每周)、基于加速度计的体力活动(步数/天)和久坐行为(百分比/天)进行了研究。通过 Kruskal-Wallis 检验和 Dunn-Bonferroni 事后检验确定组间比较:结果:步数(p = 0.005)和久坐行为百分比(p = 0.019)存在显著差异。此外,每日步数在未患肌肉疏松症(2824.4 [423-14275] )与可能患肌肉疏松症(1703.9 [118-5663] )和确诊/严重患肌肉疏松症(1571.2 [240-2392] )的组间比较中显示出显著结果(均为 p = 0.022;|r| = 0.34)。久坐行为在无肌肉疏松症组别(87.9% [69.1-94.3] )和可能患有肌肉疏松症组别(91.7% [80.4-9835] )之间存在显著差异(p = 0.018; |r| = 0.35):结论:与肌肉疏松前和肌肉疏松居民相比,非肌肉疏松居民的步数更高,久坐行为更少。在疗养院环境中,增加步数、减少久坐行为和促进日常生活活动有助于预防和治疗肌肉疏松症。
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引用次数: 0
[Design and evaluation options of multimedia applications to support the care of people with mild dementia]. [支持轻度痴呆症患者护理的多媒体应用程序的设计和评估方案]。
IF 1.1 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-01 Epub Date: 2024-01-24 DOI: 10.1007/s00391-023-02280-2
Alexa von Bosse, Alexander Bejan, Max Wessel, Christophe Kunze

Background: In order to cognitively and physically activate people with dementia (MMD) in institutional settings, there are numerous touch-based multimedia applications specifically designed for this target group that are actually being used in practice. In contrast, the use of similar applications in domestic settings has been relatively limited.

Aim and method: This study is based on 11 expert interviews guided by questions and examines design options and requirements for application content as well as requirements for study designs to provide evidence of the effectiveness of touch-based multimedia applications for MMD and their caregiving relatives (PA).

Results: There is a high degree of consensus regarding the criteria for requirements for touch-based multimedia applications. Acceptance is highly dependent on user competence, usage practices, experiences and incentive structures; however, there are diverse opinions about their structural and content-related design. The quality of life is mentioned as an essential evaluation parameter for multimedia applications.

Discussion: The highly variable individual life circumstances of MMD and their PAs, along with limited access options and a lack of suitability of the multimedia applications, may be causal factors for their relatively limited use, especially in domestic settings. Daily performance capabilities and individual disease progression pose special requirements for the scientific evaluation and the demonstration of the effectiveness of touch-based multimedia applications.

背景:为了在机构环境中激活痴呆症患者(MMD)的认知能力和身体机能,有许多专门为这一目标群体设计的触摸式多媒体应用程序正在实际应用中。相比之下,类似应用在家庭环境中的使用则相对有限:本研究以 11 个专家访谈为基础,以问题为导向,研究了应用内容的设计方案和要求以及研究设计的要求,以提供证据证明触摸式多媒体应用对多发性硬化症患者及其护理亲属(PA)的有效性:结果:对于触摸式多媒体应用软件的要求标准达成了高度共识。接受度在很大程度上取决于用户的能力、使用习惯、经验和激励结构;然而,对于其结构和内容相关的设计却存在不同意见。生活质量被认为是多媒体应用的一个重要评估参数:讨论:多发性硬化症患者及其辅助治疗人员的个人生活状况千差万别,加上使用多媒体应用的选择有限和不适合,可能是导致其使用相对有限的原因,尤其是在家庭环境中。日常表现能力和个体疾病进展对触摸式多媒体应用的科学评估和有效性展示提出了特殊要求。
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引用次数: 0
[Journal Club]. [期刊俱乐部]
IF 1.1 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-01 Epub Date: 2024-04-10 DOI: 10.1007/s00391-024-02300-9
Peter Dovjak
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引用次数: 0
Mitteilungen der ÖGGG. ÖGGG 通信。
IF 1.1 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-01 DOI: 10.1007/s00391-024-02332-1
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引用次数: 0
[Congenital malformations of the brain misinterpreted as sequelae of poliomyelitis]. [先天性脑畸形被误解为脊髓灰质炎后遗症]。
IF 1.1 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-01 Epub Date: 2023-12-18 DOI: 10.1007/s00391-023-02264-2
Marija Djukic, Helmut Eiffert, Johannes Gossner, Roland Nau

Background: Poliomyelitis is an infectious disease of the peripheral motor neurons, which predominantly affects children and causes residual palsies. Because of the oral poliomyelitis vaccination started in Germany in 1960 and 1962 and the following rapid decline of the incidence of this infection, the postpolio syndrome in Germany is a disease of older people.

Methods: Since 2008, we have offered a poliomyelitis outpatient consultation at the Center of Geriatrics, Protestant Hospital Göttingen-Weende and have treated 33 patients.

Results: The spectrum of persistent deficits after poliomyelitis ranges from palsy of single extremities to severe disability with (temporary) ventilator dependence. Many patients suffer from scoliosis or shortening of limbs of different degrees, which promotes degenerative diseases of the spinal cord and joints with secondary myelopathy, injury of spinal nerve roots or peripheral nerves or respiratory failure. The postpolio syndrome is characterized by an increase of the functional deficits after decades of compensation. The palsies of 2 of the 33 patients were not caused by poliomyelitis but by myelomeningocele and schizencephaly, respectively.

Conclusion: The motor deficits acquired in childhood enable the majority of the patients to successfully master their lives. Because of the limited compensatory capacities of postpolio patients, even small increases in the severity of the palsy can cause a severe decline of the functional status and an impairment of the ability to live an independent life. In a substantial proportion of patients with the diagnosis poliomyelitis the symptoms are caused by other diseases.

背景:脊髓灰质炎是一种外周运动神经元感染性疾病,主要影响儿童并导致残余性麻痹。由于德国在 1960 年和 1962 年开始口服脊髓灰质炎疫苗,随后脊髓灰质炎的发病率迅速下降,因此在德国脊髓灰质炎后综合征是一种老年人疾病:方法:自2008年起,我们在哥廷根-温德新教医院老年医学中心开设了脊髓灰质炎门诊,并治疗了33名患者:结果:脊髓灰质炎后的持续性缺陷范围很广,从单肢瘫痪到严重残疾并(暂时)依赖呼吸机。许多患者患有不同程度的脊柱侧弯或肢体短缩,从而引发脊髓和关节退行性疾病,继发脊髓病变、脊神经根或周围神经损伤或呼吸衰竭。后脊髓灰质炎综合征的特点是经过数十年的代偿后功能障碍加重。33 名患者中有 2 人的麻痹不是由脊髓灰质炎引起的,而是分别由脊髓脊膜膨出症和精神分裂症引起的:结论:童年时期获得的运动障碍使大多数患者能够成功地掌握自己的生活。由于小儿麻痹症后遗症患者的代偿能力有限,即使麻痹的严重程度稍有增加,也会导致功能状态严重下降,影响独立生活的能力。在被诊断为脊髓灰质炎的患者中,有相当一部分人的症状是由其他疾病引起的。
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引用次数: 0
[Cooperation of geriatrics and trauma surgery in certified geriatric trauma centers : Insights into different care models and the implementation of requirements resulting from certification]. [认证老年创伤中心的老年医学和创伤外科合作:对不同护理模式和实施认证要求的见解]。
IF 1.1 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-01 Epub Date: 2024-01-12 DOI: 10.1007/s00391-023-02271-3
Patrick Roigk, Clemens Becker, Klaus Pfeiffer, Kerstin Bühl, Gisela Büchele, Dietrich Rothenbacher, H H König, Claudia Konnopka, Thomas Fries, Kilian Rapp

Background: In Germany, different models of orthogeriatric co-management have been implemented in certified geriatric trauma centers. So far, it is not clear how the different models are implemented and what influence the certification has on the structures and processes within the centers. The present study examined the extent of cooperation between surgery and geriatrics and if the quality of care had changed since the certification of the centers.

Methods: In this study 4 guided focus group interviews (FGI) were conducted in different teams of certified geriatric trauma centers in 3 federal states with 16 participants. To specify the content of the FGI, two additional interviews were conducted with system auditors. Both types of interview were analyzed by content analysis.

Results: The certification supported the implementation of structures and processes in the different orthogeriatric models; however, the quality of care and cooperation between surgery and geriatrics depends on the spatial proximity and the orthogeriatric care model in the geriatric trauma centers. Simultaneously, challenges in the area of geriatric syndromes and the recruitment of skilled staff became relevant.

Discussion: The results can help to reflect processes in the certified geriatric trauma centers and to treat geriatric syndromes more effectively. In the future, the challenge will be to establish geriatric care under the existing shortage of skilled staff.

背景:在德国,经认证的老年创伤中心采用了不同的老年骨科共同管理模式。迄今为止,尚不清楚不同模式是如何实施的,以及认证对中心内部的结构和流程有何影响。本研究探讨了外科与老年医学之间的合作程度,以及自中心获得认证以来,医疗质量是否发生了变化:本研究在 3 个联邦州获得认证的老年创伤中心的不同团队中进行了 4 次有指导的焦点小组访谈(FGI),共有 16 人参加。为了明确焦点小组访谈的内容,还对系统审核员进行了另外两次访谈。两类访谈均通过内容分析法进行了分析:认证支持在不同的老年医学矫形模式中实施结构和流程;然而,外科和老年医学之间的护理和合作质量取决于老年创伤中心的空间距离和老年医学矫形护理模式。与此同时,老年综合症领域的挑战和熟练工作人员的招聘也变得十分重要:讨论:研究结果有助于反映认证老年创伤中心的工作流程,更有效地治疗老年综合症。未来的挑战将是如何在熟练人员短缺的情况下建立老年病护理。
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引用次数: 0
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Zeitschrift Fur Gerontologie Und Geriatrie
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