Zeitschrift Fur Gerontologie Und Geriatrie最新文献

Cognitive disorders are multifaceted and the range of neuropsychological instruments is correspondingly extensive; however, most examiners have to limit themselves to a small selection in order to master them safely. In geriatric patients the various forms and stages of dementia dominate. Delirium must be distinguished from these as an acute life-threatening event. The personal and external medical history as well as clinical observation are the first steps in the assessment of cognition; the selection of test procedures is graduated and bears the patient's benefit in mind. When compiling a toolbox for use in one's own field of work, in addition to instruments focusing on different degrees of severity, alternatives should also be considered for use in the presence of comorbidities that reduce the validity (visual, hearing and fine motor disorders) and the examination situation should be taken into account.

Background: The presence of frailty in older patients increases the risk for adverse health events and for a loss of independence. Measures for the prevention of this geriatric syndrome should be incorporated into routine healthcare.

Objective: What types of interventions could be effective in the prevention of frailty and how can preventive strategies be successfully implemented?

Method: Narrative review article.

Results: The concept of frailty is multidimensional and potential starting points for a prevention of frailty can be found within different dimensions (e.g., dimensions of physical activity and nutrition, psychosocial dimension). Epidemiological analyses have identified factors that increase or decrease the risk for becoming frail. Evidence from randomized controlled trials that examined the effectiveness of specific interventions in the prevention of frailty is still limited. Based on the available data, interventions using physical exercise appear to be effective in preventing frailty. In primary care in Germany the frailty status of older patients is not yet routinely recorded, which impedes the identification of patients at risk (patients with pre-frailty) and the implementation of targeted preventive strategies. The Integrated Care for Older People (ICOPE) concept of the World Health Organization offers a potential approach to prevent frailty and to promote healthy ageing within the population.

Conclusion: The prevention of frailty is possible and reasonable. Comprehensive and targeted preventive strategies are yet to be implemented.

Background: Recognizing functional deficits early and counteracting them with a multimodal treatment concept is one of the most important tasks of general practitioners, who are usually the primary medical contact for geriatric patients.

Aim: Illustration of strategies for a biopsychosocial assessment of geriatric patients and for the creation of individually adapted prevention concepts in general practice.

Material and methods: Literature research on the theoretical background of the most important prevention approaches for geriatric patients as well as considerations on their relevance and implementation in daily practice.

Results: For geriatric patients prevention measures should be implemented simultaneously on all four prevention levels. The main objective is promoting physical and mental exercise. The risks of immobility, depression, cognitive decline, malnutrition and, last but not least, polypharmacy are of particular importance.

Conclusion: Geriatric patients represent a very heterogeneous group. In order to be able to take individual preventive action, a multidimensional assessment of key factors for maintaining functionality and relative health is required, even though chronic conditions may already exist.

Background: Geriatric patients in subacute inpatient care (SC) with rehabilitation needs after hospitalization seldom utilize rehabilitative services and are often transitioned to long-term care (LTC), suggesting that their care in SC can be optimized.

Objective: To evaluate the effectiveness of rehabilitative subacute inpatient care (REKUP) in improving the care of geriatric patients in SC with rehabilitation needs after hospitalization.

Methods: The study was conducted as a nonrandomized intervention trial with an historical control group (CG). The intervention group (IG: n = 49) received REKUP (activating therapeutic care, functional rehabilitative therapy, psychosocial services, medical care), while the CG (n = 57) received usual care during SC. Primary outcomes were transition to inpatient rehabilitation, home, and LTC, deteriorated care setting, care level, and mortality within 3 months after SC. Secondary outcomes were functional, motor and psychological variables.

Results: The transition rate to inpatient rehabilitation (82% vs. 37%) and home (86% vs. 65%) was higher (p < 0.05) in the IG than in the CG. The proportion of persons utilizing LTC (12% vs. 35%) and with deteriorated care setting (35% vs. 60%) was lower (p < 0.01) in the IG than in the CG. The Barthel Index, visual analogue scale of the EQ-5D, and numerical pain scale improved (p < 0.05) during the SC stay in the IG but not in the CG.

Discussion: REKUP as a new care model for SC promotes the transition to inpatient rehabilitation, reduces the utilization of LTC and improves the chances of returning home and achieving greater independence in geriatric patients with rehabilitation needs after hospitalization.

Background: The current evidence regarding interventions to improve oral health in older hospital patients is unclear.

Objective: This scoping review assesses the scope and nature of research activities and identifies gaps in the existing literature.

Methods: The inclusion criteria for this study included adults over the age of 65 years who were treated as inpatient outside of intensive care units and covered all interventions aimed at promoting oral health or hygiene.

Results: The systematic search yielded 12 final studies, focusing on oral healthcare interventions in various settings, primarily in high-income countries. The studies employed diverse designs including randomized controlled trials and prospective studies, with interventions mainly provided by multidisciplinary teams. The interventions aimed to improve oral health or prevent pneumonia. Overall, the studies highlighted a potential effectiveness of multidisciplinary approaches in improving oral health and preventing pneumonia in geriatric populations.

Conclusion: This scoping review shows a limited and heterogeneous evidence base for oral health interventions for older patients in hospitals. The need for patient involvement is evident; however, there is often a lack of high-quality studies to draw robust conclusions.

Background: Particularly older people are affected by mobility restrictions and can go through the process of gradually becoming bedridden. This can potentially lead to extensive consequences for the individuals involved, which must be considered in their care.

Aims: To bundle nursing implications related to the phenomenon of being bedridden in the field of long-term care and to provide impulses for research in nursing science.

Methods: Research in relevant specialist databases (2003-2023) based on the criteria of a scoping review.

Results: In Germany there is a standard for maintaining and promoting mobility that addresses bed and local confinements but German language studies on these phenomena are rare. In the international context, these issues are researched more intensively, focussing on risk factors for the development of immobility and the negative consequences for those affected. The publications focus on the reduction of these factors, while less attention is paid to the organization of life in bed and the participation and involvement of those affected.

Discussion: The complexity of the phenomenon is not fully illustrated in current research. In order to develop a nursing perspective research projects that also include aspects of life in bed are a central aspect in order to take greater account of the reality of bedridden people's lives and their potential for participation and involvement.

Background: Assessment tools for engagement in people with dementia often rely on self-reported measures which restricts their use in people with severe cognitive limitations. The Engagement of a Person with Dementia Scale (EPWDS) is a valid and reliable tool to assess behavioral and emotional expressions and responses of engagement in people with dementia through observation; however, the EPWDS is not yet available in the German language.

Objectives: 1) Translation and cross-culturally adaptation of the original English version of the EPWDS into the German language (EPWDS-GER) and 2) to gain insights into assessing data with the newly developed instrument.

Material and methods: International recommendations were followed to cross-culturally adapt the English original version of the EPWDS into the German language in 5 steps: translation by three independent translators, synthesis, back translation, expert committee review (N = 10) and test of the prefinal version in nursing practice (N = 22) on a 5-point Likert scale to assess comprehensibility, practicability and suitability of the EPWDS-GER.

Results: The EPWDS-GER achieved high ratings for the five subscales on ease of understanding, ease of answering and importance of single items for assessing engagement. Average agreement for all items ranged from 3.86 to 4.43 (SD = 0.68-1.29). Overall rating of EPWDS-GER resulted in a mean agreement of 4.18 (SD = 0.73) for suitability and of 4.09 (SD = 0.81) for practicability.

Conclusion: The EPWDS-GER is an easy to use tool for measuring behavioral and emotional expressions and responses of engagement of a person with dementia and can now be utilized in clinical practice and research.