Innere Medizin (Heidelberg, Germany)最新文献

Background: Various concepts are used to assess the health status of geriatric patients, including frailty, resilience, and intrinsic capacity. Frailty, as the oldest and best-known concept among these, focuses on identifying functional deficits, whereas resilience and intrinsic capacity primarily assess preserved abilities. The application of all these concepts supports risk stratification and therapy planning in older patients.

Objectives: The aim of the present work is to systematically present intrinsic capacity and resilience as well as their relationship to and distinguishing characteristics from frailty. Additionally, intrinsic capacity and resilience are here considered within the framework of specific and overlapping features, as well as differences and practical relevance for geriatric care.

Material and methods: A narrative analysis of the concepts was conducted based on current literature.

Results: Content overlap between frailty, intrinsic capacity and resilience, particularly in the domains of mobility and mental abilities, is present. Since most concepts emphasize only one thematic focus, multidimensional models, such as intrinsic capacity, can be advantageous. Different versions of measurement tools, especially for frailty, exist for different clinical settings. To date, no standardized measurement tools of frailty, intrinsic capacity, and resilience have been universally recommended.

Conclusion: All concepts play an important role in the clinically meaningful stratification of older adults. In clinical practice, it is recommended to select one concept based on the parameters to be evaluated and to apply it consistently across all assessment time points.

Nutrition is considered to play a key role in the multifactorial development of frailty. Conversely, frailty also affects nutrition. The aim of this article is to describe the interactions between these two entities in detail and to derive nutritional recommendations. On the one hand undernutrition and the resulting loss of body weight and muscle mass contribute to the development of sarcopenia and thus to the development of frailty. On the other hand obesity is associated with an increased risk of frailty even in middle age, presumably due to the accompanying chronic low-grade inflammation. At the nutrient level, protein is important as a building and regulatory substance: other nutrients appear to protect against frailty due to their antioxidant and anti-inflammatory properties, with the associations best documented for a Mediterranean-style diet, which is rich in these components. In the presence of existing frailty, the same recommendations generally apply: adequate energy and protein intake as part of a plant-based, varied diet, but the implementation requires more attention. Routine screening for malnutrition is recommended to detect corresponding warning signs as early as possible and subsequently eliminate the causes. As frailty is rarely solely related to nutrition, nutritional interventions should be part of an overall program that at least includes physical activation. In summary, nutrition as a modifiable factor, offers enormous preventive potential, ideally starting early in life but even in old age it is not too late for positive adjustments.

Background: Patients with hypertension, diabetes mellitus (DM) and/or cardiovascular disease (CVD) have a higher risk of developing chronic kidney disease (CKD) and should therefore be closely monitored. Early diagnosis and guideline-directed disease management can reduce the risk of kidney failure and cardiorenal complications.

Objectives: The aim of this retrospective cross-sectional study was to gain a better understanding of the prevalence, diagnosis, and guideline-directed treatment of CKD in patients at risk for CKD in German general practitioner (GP) practices.

Materials and methods: A total of 1244 GPs provided fully anonymized electronic data sets for the analysis (study period 06/2020-06/2023). According to the screening recommendations of Kidney Disease: Improving Global Outcomes (KDIGO), adults with hypertension and/or DM and/or CVD with a documented observation period of at least 1 year were included in the study.

Results: The prevalence of CKD was 18.8% (n = 24,179), of which 16.5% of at-risk patients (n = 3986) had a documented diagnosis of CKD according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Thus, 83.5% (n = 20.193) of patients at risk remained undiagnosed. Within 6 months of diagnosis, 9.7% (n = 1740) of ICD-10-diagnosed CKD patients were treated with a renin-angiotensin system inhibitor (RASi) in combination with a sodium-glucose cotransporter‑2 inhibitor (SGLT2i).

Conclusion: The results highlight substantial gaps in early diagnosis and treatment of CKD in Germany. There is an urgent need for greater awareness among GPs of this under-recognized disease.

A 55-year-old female patient presented with a 1-week history of cough, dyspnea, pre-syncopal sensation and a history of asthma and long-lasting complete remission of diffuse large B‑cell lymphoma (LBCL). Imaging revealed a mass measuring 8 × 6.4 × 6.2 cm in the right ventricle and atrium, partially obstructing the cardiac valve plane. Biopsy was performed. With the onset of hemodynamic instability, ex juvantibus antineoplastic therapy was administered. After 36 h, echocardiography already showed a considerable size reduction to approximately 5 × 5 cm. Histology was consistent with relapsed LBCL. Staging showed no further manifestations and salvage therapy was initiated.

As a digital care concept, telemedical care for patients with chronic heart failure has developed into an independent method in recent years. It complements the outpatient care provided by general practitioners (GPs) and specialists. Randomized controlled studies have demonstrated that telemedical care reduces mortality and cardiovascular morbidity in patients with chronic heart failure. This led to the decision by the Federal Joint Committee (G-BA) to implement telemedical care as part of standard care for patients who meet certain indication criteria. In Germany, it is estimated that around 150,000 patients with chronic heart failure require telemedical care based on the G‑BA inclusion criteria; however, currently only 15% of these patients receive telemedical care. The greatest challenge for this method of digital cardiology is currently achieving quick and comprehensive implementation in standard care.

Frailty is an established clinical syndrome that occurs more frequently with increasing age, but also often contributes to irreversible functional loss in younger adults. Its multidimensional, complex pathophysiology and phenotypic nature is associated with atypical disease presentation and underdiagnosis in clinical routine. The latter still utilizes, especially in nongeriatric settings, medical technologies that are often unable to capture and measure frailty. In addition, frailty progresses per se rather imperceptibly until its late stages, when it is too close to the point of no return and difficult to treat efficiently. Therefore, prevention of frailty is key in the context demographic change, characterized by socioeconomically unsustainable rates of multimorbidity and disability. In the framework of the present special issue, this contribution aims at highlighting relevance, potential, and methodology of frailty prevention for the maintenance of function and vitality during life.