Zeitschrift fur Gerontologie最新文献

Up to now, victimology has only dealt with partial aspects of the situation of the elderly as victims of violent crime. Nevertheless, the Police Crime Statistics enable us to make the following three basic statements: In general, old people are less likely to become victims of violent crime (than young people). The acts of violence committed against the elderly are mainly ones in which there was a relationship between offender and victim before the offense. Elderly women are disproportionately more often victims of purse snatching. The increasing social isolation of old people constitutes not only a specific form of victimization, it probably also increases their susceptibility to become victims. The theory that old people have "a particularly pronounced fear of crime" cannot be generally proven. This question must be considered from differing points of view and depends largely on the individual vulnerability of the old people. In Germany, there has hardly been any empirical study of violence towards the elderly in institutions and in family households (so-called domestic violence). It is believed that more violence takes place in both than in generally assumed.

At the Institute for Legal Medicine in Hamburg, 54 car and bus accidents involving elderly people (age > or = 65 years) over the last decade have been studied. Differences in sex and age, the reasons for accident and death, and specific problems of clinical therapy are analyzed. Mostly men had been the drivers, half of them being personally responsible for the accident. Special psychophysical factors associated with old age could not be identified as causative factors for the accidents within this series.

As compared with quiescent lymphocytes, human thymocytes were found in the nucleoid sedimentation assay to be deficient in UV-induced DNA repair. Therefore, the age-related repair deficiency of human lymphocytes can result from the increased proportion of immature T cells occurring with age.

Physicians are obliged to inform all patients about the diagnosis and course as well as the purpose and risks of diagnostic and therapeutic procedures. Difficulties in informing elderly, especially cognitively impaired patients are discussed. The legal aspects in Germany are shortly reviewed.

Orchiectomy is a frequently performed therapy for prostatic carcinoma in elderly men. A so far widely neglected side-effect is the occurrence of hot flushes. They considerably decrease the quality of life of a large number of the patients who often are in a palliative situation and handicapped by other diseases. Therapeutic options are widely unknown. Therefore, the patients often consult their doctors in vain. In a study with 32 patients clinical appearance of hot flushes and their effects on the patient's quality of life were analyzed. 69% of patients with a mean age of 75 years experienced hot flushes, whereas 31% of patients with a mean age of 80 years had not been bothered by hot flushes. Possible therapeutic options are presented and discussed. Ciproteronacetate seems to be the most effective therapy with the least side-effects (9).

Scientific literature reveals different levels of efficiency in geriatric screening in the primary care setting. Part I of our review deals with the development of geriatric screening up to the implementation of regular health checks in Great Britain. Studies in primary care show that through screening 1-2 previously unknown conditions per patient can be detected, with a particularly high prevalence of unknown problems in the following areas: vision and hearing, continence, mobility, cognitive function, mood, isolation, and lack of help. Further research is still required to transfer the results of screening studies into primary care, particularly in validating instruments of geriatric assessments and selecting risk groups.

Patients of a geriatric hospital (n = 263; 145 women, 118 men) had the task of drawing a clock and indicating a given time by the placements of hands. Errors were classified hierarchically by using a five-category-panel based on defined criteria. Its use as a "first-line" screening test for cognitive disorders in old age was evaluated. Retest- (r = 0.89) and interrater- correlations (r = 0.81) were satisfying. The results of this "clock drawing test" were compared both to the outcome in the Abbreviated Mental Test (AMT) and to the general judgment of the patients' cognitive status, based on the history, the report of informants, on clinical observation and examination. Patients with faultless clock drawings performed well in the AMT. However, prediction of the outcome in the AMT gradually became impossible with poorer performance in the clock drawing test, resulting in a low specificity (0.74) for a normal AMT. Specificity of the clock drawing test increased (0.79) for the general judgment of cognitive disorder, with sensitivity remaining constant (0.84). Sudden onset of cognitive disorder (most commonly confusion) in case of acute disease was discovered by the clock drawing test. Focusing on all patients without apparent cognitive disorder and with normal AMT-result, the subgroup of patients with faultless clock drawings was significantly younger (t = 5.0); p < 0.001). It is suggested to use the clock drawing test in addition to conventional psychometric screening tests because it requires visuospatial skills and conceptual thinking in addition to mere mnestic and verbal qualities.(ABSTRACT TRUNCATED AT 250 WORDS)

246 patients (average age 82.4 years) with proximal femur fractures treated with bipolar endoprothesis, sliding lag screw or Ender nailing, related to the fracture type were analyzed in a retrospective study. Preexistent diseases, duration of operation, postoperative complications, transfusions, hospital stay, mobility achieved and mortality were noted. As a result, we found a high multimorbidity related to the age, the highest requirement of transfusions in patients undergoing Ender nailing, a long period to achieve postoperative mobility, a long hospital stay, and increasing mortality with average age and average hospital stay.

Geriatric screening detects many problems previously unknown to the primary health care physician. In spite of this, a valid judgement can only be made if the effectiveness of the induced intervention is proven. Prospective studies evaluating these screening-induced interventions show diverse results. Nevertheless, international task forces conclude from the evidence of existing studies that there are areas which are effective, efficacious, and enhance the quality of life. It remains a continuing task for research to develop geriatric assessment instruments as well as to set up objective guidelines of intervention in these areas.