Zeitschrift fur Gerontologie最新文献

Seventy-four in- and out-patients (mean age 71.9 years) with Parkinsonian syndromes (summarized as "PS": idiopathic Parkinson's disease, vascular pseudo Parkinsonian syndrome (VPS), and Parkinson-dementia (PDK)) were prospectively evaluated as to present clinical state according to usual rating scales, as to clinical syndrome and physician's diagnosis and treatment at the start of the illness, and as to current medical and social care. 54% of the patients had history and findings of tremor, 14% had visual hallucinations, 19% had depression. Ratings on part II of the "Unified Parkinson's Disease Rating Scale" (UPDRS) describing "activities of daily living" correlated highly with the ratings of part III ("motor evaluation") and with another activity of daily living scale according to Schwab and England. The mean difference between time of diagnosis and start symptoms (the "diagnostic delay") was nearly 21 months. Initial symptoms did not show an impact on this difference. 68% of patients were presently treated by general physicians and were significantly older than those treated by neurologists. 59% were in-patients during the study and were more likely to carry a diagnosis of VPS or PDK. 75% of those patients who were ever in-patients during their illness had the disease for up to six years before they were first hospitalized. 77% of the patients had drug treatment; 88% of these took L-Dopa preparations. 23% of patients with drug treatment had L-Dopa-associated motor complications. 15% of patients lived alone, 66% with their family, and 19% in a nursing home. 24% of patients had assistance in their household by a professional caretaker. 16% of patients retired early from work. The long-term care of older Parkinsonian patients is a task for general medicine based on neurogeriatric expertise.

In 12 nursing homes for older people epidemiological and therapeutic data of patients with Parkinson's disease were collected. The mean rate of Parkinson's disease in all inhabitants was 12.5%, the mean clinical disability was 15.3 +/- 4.5 (Webster score). The mean age was very old (81.3 +/- 7.8 years). All patients showed one or more different diseases. The medical treatment was often not in agreement with symptoms. Physical therapy was applied only in 33% of patients. These and further data support the thesis that patients with Parkinson's disease in nursing homes may benefit from therapeutic patterns.

We analyzed data of our clinic by a computer program for discharge letters developed by us. Structure of patients, types of diseases, and success in rehabilitation were recorded. The average age of our patients was 80 years. The biggest group have been the 80-85 years old ones. Two-thirds have been female. Our department is divided into three sections. Admissions made to the section treating patients with acute diseases were made in two-thirds of the cases from surgeries and in one-third from accidents. The section where patients are rehabilitated received only patients who had been admitted before. Two-thirds of them were suffering from surgical diseases (especially orthopedic/traumatic problems). One-third from medical or neurological diseases--especially stroke. In the section for long-term treatment we transferred patients with chronic diseases, mainly from our own sections for acute care and rehabilitation. Twenty percent came from other departments and other hospitals. Discharge: Fifty-one percent of patients treated in the section for acute care were discharged. More than one-fourth were transferred to the section for long-term treatment. Thirteen percent died. Two-thirds of the rehabilitated patients were discharged home. Sixteen percent were treated long-term; about seven percent died. From our section for long-term treatment one-third of the patients were discharged home. Nineteen percent were discharged to nursing homes or other homes for seniors. Forty-one percent died. Younger patients could more likely be discharged without home nursing care and to a household with other members. More than fifty percent of patients of 80 years and older lived alone and required homecare.(ABSTRACT TRUNCATED AT 250 WORDS)

To evaluate social aspects of elderly patients which are important for diagnosis and therapy within geriatric assessment, a questionnaire was developed and validated. Raters showed a high degree of agreement on the scale, which contains social contacts and support, activities, economic situation, and housing conditions (0.92-0.97; p < 0.05). Compared to the interrater reliability the test-retest reliability was somewhat lower (0.75), but also significant at the 5% level. The internal consistency showed high values between 0.72-0.89. In order to evaluate the validity of the screening test the answers of the patients were compared with the assessment of the therapeutic team. The team had information from a home visit, patients spouse, relatives, neighbors, community nurses and/or general practitioners. There was a significant relationship (p < 0.01) between therapeutic assessment and the scale (r = 0.51). Sensitivity, specificity, and total efficiency also attained sufficiently high values at a cut-off of 16/17 for the complete scale (max. 25 points). The test is easily and quickly performed; its acceptance is high. Social data relevant for treatment and discharge planning can thus be obtained and patients can be identified, for whom a home visit seems to be useful.

Omega-3-fatty acids play a protective role in the prevention of CHD, however, they can have a negative influence on LDL-oxidation and aging processes by the formation of peroxides. In 56 patients with HLP (40 with mixed HLP and hypertriglyceridemia, respectively, and 16 with hypercholesterolemia) changes in the lipid state and in the parameters of the antioxidative potential before and after a 4-week-olive-oil phase and after 8, 20, and 32 weeks intakes of salmon-oil capsules were determined. The treatment with salmon-oil capsules were determined. The treatment with salmon oil led to a decrease of triglycerides in patients with hypertriglyceridemia and to an increase of cholesterol in hypercholesterolemia. Following the increase of malondialdehyde as measure of the lipid peroxidation a substitution of antioxidants, like vitamin E and vitamin C, seems to be useful. Further investigations are necessary before wide use of fish-oil capsules, not least to avoid side-effects.

Studies of compliance with drug treatment in the elderly have mainly focused on treatment variables, and patient knowledge or comprehension. However, information on behavioral aspects is sparse. Therefore, interviews concerning medication were performed in 31 geriatric patients, mean age 79.6 years. The aim was to evaluate whether there were relations between coping with health problems and attitudes towards/taking of medication prescribed. It was concluded from the analysis of these tape-recorded interviews that different forms of coping strategies were reflected by patients' attitudes towards taking of medicines. There was a high degree of competence perceived by patients, and objectively as well. Nevertheless, when taking drugs patients surprisingly often relied on other persons' support.

This work studies the follow-up of vitality using parameters related to the arterial wall. This study is based on the application of several mathematical models and different calculation procedures. Humoral parameters together with measurements of the daily insulin secretion (own methodology based on the C-peptide elimination) were applied for the calculations using the exclusively healthy population. In the case of the non-selected population the percentage of disease prevalences due to vascular affections were applied for calculations.

Epidemiological work on the age-dependency of the relation between overweight and mortality confirms an opinion which is traditional among physicians and has it roots in a mixture of biological understanding and common sense. The data base can be summarized in three points: 1) Up to the age of 60-65 years, overweight is combined with decreased life expectancy. The excess mortality is found mainly in the cardiovascular area and can be explained by the well-known risk factors of atherosclerosis. In the Framingham-study, overweight per se is a risk factor for this group of diagnoses. 2) In the age group 65-74 years, the relation between overweight and excess mortality vanishes gradually; the right arm of the U- or J-curve levels off. The optimal BMI moves to the right, and the right arm of the curve is shortened. 3) In high age, from 75-80 years on, overweight coincides with improved prognosis. The geriatric literature is in agreement in the sense that overweight is no problem in high age.

Human skin fibroblasts of phase II ("young" cells derived from populations with a low population doubling level) and of phase III ("old" cells from populations, which were approx. 2 population doublings before the last possible subculture) were kept under subconfluent conditions in a defined serum-free medium. Thereby the cells are in a non-proliferative "quiescent" state. Glycosaminoglycan (GAG)- and especially hyaluronan (HA)-synthesis and release into the medium were investigated by the incorporation rate of 14C-glucosamine. About 95% of the synthesized (48 h) GAGs and HA were medium-released and 5% cell-bound. HA synthesis rate of phase III-cultures was significantly reduced, as compared with phase II-cultures. Stimulation of HA-synthesis of phase III-cells--in comparison with phase II-cells--by serum, PDGF or IGF-I was strongly reduced. While HA-synthesis of phase II-cells was maximally stimulated by 5% FCS or 20 ng/ml PDGF, phase III-cells dit not exhibit a saturation kinetics up to 20% FCS or 60 ng/ml PDGF. The strongly reduced HA-synthesis rate of phase III-cells--compared with phase II-cells--in the non-stimulated quiescent state as well as after stimulation by PDGF, IGF-I or serum might be considered as a biomarker of in vitro (and in vivo?) ageing.

Age-dependence of mechanical parameters was studied in vitro in human skin obtained at autopsy and in rat skin. Parameters indicating strength, e.g. ultimate load, tensile strength, modulus of elasticity, and ultimate extension, showed a steep increase during maturation, a maximum at adulthood and a slight but significant decrease during senescence. Parameters indicating viscosity or plasticity studied in hysteresis-, relaxation-, and creep-experiments showed a decrease during the whole life span. Simultaneous studies of biochemical parameters indicated a parallel behavior of strength with the content of insoluble cross-linked collagen and of plasticity with the content of glycosaminoglycans. The in vitro experiments in rats could be confirmed by in vivo studies. Further studies in rats indicated an excellent ability of skin in old rats for complete restoration (restitutio ad integrum) after repeated loading.