Reliability of the blood pressure response during performance of bedside Valsalva maneuver and association with NT-pBNP levels.

BACKGROUND: Heart failure (HF) is common in older people. The diagnosis of HF, however, is difficult in older subjects, especially in settings without direct access to further diagnostics. The type of blood pressure response during the performance of a Valsalva maneuver has been suggested as an easily applicable bedside test to detect HF; however, the reliability of this maneuver and the association with HF is unknown in geriatric patients. METHODS: This study included 89 patients admitted for geriatric rehabilitation. Systolic blood pressure was taken while the patient performed a Valsalva maneuver. The systolic blood pressure response was classified as sinusoidal (type A), absent overshoot (type B) or square pattern (type C). To test interrater reliability systolic blood pressure response was evaluated independently by two investigators. The procedure was repeated after 1h to estimate test-retest reliability. Both investigators were blinded to the results of the other. Interrater reliability and test-retest reliability were calculated using Cohen's kappa. Blood samples for N­terminal pro brain natriuretic peptide (NT-pBNP) were obtained on the morning the Valsalva maneuver was performed. RESULTS: Blood pressure response was sinusoidal in 37 (42%), showed an absent overshoot in 17 (19%) and had a square wave pattern in 34 (38%) patients. Cohen's kappa was 0.911 (95% CI 0.837-0.985) for interrater reliability and 0.929 (95% CI 0. 0.862-0.996) for test-retest reliability. The interrater and test-retest agreement were 94% and 96%, respectively. The mean NT-pBNP plasma levels and the interquartile ranges (IQR) in subjects with types A, B and C blood pressure response pattern were 213 (153-324) pg/ml, 805 (622-1332) pg/ml and 3964 (2595-5906) pg/ml, respectively (p < 0.001). CONCLUSION: The blood pressure response during a Valsalva maneuver shows an excellent reliability in older subjects. The type of response is associated with the NT-pBNP plasma level.

[Sleep and sleep disorders in the elderly: Part 3: Restless legs syndrome]. / Schlaf und Schlafstörungen beim alten Menschen: Teil 3: Restless-legs-Syndrom.

Restless legs syndrome (RLS) is a commonly occurring condition with a prevalence of approximately 10%. Women are more often affected than men. There is a primary and a secondary form. Secondary RLS is triggered by iron deficiency, severe renal insufficiency and many drugs and medications. The treatment for RLS is always symptomatic. In addition to treating associated diseases, dopaminergic therapy is paramount. Pharmacotherapy encompasses levodopa (L-dopa) and dopamine agonists, such as pramipexole, ropinirole and rotigotine. A serious complication of dopaminergic therapy is the so-called augmentation. In the case of insufficient efficacy, severe discomfort or augmentation, oxycodone/naloxone is now approved for the treatment of RLS.

[Sleep and sleep disorders in the elderly. Part 2: therapy]. / Schlaf und Schlafstörungen beim alten Menschen. Teil 2: Therapie.

Sleep disorders need to be treated if they affect the quality of life, lead to functional problems in daily life or unfavorably affect self-sufficiency. The large number of sleep disorders is reflected in the number of different and varied available therapeutic procedures. The basic therapeutic procedure for any sleep disorder is the use of sleep hygiene. Sleeplessness (insomnia) is most effectively treated through behavioral therapy, with stimulus control and sleep restriction as the most effective measures, whereas pharmacotherapy is considerably less effective and has side effects. Sleep-disordered breathing is also the most common cause of hypersomnia in the elderly and is most effectively treated by nocturnal positive pressure breathing.

[Sleep and sleep disorders in the elderly: Part 1: epidemiology and diagnostics]. / Schlaf und Schlafstörungen beim alten Menschen: Teil 1: Epidemiologie und Diagnostik.

Restorative sleep is an important factor for well-being, performance and quality of life. The basic diagnostic procedure of a sleep disorder is to take a comprehensive sleep history. Sleep disorders can and must be distinguished from the physiological changes of sleep in the elderly. Insomnia (difficulty in sleeping), daytime sleepiness (hypersomnia), sleep-related breathing disorders (SRBD) and movement disorders during sleep are also common in the elderly. They must be detected because they are treatable and can dominate the clinical picture of geriatric syndromes. Nursing home residents and dementia patients are in particular need of attention as their sleep is often adversely affected by the living environment and the daily institutional routine.

Treatment of chronic obstructive pulmonary disease in hospitalized geriatric patients.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is frequent in older subjects due to deterioration of pulmonary function and lifelong exposure to risk factors. Furthermore, COPD is often underreported because of the gradual onset of symptoms and reduced perception of symptoms in the elderly. There is thus a risk of undertreatment of COPD in older subjects. METHODS: We retrospectively analyzed dossiers of 229 hospitalized geriatric patients with COPD, complete assessment datasets and successful lung function tests. RESULTS: The sample comprised 78 men (38 %; mean age 77 ± 7 years) and 151 women (66 %; mean age 81 ± 6 years). The number of untreated patients decreased from 68 (28 %) at admission to 35 (14 %) at discharge (p < 0.01). Absence of treatment was associated with severity of disease: mild COPD was less likely to be treated. During the hospital stay, the prescription of metered dose inhalers (MDIs) decreased and the prescription of nebulizers increased, most likely due to the coordination problems associated with using inhalers. CONCLUSION: Undertreatment of COPD is frequent among hospitalized geriatric patients. There is a need for adaption of current guidelines to the needs of older patients with frailty or cognitive impairment.