[Sleep and sleep disorders in old age]. / Schlaf und Schlafstörungen im hohen Lebensalter.

The increasing interruptions of nocturnal sleep with aging must be distinguished from actual sleep disorders. Morbidity and medication have an impact on sleep. The relationship between sleep and morbidity is mutual. Disturbed sleep modifies many clinical symptoms and diseases affect sleep and the ability to sleep. Geriatric syndromes such as falls, depression and dementia are modified by sleep disorders. Geriatric syndromes can be favorably influenced by the treatment of sleep disorders. Adequate diagnostics are important prerequisites. Coincidences of different sleep disorders are frequent. The medical history of patients and a sleep diary form the basis of the diagnostics. Sleep medicine provides further technical examination procedures. Older people should be examined in a sleep laboratory if the results have consequences that are accepted by the patient. This should be clarified in advance.

Evaluation of drug prescriptions on hospital admission in older trauma patients using the Fit fOR The Aged (FORTA) rules.

BACKGROUND: Orthogeriatric comanagement of older patients with hip fractures has been proven to provide significant benefits concerning functional status, readmissions, nursing home placement, in-hospital complications and mortality. Medication management in older individuals is a cornerstone in orthogeriatric comanagement. The aim of the study was to analyze the extent of overprescription and undertreatment in older trauma patients. METHODS: Personal and medical data of consecutively admitted older trauma patients were analyzed. Evaluation of medication was conducted according to the Fit fOR The Aged (FORTA) criteria. Data were retrieved from an ongoing observational study on the incidence of delirium in surgical patients. RESULTS: A total of 492 patients were enrolled. There were 374 cases of overprescription and 575 cases of undertreatment. Only 78 (16%) patients had neither overprescription nor undertreatment on admission. Overprescription and undertreatment were most prevalent in cardiovascular disease. Undertreatment was most prevalent concerning osteoporosis. The number of prescribed drugs correlated with the Charlson Comorbidity Index (r = 0.478, p < 0.001), age (r = 0.122; p < 0.01), anticholinergic burden (r = 0.528, p < 0.001), FORTA score (r = 0.352, p < 0.001), and overtreatment (r = 0.492, p < 0.001), but not with undertreatment. Undertreatment also correlated with age (r = 0.172, p < 0.001) and overtreatment (r = 0.364, p < 0.01). The FORTA score correlated significantly with age (r = 0.159, p < 0.001), anticholinergic burden (ACB) score (r = 0.496, p < 0.001), Katz index (r = -0.119, p < 0.01), IADL score (r = -0.243, p < 0.001), and clinical frailty scale (CFS, r = 0.23, p < 0.001). CONCLUSION: The high numbers of overprescription and undertreatment in older trauma patients underlines the need for orthogeriatric comanagement. Besides the evaluation of multimorbidity and geriatric problems, drug management is a core topic. Future studies should investigate the impact of medication management on outcome parameters such as quality of life, functional status, and mortality. A benefit can be expected.

[Frailty phenotype and risk factor for disturbed sleep]. / Frailty-Phänotyp und Risikofaktor gestörter Schlaf.

Regardless of the nature of its operationalization, frailty has significant negative consequences for the person concerned and the community. Even if a generally accepted definition of frailty is still missing, there is no doubt about the existence of this phenomenon. Pathophysiologically, a dysfunctional interaction between multiple complex systems is discussed. Therapeutic interventions show that frailty is a dynamic state that can be improved. The pathophysiological characteristics of frailty and sleep disturbances show numerous similarities. In addition, the risk of frailty is increased in individuals with sleep disturbances. As the majority of sleep disorders can usually be well treated, screening for sleep disorders should be integrated into a comprehensive concept of management of frailty.

[Sleep and dementia]. / Schlaf und Demenz.

Aging is associated with changes in sleep structure and cerebral deposition of amyloid beta and tau proteins. Sleep disturbances precede the onset of dementia by years. Comorbid sleep disorders, such as insomnia and sleep-disordered breathing, a family history of dementia and epigenetic factors can contribute to the development of dementia. This article explores the question of the interaction between sleep and dementia based on the existing literature. Alterations caused by slow wave sleep lead to changes in the glymphatic clearance of amyloid beta, tau proteins and other proteins. Transient and chronic sleep disorders cause disturbances in the brain areas responsible for cognition and behavior. Sleep-regulating brain areas are the first to be affected in the neurodegenerative process and accelerate the risk of dementia. Circadian age-related changes in amyloid beta and tau proteins affect the amount and depth of sleep and vice versa. Amyloid beta in cerebrospinal fluid shows an inverse correlation with sleep. Orexins modulate amyloid beta and sleep.