RESUMO
Gait disorders are one of the most common gerontoneurological symptoms. Falls that occasionally cause severe injuries are highly relevant consequences. A clinical neurological examination and inspectoral gait analysis are the core investigations of the diagnostic process, which yields hypotheses with respect to the impaired structures as well as to specific diagnostic measures. The supplemental motor assessment quantifies the resulting impairment of mobility and risk of falling with the help of well-established instruments. Characteristic of gait disorders in the elderly are the multifactorial causes which make the complete identification, correct prioritization and adequate treatment the biggest challenges. The therapeutic concept is multiprofessional and includes the causal treatment of underlying diseases, physiotherapeutic training programs, prescription of medical aids and nutritional interventions. Identification and modification of risk factors (including those that are iatrogenic) are of superior importance.
Assuntos
Acidentes por Quedas/prevenção & controle , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/terapia , Avaliação Geriátrica/métodos , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Transtornos Neurológicos da Marcha/complicações , Humanos , Masculino , Transtornos dos Movimentos/complicaçõesRESUMO
INTRODUCTION: Mobile geriatric rehabilitation is an outpatient rehabilitative treatment in which a multidisciplinary team treats elderly patients at home. This kind of treatment has been performed in rare cases in Germany but there are no data available on the effectiveness in patients with severe cognitive and functional impairment. MATERIAL AND METHODS: In a retrospective study design the data of all patients who had participated in mobile geriatric rehabilitation between 1 September 2009 and 23 May 2011 were evaluated. Before treatment a comprehensive geriatric assessment was performed and after treatment an assessment of mobility and activities of daily living (ADL). After 6 months a random sample of 20 patients were contacted by telephone to check the ADL. RESULTS: A total of 87 patients were treated between 1 September 2009 and 23 May 2011. The median age was 83 years and 56 % of the patients lived in nursing homes. Only 24 % of the patients had MMSE scores > 23 points, 77 patients completed the treatment with an assessment and in these patients the ADL could be improved significantly (Barthel index at the beginning 36.2 points and on completion 50.9 points, p < 0.001). The Barthel index 6 months after treatment was only 1.25 points lower compared to the assessment at the end of the treatment. Significant improvement after therapy could also be demonstrated in the mobility assessment (timed up and go test, Tinetti mobility score and Esslinger transfer scale). CONCLUSION: The results of this non-randomized and non-blinded trial indicated the efficacy of mobile geriatric rehabilitation. In functionally and cognitively impaired elderly patients ADL and mobility can be improved. These effects seem to persist for at least for 6 months.
Assuntos
Atividades Cotidianas/psicologia , Assistência Ambulatorial/métodos , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Limitação da Mobilidade , Modalidades de Fisioterapia/psicologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/psicologia , Feminino , Avaliação Geriátrica , Humanos , Masculino , Equipe de Assistência ao Paciente , Estudos Retrospectivos , Resultado do TratamentoRESUMO
For the care of the elderly, specific geriatric care facilities in hospitals and specialized rehabilitation centers have been established in the last 20 years throughout Germany. In addition, trauma surgery departments in hospitals and clinics also provide comprehensive care for trauma patients. The present requirements catalog was developed with the aim to ensure the standardization and quality assurance of these care facilities. Thus, the structural basics and, in particular, the structured cooperation between geriatrics and trauma surgery are described and defined in terms of structure, process, and outcome quality. The Bundesverband Geriatrie, the Deutsche Gesellschaft für Geriatrie, and the Deutsche Gesellschaft für Gerontologie und Geriatrie offer documentation for external and internal use and evaluation of the structures and processes for certification of geriatric trauma centers. Prerequisite for certification is to meet the technical requirements defined in the requirements catalogue or documents derived from it, and proof of a quality management system according to ISO 9001.
Assuntos
Necessidades e Demandas de Serviços de Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Centros de Traumatologia/organização & administração , Idoso , Certificação , Comorbidade , Comportamento Cooperativo , Avaliação Geriátrica , Alemanha , Humanos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/organização & administração , Ferimentos e Lesões/cirurgiaRESUMO
INTRODUCTION: In nursing homes animal-assisted therapy has been applied in demented elderly patients for several years. There are no studies on this treatment in hospitals, especially in geriatric departments. METHODS: From September 2010 to November 2011 105 in-patients, among them 77 female, participated in a 30 min dog-assisted group therapy (mean age 84,4 ± 6,56 years). The patients had cognitive and functional impairments (mean MMSE 18 points, mean Barthel Index 34,6 points). RESULTS: Adverse events were not observed. Thirteen patients discontinued the treatment early, due to different reasons. The psychologist, who attended the treatment, observed an improvement of mood in 58 % and an improvement in activity in 54 %. DISCUSSION AND CONCLUSION: Animal assisted therapy can be safely established in a hospital among patients with cognitive impairment. The data support the hypothesis that animal assisted therapy improves mood, communication and activity in patients with cognitive impairment.
Assuntos
Terapia Assistida com Animais/estatística & dados numéricos , Demência/epidemiologia , Demência/enfermagem , Serviços de Saúde para Idosos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Demência/psicologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Prevalência , Resultado do TratamentoRESUMO
BACKGROUND: Several studies have identified moderate reliability and validity for the Mini-Mental State Examination (MMSE). Some researchers showed the superiority of other dementia screening tests over the MMSE considering the test quality criteria. The aim of this study was the evaluation of MMSE, especially in the area of geriatrics. PATIENTS AND METHODS: MMSE and DemTect were carried out with 154 geriatric patients: 71 persons without cognitive impairment and 83 persons without delirium showed cognitive impairments as revealed by the DemTect. In addition, we also applied the Clock-Drawing-Test (CDT), Reisberg-Scale, Geriatric Depression-Scale (GDS, 15-item version) and the Confusion-Assessment-Method (CAM). RESULTS: According to the multitrait-multimethod approach, MMSE's convergent and divergent validity is similar to that of the DemTect. Both tests correlate only moderately with Spearman (r = 0.609) and revealed similar results for dementia in 57.1 % of the patients. MMSE showed low reliability and moderate reliability (Cronbach's α = 0.82) when ten items with low discriminatory power were excluded from the total test score. Difficulty of all items is only moderate (p = 0.86) and only eight items of the MMSE showed good test difficulty. CONCLUSION: All in all, DemTect and MMSE are not interchangeable. The MMSE estimates the average cognitive impairment of patients as considerably less pronounced than the DemTect. MMSE is, thus, not an instrument that would be recommended for the identification of mild cognitive impairment. In this case, tests with higher reliability and validity should be used.
Assuntos
Transtornos Cognitivos/complicações , Transtornos Cognitivos/diagnóstico , Demência/complicações , Demência/diagnóstico , Avaliação Geriátrica/métodos , Entrevista Psiquiátrica Padronizada , Testes Neuropsicológicos , Idoso de 80 Anos ou mais , Feminino , Alemanha , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
For the treatment of geriatric inpatients, the efficacy of a multimodal geriatric intervention based on findings of a comprehensive geriatric assessment has well been established. Therefore, the focus of elderly inpatient care switched to the identification of geriatric patients who have unintended or unscheduled contact to an accident and emergency department. In Germany, a uniform standard on how to correctly identify geriatric patients in such settings has yet to be established.Three medical societies, the Federal Association of Geriatrics ("Bundesverband Geriatrie", BVG), the German Society for Gerontology and Geriatrics ("Deutsche Gesellschaft für Gerontologie und Geriatrie", DGGG) and the German Geriatrics Society ("Deutsche Gesellschaft für Geriatrie", DGG) have reached a consensus on tools and instruments for the identification of geriatric patients in the emergency care setting. Basis of the consensus were the existing scientific evidence and further considerations, especially the applicability of international findings in Germany and feasibility.Three recommendations are made: (1) The use of prognostic indices is not recommended, as prognostic indices appear to be inappropriate to disclose the complex needs of geriatric patients. (2) Comprehensive geriatric assessment is established and effective, but too complex for use in the emergency setting. It is recommended for cases in which information from screening instruments or other sources does not allow a clear decision. (3) Among screening instruments, the Identification of Seniors At Risk (ISAR) screening tool seems to be well established and suitable for screening purposes in Germany. A German adaption is recommended as well as the implementation in settings where no other tools or geriatric expertise are available.
Assuntos
Atenção à Saúde/normas , Serviços Médicos de Emergência/normas , Avaliação Geriátrica/métodos , Serviços de Saúde para Idosos/normas , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha , Humanos , MasculinoAssuntos
Acidentes por Quedas/prevenção & controle , Antagonistas Adrenérgicos beta/administração & dosagem , Calcifediol/administração & dosagem , Geriatria/organização & administração , Insuficiência Cardíaca/tratamento farmacológico , Fraturas do Quadril/terapia , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Limitação da Mobilidade , Ortopedia/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Resultado do Tratamento , Vitamina D/análogos & derivados , Deficiência de Vitamina D/prevenção & controleRESUMO
During recent years, specialized wards have been established in geriatric hospital departments as a consequence of the growing need of special care for acutely ill older patients, who are also cognitively impaired. However, there are neither established standards nor any commonly agreed concept of care. A written survey among 12 specialized wards in Germany revealed some characteristics of these wards: extended geriatric assessment, special education of staff including validation and gerontopsychiatric issues, and particular equipment/architecture, such as hidden doors and group rooms, and in some cases loop tracks for walking, therapeutic facilities, and 'living rooms' on the wards. There is a wide variability with respect to the designation of these wards, the number of beds, length of stay, and admission criteria. It appears from this survey that there should be an exchange of empirical experience made on these wards, and there is a need of collaborative research on its usefulness.
Assuntos
Doença Aguda/terapia , Demência/terapia , Geriatria/organização & administração , Departamentos Hospitalares/organização & administração , Idoso , Arquitetura , Comorbidade , Avaliação Geriátrica , Alemanha , Arquitetura Hospitalar , Humanos , Tempo de Internação , Admissão do Paciente , Equipe de Assistência ao Paciente/organização & administraçãoAssuntos
Doença Aguda/terapia , Doença de Alzheimer/tratamento farmacológico , Inibidores da Colinesterase/uso terapêutico , Ensaios Clínicos como Assunto/métodos , Diabetes Mellitus Tipo 2/terapia , Serviços de Saúde para Idosos/economia , Serviços de Saúde para Idosos/estatística & dados numéricos , Unidades Hospitalares , Infarto do Miocárdio/prevenção & controle , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Seleção de Pacientes , Sistema de Registros/estatística & dados numéricos , Feminino , Humanos , MasculinoAssuntos
Adenoma/prevenção & controle , Pólipos Adenomatosos/cirurgia , Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Café , Pólipos do Colo/cirurgia , Colonoscopia , Neoplasias Colorretais/prevenção & controle , Insuficiência Cardíaca/tratamento farmacológico , Mortalidade , Inibidores da Agregação Plaquetária/uso terapêutico , Varfarina/uso terapêutico , Feminino , Humanos , MasculinoRESUMO
The thalamus plays a major role in relaying and transforming information that is relayed to the cortex and in turn modulates cortical outputs. The reticular nucleus projects to the other thalamic nuclei, modulating and integrating their activity. The distribution of high affinity nicotine and alpha-bungarotoxin (alpha BTX) receptors in the human thalamus has been investigated by radioligand autoradiography in post mortem human tissue. [3H]nicotine binding in the human thalamus was high in most thalamic nuclei, especially in the lateral dorsal, the medial geniculate, lateral geniculate and anterior nuclei. The distribution of [125I] alpha BTX binding was quite distinct from [3H]nicotine binding. [125I] alpha BTX binding was generally lower (< 0.26-11.62 fmol/mg protein compared with 6.68-36.17 fmol/mg protein for nicotine binding) and concentrated in the reticular nucleus, with discrete groups of cells displaying higher binding in the latter. These results indicate differences between the distribution of nicotinic receptors in humans and those previously reported in mice and monkeys. Changes in high affinity nicotine and alpha BTX receptors in the thalamus may contribute to symptoms observed in neuropathological conditions associated with disorders of perception and movement such as Dementia with Lewy Bodies, Alzheimer's Disease and Schizophrenia.
Assuntos
Bungarotoxinas/metabolismo , Nicotina/metabolismo , Receptores Nicotínicos/análise , Tálamo/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Autorradiografia , Feminino , Humanos , Técnicas In Vitro , Masculino , Camundongos , Pessoa de Meia-Idade , Receptores Nicotínicos/metabolismo , Tálamo/metabolismo , Receptor Nicotínico de Acetilcolina alfa7RESUMO
OBJECTIVES: To establish the relative effectiveness and cost of providing a home-based exercise programme versus home-based exercise supplemented with an 8-week class-based exercise programme. DESIGN: The trial was a pragmatic, single-blind randomised clinical trial accompanied by a full economic evaluation. SETTING: Patients were randomly allocated to either home-based exercise or home exercise supplemented with class exercise programmes. PARTICIPANTS: A total of 214 patients, meeting the American College of Rheumatology's classification of knee osteoarthritis, were selected from referrals from the primary and secondary care settings. INTERVENTIONS: Both groups were given a home exercise programme aimed at increasing lower limb strength, and endurance, and improving balance. The supplemented group also attended 8 weeks of twice-weekly knee classes run by a physiotherapist. Classes represented typical knee class provision in the UK. MAIN OUTCOME MEASURES: Assessments of locomotor function, using a timed score of three locomotor activities, walking pain and self-reported disability with the Western Ontario and McMaster's Universities osteoarthritis index (WOMAC) were made. General health, lower limb strength, range of movement and compliance with exercise were also measured. Patients were assessed before and after treatment, and also at 6- and 12-month follow-ups. The economic evaluation looked at health service resource use and assessed cost-effectiveness by relating differential costs to differences in quality-adjusted life-years (QALYs) based on patients' responses to the EuroQol-5 Dimensions. Data were obtained at baseline, 1 month, 6 months and 12 months through face-to-face interviews and, where appropriate, examination of hospital medical records. RESULTS: Patients from the supplemented group demonstrated significantly greater improvement in locomotor function and decrease in pain while walking at all follow-ups. The supplemented group also demonstrated smaller but significant improvements in balance, strength, WOMAC score, and the physical function and pain dimensions of the Short Form-36. However, not all of these improvements were maintained over the 12-month follow-up period. There was no evidence that compliance with the home exercise programme was different or that total costs or mean QALY gains were significantly different between the groups. However, costs were slightly lower and QALY gains slightly higher in the group with the supplementary class-based programme. The economic evaluation suggests that supplemented programmes are likely to be considered cost-effective, although there is uncertainty around this estimate, with approximately 30--35% probability that the intervention would not be cost-effective. CONCLUSIONS: The supplementation of a home-based exercise programme with a class-based exercise programme led to superior improvement in the supplemented group. These differential improvements were still evident at review 12 months after treatment had ceased. The additional cost of the supplemented group was offset by reductions in resource use elsewhere in the system. Compliance with the home exercise programme did not differ between the groups. Based on this evidence, the supplementation of a home-based exercise programme with an 8-week class-based exercise programme can be confidently expected to produce small improvements in locomotor function and clinically important reductions in pain. It is recommended that future research investigates methods of increasing compliance with home exercise programmes and evaluates the impact of these interventions in the primary care setting, where most patients with knee osteoarthritis are managed.
Assuntos
Tecnologia Biomédica , Terapia por Exercício , Serviços de Assistência Domiciliar , Osteoartrite do Joelho , Cooperação do Paciente , Idoso , Idoso de 80 Anos ou mais , Tecnologia Biomédica/economia , Tecnologia Biomédica/métodos , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/economia , Osteoartrite do Joelho/terapia , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e QuestionáriosRESUMO
These experiments have investigated selenium movement between blood and CNS in anaesthetised rats. Each animal was surgically anaesthetised and the left femoral blood vessels cannulated for blood withdrawal and solute infusion. Each rat received 75-selenium as sodium selenite infused in normal saline and experiments lasted between 5 minutes and 5 hours during which blood samples were periodically taken. At termination, the CNS was removed, regionally dissected and analysed with the plasma samples for 75-Se radioactivity by gamma-counting. Data were analysed by graphical analysis. Results showed unidirectional uptake of 75-Se into the CNS and regional differences were not found except for the hypothalamus. On average the CNS influx rate constant (Kin) was about 7 +/- 1 x 10(-5) ml/min/g. Data suggest that the 75-Se most likely entered the CNS as a free ionic form.