[Cardiorenal syndrome in geriatric patients]. / Kardiorenales Syndrom bei geriatrischen Patienten.

The unfavorable mutual influence of the kidney and heart functions in acute or chronic kidney and/or heart failure has defined the cardiorenal syndrome (CRS) since a consensus conference in 2004. The pathophysiological considerations and the subsequent treatment approaches determine the classification into five types. The syndrome has a high prevalence in geriatric patients. The interactions of medications on one or the other organ system require an interaction of treatment modalities in order to improve the prognosis and prevent acute deterioration. Exact knowledge of the respective indications, differential treatment approaches and specifics in dealing with CRS can improve the current undertreatment due to concerns about side effects.

Pulse-echo ultrasound measurement in osteoporosis screening: a pilot study in older patients.

BACKGROUND: A mere 25% of patients who need treatment for osteoporosis receive appropriate therapy, partly due to the time-consuming and stressful diagnostic workup for older patients with functional decline. AIMS: The purpose of the present study was to investigate the accuracy of pulse-echo ultrasound measurement of the lower leg for the detection of osteoporosis in older patients, and evaluate the effect of a proposed diagnostic algorithm. METHODS: Cortical thickness and the so-called density index (DI) were measured prospectively on the lower leg with a pulse-echo ultrasound (PEUS) device. The accuracy of the device was compared with dual-energy X-ray absorptiometry (DXA) of the hip. We calculated algorithms combining FRAX® scores and PEUS measures as a guide for specific treatment of osteoporosis. RESULTS: Three hundred and thirty-three patients aged on average 81 years (82.1% women, 275/333) were included in the study. The sensitivity of the ultrasound device versus DXA for the detection of osteoporosis was 94.4% (84/89), and the specificity was 59% (144/247). The gender-specific sensitivity was 96.2% (75/78) for women and 81.8% (9/11) for men. DISCUSSION: Clinical decisions for the specific treatment of osteoporosis could be based on the proposed algorithm, without additional DXA measurements, in 90.9% (303/333) of the patients. CONCLUSION: Older patients with a similar risk profile as in our study population may benefit from PEUS, as it is a non-invasive, cost-effective, and efficient diagnostic tool with high accuracy in screening patients for osteoporosis and the risk of fractures.

Polypharmacy in elderly people.

Polypharmacy characterizes ongoing prescription of multiple medications in a patient. Following the demographic change and growing number of elderly patients, polypharmacy is of major concern due to the associated risks and even mortality. Many causes made this geriatric syndrome more common in the past decade. First, the management of comorbidities is often lacking in disease-specific guidelines. Second, multimorbidity is rising due to the ageing population. Third, deprescribing methods are sparse, and results are conflicting. This mini review integrates the effects of polypharmacy on mortality and morbidity, the causes and confounders of polypharmacy, and presents a practical stepwise manual of deprescribing. The work is based on a literature search for randomized control trials and reviews in English and German from 2015 onwards in the PubMed database, with integration of relevant citations as a result of this search.

Frailty in older adults with heart disease.

BACKGROUND: Heart failure prevalence will double in the next 40 years and affects more than 10% of persons over the age of 70 years in an age-dependent manner. Frailty is an age-associated clinical syndrome defined as a decrease in physiological reserve in situations of stress, such as operations, infections and acute illness based on a state of higher vulnerability. The prevalence is up to 74% in older individuals over the age of 80 years or those over 70 years old with a high burden of comorbidities and chronic diseases. This geriatric syndrome is associated with a worse clinical outcome and higher morbidity and mortality in acute and chronic disease than in age-matched cohorts without this syndrome. METHODS: In this brief review, the scientific evidence of appropriate tools for diagnosis of frailty in heart failure patients is addressed. Heart failure management in this special group of patients requires a holistic care planning presented here in accordance with pathophysiologic particularities. A literature search in PubMed using the terms "heart failure" and "frailty" was carried out and a further search in the references based on the findings. CONCLUSION: The diagnosis of frailty should influence the intensity of further diagnostic investigations and medical treatment based on the personal wishes of the patient, reduced organ reserves and general prognosis. The prognosis of heart failure patients remains poor, partially due to the intertwining with frailty. A clear statement for the use of an appropriate diagnostic tool for frailty and heart failure and specific therapeutic recommendations are presented based on clinical evidence.

The role of health determinants in the influenza vaccination uptake among older adults (65+): a scope review.

BACKGROUND: Although the burden of influenza infection is the highest in older adults, vaccination coverage remains low, despite this age group being more vulnerable than others. AIMS: Given the current pandemic of SARS-CoV-2, it was the aim of this scope review to update knowledge on factors affecting seasonal influenza vaccine uptake among older adults to strengthen prevention approaches in the context of an overall burden of infectious diseases. METHODS: We searched bibliographic databases from 2012 to 2019. All studies reviewed one or more social determinant of health listed by WHO, or factors affecting the decision-making process whether to accept influenza vaccine or not. RESULTS: Overall, 44 studies were included, 41 determinants were extracted and summarized into six categories. Older age and constitutional factors including multiple chronic diseases as well as preventive lifestyle and frequent routine healthcare utilization positively affected vaccination uptake (VU). Living and working conditions are also researched determinants of influenza vaccine uptake. A small number of studies explored the role of social inclusion and system-based interventions. DISCUSSION AND CONCLUSIONS: This scope review provides a comprehensive overview on factors affecting seasonal influenza vaccination uptake among older citizens. The review also clearly shows gaps for evidence on system-based level or political strategies to improve vaccination uptake.

[Diagnostics and treatment of osteoporosis in patients over 65 years old : Current status and future perspectives]. / Osteoporosediagnostik und -therapie bei über 65-Jährigen : Aktueller Stand und Zukunftsaussichten.

Only one third of all women with osteoporosis over the age of 65 years are adequately treated; therefore, many experience fractures. For men the data are insufficient. Using a newly developed algorithm and based on the current guidelines, the diagnosis and specific treatment of osteoporosis can be easily set up. The differential treatment should be selected in an individualized approach based on the side effect profile of the specific medication. No statistically significant differences were found between most specific osteoporotic drugs in head-to-head comparisons. This article presents an overview of the currently available pharmaceutical and non-pharmaceutical forms of treatment as well as approaches with novel medications and interventions for a better control of osteoporosis.

[Duodenal ulcers, gastric ulcers and Helicobacter pylori]. / Ulcus duodeni, Ulcus ventriculi und Helicobacter pylori.

The mortality in elderly patients over the age of 80 years with peptic ulcers in the case of complications, such as bleeding and perforation is higher than in the general population. Duodenal ulcers are associated with Helicobacter pylori infections in 90% of cases and in 70% of gastric ulcers. The treatment of elderly patients is often difficult due to multimorbidity and polypharmacy and necessitates a geriatric approach. Ulcers are often caused by medication with nonsteroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid. Despite the fact that progress in therapy has improved the prevalence and prognosis, the treatment of elderly patients with ulcers is complex.

Choosing wisely in case of hypertension, diabetes and hyperlipidemia in older patients.

BACKGROUND: The Choosing Wisely™ campaign was created by the American Board of Internal Medicine, it asks medical specialty societies to indicate five diagnostic and/or therapeutic interventions in their specialty to be avoided in specific cases. The aim of this campaign is to stimulate discussion between patients and their doctors about the usefulness of each procedure and also to avoid unnecessary, possibly wasteful measures. Hypertension, diabetes and hyperlipidemia are the most common conditions seen in primary care. The feasibility of applying the principles of Choosing Wisely in these cases was the target of this mini-review. METHODS: A PUBMED query based on entering the terms "choosing wisely", "elderly", "hypertension", "diabetes" and "hyperlipidemia" was performed. The search was limited to studies in human subjects using original articles and reviews in English and German that were published in the period of 1982-2015. In addition, a manual search from all relevant references and screened articles was performed. CONCLUSION: Using the up to date knowledge of precise indication for the pharmacological treatment of hypertension, diabetes and hyperlipidemia in older patients protects them from adverse effects and avoids interventions of low value. Additional tests of functionality like a frailty score or the comprehensive geriatric assessment can improve decision making for starting of medical interventions and for adjusting the intensity of treatment. Based on current literature they can help to withdraw or to abstain from unnecessary medical interventions.

Sarcopenia in cases of chronic and acute illness. A mini-review.

BACKGROUND: Loss of muscle mass and muscle weakness are often found in cases of acute or chronic illness in elderly patients. Sarcopenia is a risk factor for complications and higher mortality. Based on an exact diagnosis and knowledge of the risk factors for developing sarcopenia, it is now possible to improve the prognosis by providing effective treatment options. METHODS: This review was carried out based on a PubMed search in the period from 1998 to 2015 using original articles and reviews and posting the terms "sarcopenia", "elderly" and "acute illness". CONCLUSION: Given the evidence from the current literature, in the case of acute illness it is feasible to identify patients at risk, diagnose sarcopenia and prescribe a multidimensional treatment program to prevent or treat sarcopenia even in the bustling environment of geriatric wards or institutions.