ABSTRACT
Chronic pain in older adults should be explained and treated on the basis of the biopsychosocial model. With its interdisciplinary and interprofessional approach, multimodal pain therapy is the method of choice. In old age freedom from pain is usually not the primary goal. It is more important to restore the quality of life of those affected and to maintain independence and autonomy with a versatile treatment offer. This article explains the basics of multimodal pain therapy and its special features in old age.
Subject(s)
Chronic Pain , Quality of Life , Aged , Chronic Pain/diagnosis , Chronic Pain/therapy , Combined Modality Therapy , Humans , Pain Management , Research DesignABSTRACT
Long-term care facilities (LTCF) and their vulnerable residents are particularly affected by the coronavirus disease 2019 (COVID-19) pandemic. Estimates from various countries suggest that 3-66% of all COVID-19 deaths were residents of LTCF, of which 80% died in their facilities. Despite these significant numbers, recommendations for LTCF for the prevention and medical care of residents during the COVID-19 pandemic are still lacking. These recommendations are based on the existing literature and the expertise of the authors who are specialists in geriatric medicine. The recommendations are addressed to LTCF management, their operators, physicians working in LTCFs and also politicians, to provide the necessary framework conditions. We are confident that our recommendations will offer important help and guidance for LTCFs as well as their physicians. Adherence to these recommendations is likely to improve the outcomes and care of residents in long-term facilities during the COVID-19 pandemic.
Subject(s)
COVID-19 , Geriatrics , Aged , Humans , Long-Term Care , Pandemics/prevention & control , SARS-CoV-2ABSTRACT
Long-term care facilities (LTCF) were and are particularly affected by the COVID-19 pandemic. The dimensions of the outbreaks and the high mortality among residents led to massive restrictions in LTCFs, especially in the area of social contacts and activities but also in areas of medical care. With the start of vaccinations and the improved testing options, the situation has now changed and existing restrictions must be evaluated to determine whether they are still appropriate. In an interprofessional and interdisciplinary group of experts, considerations have been formulated on how a way back to normality could look like in LTCFs.
Subject(s)
COVID-19 , Pandemics , Disease Outbreaks/prevention & control , Humans , Long-Term Care , Pandemics/prevention & control , SARS-CoV-2ABSTRACT
The current corona crisis affects older patients as well as the geriatric infrastructure in all sectors. This article provides an overview about the current state of knowledge on COVID-19 with special consideration of geriatric aspects and the consequences for the geriatric care system.
Subject(s)
Betacoronavirus , Coronavirus Infections , Geriatrics , Pandemics , Pneumonia, Viral , Aged , COVID-19 , Coronavirus Infections/epidemiology , Geriatrics/trends , Humans , Pneumonia, Viral/epidemiology , SARS-CoV-2ABSTRACT
Delirium in older adults is associated with an increased risk for cognitive and functional decline. Multiple risk factors, such as underlying dementia, multiple comorbidities, anticholinergic medication or visual and hearing impairment foster the incidence of delirium. By identification of patients at risk and the initiation of a multiple component delirium prevention program delirium is preventable in 30-40% of all cases. There is broad evidence for comprehensive multicomponent delirium prevention strategies in patient care, but their implementation is still lacking in many hospitals. The Hospital Elder Life Program (HELP), designed in 1999 by S.K. Inouye, is a comprehensive protocol for hospitalized elderly patients and has been implemented successfully in more than 200 hospitals worldwide. In German hospitals, positive experiences with HELP, with minor modifications, have been made. The core of the HELP concept is the identification of a patient's delirium risk profile and an individually assigned intervention protocol consisting of (re-)orientation, cognitive activation, simple mobilization or meal companionship and nonpharmacological sleep promotion. Many strategies for the prevention of delirium in elders integrate substantial elements of HELP; however, a measurable preventive effect requires the modification of multiple predisposing and precipitating factors. The article reviews the original Hospital Elder Life Program and its implementation in German hospitals.
Subject(s)
Delirium/diagnosis , Delirium/prevention & control , Health Services for the Aged/organization & administration , Outcome Assessment, Health Care/organization & administration , Patient-Centered Care/organization & administration , Preventive Medicine/organization & administration , Aged , Aged, 80 and over , Combined Modality Therapy/methods , Female , Germany , Humans , Male , Preventive Medicine/methodsABSTRACT
The prevalence of malnutrition or the risk of malnourishment is high among orthogeriatric patients and a poor nutritional status is associated with a negative outcome. A comprehensive management of preoperative and postoperative nutritional and fluid intake in these patients can help to improve the situation. The management includes identification of patients affected, a thorough assessment of the nutritional status, work-up of possible underlying causes, documentation of nutritional and fluid intake and, most importantly, procedures to improve the preoperative and postoperative nutritional situation. This article gives an overview of the recently updated recommendations on nutritional management in orthogeriatric patients as published by the orthogeriatric working group of the German Geriatric Society.
Subject(s)
Geriatric Assessment/methods , Malnutrition/therapy , Nutrition Assessment , Nutrition Therapy/standards , Practice Guidelines as Topic , Wounds and Injuries/therapy , Aged , Aged, 80 and over , Geriatrics/standards , Germany , Humans , Malnutrition/diagnosis , Traumatology/standards , Wounds and Injuries/diagnosisABSTRACT
The treatment of severe symptomatic aortic valve stenosis by conventional aortic valve replacement (AVR) or by transcatheter aortic valve implantation (TAVI) has a good perinterventional prognosis even for patients of advanced age. Having a heart team select the best management strategies based on current guidelines for each individual patient is essential for success. Especially in elderly and increasingly multimorbid patients with sometimes severe preconditions, the detection of functional deficits is relevant not only for the mortality but also for perioperative and postoperative complications as well as the functional outcome. Various methods of geriatric assessment are important supplements to standard risk scores. The aim is to implement targeted interventions to minimize the risk factors and to improve the prognosis for elderly patients. The aim of this article is to provide an overview of the current therapy options for aortic valve replacement and to summarize current aspects of treatment options for elderly patients.
Subject(s)
Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/surgery , Geriatric Assessment/methods , Perioperative Care/methods , Transcatheter Aortic Valve Replacement/methods , Transcatheter Aortic Valve Replacement/rehabilitation , Aged , Aged, 80 and over , Evidence-Based Medicine , Female , Humans , Male , Treatment OutcomeABSTRACT
BACKGROUND: Elderly patients represent an increasing population in the emergency department (ED) and physicians often have to deal with multimorbidity and complexity. Infections are one of the major reasons for ED presentations of older patients and the main cause of mortality; however, infections are often difficult to diagnose in older patients. AIM: This article provides a review of important indicators for infections, diagnostic tools and limitations in elderly patients. MATERIAL AND METHODS: A literature search was carried out using PubMed in the period 1990-2015 and in addition own published data are presented. RESULTS AND CONCLUSION: Infections in the elderly are difficult to assess in the emergency department due to atypical symptoms. Even subtle changes need to be recognized. For the diagnosis of infections in older ED patients unspecific symptoms, vital parameters, laboratory parameters, including C-reactive protein (CRP) and procalcitonin levels, cognitive function and functionality of the patient need to be taken into account.
Subject(s)
Bacterial Infections/diagnosis , Bacterial Typing Techniques/methods , C-Reactive Protein/analysis , Emergency Medical Services/methods , Emergency Service, Hospital/organization & administration , Geriatric Assessment/methods , Aged , Aged, 80 and over , Bacterial Infections/blood , Bacterial Infections/microbiology , Bacterial Typing Techniques/statistics & numerical data , Biomarkers/blood , Diagnosis, Differential , Female , Geriatric Assessment/statistics & numerical data , Humans , Prevalence , Risk Assessment , Symptom Assessment/methods , Vital SignsABSTRACT
Sound knowledge in the care and management of geriatric patients is essential for doctors in almost all medical subspecialties. Therefore, it is important that pregraduate medical education adequately covers the field of geriatric medicine. However, in most medical faculties in Europe today, learning objectives in geriatric medicine are often substandard or not even explicitly addressed. As a first step to encourage undergraduate teaching in geriatric medicine, the European Union of Medical Specialists -Geriatric Medicine Section (UEMS-GMS) recently developed a catalogue of learning goals using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end of their studies.In order to ease the implementation of this new, competence-based curriculum among the medical faculties in universities teaching in the German language, the authors translated the published English language curriculum into German and adapted it according to medical language and terms used at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties adapt their curricula for undergraduate teaching based on this catalogue.
Subject(s)
Curriculum/standards , Education, Medical, Undergraduate/standards , Geriatrics/education , Guidelines as Topic , Austria , European Union , Germany , Organizational Objectives , SwitzerlandABSTRACT
BACKGROUND: The prevalence of delirium in hospitalized patients is high, but delirium is frequently not identified by treating physicians in emergency departments (EDs). Although the number of elderly patients admitted to EDs is increasing, no data on prevalence, identification and outcome of delirious elderly patients in German EDs exist. OBJECTIVES: To evaluate the prevalence and identification of delirium in elderly patients in a German ED and to identify characteristics of delirium in elderly ED patients. METHODS: Evaluation of data from a prospective single-center observational study. The study was conducted in the interdisciplinary ED of an urban university-affiliated hospital receiving approximately 80,000 visits per year. The shortened Confusion Assessment Method (CAM) was used to screen 133 consecutive ED patients, aged 75 years and older, for delirium. Comorbid conditions were ascertained by patient interview and review of medical records. Data concerning patient mortality and current living status were collected 28 days after the ED visit in a structured telephone interview. RESULTS: A positive CAM result was recorded in 14.3 % of cases; 68.4 % of these CAM-positive patients were not identified as being delirious by the ED physician. The 28-day mortality was higher among patients with delirium. Dependency on external help, polypharmacy, pre-existing cognitive or mobility impairments and the presence of any care level were strongly associated with delirium. CONCLUSION: Elderly patients with known risk factors should be routinely assessed for delirium in the ED with a standardized assessment tool such as the CAM.
Subject(s)
Cognition Disorders/mortality , Delirium/mortality , Delirium/therapy , Emergency Service, Hospital/statistics & numerical data , Geriatric Assessment/statistics & numerical data , Patient Care Team/statistics & numerical data , Polypharmacy , Aged , Aged, 80 and over , Cognition Disorders/diagnosis , Comorbidity , Delirium/diagnosis , Female , Germany/epidemiology , Humans , Male , Prevalence , Risk Assessment/methods , Survival RateABSTRACT
Delirium, the acute deterioration of cognitive function and attention, is the most frequent mental disorder in elderly. Its correct diagnosis and adequate management are of crucial importance for the patient's health and functional outcome. First of all, one has to be aware of the possibilities of preventing this complex, potentially life-threatening problem, which means recognizing the patient at risk, avoiding environmental stress and causal factors (i.e., anticholinergic medication) in cognitively impaired patients, and timely reaction to prodromal symptoms. Causal therapy (i.e., treatment of the causal condition and/or eliminating the precipitating situation) is imperative. It must be accompanied by nursing and environmental measures and, if necessary, by antipsychotic and/or sedating symptomatic treatment.
Subject(s)
Antipsychotic Agents/administration & dosage , Cognition Disorders/diagnosis , Delirium/diagnosis , Delirium/prevention & control , Geriatric Assessment/methods , Hypnotics and Sedatives/administration & dosage , Aged , Aged, 80 and over , Cognition Disorders/psychology , Cognition Disorders/therapy , Combined Modality Therapy/methods , Delirium/psychology , Female , Germany , Humans , Male , Patient Care Team/organization & administration , Prodromal Symptoms , Symptom AssessmentABSTRACT
BACKGROUND: Demographic change has also caused changes in perioperative intensive care because the proportion of geriatric patients who must undergo surgical procedures is increasing. With the current preoperative assessment instruments, it is still not possible to identify high-risk patients of this collective or to make a reliable prognosis concerning postoperative course. MATERIALS AND METHODS: In addition to pain control, important aspects to minimize complications in postoperative intensive care include adequate oxygenation, adequate fluid management, an adequate supply of energy and nutrients, good control of blood sugar levels, and early mobilization of patients. RESULTS: The perioperative intensive care treatment of geriatric patients requires the readiness to engage in interdisciplinary collaboration because only with this close dialog can the treatment results be sustained.
Subject(s)
Critical Care/methods , Exercise Therapy/methods , Fluid Therapy/methods , Geriatric Assessment/methods , Patient Care Management , Perioperative Care/methods , Postoperative Complications/prevention & control , Aged , Aged, 80 and over , Humans , Needs AssessmentABSTRACT
Delirium in older patients is also associated with persistent functional and cognitive impairment. Nevertheless, it frequently remains unrecognized or misinterpreted by treating physicians and this is particularly true in cases of hypoactive delirium. Screening and assessment instruments are helpful in the identification of patients with delirium. A multifactorial model of a combination of predisposing and precipitating factors best explains the etiology of delirium and avoidance is crucial for its prevention. Whenever delirium is suspected, immediate diagnosis and therapy of the precipitating condition are of primary importance. Non-pharmacological interventions, for example environmental modifications, play an important role in managing behavioral symptoms of delirium. Pharmacological interventions are merely symptomatic and should be limited to patients with severe symptoms when non-pharmacological means fail.
Subject(s)
Cognition Disorders/diagnosis , Cognition Disorders/therapy , Cognitive Behavioral Therapy/methods , Delirium/diagnosis , Delirium/therapy , Geriatric Assessment/methods , Nootropic Agents/therapeutic use , Aged , Aged, 80 and over , Cognition Disorders/etiology , Delirium/complications , Female , Humans , Psychometrics/methodsABSTRACT
BACKGROUND: Although the number of older patients is increasing in almost all medical specialties, the interest of medical students in geriatrics as a career is still low. Because quality of medical education and educators strongly influences student career decisions, it is important to develop curricula that motivate students to become self-directed, lifelong learners in the field of geriatric medicine. OBJECTIVES: We evaluated training aspects in terms of time, core content of teaching goals, and quality of undergraduate geriatric education in medical schools in Austria and Germany. METHODS: A standardized paper questionnaire was sent to all 36 German and 4 Austrian medical faculties to evaluate quantitative aspects, content, and quality of pregraduate medical education in geriatrics. Results were compared to the recommendations of the Geriatric Medicine Section of the European Union of Medical Specialists (UEMS). RESULTS: A total of 33/36 (92 of the German medical faculties) and 4/4 (100 of the Austrian medical faculties) responded to the questionnaire. In most of the faculties, geriatric medicine was taught as an independent discipline in the core curriculum, with learning objectives absent in almost one third of the faculties. A medical student's first contact with geriatric medicine occurred on average during the second clinical year (median 8th semester). Although the content of geriatric curricula strongly varied among the faculties, core knowledge as recommended by the UEMS was integrated into most of the curricula. Teaching strategies regarding the development of attitudes and skills also recommended by the UEMS were identified in the curriculum of only some faculties. CONCLUSIONS: Geriatrics seems to be an established subject in most German and Austrian faculties. However, the current data clearly indicate highly variable quality in geriatric pregraduate training at German and Austrian universities. Because curricula should prepare young people using competence-based training and assessment methods, room for improvement remains not only in terms of structure, but also regarding quality of training to develop self-directed lifelong learners.