[Geriatric trauma centers - requirements catalog. An initiative to promote and guarantee the quality of care of elderly trauma patients receiving inpatient care]. / Alterstraumatologisches Zentrum - Anforderungskatalog. Eine Initiative zur Förderung und Sicherung der Qualität der Versorgung alterstraumatologischer Patienten in Deutschland im Bereich der stationären Versorgung.

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.

[Ten years of early complex geriatric rehabilitation therapy in the DRG system]. / 10 Jahre geriatrische frührehabilitative Komplexbehandlung im DRG-System.

BACKGROUND: Geriatric medicine, as a specialized form of treatment for the elderly, is gaining in importance due to demographic changes. Especially important for geriatric medicine is combining acute care with the need to maintain functionality and participation. This includes prevention of dependency on structured care or chronic disability and handicap by means of rehabilitation. METHODS AND MATERIALS: Ten years ago, the German DRG system tried to incorporate procedures (e.g., "early rehabilitation in geriatric medicine") in the hospital reimbursement system. OPS 8-550.x, defined by structural quality, days of treatment, and number of therapeutic interventions, triggers 17 different geriatric DRGs, covering most of the fields of medicine. OPS 8-550.x had been revised continuously to give a clear structure to quality aspects of geriatric procedures. However, OPS 8-550.x is based on proven need of in-hospital treatment. In the last 10 years, no such definition has been produced taking aspects of the German hospital system into account as well as aspects of transparency and benefit in everyday work. RESULTS: The German DRG system covers just basic reimbursement aspects of geriatric medicine quite well; however, a practicable and patient-oriented definition of "hospital necessity" is still lacking, but is absolutely essential for proper compensation. A further problem concerning geriatric medicine reimbursement in the DRG system is due to the different structures of providing geriatric in-hospital care throughout Germany.

[Multimorbidity in elderly rheumatic patients part 1]. / Multimorbidität bei älteren Rheumapatienten Teil 1.

An appropriate treatment of elderly rheumatic patients implements comprehensive diagnostics and exclusion diagnostics of e.g. coronary heart disease, osteoporosis, renal failure, diabetes mellitus type 2 and thyroid gland dysfunction. Furthermore, the complex disease situation might require the integration of other faculties or might be a reason for inpatient treatment. The complexity in the treatment of multimorbid elderly patients suffering from rheumatism not only rises with increasing age but also constitutes a considerable challenge due to existing incapacities and preceding as well as currently performed immunosuppressive therapies. The necessary treatment framework is outlined from the perspective of rheumatologists and geriatricians. Typical geriatric symptoms, such as malnutrition, immobility and frailty might be enhanced if multimorbidity is simultaneously present.

[Multimorbidity in elderly rheumatic patients part 2]. / Multimorbidität bei älteren Rheumapatienten Teil 2.

While diseases, such as cardiovascular diseases and osteoporosis in the elderly are categorized as comorbidities of rheumatoid arthritis, elderly rheumatic patients are often additionally affected by thyroid dysfunctions and diabetes mellitus type 2, so that the risk of multimorbidity (coexistence of at least two chronic and/or acute diseases) will increase significantly in elderly patients already suffering from systemic rheumatic diseases. Restricted cognition, adherence or compliance may additionally complicate the treatment of elderly rheumatic patients. Furthermore, the pharmacokinetics of the elderly is another challenging task. Referring to selected aspects of geriatric pharmacotherapy, the use of certain substance classes is described in this context.

[Geriatric assessment. Development, status quo and perspectives]. / Das geriatrische Assessment. Entwicklung, Status quo und Perspektive.

Multimorbidity is typical for geriatric patients. Problems not identified in time may lead to increased hospitalisation or prolonged hospital stay. Problems of multimorbidity are not covered by most guidelines or clinical pathways. The geriatric assessment supports standard clinical and technical assessment. Geriatric identification screening is basic for general practitioners and in emergency rooms to filter those patients bearing a special risk. Geriatric basic assessment covers most of the problems relevant for people in old age, revealing even problems that had so far been hidden. It permits to structure a comprehensive and holistic therapeutic approach and to evaluate the targets of treatment relevant for independent living and well-being. This results in reduction of morbidity and mortality. Assessment tools focusing on pain, nutrition and frailty should be added to the standardized geriatric basic assessment in Germany.

[Geriatric medicine in the academic world]. / Akademische Stellung der Geriatrie.

Acceptance of Geriatric Medicine in the academic world in Germany is still problematic. A WHO study on undergraduate training reveals a disastrous situation in Germany compared with other countries altogether and even in the subgroup "Old Population--Weak in Geriatric Education". This is due to the fact that there is little representation in universities and insufficient integration in training curricula. Subsequently research in Geriatric Medicine in Germany still needs to be increased. Academic acceptance is also reflected by positioning in the postgraduate training rules. In contrast to the opinion of specialists in national and international boards Geriatric Medicine is mostly implemented as sub-/supraspecialty with inadequately shortened duration of specialised training and requirements for the start of specialised training that lead to a shortage of Geriatric Specialists. European recommendations on duration and contents are followed only in two regional chambers. These would enable the specialty of Geriatric Medicine either as a lone-standing specialty or within the common trunk Internal Medicine.

[Early rehabilitation care in the hospital--definition and indication. Results of the expert group "Early Rehabilitation Care in the Hospital"]. / Frührehabilitation im Krankenhaus--Definition und Indikation. Ein Ergebnisbericht der Methodengruppe "Frührehabilitation im Krankenhaus".

As a result of the continuing development in recent medicine, and improvements of emergency services, an increasing number of patients are surviving serious disease and injury. This has increased the need for rehabilitation, starting already during the acute hospital stay. Early identification and rehabilitation may reduce overall costs and help patients to regain independence earlier. Since the eighties specialized early post-acute rehabilitation units have been increasingly implemented in German hospitals. With book 9 of the German Social Code (SGB IX) coming into effect in July 2001, early post-acute rehabilitation care in hospitals became accepted as a social right. However, the specifics of early rehabilitation care have not been defined. There is a lack of generally accepted indication criteria for early rehabilitation services. Similarly, the aims, objectives and methods need to be specified. It was the objective of a group of interested experts from different fields and backgrounds to achieve an interdisciplinary consensus in terms of conceptual definitions and terminology for all early rehabilitation care services in the acute hospital. The development of the definitions and criteria was achieved by using a modified Delphi-technique. By publishing this paper the group is providing information about its activities and results. Examples of typical cases from the various fields of early rehabilitation care were identified and described. Furthermore, the report points out a number of other problems in the area of early rehabilitation care, which have yet to be solved.

[Geriatrics-quo vadis? The system of geriatric care]. / Geriatrie-quo vadis?Zur Struktur geriatrischer Versorgung.

The authors describe the current and perspective structure of geriatric care in hospital and rehabilitation units. First the specific needs of elderly patients with various medical problems (multiple morbidity) are described. Furthermore the article analyses optimised structures of geriatric care. These visions are not limited to care in hospital and rehabilitation units but include prevention and long term care for elderly people as well.

[Geriatric care in Germany--results of an empirical study]. / Geriatrische Versorgung in Deutschland--Ergebnisse einer empirischen Untersuchung.

BACKGROUND: In Germany, the situation of geriatric medicine has improved significantly over the past few years. Until now, though, there was little information available on the structure of the clinical geriatric departments. Since this information is vital to assess whether these departments can provide high-quality services, the German Federal Association of Clinical Geriatric Departments conducted a survey among its members. The goal was to gain deeper insight into the structure of the geriatric acute hospitals and rehabilitation units. METHODS: In 1999, member institutions were mailed a standardized questionnaire and all institutions (100%) returned the questionnaire to the association's central office. To increase data quality, data were screened and reports were generated for each institution. These reports were returned to the institutions which were asked to verify them. RESULTS: This article shows that in 1998 acute geriatric hospitals (n = 89), rehabilitation units (n = 52), acute day clinics (n = 45) and rehabilitation day clinics (n = 26) had--on average--60/60/15.3/14 beds/places and 828.15/677.3/164.2/125.9 patients. Occupancy rates averaged out at 88.7%/84.3%/86.4%/63.7% and daily hospital rates at DM 401.4/322.4/293.8/243.2. Basically, all geriatric institutions included in this survey had a multi-professional geriatric team. Patient-to-staff ratios for psychologists, social workers, ergo-, physio- and speech therapists were better in day clinics than in in-patient clinics and better in rehabilitation units than in acute hospitals. Geriatric institutions mainly focused on the treatment of neurological deficits. Most patients were admitted from other hospitals and discharged to their private residence. CONCLUSIONS: The results of this survey indicate that especially the acute hospitals are often not sufficiently staffed. Moreover, further efforts are necessary to clarify the indications for and modalities of geriatric day clinic treatment and rehabilitation. The data also show that a categorical distinction between geriatric acute hospitals and rehabilitation units is not possible. However, further data collection and more detailed analyses are needed.

[Current aspects of secondary and tertiary prevention from the viewpoint of the clinical gerontologist]. / Aspekte zur Sekundärund Tertiärprävention aus der Sicht des klinischen Geriaters.

Prevention is of importance when the patient is already suffering from a serious disease, e.g., from arterial obstructive disease causing a stroke or an amputation, from a hip fracture or other diseases that might threaten his independence. Prevention covers a wide field of topics. Most importantly, the patient must recover from his acute disease. It is important to avoid complications which are not specific for the disease but are typical for a bedridden old person (decubital ulcer, dehydration etc.). Prevention also means to avoid recurrence of the same disease as well as complications that frequently occur during the clinical course and may influence the outcome (spasticity in stroke patients, muscular calcification following hip replacement).

[Method and organization of geriatric assessment]. / Zur Methode und Organisation des geriatrischen Assessments.

The intention of a Geriatric Assessment (GA) is a more systematic and exact way to examine a wide range of activities of daily life. This can be achieved by the help of scientifically proved and standardized investigations which complete the medical judgment with objective and comparable results. This type of examination controls the selective observation of the investigator and makes reexamination easier. Moreover, this way of gaining information gives reliable hints about non-apparent or difficult-to-estimate risks of a patient. The methods of GA have to be adapted to different qualities of resources which will be assessed: physical resources should be assessed by standardized ways of observation; the patient's subjective well-being should be examined by standardized interviews. The standardized instruments of measurement are fairly independent from personal qualifications of the investigator.

[Secondary prevention from the viewpoint of the geriatric specialist]. / Sekundärprävention aus der Sicht des klinischen Geriaters.

Secondary prevention is of importance when the patient is already suffering from a serious disease, e.g., from arterial obstruction causing a stroke or an amputation, from a hip fracture or other diseases that might threaten his independence. Secondary prevention covers a wide field of topics. First of all, the patient must recover from his acute disease. It is important to avoid complications which are not specific for the disease, but are typical for a bedridden old person (decubital ulcer, dehydration and others). Prevention also means to avoid recurrence of the same disease as well as complications that frequently occur during the clinical course and may influence the outcome (spasticity in stroke patients, muscular calcification following hip replacement). Frequently, old persons do not completely recover following serious disease, they are limited in their daily activities and their capability to leave home. Secondary prevention tries to fight isolation; the patient should live a meaningful life.