Prevalence of skin diseases in hospitalized geriatric patients : Association with gender, duration of hospitalization and geriatric assessment.

BACKGROUND: Improvement of quality of life in old age and prevention of age-associated diseases have become the main focus of research into aging; however, information regarding the skin health status of geriatric patients still remains sparse. GOAL: To investigate the extent of dermatological diseases in hospitalized geriatric patients, map the most prevalent ones, check for any gender differences and document any correlations with duration of hospitalization and results of geriatric assessments. PATIENTS AND METHODS: A total of 110 hospitalized geriatric patients underwent a complete dermatological examination at the Evangelical Geriatric Hospital (Evangelisches Geriatriezentrum) Berlin. The collected information was stratified according to dermatological diagnosis, results of geriatric assessments, duration of hospitalization, age and gender of the patients. RESULTS: The average number of diagnosed skin diseases per patient was 3.7 ± 1.8 for the female population and 4.3 ± 2.0 for the male population. After categorizing all diagnosed skin diseases, infectious diseases were found to be most common in both female and male patients (55 % and 58 %, respectively) followed by vascular diseases (46.7 % and 54 %, respectively). Precancerous skin lesions and epithelial skin cancer were more frequent in men than in women (20 % vs. 6.7 %, p < 0.037 and 34 % vs. 13.3 %, p < 0.010, respectively). Pruritus showed a positive correlation with the duration of hospitalization and a negative correlation with the Barthel index and Tinetti score on the day of discharge, indicating that pruritus may have a significant impact on the physical condition of elderly multimorbid patients and on the static and dynamic balance abilities. CONCLUSION: Our results demonstrate that skin health in the elderly is compromised and disregarded and this should constitute one of the top priorities of healthcare specialists and physicians in the future.

[Cross-sectional field Q7"medicine of aging and the elderly" at the Charité - Universitätsmedizin Berlin : Curriculum and evaluation by students]. / Der Querschnittsbereich Q7 "Medizin des Alterns und des alten Menschen" an der Charité - Universitätsmedizin Berlin : Curriculum und Evaluation durch Studierende.

AIMS: There have only been a few publications focussing on how the curriculum Q7 "medicine of aging and the elderly" is implemented at German medical schools. In order to stimulate discussion about the implementation of Q7 the authors present the results of a survey of medical students of the Charité - Universitätsmedizin Berlin. The aim of the survey was to identify items that contribute to a good course and thus improve the quality of lectures and courses in geriatric medicine with the overall aim to encourage more students to become geriatricians after their studies. MATERIALS AND METHODS: Medical students from the fifth clinical semester were interviewed in anonymous form following each course using standardized questionnaires for organizational and didactic topics. Factor analysis, proof of reliability, descriptive statistics and correlation analysis were performed as statistical methods. RESULTS: The proof of reliability of questionnaires showed good internal consistency with Cronbachs alpha values of 0.88 (seminars), 0.91 (lectures) and 0.92 (bedside teaching). The overall response rate was very high (95.3%, n = 803 questionnaires). The ratings for questionnaire items in the three teaching formats (i.e. seminars, lectures, bedside teaching) ranged mostly from good to very good. In the correlation analysis across all three teaching formats clear communication of learning objectives, the treatment of topics according to their own expectations and the learning experience were rated as most relevant overall. CONCLUSIONS: The evaluation results indicate a high level of satisfaction with the curriculum of geriatrics at the Charité, which can therefore be recommended across faculties taking into account the criteria named.

[Neurological lower torso function test. A new assessment]. / Neurologischer Funktionstest unterer Rumpf. Ein neues Assessment.

The neurological lower torso function test was developed in addition to the Berg Balance Scale as an assessment for diagnosis and follow-up of lower torso stability and functioning in neurological patients, used for example in subjects in the early rehabilitation phase or still showing low motoric recovery after suffering a stroke. Due to the ground effect for changes in severely affected neurological patients, other tests currently available do not provide an adequate level of sensitivity. The neurological function test was integrated into the study "Combined whole body vibration and balance training using Vibrosphere" with 66 inpatient/partial inpatient neurological subjects ≥ 60 years. Based on six tasks, a qualitative assessment of the selective function of movement and posture tone of the lower extremity, the muscular system around the hip, and the lower torso are performed. Analogous to the Berg Balance Scale, a 5 point scale is used. It shows a high degree of reliability and responsiveness and can be performed with little effort of time and personnel.

Combined whole body vibration and balance training using Vibrosphere®: improvement of trunk stability, muscle tone, and postural control in stroke patients during early geriatric rehabilitation.

Strokes are a leading cause of disability, immobility, and reduced ability to perform activities of daily living (ADLs) among the elderly. Balance and postural control are often affected in stroke patients. Physical therapy for the lower back to improve posture, mobility, and ADLs can be very time consuming. In this randomized, controlled study of 66 geriatric patients (mean age 74.5 years) with stroke-related paresis or hemiplegia, it was demonstrated that stroke patients may benefit more from 3 additional weeks of combined whole body vibration and balance training than from a comprehensive inpatient geriatric rehabilitation program in terms of trunk stability, postural control, and muscle tone.

[Dysphagia treatment in a clinical-geriatric setting PEG and functional therapy of dysphagia]. / Behandlung der Dysphagie in einem klinisch-geriatrischen Setting: funktionelle Dysphagietherapie und PEG-Einsatz.

OBJECTIVES: Patients with dysphagia whose food intake is inadequate and who may compromise their airways need to receive nasogastric (NG) or gastrostomic (PEG) feeding. There are controversial discussions about the best time for intervention and the best method. Each approach has its advantages and disadvantages. Further research is required to assess the optimum method of treating patients with dysphagia. A retrospective study was undertaken to investigate the influence of functional dysphagia therapy with or without PEG feeding. METHODS: A total of 164 patients with dysphagia were investigated in a center for geriatric medicine (EGZB) within one year. Patients were divided into two groups: those with PEG (group 1, n=59) and those without (group 2, n=105). Both groups received functional training (training of oral motor skills and sensation, compensatory swallowing techniques) by speech-language therapists.Geriatric basic assessment was used. Speech-language therapists also evaluated language, speech and swallowing disorders pre- and post-training. Diet modification for oral intake altering viscosity and texture of foods and liquids was used. Additional data on the time between being admitted to hospital and receiving a PEG tube, the hospitalization period, the number of complications and mortality were collected. RESULTS: Both groups benefited from functional dysphagia therapy. The patients of group 2 showed a significant improvement in functional oral intake post-treatment. In most of the cases, diet modification improved from pasty consistency to firm meals. Swallowing abilities were much better than those of the more severely disabled patients of group 1. Group 1 still needed PEG feeding post-treatment but could also take in some food orally. However even the patients of group 1 showed a significant increase in functional oral intake.Group 2 also showed significantly stronger improvements in communication abilities and speech intelligibility after training compared to the severely disabled patients of group 1.In terms of the clinical outcome of group 1 it was demonstrated that the sooner a PEG was placed, the more significantly functional oral intake improved. The results of a multiple regression analysis showed a small but nevertheless significant association between an early supply of PEG and improvement of functional oral intake which had been achieved by functional dysphagia therapy.Significantly more complications and significantly higher mortality occurred in group 1 (PEG feeding) compared to group 2 (exclusively oral feeding). CONCLUSION: The treatment of dysphagia in the elderly requires a multi-professional setting, differentiated assessment and functional training of oral motor skills and sensation and swallowing techniques. Compared to patients with severe dysphagia, however, patients with mild to moderate dysphagia benefit most from functional training. The results reveal the importance of precise and early diagnosis of swallowing disorders in order to introduce PEG supply early in cases of persistent dysphagia.

[Does an association between increased homocystein levels and cognitive dysfunction also exist in multimorbid geriatric patients]. / Besteht auch bei multimorbiden geriatrischen Patienten ein Zusammenhang zwischen erhöhten Homocysteinspiegeln und kognitiven Defiziten?

BACKGROUND: Total blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD. METHODS: According to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 +/- 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B(12), hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional. RESULTS: According to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B(12) levels were within range, though dietary folate intake (97 [80-128] microg/d) was reduced about 75% (recommendation 400 microg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B(12) were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters. CONCLUSION: We analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B(12) concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.

Which are the most efficient items of mini nutritional assessment in multimorbid patients?

OBJECTIVE: The aim of the study was to identify the most significant MNA-items to accelerate the determination of nutritional risk of elderly patients in routine clinical practice in a geriatric hospital. Since MNA requires 10-15 min it is hardly applicable to clinical routine. DESIGN: The study was a cross-sectional study. SETTING: The study centre was an acute geriatric hospital. PARTICIPANTS: In total 808 multimorbid elderly patients were recruited. METHODS: We applied the MNA in 808 (528 f/280 m) geriatric multimorbid patients (78.5+/-8.7f / 74.6+/-9 m yrs) without cognitive impairment 48 h after hospital admission. Admission diagnoses covered orthopaedical (40%), internal (34%) and cerebrovascular (24%) diseases. According to analysis of reliability the consistency of the MNA scale for multimorbid patients has been verified. In preparation for scale reduction a factor analysis was applied. A reduced scale with selected cutoffs was configured and compared with MNA. RESULTS: According to MNA, 15% of patients were well-nourished, 65% at risk of malnutrition and 20% were malnourished. The reliability analyses showed a Cronbach's Alpha of 0.60 that represented a satisfactory result. By means of factor analysis the MNA-items were reduced from 18 to 7 items (weight loss, mobility, BMI, number of full meals, fluid consumption, mode of feeding, health status). with new cutoffs (12.5-15 well-nourished, 9-12 at risk of malnutrition, <9 malnourished). According to the modified MNA (m-MNA) 21.7% of the patients were well-nourished, 54.5% at risk of malnutrition and 21.7% were malnourished. The score of the MNA and m-MNA correlated with r=0.910. Furthermore, there was a strong correlation between MNA and m- MNA group classification of 83%. CONCLUSION: The m-MNA enables a rapid (3 min) and efficient screening of malnutrition in multimorbid geriatric patients. The m-MNA is easy to apply and may also be suitable in multimorbid patients with cognitive dysfunction. Due to the variety of items the m-MNA seems to be superior to other screening tools.

[Telereha--special challenges for telemedicine in geriatric rehabilitation]. / Telereha--die besonderen Herausforderungen der Telemedizin im Geriatrisch-Rehabilitativen Umfeld.

Modern telecommunication technology has the potential to improve the quality of life for elders with physical and mental impairments as well as for their caregiving relatives. This can be viewed as an opportunity to establish and maintain instant and personalized access to various medical services in a situation where increasing needs are opposed to decreasing resources. However, it is not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Results of a tele-rehabilitation project ("TeleReha", conducted at the Berlin Geriatric Center) which comprised mobility-impaired patients caregiving relatives and geriatric professionals, showed that participants regard telecommunicational and communicational needs.

[Primary and secondary prevention in dyslipidemia in the elderly]. / Primär- und Sekundärprävention bei Dyslipidämie im Alter.

Cardiovascular disease (CVD) is the leading cause of mortality and a major cause of disability in advanced age. The relationship between coronary heart disease (CHD) and dyslipoproteinaemia is well known. The fact, however, that atherosclerosis is a systemic disease leads also to the consideration that patients suffering from cerebrovascular and peripheral arterial disease should benefit similarly from lipid lowering therapy as do patients with CHD. There is already growing evidence that the incidence of stroke may be markedly decreased by statin therapy. Though overall, the clinical significance of hypercholesterolaemia seems to decrease with increasing age, patients at age 65 to 75 tend to benefit even more than younger patients when elevated LDL-cholesterol is treated effectively. It should be noticed that prevention or postponement of cardiovascular events may also prevent premature functional limitations and disability in old age. Hence, it is suggested to screen elderly people with CVD for dyslipoproteinaemia and to treat elevated cholesterol levels by means of life style changes, nutritional therapy, and drug therapy. Treatment regimes should be considered depending upon complete risk stratification and geriatric assessment. Chronological age alone cannot be an argument to withhold a proven effective therapy from a growing segment of the population at risk.

Ventilatory capacity and risk for dementia.

BACKGROUND: Previous studies have found a relationship between single indicators of ventilatory capacity and measures of cognitive function, but have not addressed dementia specifically. This study examined the relationship between different indicators of ventilatory capacity and dementia, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, controlling for important confounding factors. METHODS: Cross-sectional data on participants (n = 437) of the Berlin Aging Study (BASE), which are representative of former West Berlin's living population aged 70 years and older, were analyzed. Ventilatory capacity was measured by spirometry as peak expiratory flow rate (PEF-R), forced expiratory volume in 1 second (FEV-1), maximal expiratory flow at 50% of forced vital capacity (MEF50%FVC), and maximal expiratory flow at 25% of forced vital capacity (MEF25%FVC). Odds ratios (OR) for dementia associated with ventilatory capacity were obtained by logistic regression, adjusting for age, gender, education, ApoE4 status, chronic obstructive pulmonary disease, smoking, heart failure, visual and auditory functioning, grip strength, and former physical activity. RESULTS: Separate analyses for PEF-R, FEV-1, MEF50%FVC, and MEF25%FVC revealed significantly increased odds for dementia among subjects in the lowest compared with the best functioning group in ventilatory testing. The OR associated with PEF-R > or = 2 l/s was found to be 20.4 (confidence interval [CI] 5.1-82.7). For FEV-1, MEF50%FVC, and MEF25%FVC ORs of 7.5 (CI 2.1-27.9), 4.3 (CI 1.5-12.5), and 4.7 (CI 1.3-17) were obtained, respectively. CONCLUSIONS: Ventilatory capacity, measured by spirometry in a representative sample of very elderly people, is cross-sectionally related to dementia. Taking evidence from longitudinal studies into account, this result suggests that decreased respiratory function may increase the risk for dementia, independent from already known risk factors.

[Telematics in geriatrics--potentials, problems and application experiences]. / Telematik in der Geriatrie--Potentiale, Probleme und Anwendungserfahrungen.

Modern telecommunication technology (telematics) has the potential to improve the quality of life for elders with physical and mental impairments as well as for their care giving relatives. Videophones, internet resources, and multimedia computers can be used for networking them together with social workers, nurse practitioners, physicians and therapeutic staff in service-centers. This can be viewed as a unique opportunity to establish and maintain instant and personalized access to various medical services in a situation where increasing needs are opposed to decreasing resources. However, it is not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Some studies already showed its applicability and feasibility, but there are still no larger trials showing that maintenance or enhancement of autonomy can be achieved effectively by using new technologies. This article reviews the literature on telematics in geriatrics and presents data of a tele-rehabilitation project ("TeleReha", conducted at the Berlin Geriatric Center) which comprised mobility-impaired patients (N = 13, mean age 72 yrs), care giving relatives (N = 8), and geriatric professionals. Networking was established using ISDN technology with videophones or PC-based videoconferencing systems. Results showed that participants regard telecommunication devices as a valuable resource for their informational and communicational needs. Use of telecommunication systems was inversely related to physical mobility. Having access to professional service and counselling was rated highly important but also the opportunity to establish reliable contacts with non-professionals (relatives, other participants). Despite experienced technical problems, use of telecommunication systems was evaluated more positively in the post-test as compared to the pre-test. In summary, current experience suggests that telematics can be used efficiently by geriatric patients and by relatives and professionals caring for them. However, evidence for a medically and economically effective use is still scarce. A lack of structural and organizational concepts for geriatric telematics initiatives can be identified which in part may be due to the fact that the considerable potentials of telematics applications are still largely unrecognized by geriatricians.

Carotid atherosclerosis, vascular risk profile and mortality in a population-based sample of functionally healthy elderly subjects: the Berlin ageing study.

OBJECTIVES: Studies on extracranial carotid atherosclerosis have predominately been undertaken on middle-aged subjects. This study examines the prevalence of extracranial carotid atherosclerosis, its relation to vascular risk factors and its significance for survival in elderly subjects. DESIGN: Population-based cross-sectional survey. Non-modifiable vascular risk factors examined were family history of atherosclerotic disease, sex and apolipoprotein E (apoE) genotype. Potentially modifiable risk factors assessed were smoking, fibrinogen, fasting lipids, body mass index, hypertension and diabetes. SETTING AND SUBJECTS: Two hundred and twenty-five functionally healthy volunteers of the Berlin Ageing Study, aged 70-100. MAIN OUTCOME MEASURES: Presence of carotid stenosis and plaque ascertained by ultrasound imaging; 5-year mortality. RESULTS: At least one plaque was found in 144 (64%) of the volunteers; 34 (15%) had a stenosis over 50%; and nine (4%) had a stenosis over 75%. Total cholesterol > 6.5 mmol L-1, LDL cholesterol > 4.6 mmol L-1 and total cholesterol/HDL cholesterol ratio > 5 were significantly associated with presence of plaque in 70- to 80-year-old subjects, as was diabetes in subjects over 80 years. Log-linear analyses showed significant three-way interactions for high LDL cholesterol and diabetes with plaques and age. Family history, sex, apoE genotype, smoking and fibrinogen were not related to presence of plaque in the study population. Cox regression analysis revealed increased 5-year mortality rates for subjects with plaques (OR = 2. 88; 95% CI = 1.30-6.35), whereas the vascular risk profile was not associated with mortality. CONCLUSIONS: In a population-based sample of functionally healthy elderly subjects, the significance of the vascular risk profile seemed to be diminished. It had no impact on survival and only modifiable risk factors showed an age-dependent association with carotid disease.

Atherosclerotic disease in very old age: Preliminary results from the Berlin aging study (base).

Prevalence rates of atherosclerotic diseases and its association to risk- and protective factors were analyzed in an age and gender stratified sample of a Berlin population of 70-103-year-old subjects (BASE: Berlin Aging Study). The investigation revealed three essential findings. (i) Age-specific differences in the prevalence rates of coronary heart disease and peripheral vascular disease were not detectable. (ii) Cerebrovascular disease was less frequent among subjects over 90 years compared to younger subjects. (iii) Some well documented risk factors of cardiovascular morbidity (hypertension, obesity, low serum HDL-cholesterol) appeared to be unrelated to atherosclerotic manifestations in advanced old age. Hypertension, elevated serum-cholesterol and male sex, however, were significantly associated with cerebrovascular disease, as was smoking and male sex with peripheral vascular disease. The relatively low number of persons diagnosed with cerebrovascular disease.in the highest age-group (90-103 years) was probably due to selective mortality. In summary, this univariate analysis confirmed associations between cardiovascular morbidity, and risk factors also in advanced old age.

Hyperosmotic acclimation in the leech, Hirudo medicinalis L.: energy metabolism, osmotic, ionic and volume regulation.

1. Acclimation of Hirudo medicinalis L. to hyperosmotic medium (12/1000 salinity) is characterized by changes in energy metabolism. A transient succinate fermentation is followed by malate accumulation in the tissue from the control level of 41.4 +/- 7.6 to 82.8 +/- 15.4 mumol/g dry weight after 9 days. 2. Initial osmotic water loss of 40% is restored in the intravasal space by isosmotic volume regulation after 9 days, but restoration is incomplete in the tissue even after 6 weeks of acclimation. 3. Elevation of SCCA anions in the blood is a mechanism of chloride hyporegulation.