[Consensus paper--adequate medication for neurologic and geriatric patients with dysphagia]. / Konsensuspapier--Bedarfsgerechte Medikation bei neurologischen und geriatrischen Dysphagie-Patienten.

BACKGROUND: The incidence for dysphagia amounts to 44-50% in nursing homes. Dysphagia is one of the main reasons for pneumonia in elderly. METHOD: Consensus paper. RESULTS AND CONCLUSIONS: For the advisory board consisting of 2 physicians, 2 pharmacists, a speech therapist, and a respresentative of nursing service it is common understanding that for the ideal maintenance and support of patients with dysphagia an interdisciplinary approach is crucial. Despite high clinical relevance of dysphagia the basic knowledge of this field is often underdeveloped. Specific and validated screening procedures for dysphagia have to be developed and implemented into the relevant guidelines. Specifically in this field an active and discipline spanning risk management should find its way into stationary geriatric care and nursing homes. Just as important is the provision of necessary patient information on the progress of the disease, on therapeutic actions and possible diet forms in a dysphagia pass. Additionally, the mentioned disciplines require an online risk screening (for dysphagia) of the pharmacist concerning the overall medication as well as information of galenic properties like facts regarding the possibility of crushing, portioning or tube feeding of the prescribed medication. In this way health risks due to administration errors concerning the medication can be significantly reduced for this patient group. Adequate oral liquids for adapted application of drugs are missing so far.

[Dementia in Germany: results of an interdisciplinary expert workshop]. / Demenz in Deutschland--Ergebnisse eines interdisziplinären Expertenworkshops.

In the aging population of Germany the consequences of Dementia for the society and the health care sector are complex and solutions require a multidisciplinary approach. The aim of the two-day interdisciplinary expert conference was to consider dementia from different perspectives, to identify dementia-related problems and to discuss integrative solutions under consideration of complementary therapies. In different working groups the experts developed solutions and recommendations with regards to political need, health care and future research priorities. The present recommendations profited very much from the interdisciplinary participants of the conference and brought together the expertise of different fields resulting in a comprehensive picture about dementia in Germany.

Acute confusional States in the elderly--diagnosis and treatment.

BACKGROUND: Delirium is common, has multiple causes and causes distress to numerous patients and their relatives. METHOD: Selective review of the literature in PubMed and PsycINFO, with reference to selected national and international guidelines. RESULTS: The hypoactive subtype of delirium is commoner than the hyperactive type, and often overlooked. Delirium in an elderly individual is associated with an additional burden, a possible loss of potential for rehabilitation, and a marked increase in mortality. The diagnosis of delirium is primarily clinical. All professionals involved in patient care must be able to recognize the features of delirium. Dementia, dehydration and polypharmacy are particularly strongly associated, in the elderly. A careful history and examination with appropriate investigation allows underlying causes to be detected and treated. Rehabilitation strategies should be initiated without delay. Neuroleptics and benzodiazepines have an established role in the pharmacological treatment even of the hyperactive subtype. Non-pharmacological treatments include the creation of a calm and patient centred environment, and the involvement of relatives. CONCLUSION: In many cases, delirium can be diagnosed and treated in good time. Prevention is preferable to treatment.

[Fecal incontinence in elderly diabeteic patients]. / Stuhlinkontinenz des älteren Diabetikers.

Faecal incontinence is a challenging clinical condition in the elderly diabetic patient and has a significant impact on the overall quality of life, but is often neglected by the care giving professionals. Up to 22% of diabetic patients have faecal incontinence depending on the definition applied. Multiple factors are almost always involved in the pathophysiology of faecal incontinence, including physiological age-related changes, diabetic neuropathy, multimorbidity and polymedication. As for constipation, the use of a stepwise approach for the diagnosis of faecal incontinence is highly recommended. The verification of the diagnosis and underlying causes of faecal incontinence are important for improving the quality of life, as well as the employment of the appropriate therapy particularly in the case of the elderly diabetic patient. Treatment options include, in addition to an optimised blood sugar control, the use of conservative measures, bio-feedback therapy and surgical interventions.

Prospective randomized double-blind study of the wound-debriding effects of collagenase and fibrinolysin/deoxyribonuclease in pressure ulcers.

BACKGROUND: proteolytic enzymes such as collagenase, fibrinolysin and deoxyribonuclease are used for debriding purulent or fibrinous pressure ulcers. OBJECTIVE: to test the hypothesis that collagenase debrides necrotic pressure ulcers more effectively than fibrinolysin/deoxyribonuclease. METHODS: we enrolled 135 elderly patients with pressure ulcers in a randomized, prospective double-blind trial. Patients were treated until complete wound debridement or for a maximum of 4 weeks with twice-daily applications of collagenase or fibrinolysin/deoxyribonuclease. The primary endpoint was percentage change in the yellow or black wound surface. Secondary endpoints were wound environment, margins, depth, pocketing, area and healing. Assessment was by two independent dermatologists who were unaware of the treatment administered and evaluated results from photographs taken at the beginning and end of treatment. RESULTS: on intention-to-treat analysis, collagenase gave slightly better results with regard to the primary endpoint in the 121 assessable patients, but this difference was not statistically significant (P=0.115). Additional efficacy measures did not show any statistically significant difference between the groups. CONCLUSION: there was no evidence of a difference between collagenase and fibrinolysin/deoxyribonuclease in the debridement of pressure ulcers.