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1.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 54(11-12): 669-683, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31805586

RESUMO

Postoperative delirium (POD) is a common and serious complication after surgery. It is associated with increased morbidity and mortality as well as neurocognitive disorder and associated loss of autonomy and increased need for care. As professionals, it is our duty to treat our patients in a holistic individual concept with the aim to reintegrate our patients into their home and social environment afterwards. In addition to preoperative and intraoperative interventions, postoperative prevention is of particular importance. This article focuses on non-pharmacological prevention strategies to avoid postoperative delirium and neurocognitive disorder in postoperative inpatient care. It is based on the "Evidence-based and consensus-based guideline on postoperative delirium". Thus, risk factors are addressed and non-pharmacological strategies are presented, which include reorientation, mobilization and nutritional support. Interprofessional cooperation plays just as important a role as the implementation of the listed preventive measures. Finally, the modified Hospital Elder Life Program is presented, which presents and applies preventive measures as a system-oriented and interdisciplinary concept, which "prevents functional decline and allows older adults to return home at the maximal level of independence". From our point of view, the training of a professional delirium team is a future-oriented complementary measure in the treatment concept of Perioperative Neurocognitive Disorders (PND), which finds its justification as an interface in the treatment of high-risk patients.


Assuntos
Delírio , Complicações Pós-Operatórias , Idoso , Delírio/prevenção & controle , Humanos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco
2.
Sensors (Basel) ; 20(1)2019 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-31878177

RESUMO

Various gait parameters can be used to assess the risk of falling in older adults. However, the state-of-the-art systems used to quantify gait parameters often come with high costs as well as training and space requirements. Gait analysis systems, which use mobile and commercially available cameras, can be an easily available, marker-free alternative. In a study with 44 participants (age ≥ 65 years), gait patterns were analyzed with three different systems: a pressure sensitive walkway system (GAITRite-System, GS) as gold standard, Motognosis Labs Software using a Microsoft Kinect Sensor (MKS), and a smartphone camera-based application (SCA). Intertrial repeatability showed moderate to excellent results for MKS (ICC(1,1) 0.574 to 0.962) for almost all measured gait parameters and moderate reliability in SCA measures for gait speed (ICC(1,1) 0.526 to 0.535). All gait parameters of MKS showed a high level of agreement with GS (ICC(2,k) 0.811 to 0.981). Gait parameters extracted with SCA showed poor reliability. The tested gait analysis systems based on different camera systems are currently only partially able to capture valid gait parameters. If the underlying algorithms are adapted and camera technology is advancing, it is conceivable that these comparatively simple methods could be used for gait analysis.

3.
Drug Res (Stuttg) ; 69(S 01): S4, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31731297
4.
Drug Res (Stuttg) ; 69(S 01): S5, 2019 11.
Artigo em Alemão | MEDLINE | ID: mdl-31731298
5.
Dtsch Med Wochenschr ; 144(20): 1411-1416, 2019 10.
Artigo em Alemão | MEDLINE | ID: mdl-31594015

RESUMO

The physiology of aging must be understood first in order to detect pathophysiological deviations early on and to interact accordingly. To date, there exist no guidelines or recommendations, nor randomized controlled trials in the field of geriatric intensive care. The mortality of elderly ICU patients is not determined solely by age, but by the age-physiological decrease of the functional reserves and the age-related vulnerability factors.


Assuntos
Envelhecimento/fisiologia , Tomada de Decisão Clínica , Cuidados Críticos , Serviços de Saúde para Idosos , Idoso de 80 Anos ou mais , Comorbidade , Humanos , Guias de Prática Clínica como Assunto
6.
Nutrients ; 11(10)2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31658676

RESUMO

Although malnutrition is frequent in the old, little is known about its association with fatigue. We evaluated the relation of self-reported severe weight loss with fatigue and the predictors for fatigue in old patients at hospital discharge. Severe weight loss was defined according to involuntary weight loss ≥5% in the last three months. We determined fatigue with the validated Brief Fatigue Inventory questionnaire. The regression analyses were adjusted for age, sex, number of comorbidities, medications/day, and BMI. Of 424 patients aged between 61 and 98 y, 34.1% had severe weight loss. Fatigue was higher in patients with severe weight loss (3.7 ± 2.3 vs. 3.2 ± 2.3 points, p = 0.021). In a multinomial regression model, weight loss was independently associated with higher risk for moderate fatigue (OR:1.172, CI:1.026-1.338, p = 0.019) and with increased risk for severe fatigue (OR:1.209, CI:1.047-1.395, p = 0.010) together with the number of medications/day (OR:1.220, CI:1.023-1.455, p = 0.027). In a binary regression model, severe weight loss predicted moderate-to-severe fatigue in the study population (OR:1.651, CI:1.052-2.590, p = 0.029). In summary, patients with self-reported severe weight loss at hospital discharge exhibited higher fatigue levels and severe weight loss was an independent predictor of moderate and severe fatigue, placing these patients at risk for impaired outcome in the post-hospital period.

7.
BMJ ; 366: l5101, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533934

RESUMO

OBJECTIVE: To determine the safety and efficacy of aerobic exercise on activities of daily living in the subacute phase after stroke. DESIGN: Multicentre, randomised controlled, endpoint blinded trial. SETTING: Seven inpatient rehabilitation sites in Germany (2013-17). PARTICIPANTS: 200 adults with subacute stroke (days 5-45 after stroke) with a median National Institutes of Health stroke scale (NIHSS, range 0-42 points, higher values indicating more severe strokes) score of 8 (interquartile range 5-12) were randomly assigned (1:1) to aerobic physical fitness training (n=105) or relaxation sessions (n=95, control group) in addition to standard care. INTERVENTION: Participants received either aerobic, bodyweight supported, treadmill based physical fitness training or relaxation sessions, each for 25 minutes, five times weekly for four weeks, in addition to standard rehabilitation therapy. Investigators and endpoint assessors were masked to treatment assignment. MAIN OUTCOME MEASURES: The primary outcomes were change in maximal walking speed (m/s) in the 10 m walking test and change in Barthel index scores (range 0-100 points, higher scores indicating less disability) three months after stroke compared with baseline. Safety outcomes were recurrent cardiovascular events, including stroke, hospital readmissions, and death within three months after stroke. Efficacy was tested with analysis of covariance for each primary outcome in the full analysis set. Multiple imputation was used to account for missing values. RESULTS: Compared with relaxation, aerobic physical fitness training did not result in a significantly higher mean change in maximal walking speed (adjusted treatment effect 0.1 m/s (95% confidence interval 0.0 to 0.2 m/s), P=0.23) or mean change in Barthel index score (0 (-5 to 5), P=0.99) at three months after stroke. A higher rate of serious adverse events was observed in the aerobic group compared with relaxation group (incidence rate ratio 1.81, 95% confidence interval 0.97 to 3.36). CONCLUSIONS: Among moderately to severely affected adults with subacute stroke, aerobic bodyweight supported, treadmill based physical fitness training was not superior to relaxation sessions for maximal walking speed and Barthel index score but did suggest higher rates of adverse events. These results do not appear to support the use of aerobic bodyweight supported fitness training in people with subacute stroke to improve activities of daily living or maximal walking speed and should be considered in future guidelines. TRIAL REGISTRATION: ClinicalTrials.gov NCT01953549.


Assuntos
Terapia por Exercício/métodos , Aptidão Física/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Atividades Cotidianas , Adulto , Idoso , Avaliação da Deficiência , Teste de Esforço , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Terapia de Relaxamento , Índice de Gravidade de Doença , Método Simples-Cego , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Resultado do Tratamento , Caminhada/fisiologia
8.
J Wound Ostomy Continence Nurs ; 46(6): 524-529, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31478987

RESUMO

PURPOSE: The purpose of this study was to evaluate associations among use of walking aids, mobility status, and occurrence of urinary incontinence (UI) in geriatric patients residing in nursing homes, and to examine associations between UI severity (frequency and amount) and its impact on health-related quality of life (QoL). DESIGN: Multicenter descriptive cross-sectional prevalence study. SUBJECTS AND SETTING: A total of 2044 patients from nursing homes were included in the study. A majority were female (72.0%), the mean age of participants was 82.1 years (SD 11.2), their mean body mass index was 26.1 (SD 5.4), and their mean Care Dependency Scale score was 46.0 (SD 18.2), indicating a medium to high care dependency. The study setting was 30 nursing homes throughout Germany from 2014 to 2015. METHODS: Data were collected by trained nurses using a standardized data collection form to collect information about demographic characteristics, health conditions, mobility status measured according to the Elderly Mobility Scale (EMS), UI, and QoL measured using the International Consultation of Incontinence Questionnaire Short Form (ICIQ-SF). RESULTS: The prevalence of UI was 69.7% (n = 1804). Analysis of variance showed that, in 1659 nursing home residents with information on UI, 572 reported a medium amount of leakage with a mean impact on health-related QoL of 2.2 (SD 2.2, P < .001) on a scale from 0 (no impact) to 10 (very high impact). The mean of the impact on QoL in 235 residents who reported a large amount of leakage was 2.4 (SD 3.0, P < .001). In 1741 residents with information on the frequency of UI, 637 reported being urinary incontinent more than once a day with a mean impact on QoL of 2.2 (SD 2.1, P < .001) and 359 residents with permanent UI stated a mean impact on QoL of 2.1 (SD 2.8, P < .001). According to the bivariate association of UI with use of walking aids, the highest prevalence of UI (61.2%) was in patients who did not use any walking aids. The Chi-square Automatic Interaction Detector (CHAID) of the relationship between mobility according to the EMS and UI indicated that 71.1% of all patients with UI did not use any walking aids, although their mobility status had been reduced. CONCLUSIONS: Findings indicate a significant association between impaired mobility and UI in nursing home residents. Chronic, severe urinary incontinence exerted the greatest impact on health-related QoL. Therefore, we recommend measures to preserve or regain mobility to minimize or prevent UI in geriatric residents and patients and, thus, increase their health-related QoL.

9.
Int J Cardiol ; 292: 73-77, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31256990

RESUMO

BACKGROUND: The obesity paradox has been recognized in patients with cardiovascular disease. The association between obesity and outcomes in elderly patients undergoing percutaneous coronary intervention (PCI) has not been investigated, yet. METHODS: A total of 990 elderly (≥80 years) patients undergoing PCI at our institution between January 2009 and December 2017 and with available data on body mass index (BMI) were divided according to BMI tertiles (lowest BMI tertile: ≪24.1 kg/m2, middle BMI tertile: 24.1-27.2 kg/m2, and highest BMI tertile: ≫27.2 kg/m2). The primary endpoint was all-cause mortality at a median follow-up of 233 [34-862] days. RESULTS: All-cause mortality was 11.2%, 7.6%, and 5.8% in the lowest, the middle, and the highest BMI tertiles (Log Rank p = 0.008). Belonging to the lowest BMI tertile was associated with an increased risk of all-cause mortality (HR 2.14, 95% CI 1.23-3.73, p = 0.007), and associations remained significant after multivariable adjustments (adjusted HR 1.92, 95% CI 1.05-3.52, p = 0.03). While belonging to the lowest BMI tertile was independently associated with an increased all-cause mortality in patients with acute coronary syndromes (HR 2.32, 95% CI 1.24-4.35, p = 0.009; adjusted HR 2.40, 95% CI 1.19-4.84, p = 0.01), relations were not significant in patients with stable coronary artery disease (HR 1.32, 95% CI 0.38-4.56, p = 0.67; adjusted HR 0.80, 95% CI 0.21-3.05, p = 0.75). CONCLUSIONS: In elderly (≥80 years) patients undergoing PCI, belonging to the lowest BMI tertile was associated with an increased mortality, mainly in acute coronary syndromes. Hence, the BMI should be incorporated into the risk stratification of elderly patients with coronary artery disease.

10.
Artigo em Alemão | MEDLINE | ID: mdl-31278437

RESUMO

The proportion of elderly, frail, and multimorbid people has increased dramatically in recent decades resulting from demographic changes and will further increase, which will impact acute medical care. Prospective, randomized studies on geriatric intensive care are still lacking. There are also no international or national recommendations regarding the management of critically ill elderly patients. Based on an expert opinion, this consensus paper provides 16 statements that should be considered when dealing with geriatric critical care patients.

11.
Z Gerontol Geriatr ; 52(5): 440-456, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31278486

RESUMO

The proportion of elderly, frail, and multimorbid people has increased dramatically in recent decades resulting from demographic changes and will further increase, which will impact acute medical care. Prospective, randomized studies on geriatric intensive care are still lacking. There are also no international or national recommendations regarding the management of critically ill elderly patients. Based on an expert opinion, this consensus paper provides 16 statements that should be considered when dealing with geriatric critical care patients.


Assuntos
Cuidados Críticos/métodos , Estado Terminal/terapia , Avaliação Geriátrica/métodos , Idoso , Consenso , Idoso Fragilizado , Humanos
12.
Nutrition ; 63-64: 81-86, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30933730

RESUMO

OBJECTIVE: Fibroblast growth factor (FGF)21 is promptly induced by short fasting in animal models to regulate glucose and fat metabolism. Data on FGF21 in humans are inconsistent and FGF21 has not yet been investigated in old patients with cachexia, a complex syndrome characterized by inflammation and weight loss. The aim of this study was to explore the association of FGF21 with cachexia in old patients compared with their healthy counterparts. METHODS: Serum FGF21 and its inactivating enzyme fibroblast activation protein (FAP)-α were measured with enzyme-linked immunoassays. Cachexia was defined as ≥5% weight loss in the previous 3 mo and concurrent anorexia (Council on Nutrition appetite questionnaire). RESULTS: We included 103 patients with and without cachexia (76.9 ± 5.2 y of age) and 56 healthy controls (72.9 ± 5.9 y of age). Cachexia was present in 16.5% of patients. These patients had significantly higher total FGF21 levels than controls (952.1 ± 821.3 versus 525.2 ± 560.3 pg/mL; P = 0.012) and the lowest FGF21 levels (293.3 ± 150.9 pg/mL) were found in the control group (global P < 0.001). Although FAP-α did not differ between the three groups (global P = 0.082), bioactive FGF21 was significantly higher in patients with cachexia (global P = 0.002). Risk factor-adjusted regression analyses revealed a significant association between cachexia and total (ß = 649.745 pg/mL; P < 0.001) and bioactive FGF21 (ß = 393.200 pg/mL; P <0.001), independent of sex, age, and body mass index. CONCLUSIONS: Patients with cachexia exhibited the highest FGF21 levels. Clarification is needed to determine whether this is an adaptive response to nutrient deprivation in disease-related cachexia or whether the increased FGF21 values contribute to the catabolic state.

13.
BMC Health Serv Res ; 19(1): 105, 2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30732604

RESUMO

BACKGROUND: Especially patients older than 65 years undergoing surgery are prone to develop frailty-related complications that may go far beyond the index hospitalization (e.g., cognitive impairment following postoperative delirium). However, aging-relevant information are currently not fully integrated into hospitals' perioperative processes. METHODS: We introduce a temporal perspective, which focuses on the social construction of time, to better understand existing barriers to the exchange of frailty-related data, targeting complexity research. Our chosen context is perioperative care provided by a tertiary hospital in Germany that has implemented a special track for patients over 65 years old undergoing elective surgery. The research followed a participatory modelling approach between domain and modelling experts with the goal of creating a feedback loop model of the relevant system relationships and dynamics. RESULTS: The results of the study show how disparate temporal regimes, understood as frameworks for organizing actions in the light of time constraints, time pressure, and deadlines, across different clinical, ambulant, and geriatric care sectors create disincentives to cooperate in frailty-related data exchanges. Moreover, we find that shifting baselines, meaning continuous increases in cost and time pressure in individual sectors, may unintentionally reinforce - rather than discourage - disparate temporal regimes. CONCLUSIONS: Together, these results may (1) help to increase awareness of the importance of frailty-related data exchanges, and (2) impel efforts aiming to transform treatment processes to go beyond sectoral boundaries, taking into account the potential benefits for frail patients arising from integrated care processes using information technology.


Assuntos
Avaliação Geriátrica/métodos , Disseminação de Informação , Assistência Perioperatória , Complicações Pós-Operatórias/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Idoso Fragilizado , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Segurança do Paciente , Procedimentos Cirúrgicos Operatórios
14.
Z Evid Fortbild Qual Gesundhwes ; 140: 14-21, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30777680

RESUMO

INTRODUCTION: Chronic or non-healing wounds are a serious problem for both the parties involved and the healthcare system. Currently, there are hardly any reliable data on the prevalence of chronic wounds in outpatient care, although this setting is becoming increasingly important. Therefore, the aim of this study was to determine the prevalence of and the factors associated with chronic wounds in clients cared for by home care services. METHOD: As part of a cross-sectional study throughout Germany in 2012, a survey was conducted among care recipients provided by home care services. The sample was drawn in a two-step procedure. First, a random sample of home care services was drawn for each federal state, followed by random selection of clients to be interviewed for each service. The aim of the study was to describe the prevalence of chronic wounds and influencing factors such as BMI, age, housing situation, activity and diabetes mellitus. Data collection through questionnaire was carried out by trained nurses. RESULTS: A total of 144 home care services with 1,296 clients had agreed to participate. With 880 care recipients from 100 home care services finally taking part in the survey, the response rate was 68 %. Of all care recipients examined, 101 had at least one chronic wound; the highest prevalence rates were observed for pressure ulcers (4.6 %) and leg ulcers (4.0 %). Care recipients with diabetes mellitus were more frequently affected by chronic wounds (16.4 %) than non-diabetic recipients (9.5 %). Community-living care recipients (14.1 % chronic wounds; 6.0 % pressure ulcers) and care recipients under the age of 65 (20 % chronic wounds; 9.5 % pressure ulcers) were affected more frequently than care recipients living alone (9.1 % chronic wounds; 3.0 % pressure ulcers) or care recipients older than 65 years (10.5 % chronic wounds; 4.0 % pressure ulcers). In the multivariate calculation, the BMI proved to be the strongest predictor. The prevalence of chronic wounds in the group of obese (BMI>35.3kg/m2) care recipients and those with activity restriction is 44.8 %. CONCLUSION: In view of the fact that one out of nine care recipients receiving assistance from home care services is affected by at least one non-healing wound, special attention should be paid to the prevention, detection and treatment of chronic wounds. Furthermore, it seems particularly necessary to identify the relevant risk groups in order to be able to initiate adequate and preventive measures at an early stage.


Assuntos
Serviços de Assistência Domiciliar , Lesão por Pressão , Ferimentos e Lesões/epidemiologia , Estudos Transversais , Alemanha/epidemiologia , Humanos , Prevalência
15.
Age Ageing ; 48(3): 413-418, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30608508

RESUMO

OBJECTIVES: sarcopenia is common especially in hospitalised older populations. The aim of this study was to assess the prevalence of sarcopenia, defined as low skeletal mass and muscle strength, and its impact on 1-year mortality in older patients with cancer. METHODS: skeletal muscle mass was estimated using bioelectric impedance analysis and related to height2 (SMI; Janssen et al. 2002). Grip strength was measured with the JAMAR dynamometer and the cut-offs suggested by the European Working Group on Sarcopenia in Older People (EWGSOP) were applied. One-year mortality was assessed by telephone follow-up and the local cancer death registry. RESULTS: of the 439 consecutively recruited cancer patients (60-95 years; 43.5% women), 119 (27.1%) had sarcopenia. Of the patients with sarcopenia, 62 (52.5%) died within 1 year after study entry compared to 108 (35.1%) patients who did not have sarcopenia (P = 0.001). In a stepwise, forward Cox proportional hazards analysis, sarcopenia (HR = 1.53; 95% CI: 1.034-2.250; P < 0.05), advanced disease (HR = 1.87; 95% CI: 1.228-2.847; P < 0.05), number of drugs/day (HR = 1.11; 95% CI: 1.057-1.170; P < 0.001), tumour diagnosis (overall P < 0.05) and Karnofsky index (HR = 0.98, 95% CI: 0.963-0.995; P < 0.05) associated with 1-year mortality risk. The factors sex, age, co-morbidities and involuntary 6-month weight loss ≥5% were insignificant. CONCLUSIONS: sarcopenia was present in 27.1% of older patients with cancer and was independently associated with 1-year mortality. The fact that sarcopenia was nearly as predictive for 1-year mortality as an advanced disease stage underlines the importance of preservation of muscle mass and function as a potential target of intervention in older patients with cancer.

16.
Nurs Open ; 6(1): 189-196, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30534408

RESUMO

Aims: To describe the prevalence of dry skin in nursing homes and hospitals and to describe relationships between topical skincare interventions and dry skin. Design: Two multicentre descriptive cross-sectional prevalence studies. Methods: The studies were performed in German nursing homes and hospitals in 2015 and 2016. Data were collected by trained nurses based on a standardized data collection form. The severity of dry skin was measured using the Overall Dry Skin Score. Results: In total, 1,662 nursing home residents and 1,486 hospital patients participated. The prevalence of dry skin was 41.2% in nursing homes and 55.2% in hospitals. In case of skincare dependency, the proportions of participants with dry skin were higher, particularly in hospitals (70.2%). In both institutions, the application of leave-on products increased when dry skin was present but remained lower in hospitals. Considering the high amount of skin dryness in skincare-dependent participants, interventions seem not to be successful. Results indicate a need for skincare improvement in future.

17.
Z Evid Fortbild Qual Gesundhwes ; 135-136: 81-88, 2018 09.
Artigo em Alemão | MEDLINE | ID: mdl-30122458

RESUMO

The number of patients seeking help in emergency departments is steadily increasing. In part, this is due to patients who have acute symptoms, but do not require emergency care, as well as multimorbid patients needing complex medical care. Emergency departments serve as an interface between primary care and in-patient as well as out-patient care. The ongoing public discussion about the need to readjust emergency care structures in Germany does not adequately address this aspect. The knowledge of characteristics and needs of patients seeking help in emergency departments is insufficient. In order to develop interventions matching these needs it is necessary to gain deeper insight into these characteristics and needs. EMANet is a health services research project funded by the Federal Ministry of Education and Research. Its aim is to collect representative data on the course of medical care of emergency patients with ambulatory care sensitive conditions in all eight emergency departments in Mitte, the inner city district of Berlin. The EMANet project focuses on three patient groups: a) patients with cardiac symptoms and possible psychiatric comorbidities, b) ambulatory patients with acute or chronic diseases of the respiratory tract, and c) geriatric patients with hip fractures. The collected data shall be used to gain a better understanding of health care utilization patterns, patient-perceived satisfaction and risk factors for potentially avoidable medical conditions or worsening of chronic disease. The mixed methods design of EMANet includes quantitative data of 1,650 patients at two time points and corresponding secondary (i. e. routine) data from hospital information systems. In addition, qualitative interviews with patients and health care professionals shall reveal unmet needs for medical care. The results will give us more in-depth insight into the perceived current capacity overload and help implement structural changes in the health care system.


Assuntos
Serviços Médicos de Emergência , Pesquisa sobre Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Berlim , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/tendências , Alemanha , Humanos
18.
Nutrition ; 55-56: 51-55, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29960157

RESUMO

OBJECTIVE: We analyzed the prevalence of sarcopenia among systemic sclerosis (SSc) patients with respect to quality of life, disability, organ involvement, and muscle function. METHODS: A total of 129 patients who met the ACR/EULAR 2013 classification criteria were included. Body composition was measured using bioelectric impedance analysis. Sarcopenia was defined according to the criteria of the European Working Group on Sarcopenia in Older People. Handgrip and knee extension strength and pulmonary peak flow were measured. Physical function was assessed with the Short Form-36 Health Survey and Scleroderma Health Assessment Questionnaire. RESULTS: Sarcopenia was prevalent in 22.5% of patients. There were significant differences between patients with and without sarcopenia regarding handgrip strength (11.5 [2.0-30.0] versus 18.0 [1.0-41.0] kilogram force [kgf]; P <0.001) and knee extension strength (11.0 [3.5-32.5] versus 17.5 [3.5-88.0] kgf; P = 0.006), physical function (38.8 [9.9-85.0] versus 48.8 [0-88.0]; P = 0.032) and number of immunosuppressants (2 [0-4] versus 1 [0-5]; P = 0.009). There were no differences regarding age (57.0 [32.0-83.0] versus 60.5 [28.0-82.0] years; P = 0.350) and disease duration (8 [1-27] versus 7 [0-34] years; P = 0.350). CONCLUSIONS: Sarcopenia is common in patients with SSc and is associated with physical impairment that affects everyday life and participation in work. Interestingly, although age is the main risk factor for sarcopenia in the general population, it did not differ between sarcopenic and non-sarcopenic SSc patients in our study. Instead, the number of immunosuppressive drugs was significantly higher among sarcopenic patients.


Assuntos
Sarcopenia/epidemiologia , Escleroderma Sistêmico/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Avaliação da Deficiência , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Desempenho Físico Funcional , Prevalência , Fatores de Risco , Sarcopenia/etiologia , Escleroderma Sistêmico/complicações , Índice de Gravidade de Doença
19.
Dtsch Med Wochenschr ; 143(7): 460-464, 2018 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-29614534

RESUMO

MYOCARDIAL INFARCTION IN THE OLD PATIENT: Even old patients may crucially benefit from reopening the occluded coronary artery by percutaneous coronary intervention with stent implantation. Bleeding complications can be reduced by choosing the radial instead of the femoral vascular approach for cardiac catheterization. STATINS FOR THE ELDERLY: WHEN TO START UND WHEN TO STOP?: Elderly benefit no less than the younger from statins. "Goal-oriented statin therapy" is preferable to the "statin strategy of fixed dose". In a patient with life expectancy of less than three years, statin therapy is dispensable. MALNUTRITION IN THE OLD AGE - SERIOUSLY UNDERVALUED AND UNDERTREATED: Cachexia, sarcopenia and deficiencies in micronutrients can effectively be met by an individualized nutrition therapy. TAVI APT FOR PATIENTS WITH INTERMEDIATE SURGICAL RISK, AS WELL: The SURTAVI trial showed TAVI to be a noninferior alternative to surgery in patients with severe aortic stenosis at intermediate surgical risk. POST-TAVI-ENDOCARDITIS: A NOVEL SYNDROME OF THE AGED PATIENT: Diabetes mellitus and preexisting aortic insufficiency increase the risk. Enterococci and S. aureus trigger every other post-TAVI-endocarditis.


Assuntos
Estenose da Valva Aórtica/cirurgia , Cateterismo Cardíaco , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases
20.
Skin Pharmacol Physiol ; 31(3): 155-162, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29614497

RESUMO

BACKGROUND/AIM: Inadequate fluid intake is assumed to be a trigger of water-loss dehydration, which is a major health risk in aged and geriatric populations. Thus, there is a need to search for easy to use diagnostic tests to identify dehydration. Our overall aim was to investigate whether skin barrier parameters could be used for predicting fluid intake and/or hydration status in geriatric patients. METHODS: An explorative observational comparative study was conducted in a geriatric hospital including patients aged 65 years and older. We measured 3-day fluid intake, skin barrier parameters, Overall Dry Skin Score, serum osmolality, cognitive and functional health, and medications. RESULTS: Forty patients were included (mean age 78.45 years and 65% women) with a mean fluid intake of 1,747 mL/day. 20% of the patients were dehydrated and 22.5% had an impending dehydration according to serum osmolality. Multivariate analysis suggested that skin surface pH and epidermal hydration at the face were associated with fluid intake. Serum osmolality was associated with epidermal hydration at the leg and skin surface pH at the face. Fluid intake was not correlated with serum osmolality. Diuretics were associated with high serum osmolality. CONCLUSIONS: Approximately half of the patients were diagnosed as being dehydrated according to osmolality, which is the current reference standard. However, there was no association with fluid intake, questioning the clinical relevance of this measure. Results indicate that single skin barrier parameters are poor markers for fluid intake or osmolality. Epidermal hydration might play a role but most probably in combination with other tests.


Assuntos
Desidratação/epidemiologia , Ingestão de Líquidos/fisiologia , Concentração Osmolar , Pele/metabolismo , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Diuréticos/administração & dosagem , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Análise Multivariada , Estado de Hidratação do Organismo/fisiologia , Água/metabolismo
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