Geriatric assessment in the inpatient sector : 20 years quality assurance of the Geriatrics in Bavaria Database.

BACKGROUND: Geriatric assessment is an integral part of geriatrics and leads to various improvements in the treatment of geriatric patients. MATERIAL AND METHODS: Analysis of assessment data and patient characteristics in a large inpatient geriatric patient population. Evaluation of data from the Geriatrics in Bavaria Database (GiB-DAT) over 20 years as well as a cross-sectional study from 2020. Presentation of data for patients in inpatient acute geriatrics as well as continuing geriatric rehabilitation. RESULTS: The number of patient records and participating hospitals has steadily increased for both inpatient care types to 821,913 (status 31 March 2021). The Barthel index and other assessment results show differentiated values between acute geriatrics and continuing geriatric rehabilitation. CONCLUSION: The results demonstrate the differences in patient outcomes between the two types of care as well as changes in the setting over time. The constancy of the applied assessment instruments contributes to the comparability of the different hospitals; however, it is necessary to introduce new and alternative assessment instruments and to further develop inpatient geriatrics.

[German translation of the performance-oriented mobility assessment according to Tinetti]. / Deutsche Übersetzung des "Performance-Oriented Mobility Assessment" nach Tinetti.

BACKGROUND: In clinical research as well as good clinical practice increasing importance is placed on standardized and evaluated procedures. They provide information which is important for the prognosis, determination of the need for interventions, determination of treatment goals and evaluation of treatment approaches and outcomes. Furthermore, they serve as justification of the reimbursement for presentation to official bodies. Until now no officially authorized German version of the performance-oriented mobility assessment (POMA) according to Tinetti was available. OBJECTIVES: This article presents a methodically translated German version of the POMA that also includes so far partially unpublished instructions for the examiner and the examined person. MATERIAL AND METHODS: The internationally recognized recommendations for the cross-cultural adaptation of health status measures served as the foundation of the translation process. By means of three translations from the original language into the target language a preliminary consensus version was developed, which was then translated back into the original language by two native speakers. RESULTS AND CONCLUSION: With this new and for the first time authorized German translation of the POMA a version of this assessment is available that achieves unification and standardization in German speaking countries and guarantees an improved comparability with international studies.

Evaluation of the nutritional status of older hospitalised geriatric patients: a comparative analysis of a Mini Nutritional Assessment (MNA) version and the Nutritional Risk Screening (NRS 2002).

BACKGROUND: The present study aimed to evaluate a short-form (MNA-SF) version of the Mini Nutritional Assessment (MNA), in which some of the items were operationalised, based on scores from tools used for a comprehensive geriatric assessment, as a method for analysing the nutritional status of hospitalised geriatric patients. We compared this MNA-SF version with the corresponding MNA long-form (MNA-LF) and Nutritional Risk Screening 2002 (NRS 2002) in terms of completion rate, prevalence and agreement regarding malnutrition and/or the risk of this. METHODS: In total, 201 patients aged ≥65 years who were hospitalised in geriatric wards were included in this analysis. RESULTS: The MNA-SF, MNA-LF and NRS 2002 were completed in 98.0%, 95.5% and 99.5% of patients (P = 0.06), respectively. The MNA-SF, MNA-LF and NRS 2002 categorised 93.4%, 91.1% and 66.0% of patients as being malnourished or at risk of being malnourished (P < 0.001). Agreement between the MNA-SF and MNA-LF was substantial (κ = 0.70, P < 0.001). No agreement between the MNA-SF and NRS 2002 was found (κ = -0.12, P < 0.001). Interestingly, NRS 2002 part 1 (prescreening) revealed a false negative rate of 21.0% (only in patients aged ≥70 years who showed moderate disease severity) in relation to the NRS 2002 part 2. CONCLUSIONS: The MNA-SF version emerged as a useful tool for evaluating the nutritional status of hospitalised geriatric patients. The NRS 2002 part 1 showed limited value as a prescreening aid in relation to the NRS 2002 part 2 in the same group of patients.

Prediction of future falls in a community dwelling older adult population using instrumented balance and gait analysis.

BACKGROUND: The role of instrumented balance and gait assessment when screening for prospective fallers is currently a topic of controversial discussion. OBJECTIVES: This study analyzed the association between variables derived from static posturography, instrumented gait analysis and clinical assessments with the occurrence of prospective falls in a sample of community dwelling older people. METHODS: In this study 84 older people were analyzed. Based on a prospective occurrence of falls, participants were categorized into fallers and non-fallers. Variables derived from clinical assessments, static posturography and instrumented gait analysis were evaluated with respect to the association with the occurrence of prospective falls using a forward stepwise, binary, logistic regression procedure. RESULTS: Fallers displayed a significantly shorter single support time during walking while counting backwards, increased mediolateral to anteroposterior sway amplitude ratio, increased fast mediolateral oscillations and a larger coefficient (Coeff) of sway direction during various static posturography tests. Previous falls were insignificantly associated with the occurrence of prospective falls. CONCLUSION: Variables derived from posturography and instrumented gait analysis showed significant associations with the occurrence of prospective falls in a sample of community dwelling older adults.

[Implementation and results of a geriatric medication database]. / Aufbau und Ergebnisse einer geriatrischen Medikamentendatenbank.

BACKGROUND: The aim of this project was to obtain information about drug therapy in geriatric units. PATIENTS AND METHODS: Members of the geriatrics in Bavaria database (GiB-DAT) collected data on discharge medication and transferred them to the database. A total of 88,840 data sets of geriatric rehabilitation clinics and acute geriatric units were evaluated according to the anatomical therapeutic chemical (ATC) system. RESULTS: Patients (mean age: 81.1 years, female 67.7%) had an average of 10.4 diagnoses and took 8.0 drugs at discharge. A peak number of prescribed drugs was reached at the age of 60-70 years with a decrease in the following decades of life. Female patients received more drugs, significantly those in the decades from 71 to 80 and 81 to 90 years old. The bulk of the drugs were from the ATC groups "Cardiovascular system" (89.9%), "Nervous system" (82.3%) and "Alimentary tract and metabolism" (78%).

[Reliability of static posturography in elderly persons]. / Reliabilität der statischen Posturografie bei älteren Personen.

BACKGROUND AND OBJECTIVE: Static posturography is used to quantify body sway. It is used to assess the balance of elderly persons who are prone to falls. There is still no general opinion concerning the reliability of force platform measurements. The aim of this study was to test the reliability of force platform parameters when measuring elderly persons. PROBANDS AND METHODS: The reliability of 11 force platform parameters was tested measuring 30 elderly persons. The following parameters were calculated: mean speed of center of pressure displacement in mm/s, length of sway in mm, sway area in mm(2), amplitudes of center of pressure movement, the axis of oscillation in degrees and the person's angles of inclination in degrees. Three measurements were taken on the same day, with a resting period of 2 min. Four different test conditions were used: normal standing and narrow stand with eyes open and eyes closed, respectively. Reliability was determined by using intraclass correlation coefficients. RESULTS: Six parameters had excellent reliability with a correlation coefficient of >0.9: mean speed of center of pressure movement during narrow stand, area of sway during narrow stand, length of sway during normal and narrow stand, and the angle of inclination in the sagittal plane during normal stand and narrow stand. The condition "narrow stand eyes closed" proved to be the most reliable test position. CONCLUSION: Six parameters proved to have excellent reliability and are recommended to be used in further investigations. Narrow stand with eyes closed should be used as the test position. The tested protocol proved to be reliable. Whether these parameters can be used to predict falls in elderly persons remains to be investigated.

Dizziness in an older community dwelling population: a multifactorial syndrome.

OBJECTIVES: The aim of this study was to determine the prevalence and related predictors of dizziness in a sample of community-dwelling people 65 years of age and older living in a metropolitan area in Germany. DESIGN: Prospective cohort study. SETTING: Interdisciplinary Centre of Gerontology at the University of Erlangen- Nuremberg, Germany. PARTICIPANTS: 6000 people aged 65 years and older recruited and randomized from the registration office, 1801 were fully evaluated at baseline and were re-evaluated in a prospective follow-up two years later. A full data set was obtained for 620 participants, of which 297 (47.9%) were females. Mean age was 73.45 +/- 6.05. 200 participants (32.4%) were 65-69 years, 315 (51%) were 70-79 years, 92 (14.9%) 80-89 years and 11 (1.8%) 90 years and older. MEASUREMENTS: Demographic, medical, functional and psychological factors were measured by a standardised questionnaire in 2004. In a follow-up survey participants were reevaluated in a prospective design two years later (2006), including a dizziness questionnaire, containing frequency, duration, space of dizziness and releasing positions and activities. RESULTS: At the second measurement 181 persons (29.2%) reported dizziness in the last 6 months. Dizziness was age dependent, with a prevalence of 27% in participants aged 70 years and younger, up to 54% in the group of 90 years and older. 96 (68.2%) persons reported daily or weekly dizziness. 46 (27.9%) participants reported multiple sensations of dizziness. In 108 (59.7) persons dizziness was released by multiple positions or activities. The main predictors of dizziness were age, female gender, cardiovascular disease, osteoporosis, depression, sleep disorder, disturbance of memory, shortsightedness (defined by glasses), incontinence, 3 and more medical conditions, 4 and more medications, poor health status, falls and mobility problems. We found similar risk factors for dizziness and falls. CONCLUSION: Dizziness is a very common symptom in older community dwelling persons. Comorbidity, poor health status and mobility problems are strong medical predictors; age and female gender and decline in mobility are important predictors as well. Our study suggests, that dizziness in older age is often caused by multifactorial medical and functional conditions. Gait disorders and mobility problems also seem to play an important role in dizziness among older people. Therefore, interventions in dizziness should be developed in a multifactorial way. We suggest, that the interventions to be tested first, should be those that have been previously successful in older persons with gait disorders and falls.

Predictors for occasional and recurrent falls in community-dwelling older people.

BACKGROUND: Little is known about the prevalence of falls and the related risk factors in the general population of community-living older people in Germany. OBJECTIVES: To assess the prevalence and related predictors of different types of falls in a sample of community-dwelling 65 years and older people in Germany living in a metropolitan area. Study design and setting prospective cohort study in 622 community dwelling people aged > or =65 years. RESULTS: A total of 107 persons (17.2%) reported falling at least once (occasional fallers), while 36 (5.7%) experienced two or more falls (recurrent fallers) in the last 6 months. Main predictors for all fallers were age (OR 1.8; 95% CI 1.1-3.0), being female (OR 1.7; 95% CI 1.1-2.2), living alone (OR 1.9; 95% CI 1.2-2.9), poor health status (OR 3.3; 95% CI 2.1-5.3), varifocals (OR 1.7; 95% CI 1.0-3.1), disturbance of memory (OR 1.7; 95% CI 1.0-3.0), depression (OR 4.8; 95% CI 2.5-9.2), sleep disturbances (OR 2.7; 95% CI 1.7-4.3), incontinence (OR 2.1; 95% CI 1.3-4.9), dizziness (OR 3.0; 95% CI 1.9-5.0), 3 medical conditions or more (OR 3.3; 95% CI 2.1-5.1), lower physical functioning and mobility. Two of the strongest predictors were reported falls (OR 4.9; 95% CI 3.1-7.7) and recurrent falls (OR 10.0; 95% CI 5.0-20.0) in the last 6 months. CONCLUSION: Older adults living at home should be screened for falls in history and problems in gait and mobility in any anamnesis to identify those who are at risk for falls.

[Mobility and safety for elderly (MoSi), a new intervention to improve mobility and gait in elderly people]. / Mobilität und Sicherheit im Alter (MoSi), ein neues Trainingsprogramm zur Verbesserung der Mobilität und Gangsicherheit bei Senioren.

BACKGROUND: "Mobility and safety for the elderly (MoSi)") is a new intervention, especially designed for elderly people with gait disorders and for fallers. METHOD: 165 persons, 65 years or older, participated in this study.The participants were assessed prior to and after the 5-week intervention. The intervention included various elements of strength and balance training, stretching, reaction and coordination training, and information. The participants were instructed about how to prevent falls and what measures to take after a fall has occurred. Furthermore, they were taught home exercises. The intervention was set in an ambulatory physiotherapy department and consisted of 10 training sessions. RESULTS: Participants reported improved performance of gait (66 %), gait security (66 %), power (65 %), balance (62 %), sense of security (61 %) capacity (70 %) and well being (63 %).The Berg Balance Scale and the Balance test of the "Tinetti Balance Scale" showed significant improvements (p<.001). The Timed Up and Go Test, the gait test of the Tinetti Balance Scale showed improvements in persons with very impaired gait (p<.005). The Repeated Chair Stands Test showed no significant improvements. 137 (95 %) of the participants stated they would continue the exercises at home, 112 (79 %) stated they would continue the exercises under therapeutic supervision. DISCUSSION: The results show that the intervention is able to improve mobility and gait of elderly persons, subjectively and objectively, especially of persons with impaired gait. The motivation effect of the intervention was high which was marked by the large number of participants which wanted to continue their exercises at home. Furthermore, the intervention resulted in participants reporting improvements in other parameters such as capacity and well being. CONCLUSION: The intervention is able to improve important measures of balance in community dwelling older people. However, the effect on the number of falls still has to be investigated. The intervention is suitable for an ambulatory setting and shows significant effects after a short time. Due to the intervention's compactness it is appropriate for persons who normally would avoid training programs because of the duration.

Women encounter ADRs more often than do men.

BACKGROUND: Several publications indicate that the female gender experiences a higher incidence of adverse drug reactions (ADRs) than does the male gender. The reasons, however, remain unclear. Gender-specific differences in the pharmacokinetic and pharmacodynamic behaviour of drugs could not be identified as an explanation. The aim of this study was to analyse ADR risk with respect to gender, age and number of prescribed drugs. METHODS: A prospective multicenter study based on intensive pharmacovigilance was conducted. Information on patient characteristics and evaluated ADRs was stored in a pharmacovigilance database--KLASSE. RESULTS: In 2,371 patients (1,012 female subjects), 25,532 drugs were prescribed. In 782 patients, at least one ADR was found. A multivariate regression analysis adjusting for age, body mass index (BMI) and number of prescribed drugs showed a significant influence of female gender on the risk of encountering ADRs [odds ratio (OR) 1.596, confidence interval (CI) 1.31-1.94; p < 0.0001). Dose-related ADRs (51.8%) were the dominant type in female subjects. Comparing system organ classes of the World Health Organisation (SOC-WHO), cardiovascular (CV) ADRs were particularly frequent in female subjects (OR 1.92, CI 1.15-3.19; p = 0.012). CONCLUSION: Our data confirm the higher risk of ADRs among female subjects compared with a male cohort. Several explanations were investigated. No single risk factor could be identified.

High-Technology Based Gait Assessment in Frail People: Associations between Spatio-Temporal and Three-Dimensional Gait Characteristics with Frailty Status across Four Different Frailty Measures.

OBJECTIVE: We analyzed associations between a battery of gait characteristics and frailty status across four different frailty instruments in old patients. DESIGN: Cross-sectional study. SETTING: Geriatric wards of a general hospital. PARTICIPANTS: 123 hospitalized patients aged ≥65 years. MEASUREMENTS: Spatio-temporal and three-dimensional gait characteristics were assessed by an electronic walkway and a shoe-mounted, inertial sensor-based mobile gait analysis system. Frailty status was assessed by the frailty phenotype (FP), Clinical Frailty Scale (CFS), frailty index (FI), and frailty index based on a comprehensive geriatric assessment (FI-CGA). RESULTS: A reduction in walking speed (FP, FI, FI-CGA), stride length (FP, FI, FI-CGA), maximum toe clearance (FP, CFS, FI, FI-CGA), toe off angle (FP, CFS, FI, FI-CGA), heal strike angle (FI-CGA) and greater stride length variability (FP, CFS, FI, FI-CGA), stride time variability (FP, FI), double support time (FP, FI), and stride width (CFA, FI-CGA) were associated with frailty status across the four frailty instruments (all P < 0.05, respectively). Walking speed (FP, CFS, FI, FI-CGA), stride length (FP, CFS, FI, FI-CGA), maximum toe clearance (FP, CFS, FI, FI-CGA), toe off angle (FP, CFS, FI, FI-CGA), heal strike angle (FP, FI), stride length variability (CFS, FI, FI-CGA), stride time variability (FI), double support time (FP), and stride width (FP, CFS, FI) were related with frailty severity across the four frailty instruments independent of age and sex (all P adjusted < 0.05, respectively). CONCLUSIONS: Gait changes in frail patients include more than solely a reduction in walking speed.

Prediction of one-year mortality by five different frailty instruments: A comparative study in hospitalized geriatric patients.

BACKGROUND: Data comparing the ability of different major frailty instruments for predicting mortality in hospitalized geriatric patients are scare. MATERIAL AND METHODS: 307 patients ≥65years who were hospitalized on geriatric wards were included in this prospective analysis. A fifty-item frailty index (FI), a ten-domain+co-morbidity frailty index based on a standardized comprehensive geriatric assessment (FI-CGA), the nine category Clinical Frailty Scale (CFS-9), the CSHA rules-based frailty definition (CSHA-RBFD), and the frailty phenotype (FP) were assessed during the patients' hospital stays. Patients were followed up over a one-year period. RESULTS: Follow-up data after one year could be obtained from 305 out of the 307 participants. Sixty two participants (20.3%) had died after that time. The FI, FI-CGA, CFS-9, CSHA-RBFD, and FP could all discriminate between patients who died and those who survived during follow-up (areas under the ROC curves: 0.805, 0.808, 0.852, 0.703 and 0.757, all P<0.001, respectively). The CFS-9 showed a better discriminative ability for one-year mortality compared to the FI, FI-CGA, CSHA-RBFD, and FP (all P<0.05, respectively). The FI and the FI-CGA did not differ in their discriminative ability for one-year mortality (P=0.440). The CSHA-RBFD and the FP demonstrated a comparable discriminative ability (P=0.241) and, when compared to the CFS-9, FI, and FI-CGA, an inferior discriminative ability for one-year mortality (all P<0.05, respectively). CONCLUSION: Among those frailty instruments that were evaluated, the CFS-9 emerged as the most powerful for prediction of one-year mortality.

A comparison of Frailty Indexes Based on a Comprehensive Geriatric Assessment for the Prediction of Adverse Outcomes.

OBJECTIVE: To compare the ability of different frailty indexes based on a standardized comprehensive geriatric assessment (FI-CGAs) for predicting adverse outcomes. DESIGN AND SETTING: Prospective cohort study. Geriatric wards of a general hospital. PARTICIPANTS: 307 hospitalized patients ≥ 65 years. MEASUREMENTS: The FI-CGA-10D (potential health deficits in ten functional domains), the FI-CGA-10D+CM (aforementioned potential health deficits and co-morbidity burden) and the FI-CGA-MIHD (multiple, individual potential health deficits, including functional deficits, co-morbid diseases, amongst others) were assessed at baseline during the patients` hospital stay. The FI-CGAs were analyzed as categorical (according to a FI-CGA score < and ≥ 0.25) and continuous variables. Patients were followed up over 6 months. RESULTS: The FI-CGA-10D, FI-CGA-10+CM and the FI-CGA-MIHD predicted 6-month mortality when expressed as categorical (area under the receiver operating characteristic curve (AUC): AUC = 0.611, AUC = 0.637, AUC = 0.616, all p < 0.050, respectively) or continuous variables (AUC = 0.769, AUC = 0.837, AUC = 0.834, all p < 0.001, respectively). AUC comparisons showed that all three FI-CGAs exhibited a comparable ability to predict 6-month mortality when the FI-CGAs were expressed as categorical variables (all p > 0.200) and the FI-CGA-10D+CM and the FI-CGA-MIHD showed a better ability to predict 6-month mortality than the FI-CGA-10D, when the FI-CGAs were expressed as continuous variables (p < 0.001 and p = 0.007, respectively). None of the FI-CGAs predicted any of the other outcomes, i.e., unplanned re-admission to hospital and a fall during follow-up, irrespective of whether the FI-CGAs were expressed as categorical or continuous variables (all p ≥ 0.050). CONCLUSIONS: The more complex FI-CGAs, i.e., the FI-CGA-10D+CM and the FI-CGA-MIHD, revealed better ability to predict 6 month mortality than the more simple FI-CGA, i.e., the FI-CGA-10D.

Analysis of Rockwood et Al's Clinical Frailty Scale and Fried et Al's Frailty Phenotype as Predictors of Mortality and Other Clinical Outcomes in Older Patients Who Were Admitted to a Geriatric Ward.

OBJECTIVES: There are few data regarding the accuracy of short frailty tools as predictors of mortality and other clinical outcomes of older patients admitted to a geriatric ward. We therefore analyzed the accuracy of Rockwood et al's Clinical Frailty Scale and an easy and quick to perform operationalization of Fried et al's frailty phenotype, as predictors of mortality and other clinical outcomes in our cohort of patients. DESIGN: Prospective analysis with a follow-up period of 6 months. SETTING AND PARTICIPANTS: 307 patients who were 65 years of age or older were included in the study. The patients were assessed in terms of the two frailty measures during their stay in a geriatric ward. RESULTS: The Clinical Frailty Scale and the frailty phenotype were both suitable for differentiating between patients who died due to any cause from those who survived during follow-up (primary outcome) (area under the ROC curves (AUC) values 0.867 (95% CI 0.807-0.926), p<0.001 and 0.754 (95% CI 0.688-0.821), p<0.001, respectively). Regarding the secondary outcomes: 1. unplanned admission to hospital and 2. a fall during follow-up, the Clinical Frailty Scale discriminated or tended to discriminate between patients to whom these criteria applied and those to whom they did not (AUC=0.569 (95% CI 0.502-0.636), p=0.046 and AUC=0.574 (95% CI 0.501-0.647), p=0.071, respectively). The frailty phenotype did not show such a differentiation when applied to secondary outcomes (AUC=0.500 (95% CI 0.432-0.568), p=0.994 and AUC=0.518 (95% CI 0.439-0.598), p=0.658, respectively). CONCLUSIONS: Both short frailty instruments are suitable predictors of mortality in older patients who were admitted to a geriatric ward. The Clinical Frailty Scale, but not the frailty phenotype, predicted at least some of the secondary outcomes, i.e., the outcome unplanned admission to hospital during follow-up.

[Cardiopulmonary normal values in geriatrics]. / Kardiopulmonale Normwerte in der Geriatrie.

Because of age-related modifications of the heart, lung, and circulation, several cardiopulmonary parameters present altered normal and reference values with increasing age. Other parameters, for example, arterial blood pressure, change only insignificantly with age. In older age groups it is more difficult to establish reference ranges and values because of the lack of "healthy" subjects. To establish cardiopulmonary parameters, appropriate investigations for the age group, for example, treadmill-ergometer, should be preferred. In judging if a value resulting out of the reference range is to be considered really pathologic, other factors are to be taken into account, such as circadian variations, motivation, associated pathologies as well as the actual physical and psychological conditions, when we are dealing with older subjects or patients.

A prospective community-based study of stroke in Germany--the Erlangen Stroke Project (ESPro): incidence and case fatality at 1, 3, and 12 months.

BACKGROUND AND PURPOSE: In Germany, basic data on stroke morbidity are lacking. If a population-based register in former East Germany is excluded, only routine mortality statistics have thus far provided information on epidemiology of stroke. Therefore, a population-based register of stroke was set up in Southern Germany to determine incidence and case fatality in a defined German population. METHODS: The Erlangen Stroke Project (ESPro) is a prospective community-based study among the 101 450 residents of the city of Erlangen, Bavaria, Germany. Standard definitions and overlapping case-finding methods were used to identify all cases of first-ever stroke in all age-groups, occurring in the 2 years of registration (April 1, 1994, to March 31, 1996). All identified cases of first-ever strokes were followed up at 3 and 12 months from onset. RESULTS: During 2 years of registration, 354 first-ever-in-a-lifetime strokes (FELS) were registered. The diagnosis and stroke type were confirmed by CT scan in 95% of cases. Fifty-one percent of all FELS occurred in the age group >/=75 years of age. The crude annual incidence rate was 1.74 per 1000 (1.47 for men and 2.01 for women). After age-adjustment to the European population, the incidence rate was 1.34 per 1000 (1.48 for men and 1. 25 for women). The annual crude incidence rate of cerebral infarction was 1.37/1000, intracerebral hemorrhage 0.24/1000, subarachnoid hemorrhage 0.06/1000, and unspecified stroke 0.08/1000. Overall case fatality at 28 days was 19.4%, at 3 months it was 28.5%, and at 1 year 37.3%. CONCLUSIONS: The first prospective community-based stroke register including all age groups in Germany revealed incidence rates of stroke similar to those reported from other population-based studies in western industrialized countries, but lower than that observed in former East Germany.