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Elgg / Städtchen und Umgebung, Switzerland

The demographic shift is leading to a rapid rise in the number of elderly citizens. Accordingly, the number of geriatric problems is also increasing within the population of rheumatic patients. Geriatric patients are characterized through the triad of high age, multimorbidity and functional deficits. Almost all will show signs of arthritis and other degenerative musculoskeletal illnesses. Inflammatory rheumatic diseases within the geriatric population are found to be mostly in the chronic stage or with defective conditions. Problems typical of this population, such as comorbidities especially in the cardiovascular sector, must be assessed prior to the application of therapeutic concepts. The focus is on activating therapies, such as physiotherapy and occupational therapy, where the functional usefulness is proven. The use of thermal therapy, especially applied in the form of heat, as well as electrotherapy and high frequency therapy are also useful when indicated. Balneotherapy and hydrotherapy, as well as massage therapy and lymphatic drainage, must be adapted to the cardiovascular function of geriatric patients; this applies especially to heart failure patients. Physical therapy concepts in elderly rheumatic patients should preferably be implemented and managed by a multidisciplinary geriatric team. © Springer-Verlag 2012. Source

Mau W.,Martin Luther University of Halle Wittenberg | Reuter S.,Geriatrische Klinik
Deutsche Medizinische Wochenschrift | Year: 2011

Considering the increasing disability with higher age and the demographic changes health promotion, prevention and rehabilitation are of high relevance for the maintenance and restoration of activity and participation of the elderly. Among the most important goals of prevention are mobility including physical activity and prevention of falls, adequate nutrition, maintenance of mental health, social integration and function. Different conditions of geriatric rehabilitation in Germany focussing either on acute care hospitals with early rehabilitation (inpatient or outpatient) or on rehabilitation in specialized centres lead to regional disparities. The application for rehabilitation measures has to consider the need, ability to participate, specified goals and prognosis after the interventions. Disease specific rehabilitation has to be differentiated from general geriatric rehabilitation addressing typical multimorbidity and geriatric syndromes. Significant characteristics of geriatric rehabilitation are regular patient oriented discussions within the multi-professional and interdisciplinary team coordinated by geriatricians. This includes prioritizing the patients problems according to their significance and availability of effective therapy, evaluation of the results and adjustment of treatment goals if necessary. Standardised geriatric assessments should be applied. Geriatric rehabilitation including the interdisciplinary team increases function and reduces the risks of nursing home admissions and mortality. Therefore, the access to and the capacities of geriatric rehabilitation should be further improved. © Georg Thieme Verlag KG Stuttgart. Source

Frohnhofen H.,Kliniken Essen Mitte | Frohnhofen H.,Witten/Herdecke University | Hagen O.,Geriatrische Klinik | Heuer H.C.,Kliniken Essen Mitte | And 3 more authors.
Zeitschrift fur Gerontologie und Geriatrie | Year: 2011

Background: In most elderly people, the final-terminal-phase of life is characterized by permanent dependency and a complete inability to perform activities of daily living. Treatment targets usually switch from rehabilitation to palliation. However, the prevalence of the clinical judgment "last phase of life" and its association with in-hospital death is unknown in geriatric patients. Patients and methods: We retrospectively analyzed GEMIDAS data from two geriatric units. Patients without cancer and an in-hospital stay of at least 1 week were included in our study. Prevalence of the terminal phase of life was clinically assessed according to the proposals made by M. Gillick. This clinical judgment was pronounced by the geriatric team after a stay in the hospital of at least 1 week. The clinical judgment took into account all available assessment parameters, as well as the impact of a geriatric treatment trial. In addition, the association between the clinical judgment and the risk of in-hospital mortality was analyzed. Results: Records from 2,433 (56%) patients in hospital A and from 1,912 (44%) patients in hospital B were analyzed. The frequency of a terminal phase of life was 30% and 9% (p<0.01), respectively. The frequency depended on the manner of admission to the hospital. In both hospitals, mortality was significantly higher in terminal patients (27% and 37%) than in other patients (0-8% and 0-6%). In both hospitals, the risk of in-hospital mortality was significantly associated with the clinical judgment (OR 3.1 and 2.7), heart failure (OR 2.2 and 2.1), and dementia (OR 2.0 and 1.8). Age, residency in a nursing home, and the Barthel Index on admission were all without relevant impact. Conclusion: The frequency of the clinical construct "terminal phase of life" varies in geriatric units between 9% and 30%. This clinical construct is significantly associated with increased in-hospital mortality. Therefore, this construct possesses external validity. Further studies are needed in order to assess the significance of such a clinical judgment, the associations with clinical burdens of symptoms, and the supply structure required to cover the needs of patients and their families. © 2011 Springer-Verlag. Source

Vogt L.,Goethe University Frankfurt | Lucki K.,Goethe University Frankfurt | Bach M.,Geriatrische Klinik | Banzer W.,Goethe University Frankfurt
Journal of Rehabilitation Research and Development | Year: 2010

In a quasi-experimental preand postdesign, we examined the effect of rollator use on functional rehabilitation outcome in geriatric patients. From a sample of 458 geriatric inpatients, we matched 30 subjects who were not using assistive devices in their everyday lives but received a wheeled walker at the time of hospital admission (first-time user group) according to their admission scores on three motor performance tests (Timed Up-and-Go, Five-Times-Sit-to-Stand, and Performance-Oriented Mobility Assessment-Balance) with 30 patients who were actively using rollators as their primary walking aid for at least 3 months (long-term user group) and 30 control subjects without walking-aid assistance. Measurements were repeated after the inpatient rehabilitation regimen. The Kruskal-Wallis test did not reveal significant group differences in rehabilitation progress. Controls and device users, regardless of walking-aid experience, demonstrated nearly comparable mobility, strength, and balance improvements. More than half of each cohort (controls, n = 22; first-time, n = 17; long-term, n = 18) achieved functional gains in all three motor tests. The study showed that rollator assistance does not interfere with rehabilitation outcome and, to some extent, legitimates the prescription of assistive devices to improve confidence and restore or maintain motor ability at the highest possible level. Source

Singler K.,Abteilung fur Geriatrie | Singler K.,Friedrich - Alexander - University, Erlangen - Nuremberg | Thiem U.,Ruhr University Bochum | Christ M.,Klinik fur Notfall und Internistische Intensivmedizin | And 4 more authors.
Zeitschrift fur Gerontologie und Geriatrie | Year: 2014

Background: The prevalence of delirium in hospitalized patients is high, but delirium is frequently not identified by treating physicians in emergency departments (EDs). Although the number of elderly patients admitted to EDs is increasing, no data on prevalence, identification and outcome of delirious elderly patients in German EDs exist.Objectives: To evaluate the prevalence and identification of delirium in elderly patients in a German ED and to identify characteristics of delirium in elderly ED patients.Methods: Evaluation of data from a prospective single-center observational study. The study was conducted in the interdisciplinary ED of an urban university-affiliated hospital receiving approximately 80,000 visits per year. The shortened Confusion Assessment Method (CAM) was used to screen 133 consecutive ED patients, aged 75 years and older, for delirium. Comorbid conditions were ascertained by patient interview and review of medical records. Data concerning patient mortality and current living status were collected 28 days after the ED visit in a structured telephone interview.Results: A positive CAM result was recorded in 14.3 % of cases; 68.4 % of these CAM-positive patients were not identified as being delirious by the ED physician. The 28-day mortality was higher among patients with delirium. Dependency on external help, polypharmacy, pre-existing cognitive or mobility impairments and the presence of any care level were strongly associated with delirium.Conclusion: Elderly patients with known risk factors should be routinely assessed for delirium in the ED with a standardized assessment tool such as the CAM. © 2014, Springer-Verlag Berlin Heidelberg. Source

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