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Das Vorliegen eines sog. Frailty-Syndroms („Gebrechlichkeit“) ist für den postoperativen Verlauf ein entscheidender Faktor. So kommt es, auch durch eine zunehmende Fokussierung auf die patientenzentrierte Versorgung, zu einer erhöhten Nachfrage nach Instrumenten, die den Patient*innenstatus umfassender beurteilen und Krankheitsverläufe vorhersagen können. Der Beitrag stellt die 3 führenden Modelle zur Frailty-Diagnostik vor.

Frailty Syndrome has been recognized in several settings as a major predictor of negative outcomes. A frailty diagnosis can have important consequences for clinical decision-making and provides the opportunity to implement preventive strategies. Despite its importance, a gold standard for the diagnosis of frailty is still lacking. There are distinct frailty models and a large number of assessments are available, and they vary greatly in terms of time, training, and equipment necessary, but also on their relevance to specific outcomes. Diagnostic tools must be based on the resources available and on their relevance for the particular setting. The current review offers insights on current models and the most successful diagnostic instruments used in the anesthesia, intensive care, emergency, and palliative settings.

With increasing frailty and complaint-oriented utilization of dental care, the prevalence of oral diseases also increases.To clarify whether there is a need for dental prosthodontic treatment during residential acute geriatric rehabilitation.Within 3 weeks in a hospital for acute geriatric patients, 79 out of 157 newly admitted patients were interviewed as study participants (age: median 79.0 years, range 66-96 years, female 51.9%), dental findings were recorded, treatment needs were determined but X‑rays were not taken.Of the participants 31.1% had not seen a dentist for more than 1 year and 18.2% were edentulous. The median number of teeth in dentate participants was 16 (range 1-28 teeth); based on all participants, there was a median of 12.0 teeth (range 0-28 teeth). Of the 52 denture wearers (45 upper jaw and 43 lower jaw), 5 each of the maxillary and mandibular dentures could not be assessed because they were not available at the hospital. Moderate denture deficiencies were present in 62.5% of participants wearing upper dentures (mandibular 55.3%).Dental treatment is needed in this vulnerable patient group. Therefore, the oral cavity should be assessed as part of the geriatric assessment. The available data confirm that the use of validated assessment instruments, such as the mini dental assessment as part of the comprehensive geriatric assessment would be useful. In addition to an oral examination, simple dental treatment should be provided to reduce infections and improve chewing ability. The geriatrician should be informed of the urgency of treatment. The overall rehabilitative approach of acute geriatric treatment would be complete if oral health would not be excluded.HINTERGRUND: Mit zunehmender Gebrechlichkeit und beschwerdeorientierter Inanspruchnahme des Zahnarztes steigt auch die Prävalenz von Erkrankungen der Mundhöhle. ZIEL: Es soll geklärt werden, ob ein zahnärztlich-prothetischer Behandlungsbedarf während einer stationären akutgeriatrischen Rehabilitation besteht.Innerhalb von 3 Wochen wurden in einem Krankenhaus für Akutgeriatrie von 157 neuaufgenommen Patienten 79 als Studienteilnehmende (Altersmedian: 79,0 Jahre, Range: 66–96 Jahre, davon Frauen: 51,9 %) strukturiert interviewt, ein zahnärztlicher Befund aufgenommen und der Behandlungsbedarf dann abgeleitet. Röntgenbilder wurden nicht erstellt.Von den Studienteilnehmenden waren 31,1 % länger als ein Jahr nicht beim Zahnarzt, 18,2 % waren zahnlos. Die mittlere Zahnzahl der bezahnten Studienteilnehmenden betrug 16 Zähne (Range: 1–28), bezogen auf alle Teilnehmenden waren im Mittel 12 Zähne (Range: 0–28) vorhanden. Von den 52 Prothesenträgern (45 im Oberkiefer; 43 im Unterkiefer) konnten jeweils 5 Prothesen des Ober- und Unterkiefers nicht beurteilt werden, da sie im Krankenhaus fehlten. Bei 62,5 % der Studienteilnehmenden, die im Oberkiefer eine Prothese tragen (Unterkiefer: 55,3 %) lagen mäßige Mängel am Zahnersatz vor.Bei dieser vulnerablen Patientengruppe besteht zahnärztlich-prothetischer Behandlungsbedarf. Die Mundhöhle sollte daher im Rahmen des Geriatrischen Assessments befundet werden. Die vorliegenden Daten bestätigen, dass der Einsatz validierter Assessment-Instrumente, wie z. B. das Mini-Dental-Assessment als Teil des Comprehensive Geriatric Assessment sinnvoll wäre. Aus der Erhebung des oralen Befundes können sich während der geriatrischen Behandlung einfache zahnärztliche Behandlungen zur Reduktion von Infektionen und zur Verbesserung der Kaufähigkeit anschließen. Der Geriater sollte zur Therapiedringlichkeit informiert werden. Der gesamtrehabilitative Ansatz einer akutgeriatrischen Therapie wäre vervollständigt, wenn die Gesundheit der Mundhöhle nicht ausgeschlossen würde.

Aims Adequate medication management is a key condition to ensuring effective pharmacotherapy. However, it is well acknowledged that older people may encounter difficulties self-administering medicines in a correct manner. Methods A mixed method pilot study was performed to investigate medication self-management in older and multimorbid patients with polypharmacy. The pilot study involved medication management tasks followed by semi-structured interviews in 20 patients. The tasks and interviews were based on the patients' individual medication plans, which had been prepared earlier by the pharmacy for each patient on basis of all their prescriptions. Results The patients' self-reported medication management skills differed from their actual observed medication management performance. In addition, the routines and coping strategies used by the patients to deal with the complexity of their overall medication regimen were not in accordance with the medication plan and the instructions for use on the product labels. Issues were observed on all stages of the medication process that can be considered relevant to patient adherence, especially medication plan recall, product identification, product selection, product handling and product recognition in a multicompartment compliance aid. Conclusions The pilot study suggested that medication management issues by older and multimorbid patients remain widely undetermined and unrecognized in primary care. Further investigation and interdisciplinary collaboration will be required to resolve the user problems and ensure adequate patient adherence.

Unter Sarkopenie versteht man den altersassoziierten Verlust an Muskelmasse und -funktion, der mit zunehmendem Ausmaß erhebliche klinische Relevanz besitzt, z. B. was die selbstständige Ausführung der Aktivitäten des täglichen Lebens angeht. Mittlerweile existieren ein ICD-10-CM-Code und mehrere von Fachgesellschaften und in Konsensusdokumenten festgeschriebene diagnostische Kriterien. Die vorliegende Arbeit gibt einen Überblick über die Prävalenz, die zugrunde liegende Pathophysiologie sowie die Folgen der Sarkopenie. Ein weiterer Schwerpunkt sind die Methoden und Problemstellungen in der Diagnostik und die nach aktuellem Kenntnisstand möglichen therapeutischen Ansätze.

Research regarding effective collaboration and communication between professional caregivers and dermatologists and the need for further education and training for caregivers in the field of geriatric dermatology still remains relatively scarce. To document the state of knowledge of professional caregivers in the field of geriatric dermatology and make recommendations for dermatological education and postgraduate training. A questionnaire with open and closed questions was used to evaluate the level of knowledge and current need for information in geriatric dermatology. A total of 58 professional caregivers from several hospital departments, including geriatric wards and nursing homes participated in this study. Quantitative and qualitative data were generated and responses to open questions were categorized according to the most quoted contents. The study was approved by the Charite University in Berlin ethics committee. The study demonstrates that there is a lack of dermatological knowledge. Participants indicated a huge information need regarding skin tumors (77.2 %), prevention of skin diseases (50.0 %) and pruritus (41.4 %). According to the caregivers, communication problems with physicians arise in view of using standardized terms of skin diseases (22.9 %) and formulating unclear care records of skin diseases (20.8 %). Difficulties in communication between professional caregivers and physicians can influence patients’ punctual and well-founded treatment; therefore, further education must be mediated vividly and practically. Moreover, training should focus on learning standardized terms and descriptions for optimizing the flow of information with physicians and written communication, such as care records.

Background Postoperative delirium (POD) is a common complication after surgery. Objective We sought to determine the association between preoperative anticholinergic load calculated using the anticholinergic drug scale (ADS) and POD in cancer patients over 65 years of age. Design A retrospective sub-investigation of a randomised controlled interventional trial. Setting Two tertiary university hospitals. Patients Overall, patients aged 65 years and older scheduled for surgical treatment of gastrointestinary, genitourinary or gynaecological cancers. Main outcome measures The primary outcome was the interaction between anticholinergic drug scale and occurrence of postoperative delirium. Patient clinical parameters and ADS scores were assessed preoperatively. POD screening was conducted for a total of 7 days following surgery using validated measures. Independent associations between ADS and POD were assessed using multivariate logistical regression analyses. Results A total of 651 patients (mean age, 71.8 years; 68.5% males) were included. Of those, 66 patients (10.1%) developed POD. The ADS score was independently associated with the occurrence of POD (higher ADS per point OR 1.496; 95% CI 1.09–2.05; p = 0.01). Additionally, age (per year OR 1.06; CI 95% CI 1.01–1.11; p = 0.03) and ASA state (OR 2.16; 95% CI 1.22–3.83; p = 0.01), as well as stay on ICU (yes vs. no OR 2.8; 95% CI 1.57–4.998; p Conclusions ADS assessment according to chronic medication use is a cost-effective, non-invasive method of identifying elderly cancer patients at risk for POD. Trial registry: www.clinicaltrials.gov . Identifier NCT01278537 . Ethics: IRB of Charite University-Medicine Berlin, Germany; EA2/241/08.

Sarcopenia describes the age-associated loss of muscle mass, strength and function. The aim of this study was to compare the prevalence of sarcopenia in a cohort of community dwelling elderly people living in Berlin, Germany, according to the criteria proposed by current consensus statements and to study the respective impact on self-reported physical performance. This study included 1405 participants from the Berlin aging study II (BASE-II). The appendicular skeletal muscle mass index (SMI) was assessed with dual energy X-ray absorptiometry (DXA), muscle strength was measured by hand grip strength and the timed up and go” test (TUG) was performed as a functional parameter to reflect mobility. The prevalence of sarcopenia was 24.3 % in terms of reduced SMI only and considerably lower for sarcopenia with reduced grip strength (4.1 %) and sarcopenia with limited mobility (2.4 %). Only 0.6 % of the participants fulfilled all three criteria. Of the subjects with a normal SMI, 8.6 % had reduced grip strength and 5.1 % had limited mobility, whereas 1.3 % subjects fulfilled both criteria. Participants with reduced strength or function reported severe difficulties in performing physical tasks significantly more often than participants with normal or reduced SMI alone (p

Die Haut, das groste Organ des menschlichen Korpers mit einem Korpergewichtsanteil von 12–16 %, ist ein bedeutender Spiegel des Alterungsprozesses. Dieser wird masgeblich durch endogene, z. B. genetische, hormonelle und metabolische Faktoren, sowie exogene Noxen wie ultraviolette Strahlung, Ozon und Luftverschmutzung beeinflusst. Welche Hauterkrankungen typisch fur die alte Haut sind und was Sie Ihren Patienten raten konnen, um den Altersprozess zu verlangsamen, erfahren Sie in diesem Beitrag.

Hintergrund Es gibt bislang kaum Veroffentlichungen zur inhaltlichen und methodischen Umsetzung des Curriculums Q7 „Medizin des Alterns und des alten Menschen“ an deutschen Universitaten. Um die Diskussion uber die Konzeption von Q7 anzuregen, werden im Folgenden Ergebnisse einer Befragung von Studierenden des Q7-Curriculum an der Charite – Universitatsmedizin Berlin vorgestellt. Ziel ist es, durch Identifikation von Items, die zu einer guten Lehrveranstaltung beitragen, die Qualitat der Lehre im Fach Geriatrie zu verbessern und damit das Berufsziel „Geriater“ attraktiver zu machen.

In den letzten Jahren hat die Inzidenz altersassoziierter Hauterkrankungen, insbesondere entzundlicher Dermatosen, Autoimmunerkrankungen, Tumoren und paraneoplastischer Syndrome progredient zugenommen. Diese bedeutende Entwicklung liegt in einer erhohten Fruh- und lebenslangen UV-Exposition sowie im demographischen Alterungsprozess begrundet. Um den demographischen Wandel zukunftig als Chance zu erleben, sind ein besseres Verstandnis der Pathomechanismen dieser speziellen Erkrankungen sowie eine fruhzeitige Diagnose und Therapie essenziell. Daruber hinaus muss die breite Offentlichkeit fur diesen Themenkomplex sensibilisiert und der Patient individuell aufgeklart werden. Diese Strategie beinhaltet fruhzeitige, prophylaktische Masnahmen und eine konsequente Uberwachung von Hochrisikogruppen. In der vorliegenden Arbeit wird die erwahnte Beziehung zwischen Hautalterung und der Epidemiologie assoziierter Erkrankungen unter Berucksichtigung der Risikofaktoren im Detail dargestellt.

Objective To investigate the prognostic value of elements of the Geriatric Assessment, in particular the Timed Up and Go (TUG) Test and the Barthel Index of Activities of Daily Living (ADL) for one-year post-operative mortality in elderly patients with cancer. Materials and Methods This prospective cohort study included patients 65 years of age or older undergoing elective major surgery for cancer between June 2008 and June 2010. Preoperative functional status was measured by the TUG Test and the Barthel Index of ADL Cognitive state was assessed by the Mini Mental State Examination (MMSE). Complications were recorded prospectively. The degree of resection was noted. Results Data from 131 patients (56% women; median age, 71 years) were analysed at 1 year of follow-up. Mortality after 1 year was 28.2%. Twenty-nine patients (22.3%) were dependent in ADLs, and 43 (35.2%) impaired in TUG. Thirteen patients (10.7%) were both, dependent in ADLs and impaired in TUG. Short-term complications after surgery occurred in 66% of patients, and major complications occurred in 29%. Patients who were dependent in ADLs and impaired in TUG had significantly higher 1-year mortality (OR, 4.5; 95% CI, 1.21–18.25; p = 0.034). Lower scores on the MMSE (OR, 0.64; 95% CI, 0.43–0.95; p = 0.048) and incomplete surgical resection (OR, 3.25; 95% CI, 1.15–9.20; p = 0.026) were independently associated with higher 1-year mortality. Conclusion Functional assessments, such as ADL and TUG scores, as well as mild cognitive impairment, are predictors of long-term outcome in elderly cancer patients. Trial Registration German Clinical Trials Register (DRKS 00005150)

Pharmacological options for the treatment of sarcopenia currently do not exist. However, off-label treatment options of some established drugs have been suggested. The aim of this study was to assess differences in various muscle and physical performance parameters in relation to the intake of angiotensin-converting enzyme (ACE) inhibitors in a cohort of community-dwelling older people. Eight hundred and thirty-eight participants from the Berlin Aging Study-II (BASE-II) were included. Appendicular lean mass was assessed with dual-energy X-ray absorptiometry and related to height and body mass index. Muscle strength was measured by grip strength and related to muscle mass (arm muscle quality) and functional status was assessed via the timed “Up and Go” test. Users of ACE inhibitors had higher lean mass related to height but significantly lower lean mass related to body mass index (p = 0.001 for women and p

Purpose This study aimed to determine the effect of patient empowerment on acute postoperative pain. This research was part of the Patient Empowerment and Risk-Assessed Treatment to Improve Outcome in the Elderly After Onco-Surgery Trial. Design This research was a prospective randomized controlled interventional study. Methods Patients who underwent gynecologic onco-surgery were included in this analysis of demographic data, basic characteristics, pain intensity by numeric rating scale, and mode of pain therapy. The intervention included provision of detailed information booklet and patient diary. Findings Ninety-one patients were enrolled (treatment group, n = 51; control group, n = 40). With the same medications, pain on the first postoperative day was significantly less severe in the treatment group than in the control group ( P = .03). On multivariate logistic regression, patient empowerment had a significant effect on pain intensity (odds ratio, 3.46; 95% confidence interval, 1.35 to 8.86; P = .01). The number needed to treat to decrease pain from severe to mild (numeric rating scale, 5 to 10 to 0 to 4) was 4.35. Conclusions Patient empowerment significantly reduces postoperative pain in elderly patients undergoing gynecologic cancer surgery.

Background Loss of muscle mass, particularly in old age, can restrict mobility and physical function. Sleep is thought to play a key role in the maintenance of muscle mass; sleep disturbances have a prevalence of 6–30% in Germany. In this study, based on data from the Berlin Aging Study II (BASE-II), we analyze the relationship between sleep efficiency and quality on the one hand, and muscle mass and muscle function on the other.

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. 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. 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. 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. 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.

Background Selected nutrients or food groups have often been studied with regard to long-term mortality and cardiovascular disease, whereas the relation between diet quality and appendicular lean mass (ALM) has rarely been researched. Objective The aim of this study was to explore the association between a Mediterranean-style diet and ALM in community-dwelling older people. Methods Cross-sectional data from the Berlin Aging Study II were available for 1,509 participants (51% women, 68.2±3.7 years). Nutrient intake was assessed using the European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire. Adherence to a Mediterranean-style diet was evaluated with the modified Mediterranean-type diet score (mMedTypeDiet). ALM was determined by dual-energy X-ray absorptiometry and related to body mass index (ALM/BMI). A general linear regression model was carried out to assess the association between mMedTypeDiet score groups and ALM/BMI. Results ALM/BMI was higher in women with a higher adherence to the mMedTypeDiet (0.64±0.1 vs 0.62±0.1 and 0.61±0.1 in low and medium adherence, retrospectively, p = .004). In the risk factor-adjusted general linear regression analysis, a higher adherence to the mMedTypeDiet was associated with higher ALM/BMI in women and better ALM/fat mass ratio when compared to a medium and a low diet quality. No significant associations were seen in men. Conclusions Higher adherence to a Mediterranean-style diet was associated with a positive effect on ALM/BMI in women.

Background: Decreased bone mineral density (BMD) has been linked to metabolic disorders, such as type 2 diabetes. However, results regarding the metabolic syndrome (MetS), a cluster of at least 3 of 5 cardiovascular risk parameters with potentially contradictory effects on BMD are still inconclusive. Objective: We investigated the effect of MetS and its single parameters on BMD at 3 sites in community-dwelling older subjects. Methods: 1,402 subjects (51.1% female, 68 ± 4 years old) from the Berlin Aging Study II (BASE-II) were included. MetS was defined as suggested by IDF/NHLBI/AHA. Insulin resistance (IR) was assessed by the homeostasis model of IR. BMD (lumbar spine, femur neck, hip) and trunk fat were measured by dual-energy X-ray absorptiometry. Osteoporosis was defined by a T score of ≤-2.5. Results: MetS was present in 29.6% of women and 41.7% of men. In regression models, we observed a positive association of MetS with the BMD of the lumbar spine (p = 0.005) and hip (p = 0.028) in women even after adjustment for risk factors, but no effect of the single parameters apart from IR. In contrast, there was no association between MetS and BMD in men. However, higher trunk fat and higher waist circumference were associated with lower levels of BMD in men with or without MetS (p < 0.05). Conclusion: We obtained different results in men and women. In women, the positive though slight effect of MetS on BMD could not be explained by single MetS components apart from IR. In men, central obesity was negatively associated with BMD, suggesting that the metabolic effects driven by visceral fat have a negative impact.

Mit dem neurologischen Funktionstest unterer Rumpf wurde in Erganzung zur Berg Balance Scale ein Assessment fur die Diagnostik und Verlaufskontrolle der Stabilitat und Funktion des unteren Rumpfes neurologischer Patienten entwickelt. Eingesetzt wird es beispielsweise nach Schlaganfall in der Fruhphase der Rehabilitation oder bei noch geringer motorischer Erholung. Bisher verfugbare Tests sind aufgrund des Bodeneffekts fur Veranderungen bei schwer betroffenen neurologischen Patienten zu wenig empfindlich. Der Funktionstest unterer Rumpf wurde in der Studie „Combined whole body vibration and balance training using Vibrosphere“ an 66 stationaren/teilstationaren neurologischen Patienten ≥ 60 Jahre integriert. Anhand von sechs Aufgaben erfolgte eine qualitative Einschatzung der selektiven Funktion, des Bewegungs- und Haltungstonus der unteren Extremitat, der huftumgebenden Muskulatur sowie des unteren Rumpfes. Analog der Berg Balance Scale wird die Bewertung auf einer 5-Punkte-Skala vorgenommen. Der Test zeigt eine hohe Reliabilitat sowie Responsivitat und ist mit geringem zeitlichen und personellen Aufwand durchzufuhren.

Ziel der RAN-Studie (Ruckenschmerzen, Adipositas und Nikotinkonsum) war es, den Nutzen von Masnahmen zur betrieblichen Gesundheitsforderung und Pravention darzustellen. Dabei sollte gezeigt werden, dass durch betriebliche Praventionsstrategien lebensstilbedingter Risikofaktoren wie z. B. Rauchen und Ubergewicht die Gesundheit und Arbeitsfahigkeit der Mitarbeiter moglichst lange erhalten werden kann. Der Beitrag stellt Studiendesign und erste Ergebnisse hinsichtlich Nikotinkonsum und „Body Mass Index“ (BMI) vor. Die Studie wurde in einem Berliner Betrieb der Siemens AG zwischen 2006–2009 durchgefuhrt. Als Grundgesamtheit wurden 875 Mitarbeiter eingeschlossen. Die Studienteilnehmer wurden einmal jahrlich bezuglich ihres Gesundheitszustands und -verhaltens beraten und verschiedenen Interventionskursen mit den Schwerpunkten „Ruckenschmerzen“, „Gewichtsreduktion“ oder „Rauchentwohnung“ zugeteilt. Die Methode der RAN-Studie beruhte auf einer Verknupfung von subjektiven Daten zu den Risikofaktoren chronischer Krankheiten, die in Anlehnung an den Bundesgesundheitssurvey 1998 erhoben wurden, mit den objektiven Daten aus medizinischen Untersuchungen sowie den Krankenkassendaten der Studienteilnehmer. Die Teilnahmerate an der RAN-Studie konnte trotz Konzernumbau bei ca. 46% stabil gehalten werden. Hierzu durften auch die eingesetzten Methoden des sozialen Marketings beigetragen haben. Die Raucherpravalenz unter den Studienteilnehmern konnte von 21,2% im Jahr 2006 auf 14,2% im Jahr 2009 (−33%) gesenkt werden. Bezuglich des BMI ergaben sich im Studienverlauf keine signifikanten Veranderungen. Die Ergebnisse weiterer Datenanalysen sollen zeigen, inwieweit die eingesetzten Methoden der RAN-Studie zu einer kardiovaskularen Risikoreduktion beitragen, die Pravalenz von Folgekrankheiten und deren Kosten vermindert oder deren Eintritt verzogert sowie die Arbeitsfahigkeit der Mitarbeiter nachhaltig verlangert werden kann. Die Koppelung von Surveydaten, arztlichen Untersuchungsdaten und Krankenkassendaten in einer Langsschnittstudie darf als innovativer Ansatz der RAN-Studie angesehen werden.

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.

The aim of this study was to explore the effects of a single lipoprotein apheresis session on myocardial stress/rest (S/R) perfusion in patients with elevated lipoprotein(a) (Lp(a)) and coronary artery disease using cardiac magnetic resonance imaging. Twenty patients with Lp(a) > 60 mg/dL and coronary artery disease were randomized into a control or a treatment group. Both groups underwent cardiac magnetic resonance imaging with assessment of left ventricular function, perfusion and viability, and the treatment group underwent lipoprotein apheresis immediately afterwards. Repeat magnetic resonance imaging was performed at 24 h for both groups and at 96 h for just the treatment group. The transmyocardial perfusion gradient (i.e. endo-epi ratio [EER]) was determined and a comprehensive parameter of resting and adenosine-induced stress perfusion was derived (EER-S/R). While the hematocrit remained unchanged, apheresis reduced lipoproteins and rheological parameters: Lp(a) - 55.1%, total cholesterol - 34.5%, low density lipoprotein (LDL) - 54.6%, Lp(a)-corrected LDL - 54.3%, high density lipoprotein - 17.4%, apolipoprotein B - 39.2%, plasma viscosity - 10.7%, and fibrinogen - 30.6% at 24 h (P < 0.05 for all). At 96 h these parameters, except for plasma viscosity, apolipoprotein B and Lp(a)-corrected LDL, recovered but did not reach baseline values (P < 0.05 for all). The EER-S/R at 24 h was lowered by therapy (DeltaEER-S/R 5%; P < 0.03), whereas this effect disappeared at 96 h. The ejection fraction (EF) was slightly improved at 24 h (67.07 +/- 6.28% vs. 64.89 +/- 6.39%; DeltaEF 2.2%, P < 0.05) and returned to baseline at 96 h. In the control group no corresponding changes were detected. In conclusion, cardiac magnetic resonance imaging detects subtle treatment-related changes in regional myocardial perfusion in patients with elevated Lp(a) and coronary artery disease undergoing lipoprotein apheresis.

Reduced pulmonary function and elevated serum cholesterol levels are recognized risk factors for cardiovascular disease. Currently, there is some controversy concerning relationships between cholesterol, LDL-cholesterol, HDL-cholesterol, serum triglycerides and lung function. However, most previous studies compared patients suffering from chronic obstructive pulmonary disease (COPD) with healthy controls, and only a small number examined this relationship in population-based cohorts. Moreover, lipoprotein a [Lp(a)], another lipid parameter independently associated with cardiovascular diseases, appears not to have been addressed at all in studies of lung function at the population level. Here, we determined relationships between lung function and several lipid parameters including Lp(a) in 606 older community-dwelling participants (55.1% women, 68±4 years old) from the Berlin Aging Study II (BASE-II). We found a significantly lower forced expiration volume in 1 second (FEV1) in men with low Lp(a) concentrations (t-test). This finding was further substantiated by linear regression models adjusting for known covariates, showing that these associations are statistically significant in both men and women. According to the highest adjusted model, men and women with Lp(a) levels below the 20th percentile had 217.3ml and 124.2ml less FEV1 and 239.0ml and 135.2ml less FVC, respectively, compared to participants with higher Lp(a) levels. The adjusted models also suggest that the known strong correlation between pro-inflammatory parameters and lung function has only a marginal impact on the Lp(a)-pulmonary function association. Our results do not support the hypothesis that higher Lp(a) levels are responsible for the increased CVD risk in people with reduced lung function, at least not in the group of community-dwelling older people studied here.

To increase our understanding of the genetic basis of adiposity and its links to cardiometabolic disease risk, we conducted a genome-wide association meta-analysis of body fat percentage (BF%) in up to 100,716 individuals. Twelve loci reached genome-wide significance (P, A genome-wide association meta-analysis study here shows novel genetic loci to be associated to body fat percentage, and describes cross-phenotype association that further demonstrate a close relationship between adiposity and cardiovascular disease risk.

PurposeThis randomized controlled, clinical prospective interventional trial was aimed at exploring the effect of patient empowerment on short- and long-term outcomes after major oncologic surgery in elderly cancer patients.MethodsThis trial was performed from February 2011 to January 2014 at two tertiary medical centers in Germany. The study included patients aged 65 years and older undergoing elective surgery for gastro-intestinal, genitourinary, and thoracic cancer. The patients were randomly assigned to the intervention group, i.e. patient empowerment through information booklet and diary keeping, or to the control group, which received standard care. Randomization was done by block randomization in blocks of four in order of enrollment. The primary outcome were 1,postoperative length of hospital stay (LOS) and 2. long-term global health-related quality of life (HRQoL) one year postoperatively. HRQoL was assessed using the EORTC QLQ C30 questionnaire. Secondary outcomes encompassed postoperative stress and complications. Further objectives were the identification of predictors of LOS, and HRQoL at 12 months.ResultsOverall 652 patients were included. The mean age was 72 ± 4.9 years, and the majority of patients were male (68.6%, n = 447). The ^median of postoperative length of stay was 9 days (IQR 7-14 day). There were no significant differences between the intervention and the control groups in postoperative LOS (p = 0.99) or global HRQoL after one year (women: p = 0.54, men: p = 0.94). While overall complications and major complications occurred in 74% and 24% of the cases, respectively, frequency and severity of complications did not differ significantly between the groups. Patients in the intervention group reported significantly less postoperative pain (p = 0.03) than the control group. Independent predictors for LOS were identified as severity of surgery, length of anesthesia, major postoperative complications, nutritional state, and pre-operative physical functional capacity measured by the Timed Up and Go-test by multiple robust regressions.ConclusionPatient empowerment through information booklet and diary keeping did not shorten the postoperative LOS in elderly onco-surgical patients, but improved quality of care regarding postoperative pain. Postoperative length of stay is influenced by pre-operative nutritional state, pre-operative functional impairment, severity of surgery, and length of anesthesia.Trial registrationClinicaltrials.gov. Identifier NCT01278537.

Background The metabolic syndrome (MetS) is a cluster of cardiovascular risk factors which has been linked with a decline in muscle mass. However, with a variety of sarcopenia definitions, it is unclear which approach is suitable to detect reduced muscle mass in subjects with MetS who are frequently characterized by an increased fat mass and higher body weight. Methods We analyzed cross-sectional data of 1,402 (51.1% female; 69±3.7 years) old community-dwelling subjects of the Berlin Aging Study II. MetS was defined according to the guidelines of the International Diabetes Federation/American Heart Association/National Heart, Lung, and Blood Institute (IDF/AHA/NHLBI, 2009). Sarcopenia was defined as suggested by Baumgartner et al. (low appendicular lean mass corrected for height, ALM/HT(2)) and according to standardized residuals following the approach suggested by Newman et al., which corrects appendicular lean mass (ALM) for weight and height. Results MetS was identified in 35% of the participants, 25.6% had sarcopenia according to ALM/HT(2), 20% according to the residual approach. We compared the two operational parameters and found that the majority of physical and metabolic parameters were more impaired and self-reported difficulties in physical performance were greater in individuals defined sarcopenic according to residuals than subjects who were sarcopenic according to a low ALM/HT(2). Conclusion Our results indicate that an approach to define sarcopenia which corrects ALM both for height and weight is more suitable to detect increased physical limitations as well as higher metabolic impairment, compared to adjustment of ALM only for height.

We investigated the impact of low phase angle (PhA) values on muscle strength, quality of life, symptom severity, and 1-year mortality in older cancer patients.Prospective study with 1-year follow-up.Cancer patients aged60 years.PhA was derived from whole body impedance analysis. The fifth percentile of age-, sex-, and body mass index-stratified reference values were used as cut-off. Quality of life was determined with the European Organization of Research and Treatment in Cancer questionnaire, reflecting both several function scales and symptom severity. Muscle strength was assessed by hand grip strength, knee extension strength, and peak expiratory flow.433 cancer patients, aged 60-95 years, were recruited. Patients with low PhA (n = 197) exhibited decreased muscle strength compared with patients with normal PhA (hand grip strength: 22 ± 8.6 vs 28.9 ± 8.9 kg, knee extension strength: 20.8 ± 11.8 vs 28.1 ± 14.9 kg, and peak expiratory flow: 301.1 ± 118 vs 401.7 ± 142.6 L/min, P.001). Physical function, global health status, and role function from the European Organization of Research and Treatment in Cancer questionnaire were reduced, and most symptoms (fatigue, anorexia, pain, and dyspnea) increased in patients with low PhA (P.001). In a risk-factor adjusted regression analysis, PhA emerged as independent predictor of physical function (ß:-0.538, P = .023), hand grip strength (ß:-4.684, P.0001), knee extension strength (ß:-4.548, P = .035), and peak expiratory flow (ß:-66.836, P.0001). Low PhA moreover predicted 1-year mortality in the Cox proportional hazards regression model, whereas grip strength was no longer significant.PhA below the fifth reference percentile is highly predictive of decreased muscle strength, impaired quality of life, and increased mortality in old patients with cancer and should be evaluated in routine assessment.

Background. F or prevention and treatment of sarcopenia, defined as a decline in lean mass, reliable diagnostic criteria and cutpoints reflecting a clinically relevant threshold are indispensable. As of yet, various parameters have been proposed but no gold standard exists. The aim of this study was to compare cutpoints of appendicular lean mass related to body mass index (ALM BMI ) or height (ALM/height 2 ) regarding their association with self-reported physical limitations and frailty status in a sample of community-dwelling older adults. Methods. A total of 1,343 participants from the Berlin Aging Study II were included. ALM index was assessed with dual-energy X-ray absorptiometry. Limitations in physical performance were assessed via questionnaire and frailty status was defined according to the Fried criteria. Results. In a risk factor -adjusted analysis, participants with an ALM BMI below the cutpoints had 1.4–2.8 times higher odds of difficulties in several domains of physical activity (p = .031 to p < .0001) compared with participants with normal ALM BMI . In participants with low ALM/height 2 , no associations with physical limitations were found. Moreover, the odds of being prefrail/frail were statistically significant for the low ALM BMI group only (odds ratio = 2.403, 95% confidence interval: 1.671–3.454, p < .0001) and not for the low ALM/height 2 group. Conclusions. This study showed striking dif ferences between the two operational criteria ALM/ height 2 and ALM BMI concerning their association with physical limitations and prefrailty/frailty. The low ALM BMI cutpoints seem suitable to detect patients at risk for negative outcomes such as frailty who might benefit from interventions targeted at improving lean mass.

Previous studies have indicated a relationship between type II diabetes (T2D), metabolic syndrome (MetS) and pulmonary function but the pathological mechanism responsible remains unclear. The aim of the current analysis within the Berlin Aging Study II (BASE-II) was to investigate the influence of abdominal obesity and muscle mass on pulmonary function in subjects with T2D and MetS.A prebronchodilator pulmonary function test was carried out in 1369 subjects from the BASE-II (mean age 69 ± 4 years, 51.6 % women) where T2D was defined according to the German Diabetes Association (DDG) criteria, MetS according to the criteria of the International Diabetes Federation (IDF), American Heart Association (AHA) and National Heart, Lung and Blood Institute (NHLBI) criteria from 2009 and pulmonary obstruction (obstructive lung disease, OLD) by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria of a forced expiratory volume in 1 s (FEV1 and forced vital capacity (FVC) ratio 70 %.Of the subjects 50.9 % achieved a sufficient level of quality according to the GOLD guidelines and were analyzed with respect to the research question. The FEV1 and FVC were decreased in study participants with T2D and MetS and the lung volume decreased with an increasing number of MetS criteria. Parameters of body composition, such as waist circumference and muscle mass had a significant influence on lung volumes, independent of MetS or T2D.In this study MetS and T2D were associated with decreased lung volumes; however, muscle mass and abdominal obesity proved to be the most important factors influencing pulmonary function and could thus form the link between pulmonary function and MetS or T2D. Measurement of grip strength for the determination of muscle mass and waist circumference for determining abdominal obesity could contribute to the interpretation of the results of pulmonary function tests.

Previous studies have indicated a relationship between type II diabetes (T2D), metabolic syndrome (MetS) and pulmonary function but the pathological mechanism responsible remains unclear. The aim of the current analysis within the Berlin Aging Study II (BASE-II) was to investigate the influence of abdominal obesity and muscle mass on pulmonary function in subjects with T2D and MetS. A prebronchodilator pulmonary function test was carried out in 1369 subjects from the BASE-II (mean age 69 ± 4 years, 51.6 % women) where T2D was defined according to the German Diabetes Association (DDG) criteria, MetS according to the criteria of the International Diabetes Foundation (IDF), American Heart Association (AHA) and National Heart, Lung and Blood Institute (NHLBI) criteria from 2009 and pulmonary obstruction (obstructive lung disease, OLD) by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria of a forced expiratory volume in 1 s (FEV1 and forced vital capacity (FVC) ratio < 70 %. Of the subjects 50.9 % achieved a sufficient level of quality according to the GOLD guidelines and were analyzed with respect to the research question. The FEV1 and FVC were decreased in study participants with T2D and MetS and the lung volume decreased with an increasing number of MetS criteria. Parameters of body composition, such as waist circumference and muscle mass had a significant influence on lung volumes, independent of MetS or T2D. In this study MetS and T2D were associated with decreased lung volumes; however, muscle mass and abdominal obesity proved to be the most important factors influencing pulmonary function and could thus form the link between pulmonary function and MetS or T2D. Measurement of grip strength for the determination of muscle mass and waist circumference for determining abdominal obesity could contribute to the interpretation of the results of pulmonary function tests.

Similar to other industrialized countries, Germany's population is ageing. Whereas some people enjoy good physical and cognitive health into old age, others suffer from a multitude of age-related disorders and impairments which reduce life expectancy and affect quality of life. To identify and characterize the factors associated with 'healthy' vs. 'unhealthy' ageing, we have launched the Berlin Aging Study II (BASE-II), a multidisciplinary and multi-institutional project that ascertains a large number of ageing-related variables from a wide range of different functional domains. Phenotypic assessments include factors related to geriatrics and internal medicine, immunology, genetics, psychology, sociology and economics. Baseline recruitment of the BASE-II cohort was recently completed and has led to the sampling of 1600 older adults (age range 60-80 years), as well as 600 younger adults (20-35 years) serving as the basic population for in-depth analyses. BASE-II data are linked to the German Socio-Economic Panel Study (SOEP), a long-running panel survey representative of the German population, to estimate sample selectivity. A major goal of BASE-II is to facilitate collaboration with other research groups by freely sharing relevant phenotypic and genotypic data with qualified outside investigators.

Objective Aim of this study was to evaluate the association between preoperative health-related quality of life (HRQoL) and mortality in a cohort of elderly patients (>65 years) with gastrointestinal, gynecological and genitourinary carcinomas. Design Prospective cohort pilot study. Setting Tertiary university hospital in Germany. Patients Between June 2008 and July 2010 and after ethical committee approval and written informed consent, 126 patients scheduled for onco-surgery were included. Prior to surgery as well as 3 and 12 months postoperatively all participants completed the EORTC-QLQ-C30 questionnaire (measuring self-reported health-related quality of life). Additionally, demographic and clinical data including the Mini Mental State Examination (MMSE) were collected. Surgery and anesthesia were conducted according to the standard operating procedures. Primary endpoint was the cumulative mortality rate over 12 months after one year. Changes in Quality of life were considered as secondary outcome. Results Mortality after one year was 28%. In univariable and multivariable logistic regression analysis baseline HRQoL self-reported cognitive function (OR per point: 0.98; CI 95% 0.96–0.99; p = 0.024) and higher symptom burden for appetite loss (per point: OR 1.02; CI 95% 1.00–1.03; p = 0.014) were predictive for long-term mortality. Additionally the MMSE as an objective measure of cognitive impairment (per point: OR 0.69; CI 95% 0.51–0.96; p = 0.026) as well as severity of surgery (OR 0.31; CI 95% 0.11–0.93; p = 0.036) were predictive for long-term mortality. Global health status 12 months after surgery was comparable to the baseline levels in survivors despite moderate impairments in other domains. Conclusion This study showed that objective and self-reported cognitive functioning together with appetite loss were prognostic for mortality in elderly cancer patients. In addition, impaired cognitive dysfunction and severity of surgery were predictive for one-year mortality whereas in this selected population scheduled for surgery age, gender, cancer site and metastases were not.

The present study focuses on auditory discrimination abilities in older adults aged 65–89 years. We applied the “Leipzig inventory for patient psychoacoustic” (LIPP), a psychoacoustic test battery specifically designed to identify deficits in central auditory processing. These tests quantify the just noticeable differences (JND) for the three basic acoustic parameters (i.e., frequency, intensity, and signal duration). Three different test modes [monaural, dichotic signal/noise (s/n) and interaural] were used, stimulus level was 35 dB sensation level. The tests are designed as three-alternative forced-choice procedure with a maximum-likelihood procedure estimating p = 0.5 correct response value. These procedures have proven to be highly efficient and provide a reliable outcome. The measurements yielded significant age-dependent deteriorations in the ability to discriminate single acoustic features pointing to progressive impairments in central auditory processing. The degree of deterioration was correlated to the different acoustic features and to the test modes. Most prominent, interaural frequency and signal duration discrimination at low test frequencies was elevated which indicates a deterioration of time- and phase-dependent processing at brain stem and cortical levels. LIPP proves to be an effective tool to identify basic pathophysiological mechanisms and the source of a specific impairment in auditory processing of the elderly.

counseling is beneficial to nutritional status, QoL and survival in AL. Methods: In this single-center, randomized, controlled trial, 144 adult AL treatment naive outpatients were randomized to ad libitum food intake (usual care; N = 72) and nutritional counseling (N = 72). The primary endpoint was body weight change at 12 months. Secondary endpoints included change in QoL (SF-36) and survival. Results: Forty-one patients (N = 25 usual care, N = 16 nutritional counseling) died before the first follow-up visit. In the modified intention-to-treat population (patients who underwent at least one control visit [month 3]; N = 103), the difference in body weight between groups was not significant (weight loss [WL] difference = 1.6 kg [95%CI, 0.5, 3.6]; P= 0.137). However, patients assigned to nutritional counseling maintained a stable body weight ([N = 56]; WL = 0.8±4.9 kg; P= 0.214), whereas in the usual care group a significant decrease was observed ([N = 47]; WL = 2.4±5.5 kg; P= 0.003). A significant increase in the mental component summary of QoL was found in patients randomized to nutritional counselling (8.1 [95%CI: 2.3, 13.9]; P= 0.007). In the randomized population, nutritional counselling was significantly associated with improved survival (HR = 0.57 [95%CI: 0.35, 0.94]; P= 0.028). In a multivariable model, adjusted for baseline BMI, hematologic response and cardiac stage, a trend in reduced mortality was still observed for patients assigned to nutritional counseling (HR = 0.62 [95%CI: 0.37, 1.05]; P= 0.074). Conclusion: In AL outpatients, nutritional counseling is helpful in maintaining nutritional status, may positively affect survival and is effective in improving mental quality of life.