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The current corona crisis affects older patients as well as the geriatric infrastructure in all sectors. This article provides an overview about the current state of knowledge on COVID-19 with special consideration of geriatric aspects and the consequences for the geriatric care system.

In Germany up to 20% of the population are affected by influenza every year. Particularly for the elderly, influenza is related to high morbidity and mortality and 90% of deaths are related to the group of 60 years and older. In this context, seasonal influenza caused by influenza A (H3N2) viruses is exceedingly relevant for the elderly. The aging of the immune system, immunosenescence, is well documented as the cause of increased susceptibility to infection and change of typical symptoms. This can cause a delay in diagnosing and treatment of influenza infections. Furthermore, immunosenescence can lead to decreased efficacy of vaccination. Adjuvanted vaccines and vaccines with higher antigen content cause an enhanced immune response and are therefore especially suitable for prevention. The Standing Vaccination Committee (STIKO) recommends vaccination against seasonal influenza for all persons 60 years of age and over as well as for nursing home residents, pregnant women and chronically ill patients. For the coming influenza season 2018/19, the STIKO generally recommends the administration of quadrivalent (tetravalent) vaccines for the first time.

Nursing home residents and older hospitalized patients have a significantly higher risk to suffer from nosocomial infections (NI). It is still an unanswered question whether patients suffering from NI are at greater risk for deterioration of activities of daily living.In a retrospective observational study, we evaluated the prevalence of NI during hospitalization of acute geriatric inpatients of the geriatric department at Jena University Hospital by patient records. The study included data from 555 patients, hospitalized from 1 August 2011 to 31 August 2012. We included patients without acute complications and those who developed NI after the second day of hospitalization.Every third patient developed a NI during the observation period. Consequently, the incidence of NI was approximately 18 patients with NI per 1000 days of hospitalization. This rate was considerably higher than the national average. The most frequent NIs were urinary tract infection, gastroenteritis and infections of the lower respiratory tract. A low value of Barthel index at admission, high multimorbidity index and transurethral indwelling catheters promoted the development of NI. An improvement in activities of daily living, assessed by mean values of the difference in the Barthel index, was significantly lower in patients who developed NI (mean value14.5 ± 16.3) than in patients who did not (mean value 18.1 ± 14.8).Nosocomial infections were a relevant factor for deterioration of the Barthel Index, at least temporarily and NIs, in particular the combination of several NIs, jeopardized an improvement in the activities of daily living. This was particularly true for infections of the lower respiratory tract and gastroenteritis.

Aging of the immune system, so-called immunosenescence, is well documented as the cause of increased infection rates and severe, often complicated courses of infections in older adults. This is particularly true for pneumococcal pneumonia in older adults; therefore, the standing committee on vaccination of the Robert Koch Institute (STIKO) recommends a once only vaccination with 23-valent pneumococcal polysaccharide vaccine for all persons aged 60 years and over. Furthermore, the 13-valent pneumococcal conjugate vaccine is also available for administration in adults and is recommended by the STIKO for particular indications. The advantage of the pneumococcal conjugate vaccine is the additional induction of a T-cell dependent immune response that leads to good immunogenicity despite immunosenescence. Initial data from a recent randomized controlled trial, so far only presented at conferences, confirm that the conjugate vaccine also provides protection against non-bacteremic pneumococcal pneumonia, which is not provided by the polysaccharide vaccine. Thus, there are two vaccines for prevention of pneumococcal diseases: one with a broader range of serotype coverage but with an uncertain protection against non-bacteremic pneumococcal pneumonia and another one with less serotype coverage but more effective protection. Vaccination of children with the conjugate vaccine also leads to a rapid decrease of infections by the 13 vaccine serotypes even in adults because of herd protection effects. For prevention of pneumonia in older adults the additional benefit of a concurrent application of influenza vaccine and pneumococcal vaccine should be considered.

Despite annual updates of vaccination recommendations by the German Standing Committee on Vaccination (STIKO) at the Robert Koch Institute, diseases preventable by vaccination still cause a relevant burden of disease in the elderly.A comparison of the vaccination status of the elderly in Bavaria and Thuringia was carried out.Medical settlement data from the first quarter of 2007 to the second quarter of 2008 from the association of panel doctors in Bavaria and Thuringia for insured persons aged 60 years and above were analyzed concerning vaccinations, age, gender and multimorbidity. The vaccination rates for influenza were calculated.The use of all recommended vaccinations in this age group was greater in Thuringia (eastern federal state) than in Bavaria (western federal state). In both states the administration rates of tetanus and diphtheria vaccines were lower in individuals with higher comorbidity and age. Protection rates against diphtheria were incomplete as a result of inadequate use of combination vaccines. In both states the administration of pneumococcal vaccine was higher in subjects with more comorbidities. In Bavaria administration rates increased with age. Influenza vaccination rates increased in association with age and comorbidity in both states. In elderly individuals influenza vaccination was used more often in the third quarter of 2007.Old age and multimorbidity are often insufficiently taken into consideration in studies on vaccination rates. The data from this study confirmed the relevant findings from other studies and emphasize the deficient implementation of standard vaccinations in primary prevention. In this study very old patients were differentiated and considered according to age groups for the first time.

Physicians in Germany who are not specialized in geriatric medicine often have to make decisions regarding referral of patients for early geriatric rehabilitation. The risk of inadequate patient allocation is due to lack of knowledge or underestimation of the potential benefit of early rehabilitation in reducing a patient's need of care. Particularly the oldest old are affected by those inadequate decisions.Based on the nationwide database Gemidas Pro, the data sets of ≥ 90-year-old patients were analysed regarding diagnoses, multimorbidity, gender, length of stay, procedures, outcome parameters as nursing personnel regulation (PPR), Barthel index and the Timed Up and Go (TUG) test compared to younger age groups. Data from 85 acute inpatient geriatric institutions during the period from January 2006 to December 2009 were included.Neither the analysis of the diagnosis nor multimorbidity showed relevant differences compared to younger patients. Despite poorer functional status at admission, the ≥ 90 year olds experienced a 25 % increase in the activities of daily living (ADL) measured by PPR, 30 % increase in mobility classification based on the TUG and 59 % increase in ADL measured with the Barthel index. These changes were significantly different. In addition, the length of stay was 18.96 days on average in the group of ≥ 90-year-old patients, which was but not significantly shorter than the length of stay in the group of 70- to 79-year-old (19.7 days) and 80- to 89-year-old patients (19.65 days).The analyses show that the oldest old suffer from more severe deficits in functional status on admission in acute geriatric wards compared to younger patient groups. However, on discharge the oldest old show a significant and relevant increase in mobility and ADL without increase in length of stay.

Infections due to pneumococci especially in the elderly are vastly underestimated, e.g., because non-invasive infections such as pneumonia may appear with only few symptoms. Sequential vaccination with the pneumococcal conjugate vaccine PCV13, followed by the 23-valent polysaccharide vaccine, is considered as the best preventive measure for individual protection, even though clinical study data demonstrating the efficacy of this sequence are not yet available. Increase of "awareness" by use of computer-based reminder functions may result in a significant improvement of vaccination compliance.

The aging immune system, so-called immunosenescence, is well documented as the cause of increased infection rates and severe, often complicated course of infections in the elderly with increased morbidity and mortality rates. Furthermore, it can lead to decreased efficacy of vaccination. The administration of more immunogenic vaccines can be beneficial in the elderly. Implementing vaccination recommendations for the elderly by STIKO can reduce burden of infectious diseases by prevention of infection or reduction of severity of infection. The following vaccinations are recommended by STIKO for all persons aged 60 and above: annual influenza vaccination (additionally all nursing home residents independently of age), once only pneumococcal polysaccharide vaccination, completion of tetanus and diphtheria (Td) vaccination as well as regular revaccination. All adults should be vaccinated against pertussis with Tdap vaccine once. Meanwhile, pneumococcal conjugate vaccine is allowed for administration in adults but is not recommended by STIKO yet. A lifelong course of vaccination may help to attenuate the effect of immunosenescence.

Ageing shows a high interindividual and intraindividual variability. Subclinical and clinical cardiovascular diseases accelerate the ageing process in part and in total. This leads to the idea that ageing is a result of a chronic inflammation process and to the term "inflammageing". A variety of biomarkers (e.g. C-reactive protein, interleukin-6, tumor necrosis factor alpha, fibrinogen, albumin and serum amyloid A) are described in this context. Furthermore there is a relationship to changes in the immune system across the lifespan (immunosenescence), viral infections, the occurrence of markers of oxidative stress and genetic changes. At this point in time the role for determining ageing and its use as a prognostic tool seems to be impossible. Whether inflammageing is a valid model for describing the ageing process or is the consequence of other mechanisms needs further discussion.