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Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: Geriatric patients are more predisposed to the occurrence of wounds due to age and disease, affecting functional status and quality of life. This aspect has rarely been researched in this population., Objective: The aim of this study was to investigate the influence of chronic (cW) and acute wounds (aW) on the objective functional status and wound-related subjective quality of life in hospitalized geriatric patients., Methods: In this exploratory cross-sectional analysis, data from 41 patients with wounds were examined. Patients were participating and recruited in the TIGER study (n = 244). Depending on the type of wound, patients were assigned to the aW (n = 19) or cW (n = 22) group. The two groups were compared in terms of physical function, hand strength, activities of daily living, depression, cognition, nutrition, quality of life (Wound-QoL) and sociodemographic data., Results: There was a significant difference between the aW and cW groups in terms of gender (p = 0.045) and living conditions (p = 0.047). The type of wound was associated with the Barthel index (p = 0.010) and the Wound-QoL (p = 0.022)., Conclusion: Compared to aW patients, cW patients were more limited in the physical and social dimensions and reported a lower quality of live. Living alone seems to play a relevant role. Among the patients of the TIGER study, men living alone were particularly more affected by cW. The care for these specific patients population should follow a holistic approach., (© 2021. The Author(s).)

An increasing proportion of oldest old persons (over 80 years) accompanies the demographic change. Furthermore, the gender ration will also change and the percentage of older men will increase. Mobility is an important factor for maintaining independence and for "healthy aging". Mobility has to be regarded in the context of individual and environmental factors. With increasing age, the risk of mobility limitation increases. Next to mobility, falls are also a drastic experience for older persons and cannot only have physical consequences like injuries but also psychological consequences as fall-related psychological concerns. These psychological consequences can produce negative behavior e. g. reducing physical activity., Competing Interests: Erklärung zu finanziellen InteressenForschungsförderung erhalten: Ja, von einem/den Sponsor(en) dieser Fortbildungseinheit und von einer anderen Institution (Pharma- oder Medizintechnikfirma usw.); Honorar/geldwerten Vorteil für Referententätigkeit erhalten: Ja, von einem/den Sponsor(en) dieser Fortbildungseinheit und von einer anderen Institution (Pharma- oder Medizintechnikfirma usw.); Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: Ja, von einem/den Sponsor(en) dieser Fortbildungseinheit und von einer anderen Institution (Pharma- oder Medizintechnikfirma usw.); Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Sponsor der Veranstaltung): Ja; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Nicht-Sponsor der Veranstaltung): Nein.Erklärung zu nichtfinanziellen InteressenKatrin Singler: Mitglied der Deutschen Gesellschaft für Innere Medizin (DGIM), Mitglied der Deutschen Gesellschaft für Geriatrie (DGG) Ellen Freiberger: Mitglied im DVGS, DGGG und in der Bundesinitiative für Sturzprävention., (© Georg Thieme Verlag KG Stuttgart · New York.)

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

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

Since 2016 sarcopenia, the age-associated loss of muscle mass, strength and function, has the ICD-10-GM code M62.50 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification). The diagnosis of sarcopenia requires the combined presence of low muscle strength and low muscle mass. Well-established approaches for the prevention and therapy of sarcopenia are exercise programs-in particular strength, endurance and power training-and nutritional interventions, preferably a combination of both. Adequate protein intake is considered highly relevant, while the role of other nutrients involved in muscle metabolism (e. g. creatine, vitamin D, antioxidants, omega-3 fatty acids) is less clear, being still the subject of controversial discussions. Innovative pharmacological therapies are currently under investigation and their future relevance for this indication is unclear. In general, it has to be stated that there are still only few intervention studies available that focused specifically on sarcopenia in older individuals. More studies in this rapidly increasing population are urgently needed.

Falls in older adults are a major public health problem with a high incidence and severe consequences for the older individual. The age-related loss of muscle strength as well as muscle mass and muscle function (sarcopenia) are i) risk factors for falling, ii) associated with physical function and iii) markers of the frailty syndrome. Muscle function appears to play a bigger role than muscle mass. The operationalization of sarcopenia using the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm is consistently associated with falling events. Structured physical exercise plays the key role in the prevention of falls and the management of functional decline caused by sarcopenia and frailty. The combined supplementation with proteins and vitamin D supports muscle protein synthesis in undersupplied persons and improves aspects of physical function.

Background: Communicating and interacting with persons diagnosed with dementia (PwD) present a challenge to pastoral carers, since most classical pastoral care approaches concentrate on conversation as a medium of relationship formation and do not take limited communication skills into account. This study focuses on the following question: how can hospital-based pastoral carers find appropriate methods of communication and interaction with PwD and provide them with pastoral care?, Methods: A total of 10 professional pastoral carers participated in the study. Each of these persons had extensive experience with PwD. Data were collected with the use of guideline-based interviews. The interviews were evaluated using Mayring's method of qualitative content analysis., Results: One of the main challenges faced by the pastoral carers in interacting with PwD was to explore communication strategies based on non-verbal communication, in addition to verbal communication. Pastoral carers need to find alternative communicative approaches, such as biographical, non-verbal, and physical sense-related methods. Clinical pastoral education did not adequately equip these professionals for communicating and interacting with PwD. The interviewed pastoral carers acquired this specific knowledge through independent research of the academic literature, observation of other professionals, dementia-specific training courses, and practical experience., Conclusion: Pastoral carers can make a positive contribution to the holistic care of PwD through their unique communicative and relationship approach to care. It is imperative to develop adequate pastoral care concepts and to integrate methodologies for dealing with PwD into the training curriculum of pastoral carers.

Dizziness/vertigo, falls and syncope are among the most common reasons for seeking medical care. As clinical entities they share common pathogenetic and clinical features and differences. The diagnostic work-up can often be initiated in a general practitioner's or internist's practice and, if necessary, completed in an interdisciplinary emergency unit. Simple diagnostic tools can be used in an outpatient setting to obtain valuable diagnostic information. First and foremost, it is important to differentiate between prognostically favorable clinical events and potentially serious disease. In younger patients diagnostic procedures should primarily focus on potential structural cardiac disease and/or primary arrhythmia. The same applies to elderly patients in whom, however, multicausal clinical symptoms and severe complications in the case of falls are characteristic. Elderly patients frequently require the involvement of various clinical specialties to investigate a broad spectrum of potential differential diagnoses in an interdisciplinary diagnostic approach, which is not always available in practice. In the emergency unit, decisions regarding inpatient care need to be made individually. In elderly patients, inpatient care is sometimes necessary not only due to acute disease, but also in order to ensure social care. Geriatric day hospitals may be a suitable option for some of these patients.

Aging is normal process, only somehow questioned by the "anti-aging wave". Normal and pathological aging are therefore separate developments. Older adults often suffer from the frailty syndrome, partly due to diminished resilience. Aging per se is not a comorbidity., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

A higher age is usually associated with multimorbidity due to chronic illnesses intermittently aggravated by acute disease and exarcerbation of pre-existing chronic illnesses. Physical and psychological diseases often coexist. Cure in the classical sense should not be the priority of diagnostic and therapeutic decision making, but more a prioritization of patient-oriented care. This includes polypharmacy which most often accompanies multimorbidity. Therapeutic actions and designated endpoints are therefore different from those in younger persons because preservation of functionality and independence is priority, not survival. Rehabilitative treatments are important in all settings that care for old and very old persons. Older adults and their care-givers also often express different time and treatment goals.

Falls in older adults are a major public health problem, affecting 1 in 3 persons aged 65 and over at least once a year. Consequences of falling include death, injuries, fear of falling, and subsequent loss of independence. The age-related loss of muscle mass and function (sarcopenia) as well as muscle strength are markers of the frailty syndrome. In addition, they are associated with physical function and are a risk factor for falling. Older adults should be screened for falls at least annually. If evaluated as at-risk, a comprehensive falls assessment should be conducted to determine an individual's risk profile. Physical exercise with balance and strength training play a key role in the prevention and management of functional decline and fall risk. Multifactorial interventions are indicated in at-risk individuals. In sarcopenic individuals, sufficient intake of protein must be taken into account and supplementation in combination with exercise appears to be useful.

Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. In an international expert group, initiated by the European Society for Clinical Nutrition and Metabolism (ESPEN), 26 evidence-based recommendations for nutritional care of older persons with dementia have been developed, covering the topics of screening and assessment of malnutrition, strategies to support oral nutrition, oral supplementation and artificial nutrition. This article is a short version of the guideline., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Geriatric rehabilitation might be the only way for the very old to maintain their participation in social life, since in many cases self care, everyday skills and basic activities of daily living can only be recovered by an integrative treatment approach using a multiprofessional team setting. At the same time limited financial resources in health care have to be considered to make appropriate allocation decisions in geriatric rehabilitation., Purpose: The goal of this work was to determine whether chronological age is a limiting factor for functional outcome in geriatric rehabilitation., Materials and Methods: Data from the state of Baden-Württemberg (KODAS data set) from the years 2005-2011 for nonagenarians and data for centenarians from the Geriatrics in Bavaria database (GiB-DAT) project from the years 2003-2011 were compared to the data of the younger seniors undergoing geriatric rehabilitation. For the KODAS data collection, 31 geriatric rehabilitation clinics in Baden-Württemberg were involved. The GiB-DAT project included 59 geriatric rehabilitation clinics in Bavaria. Both databases compare the results of the geriatric assessment at the beginning and at the end of geriatric rehabilitation., Results: The analyzed data are presented with regard to the functional outcome in the very elderly and are discussed with respect to policy implications.

The term sarcopenia stands for the age-related loss of muscle mass and is pahophysiologically closely linked to the "frailty syndrome". The search for sarcopenia - the combination of both a muscle loss and a reduced muscle function or strength - is nowadays part of the comprehensive geriatric assessment in Geriatric Medicine. From a pahophysiological point of view, different factors are involved as in all geriatric snydromes, but a low-grade inflammatory state is a cornerstone in all of them. Differentiation to cachexia is important, as the latter is not as amenable to treatment strategies. Many questions including the international full acceptance of the defintition of sarcopenia remain open. A good example is sarcoepnic obesity, a quantitatively fast increasing challenge in elderly persons.

Biological aging means a time-dependent accumulation of changes to which a living organism is being exposed during its lifetime. Biological aging normally concurs with chronological aging the time frame of which is set by an upper limit, the lifespan (in humans approximately 120 years). New findings in experimental biogerontology are challenging both the dogma of irreversibility of biological aging and the preset species-specific limitations of life. The present overview first explains the general principle of rejuvenation and reversal of biological aging with paradigms from stem cell research. Secondly, recent key publications on artificial telomerase elongation and (alleged) lifespan enhancement by sirtuins and resveratrol will be discussed with an emphasis on the implications for (future) geriatric medicine.

Contemporary geriatric research focuses mainly on observational clinical studies and epidemiological surveys and the translation of basic scientific results from biogerontology into a clinical context is often neglected. Following a definition of translational research the article gives an overview of recent key publications in experimental biogerontology with a special emphasis on their relevance for clinical geriatrics. The topics dealt with include age-induced loss of skeletal muscle (sarcopenia), the aging immune system (immunosenescence) and neurodegenerative disorders (Alzheimer's and Parkinson's disease).

Diabetes mellitus is a known risk factor for cognitive dysfunction and dementia. Chronic hyperglycemia, genetic predisposition, arterial hypertension, hyperlipoproteinemia, micro- and macrovascular diseases, and depression play a major role in the development of cognitive dysfunction. Both pathophysiology of diabetes and dementia and the specifics of diabetes therapy in patients with dementia are presented in this review.

The early diagnosis of an acute myocardial infarction (MI) is improved by the introduction of novel high-sensitivity troponin assays. These assays can measure low level myocardial injury not detectable by standard troponin assays. Especially in older patients who appear to have a higher basal troponin level, the results must always be judged in the context of the medical history, physical examination, electrocardiogram (ECG) and any further findings. Even small increases in high-sensitivity troponin indicate increased risk for death or MI during follow-up. In the case of MI an invasive strategy results in better survival rates compared with conservative therapy but at the expense of an increased risk of bleeding in elderly patients. This article provides an overview on the diagnosis of MI in elderly patients.

The demographic shift means that there are an increasing number of elderly critically ill patients with various comorbidities. This very specific group needs particular treatment which has not been considered sufficiently in medical guidelines so far. To improve health care, it is indispensable not only to work out the current guidelines, but aspects of geriatric medicine must also be integrated into future developments. Using the example of the recent guideline "non-invasive ventilation," it is shown how the process of designing and implication can actively be realized in clinical daily routine.

Geriatric rehabilitation is a cornerstone of every treatment plan in elderly persons in the inpatient, day clinic and outpatient settings. Geriatric patients tend to be more in need of care and to have a loss of domestic independence due to multimorbidities. The goal of geriatric rehabilitation is to preserve and/or restore the disease-related functional deficits in order to guarantee mobility and activities of daily living (ADL) in addition to curative treatment. Structural prerequisites in all geriatric units are the comprehensive geriatric assessment (CGA) and the existence of an interdisciplinary geriatric team. Geriatric rehabilitative treatment is based on functionality (ICF) and is therefore indicated in a wide spectrum of diseases. The demographic shift necessitates an increase in geriatric treatment structures with innovative concepts such as geronto-traumatological interdisciplinary units or geriatric outpatient office groups with a better networking of different care structures.

Malnutrition, sarcopenia and cachexia are three syndromes that are highly relevant for capacity, morbidity and mortality of the elderly. The term malnutrition denotes a deficit of macro- und micronutrients, while sarcopenia describes an age-associated loss of muscle mass and strength. In cachexia weight loss und changes in body composition are closely related to acute and chronic inflammatory co-morbidities. A wide array of possible causal factors is typical for all three entities. Inflammatory processes and changes in hormonal regulation are of prominent importance for sarcopenia and cachexia. The diagnosis of malnutrition, sarcopenia and cachexia requires, in addition to a special interest of the treating physician, a thorough knowledge of pathophysiology as well as the use of specific diagnostic methods. A better understanding of the causes of malnutrition, sarcopenia and cachexia will make it possible to use specific modes of treatment. Because of the demographic shift an increasing financial burden has to be faced by the public health system resulting from the growing expenditure needed for the care of affected patients. Additional studies are, therefore, necessary to develop new therapeutic options based on the pathophysiology of these three entities. This is especially important with regard to sarcopenia and cachexia.

From a chronological viewpoint, medical treatment of the elderly (geriatrics) starts from the age of 65 years old. This definition per se is nowadays certainly not really an adequate definition of an elderly patient and the reason to be treated by a geriatrician. In addition to chronological age, other factors must be considered in order to define the elderly patient. Functional reserves decrease with age, which leads to increased vulnerability. Frailty as a term describes this situation and can be defined pathophysiologically by a mainly subclinical inflammatory state. Therefore, in 2007 the German Society of Geriatrics (DGG), the German Society of Gerontology and Geriatrics (DGGG), and the German Group of Geriatric Institutions (BAG) have jointly developed a definition of the geriatric patient.

A balanced nutrition is the best prerequisite for health and prevention of disease in age and against "nutritional frailty". Many elderly people, however, are unable to comply with an adequate nutrition, in particular isolated people and people in elderly homes with or without dementia. Under those conditions "functional foods" may be an important alternative, but evidence based studies, that would show a benefit, are scarce so far. In the future probiotics may show benefits in cancer prevention; since most malignant tumors are associated with age, the elderly may then profit for the most.

The placement of a percutaneous endoscopic gastrostomy (PEG) is a safe and widely accepted method of artificial enteral nutrition. In Germany, PEG placement is performed approximately 140,000 times a year, about 65% of them in elderly patients. Yet indications for PEG placement in the elderly, as well as the health and functional status of these patients are unexplored in Germany. To draw conclusions about the indication for PEG placement, the health status and the further development of patients undergoing PEG in acute geriatric wards, we performed an analysis of the 2004 annual data set of the German Gemidas database. The Gemidas database is an instrument of voluntary quality assurance, where the treatment data of patients in German geriatric hospital units are registered. Data of 40 acute geriatric hospital units with 27,775 patients and 393 PEG tube placements were analyzed. According to the database items, we received information about the incidence of PEG placement, nutrition-relevant treatment diagnosis, patients age, functional and mental status, length of hospital stay, where patients were admitted from and discharged to and the hospital mortality of geriatric patients with and without PEG placement. In 1.4% of all treatment cases, a PEG was inserted. PEG placement was mainly performed in patients with the treatment diagnosis stroke (65.1%) and dysphagia (64.1%). The functional status of patients with PEG tube placement was very poor, with an Barthel Index of 8.2 (+/- 14.6) points at admission. Due to the severity of the disease and in concordance with existing data the overall hospital mortality of patients undergoing PEG placement was 17.6%, which is higher than in patients without PEG placement (4.3%). In all 27 775 analyzed geriatric patients, a diagnosis related to malnutrition was coded in only 7.0%, although sufficient data show a prevalence of about 50% in elderly hospital patients.

In certain high-risk groups like geriatric hospital patients and nursing home inhabitants malnutrition has a high prevalence and is highly relevant for morbidity and mortality in these populations. The diagnosis of malnutrition in the elderly can be achieved by simple parameters like loss of weight, BMI and oral intake. The available screening and assessment instruments like Mini Nutritional Assessment (MNA) and Nutritional Risk Screening (NRS 2002) aim at the standardization of the diagnosis and early recognition of malnutrition. While the MNA seems to be more appropriate for the community-dwelling elderly, the NRS 2002 offers advantages for the hospital setting. The dissimilarity of the two instruments makes the comparison of study populations difficult. Both the results of the MNA and those of the NRS 2002 are unsuitable as follow-up parameters and inappropriate for the evaluation of nutritional intervention. There is still a strong need for studies on the diagnosis and therapy of malnutrition in the elderly, especially in the nursing home setting. For scientific purposes a standardization of the instruments used for the diagnosis of malnutrition and for the evaluation of the study results is essential. The Minimum Data Set may be a first step in the right direction.

The demographic shift demands more and more customized medical supplies and management structures for geriatric patients. The elderly patient with age-related functional restrictions and multi-morbidity is at special risk for an ill-adapted pharmacotherapy. In addition the frail elderly person is dependent on general-practitioner assistance. The prescription of a suitable drug and a safe and workable (galenic) application form is key to therapeutic success. Age-based intake regulations, repeated education, and intake training are crucial tasks for the general-practitioner when caring for a fast growing elderly patient population.

The concept of malnutrition in the geriatric population describes a deficient state of energy and nutrient intake with harmful clinical consequences. Despite of having a significant effect on morbidity and mortality, there are no generally accepted criteria for diagnosing malnutrition in the elderly. With increasing age the general recognition of the nutritional status becomes more important for the diagnosis of malnutrition than isolated parameters. Recording a patient"s history must include any weight loss and changes in appetite. Reasons for a diminished nutritional intake must be explored systematically as well. As part of physical examination one has to pay attention to clinical signs of malnutrition (general muscular atrophy, loss of subcutaneous fat) and to signs of micronutrient deficiencies. The documentation of oral intake can supply important evidence for deficient intake of energy and nutrients. Of special relevance among anthropometric values are a BMI of less than 20 kg/m and calf circumference of less than 31 cm. Individual follow-up data are superior to isolated measurements Laboratory diagnostic tests (for example albumin) are of minor importance for the diagnosis of malnutrition because of their low specificity. As a consequence of unsolved methodical problems, bioelectrical impedance analysis can currently be recommended only to those who are experienced with this method and its limitations. Screening and assessment tools like Mini Nutritional Assessment (MNA) and Nutritional Risk Screening(NRS) are helpful for a quick and simple identification of malnourished patients and those who are at risk. The MNA is especially applicable for people who live independently and for cooperative residents of nursing homes. The NRS is a valuable alternative for hospital patients and those unable to cooperate. Screening for malnutrition should be routine practice in the elderly population, especially for those at high risk for it like in hospitals and in nursing homes.

Frailty--the weakness of many (oldest) old persons--induces a lot of human sorrow with functional disabilities as well as health-economic costs. Sarcopenia (loss of muscle mass) is also a form of frailty and a co-factor of two of the "geriatric Is"--immobility and instability. Pathophysiologically, both phenomena show signs of an inflammatory state. Physical activity and a healthy diet can partially reverse these health problems. Therefore, therapeutic strategies emerge to treat these frequent and clinically relevant phenomena.

Portal hypertension is a frequent and clinically important complication of chronic liver diseases. Beside bleeding episodes from oesophageal and gastric varices, ascites formation and hepatic encephalopathy are sequelae of the haemodynamic changes seen under chronic portal hypertensive conditions. These are characterized by a systemic vasodilatation and a subsequent hyperdynamic circulation, leading to an increased arterial inflow into the splanchnic vascular bed. This so-called "arterial vasodilatation theory" is crucial for the persistence of portal hypertension even after the opening of decompressing collaterals. Furthermore, these changes are pathophysiologically linked to ascites formation and the development of hepatic encephalopathy. This article briefly discusses the diagnostic and therapeutic procedures in patients with ascites and hepatic encephalopathy. With regard to the diagnosis and treatment of varices and their bleeding, the reader is referred to the article of Eberhard Renner in the same issue of this journal.

Duplex sonography as a non-invasive technique to measure splanchnic and hepatoportal haemodynamics under physiological and pathophysiological conditions has recently attracted much attention. Determination of arterial and venous profiles enables reproducible pre- and postoperative flow estimations. Furthermore, this technique has harvested many interesting results in the complicating haemodynamic changes seen in patients with portal hypertension. The technique can even be considered as gold standard in the evaluation of flow changes in patients after orthotopic liver transplantation. This article reviews the use of duplex scanning in the splanchnic vascular bed.

Gastroduodenal ulcers are strongly associated with Helicobacter pylori (HP) infection. Successful eradication drastically diminishes ulcer recurrence. Most of the eradication schemes include metronidazole (Flagyl). The present study was designed to establish the metronidazole resistance rate in Switzerland. Antral biopsies were taken in 153 patients with suspected ulcers (115 men, 38 women, mean age 46 +/- 16 [SD] years) during upper endoscopy for bacteriological testing. Metronidazole resistance (> 8 micrograms/ml) was found in 47/153 (31%) of the isolates. Resistance was found in no case to amoxicillin (Clamoxyl) (0/104 = 0%) and only in 3% (2/66) to clarithromycin (Klazid). Metronidazole resistance of HP in a third of the isolates studied is comparable to numbers found in other European countries. These findings raise the question whether eradication schemes including metronidazole without prior sensitivity testing are justified. Amoxicillin and clarithromycin appear to be valid alternatives.

Pharmacological prophylaxis and the therapy of complications of portal hypertension have recently been attracting more attention. This especially holds true for gastroesophageal variceal bleeding. Vasoconstrictors such as vasopressin, somatostatin, and beta-blockers, as well as vasodilators such as organic nitrates, alpha 2-adrenergic agonists and serotonin-antagonists, are currently used in clinical settings. The aim of this article is to delineate the present pathophysiological concepts accounting for the hemodynamic changes in animal models and patients with portal hypertension, and to summarize the mechanisms of action of the most frequently used pharmacological agents.