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Study design Because of current demographic developments, a hypothesis was proposed whereby older female patients aged > 65 years can be safely operated using minimally invasive, robotic-assisted surgery, despite having more preoperative comorbidities. A comparative cohort study was designed to compare the age group ≥ 65 years (older age group, OAG) with the age group Patients and methods Consecutive RAS procedures performed between 2016 and 2021 at the Women’s University Hospital of Jena and the Robotic Center Eisenach to treat benign or oncological indications were included in the study. The age groups were compared according to their preoperative comorbidities (ASA, Charlson comorbidity index [CCI], cumulative illness rating scale – geriatric version [CIRS-G]) and perioperative parameters such as Clavien-Dindo (CD) classification of surgical complications. Analysis was performed using Welch’s t-test, chi2 test, and Fisher’s exact test. Results A total of 242 datasets were identified, of which 63 (73 ± 5 years) were OAG and 179 were YAG (48 ± 10 years). Patient characteristics and the percentage of benign or oncological indications did not differ between the two age groups. Comorbidity scores and the percentage of obese patients were higher in the OAG group: CCI (2.7 ± 2.0 vs. 1.5 ± 1.3; p Conclusion Although preoperative comorbidity was higher in the group of older female patients, no differences were found between age groups with regard to perioperative outcomes following robotic-assisted gynecological surgery. Patient age is not a contraindication for robotic gynecological surgery.

ZusammenfassungDie saisonale Influenza verursacht eine signifikante Krankheitslast in der deutschen Bevölkerung und geht mit hohen volkswirtschaftlichen Kosten einher. Personen ab 60 Jahren sind aufgrund von Immunseneszenz und chronischen Erkrankungen besonders gefährdet und machen einen Großteil der influenzaassoziierten Hospitalisierungen und Todesfälle aus. Adjuvantierter, Hochdosis-, rekombinanter und zellbasierter Influenzaimpfstoff wurden entwickelt, um die Effektivität im Vergleich zu herkömmlichen Impfstoffen zu verbessern. Neueste Beobachtungsstudien zeigen eine bessere Effektivität des adjuvantierten Impfstoffs gegenüber herkömmlichen Impfstoffen und eine ähnliche Effektivität wie der Hochdosis-Impfstoff bei älteren Erwachsenen. Einige Länder berücksichtigten die neue Evidenz bereits in ihren Impfempfehlungen für die aktuelle oder frühere Saisons. Auch in Deutschland sollte die Verfügbarkeit der Impfstoffe für ältere Erwachsene sichergestellt sein, um einen hohen Impfschutz zu garantieren.

There is an urgent need for improved influenza vaccines especially for older adults due to the presence of immunosenescence. It is therefore highly relevant to compare enhanced influenza vaccines with traditional influenza vaccines with respect to their effectiveness.To compare vaccine efficacy and effectiveness of adjuvanted influenza vaccines (aTIV/aQIV) vs. non-adjuvanted standard-dose (TIV/QIV) and high-dose (TIV-HD/QIV-HD) influenza vaccines regarding influenza-related outcomes in older adults, complementing findings from the European Centre for Disease Prevention and Control (ECDC)'s systematic review of enhanced seasonal influenza vaccines from February 2020.A systematic literature search was conducted in Embase and MEDLINE to identify randomised controlled trials, observational studies and systematic reviews, published since ECDC's systematic review (between 7 February 2020 and 6 September 2021). Included studies were appraised with either the Cochrane Risk of Bias tool, ROBINS-I or AMSTAR 2.Eleven analyses from nine real-world evidence (RWE) studies comprising ∼53 million participants and assessing the relative vaccine effectiveness (rVE) of aTIV vs. TIV, QIV and/or TIV-HD in adults aged ≥65 years over the 2006/07-2008/09 and 2011/12-2019/20 influenza seasons were identified. Nine analyses found that aTIV was significantly more effective than TIV and QIV in reducing influenza-related outcomes by clinical setting and suspected influenza outbreaks (rVE ranging from 7.5% to 25.6% for aTIV vs. TIV and 7.1% to 36.3% for aTIV vs. QIV). Seven analyses found similar effectiveness of aTIV vs. TIV-HD in reducing influenza-related medical encounters, inpatient stays and hospitalisations/emergency room visits. In three analyses, aTIV was significantly more effective than TIV-HD in reducing influenza-related medical encounters and office visits (rVE ranging from 6.6% to 16.6%). Risk of bias of identified studies was moderate to high.Our study suggests that both adjuvanted and high-dose vaccines are effective alternatives for vaccination programmes in older adults and preferable over conventional standard-dose vaccines.

Objective: To investigate the effectiveness of individual oral health care training (IndOHCT) on dental plaque removal and denture cleaning in hospitalized geriatric inpatients. Background: The literature reveals neglect of hygiene and oral care in people aged over 65 years, especially in persons in need of care. Hospitalized geriatric inpatients have poorer dental health than those non-hospitalized. Furthermore, the existing literature reporting on oral healthcare training interventions for hospitalized geriatric inpatients is scarce. Materials and Methods: This pre-post-controlled intervention study dichotomized 90 hospitalized geriatric inpatients into an intervention group (IG) and a control group (CG). Inpatients in the IG received IndOHCT. Oral hygiene was assessed using the Turesky modified Quigley–Hein index (TmQHI) and the denture hygiene index (DHI), at baseline (T0), at a second examination (T1a), and after supervised autonomous tooth brushing and denture cleaning (T1b). The influence of the Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Barthel Index (BI) scores on oral hygiene was examined. Results: There was no significant plaque reduction on teeth or dentures between T0 and T1a in either group. Between T1a and T1b, plaque reduction on the teeth was more effective in the IG than in the CG (p < 0.001). Inpatients with 1–9 remaining teeth removed significantly more dental plaque than inpatients with 10 or more remaining teeth. Inpatients with lower MMSE scores (p = 0.021) and higher age (p = 0.044) reached higher plaque reduction on dentures. Conclusions: IndOHCT improved oral and denture hygiene in geriatric inpatients by enabling them to clean their teeth and dentures more effectively.

Objective: Assuming that elderly patients suffer more severely from side effects of the standard therapies, less aggressive treatment protocols have been established, e.g. the NOA-8 study. This practice has been questioned by several retrospective studies using standard protocol. However, none of these [for full text, please go to the a.m. URL]

Alte und multimorbide Patienten sind besonders vulnerabel fur einen schweren Verlauf von COVID-19. Die Masnahmen zur Eindammung der Pandemie und die Anpassung der Versorgungsstrukturen wirken sich massiv auf die ambulante geriatrische und die Notfallversorgung aus, sowie auf den akutstationaren Bereich bis hin zu geriatrischer Rehabilitation und stationarer Pflege.

Dieser Beitrag mochte einen Uberblick daruber geben, wie und mit Hilfe welcher Kriterien eine medizinisch, ethisch und rechtlich vertretbare Entscheidung daruber getroffen werden kann, welche der betagten Patienten mit einer schweren COVID-19-Pneumonie mittels kunstlicher Beatmung behandelt werden sollten und welche von einer solchen Therapie eher nicht profitieren wurden.

Dieser Beitrag mochte einen Uberblick daruber geben, wie und mit Hilfe welcher Kriterien eine medizinisch, ethisch und rechtlich vertretbare Entscheidung daruber getroffen werden kann, welche der betagten Patienten mit einer schweren COVID-19-Pneumonie mittels kunstlicher Beatmung behandelt werden sollten und welche von einer solchen Therapie eher nicht profitieren wurden.

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.

Alte und multimorbide Patienten sind besonders vulnerabel für einen schweren Verlauf von COVID-19. Die Maßnahmen zur Eindämmung der Pandemie und die Anpassung der Versorgungsstrukturen wirken sich massiv auf die ambulante geriatrische und die Notfallversorgung aus, sowie auf den akutstationären Bereich bis hin zu geriatrischer Rehabilitation und stationärer Pflege.

Jahrlich erkranken bis zu 20 % der Bevolkerung in Deutschland an Influenza. Sie ist fur Altere mit einer deutlich erhohten Morbiditat und Mortalitat verbunden. Auf die Gruppe der ≥60-Jahrigen entfallen 90 % der Todesfalle. Vor allem der Virusstamm A(H3N2) ist von Bedeutung. Die Alterung des Immunsystems, Immunseneszenz, fuhrt zum Anstieg der Infektionsanfalligkeit und ist am Symptomwandel beteiligt. Daruber werden eine verzogerte Diagnostik und Therapie begunstigt. Ferner verursacht Immunseneszenz eine Wirksamkeitsabschwachung von Impfungen. Im Vergleich zu den Standardvakzinen starker immunogene Impfstoffe, wie adjuvantierte Vakzine oder Impfstoffe mit erhohtem Antigengehalt, sind somit zur Pravention besonders geeignet. Die Standige Impfkommission (STIKO) empfiehlt die Impfung gegen saisonale Influenza fur ≥60-Jahrige als Standard- sowie fur Pflegeheimbewohner, Schwangere und chronisch Kranke als Indikationsimpfung. Fur die kommende Grippesaison 2018/19 hat die STIKIO erstmals quadrivalente (tetravalente) Impfstoffe empfohlen.

OBJECTIVES Although delirium is often investigated, little is known about the outcomes of patients having acute neuropsychological changes at a single time point without fulfilling the criteria of full delirium. Our aim was to determine point prevalence, predictors, and long-term outcomes of delirium and acute neuropsychological changes in patients aged 60 years and older across different departments of a university hospital with general inpatient care. DESIGN Prospective observational study. SETTING University hospital excluding psychiatric wards. PARTICIPANTS At baseline, 669 patients were assessed, and follow-ups occurred at months 6, 12, 18, and 36. MEASUREMENTS Measurements were obtained using the Confusion Assessment Method (CAM), comprehensive geriatric assessment, health-related quality of life, functional state (month 6), and mortality rates (months 6, 12, 18, and 36). Subjects were classified into (1) patients with delirium according to the CAM, (2) patients with only two positive CAM items (2-CAM state), and (3) patients without delirium. RESULTS Delirium was present in 10.8% and the 2-CAM state in an additional 12.7% of patients. Highest prevalence of delirium was observed in medical and surgical intensive care units and neurosurgical wards. Cognitive restrictions, restricted mobility, electrolyte imbalance, the number of medications per day, any fixations, and the presence of a urinary catheter predicted the presence of delirium and 2-CAM-state. The mean Karnofsky Performance Score and EuroQol-5D were comparable between delirium and the 2-CAM state after 6 months. The 6-, 12-, 18-, and 36-month mortality rates of patients with delirium and the 2-CAM state were comparable. The nurses' evaluation of distinct patients showed high specificity (89%) but low sensitivity (53%) for the detection of delirium in wide-awake patients. CONCLUSION Patients with an acute change or fluctuation in mental status or inattention with one additional CAM symptom (ie, disorganized thinking or an altered level of consciousness) have a similar risk for a lower quality of life and death as patients with delirium. J Am Geriatr Soc 68:1469-1475, 2020.

Background: The aim of this study is to compare very elderly female patients with a younger control group after prolapse surgery with regard to co-morbidity and complications. Method: In a case-control design, the consecutive data of patients after prolapse surgery at the age of over 80 years and those of a control group were analysed by means of the Clavien-Dindo (CD) classification of surgical complications, the Charlson Comorbidity Index and the Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistics: Studentʼs t, Fisherʼs exact and Mann-Whitney U tests. Results: The analysis comprised n = 57 vs. n = 60 operations. In the very elderly patients there was often a grade IV prolapse (p

In the original publication of this article, the members of the FORTA group were provided in such a way that they could not be indexed as collaborators on PubMed. The article should have included an Acknowledgement section as shown below.

The aim of this study is to compare very elderly female patients with a younger control group after prolapse surgery with regard to co-morbidity and complications.In a case-control design, the consecutive data of patients after prolapse surgery at the age of over 80 years and those of a control group were analysed by means of the Clavien-Dindo (CD) classification of surgical complications, the Charlson Comorbidity Index and the Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistics: Student's t, Fisher's exact and Mann-Whitney U tests.The analysis comprised n = 57 vs. n = 60 operations. In the very elderly patients there was often a grade IV prolapse (p 0.001), apical fixations were more frequent (p 0.001), but the operating times were not different. In the very elderly patients 21 % CD II+III complications were observed, in the control group 6.6 % (p = 0.031). No CD IV and V complications occurred in either group, the duration of inpatient stay amounted to 5 (± 1) vs. 4.1 (± 0.8; p 0.001) days, the very elderly patients needed an inpatient follow-up more frequently (p 0.001). The co-morbidities of the very elderly patients differed from those of the control group in number (median 2.0 vs. 1.5; p 0.001), in CIRS-G (4.1 ± 2.2 vs. 2.4 ± 1.7; p 0.01) and in Charlson Index (1.6 ± 1.6 vs. 0.5 ± 0.7; p 0.001).A prolapse in very elderly women can be safely managed by surgery. In no case did the complications require intensive care treatment nor were they life-threatening, but they did lead to a longer duration of hospital stay and more frequently to further treatment geriatric or inpatient internal medicine facilities.

Background: According to experience the amount of medication grows with increasing age. In addition to that the risk of adverse drug events increases as well. Because of their pharmacological effects certain drugs are regarded as „potentially inappropriate“ for the elderly. This poses [for full text, please go to the a.m. URL], 21. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie, 9. Deutscher Pharmakovigilanztag

Hintergrund: Die Ständige Impfkommission STIKO empfiehlt die jährliche Influenza-Impfung (II) als primär präventive Maßnahme altersabhängig für Senioren ab 60 Jahre wegen der Zunahme der Krankheitslast und Übersterblichkeit mit steigendem Alter. Fragestellung:[for full text, please go to the a.m. URL], 48. Kongress für Allgemeinmedizin und Familienmedizin

The mixed micellization between the anionic dimeric surfactant Dim1 (disodium 1,11-didecyl-3,6,9-trioxaundecane 1,11-disulfate) and the two nonionic surfactants C12E5 and C12E8 (penta- and octaoxyethylene monododecyl ethers, respectively) has been investigated. The cmc of the mixtures has been measured by fluorescence probing, using the fluorescent probe pyrene. Its variation with composition revealed synergism in micelle formation. The micelle aggregation (N) numbers have been measured using time-resolved fluorescence quenching at a total surfactant concentration of about 70 mM and at 25, 40, and 55deg;C. The differences in total aggregation number of the mixed micelles in the two systems reflect (i) the higher aggregation number of C12E5 micelles with respect to C12E8 and Dim1 micelles; (ii) the higher cloud temperature of C12E8 with respect to C12E5; and (iii) the opposite temperature dependences of N for Dim1 and nonionic surfactants micelles. The results show nonideal mixing behavior with a shallow minimum in the variation of the mixed micelle aggregation number with the mixture composition at a Dim1 mole fraction around 0.5. Copyright 1998 Academic Press. Copyright 1998Academic Press

Diallyl ethers containing two trimethylstannyl moieties or one triorganostannyl and one trimetyylsilyl moiety attached to the olefinic carbon atoms of one allyl group can undergo either an allyl-vinyl ether rearrangement or a [2,3] Wittig sigmatropic rearrangement when treated with a strong non-nucleophilic base. While the use of lithium diisopropylamide favours the Wittig rearrangement, lithium diethylamide can shift the course of reaction towards the allyl-vinyl ether rearrangment.

The aqueous solutions of mixtures of various conventional surfactants and dimeric anionic and cationic surfactants have been investigated by electrical conductivity, spectrofluorometry, and time-resolved fluorescence quenching to determine the critical micelle concentrations and the micelle aggregation numbers in these mixtures. The following systems have been investigated: 12-2-12/DTAB, 12-2-12/C(12)E(6), 12-2-12/C(12)E(8), 12-3-12/C(12)E(8), Dim3/C(12)E(8), and Dim4/C(12)E(8) (12-2-12 and 12-3-12=dimethylene-1,2- and trimethylene-1,3-bis(dodecyldimethylammonium bromide), respectively; C(12)E(6) and C(12)E(8)=hexa- and octaethyleneglycol monododecylethers, respectively; Dim3 and Dim4=anionic dimeric surfactants of the disodium sulfonate type, Scheme 1; DTAB=dodecyltrimethylammonium bromide). For the sake of comparison the conventional surfactant mixtures DTAB/C(12)E(8) and SDS/C(12)E(8) (SDS=sodium dodecylsulfate) have also been investigated (reference systems). Synergism in micelle formation (presence of a minimum in the cmc vs composition plot) has been observed for the Dim4/C(12)E(8) mixture but not for other dimeric surfactant/nonionic surfactant mixtures investigated. The aggregation numbers of the mixed reference systems DTAB/C(12)E(8) and SDS/C(12)E(8) vary monotonously with composition from the value of the aggregation number of the pure C(12)E(8) to that of the pure ionic component. In contrast, the aggregation number of the dimeric surfactant/C(12)E(8) mixtures goes through a minimum at a low value of the dimeric surfactant mole fraction. This minimum does not appear to be correlated to the existence of synergism in micelle formation. The initial decrease of the aggregation number of the nonionic surfactant upon addition of ionic surfactant, up to a mole fraction of ionic surfactant of about 0.2 (in equivalent per total equivalent), depends little on the nature the surfactant, whether conventional or dimeric. The results also show that the microviscosity of the systems containing dimeric surfactants is larger than that of the reference systems. Copyright 2001 Academic Press.