Search

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

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.

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.