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The determination of step length, an important gait parameter, has been a challenging task. Although unobtrusive sensors (inertial measurement units) have been developed recently, they cannot facilitate the automatic estimation of step length. In this article, we use a model-based technique to determine the step length using the Unscented Kalman Filter with angular velocity from a gyroscope inside the thigh pocket. We then propose a novel covariance estimation algorithm based on a screening technique that performs a search for the optimal Process Noise Covariance matrix. Upon implementing the Unscented Kalman Filter, the step length is found using the horizontal position of the foot relative to the hip using a patient-independent robust peak detection algorithm. This research article paves the way for algorithms that are computationally much faster than black box methods, with more scope for the development of better algorithms for covariance estimation using the one proposed in this article as a foundation.

Sarcopenia, a condition characterized by gradual loss of skeletal muscle mass and function, is a complex diagnosis; the decisive criterion in this diagnosis is the measurement of appendicular skeletal muscle index (ASMI). To identify potential serum markers predictive of sarcopenia in older adults, we evaluated correlations between ASMI, clinical data, and 34 serum inflammation markers in 80 older adults. Pearson’s correlation analyses confirmed that ASMI was positively correlated with nutritional status (p = 0.001) and serum creatine kinase (CK) (p = 0.019) but negatively correlated with serum CXCL12α (p = 0.023), a chemoattractant for muscle stem cells. In the case group, ASMI was negatively correlated with serum interleukin (IL)-7 (p = 0.024), a myokine expressed and secreted from skeletal muscle cells in vitro. Multivariate binary logistic regression analyses identified four risk factors for sarcopenia in our study: advanced age (p = 0.012), malnutrition (p = 0.038), low serum CK levels (p = 0.044), and high serum CXCL12α levels (p = 0.029). Low CK and high CXCL12α levels serve as combinatorial serum markers of sarcopenia in older adults. The linear correlation between ASMI and CXCL12α levels may facilitate the development of new regression models for future studies on sarcopenia.

So far, advances in vascular surgery and geriatrics have developed largely independent of each other, and there are - unlike orthogeriatrics - hardly any overlaps in daily clinical practice. Yet in an interdisciplinary setting, geriatric concepts might be helpful in individualized indication, choice of therapy and prognosis in vascular surgery, especially in terms of old(est)-old patients (85+). Geriatric notions, such as biological age and functionality, are not sufficiently reflected by the vascular status, but have to consider other organ-specific components (e.g., immunology, musculoskeletal system) as well as psychological/neurocognitive issues and social contextual factors. Limitations to chronological age, the vascular status or paraphrasing geriatric surrogate parameters like "frailty" do not properly characterize the functional health status of old people. In the present article we follow this train of thought at the interface between vascular surgery and geriatrics using the examples of abdominal aortic aneurysm (AAA) and peripheral arterial occlusive disease (PAOD).

Gait behavior is considered an important indicator for the assessment of the general health status and provides a diagnostic observation for neuro-degenerative and musculo-skeletal diseases. Individual changes in gait behavior often reflect a deterioration of the current health status in a general sense and therefore provide significant information for clinicians and care-givers. In this work, we have used an unobtrusive sensor setup comprising three inertial measurement units (IMUs) located at the wrist, the chest and the thigh to obtain an objective measure of the human locomotion. We conducted a clinical trial in a movement laboratory environment to obtain a database of gait data at different walking speeds and conditions. The aging-simulation suit GERT was used to deteriorate the individual gait behavior during the experiments. Treadmill walking trials were used to train different classifiers to discriminate normal walking from GERT-affected walking patterns. Level-ground walking trials were used to validate the previously generated classifiers. A five-fold cross validation during the training process yielded overall F

SN comprehensive clinical medicine 2(12), 2540-2545 (2020). doi:10.1007/s42399-020-00597-2 special issue: "Topical Collection on COVID-19", Published by Springer International Publishing, [Cham]

Geriatric medicine is a rapidly evolving field that addresses diagnostic, therapeutic and care aspects of older adults. Some disabilities and disorders affecting cognition (e.g. dementia), motor function (e.g. stroke, Parkinson’s disease, neuropathies), mood (e.g. depression), behavior (e.g. delirium) and chronic pain disorders are particularly frequent in old subjects. As knowledge about these age-associated conditions and disabilities is steadily increasing, the integral implementation of neurogeriatric knowledge in geriatric medicine and specific neurogeriatric research is essential to develop the field. This article discusses how neurological know-how could be integrated in academic geriatric medicine to improve care of neurogeriatric patients, to foster neurogeriatric research and training concepts and to provide innovative care concepts for geriatric patients with predominant neurological conditions and disabilities.

Lyapunov exponent is a promising parameter to ascertain the stability of the human gait. In this work, we use a time-series model based on a second-order delay-system with inertial measurement units placed on the foot and wrist. Stability is analyzed in a localized sense, with the Lyapunov exponent computed in the temporal region between two heel-strike points, which are determined using a peak-detection algorithm. We have attempted to show correlations between variations in the stride time and stability of the gait under normal and abnormal conditions. In the latter case, we attach a weight on foot to emulate weakness. On comparison between both cases, we observe a statistical significance of p=0.0039 using Wilcoxon’s rank-sum test. Moreover, on observing the correlations between Lyapunov Exponent and Stride Time Variability, we notice a left-shift in the abnormal case, indicating a lower threshold for instability, with the Stride Time Variability being 0.07 as compared to 0.11 in the normal case.The results indicate that by exploiting the correlation between stride time variability and Lyapunov exponents, one can establish a threshold for gait stability., Current Directions in Biomedical Engineering, 8 (2), ISSN:2364-5504

Entwicklungen und Fortschritte in Gefäßchirurgie und Geriatrie verlaufen bis dato weitgehend unabhängig voneinander; auch im klinischen Alltag der Krankenversorgung gibt es bislang – anders als bei der Alterstraumatologie – kaum Überschneidungen und Synergismen. Dabei wären interdisziplinär umgesetzte geriatrische Konzepte bei der individualisierten Indikationsstellung, Therapiewahl und Prognoseabschätzung in der Gefäßchirurgie sicherlich hilfreich, v. a. bei hochaltrigen Patienten (85+ Jahre). Geriatrische Begrifflichkeiten wie biologisches Alter und Funktionalität sind dabei kein alleiniges Spiegelbild des Gefäßstatus, sondern schließen neben weiteren organspezifischen Komponenten (z. B. Immunologie, muskuloskelettales System etc.) v. a. auch die psychisch-neurokognitive Domäne und sozialmedizinische Kontextfaktoren ein. Eine Beschränkung auf das kalendarische Alter, den Gefäßstatus oder auch schlagwortartige geriatrische Surrogatparameter wie Frailty wird dabei der gesundheitlichen Charakterisierung von alten Menschen nicht gerecht. Im vorliegenden Artikel werden die Gedankengänge an der Schnittstelle zwischen Gefäßchirurgie und Geriatrie am Beispiel des Bauchaortenaneurysmas (BAA) und der peripheren arteriellen Verschlusskrankheit (pAVK) vertieft.

Assistive Robotik als gerontologisch-geriatrisches Forschungsfeld scheint bislang eher als „sprode“ wahrgenommen zu werden. Vorherrschend ist eine reservierte Haltung, inwieweit es sich uberhaupt um einen ernstzunehmenden Forschungstopos handelt. Die Belastbarkeit der Forschungsbefunde und ihre wissenschaftliche Halbwertszeit werden hinterfragt, da sich digitale Technikgenerationen uberaus schnell verandern sowie erst wenige nachhaltige Standards und Richtlinien etabliert sind. Hierbei droht die Gefahr, dass in der Gerontologie und Geriatrie Wesentliches verpasst wird, denn das Momentum ist genau jetzt aktiv und jetzt gestaltbar. In der wissenschaftlichen Gerontologie und Geriatrie durfen diese Entwicklungen nicht verschlafen, sondern mussen mit Pioniergeist aufgegriffen und proaktiv mitgestaltet werden. Dies kann durch weitere Forschungsanstrengungen, Wirken in die Offentlichkeit hinein sowie die Verwertung von klinischem und pflegerischem Praxiswissen mit jeweils Ruckspeisung in Entwicklung und Forschung geschehen.

In this paper, we present a novel unobtrusive multi-modal sensor for monitoring of physiological parameters featuring capacitive electrocardiogram (cECG), reflective photoplethysmogram (rPPG), and magnetic induction monitoring (MI) in a single sensor. The sensor system comprises sensor nodes designed and optimized for integration into a grid-like array of multiple sensors in a bed and a central controller box for data collection and processing. Hence, it is highly versatile in application and suitable for unobtrusive monitoring of vital signs, both in a professional setting and a home-care environment. The presented hardware design takes both inter-modal interference between cECG and MI into account as well as intra-modal interference due to cross talk between two MI sensors in close vicinity. In a lab study, we evaluated a prototype of our new multi-modal sensor with two sensor nodes on four healthy subjects. The subjects were lying on the sensors and exercising with a hand grip in order to increase heart rate and thus evaluate our sensor both during changing physiological parameters as well as a wider range of those. Heart beat intervals and heart rate variability were derived from both cECG and rPPG. Breathing intervals were derived from the MI sensor. For heart beat intervals, we achieved an RMSE of 2.3 ms and a correlation of 0.99 using cECG. Similarly, using rPPG, an RMSE of 18.9 ms with a correlation of 0.99 was achieved. With regard to breathing intervals derived from MI, we achieved an RMSE of 1.12 s and a correlation of 0.90.

Hypoglycemia is a potentially life-threatening drug event under antidiabetic treatment. The aim of the study was to examine time trends in severe hypoglycemia in older adults with type 2 diabetes mellitus (T2DM) and antidiabetic treatment.Multicenter prospective diabetes patient follow-up registry (DPV).Patients aged ≥75 years with T2DM and documented treatment between 2005 and 2019.Outcomes of interest were rates of severe hypoglycemia, diabetes therapy, body mass index, HbA1c, and estimated glomerular filtration rate. Time trends of outcomes were analyzed in the whole cohort and compared between age groups (75-80, 80-85, ≥85 years).A total of 136,931 patients from 188 diabetes centers were included. The adjusted HbA1c decreased from 7.3% (95% confidence interval 7.3-7.4) in 2005 to 7.2% (7.2-7.2) in 2019 (P.001), with no significant difference between age groups (P = .47). Rates of severe hypoglycemia decreased from 6.7 (6.0-7.4) to 4.1 of 100 person-years (3.7-4.5) (P.001) in the entire population. Patients aged ≥85 years had constantly lower HbA1c levels compared with younger groups (P.001). Although severe hypoglycemia decreased the most in the ≥85 age group (P.001), severe hypoglycemia remained consistently higher in this group compared with the 75 to80 years group (P.001).During the analyzed time, the risk for severe hypoglycemia decreased. Although drugs with intrinsic risk for hypoglycemia were used less frequently, antidiabetic treatment in older adults should be further improved to continue reducing severe hypoglycemia in this age group, potentially accepting less strict metabolic control and age-specific target ranges.

Introduction: Frailty is a central geriatric syndrome characterized by a state of increased physiological vulnerability. As the key components of frailty are difficult to capture in their entirety, easily measurable and reliable surrogate parameters are desirable. Since frailty influences heart rate variability (HRV), HRV may be such a surrogate parameter. HRV is typically acquired by an ECG, which, however, may not be tolerated by all patients; in some, it may even trigger delirium. Therefore, we sought to measure HRV in a non-contact and unobtrusive way through photoplethysmography imaging (PPGI). Using our previously presented HRV estimation algorithm for PPGI, we investigated whether PPGI could reveal (1) HRV differences between frail and non-frail individuals and (2) the influences of early geriatric rehabilitation on HRV. Methods: The study involved 10 frail geriatric inpatients undergoing early geriatric rehabilitation and 10 healthy community-dwelling older adults. All participants underwent a comprehensive geriatric assessment. HRV measurements using a PPGI system and a reference ECG were made at the beginning and the end of the rehabilitation. HRV in terms of LF/HF ratio was analysed for both intra-individual changes during the geriatric rehabilitation and differences between frail geriatric patients and healthy community-dwelling individuals. Results: Across all geriatric patients, the median LF/HF ratio obtained with PPGI was found to be reduced by 0.178 (24.8%) during early geriatric rehabilitation. The assessment at the end of the rehabilitation revealed a simultaneous improvement of the functional state. Moreover, frail geriatric patients had a higher LF/HF ratio than their community-dwelling counterparts. Both observations in PPGI-based HRV were confirmed by the reference. The capability of PPGI to track intra-individual HRV changes was also analysed; a Spearman correlation of ρ = 1.0 between PPGI-based HRV and reference was achieved for 58.8% of the participants. Conclusion: Early geriatric rehabilitation improves the functional state, which is associated with an increased HRV. PPGI is capable of detecting HRV changes/trends in that age group. While the tracking of intra-individual HRV changes is also possible, its reliability needs improvement. Nevertheless, the capabilities demonstrated in our study and the non-contact measurement principle of PPGI emphasize its potential for application in geriatric medicine.

Frontiers in Public Health 9, 653931 (2021). doi:10.3389/fpubh.2021.653931, Published by Frontiers Media, Lausanne

Sarcopenic obesity is a multifactorial syndrome that is characterized by the co-occurrence of obesity and sarcopenia. The pathogenic mechanisms of sarcopenia and obesity seem to be synergistically connected and increase the risk of all-cause mortality in aging populations. With the increasing trend of obesity in our globally growing aging population, sarcopenic obesity will become a major public health issue over the next few decades. Thus, capturing the underlying mechanisms of sarcopenic obesity has strong potential in the development of preventive strategies, which may reduce the future burden of morbidity and mortality. This chapter focuses on the current definitions, diagnostic criteria, and knowledge of dysregulated pathways and the common molecular mechanisms of sarcopenia and obesity that are possibly involved in the pathogenesis of sarcopenic obesity.

IEEE transactions on neural systems and rehabilitation engineering 29, 2655-2665 (2021). doi:10.1109/TNSRE.2021.3133535, Published by IEEE, New York, NY

Body sensor networks (BSNs) represent an important research tool for exploring novel diagnostic or therapeutic approaches. They allow for integrating different measurement techniques into body-worn sensors organized in a network structure. In 2011, the first Integrated Posture and Activity Network by MedIT Aachen (IPANEMA) was introduced. In this work, we present a recently developed platform for a wireless body sensor network with customizable applications based on a proprietary 868MHz communication interface. In particular, we present a sensor setup for gait analysis during everyday life monitoring. The arrangement consists of three identical inertial measurement sensors attached at the wrist, thigh, and chest. We additionally introduce a force-sensitive resistor integrated insole for measurement of ground reaction forces (GRFs), to enhance the assessment possibilities and generate ground truth data for inertial measurement sensors. Since the 868MHz is not strongly represented in existing BSN implementations, we validate the proposed system concerning an application in gait analysis and use this as a representative demonstration of realizability. Hence, there are three key aspects of this project. The system is evaluated with respect to (I) accurate timing, (II) received signal quality, and (III) measurement capabilities of the insole pressure nodes. In addition to the demonstration of feasibility, we achieved promising results regarding the extractions of gait parameters (stride detection accuracy: 99.6&plusmn, 0.8%, Root-Mean-Square Deviation (RMSE) of mean stride time: 5ms, RMSE of percentage stance time: 2.3%). Conclusion: With the satisfactory technical performance in laboratory and application environment and the convincing accuracy of the gait parameter extraction, the presented system offers a solid basis for a gait monitoring system in everyday life.

Objective: Geriatric patients, especially those with dementia or in a delirious state, do not accept conventional contact-based monitoring. Therefore, we propose to measure heart rate (HR) and heart rate variability (HRV) of geriatric patients in a noncontact and unobtrusive way using photoplethysmography imaging (PPGI). Methods: PPGI video sequences were recorded from 10 geriatric patients and 10 healthy elderly people using a monochrome camera operating in the near-infrared spectrum and a colour camera operating in the visible spectrum. PPGI waveforms were extracted from both cameras using superpixel-based regions of interests (ROI). A classifier based on bagged trees was trained to automatically select artefact-free ROIs for HR estimation. HRV was calculated in the time-domain and frequency-domain. Results: an RMSE of 1.03 bpm and a correlation of 0.8 with the reference was achieved using the NIR camera for HR estimation. Using the RGB camera, RMSE and correlation improved to 0.48 bpm and 0.95, respectively. Correlation for HRV in the frequency-domain (LF/HF-ratio) was 0.50 using the NIR camera and 0.70 using the RGB camera. Conclusion: We were able to demonstrate that PPGI is very suitable to measure HR and HRV in geriatric patients. We strongly believe that PPGI will become clinically relevant in monitoring of geriatric patients. Significance: we are the first group to measure both HR and HRV in awake geriatric patients using PPGI. Moreover, we systematically evaluate the effects of the spectrum (near-infrared vs. visible), ROI, and additional motion artefact reduction algorithms on the accuracy of estimated HR and HRV.

Stride time variability is an important indicator for the assessment of gait stability. An accurate extraction of the stride intervals is essential for determining stride time variability. Peak detection is a commonly used method for gait segmentation and stride time estimation. Standard peak detection algorithms often fail due to additional movement components and measurement noise. A novel algorithm for robust peak detection in inertial sensor signals was proposed in a previous contribution. In this work, we present a novel approach for estimation of stride time variability based on the formerly proposed peak detection algorithm applied to an unobtrusive sensor setup for motion monitoring. The unobtrusive sensor setup includes a wrist sensor, a pocket or belt sensor, and a necklace sensor, all equipped with both accelerometer and gyroscope. The goal of this work is to implement a generalized approach for accurate and robust stride interval determining algorithm for different sensor locations. Therefore, treadmill and level ground walking experiments were conducted with ten healthy subjects at increasing walking speeds and an age-simulating suit. With the proposed algorithm, we achieved a RMSE of 0.07 s for the stride interval estimation during treadmill walking experiments. The results give promising indications that detection of variation of stride time variability is possible using the proposed unobtrusive sensor setup.

Chronische Niereninsuffizienz (CKD) fuhrt zu einer biologischen Voralterung mit Multimorbiditat und Einschrankung der Funktionalitat. Die damit einhergehende mangelnde Teilhabe und die erhohte Gefahr des Autonomieverlusts stehen im Zentrum eines geriatrietypischen Behandlungsansatzes. In diesem Zusammenhang relevante Fachtermini sind „geriatrisches Basis-Assessment“, „Frailty“ und „Sarkopenie“, die auch fur eine umfassende Behandlung chronisch kranker Nierenpatienten von Bedeutung sein konnen.

Die Begleitung demenzbetroffener Patienten stellt Klinikseelsorger vor eine Herausforderung, da die meisten klassischen Seelsorgeansatze das Gesprach als Medium der Beziehungsgestaltung fokussieren und eingeschrankte Kommunikationsfahigkeiten nicht berucksichtigen. Dieser Beitrag befasst sich mit der Situation von Klinikseelsorgern im Kontakt mit Demenzbetroffenen und der Frage, wie Klinikseelsorger Menschen mit Demenz kommunikativ erreichen und seelsorgerlich begleiten konnen. An der Studie nahmen 10 professionelle Klinikseelsorger teil, die Erfahrung im Umgang mit Menschen mit Demenz aufweisen. Die Datenerhebung erfolgte mittels leitfadengestutzter Experteninterviews. Zur Auswertung der Interviews diente die Methode der qualitativen Inhaltsanalyse nach Mayring. Klinikseelsorger stehen bei der Begleitung von Menschen mit Demenz vor der Herausforderung, alternativ zur Sprache andere Formen der Kommunikation zu erschliesen. Sie nutzen daher insbesondere biografieorientierte, nonverbale, sinnesbezogene und korperorientierte Zugange zu diesen Patienten. Ihr Expertenwissen eigneten sich die Interviewpartner uberwiegend durch demenzspezifische Fortbildungen, Hospitationen, wissenschaftliche Fachliteratur und Praxiserfahrung an, da die klinische Seelsorgeausbildung sowie klassische Seelsorgeansatze lange Zeit nicht auf diese Thematik vorbereiteten. Klinikseelsorger konnen durch Kommunikations- und Beziehungsarbeit einen Beitrag zur ganzheitlichen Versorgung von Menschen mit Demenz leisten. Dafur ist es notwendig, adaquate Seelsorgekonzepte zu entwickeln und Hilfestellungen fur den Umgang mit Demenzbetroffenen im Lehrplan der klinischen Seelsorgeausbildung zu verankern.

BACKGROUND Previous studies on orthogeriatric models of care suggest that there is substantial variability in how geriatric care is integrated in the patient management and the necessary intensity of geriatric involvement is questionable. OBJECTIVE The aim of the current prospective cohort study was the clinical and economic evaluation of fragility fracture treatment pathways before and after the implementation of a geriatric trauma center in conformity with the guidelines of the German Trauma Society (DGU). METHODS A comparison of three different treatment models (6 months each) was performed: A: Standard treatment in Orthopaedic Trauma; B: Special care pathways with improvement of the quality management system and implementation of standard operating procedures; C: Interdisciplinary treatment with care pathways and collaboration with geriatricians (ward round model). RESULTS In the 151 examined patients (m/w 47/104; 83.5 (70-100) years; A: n = 64, B: n = 44, C: n = 43) pathways with orthogeriatric comanagement (C) improved frequency of postoperative mobilization (p = 0.021), frequency of osteoporosis prophylaxis (p = 0.001) and the discharge procedure (p = 0.024). In comparison to standard treatment (A), orthogeriatric comanagement (C) was associated with lower rates of mortality (9% vs. 2%; p = 0.147) and cardio-respiratory complications (39% vs. 28%; p = 0.235) by trend. In this context, there were low rates of myocardial infarction (6% vs. 0%), dehydration (6% vs. 0%), cardiac dysrhythmia (8% vs. 0%), pulmonary decompensation (28% vs. 16%), electrolyt dysbalance (34% vs. 19%) and pulmonary edema (11% vs. 2%). Duration of stay in an intensive care unit was 29 h (A) and 18 h (C) respectively (p = 0.205), with consecutive reduction in costs. A sole establishment of a special care pathway for older hip fracture patients (B) showed a lower rate of myocardial infarction (A: 11%, B: 0%, C: 0%; p = 0.035). CONCLUSION There was a clear tendency to a better overall result in patients receiving multidisciplinary orthogeriatric treatment using a ward visit model of orthogeriatric comanagement, with lower rates of cardiorespiratory complications and mortality. While special care pathways could reduce the rate of myocardial infarction in hip fracture patients, costs and revenues showed no difference between all care models evaluated. However, patients with hip fracture or periprosthetic fracture represent cohorts at clinical and economic risk as well.

Obwohl Sturze eine enorme volkswirtschaftliche Bedeutung verkorpern, ist das Thema Pravention auf ambulanter Ebene bisher nur unzureichend umgesetzt. Indem der Aachener Sturzpass (ASP) als einfaches Testverfahren eine schnelle und regelmasige Abschatzung des personlichen Sturzrisikos in der hauslichen Umgebung erlaubt, kann er altere Personen und ihre Angehorigen fur die reale Sturzgefahr, aber auch fur die Sturzprophylaxe sensibilisieren. Es war die Akzeptanz des ASP unter geriatrischen Patienten zu evaluieren. Daneben sollten signifikante Einflussfaktoren wie objektives/subjektives Sturzrisiko, Sturzangst oder demografische Kennzahlen auf diese Nutzenbewertung des ASP analysiert und die Bereitschaft fur praventive Masnahmen (potenzielle Arztkontakte, Veranderungen des hauslichen Umfelds oder Nutzung von Sport- und Fitnessgruppen) detektiert werden. Es wurden retrospektiv alle Patienten erfasst, die im Zeitraum Juli 2014 bis April 2016 unfallchirurgisch stationar behandelt wurden (Alter >70 Jahre). Nach Determinierung einer Patientenzahl von 884 wurden den Patienten postalisch ein Fragebogen (47 Fragen, Ja/Nein, Likert-Skala) sowie erneut eine aktuelle Version des ASP zugesendet. Zuzuglich wurden von Juli bis August 2016 Patienten der ambulanten Frakturnachsorge zur Teilnahme an der Studie eingeladen. Es nahmen 201 Patienten (80,4 (63 bis 97) Jahre) an der Studie teil. Nach Absolvieren beider Teile des ASP sahen 95 (47 %) Teilnehmer in der Selbsteinschatzung ein relevantes Sturzrisiko. In der ambulanten Sturzpravention spielt der Hausarzt eine entscheidende Rolle. Zunachst wurden sich 67 % (n = 77) der Befragten an ihn wenden. Generell sahen 43 % der Befragten den ASP als wichtiges Hilfsmittel zur Beurteilung des Sturzrisikos an, bei nur 8 %, die diesen Ansatz komplett ablehnten. Es waren 88 Patienten (44 %) objektiv sturzgefahrdet. Dieses objektive Sturzrisiko hatte dabei einen signifikanten Einfluss auf die Bewertung des ASP, wie auch auf das subjektive Sturzrisiko. Nur 12 % der Teilnehmer sahen eine App-Nutzung des ASP als praktikable Option an. Risikopersonen zunachst in ihrer vertrauten Umgebung unter Nutzung simpler Testmethoden zu evaluieren, mit dem Ziel der Identifikation von potenziellen Balanceproblemen, erscheint aus vielerlei Sicht von Vorteil. Die Chancen dieser Form der ambulanten Sturzpravention sind enorm, da nicht nur Kosteneinsparungen moglich waren, sondern auch die Lebensqualitat der alteren Mitburger verbessert werden konnte.

The treatment of gout is based on several principles. Symptom control and termination of the inflammatory process are important early goals, whereas the urate level should be lowered in the long term to prevent further gout attacks and complications. The non-pharmacological approach is based on individually informing the patient on dietary measures and changes of life style. Besides physical measures, such as cold applications on the affected joint, various medications are available for treatment of an acute gout attack. The choice of drug depends on the individual risk profile. If non-steroidal anti-inflammatory drugs (NSAID) and coxibs are chosen it should be taken into account that the use is restricted in patients with renal insufficiency. Moreover, these drugs may have gastrointestinal side effects and are associated with increased cardiovascular morbidity and mortality. Colchicine has gastrointestinal side effects at high dosages but can also be used for differential diagnostics if there is a quick response to treatment. Steroids are an effective alternative and can be given orally or parenterally in patients with dysphagia. Moreover, steroids can be used in cases of renal insufficiency. After symptoms of the acute attack have subsided, urate lowering therapy should be initiated to prevent further attacks. Low-dose urate lowering therapy can be started during an acute gout attack when acute therapy is initiated. Allopurinol is still the medication of choice but its use is restricted in patients with renal insufficiency. A rare but serious side effect is allopurinol hypersensitivity syndrome. Febuxostat can be an alternative in patients who do not tolerate allopurinol. In February 2016, lesinurad, an URAT-1 and OAT-4 inhibitor, was approved in combination with allopurinol or febuxostat. Data on the effectiveness and safety of synthetic uricases and biologicals are still sparse for elderly patients. These substances are reserved for severe cases of gout.

European review of aging and physical activity 16(1), 15 (2019). doi:10.1186/s11556-019-0222-5, Published by Springer, Heidelberg

Journal of Inflammation 16(1), 14 (2019). doi:10.1186/s12950-019-0219-x, Published by BioMed Central, London

Stride time is an important indicator for the assessment of gait stability in long-term measurements using inertial measurement sensors. Peak detection is a commonly used method for gait segmentation and stride time estimation. Standard peak detection algorithms often fail due to additional movement components and measurement noise. This paper proposes a novel algorithm for robust peak detection in inertial sensor signals. The multi-stage implementation includes frequency analysis, reference signal synthesis, correlation and statistical analysis and a successive peak detection. The algorithm is validated on different inertial measurement datasets and compared to commonly known peak detection algorithms for periodic signals. In a movement laboratory setup of both healthy elderly and high risk fallers, we achieved satisfying detection results with a $\boldsymbol{F}_{1}$ -measure of 95.5%, which exceeded all additionally implemented algorithms for peak detection in gait signals based on inertial sensor measurements. In addition, we evaluated the stride time estimation performance using the proposed algorithms applied to different sensor positions and found sufficiently high correlation with optical reference data.

Background Personal autonomy in advanced age critically depends on mobility in the environment. Geriatric patients are often not able to walk safely with sufficient velocity. In many cases, multiple factors contribute to the deficit. Diagnostic identification of single components enables a specific treatment. Objective This article describes the most common neurological causes of imbalance and impaired gait that are relevant for a pragmatic approach for the assessment of deficits in clinical and natural environments taking into account the physiology of balance and gait control, typical morbidities in older people and the potential of innovative assessment technologies. Material and methods Expert opinion based on a narrative review of the literature and with reference to selected research topics. Results and discussion Common neurological causes of impaired balance and mobility are sensory deficits (reduced vision, peripheral neuropathy, vestibulopathy), neurodegeneration in disorders with an impact on movement control and motoric functions (Parkinsonian syndromes, cerebellar ataxia, vascular encephalopathy) and functional (psychogenic) disorders, particularly a fear of falling. Clinical tests and scores in laboratory environments are complemented by the assessment in the natural environment. Wearable sensors, mobile smartphone-based assessment of symptoms and functions and adopted strategies for analysis are currently emerging. Use of these data enables a personalized treatment. Furthermore, sensor-based assessment ensures that effects are measured objectively.

Swiss medical weekly 151, w20500 (2021). doi:10.4414/smw.2021.20500, Published by EMH Schweizerischer Ärzteverl., Basel