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Aufgrund komplexer physischer und psychischer Veranderungen im Alter stellen die Schmerzmessung und Schmerztherapie fur altere und betagte Patienten besondere Herausforderungen dar. Doch auch bei dieser Gruppe von Patienten sind gute Behandlungserfolge erreichbar, wenn altersbedingte Spezifika und Probleme konsequent beachtet und berucksichtigt werden. Dazu gehoren sensorische und kongnitive Beeintrachtigungen ebenso wie die Multimorbiditat und die damit haufig verbundene Polypharmazie. Eine wesentliche Voraussetzung fur eine adaquate schmerztherapeutische Versorgung alterer Patienten ist die konsequente Schmerzmessung. Wahrend numerische und verbale Skalen auch fur kognitiv nicht beeintrachtigte Patienten im fortgeschrittenen Alter ihre Zweckmasigkeit unter Beweis gestellt haben, mussen fur altere Menschen mit kommunikativen und/oder kognitiven Einschrankungen Instrumente eingesetzt werden, mit denen das beobachtete Verhalten der Betroffenen mehrdimensional erhoben werden kann.

Despite the widespread use of prostate specific antigen for early prostate cancer (PCa) detection in younger men, PCa is still as disease of the elderly as 2/3 of incident cases are detected in men older than 65 years and 25% are older than 75 years at diagnosis. Opportunistic screening for PCa is not recommended for men with a life expectancy of less than 10 years. The therapeutic strategy for senior adults is driven by tumour stage/aggressiveness, co-morbidity and chronological age. Elderly patients with low/intermediate risk tumours - particularly those with a life expectancy of less than 10 years - are best managed by watchful waiting. Senior adults with intermediate/high risk tumours and a life expectancy of >10 years may benefit from curative local therapy such as radical prostatectomy or combined external beam irradiation/androgen ablation therapy. For elderly patients with metastatic disease, androgen deprivation remains the mainstay of therapy, intermittent androgen ablation is a promising approach.

BACKGROUND: In the geriatric population the autopsy rate is low, leading to mortality statistics often based on clinical diagnoses alone. OBJECTIVES: To determine the clinical diagnostic accuracy rate regarding the immediate cause of death (CDARCD), the number of major underlying diseases and sole diagnoses, and general data about the immediate cause of death in geriatric hospitalized patients. METHODS: The autopsy-proven immediate cause of death was compared with the clinical diagnosis in 1594 patients over 69 years of age. On the basis of the autopsy protocols, the mean number of major underlying diseases and sole diagnoses were calculated. The immediate cause of death was classified into six groups: cardiovascular disease (CVD), malignant neoplasms (MN), bronchopulmonary disease (BPD), fatal pulmonary embolism (PE), miscellaneous (M), and marantic atrophy (MA). RESULTS: The overall CDARCD was 52.5%, being highest in MN (65.0%), followed by CVD (56.0%), MA (50%), BPD (48.3%), M (44.3%), and PE (26.7%). The most common cause of death was CVD (35.8%), followed by MN (24.3%), BPD (19.8%), PE (10.6%), M (7.7%) and MA (1.9%). The mean number of major underlying diseases and sole diagnoses was 2.0 and 14.4 respectively. CONCLUSIONS: The low CDARCD in our study strongly indicates the need for autopsy when reliable mortality statistics are desired.

The measurement of soluble transferrin receptor (sTfR) has been proposed as a novel approach to the diagnosis of iron deficiency, especially in anaemia of chronic diseases (ACD). Our aim was to study the utility of sTfR under 'everyday conditions' as seen in a geriatric hospital in the following groups of patients: First, in a pilot group of 99 multimorbid geriatric patients (85 women, 14 men; 82.00 +/- 6.32 years) admitted for rehabilitation after recent surgical treatment of a bone fracture; second, in 677 geriatric patients (506 women, 171 men; 79.17 +/- 11.47 years) with different diagnoses admitted to a department of internal medicine; third, in some remarkable clinical cases in order to illustrate the diagnostic limits of sTfR. In general, both genders showed a remarkable age-dependent decrease in erythropoiesis. In patients with haemoglobin levels below 12.0 mg/dL, this parameter correlated significantly with sTfR. However, this was seen only in women, not in men. Moreover, an age-dependent increase in sTfR was seen in women, while in men it remained almost constant. Based on these findings, we conclude that there is a different, gender-specific aetiology of iron deficiency in the elderly. About 30% of patients of both genders simultaneously had low haemoglobin levels and low sTfR. This was interpreted as 'adaptation' or 'tolerance' to the iron deficiency. This was illustrated by a clinical case of megaloblastic anaemia: Initially low sTfR rose only during the vitamin B12 substitution and normalized after recovery. We conclude that sTfR provides an insight into the 'dynamics' of iron metabolism: A rise in sTfR indicates an 'acute readiness to refill iron stores', while a low (non-stimulated) sTfR level corresponds to the quite frequent adaptation to iron deficiency and/or inhibition of resorption. Finally, extremely high sTfR levels were observed in some cases of malignancy such as in acute leukaemia and in hypernephroma. Thus, increased sTfR levels can be caused by paraneoplastic effects.

In this prospective treatment study, the effects of two different occupational therapy strategies were compared in two samples of long-term geriatric inpatients (n = 22 in each group) with slight to moderate dementia according to DSM-III-R. Psychometric ratings after 12 weeks and 24 weeks of treatment have demonstrated that the application of a reactivating occupational therapy programme in addition to functional rehabilitation is significantly more efficient than the application of functional rehabilitation alone on levels of cognitive performance, psychosocial functioning, and the degree of contentedness with life. These results support the assumption that geriatric patients, if stimulated for a longer time, are able to mobilize latent resources of cognitive and psychosocial performance. Reactivating occupational therapy has a place in the treatment of long-term geriatric patients.

Computed tomography (CT), electroencephalograms (EEG), clinical and psychometric data were obtained in 96 mildly to moderately demented patients (72 women, 24 men), aged 61–96 years (mean 82), diagnosed according to DSM-III criteria. Patients were off drugs for at least 2 weeks and subdiagnosed according to the modified Marshall-Hachinski ischemic score and CT in 45 senile dementia of the Alzheimer type (SDAT) and 51 multiinfarct dimentia (MID) patients. Evaluations were carried out before and 12 weeks after treatment with either 100 mg denbufylline BID or placebo and included EEG mapping, the Sandoz Clinical Assessment Geriatric (SCAG) score/factors, the Clinical Global Impression (CGI), the Digit Symbol Substitution Test (DSST), the Trail-Making Test (TMT) and the Digit Span Test (DS). Descriptive data analysis including confirmatory statements found delta/theta activity enhanced, alpha and beta activity reduced, total power augmented, and the centroid slowed down over various brain regions in patients as compared with controls. The two subtypes of dementia could be differentiated in some conventional EEG variables but mostly by means of power asymmetry indices. Denbufylline induced a statistically significant and clinically relevant improvement in both SDAT and MID patients, whereas after placebo this was not the case in CGI, the TMT, and the DS, with interdrug differences being significant in all primary target variables such as the CGI, MMS, SCAG, and DSST. Thus, both the degenerative and vascular type of dementia exhibited a therapeutic benefit that could be objectified at the neurophysiological level by EEG mapping in an improvement of vigilance.

Due to complex physical and psychological changes in aging, pain measurement and therapeutic treatment of older and geriatric patients present a special challenge. Nevertheless, even for this category of patients, good treatment results are achievable if age-related particulars and problems are consistently heeded and accounted for. That includes adverse sensory and cognitive effects as much as multimorbidity and the polypharmacy that is frequently related to it. An essential prerequisite for adequate pain therapeutic care in elderly patients is consistent pain measurement. While numerical and verbal scales have also proven their usefulness for patients in advanced age who are not cognitively impaired, instruments must be applied for older people with communicative and/or cognitive restrictions with which the observed behavior of those involved can be surveyed in a multidimensional way.

As he/she approaches the end of life, the healthy elderly person comes to be seen rather as a “biological curiosity” than as a normal case. For laboratory testing it becomes increasingly difficult to determine appropriately stratified and statistically relevant reference groups. More appropriate would be individual monitoring, which, however, requires long-term stable quality in laboratory analyses. Despite “consolidation” in laboratory medicine, the pre-analytical phase, which is especially important in the elderly, remains underestimated. This problem is aggravated by insufficient harmonisation between laboratory tests, especially when point-of-care testing is included. Since in geriatrics the maintenance of life quality is more important than curative therapy, clinicians are forced to undergo therapeutic compromises applying symptomatic, supportive or palliative therapies. In this situation, information on “still remaining functional capacities” of organs is particularly helpful. Diagnostic problems resulting from underestimation of “multi-morbidity” and especially “multi-aetiology” can be complicated by “degradation of clinical information”, especially in patients in cognitive and/or physical decline. The specific purpose of “geriatric” laboratory medicine seems to induce a change of paradigms: not only statistically established “evidence”, but “individuality” in a single patient will need more profound insight. Not so much differentiation between “physiology” and “pathology”, but the consideration of “clinical individuality” as relative risk in dimension of time is of importance.

The aim of the study was to evaluate, if elderly persons are sufficiently protected against infectious diseases by vaccination.300 elderly (60 years) and 300 young (35 years) persons from five Austrian cities were recruited according to the criteria of a field study. Antibody concentrations against tetanus, diphtheria, tickborne encephalitis and influenza were assessed by ELISA or by haemagglutination inhibition test. Disease and vaccination histories were recorded.The results of the study demonstrate that protection against infectious diseases was frequently insufficient in the elderly. This was partly due to the fact that old persons were not vaccinated according to recommended strategies. However, low antibody concentration and a short duration of protective humoral immunity were also observed in many elderly persons in spite of regular vaccination. This was not only the case in frail, but also in healthy elderlies.The data demonstrate that vaccination has a relatively weak and short-lasting effect in old age. The results of the study should stimulate discussions about strategies how vaccinations can be made more effective in old age. Improved campaigns, shortened vaccination intervals as well as the design of novel vaccines tailored to fulfill the specific demands of the aging immune system are imaginable.

Der grenzuberschreitende Verkehr mit gefahrdeten Tier- und Pflanzenarten unterliegt in der Bundesrepublik Deutschland internationalen und nationalen Ubereinkommen und Gesetzen. Aufbau, Inhalt und praktische Umsetzung dieser Rechtsgrundlagen sind Inhalt dieses Beitrages. Die Ausfuhrungen werden durch die Darstellung der nationalen Besonderheiten und der Eingriffsmoglichkeiten der zustandigen Behorden erganzt. Das trotzdem immer wieder versucht wird, diese Regelungen zu umgehen, belegen einige Beispiele ausgewahlter Schmuggelfalle.

In previous studies, results from psychometric measures suggested an association between alexithymia and somatization. However, alexithymia has not been examined in relation to somatoform disorders and other standard psychiatric diagnoses. In the present study, the prevalence of DSM-III-R diagnoses was determined by SCID interviews among 45 psychiatric inpatients with functional somatic syndromes. In addition, the Toronto Alexithymia Scale (TAS) and the SCL-90-R were administered. Of the sample, 42.2% scored in the alexithymic range of the TAS. The alexithymic patients presented significantly more psychological turmoil and overall psychopathology on the SCL-90-R, as well as a significantly higher number of current DSM-III-R diagnoses. However, alexithymia was unrelated to DSM-III-R somatoform disorders and other DSM-III-R diagnoses, as well as the course of illness. These results suggest that assessing clinical features in addition to psychometric measures seems to be necessary for further validating the potential role of the alexithymia construct in somatic symptom formation.