Suchergebnisse

Background: Although the number of older patients is increasing in almost all medical specialties, the interest of medical students in geriatrics as a career is still low. Because quality of medical education and educators strongly influences student career decisions, it is important to develop curricula that motivate students to become self-directed, lifelong learners in the field of geriatric medicine. Objectives: We evaluated training aspects in terms of time, core content of teaching goals, and quality of undergraduate geriatric education in medical schools in Austria and Germany. Methods: A standardized paper questionnaire was sent to all 36 German and 4 Austrian medical faculties to evaluate quantitative aspects, content, and quality of pregraduate medical education in geriatrics. Results were compared to the recommendations of the Geriatric Medicine Section of the European Union of Medical Specialists (UEMS). Results: A total of 33/36 (92 of the German medical faculties) and 4/4 (100 of the Austrian medical faculties) responded to the questionnaire. In most of the faculties, geriatric medicine was taught as an independent discipline in the core curriculum, with learning objectives absent in almost one third of the faculties. A medical student's first contact with geriatric medicine occurred on average during the second clinical year (median 8th semester). Although the content of geriatric curricula strongly varied among the faculties, core knowledge as recommended by the UEMS was integrated into most of the curricula. Teaching strategies regarding the development of attitudes and skills also recommended by the UEMS were identified in the curriculum of only some faculties. Conclusions: Geriatrics seems to be an established subject in most German and Austrian faculties. However, the current data clearly indicate highly variable quality in geriatric pregraduate training at German and Austrian universities. Because curricula should prepare young people using competence- based training and assessment methods, ...

Im Zentrum des Buchs steht der alternde Mensch mit seinen Angehörigen. Seine Interaktion mit dem Gesundheits- und Pflegesystem, den Ärzten und Pflegekräften verändert sich über den Prozess des Alterns hinweg. Zugleich ändern sich derzeit die gesellschaftlichen Rahmenbedingungen grundlegend. Dadurch entstehen immer wieder neue ethische Herausforderungen für die Patienten selbst, ihre Angehörigen, die Gesundheitsprofessionellen, die Institutionen und die Gesellschaft insgesamt. Das Buch beleuchtet die verschiedenen Sichtweisen eingehender und zeigt anhand von vielen Praxisbeispielen nicht nur die ethischen Dilemmata, sondern bietet auch etliche Lösungsmöglichkeiten an.

BackgroundMobility limitations are of particular interest in people with intellectual disabilities. The aim of this study was to present feasibility and mean values of gait parameters in people with intellectual disability and it was hypothesized that several trials would be necessary to gain stable values for this cohort.Material and MethodsThirty‐two adults with intellectual disability living in a residential facility were asked to do four walks in both normal and fast speed conditions over an instrumented walkway. Mean values of gait parameters were calculated over two different trial combinations, with TC1&2 representing the mean value of trials 1 and 2, and TC1‐4 representing the mean over all four trials.ResultsAll participants (Mage = 59.6 years; SD = 16.71) successfully performed the protocol. Gait parameters remained constant over all trials. No significant differences were found between the trial combination TC1&2 and trial combination TC1–4.ConclusionGait analysis was found to be feasible in people with intellectual disability. Overall, the present authors recommend performing two trials and to calculate the means of gait parameters over these two trials to gain stable values.

Background Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components' role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes). Methods Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed. Results Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months). Conclusions Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, ...

BACKGROUND: Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components' role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes). METHODS: Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed. RESULTS: Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months). CONCLUSIONS: Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, ...

Die durchschnittliche Lebenserwartung in Deutschland ist in den vergangenen Jahren deutlich gestiegen. Mit dieser Entwicklung sind neue Herausforderungen verbunden. So gilt es, die hohe Lebensqualität, Produktivität und Innovationsfähigkeit in einer Gesellschaft des längeren Lebens zu erhalten. Mit diesen Herausforderungen befasst sich die Alterns- und Lebensverlaufsforschung. Insbesondere sollte in Deutschland die Zusammenarbeit der einzelnen Disziplinen gestärkt werden. Gegenwärtig bleibt das Forschungsfeld noch hinter seinen Möglichkeiten zurück, schreiben Expertinnen und Experten der Nationalen Akademie der Wissenschaften Leopoldina im Zukunftsreport Wissenschaft "Forschung für die gewonnenen Jahre: Zukunft der Alterns- und Lebensverlaufsforschung".

Die durchschnittliche Lebenserwartung in Deutschland ist in den vergangenen Jahren deutlich gestiegen. Mit dieser Entwicklung sind neue Herausforderungen verbunden. So gilt es, die hohe Lebensqualität, Produktivität und Innovationsfähigkeit in einer Gesellschaft des längeren Lebens zu erhalten. Mit diesen Herausforderungen befasst sich die Alterns- und Lebensverlaufsforschung. Insbesondere sollte in Deutschland die Zusammenarbeit der einzelnen Disziplinen gestärkt werden. Gegenwärtig bleibt das Forschungsfeld noch hinter seinen Möglichkeiten zurück, schreiben Expertinnen und Experten der Nationalen Akademie der Wissenschaften Leopoldina im Zukunftsreport Wissenschaft "Forschung für die gewonnenen Jahre: Zukunft der Alterns- und Lebensverlaufsforschung".

New evidence shows that older adults need more dietary protein than do younger adults to support good health, promote recovery from illness, and maintain functionality. Older people need to make up for age-related changes in protein metabolism, such as high splanchnic extraction and declining anabolic responses to ingested protein. They also need more protein to offset inflammatory and catabolic conditions associated with chronic and acute diseases that occur commonly with aging. With the goal of developing updated, evidence-based recommendations for optimal protein intake by older people, the European Union Geriatric Medicine Society (EUGMS), in cooperation with other scientific organizations, appointed an international study group to review dietary protein needs with aging (PROT-AGE Study Group). To help older people (>65 years) maintain and regain lean body mass and function, the PROT-AGE study group recommends average daily intake at least in the range of 1.0 to 1.2 g protein per kilogram of body weight per day. Both endurance-and resistance-type exercises are recommended at individualized levels that are safe and tolerated, and higher protein intake (ie, >= 1.2 g/kg body weight/d) is advised for those who are exercising and otherwise active. Most older adults who have acute or chronic diseases need even more dietary protein (ie, 1.2-1.5 g/kg body weight/d). Older people with severe kidney disease (ie, estimated GFR <30 mL/min/1.73m(2)), but who are not on dialysis, are an exception to this rule; these individuals may need to limit protein intake. Protein quality, timing of ingestion, and intake of other nutritional supplements may be relevant, but evidence is not yet sufficient to support specific recommendations. Older people are vulnerable to losses in physical function capacity, and such losses predict loss of independence, falls, and even mortality. Thus, future studies aimed at pinpointing optimal protein intake in specific populations of older people need to include measures of physical function. Copyright (C) 2013 - American Medical Directors Association, Inc.

Introduction: Various operational definitions have been proposed to assess the frailty condition among older individuals. Our objective was to assess how practitioners measure the geriatric syndrome of frailty in their daily routine. Methods: An online survey was sent to national geriatric societies affiliated to the European Union Geriatric Medicine Society (EUGMS) and to members of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Results: A total of 388 clinicians from 44 countries answered to the survey. Most of them were medical doctors (93%), and their primary field of practice was geriatrics (83%). Two hundred and five clinicians (52.8%) always assessed frailty in their daily practice, 38.1% reported to "sometimes" measure it, and 9.1% never assess it. A substantial proportion of clinicians (64.9%) diagnose frailty using more than one instrument. The most widely used tool was the gait speed test, adopted by 43.8% of the clinicians, followed by clinical frailty scale (34.3%), the SPPB test (30.2%), the frailty phenotype (26.8%) and the frailty index (16.8%). Conclusion: A variety of tools is used to assess frailty of older patients in clinical practice highlighting the need for standardisation and guidelines.