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  • 1
    Language: English
    In: Dysphagia, 2011, Vol.26(2), pp.108-116
    Description: Functional dysphagia therapy (FDT) is a noninvasive procedure that can accompany percutaneous endoscopic gastrostomy (PEG) treatment and supports transitioning from tube to oral feeding. In this retrospective study, we investigated the outcome of FDT with or without PEG feeding. Patients with dysphagia were divided into two groups: those with PEG feeding ( N  = 117) and those with exclusively oral feeding ( N  = 105). Both groups received functional training (oral motor skills/sensation, compensatory swallowing techniques) from speech-language therapists. Functional oral intake, weight, Barthel index, and speech and language abilities were evaluated pre- and post-training. The non-PEG group showed a significant post-treatment improvement in functional oral intake, with diet improvement from pasty consistency to firm meals in most cases. However, even severely disordered patients (with PEG feeding) showed a significant increase in functional oral intake, still requiring PEG feeding post-treatment but able to take some food orally. The sooner a PEG was placed, the more functional oral intake improved. Significantly more complications and higher mortality occurred in the PEG group compared to the group with exclusively oral feeding. Dysphagia treatment in the elderly requires a multiprofessional setting, differentiated assessment, and functional training of oral motor skills and sensation and swallowing techniques.
    Keywords: Dysphagia ; Nutrition ; PEG feeding tube ; Functional therapy ; Deglutition ; Deglutition disorders
    ISSN: 0179-051X
    E-ISSN: 1432-0460
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  • 2
    Language: English
    In: International Orthopaedics, 2012, Vol.36(6), pp.1181-1183
    Description: Byline: Kiriakos Daniilidis (1), Bjoern Vogt (1), Georg Gosheger (1), Marcel Henrichs (1), Ralf Dieckmann (1), Dino Schulz (1), Steffen Hoell (1) Abstract: Purpose Knee pain after total knee arthroplasty may be caused by an unresurfaced patella. Secondary isolated resurfacing of the previously unresurfaced patella in total knee arthroplasty remains controversial. The aim of this retrospective study was to evaluate the outcome after patellar resurfacing as a second stage procedure. Methods The study included 22 patients (13 female/nine male) who underwent resurfacing of the patella with a mean follow-up of 61.8+-39.2 months. The mean age of the patients was 60+-9.7 years at the time of operation. The average period between total knee arthroplasty and patellar resurfacing was 26.3+-15.2 months. The patient's subjective satisfaction was assessed by a custom-made questionnaire. Results The mean Knee Society Score improved significantly from 60.1+-8.3 to 77.0+-6.3 (p=0.0063). The mean functional score also improved significantly from 42.7+-2.3 to 60.2+-3.9 (p=0.001). Three patients (13.6%) needed further operative revision. Conclusions Although clinical scores showed significant improvement some patients continued to have pain and remained dissatisfied without detecting a specific reason. Further studies are needed to better elucidate the benefit of patellar resurfacing as second stage procedure. Author Affiliation: (1) Orthopaedic and Tumour Orthopaedic, University Hospital Munster, Munster, Germany Article History: Registration Date: 06/12/2011 Received Date: 31/10/2011 Accepted Date: 05/12/2011 Online Date: 14/01/2012
    Keywords: Arthroplasty ; Orthopedic Surgery ; Knee Replacement Arthroplasty;
    ISSN: 0341-2695
    E-ISSN: 1432-5195
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  • 3
    In: DMW - Deutsche Medizinische Wochenschrift, 2017, Vol.142(02), pp.117-122
    Description: Physical frailty is a physiological syndrome of older people. It is characterized by a reduced reserve, a reduced stressor resistance, and vulnerability to negative health outcomes. The assessment of physical frailty is increasingly applied to identify high risk patients prior to medical or surgical interventions. The present article describes Fried’s frailty phenotype, which is the most frequently applied diagnostic instrument of physical frailty, together with evidence based treatment options.
    Keywords: Gebrechlichkeit ; Physische frailty ; Frailty phänotyp ; Geriatrisches assessment ; Frailty ; Physical frailty ; Frailty phenotype ; Geriatric assessment
    ISSN: 0012-0472
    E-ISSN: 1439-4413
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  • 4
    Language: English
    In: Zeitschrift für Gerontologie und Geriatrie, 2016, Vol.49(7), pp.626-631
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s00391-015-0984-y Byline: Benjamin Lieske (1), Ingrid Becker (2), Ralf Joachim Schulz (1), Maria Cristina Polidori (3), Jan Kassubek (3), Gabriele Roehrig (1,4) Keywords: Aged; Iron deficiency; Geriatrics; Severity scale; Activities of daily living; Alter; Eisenmangel; Geriatrie; Schweregradskala; Aktivitaten des taglichen Lebens Abstract: Background This observational study was carried out to investigate the effect of intravenous (i.v.) iron administration on the clinical symptoms of restless legs syndrome (RLS) in geriatric outpatients over 65 years old. Methods In this study geriatric outpatients (mean 4.5[+ or -]3.4 comorbidities and 5.7[+ or -]4.4 drugs taken) were recruited according to the following inclusion criteria: a[yen]65 years, diagnosis of RLS due to iron deficiency, i.e. ferritin 〈50 A[micro]g/l or transferrin saturation (TFS) 〈16%) as well as no other iron therapy within 2 weeks prior to the study. Of the patients 7 (41%) received 500 mg ferric carboxymaltose (FCM) and 10 patients (59%) received iron gluconate (62.5 mg) based on the degree of iron deficiency. As assessed by the international RLS severity scale (IRLS) symptoms were recorded 3 times: at the beginning of iron therapy (t.sub.0), after 2 weeks (t.sub.1) and after 12 weeks (t.sub.2). Results A total of 17 patients (13 female, 4 male, mean age 73.2[+ or -]5.9 years) were included. The IRLS score significantly improved in all patients as shown by an average decrease from 30.2 ([+ or -]4.3) to 20.2 ([+ or -]4.7) (p〈0.001) after 2 weeks of i.v. iron treatment and to 23.2[+ or -]6.6 (p〈0.001) after 12 weeks. There was a high correlation between ferritin values and the IRLS score (C 0.729, p〈0.001). The part of the IRLS referring to activities of daily living (ADL) improved from a median of 3 (scores 3--4) to 2 (scores 2--3, p=0.001) after 2 weeks (effect size -0.6). Conclusion In this study group of geriatric outpatients i.v. administration of iron was associated with a significant improvement of symptoms in RLS as assessed by the IRLS score 2 weeks after treatment. In geriatric patients with RLS associated with iron deficiency, i.v. iron administration should be considered regarding improvement of RLS symptoms and ADL. Abstract (German): Hintergrund Es wurde eine Beobachtungstudie zur Untersuchung der Wirkung der intravenosen (i.v.) Eisengabe auf die klinischen Symptome des Restless-legs-Syndroms (RLS) bei geriatrischen ambulanten Patienten uber 65 Jahren durchgefuhrt. Methoden Eingeschlossen wurden Patienten (4,5[+ or -]3,4 Komorbiditaten, 5,7[+ or -]4,4 eingenommene Wirkstoffe) gema[sz] folgender Einschlusskriterien: a[yen]65 Jahre, Eisenmangel assoziiertes RLS (Ferritin 〈50 A[micro]g/l oder Transferrinsattigung (TFS) 〈16%) sowie keine Eisengabe 2 Wochen vor Studieneinschluss. Sieben Patienten (41%) erhielten 500 mg Eisencarboxymaltose (FCM) und 10 Patienten (59%) erhielten Eisenglukonat (62,5 mg) basierend auf der Hohe des Eisenmangels. Mittels International RLS Severity Scale (IRLS), wurde der Schweregrad des RLS dreimal bewertet: zu Beginn der Eisengabe (t.sub.0), nach 2 Wochen (t.sub.1) und nach 12 Wochen (t.sub.2). Ergebnisse Siebzehn Patienten (13 weiblich, 4 mannlich, mittleres Alter 73,2[+ or -]5,9 Jahre) wurden eingeschlossen. Der IRLS-Score verbesserte sich signifikant bei allen Patienten, basierend auf einer Abnahme des IRLS-Score von 30,2 ([+ or -]4,3) auf 20,2 ([+ or -]4,7) (p〈0,001) 2 Wochen nach der i.v. Eisenbehandlung und auf 23,2[+ or -]6,6 (p〈0,001) nach 12 Wochen. Der Schweregrad des RLS zeigte eine hohe Korrelation mit den gemessenen Ferritinwerten (C 0,729, p〈0,001). Der Teil des IRLS, welcher die Aktivitaten des taglichen Lebens (ADL) abbildet verbesserte sich im Median von 3 [3--4] auf 2 [2--3 p=0,001)] nach 2 Wochen (Effektgro[sz]e -0,6). Schlussfolgerung In diesem geriatrischen ambulanten Kollektiv ist eine i.v. Eisengabe mit einer signifikanten Besserung der RLS Symptome nach 2 Wochen verbunden. Bei geriatrischen Patienten mit Eisenmangel assoziiertem RLS sollte immer auch eine i.v. Eisengabe zur Besserung von RLS und ADL erwogen werden. Author Affiliation: (1) Department of Geriatric Medicine, St. Marien-Hospital, Cologne, Germany (2) Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany (3) Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany (4) Ageing Clinical Research, Department II of Internal Medicine, University of Cologne, Herderstra[sz]e 52, 50931, Cologne, Germany Article History: Registration Date: 23/10/2015 Received Date: 09/09/2015 Accepted Date: 23/10/2015 Online Date: 23/11/2015
    Keywords: Aged ; Iron deficiency ; Geriatrics ; Severity scale ; Activities of daily living
    ISSN: 0948-6704
    E-ISSN: 1435-1269
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  • 5
    Language: German
    In: MMW Fortschritte der Medizin, March 2017, Vol.159(Suppl 4), pp.12-17
    Description: The Restless Legs Syndrome (RLS) is a clinically relevant condition in geriatric patients. An association between iron deficiency and RLS is largely acknowledged. The clinical and therapeutic management of iron deficiency-associated RLS has been, however, poorly evaluated in geriatric patients. Data from all RLS inpatients admitted to a geriatric unit between 2009 and 2011 were retrospectively collected on demographics and clinical characteristics, iron status, drug treatment including iron substitution, as well as comprehensive geriatric assessment (CGA) scores. RLS was diagnosed in 56 of the 4,063 admitted patients during the two years. Of the RLS cases, 20 (36%) showed iron deficiency. Thirteen of these were treated with iron substitution according to the existing guidelines. Both RLS patients with and without iron deficiency showed a significant clinical improvement between admission to discharge according to the CGA scores. Iron substituted geriatric patients with iron deficiency-associated RLS substantially benefited from the treatment, similarly to RLS patients without iron deficiency. A multidimensional assessment, careful iron metabolism examination and adequate treatment choice should be equally importantly considered in geriatric patients with RLS.
    Keywords: Comprehensive Geriatric Assessment ; Diagnosis ; Geriatrics ; Iron Deficiency ; Restless Legs Syndrome ; Restless Legs Syndrome -- Drug Therapy
    ISSN: 1438-3276
    E-ISSN: 16133560
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 6
    Language: English
    In: Annals of Hematology, 2014, Vol.93(10), pp.1645-1654
    Description: The purpose of this cross-sectional prospective study was to determine the prevalence of anemia among elderly hospitalized patients in Germany and to investigate its association with multidimensional loss of function (MLF). One hundred participants aged 70 years or older from two distinct wards (50 each from an emergency department and a medical ward, respectively) underwent a comprehensive geriatric assessment (CGA) consisting of the following six tools: Barthel Index, mini-mental state examination, clock-drawing test, timed up and go test, Esslinger transfer scale, and Daniels test. MLF as an aggregated outcome was diagnosed when three or more tests of the CGA showed an abnormal result. Anemia was defined according to WHO criteria as a hemoglobin (Hb) concentration of 〈13 g/dL for men and 〈12 g/dL for women. The prevalence of anemia was 60 %. Overall, 61 % of patients presented with three or more abnormal results in the six tests of the CGA and, thus, with MLF. Using logistic regression, we found a significant association of both anemia and low Hb concentrations with abnormal outcomes in five tests of the CGA and, therefore, with domain-specific deficits like mobility limitations, impaired cognition, and dysphagia. Furthermore, being anemic increased the odds of featuring MLF more than fourfold. This significant relationship persisted after adjustment for various major comorbidities. Both anemia and geriatric conditions are common in the hospitalized elderly. Given the association of anemia with MLF, Hb level might serve as a useful geriatric screening marker to identify frail older people at risk for adverse outcomes.
    Keywords: Anemia ; Elderly ; Functional status ; Prevalence ; Comprehensive geriatric assessment ; Cognition
    ISSN: 0939-5555
    E-ISSN: 1432-0584
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  • 7
    Language: English
    In: The Journals of Gerontology: Series A, 10/17/2018
    Description: Background Multidimensional Prognostic Index (MPI) is useful as a prognostic tool in hospitalized older patients, but our knowledge is derived from retrospective studies. We therefore aimed to evaluate in a multicenter, longitudinal, cohort study whether the MPI at hospital admission is useful to identify groups with different mortality risk and whether MPI at discharge may predict institutionalization, rehospitalization, and use of home care services during 12 months. Methods This longitudinal study, carried out between February 2015 and August 2017, included nine public hospitals in Europe and Australia. A standardized comprehensive geriatric assessment including information on functional, nutritional, cognitive status, risk of pressure sores, comorbidities, medications, and cohabitation status was used to calculate the MPI and to categorize participants in low, moderate, and severe risk of mortality. Data regarding mortality, institutionalization, rehospitalization, and use of home care services were recorded through administrative information. Results Altogether, 1,140 hospitalized patients (mean age 84.1 years, women = 60.8%) were included. In the multivariable analysis, compared to patients with low risk group at admission, patients in moderate (odds ratio [OR] = 3.32; 95% CI: 1.79–6.17; p 〈 .001) and severe risk (OR = 10.72, 95% CI: 5.70–20.18, p 〈 .0001) groups were at higher risk of overall mortality. Among the 984 older patients with follow-up data available, those in the severe-risk group experienced a higher risk of overall mortality, institutionalization, rehospitalization, and access to home care services. Conclusions In this cohort of hospitalized older adults, higher MPI values are associated with higher mortality and other negative outcomes. Multidimensional assessment of older people admitted to hospital may facilitate appropriate clinical and postdischarge management.
    Keywords: Older People ; Mortality ; Risk Factors ; Risk Assessment ; Hospitals ; Patients ; Cognitive Ability ; Mortality;
    ISSN: 1079-5006
    E-ISSN: 1758-535X
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  • 8
    Language: English
    In: Experimental Gerontology, November 2014, Vol.59, pp.47-50
    Description: The basis of nutritional therapy and thus an adequate nutrient intake is the assessment of energy need. On the other end, the assessment of individual energy requirements based on the gold standard, indirect calorimetry, is associated with feasibility difficulties in geriatric settings. To identify the most accurate predictive equations for resting energy expenditure (REE) in older subjects with overweight, 17 predictive equations were compared to indirect calorimetry measurement in a study population of 20 obese older subjects (mean BMI 33.7 ± 4.5 kg/m ; mean age 79.8 ± 8.1 years; gender 5 males and 15 females) and 20 age-matched controls with a normal body weight (mean BMI 24.9 ± 2.5 kg/m ; mean age 82.1 ± 6.6 years; gender 9 males and 11 females). The comparison led to two significant observations: the predictive equations used led to a much better estimation of the REE in the control group than in the obese older subjects. In addition, the most accurate equation for estimating the REE in the obese older subjects has been shown to be that by Lührmann et al. Further studies are needed to assess the feasibility of using this equation in a routine geriatric setting.
    Keywords: Resting Energy Expenditure ; Overweight ; Obesity ; Indirect Calorimetry ; Aged ; Medicine ; Social Welfare & Social Work ; Anatomy & Physiology
    ISSN: 0531-5565
    E-ISSN: 1873-6815
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  • 9
    Language: English
    In: Maturitas, August 2016, Vol.90, pp.37-41
    Description: Objective of this study was to analyse the association between impairment of Barthel Index items and hematologic parameters in geriatric inpatients. Patient recruitment of the “GeriPrävalenz2013” study has been described before. Inclusion criteria: in-patient aged 〉 = 70 years; exclusion criteria: actual cancer disease or cancer associated treatment. Anemia was defined according to WHO criteria. Physical impairment was assessed by Barthel Index (BI). Association between all 10 items of the BI and hematologic parameters was statistically evaluated. Anemia prevalence was 55.1% (319/579) with BI impairment in 96.2% patients. T-test revealed significant lower BI in anemic patients (47.9 vs 54.3; p = 0.004). Binary logistic regression revealed that growing age, reduced MCV, reduced iron levels and reduced Hb levels were associated with increased impairment of several items of the Barthel-Index. Interestingly, increased levels of albumin and folic acid (FA) were associated with increased impairment of BI items. Anemia and lower levels of anemia related parameters showed a negative impact on ADL and physical performance based on BI items. An impaired total BI should result in an analysis of BI subitems, particularly if anemia related laboratory parameters are deviant. Reasons for the negative impact of elevated FA and albumin levels on BI remain speculative.
    Keywords: Anemia ; Hematologic Parameters ; Functional Impairment ; Barthel Index ; Hamburg Classification Manual ; Geriatrics ; Medicine
    ISSN: 0378-5122
    E-ISSN: 1873-4111
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  • 10
    Language: English
    In: BMC Geriatrics, May 3, 2015, Vol.15(1)
    Description: Background Mobility is a key outcome in geriatric rehabilitation. The de Morton Mobility Index (DEMMI) is an internationally well-established, unidimensional measure of mobility with good psychometric properties. The aim of this study was to examine the reliability and construct validity of the German translation of the DEMMI in geriatric inpatients. Methods This cross-sectional study included patients admitted to a sub-acute inpatient geriatric rehabilitation hospital (reliability sample: N = 33; validity sample: N = 107). Reliability, validity, and unidimensionality were investigated. Results Inter-rater reliability between two graduate physiotherapists was excellent, with intra-class correlation coefficient of 0.94 (95% confidence interval: 0.88-0.97). The minimal detectable change with 90% confidence was 9 points. Construct validity for the DEMMI was evidenced by significant moderate to strong correlations with other measures of mobility and related constructs (Performance Oriented Mobility Assessment: rho = 0.89; Functional Ambulation Categories: rho = 0.70; six-minute walk test: rho = 0.73; gait speed: rho = 0.67; Falls Efficacy Scale International: rho = -0.68). Known-groups validity was indicated by significant DEMMI mean group differences between independent versus dependent walkers and walking aid users versus non-users. Unidimensionality of the German DEMMI translation was confirmed by Rasch analysis. Conclusions The German translation of the DEMMI is a unidimensional instrument producing valid and reproducible measurement of mobility in an inpatient geriatric rehabilitation setting. Keywords: Aged, Mobility limitation, Geriatric assessment, Psychometrics, Rehabilitation
    Keywords: Ambulation Aids ; Health Screening ; Medical Research ; Activities of Daily Living ; Physical Therapists
    ISSN: 1471-2318
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