Background
Geriatric rehabilitation aims to maintain the functional reserves of older adults in order to optimize social participation and prevent disability. After discharge from inpatient geriatric rehabilitation, patients are at high risk for decreased physical capacity, increased vulnerability, and limitations in mobility. As a result, ageing in place becomes uncertain for a plethora of patients after discharge from geriatric rehabilitation and effective strategies to prevent physical decline are required. Collaboration between different health-care providers is essential to improve continuity of care after discharge from inpatient geriatric rehabilitation. The aim of this study is to evaluate the effectiveness of a multi-professional home-based intervention program (GeRas) to improve functional capacity and social participation in older persons after discharge from inpatient geriatric rehabilitation.
Methods
The study is a multicenter, three-arm, randomized controlled trial with a three-month intervention period. Two hundred and seventy community-dwelling older people receiving inpatient geriatric rehabilitation will be randomized with a 1:1:1 ratio to one of the parallel intervention groups (conventional IG or tablet IG) or the control group (CG). The participants of both IGs will receive a home-based physical exercise program supervised by physical therapists, a nutritional recommendation by a physician, and social counseling by social workers of the health insurance company. The collaboration between the health-care providers and management of participants will be realized within a cloud environment based on a telemedicine platform and supported by multi-professional case conferences. The CG will receive usual care, two short handouts on general health-related topics, and facultative lifestyle counseling with general recommendations for a healthy diet and active ageing. The primary outcomes will be the physical capacity measured by the Short Physical Performance Battery and social participation assessed by the modified Reintegration to Normal Living Index, three months after discharge.
Discussion
The GeRas program is designed to improve the collaboration between health-care providers in the transition from inpatient geriatric rehabilitation to outpatient settings. Compared to usual care, it is expected to improve physical capacity and participation in geriatric patients after discharge from inpatient geriatric rehabilitation.
Background
Hospital admissions resulting from traumatic intracranial haemorrhages (TIH) in older people are increasing. There are concerns regarding an increased risk of a TIH in people taking oral anticoagulants (OAC) like phenprocoumon.
Aims
The aim of this study was to estimate the incremental risk of a TIH associated with OAC in older people. Furthermore, this study explored differences in risk according to functional status.
Methods
The study took data from a large German health insurance provider and combined hospital diagnoses with data regarding drug dispensing to estimate rates of a TIH in people with and without exposure to phenprocoumon. Analyses were stratified by sex and by severe functional impairment as disclosed by the long-term care insurance provider.
Results
Overall, exposure to OAC resulted in 2.7 times higher rates of TIH. People with severe functional impairment had a higher baseline risk of TIH than people without severe functional impairment. However, the incremental risk in those exposed to OAC was similar among people with and without severe functional impairment (standardised incidence rate difference 15.73 (95% CI 7.84; 23.61) and 12.10 (95% CI 9.63; 14.57) per 10,000 person-years, respectively.
Conclusions
OAC increases the risk of TIH considerably. The incremental risk of TIH in those exposed to OAC is comparable between people with and without severe functional impairment. The presence of severe functional impairment per se should not exclude such patients from the potential benefits of OAC. For now, the prescription should be personalized based on individual fall risk factors and risk-taking behaviour.
Durch das Konzept von Frailty wird eine ältere Risikopopulation beschrieben, die eine erhöhte Wahrscheinlichkeit für das Auftreten negativer Gesundheitsereignisse aufweist. Aus gesellschaftlicher und auch aus individueller Sicht erscheint es erstrebenswert, die Prognose dieser Menschen durch gezielte Interventionen zu verbessern. Zwischenzeitlich liegt eine Reihe von systematischen Übersichtsarbeiten und Metaanalysen vor, die ganz unterschiedliche Interventionen vergleichen. Diese Arbeiten kommen zu dem Schluss, dass Trainingsinterventionen die besten Effekte erzielen. Gruppenangebote scheinen effektiver zu sein als Trainingsprogramme, die (teilweise) im häuslichen Setting absolviert werden. Das „case finding“ für solche Interventionen sollte mithilfe von Frailty-Instrumenten erfolgen, die auf Kraft, Ausdauer und/oder körperliche Aktivität fokussiert. Hier eignen sich insbesondere die Frailty-Kriterien nach Fried oder aber das Gehtempo und die Short Physical Performance Battery (SPPB). Ein flächendeckendes Angebot entsprechender Trainingsgruppen erscheint aus geriatrischer Sicht dringend erforderlich. Die Umsetzung erfordert jedoch einen deutlichen Ausbau bestehender Strukturen und neue Wege, um ältere Menschen mit Frailty zu erreichen.
Ein Sturz ist ein Ereignis, bei dem eine Person unbeabsichtigt zu Fall kommt. Stürze sind dabei nicht als Erkrankung, sondern als Ereignisse bzw. Unfälle aufzufassen. Das Sturzgeschehen ist ein geriatrisches „Kernsyndrom“, d. h. es ist Folge verschiedener Krankheits- und Alterungsprozesse und gehört zu den dominierenden Problemen hochaltriger Menschen. Ärztliches Handeln sollte neben der Behandlung sturzbedingter Verletzungen darauf gerichtet sein, Stürze und sturzbedingte Verletzungen zu verhindern. Hierfür ist ein Verständnis für das Zusammenspiel von intrinsischen, extrinsischen und situativen (Risiko-)Faktoren notwendig.
Background
Hip fractures are regarded as a worldwide epidemic and a major public health concern. Changing risk factors, local differences and temporal trends contribute to the particular epidemiology of hip fractures. This overview gives a comprehensive insight into the epidemiology of hip fractures and reviews where German data have contributed to the literature.
Methods
The review of the epidemiology of hip fractures in Germany is based on a systematic literature search in PubMed.
Information about the global epidemiology of hip fractures was provided by a selective literature review focusing on specific aspects
of the epidemiology of hip fractures.
Results
Hip fracture rates vary more than 100-fold between different countries. In most high-income countries, a rise in agestandardized
hip fracture rates was observed until the 1980s and 1990s and a decrease thereafter. Such a decrease has not been observed for Germany so far. Many factors,diseases and drugs have been found to be
associated with hip fractures and there is some evidence that fracture risk in later life is already programmed during fetal life and
early childhood. Of the hip fracture burden 50% occur in people with disability and in need of care. In nursing homes approximately 4 fractures can be expected in 100 women per year. In people with intellectual or developmental disabilities comparable risks of hip fracture occur 10–40 years earlier than in the general population. Incidence of disability, institutionalization and death are frequent consequences of hip fractures.
Conclusion
The epidemiology of hip fractures is characterizedby a high burden of disease, local differences, temporal trends, well-defined high-risk populations and many established risk factors.