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Kwetkat A, Leischker A, Endres AS, Heppner HJ. [After the COVID-19 pandemic-Which new vaccinations for adults are available or coming soon?]. Inn Med (Heidelb) 2024; 65:79-85. [PMID: 38108878 DOI: 10.1007/s00108-023-01640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
The accumulation of respiratory infections in the winter months repeatedly highlights the relevance of prevention through vaccination, even beyond a pandemic. Current developments in this field are therefore highly relevant, particularly for older people who are more susceptible to infections due to immune senescence and comorbidities. The Standing Committee on Vaccination (STIKO) has responded accordingly by recommending the 20-valent pneumococcal conjugate vaccine PCV20 for standard and indication vaccination of adults. Furthermore, new vaccines against respiratory syncytial virus (RSV) infections are available for which the STIKO has not yet issued a recommendation. The development of other more effective and more immunogenic vac2cines is being driven in particular by new technologies, such as mRNA or vector vaccines. Various higher valent pneumococcal vaccine candidates and, for example, universal influenza vaccines are also already in development.
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Affiliation(s)
- A Kwetkat
- Klinik für Geriatrie und Palliativmedizin, Klinikum Osnabrück GmbH, Am Finkenhügel 1, 49076, Osnabrück, Deutschland.
- Universität Osnabrück, Osnabrück, Deutschland.
- AG Impfen der Deutschen Gesellschaft für Geriatrie e. V., Berlin, Deutschland.
| | - A Leischker
- AG Impfen der Deutschen Gesellschaft für Geriatrie e. V., Berlin, Deutschland
- Asklepios Klinik Wandsbek, Hamburg, Deutschland
| | - A-S Endres
- AG Impfen der Deutschen Gesellschaft für Geriatrie e. V., Berlin, Deutschland
- Evangelisches Geriatriezentrum Berlin, Berlin, Deutschland
| | - H J Heppner
- AG Impfen der Deutschen Gesellschaft für Geriatrie e. V., Berlin, Deutschland
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth, Bayreuth, Deutschland
- Medizincampus Oberfranken, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
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2
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Wiedemann A, Heppner HJ. [Urine retention-From the symptom to the structure]. Urologie 2023; 62:1223-1233. [PMID: 37878041 DOI: 10.1007/s00120-023-02216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Urinary retention describes the inability to urinate. Based on the symptoms and the amount of the initial residual urine formation, a differentiation can be made between acute and chronic forms. The cause can be a subvesical obstruction or a bladder atony. In addition to emergency treatment in the form of initial relief of the strain on the bladder by insertion of a catheter, the indication for a definitive treatment with a clarification of the question whether an acute or chronic event is present is also important. Although the selection of the catheter is subject to few criteria, the further structured approach is complex. Both decision trees are presented in this article.
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Affiliation(s)
- A Wiedemann
- Urologische Abteilung, Evangelisches Krankenhaus Witten gGmbH, Pferdebachstr. 27, 58455, Witten, Deutschland.
| | - H J Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken, Bayreuth, Deutschland
- Lehrstuhl für Geriatrie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
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3
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Wirth R, Verdon J, Frohnhofen H, Djukic M, Meisel M, Musolf M, Zinke A, Heppner HJ, Jamour M, Denkinger M, Trampisch US. Characterization of patients admitted to specialized geriatric acute care hospital units with the German version of the Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening-instrument: a cross-sectional study. BMC Geriatr 2023; 23:613. [PMID: 37775729 PMCID: PMC10542688 DOI: 10.1186/s12877-023-04338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening tool records major geriatric problems, originally applied in the emergency department. Particularly, the distinction of compensated and uncompensated problems is an interesting and new approach. Therefore, we translated the SEISAR in German language and used it to characterize patients in specialized geriatric hospital wards in Germany and to gather initial experience regarding its usability and practicability. METHODS The tool was translated by three independent specialists in geriatric medicine and backtranslated for quality-assurance by a non-medical English native speaker. In a second step, 8 acute care geriatric hospital departments used the translated version to characterize all consecutive patients admitted over a period of one month between December 2019 and May 2020 at time of admission. RESULTS Most of the 756 patients (78%) lived in an own apartment or house prior to hospital admission. Participants had on average 4 compensated and 6 uncompensated problems, a Barthel-Index of 40 pts. on admission with a median increase of 15 points during hospital stay, and a median length of stay of 16 days in the geriatric hospital department. CONCLUSION SEISAR is an interesting standardized brief comprehensive geriatric assessment tool for the identification of compensated and uncompensated health problems in older persons. The data of this study highlights the number, variability, and complexity of geriatric problems in patients treated in specialized acute care geriatric hospital wards in Germany. TRIAL REGISTRATION German Clinical trial register (DRKS-ID: DRKS00031354 on 27.02.2023).
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Affiliation(s)
- Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - J Verdon
- McGill University Health Center, Royal Victoria Hospital, Montreal, QC, Canada
| | - H Frohnhofen
- Department of Orthopedics and Traumasurgery, Heinrich Heine University, Düsseldorf, Germany
- Department of Health, University Witten-Herdecke, Witten, Germany
| | - M Djukic
- Department of Geriatric Medicine, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany
| | - M Meisel
- MEDICLIN Heart-Center, Coswig, Germany
| | - M Musolf
- Department of Geriatric Medicine, Ev. Amalie Sieveking-Krankenhaus, Hamburg, Germany
| | - A Zinke
- Department of Geriatric Medicine, St. Marien- und St. Annastiftskrankenhaus, Ludwigshafen, Germany
| | - H J Heppner
- Department of Geriatric Medicine, Klinikum Bayreuth, Bayreuth, Germany
| | - M Jamour
- Department of Internal and Geriatric Medicine, Alb-Donau-Klinikum, Ehingen, Germany
| | - M Denkinger
- Geriatric Centre Ulm, Agaplesion Bethesda Clinic, Ulm University, Ulm, Germany
| | - U S Trampisch
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany.
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4
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Gosch M, Singler K, Heppner HJ. [Geriatrics-Challenges in the clinical routine]. Z Gerontol Geriatr 2021; 54:429-430. [PMID: 34374856 DOI: 10.1007/s00391-021-01934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- M Gosch
- Medizinische Klinik 2, Schwerpunkt Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90427, Nürnberg, Deutschland.
| | - K Singler
- Medizinische Klinik 2, Schwerpunkt Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90427, Nürnberg, Deutschland. .,Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland.
| | - H J Heppner
- Klinik für Geriatrie, Helios Klinikum Schwelm, Dr.-Moeller-Str. 15, 58332, Schwelm, Deutschland.
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Wirth R, Becker C, Djukic M, Drebenstedt C, Heppner HJ, Jacobs AH, Meisel M, Michels G, Nau R, Pantel J, Bauer JM. [COVID-19 in old age-The geriatric perspective]. Z Gerontol Geriatr 2021; 54:152-160. [PMID: 33595696 PMCID: PMC7887547 DOI: 10.1007/s00391-021-01864-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/02/2021] [Indexed: 01/16/2023]
Abstract
Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.
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Affiliation(s)
- R Wirth
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland.
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
| | - C Becker
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Deutschland
| | - M Djukic
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Deutschland
- Abteilung für Neuropathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Drebenstedt
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Innere Medizin und Geriatrie, St.-Marien-Hospital Friesoythe, Friesoythe, Deutschland
| | - H J Heppner
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie, Helios Klinikum Schwelm, Lehrstuhl für Geriatrie, Universität Witten-Herdecke, Schwelm, Deutschland
| | - A H Jacobs
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie mit Neurologie, Johanniter Krankenhaus Bonn, Bonn, Deutschland
- CIO, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
- EIMI, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - M Meisel
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Innere Medizin und Geriatrie, Diakonissenkrankenhaus Dessau, Dessau, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - R Nau
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Deutschland
- Abteilung für Neuropathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - J Pantel
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Institut für Allgemeinmedizin, Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - J M Bauer
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum und Netzwerk Altersmedizin, Agaplesion Bethanien Krankenhaus Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
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6
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Thiem U, Heppner HJ, Sieber C. [Less can be more-Examples on medication in older and geriatric patients from current studies]. Internist (Berl) 2021; 62:363-372. [PMID: 33630097 DOI: 10.1007/s00108-021-00981-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
Polypharmacy, i.e. the prescription of five or more different drugs for medicinal treatment, is a typical problem in older and geriatric patients. Polypharmacy predisposes to different negative health sequelae, such as undesired side effects, drug interactions, potentially inappropriate medication, reduced functional abilities, increased hospitalization and increased mortality. Various consensus groups and specialist societies have developed recommendations on how to handle polypharmacy in geriatric patients. Although concepts to reduce the number of drugs are considered necessary, in many areas there is a lack of evidence on how to limit polypharmacy in geriatric patients and to reduce and discontinue medication. This article presents examples of recent studies dealing with potentially inappropriate medication, vitamin D substitution and antipsychotic drugs, which show how to critically appraise a prescribed medication, to critically check the indications for drugs and to discontinue drug use.
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Affiliation(s)
- U Thiem
- Lehrstuhl für Geriatrie und Gerontologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
- Zentrum für Altersmedizin, Medizinisch-Geriatrische Klinik, Albertinen-Haus, Sellhopsweg 18-22, 22459, Hamburg, Deutschland.
| | - H J Heppner
- Lehrstuhl für Geriatrie, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland
- Klinik für Geriatrie mit Tagesklinik, Helios Klinikum, Schwelm, Deutschland
- Lehrstuhl für Innere Medizin und Geriatrie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - C Sieber
- Lehrstuhl für Innere Medizin und Geriatrie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
- Department für Innere Medizin, Kantonsspital Winterthur, Winterthur, Schweiz
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7
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Schönhofer B, Barchfeld T, Geiseler J, Heppner HJ. [Limits and Ethics of Mechanical Ventilation and Intensive Care Medicine in Old Age]. Pneumologie 2021; 75:142-155. [PMID: 33578435 DOI: 10.1055/a-1201-9007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Changing demography with more older people and more patients with chronic diseases as well as the progress of medicine leads to more geriatric patients treated in intensive care and requiring mechanical ventilation due to severe respiratory insufficiency.Frailty is associated with a more complicated intensive care stay, more difficult convalescence and with a higher mortality.In principle, geriatric expertise should be brought in as early as possible in the course of intensive care treatment for older patients in order to carry out adequate risk stratification and, depending on the extent of the impairment, to plan discharge or early rehabilitation.In older and frail patients preexisting chronic ventilatory insufficiency often leads to prolonged weaning. Patients with weaning failure should be referred to a specialized weaning center. Part of the assessment will be whether out-of-hospital invasive or non invasive ventilation is indicated and the wish of the patient.In intensive care the likelihood of a successful outcome and the patient's wishes must constantly be re-evaluated. This is particularly true in older patients. In addition it should be clarified with the patients and relatives what constitutes "success"; for example a patient may consider intensive care "worth it" if the ultimate goal is discharge to their own home but not if nursing home care and tracheostomy ventilation is the best that can be achieved. It may become apparent that a successful outcome is unlikely and then withdrawal of invasive ventilation is appropriate.
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8
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Schlitzer J, Heppner HJ, Frohnhofen H. Reliability of the blood pressure response during performance of bedside Valsalva maneuver and association with NT-pBNP levels. Z Gerontol Geriatr 2021; 54:371-376. [PMID: 33533962 DOI: 10.1007/s00391-021-01849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Heart failure (HF) is common in older people. The diagnosis of HF, however, is difficult in older subjects, especially in settings without direct access to further diagnostics. The type of blood pressure response during the performance of a Valsalva maneuver has been suggested as an easily applicable bedside test to detect HF; however, the reliability of this maneuver and the association with HF is unknown in geriatric patients. METHODS This study included 89 patients admitted for geriatric rehabilitation. Systolic blood pressure was taken while the patient performed a Valsalva maneuver. The systolic blood pressure response was classified as sinusoidal (type A), absent overshoot (type B) or square pattern (type C). To test interrater reliability systolic blood pressure response was evaluated independently by two investigators. The procedure was repeated after 1h to estimate test-retest reliability. Both investigators were blinded to the results of the other. Interrater reliability and test-retest reliability were calculated using Cohen's kappa. Blood samples for N‑terminal pro brain natriuretic peptide (NT-pBNP) were obtained on the morning the Valsalva maneuver was performed. RESULTS Blood pressure response was sinusoidal in 37 (42%), showed an absent overshoot in 17 (19%) and had a square wave pattern in 34 (38%) patients. Cohen's kappa was 0.911 (95% CI 0.837-0.985) for interrater reliability and 0.929 (95% CI 0. 0.862-0.996) for test-retest reliability. The interrater and test-retest agreement were 94% and 96%, respectively. The mean NT-pBNP plasma levels and the interquartile ranges (IQR) in subjects with types A, B and C blood pressure response pattern were 213 (153-324) pg/ml, 805 (622-1332) pg/ml and 3964 (2595-5906) pg/ml, respectively (p < 0.001). CONCLUSION The blood pressure response during a Valsalva maneuver shows an excellent reliability in older subjects. The type of response is associated with the NT-pBNP plasma level.
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Affiliation(s)
- J Schlitzer
- Department of Geriatrics, Kliniken Essen Mitte, Essen, Germany
| | - H J Heppner
- Department of Geriatrics, Helios Klinikum Schwelm, Schwelm, Germany.,Faculty of Health, Department of Medicine, University Witten-Herdecke, Witten, Germany
| | - H Frohnhofen
- Faculty of Health, Department of Medicine, University Witten-Herdecke, Witten, Germany. .,Department of Orthopedics and Accident Surgery, University-Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany.
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9
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Affiliation(s)
- H J Heppner
- Klinik für Geriatrie Helios Klinikum Schwelm, Universität Witten/Herdecke, Dr.-Moeller-Str. 15, D-58332, Schwelm, Deutschland.
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10
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Jacobs AH, Emmert K, Baron R, Bartsch T, Bauer J, Becker C, Berg D, Bergmann P, Boetzel K, Bollheimer C, Deuschl G, Djukic M, Drey M, Durwen H, Ebersbach G, Elshehabi M, Geritz J, Gisinger C, Guennewig T, Hauptmann B, Heppner HJ, Hobert MA, Hofmann W, Huellemann P, Jahn K, Klucken J, Kurth R, Lindner R, Lingor P, Lukas A, Maetzold S, Mokrusch T, Mollenhauer B, Nau R, Plate A, Polidori MC, Prell T, Schellinger P, Spira D, Stephani U, Studt S, Trenkwalder C, Unger HL, Urban P, von Arnim CAF, Warnecke T, Weiss M, Wiedemann A, Wirth R, Witt K, Dodel R, Maetzler W. Neurogeriatrics-a vision for improved care and research for geriatric patients with predominating neurological disabilities. Z Gerontol Geriatr 2020; 53:340-346. [PMID: 32430766 PMCID: PMC7311516 DOI: 10.1007/s00391-020-01734-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/20/2020] [Indexed: 01/06/2023]
Abstract
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.
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Affiliation(s)
- Andreas H Jacobs
- Department for Geriatric Medicine and Neurology, Johanniter Hospital, Bonn and European Institute for Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Kirsten Emmert
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Ralf Baron
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Thorsten Bartsch
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Juergen Bauer
- Center for Geriatric Medicine, University of Heidelberg and Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Philipp Bergmann
- Department of Internal Medicine I, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Kiel, Germany
| | - Kai Boetzel
- Department of Neurology, University Hospital LMU Munich, Munich, Germany
| | - Cornelius Bollheimer
- Department of Geriatric Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Guenther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Marija Djukic
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Department of Geriatrics, Protestant Hospital Göttingen-Weende, Göttingen, Germany
| | - Michael Drey
- Department of Medicine IV, University Hospital LMU Munich, Munich, Germany
| | - Herbert Durwen
- Department of Geriatric Medicine, St. Martinus Hospital Düsseldorf, Düsseldorf, Germany
| | - Georg Ebersbach
- Hospital for Movement Disorders/Parkinson's Disease, Beelitz-Heilstätten, Beelitz, Germany
| | - Morad Elshehabi
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Christoph Gisinger
- Center for Geriatric Medicine and Geriatric Nursing, Danube University Krems, Krems an der Donau, Austria
| | - Thomas Guennewig
- Department of Geriatrics and Neurology, Elisabeth Hospital Recklinghausen, Recklinghausen, Germany
| | - Bjoern Hauptmann
- Department of Neurology, Segeberger Kliniken, Bad Segeberg, Germany.,Department of Therapeutic Sciences, MSH Medical School Hamburg, Hamburg, Germany
| | - Hans-Juergen Heppner
- Department of Geriatrics, University Witten/Herdecke, Schwelm, Germany.,Helios Clinic Schwelm, Schwelm, Germany
| | - Markus A Hobert
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Werner Hofmann
- Geriatric Center Neumünster and Bad Bramstedt, Friedrich-Ebert-Hospital Neumünster, Neumünster, Germany
| | - Philipp Huellemann
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Klaus Jahn
- Schön Klinik Bad Aibling, Bad Aibling, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Research Group Digital Health Pathways, Fraunhofer IIS, Erlangen, Germany
| | - Roland Kurth
- Neurological Practice Roland Kurth, Kiel, Germany
| | - Reinhard Lindner
- Institute for Social Work, University of Kassel, Kassel, Germany
| | - Paul Lingor
- Department of Neurology, Technical University of Munich, Munich, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Albert Lukas
- Agaplesion Bethesda Clinic, Competence Centre of Geriatrics and Aging Research, University of Ulm, Ulm, Germany.,Malteser Hospital Bonn, Geriatric Centre, Academic Teaching Hospital, University of Bonn, Bonn, Germany
| | - Sara Maetzold
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Thomas Mokrusch
- Department of Neurology and Early Neurological Rehabilitation, MediClin Hedon Klinik Lingen, Lingen, Germany
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik Kassel, Kassel, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Roland Nau
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Department of Geriatrics, Protestant Hospital Göttingen-Weende, Göttingen, Germany
| | - Annika Plate
- Department of Neurology, University Hospital LMU Munich, Munich, Germany
| | - Maria Cristina Polidori
- Ageing Clinical Research, Dpt. II Internal Medicine, University Hospital of Cologne, and Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Diseases, Cologne, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Peter Schellinger
- Departments of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany
| | - Dominik Spira
- Department of Endocrinology and Metabolism, Charité-University Medical Center, Berlin, Germany
| | - Ulrich Stephani
- Department of Neuropediatrics, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Kiel, Germany
| | - Simone Studt
- Gerontopsychiatry, Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Kiel, Germany
| | - Claudia Trenkwalder
- Clinic of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.,Paracelsus-Elena Klinik, Kassel, Germany
| | - Heinz L Unger
- Department of Geriatrics and Early Rehabilitation, Evangelical Hospital Kalk Cologne, Cologne, Germany
| | - Peter Urban
- Department of Neurology, Asklepios Klinik Barmbek, Hamburg, Germany
| | | | - Tobias Warnecke
- Department of Neurology, University of Münster, Münster, Germany
| | - Michael Weiss
- Clinic for Neurology and Clinical Neurophysiology, Schön Klinik Neustadt, Neustadt, Germany
| | - Andreas Wiedemann
- Department of Urology, Evangelical Hospital Witten, Witten, Germany.,Department of Geriatrics, Witten-Herdecke University, Witten, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr University Bochum, Bochum, Germany
| | - Karsten Witt
- Department of Neurology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Richard Dodel
- Chair of Geriatrics, University Hospital Essen and Geriatriezentrum Haus Berge, Contilia Group, Essen, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany.
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Affiliation(s)
- H J Heppner
- Klinik für Geriatrie Helios Klinikum Schwelm, Universität Witten/Herdecke, Dr.-Moeller-Str. 15, D-58332, Schwelm, Deutschland.
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Stieglitz S, Heppner HJ, Netzer N. Abnormal things happening during sleep: parasomnias. Z Gerontol Geriatr 2020; 53:119-122. [PMID: 32140765 DOI: 10.1007/s00391-020-01714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022]
Abstract
Parasomnias are characterized by abnormal experiences, dreams, movements and behavior during sleep. They may occur in the middle of the sleep during REM (rapid eye movement) or NREM (non-rapid eye movement), during falling asleep or waking up. Characteristically for REM behavior disorder is an increased muscle tone although usually REM is defined by an absence of muscle tone. For these forms aggressive dreams may lead to violating bed partners or self-injury of the sleeping person. Even killing bed partners has been described. Many of the patients develop a kind of Parkinson's disease (synucleinopathies). The rate of phenoconversion is more than 30% in 5 years and nearly 100% after 15 years. There are several recommendations regarding a safe sleeping environment. Medicinal treatment consists of either melatonin or clonazepam.
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Affiliation(s)
- S Stieglitz
- Department of Pneumology, Allergy, Sleep and Intensive Care Medicine, Petrus Hospital Wuppertal, Carnaper Str. 48, 42283, Wuppertal, Germany. .,University of Witten-Herdecke, Witten-Herdecke, Germany.
| | - H J Heppner
- Department of Geriatrics, Helios Clinic Schwelm, Schwelm, Germany
| | - N Netzer
- Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Bad Aibling, Germany
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Affiliation(s)
- H J Heppner
- Klinik für Geriatrie, Helios Klinikum Schwelm, Universität Witten/Herdecke, Dr.-Moeller-Str. 15, D-58332, Schwelm, Deutschland.
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Weinrebe W, Schiefer Y, Weckmüller K, Schulz RJ, Rupp S, Bischoff S, Karaman M, Goetz S, Heppner HJ, Polidori MC. Does the identification of seniors at risk (ISAR) score effectively select geriatric patients on emergency admission? Aging Clin Exp Res 2019; 31:1839-1842. [PMID: 30623316 DOI: 10.1007/s40520-018-1105-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/14/2018] [Indexed: 01/01/2023]
Abstract
The number of older patients admitted to emergency departments (ED) increases continuously. The Identification of Seniors at Risk (ISAR) score is currently recommended to screen patients in German ED, but its appropriateness is being criticized. ISAR scores and clinical characteristics from 98 emergency admissions (EA), 80 from acute geriatrics (AG) and 89 from a geriatric rehabilitation (GR) unit were compared retrospectively. No significant differences were found between groups, being the ISAR score positive in 87.7% of EA, 94.9% of AG and 94.4% of GR cases. None of positively identified geriatric patients in the EA was transferred to the geriatric ward of competence. EA patients showed significantly higher number of functional impairments (p = 0.001) and higher BI score (p < 0.0001) compared to AG and GR groups. A higher ISAR score threshold and additional functional information might be needed to better select patients in need of prompt treatment by a geriatric team.
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Affiliation(s)
- W Weinrebe
- Department of Geriatrics, Hospital Meyriez and Tafers, HFR, University Fribourg, Fribourg, Switzerland.
| | - Y Schiefer
- Ageing Clinical Research, Department of Internal Medicine II, University Hospital Cologne, Cologne, North Rhine Westphalia, Germany
| | - K Weckmüller
- Clinic for Orthopedics and Trauma Surgery, Coblenz, Rhineland-Palatibate, Germany
| | - R J Schulz
- Department of Geriatrics, St. Marien Hospital, Cologne, North Rhine Westphalia, Germany
| | - S Rupp
- Department of Geriatrics/Rehabilitation, Clinic Wartenberg, Wartenberg, Bavaria, Germany
| | - S Bischoff
- Outpatient Clinic for Occupational Therapy, Bad Friedrichshall, Baden-Württemberg, Germany
| | - M Karaman
- Institute for Biostatistics, Berlin, Germany
| | - S Goetz
- Department of Geriatrics, Hospital Meyriez and Tafers, HFR, University Fribourg, Fribourg, Switzerland
| | - H J Heppner
- Department of Geriatrics, Helios Clinic Schwelm, University Witten-Herdecke, Witten, North Rhine Westphalia, Germany
| | - M C Polidori
- Ageing Clinical Research, Department of Internal Medicine II, University Hospital Cologne, Cologne, North Rhine Westphalia, Germany
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Affiliation(s)
- H J Heppner
- Klinik für Geriatrie Helios Klinikum Schwelm, Universität Witten/Herdecke, Dr.-Moeller-Str. 15, D-58332, Schwelm, Deutschland.
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Affiliation(s)
- H J Heppner
- Klinik für Geriatrie Helios Klinikum Schwelm, Universität Witten/Herdecke, Dr.-Moeller-Str. 15, 58332, Schwelm, Deutschland.
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Knobe M, Böttcher B, Coburn M, Friess T, Bollheimer LC, Heppner HJ, Werner CJ, Bach JP, Wollgarten M, Poßelt S, Bliemel C, Bücking B. [Geriatric Trauma Center DGU®: Evaluation of clinical and economic parameters : A pilot study in a german university hospital]. Unfallchirurg 2019; 122:134-146. [PMID: 29675629 DOI: 10.1007/s00113-018-0502-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- M Knobe
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - B Böttcher
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Coburn
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - T Friess
- Klinik für Unfall- und Handchirurgie, Zentrum für Alterstraumatologie im St. Clemens-Hospital Oberhausen, Oberhausen, Deutschland
| | - L C Bollheimer
- Lehrstuhl für Altersmedizin, RWTH Aachen mit Klinik für Innere Medizin und Geriatrie am Franziskushospital Aachen, Aachen, Deutschland
| | - H J Heppner
- Geriatrische Klinik und Tagesklinik, Lehrstuhl für Geriatrie, Universität Witten/Herdecke, Witten, Deutschland
| | - C J Werner
- Klinik für Neurologie, Sektion Interdisziplinäre Geriatrie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J-P Bach
- Klinik für Neurologie, Sektion Interdisziplinäre Geriatrie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - M Wollgarten
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - S Poßelt
- Kaufmännisches Controlling, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - C Bliemel
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland
| | - B Bücking
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland
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Abstract
Infectious diseases are responsible for up to 5% of fatalities even in developed countries. In addition, there is an increasing susceptibility for infections in elderly people due to physiological aging of the immune system. The principles of vaccination are based on a targeted activation of the human immune system. Principally, a distinction is made between passive immunization, i.e. the application of specific antibodies against a pathogen and active immunization. In active immunization, i.e. vaccination, weakened (attenuated) or dead pathogens or components of pathogens (antigens) are administered. After a latency period that depends on the vaccine, complete immune protection is achieved and immunity is maintained for a certain period of time. In contrast to dead vaccines, by the use of live vaccines there is always a risk for infection with the administered vaccine. In passive immunization antibodies are administered. As a rule passive immunization is carried out in persons who have had contact with an infected person and in whom no or uncertain immunity against the corresponding disease is present. Based on the recommendations of the Standing Committee on Vaccination (STIKO), influenza, pneumococcal, herpes zoster, early summer meningoencephalitis (FSME) and travel vaccines are described.
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Affiliation(s)
- H J Heppner
- Lehrstuhl für Geriatrie, Universität Witten/Herdecke, Witten, Deutschland. .,Geriatrische Klinik und Tagesklinik, Helios Klinikum Schwelm, Dr.-Moeller-Str. 15, 58332, Schwelm, Deutschland. .,Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland.
| | - A Leischker
- Klinik für Geriatrie, Alexianer Krefeld, Krefeld, Deutschland
| | - P Wutzler
- Institut für Virologie und Antivirale Therapie, Universitätsklinikum Jena, Jena, Deutschland
| | - A Kwetkat
- Klinik für Geriatrie, Universitätsklinikum Jena, Jena, Deutschland
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Abstract
A serious voiding disorder or urinary incontinence represent indications for long-term catheterization of the urinary bladder. Treatment by a transurethral or suprapubic bladder catheter for life-long bladder drainage is accompanied by technical short-term complications and long-term sequelae. The mortality risk associated with inserting a suprapubic catheter is approximately 2% due to an incorrect bladder puncture. Long-term consequences of life-long bladder drainage are hematuria, infection, spasms, stone formation, obstruction, catheter loss, risk of falls and automanipulation especially in cognitively impaired persons. These constitute frequent reasons for emergency treatment or hospitalization. Further problem areas are dependency on caregivers to perform the catheter change and dermal problems in the area of the fistula stoma. To what extent this limits the quality of life of those affected remains unclear up to now. The acute complications and the long-term consequences of life-long bladder drainage make careful decision-making necessary after other therapeutic options have failed, are not appropriate or not desired.
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Affiliation(s)
- A Wiedemann
- Urologische Abteilung, Evangelisches Krankenhaus Witten, Pferdebachstr. 27, 58455, Witten, Deutschland. .,Lehrstuhl für Geriatrie der Universität Witten/Herdecke, Witten, Deutschland.
| | - R Kirschner-Hermanns
- Neuro-Urologie, Universitätsklinikum der Rheinischen Friedrich-Wilhelms Universität, Bonn, Deutschland.,Neurologisches Rehabilitationszentrum der Godeshöhe, Bonn, Deutschland
| | - H J Heppner
- Lehrstuhl für Geriatrie der Universität Witten/Herdecke, Witten, Deutschland.,Geriatrische Klinik und Tagesklinik, Helios-Klinikum, Schwelm, Deutschland.,Institut für Biomedizin des Alterns der FAU Erlangen-Nürnberg, Nürnberg, Deutschland
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Affiliation(s)
- H J Heppner
- Klinik für Geriatrie HELIOS Klinikum Schwelm, Lehrstuhl Geriatrie, Universität Witten/Herdecke, Dr.-Moeller-Str. 15, D-58332, Schwelm, Deutschland.
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Affiliation(s)
- H J Heppner
- Klinik für Geriatrie HELIOS Klinikum Schwelm, Lehrstuhl Geriatrie Universität Witten/Herdecke, Dr.-Moeller-Str. 15, D-58332, Schwelm, Deutschland.
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Dovjak P, Heppner HJ. [Not Available]. MMW Fortschr Med 2017; 159:35. [PMID: 28097559 DOI: 10.1007/s15006-017-9155-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Affiliation(s)
- H J Heppner
- Klinik für Geriatrie HELIOS Klinikum Schwelm, Universität Witten/Herdecke, Dr.-Moeller-Str. 15, D-58332, Schwelm, Deutschland.
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41
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Affiliation(s)
- H J Heppner
- Klinik für Geriatrie HELIOS Klinikum Schwelm, Universität Witten/Herdecke, Dr.-Moeller-Str. 15, D-58332, Schwelm, Deutschland.
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Affiliation(s)
- H J Heppner
- Klinik für Geriatrie HELIOS Klinikum Schwelm, Universität Witten/Herdecke, Dr.-Moeller-Str. 15, D-58332, Schwelm, Deutschland.
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Affiliation(s)
- H J Heppner
- Klinik für Geriatrie, HELIOS Klinikum Schwelm, Witten/Herdecke, Dr.-Moeller-Str. 15, D-58332, Schwelm, Deutschland.
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Westhoff M, Schönhofer B, Neumann P, Bickenbach J, Barchfeld T, Becker H, Dubb R, Fuchs H, Heppner HJ, Janssens U, Jehser T, Karg O, Kilger E, Köhler HD, Köhnlein T, Max M, Meyer FJ, Müllges W, Putensen C, Schreiter D, Storre JH, Windisch W. [Noninvasive Mechanical Ventilation in Acute Respiratory Failure]. Pneumologie 2015; 69:719-756. [PMID: 26649598 DOI: 10.1055/s-0034-1393309] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The non-invasive ventilation (NIV) is widespread in the clinical medicine and has attained meanwhile a high value in the clinical daily routine. The application of NIV reduces the length of ICU stay and hospitalization as well as mortality of patients with hypercapnic acute respiratory failure. Patients with acute respiratory failure in context of a cardiopulmonary edema should be treated in addition to necessary cardiological interventions with continuous positive airway pressure (CPAP) or NIV. In case of other forms of acute hypoxaemic respiratory failure it is recommended the application of NIV to be limited to mild forms of ARDS as the application of NIV in severe forms of ARDS is associated with higher rates of treatment failure and mortality. In weaning process from invasive ventilation the NIV reduces the risk of reintubation essentially in hypercapnic patients. A delayed intubation of patients with NIV failure leads to an increase of mortality and should therefore be avoided. With appropriate monitoring in intensive care NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency. Furthermore NIV can be useful within palliative care for reduction of dyspnea and improving quality of life. The aim of the guideline update is, taking into account the growing scientific evidence, to outline the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.
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Affiliation(s)
| | | | - P Neumann
- Evangelisches Krankenhaus Göttingen-Weende gGmbH, Göttingen
| | | | - T Barchfeld
- Knappschaftskrankenhaus Dortmund, Klinikum Westfalen GmbH, Dortmund
| | - H Becker
- Asklepios Klinikum Barmbeck, Hamburg
| | - R Dubb
- Klinikum Stuttgart, Katharinenhospital, Stuttgart
| | - H Fuchs
- Uniklinik Freiburg, Freiburg
| | - H J Heppner
- Geriatrische Klinik, HELIOS Klinikum Schwelm, Schwelm
| | - U Janssens
- St.- Antonius-Hospital Eschweiler, Akad. Lehrkrankenhaus der RWTH Aachen, Eschweiler
| | - T Jehser
- Gemeinschaftskrankenhaus Havelhöhe, Berlin
| | - O Karg
- Asklepios Fachkliniken München-Gauting, Gauting
| | - E Kilger
- Ludwig-Maximilians-Universität, München
| | - H-D Köhler
- Fachkrankenhaus Klostergrafschaft, Schmallenberg
| | | | - M Max
- Centre Hospitalier de Luxembourg, Luxemburg
| | - F J Meyer
- Klinikum Harlaching, Städtisches Klinikum München, München
| | - W Müllges
- Universitätsklinikum Würzburg, Würzburg
| | | | - D Schreiter
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - J H Storre
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln
| | - W Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln
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Schwaiger K, Christ M, Battegay M, Heppner HJ. [Prevention of catheter-related infections: minimizing secondary complications in geriatric patients]. Z Gerontol Geriatr 2014; 46:361-71. [PMID: 23712634 DOI: 10.1007/s00391-013-0486-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The use of intravascular or intraluminal catheters is common in geriatric medicine. Blood stream infections due to intravascular catheterization, peritoneal catheters for dialysis, suprapubic or transurethral catheters, or percutaneous endoscopic gastrostomy are a major source of nosocomial infections. Therefore, the prevention of catheter-associated infections is an important issue for physicians and nursing staff working in hospitals or in outpatient settings. The risk can be minimized by diligent checking of the indications, hygienic measures, using the correct materials, thorough follow-up, and education of the medical and nursing staff. Thus, it is possible to avoid individual suffering of patients and to reduce costs in the healthcare system.
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Affiliation(s)
- K Schwaiger
- Klinik für Notfall- und Internistische Intensivmedizin, Klinikum Nürnberg, Prof.-Ernst-Nathan Str. 1, 90419, Nürnberg, Deutschland
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Heppner HJ, Christ M, Gosch M, Mühlberg W, Bahrmann P, Bertsch T, Sieber C, Singler K. Polypharmacy in the elderly from the clinical toxicologist perspective. Z Gerontol Geriatr 2013; 45:473-8. [PMID: 22915001 DOI: 10.1007/s00391-012-0383-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Polypharmacy is closely associated with multimorbidity in the elderly and can lead to problems and drug interactions. AIM This study assessed polypharmacy in the elderly, tracking inquiries to the Poison Information Centre Nuremberg (PICN) and patients needing toxicological intensive care therapy. METHODS From 2006-2009, all PICN inquiries involving individuals > 70 years were tracked, as were cases at the Toxicological Intensive Care Unit (T-ICU) regarding adverse drug reactions (ADRs) and drug poisoning. RESULTS Of 11,683 PICN calls about pharmaceuticals, 175 (1.5%) were from people > 70 years; 156 (4.8%) of 3,272 T-ICU patients were > 70 years. Calls about psychopharmaceuticals (46.9%) and analgesics (25.7%) were most frequent. Among the T-ICU patients, psychopharmaceuticals like sedatives and hypnotics were frequently involved (20.5%), as were tricyclic antidepressants (17.9%) and analgesics (29.5%). Ethanol was co-ingested by 18.3%. CONCLUSION Population-specific poison prevention strategies are needed to reduce toxic exposures. Such strategies could include pharmacist intervention, improved prescriber communication and education regarding the geriatric population, and computerized drug databases.
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Affiliation(s)
- H J Heppner
- Department of Emergency and Intensive Care Medicine, Klinikum Nuremberg, Prof.-E.-Nathan-Str. 1, 90419, Nuremberg, Germany.
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Heppner HJ, Sieber C, Singler K. [Intensive care in the elderly]. Dtsch Med Wochenschr 2013; 138:176-9. [PMID: 23340934 DOI: 10.1055/s-0032-1327399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- H J Heppner
- Klinik für Notfall- und Intensivmedizin, Klinikum Nürnberg, Institut für Biomedizin des Alters, Friedrich-Alexander-Universität Erlangen-Nürnberg.
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Heppner HJ, Sehlhoff B, Niklaus D, Pientka L, Thiem U. [Pneumonia Severity Index (PSI), CURB-65, and mortality in hospitalized elderly patients with aspiration pneumonia]. Z Gerontol Geriatr 2012; 44:229-34. [PMID: 21769515 DOI: 10.1007/s00391-011-0184-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Aspiration pneumonia is associated with a high morbidity and mortality in elderly patients. In order to provide risk-adapted medical care, it is necessary to establish valid prognostic tools for these patients. OBJECTIVE The value of two well-established scores to assess prognosis in community-acquired pneumonia (CAP), i.e., CURB-65 and the Pneumonia Severity Index (PSI), was evaluated in elderly patients hospitalized for aspiration pneumonia. MATERIAL AND METHODS A total of 209 patients hospitalized with aspiration pneumonia between 2001 and 2005 in a single center were evaluated using PSI and CURB-65. For comparison of morbidity and mortality, an equally large group of inpatients with CAP was analyzed. RESULTS The mean age of patients with aspiration pneumonia was 76.7 ± 13.4 years, and 104 (49.8 %) were female. Patients with aspiration pneumonia more frequently showed a history of cancer, hypotension, and hyponatriemia on admission. Mortality was clearly higher in comparison to patients with CAP (39.2% vs. 16.3%). The Odds Ratio (OR) for mortality was 1.03 (95% CI 0.59; 1.79) for a CURB-65 score of 3-5 points compared to 0-2 points. In cases of CAP, OR showed a statistically significant increase of risk (OR 2.50; 95% CI 1.04; 6.06), for CURB-65 scores of 3-5 points vs. 0-2 points). In aspiration pneumonia, the PSI showed a trend towards increasing mortality within higher risk class. CONCLUSIONS In geriatric patients hospitalized with aspiration pneumonia, CURB-65 and PSI have no prognostic value.
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Affiliation(s)
- H J Heppner
- Klinik für Notfall- und internistische Intensivmedizin, Klinikum Nürnberg, Nürnberg, Deutschland
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Bahrmann P, Heppner HJ, Christ M, Bertsch T, Sieber C. Early detection of non-ST-elevation myocardial infarction in geriatric patients by a new high-sensitive cardiac troponin T assay. Aging Clin Exp Res 2011; 24:290-4. [PMID: 21952408 DOI: 10.3275/7927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS The new high sensitivity cardiac Troponin T (cTnThs) assay has recently been introduced in our clinic and ensures higher sensitivity than the fourth-generation cardiac troponin T (cTnT) assay from the same manufacturer (Roche Diagnostics). We determined the diagnostic performance of the cTnThs compared with the cTnT assay in geriatric patients, especially those with non-ST elevation myocardial infarction (NSTE- MI). METHODS We retrospectively analysed 253 patients (age 82 ± 8 years; 82 men, 172 women) with diagnoses of suspected NSTEMI admitted to our Department of Geriatric Medicine. Patients were divided into one group of 113 patients using cTnThs, and another of 140 patients using cTnT for diagnosis. Each group included patients at the same months but different years, in either cTnThs or cTnT assays. NSTEMI was diagnosed according to current guidelines. RESULTS Baseline characteristics were similar in both groups. The proportions of patients with elevated cardiac troponin (cTn) levels significantly increased from 35% in the cTnT group to 76% in the cTnThs group (p<0.001), although no coronary cause for the elevated cTn levels was shown in about two-thirds of these patients. In patients with NSTE- MI, 58% in the cTnThs group vs 42% in the cTnT group were diagnosed within 4 hours of the onset of symptoms, whereas 42% in the cTnThs group vs 58% in the cTnT group were diagnosed more than 4 hours later (p=0.018). CONCLUSIONS The prevalence of elevated cTn has more than doubled with the use of cTnThs. However, no coronary cause was found in two-thirds of our geriatric patients, al- though more NSTEMI patients were diagnosed earlier by cTnThs.
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Affiliation(s)
- Philipp Bahrmann
- Institute for Biomedicine of Ageing, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
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