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Lucke JA, Mooijaart SP, Heeren P, Singler K, McNamara R, Gilbert T, Nickel CH, Castejon S, Mitchell A, Mezera V, Van der Linden L, Lim SE, Thaur A, Karamercan MA, Blomaard LC, Dundar ZD, Chueng KY, Islam F, de Groot B, Conroy S. Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine. Eur Geriatr Med 2021; 13:309-317. [PMID: 34738224 PMCID: PMC8568564 DOI: 10.1007/s41999-021-00578-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 09/18/2021] [Accepted: 10/20/2021] [Indexed: 01/08/2023]
Abstract
Aim The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. Findings Eight posters with expert clinical guidelines on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/. Message Expert clinical recommendations for Geriatric Emergency Medicine in Europe were created and are ready for dissemination across Europe. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00578-1. Purpose Despite the rapidly expanding knowledge in the field of Geriatric Emergency Medicine in Europe, widespread implementation of change is still lacking. Many opportunities in everyday clinical care are missed to improve care for this susceptible and growing patient group. The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. Methods A group of multi-disciplinary experts in the field of Geriatric Emergency Medicine in Europe was assembled. Using a modified Delphi procedure, a prioritized list of topics related to Geriatric Emergency Medicine was created. Next, a multi-disciplinary group of nurses, geriatricians and emergency physicians performed a review of recent guidelines and literature to create recommendations. These recommendations were voted upon by a group of experts and placed on visually attractive posters. The expert group identified the following eight subject areas to develop expert recommendations on: Comprehensive Geriatric Assessment in the Emergency Department (ED), age/frailty adjusted risk stratification, delirium and cognitive impairment, medication reviews in the ED for older adults, family involvement, ED environment, silver trauma, end of life care in the acute setting. Results Eight posters with expert clinical recommendations on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/. Conclusion Expert clinical recommendations for Geriatric Emergency Medicine may help to improve care for older patients in the Emergency Department and are ready for dissemination across Europe. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00578-1.
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Affiliation(s)
- J A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands.
| | - S P Mooijaart
- Department of Internal Medicine, Section on Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - P Heeren
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - K Singler
- Department of Geriatrics, Klinikum Nürnberg, Paracelsus Private, Medical University, Nuremberg, Germany.,Institute for Biomedicine of Ageing, Friedrich-Alexander-University, Erlangen-Nuremberg, Erlangen, Germany
| | - R McNamara
- Department of Emergency Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - T Gilbert
- Department of Geriatric Medicine, Lyon-Sud University Hospital, Lyon, France
| | - C H Nickel
- Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - S Castejon
- Department of Geriatrics and Palliative Care, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - A Mitchell
- Department of Emergency Medicine, Sligo University Hospital, Sligo, Ireland
| | - V Mezera
- Geriatric Center, Pardubice Hospital, Pardubice, Czech Republic
| | - L Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - S E Lim
- Academic Geriatric Medicine, University of Southampton, Southampton, UK
| | - A Thaur
- Department of Emergency Medicine, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - M A Karamercan
- Department of Emergency Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - L C Blomaard
- Department of Internal Medicine, Section on Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Z D Dundar
- Department of Emergency Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - K Y Chueng
- Accident and Emergency Department, United Christian Hospital, Kwun Tong, Hong Kong
| | - F Islam
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - B de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - S Conroy
- Geriatric Medicine, MRC Unit for Lifelong Health and Ageing at UCL, 5th Floor, 1-19 Torrington Place, London, WC1E 7HB, UK
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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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Gosch M, Pils K, Venkat S, Singler K. [Aspects of multimodal pain therapy in old age]. Z Gerontol Geriatr 2021; 54:823-832. [PMID: 34319451 DOI: 10.1007/s00391-021-01952-1] [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: 03/08/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
Abstract
Chronic pain in older adults should be explained and treated on the basis of the biopsychosocial model. With its interdisciplinary and interprofessional approach, multimodal pain therapy is the method of choice. In old age freedom from pain is usually not the primary goal. It is more important to restore the quality of life of those affected and to maintain independence and autonomy with a versatile treatment offer. This article explains the basics of multimodal pain therapy and its special features in old age.
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Affiliation(s)
- M Gosch
- Medizinische Klinik 2, Schwerpunkt Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - K Pils
- Institut für Physikalische Medizin und Rehabilitation, Wiener Gesundheitsverbund - Klinik Favoriten, Kundratstr. 1, 1100, Wien, Österreich
| | - S Venkat
- Klinik für Psychosomatische Medizin und Psychotherapie, Schmerztagesklinik, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - K Singler
- Medizinische Klinik 2, Schwerpunkt Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.,Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Deutschland
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Gosch M, Altrichter D, Pflügner M, Frohnhofen H, Steinmann J, Schmude-Basic I, Adamek A, Johnscher I, Kandler U, Wunner C, Waller C, Speer R, Habboub B, Brons-Daymond S, Schadinger C, Singler K. [Long-term care facilities during the COVID-19 pandemic : Considerations on the way back to normality]. Z Gerontol Geriatr 2021; 54:377-383. [PMID: 33999311 PMCID: PMC8127853 DOI: 10.1007/s00391-021-01922-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/11/2021] [Indexed: 11/27/2022]
Abstract
Langzeitpflegeeinrichtungen (LPE) waren und sind von der COVID-19-Pandemie besonders betroffen. Die Dimension der Ausbrüche und die hohe Letalität unter den Bewohner(innen) (BW) führten zu massiven Einschränkungen, v. a. im Bereich der sozialen Kontakte und Aktivitäten, aber auch in Bereichen der medizinischen Versorgung. Mit dem Start der Impfungen und den verbesserten Testmöglichkeiten haben sich nun aber die Voraussetzungen geändert, und bestehende Beschränkungen müssen auf ihre Zweckmäßigkeit evaluiert werden. In einer interprofessionellen und interdisziplinären Expertengruppe wurden Überlegungen erstellt, wie ein Weg zurück in die Normalität für LPE ausehen kann.
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Affiliation(s)
- M Gosch
- Universitätsklinik für Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland.
| | - D Altrichter
- Gemeinschaftspraxis S. Hofius, St. Pühlhorn, Dr. D. Altrichter, Nürnberg, Deutschland
| | | | - H Frohnhofen
- Medizinische Universität Düsseldorf, Düsseldorf, Deutschland
| | - J Steinmann
- Institut für Klinikhygiene, Medizinische Mikrobiologie und Klinische Infektiologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | | | - A Adamek
- NürnbergStift, Nürnberg, Deutschland
| | - I Johnscher
- Institut für Klinikhygiene, Medizinische Mikrobiologie und Klinische Infektiologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - U Kandler
- Institut für Klinikhygiene, Medizinische Mikrobiologie und Klinische Infektiologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - C Wunner
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - C Waller
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - R Speer
- Universitätsklinik für Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
| | - B Habboub
- Universitätsklinik für Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
| | - S Brons-Daymond
- Universitätsklinik für Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
| | | | - K Singler
- Universitätsklinik für Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen, Nürnberg, Deutschland
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Singler K, Dormann H, Dodt C, Heppner HJ, Püllen R, Burkhardt H, Swoboda W, Roller-Wirnsberger RE, Pinter G, Mrak P, Münzer T. Erratum zu: Der geriatrische Patient in der Notaufnahme. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0231-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Singler K, Dormann H, Dodt C, Heppner HJ, Püllen R, Burkhardt M, Swoboda W, Roller-Wirnsberger RE, Pinter G, Mrak P, Münzer T. Der geriatrische Patient in der Notaufnahme. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0216-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Glöckner E, Christ M, Geier F, Otte P, Thiem U, Neubauer S, Kohfeldt V, Singler K. Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure. Ultrasound Int Open 2016; 2:E90-2. [PMID: 27689182 DOI: 10.1055/s-0042-108343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/21/2015] [Revised: 03/04/2016] [Accepted: 04/21/2016] [Indexed: 01/06/2023] Open
Abstract
AIM The objective of this pilot study was to determine the accuracy of point-of-care B-line lung ultrasound in comparison to NT Pro-BNP for screening acute heart failure. MATERIALS AND METHODS An 8-zone lung ultrasound was performed by experienced sonographers in patients presenting with acute dyspnea in the ED. AHF was determined as the final diagnosis by 2 independent reviewers. RESULTS Contrary to prior studies, B-line ultrasound in our study was highly specific, but moderately sensitive for identifying patients with AHF. There was a strong association between elevated NT-proBNP levels and an increased number of B-lines. CONCLUSION In conclusion, point-of-care lung ultrasound is a helpful tool for ruling in or ruling out important differential diagnoses in ED patients with acute dyspnea.
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Affiliation(s)
- E Glöckner
- Geriatrics, Klinikum Nuernberg, Paracelsus Medical University, Nürnberg, Germany
| | - M Christ
- Department of Emergency and Critical Care Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - F Geier
- Geriatrics, Klinikum Nuernberg, Paracelsus Medical University, Nürnberg, Germany
| | - P Otte
- Radiology, Klinikum Nuernberg, Paracelsus Medical University, Nürnberg, Germany
| | - U Thiem
- Department of Geriatrics, Marienhospital Herne, University Bochum, Nürnberg, Germany
| | - S Neubauer
- Geriatrics, Klinikum Nuernberg, Paracelsus Medical University, Nürnberg, Germany
| | - V Kohfeldt
- Geriatrics, Klinikum Nuernberg, Paracelsus Medical University, Nürnberg, Germany
| | - K Singler
- Department of Geriatrics, Klinikum Nuernberg, Paracelsus Medical University, Nürnberg, Germany; Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nuremberg, Nürnberg, Germany
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Singler K, Goisser S, Volkert D. Ernährungsmanagement in der Alterstraumatologie. Z Gerontol Geriatr 2016; 49:535-46. [DOI: 10.1007/s00391-016-1091-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/21/2016] [Accepted: 05/19/2016] [Indexed: 11/25/2022]
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Stuck AE, Jónsdóttir AB, Singler K, Roller RE, Holm EA, Masud T. The length of postgraduate training for geriatric medicine in European countries: an update for the year 2015. Aging Clin Exp Res 2016; 28:169-70. [PMID: 26690756 DOI: 10.1007/s40520-015-0514-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A E Stuck
- Department of Geriatrics, Inselspital University Hospital and University of Bern, Inselspital, Bern, Switzerland.
| | - A B Jónsdóttir
- Department of Geriatric Medicine, University Hospital of Iceland, Landakoti, Reykjavík, Iceland
| | - K Singler
- Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany
- Department of Geriatrics, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - R E Roller
- Department of Geriatrics and Curriculum Development, University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - E A Holm
- Geriatric Department, Nykobing Falster Hospital, Nykobing Falster, Denmark
| | - T Masud
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Singler K, Thiem U, Christ M, Zenk P, Biber R, Sieber CC, Heppner HJ. Aspects and assessment of delirium in old age. First data from a German interdisciplinary emergency department. Z Gerontol Geriatr 2015; 47:680-5. [PMID: 24733451 DOI: 10.1007/s00391-014-0615-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The prevalence of delirium in hospitalized patients is high, but delirium is frequently not identified by treating physicians in emergency departments (EDs). Although the number of elderly patients admitted to EDs is increasing, no data on prevalence, identification and outcome of delirious elderly patients in German EDs exist. OBJECTIVES To evaluate the prevalence and identification of delirium in elderly patients in a German ED and to identify characteristics of delirium in elderly ED patients. METHODS Evaluation of data from a prospective single-center observational study. The study was conducted in the interdisciplinary ED of an urban university-affiliated hospital receiving approximately 80,000 visits per year. The shortened Confusion Assessment Method (CAM) was used to screen 133 consecutive ED patients, aged 75 years and older, for delirium. Comorbid conditions were ascertained by patient interview and review of medical records. Data concerning patient mortality and current living status were collected 28 days after the ED visit in a structured telephone interview. RESULTS A positive CAM result was recorded in 14.3 % of cases; 68.4 % of these CAM-positive patients were not identified as being delirious by the ED physician. The 28-day mortality was higher among patients with delirium. Dependency on external help, polypharmacy, pre-existing cognitive or mobility impairments and the presence of any care level were strongly associated with delirium. CONCLUSION Elderly patients with known risk factors should be routinely assessed for delirium in the ED with a standardized assessment tool such as the CAM.
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Affiliation(s)
- K Singler
- Abteilung für Geriatrie, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Germany,
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Singler K, Stuck AE, Masud T, Goeldlin A, Roller RE. [Catalogue of learning goals for pregraduate education in geriatric medicine. A recommendation of the German Geriatric Society (DGG), the German Society of Gerontology and Geriatrics (DGGG), the Austrian Society of Geriatrics and Gerontology (ÖGGG) and the Swiss Society of Geriatric Medicine (SFGG) on the basis of recommendations of the European Union of Medical Specialists Geriatric Medicine Section (UEMS-GMS) 2013]. Z Gerontol Geriatr 2015; 47:570-6. [PMID: 25217287 DOI: 10.1007/s00391-014-0809-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sound knowledge in the care and management of geriatric patients is essential for doctors in almost all medical subspecialties. Therefore, it is important that pregraduate medical education adequately covers the field of geriatric medicine. However, in most medical faculties in Europe today, learning objectives in geriatric medicine are often substandard or not even explicitly addressed. As a first step to encourage undergraduate teaching in geriatric medicine, the European Union of Medical Specialists -Geriatric Medicine Section (UEMS-GMS) recently developed a catalogue of learning goals using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end of their studies.In order to ease the implementation of this new, competence-based curriculum among the medical faculties in universities teaching in the German language, the authors translated the published English language curriculum into German and adapted it according to medical language and terms used at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties adapt their curricula for undergraduate teaching based on this catalogue.
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Affiliation(s)
- K Singler
- Institut für Biomedizin des Alterns, Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Deutschland,
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Hortmann M, Singler K, Geier F, Christ M. [Recognition of infections in elderly emergency patients]. Z Gerontol Geriatr 2015; 48:601-7. [PMID: 25986073 DOI: 10.1007/s00391-015-0903-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/15/2015] [Accepted: 04/17/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Elderly patients represent an increasing population in the emergency department (ED) and physicians often have to deal with multimorbidity and complexity. Infections are one of the major reasons for ED presentations of older patients and the main cause of mortality; however, infections are often difficult to diagnose in older patients. AIM This article provides a review of important indicators for infections, diagnostic tools and limitations in elderly patients. MATERIAL AND METHODS A literature search was carried out using PubMed in the period 1990-2015 and in addition own published data are presented. RESULTS AND CONCLUSION Infections in the elderly are difficult to assess in the emergency department due to atypical symptoms. Even subtle changes need to be recognized. For the diagnosis of infections in older ED patients unspecific symptoms, vital parameters, laboratory parameters, including C-reactive protein (CRP) and procalcitonin levels, cognitive function and functionality of the patient need to be taken into account.
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Affiliation(s)
- M Hortmann
- Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg, Freiburg, Deutschland
| | - K Singler
- Institut für Biomedizin des Alterns, Klinik für Geriatrie, Klinikum Nürnberg, Friedrich-Alexander Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - F Geier
- Universitätsklinik für Notfallmedizin und Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Prof. Ernst Nathan Str. 1, 90419, Nürnberg, Deutschland
| | - M Christ
- Universitätsklinik für Notfallmedizin und Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Prof. Ernst Nathan Str. 1, 90419, Nürnberg, Deutschland.
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Frühwald T, Weissenberger-Leduc M, Jagsch C, Singler K, Gurlit S, Hofmann W, Böhmdorfer B, Iglseder B. [Delirium: an interdisciplinary challenge]. Z Gerontol Geriatr 2015; 47:425-38; quiz 439-40. [PMID: 24609425 DOI: 10.1007/s00391-014-0613-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Delirium, the acute deterioration of cognitive function and attention, is the most frequent mental disorder in elderly. Its correct diagnosis and adequate management are of crucial importance for the patient's health and functional outcome. First of all, one has to be aware of the possibilities of preventing this complex, potentially life-threatening problem, which means recognizing the patient at risk, avoiding environmental stress and causal factors (i.e., anticholinergic medication) in cognitively impaired patients, and timely reaction to prodromal symptoms. Causal therapy (i.e., treatment of the causal condition and/or eliminating the precipitating situation) is imperative. It must be accompanied by nursing and environmental measures and, if necessary, by antipsychotic and/or sedating symptomatic treatment.
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Affiliation(s)
- T Frühwald
- Abteilung für Akutgeriatrie, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Wolkersbergenstr. 1, 1130, Wien, Österreich,
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Goisser S, Schrader E, Singler K, Sieber C, Volkert D. P383: Low postoperative dietary intake is associated with more complications in geriatric hip fracture patients. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Goisser S, Schrader E, Singler K, Sieber C, Volkert D. PP033-MON: Low Postoperative Dietary Intake is Associated with Functional Impairment in Geriatric Patients up to 6 Months After HIP Fracture. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Delirium in older patients is also associated with persistent functional and cognitive impairment. Nevertheless, it frequently remains unrecognized or misinterpreted by treating physicians and this is particularly true in cases of hypoactive delirium. Screening and assessment instruments are helpful in the identification of patients with delirium. A multifactorial model of a combination of predisposing and precipitating factors best explains the etiology of delirium and avoidance is crucial for its prevention. Whenever delirium is suspected, immediate diagnosis and therapy of the precipitating condition are of primary importance. Non-pharmacological interventions, for example environmental modifications, play an important role in managing behavioral symptoms of delirium. Pharmacological interventions are merely symptomatic and should be limited to patients with severe symptoms when non-pharmacological means fail.
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Affiliation(s)
- K Singler
- Institut für Biomedizin des Alterns, Friedrich-Alexander Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Deutschland,
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Goisser S, Schrader E, Ender C, Purucker K, Singler K, Biber R, Bail HJ, Sieber C, Volkert D. PP036-SUN IS AN ESTIMATED PLATE DIAGRAM SUITABLE TO CORRECTLY ASSESS POSTOPERATIVE DIETARY INTAKE OF GERIATRIC PATIENTS WITH HIP FRACTURE? Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Goisser S, Schrader E, Purucker K, Singler K, Biber R, Bail HJ, Sieber C, Volkert D. PP025-MON MALNUTRITION IS ASSOCIATED WITH FUNCTIONAL IMPAIRMENT IN GERIATRIC PATIENTS WITH HIP FRACTURE. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schrader E, Goisser S, Purucker K, Singler K, Biber R, Bail H, Bertsch T, Sieber C, Volkert D. PP036-MON IS THERE AN ASSOCIATION BETWEEN MICRONUTRIENT AND NUTRITIONAL STATUS IN GERIATRIC HIP FRACTURE PATIENTS? Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Singler K, Bail HJ, Christ M, Weis P, Sieber C, Heppner HJ, Kob R, Biber R. [Correlation of patients age on length of stay and admission rate in a German emergency department]. Dtsch Med Wochenschr 2013; 138:1503-8. [PMID: 23860679 DOI: 10.1055/s-0033-1343315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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
BACKGROUND This study aimed to examine correlations between patient age, length-of-stay (LOS) in the emergency department (ED), admission rate for various medical disciplines and probabilities of admission in a German interdisciplinary ED. PATIENTS AND METHODS In a retrospective cohort analysis, 7937 patients of the ED were evaluated for age, gender, ED-LOS and admission rate. Rank correlation coefficients were calculated in order to analyze the influence of patient age for each discipline. Statistical tests were performed to evaluate explorative hypotheses on specific discipline influence of patient age. RESULTS Patients age significantly differed between the disciplines. There was a strong correlation between patient age and LOS for trauma surgery, visceral surgery and ophthalmology. The correlation between patient age and admission rate was highest in patients with problems regarding internal medicine, trauma surgery and neurology. CONCLUSION There is a correlation between patients age, LOS and admission rate in the ED.
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Affiliation(s)
- K Singler
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
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Sieber C, Singler K, Dürk I. e.Curriculum Geriatrie. Internist (Berl) 2013; 54:507-8. [DOI: 10.1007/s00108-013-3267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sieber C, Singler K, Dürk I. e.Curriculum Geriatrie. Z Gerontol Geriatr 2013; 46:268-9. [DOI: 10.1007/s00391-013-0489-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Biber R, Möllers M, Wicklein S, Singler K, Sieber C, Bail HJ. [Hemiarthroplasty for femoral neck fracture in the elderly--an operation suitable for teaching?]. Zentralbl Chir 2013; 138 Suppl 2:e41-6. [PMID: 23460107 DOI: 10.1055/s-0032-1327965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hemiarthroplasty is a common procedure for treating femoral neck fractures in orthogeriatrics. For training purposes the operation may also be performed by supervised residents. Our study aims at evaluating the rates of early surgical complications after hemiarthroplasty in different age groups, comparing operations performed by consultants and residents. METHODS All patients treated with hemiarthroplasty between December 2006 and July 2011 at our municipal, maximum-care-providing hospital were included in a retrospective cohort. The Excia® stem with a self-centering bipolar head (Aesculap, Tuttlingen) was used in all patients. Educational level of the operator (consultant vs. resident) and operation time were noted as well as early complications including luxation, infection, haematoma, seroma, and early periprosthetic fractures (e.g., intraoperative lesions of the greater trochanter). The complication rates were evaluated and compared by the chi-square test. RESULTS 241 of 729 hemiarthroplasties were performed by supervised residents. Neither the overall complication rate nor the rates of specific complications differed significantly between the patients operated by consultants and those operated by residents. The result was still true if comparing the different age groups. On average operation time was 8 minutes longer in teaching operations. CONCLUSIONS Focusing on early surgical complications, the teaching of hemiarthroplasty does not seem to increase the risk to patients of any age. We conclude that the hemiarthroplasty procedure is suitable for teaching younger colleagues in orthogeriatrics. As age is just one of several potential risk factors, additional studies on this topic should be undertaken.
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Affiliation(s)
- R Biber
- Klinik für Unfall- und Orthopädische Chirurgie, Klinikum Nürnberg, Nürnberg, Deutschland
| | - M Möllers
- Klinik für Unfall- und Orthopädische Chirurgie, Klinikum Nürnberg, Nürnberg, Deutschland
| | - S Wicklein
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - K Singler
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - C Sieber
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - H J Bail
- Klinik für Unfall- und Orthopädische Chirurgie, Klinikum Nürnberg, Nürnberg, Deutschland
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Singler K, Sieber CC, Biber R, Roller RE. Considerations for the development of an undergraduate curriculum in geriatric medicine. Gerontology 2013; 59:385-91. [PMID: 23407132 DOI: 10.1159/000346511] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 12/17/2012] [Indexed: 11/19/2022] Open
Abstract
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, room for improvement remains not only in terms of structure, but also regarding quality of training to develop self-directed lifelong learners.
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Affiliation(s)
- K Singler
- Institute for Biomedicine of Aging, Friedrich-Alexander University, Nürnberg, Germany.
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Singler K, Biber R, Wicklein S, Sieber C, Bollheimer L. A plea for an early mobilization after hip fractures. The geriatric point of view. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2012.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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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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Biber R, Grüninger S, Singler K, Sieber CC, Bail HJ. Is proximal femoral nailing a good procedure for teaching in orthogeriatrics? Arch Orthop Trauma Surg 2012; 132:997-1002. [PMID: 22467120 DOI: 10.1007/s00402-012-1511-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Proximal femoral nailing is a common operation in orthogeriatrics and a highly standardized procedure. For teaching purposes, this operation is often performed by residents and supervised by attending physicians. The objective of this study is to investigate if teaching this operation influences the surgical in-house complication rate. PATIENTS AND METHODS All patients who received a proximal femoral Targon PF nail (Aesculap AG, Tuttlingen, Germany) for trochanteric fractures were included in a cohort at our urban academic teaching hospital between 1998 and 2010. To evaluate potential effects of patient age, we separately analyzed several age groups. Complications including wound infection, hematoma, intraoperative malreduction or implant malpositioning causing revision, pain, cut-out and readmission due to nonunion were recorded. RESULTS Our collective consists of 1,516 patients (m/f: 410/1,106). The mean age was 78.7 years (range: 19-103 years). The overall complication rate was 7.9 %. In 857 cases operated by attending physicians, the complication rate was 6.9 %. However in the 659 operations performed by residents, we found a higher complication rate of 9.3 %. Further investigating this difference by χ(2) test, we found no significance (p = 0.09). Whilst analyzing the complication rates for the different age groups, we did not find a statistically significant difference except in the age group between 71 and 80 years, for which the odds ratio indicated a 2.6-fold increased complication risk for operations performed by residents (p = 0.01). Further analysis revealed that this increased complication rate was mainly due to increased numbers of cut-out. CONCLUSION We conclude that proximal femoral nailing is an operation suitable for teaching purposes. However, patients between 71 and 80 years of age seem to be at an increased risk for cut-out if operated by a resident.
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Affiliation(s)
- R Biber
- Department of Trauma and Orthopaedic Surgery, Klinikum Nürnberg, Breslauer Strasse 201, Nürnberg, Germany.
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Singler K, Biber R, Wicklein S, Heppner H, Sieber C, Bail H. “N-active”: a new comanaged, orthogeriatric ward. Z Gerontol Geriatr 2011; 44:368-74. [DOI: 10.1007/s00391-011-0250-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 10/11/2011] [Indexed: 11/28/2022]
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Heppner HJ, Singler K, Sieber CC, Christ M, Heirler F, Schönhofer B. [Evidence-based medicine: implications from the guideline "non-invasive ventilation" in critically ill elderly patients]. Z Gerontol Geriatr 2011; 44:103-8. [PMID: 21494932 DOI: 10.1007/s00391-010-0162-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
The demographic shift means that there are an increasing number of elderly critically ill patients with various comorbidities. This very specific group needs particular treatment which has not been considered sufficiently in medical guidelines so far. To improve health care, it is indispensable not only to work out the current guidelines, but aspects of geriatric medicine must also be integrated into future developments. Using the example of the recent guideline "non-invasive ventilation," it is shown how the process of designing and implication can actively be realized in clinical daily routine.
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Affiliation(s)
- H J Heppner
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Heimerichstr. 58, 90419, Nürnberg, Deutschland.
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Drescher T, Singler K, Ulrich A, Koller M, Keller U, Christ-Crain M, Kressig RW. Comparison of two malnutrition risk screening methods (MNA and NRS 2002) and their association with markers of protein malnutrition in geriatric hospitalized patients. Eur J Clin Nutr 2010; 64:887-93. [DOI: 10.1038/ejcn.2010.64] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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