[Special care units for the treatment of acutely ill, cognitively impaired geriatric patients in Germany]

During recent years, specialized wards have been established in geriatric hospital departments as a consequence of the growing need of special care for acutely ill older patients, who are also cognitively impaired. However, there are neither established standards nor any commonly agreed concept of care. A written survey among 12 specialized wards in Germany revealed some characteristics of these wards: extended geriatric assessment, special education of staff including validation and gerontopsychiatric issues, and particular equipment/architecture, such as hidden doors and group rooms, and in some cases loop tracks for walking, therapeutic facilities, and 'living rooms' on the wards. There is a wide variability with respect to the designation of these wards, the number of beds, length of stay, and admission criteria. It appears from this survey that there should be an exchange of empirical experience made on these wards, and there is a need of collaborative research on its usefulness.

[Treatment of pressure sores in elderly patients]

The treatment of pressure sores in elderly patients requires careful documentation and a comprehensive treatment plan, which takes into account the patient's overall situation. The treatment has to be evidence based. At the moment only three recommendations can be based on two or more prospective, randomized clinical studies: to use a dressing to maintain a moist environment at the wound/dressing interface, to reduce the risk of infection and enhance wound healing by hand washing, wound cleansing and debridement and to institute a systemic antibiotic treatment for patients with advancing cellulitis, sepsis and osteomyelitis. For other treatment options such as topical negative pressure, maggot therapy, electromagnetic therapy, therapeutic ultrasound or growth factors, the data at present are not sufficient to support general use in pressure sore treatment.

[The elderly stroke patient - observations 18 months after the event]

The further development of 162 stroke patients (average age 77 years), who were geriatrically assessed during hospitalization, was evaluated ca. 18 months after stroke. Questionnaires were mailed to patients. 53% of the patients (n = 86) returned the questionnaire duly filled in; 20% (n = 32) had died; in the remaining 27% of cases (n = 44) no information was obtained on further development. 80% of those patients who responded lived at home despite numerous medical problems. Family members assumed most of the care required. Follow-up treatment and pain therapy proved to be particularly problematic. The Barthel Index according to data collected was significantly lower compared to figures noted upon release from the hospital. Hardly anyone among those patients received follow-up treatment. 74% of patients complained of pain although the majority has regular contacts with the family doctor. For those patients who died in the 18 months interval, significantly lower values for the activities of daily living (ADL) has already been recorded upon hospitalization. They had a less favorable view of their state of health and were less satisfied with life in general.

[Psychotropic drugs and automobile driving ability of elderly patients]

Many elderly patients are prescribed psychotropic medication, many of them are car drivers. Driving ability may be impaired by the underlying psychiatric disease, the medication or the combination of both. Psychoactive medications do not all influence driving ability to the same extent. Cyclic antidepressants impair driving performance to a higher degree than selective serotonin reuptake inhibitors (SSRI) or MAO inhibitors. In cases of severe psychiatric diseases like major depression an appropriate psychoactive medication may improve driving performance. The influence of psychoactive drugs on driving ability is not always taken into account. There are no data available that allow a reliable assessment of these drugs in elderly patients. To meet the challenge of this problem, patients and doctors have to be aware of this problem; studies about the impact of psychoactive drugs on driving ability are necessary.

[Dementia and automobile driving capacity]

There are only few investigations about the driving ability in demented patients. The available data point to an elevated risk of accident. Patients with very mild dementia, however, are often fit enough to drive. Unfortunately there are no tests available to identify demented drivers with a high risk of accidents. So it remains an individual decision of the doctor to assess the driving ability in demented patients. The caregiver's assessment of the driving competency and psychometric tests are helpful, if an in-car road test is not possible. Further investigations and simple tests are needed.