Geriatrietypische Multimorbidit?t im Spiegel von Routinedaten – Teil?1

Background

In Germany, typical geriatric multimorbidity is—next to age itself—of special significance for the identification of target groups for specific geriatric care offers. The present article primarily focuses on typical geriatric multimorbidity in the claims data of statutory health insurance and long-term care insurance in Germany. Using the definition of “the geriatric patient” that is agreed on by providers of services as well as by cost bearers, geriatric multimorbidity is defined as the coexistence of at least 2?of 15?typical geriatric conditions. A suggestion made by the German Geriatric Association was to assign ICD-10-GM codes to each of these 15?conditions. Thus, it becomes possible to identify the corresponding geriatric conditions in claims data.

Methods

The article investigates the frequency of geriatric conditions and, thus, of geriatric multimorbidity of patients aged ≥?60?years admitted to a hospital with a geriatric ward. Patients treated in a geriatric ward were compared with those who did not receive geriatric care. In anticipation of a high correlation between typical geriatric conditions and specific features that are preconditions for receiving long-term care insurance benefits (such as care levels and status of a nursing home resident), claims data of the long-term care insurance were included for external validation.

Results

The analyses showed a distinctly higher proportion of insured people with typical geriatric multimorbidity or rather a certain care level among the geriatrically treated cases than among those patients not receiving geriatric treatment (68.5%/67.9% versus 24.2%/33.4%). The different proportions of typical geriatric multimorbidity coded among the patients with features of a certain care level in the two given groups give rise to the suspicion that typical geriatric multimorbidity is not always statistically recorded—especially in cases of treatment without provision of geriatric care.

Conclusion

The frequency of cases of typical geriatric multimorbidity and a certain care level shows that—even when a specific geriatric offer exists—a considerable proportion of cases with typical geriatric conditions are treated in other medical departments.     

Geriatrietypische Multimorbidit?t im Spiegel von Routinedaten – Teil?2

Background

Due to demographics, characteristic multimorbidity in geriatric patients is resulting in increased social, medical, and healthcare challenges. Geriatric multimorbidity (GM) can be defined as the simultaneous occurrence of at least two diseases that require medical care with an interdisciplinary focus on independence in activities of daily living. Typical conditions of GM are, e.g., incontinence, cognitive impairment, frailty, and decubitus.

Material and methods

Part 2 of this study is based on claims data of 240,502 AOK insurants (AOK is one of the major health insurance companies of the German statutory health insurance system) aged ≥?60 years with at least one admission to a hospital with a geriatric ward. Geriatric conditions (GCs) were ascertained in two ways: diagnoses from physicians in the ambulant care setting and diagnoses in a hospital setting in 2008. A total of 15 GC were assessed using diagnoses based on ICD-10 codes (as per suggestion from scientific geriatric societies). An insurant was defined as a person with GM, if he/she had at least two GCs.

Results

The proportion of GCs in ambulant or inpatient diagnoses of 240,502 insurants varied significantly in most cases. For specific GCs, considerably higher proportions of ambulant diagnoses (e.g., pain, impairment of vision, or hearing) or for inpatient diagnoses (e.g., electrolyte or fluid metabolism disorders, malnutrition, incontinence) were identified. Only on rare occasions were small differences observed comparing the proportions of specific GCs in the diagnoses of the two different care sectors. This finding reduces considerably the accordance between the two care sectors with reference to the presence or absence of a GC for ambulant or inpatient diagnoses. The main agreement was with the non-coding of specific GCs, not with ambulant or inpatient diagnoses. Insurants with a geriatric hospital admission or certain care level (level ≥?1) generally had higher proportions for specific GCs for inpatient and ambulant diagnoses than non-geriatric treated insurants or insurants without a certain care level. Of the geriatric treated insurants and those with certain care levels, 90% were characterized by the presence of GM for both ambulant or inpatient diagnoses. This percentage is remarkably higher than for patients who featured no geriatric treatment or had no certain care level.

Conclusion

The inclusion of ambulant diagnoses in addition to inpatient diagnosis offers comprehensive possibilities to identify insurants with GM in claims data. The contribution of the diagnoses of both care sectors for the identification of GC and GM varies with regard to attribute and insurant orientation. Furthermore, significant attribute-oriented overlap of insurants claiming geriatric treatments and insurants with certain care levels became visible, which can open new possibilities for simpler identification of a portion of patients with GM.     

Epidemiologie von Suizidalität im Alter

The suicide risk in Germany increases with age. The suicide rates follow the so called "Hungarian" pattern. Especially the percentage of older females among all suicides has increased unproportionally in recent years in relation to their percentage in the population. Every second suicide of a female is today a suicide of a female older than 60 years. The main suicide method among older persons is hanging. Suicide attempts are rare among older persons; however, the rates are increasing among the oldest age groups. The suicide attempts of older persons are committed with a higher lethality and show rarely appellative components. Suicide attempt methods are often poisoning with pharmaceuticals. In total the suicide and suicide attempt rates among elderly are underestimated due to indirect methods (passive reactions, e.g. noneating). Reasons for suicides and suicide attempts among older persons are often psychic illnesses (mostly depression), motives often include loss of partners, loss of the social network, fear of the consequences of somatic illnesses and loss of freedom of action. Thus, often the social situation of older persons with suicide attempts changed before suicide was attempted.     

Dekubitus: Kenntnis von Risikofaktoren und Bewusstsein von Problemen der Versorgungsqualität im Spiegel einer Befragung von Pflegekräften und Ärzten

A number of risk factors for pressure sores are well known. However, their causal relationship with the development of pressure sores is ambiguous. In fact, there is varying awareness of the problems in nursing staff and physicians caused by its' complexity and sometimes unclear evidence-even in standards and guidelines. In the present investigation, 256 members of a nursing staff and 245 physicians were asked by questionnaire about risk factors for pressure sores and problems with quality of care. The results revealed different views of the pathophysiology of pressure sores and also problems in the quality of care. There was agreement about the urgent need of consideration of these topics in education and postgraduate training.     

Multimorbidität bei älteren Rheumapatienten Teil 2

While diseases, such as cardiovascular diseases and osteoporosis in the elderly are categorized as comorbidities of rheumatoid arthritis, elderly rheumatic patients are often additionally affected by thyroid dysfunctions and diabetes mellitus type 2, so that the risk of multimorbidity (coexistence of at least two chronic and/or acute diseases) will increase significantly in elderly patients already suffering from systemic rheumatic diseases. Restricted cognition, adherence or compliance may additionally complicate the treatment of elderly rheumatic patients. Furthermore, the pharmacokinetics of the elderly is another challenging task. Referring to selected aspects of geriatric pharmacotherapy, the use of certain substance classes is described in this context.     

Die Heterogenität von Fermenten im Serum

Ohne Zusammenfassung     

Religiosität und Spiritualität im Alter

The present paper presents results regarding religious attitudes and behaviors as well as the perceived social support by religious communities in n = 593 elderly over 60 years (31.2% female, mean age 69.5 years) from the German general population. The results are based on the German 15-item version SBI-15R-D of the "Systems of Belief Inventory" (Holland et al., 1998). Furthermore, religiosity was analyzed as a potential protective factor regarding body complaints in the elderly. Higher scores on religiosity could be found in women compared to men and in elderly from Western Germany compared to those from Eastern Germany. There were no significant correlations between religiosity and body complaints. It is discussed whether the self-ratings of religiosity reflect conventional ideas of a religious orientated person rather than a genuine spiritual attitude.     

Lebensqualität im Alter

Ohne Zusammenfassung     

Wohnmobilität im Alter

Background

Unfavorable living conditions in old age have negative physical, psychological and social implications and increase the risk of institutionalization. The aim of this study is to examine older adults’ readiness to relocate to age-appropriate housing versus the wish to stay where they are.

Methods

A total of 103 older men and women were questioned prospectively, face-to-face, regarding their readiness to relocate. In addition to assessing several established predictors of residential mobility, data on objective living situations were collected. The data were subjected to bi- and multivariate analysis.

Results

At 70.9?%, the proportion of respondents who are not willing to move (stayers) far exceeds the proportion of those who are (movers, 29.1?%). Older respondents are more satisfied with their living situation and less likely to move. This study provides empirical evidence for the “satisfaction paradox” with respect to living conditions and for the importance of the subjective standard of living for quality of life in old age.

Conclusion

Modern housing counseling should more strongly reflect the variety of needs, requirements and living situations of older people today than it has done in the past. It is therefore recommended that the currently dominating paradigm of“aging in place” be critically re-evaluated.     

Suizidalität im Alter

Ohne Zusammenfassung     

Die subjektive Gesundheit älterer Menschen im Spiegel des SF-36

This paper presents data regarding the German version of the SF-36 (Short Form 36 Questionnaire; Bullinger and Kirchberger, 1998) that were obtained from a large community based sample of the German population. Results are reported for the elderly at the age of 60 and older from the German general population (N = 690; 57% female). Presented are the internal consistencies of the scales (Cronbach's Alpha), the intercorrelations of the scales, mean values of the scales separated by sex, age group (60-64 years, 65-69 years, 70-74 years, 75-79 years, 80 years and older) and residence (Eastern and Western Germany) as well as percentile ranks for the whole sample.     

Berufliche Aktivität im Ruhestand

Background

This article investigates employment of retired persons with different ethnic backgrounds, namely Germans, ethnic Germans and immigrants. The central issue of this paper addresses the influencing factors on employment during retirement.

Data and methods

A total of 25,304 recipients of statutory pension payments were analyzed using administrative data of the German Pension Insurance and the Federal Employment Agency. The parameters of being employed, whilst drawing statutory pension payments, were determined by means of a binary probability model.

Results

About 20% of the investigated pensioners hold an occupational activity. In the majority of cases this activity equates to part-time employment. Not only the amount of pension received, but also lack of continuous employment prior to retirement influence whether retirees stay in the labor force. Furthermore there are differences between Germans and immigrants.

Conclusion

The combination of the influencing parameters on working beyond retirement permits the conclusion that persons who face the risk of old-age poverty are more likely to work when they are retired.     

Quantitative Cholinbestimmungen im Serum von Carcinompatienten mit erhöhter Phosphataseaktivität

Zusammenfassung Im Serum von Carcinompatienten wiesen wir in allen Fällen mit erhöhter Phosphataseaktivität eine Substanz nach, die sich bei der von uns angewandten Methode wie Cholin verhält, im Gegensatz zu Cholin jedoch durch Kochen mit n-HCl zerstört wird. Sie läßt sich auch in Seren, die längere Zeit gestanden haben, nicht mehr nachweisen, ebensowenig wie in Seren von Carcinomkranken mit normaler Serumphosphataseaktivität. Die Substanz steht in keinem unmittelbaren Zusammenhang zum Cholinstoffwechsel. Versuche, sie zu identifizieren, waren bisher erfolglos.     

Effekt von CRT auf Morbidität und Mortalität

Zusammenfassung Herzinsuffiziente Patienten, die trotz optimaler chronischer Medikation eine stabile linksventrikuläre Ejektionsfraktion 35% aufweisen und in NYHA-Klasse III oder IV verbleiben, profitieren bezüglich Morbidität und Mortalität von einer kardialen Resynchronisationstherapie (CRT), wenn der linke Ventrikel vor Implantation Zeichen der Asynchronität zeigt. Bisher konnte nur eine einzelne Studie eindeutig eine Verbesserung der Mortalität zeigen, es ist aber von einer absoluten jährlichen Verringerung von 4% in den ersten beiden Jahren auszugehen. Die durch die Implantation verursachte Mortalität ist mit unter 1% anzunehmen. Durch eine Verbesserung der Herzinsuffizienz um im Mittel eine NYHA-Klasse werden ca. 10–20% weniger Patienten in den ersten beiden Jahren mit CRT wegen einer zunehmenden Herzinsuffizienz hospitalisiert. Hospitalisierte Patienten weisen relativ kurze stationäre Aufenthalte von im Mittel unter 5 Tagen auf. Revisionsoperationen auf Grund von Infektionen, Dislokationen und Reizschwellenansteigen der linksventrikulären Sonde sind derzeit bei mindestens 10% der Patienten zu erwarten. Ob die eingesparten Kosten durch die verminderte Inanspruchnahme der stationären Therapie die Kosten der CRT abdecken ist derzeit unklar.     

Aspekte der Lebensqualität im Alter

Ohne Zusammenfassung     

Multimodales Erklärungsmodell der Suizidalität im Alter

General theories of suicidology are insufficient to explain the overproportional rate of suicidal behaviour in the elderly. The proposed transactional model represents a bio-psycho-social foundation of suicidal behavior in the elderly. The reciprocal interactions of biological, somatic, psychological and social factors in old age which may enhance suicidal behavior as a mode of problem-solving behavior are discussed.     

Hauterkrankungen als Spiegel von Magen-Darm-Ver?nderungen

The skin is the most obvious organ of man and may be affected in a strictly isolated manner or within the context of a systemic disease, thus reflecting internal processes. Bowel diseases with malabsorption can present on the skin as itching or scaling or as characteristic diseases like pellagra and acrodermatitis enteropathica. Dermatitis herpetiformis as a distinct cutaneous entity shows immunological similarities with celiac disease like the presence of anti-transglutaminase antibodies, yet characteristic discrepancies at the same time. Chronic inflammatory bowel diseases are associated with erythema nodosum or pyoderma gangrenosum as defined dermatological entities which are indicative for, yet not proof of an underlying disease. Inflammatory processes of the oral cavity or perianal region are mostly unspecific, yet aphthous membrane involvement, fistulae, and pyostomatitis vegetans are more or less pathognomonic for chronic inflammatory bowel diseases. Apart from these more or less typical skin manifestations, a number of skin diseases have been found to be associated with bowel diseases, however mostly without a specific pathogenic relation. Therapeutic approaches are in many cases only successful when the underlying bowel disease is targeted or treated as well.