Patient assessment and feasibility of treatment in older patients with cancer: results from the IN-GHO Registry.

Purpose: Predicting feasibility of treatment in older patients with cancer is a major clinical task. The Initiative Geriatrische Hämatologie und Onkologie (IN-GHO) registry prospectively collected data on the comprehensive geriatric assessment (CGA), physician's and patient's-self assessment of fitness for treatment, and the course of treatment in patients within a treatment decision aged ≥ 70 years.

Patients And Methods: The registry included 3169 patients from 93 centres and evaluated clinical course and treatment outcomes 2-3 and 6 months after initial assessment.

[Challenges of implementing a geriatric trauma network : A regional structure].

Background: At present, there is a high percentage and increasing tendency of patients presenting with orthogeriatric injuries. Moreover, significant comorbidities often exist, requiring increased interdisciplinary treatment. These developments have led the German Society of Trauma Surgery, in cooperation with the German Society of Geriatrics, to establish geriatric trauma centers.

Short-term mortality of adult inpatients with community-acquired pneumonia: external validation of a modified CURB-65 score.

Objective: The management of community-acquired pneumonia (CAP) continues to be a challenge, especially in older people. To enable better risk stratification, a variation of the severity scores CRB-65 and CURB-65, called CURB-age, has been suggested. We compared the association between risk groups as defined by the scores and 30-day mortality for a cohort of mainly older inpatients with CAP.

Pneumonia severity, comorbidity and 1-year mortality in predominantly older adults with community-acquired pneumonia: a cohort study.

Background: In patients with community-acquired pneumonia (CAP), short-term mortality is largely dependent on pneumonia severity, whereas long-term mortality is considered to depend on comorbidity. However, evidence indicates that severity scores used to assist management decisions at disease onset may also be associated with long-term mortality. Therefore, the objective of the study was to investigate the performance of the pneumonia severity scores CURB-65 and CRB-65 compared to the Charlson Comorbidity Index (CCI) for predicting 1-year mortality in adults discharged from hospital after inpatient treatment for CAP.

External validation of the CURSI criteria (confusion, urea, respiratory rate and shock index) in adults hospitalised for community-acquired pneumonia.

Background: For patients hospitalised due to community-acquired pneumonia (CAP), mortality risk is usually estimated with prognostic scores such as CRB-65 or CURB-65. For elderly patients, a new score referred to as CURSI has been proposed which uses shock index (SI) instead of the blood pressure (B) and age (65) criteria. The new score has not been externally validated to date.

Falls and EQ-5D rated quality of life in community-dwelling seniors with concurrent chronic diseases: a cross-sectional study.

Background: Although recommended for use in studies investigating falls in the elderly, the European Quality of Life Group instrument, EQ-5D, has not been widely used to assess the impact of falls on quality of life. The aim of this study was to investigate the association of single and frequent falls with EQ-5D rated quality of life in a sample of German community-dwelling seniors in primary care suffering a variety of concurrent chronic diseases and conditions.

Methods: In a cross-sectional study, a sample of community-dwelling seniors aged ≥ 72 years was interviewed by means of a standardised telephone interview.

Prevalence of self-reported pain, joint complaints and knee or hip complaints in adults aged ≥ 40 years: a cross-sectional survey in Herne, Germany.

Background: Pain and musculoskeletal complaints are among the most common symptoms in the general population. Despite their epidemiological, clinical and health economic importance, prevalence data on pain and musculoskeletal complaints for Germany are scarce.

Methods: A cross-sectional survey of a random sample of citizens of Herne, Germany, aged ≥ 40 years was performed.

A review of the major vascular risk factors related to Alzheimer's disease.

The present review is dedicated to the epidemiology of vascular risk factors proven to play a role in facilitating onset and progression of cognitive impairment. These include hypertension, hypercholesterolemia, diabetes, obesity, atherosclerosis, and cardiac diseases. The targeted, chance-free identification and management of traditional vascular risk factors in midlife is a general public health strategy against the onset of mild to severe cognitive impairment in advanced age.

Conflict of evidence: carotenoids and other micronutrients in the prevention and treatment of cognitive impairment.

Cognitive impairment is a common age-related disorder which affects in the stadium and type Alzheimer's Disease (AD) a steadily growing number of patients. AD is not curable and is not being easily diagnosed in its preclinical phase. This work aims at highlighting the complex though promising rationale for the use of selected micronutrients against age-related cognitive impairment and its progression.

Bridging the pathophysiology of Alzheimer's disease with vascular pathology: the feed-back, the feed-forward, and oxidative stress.

Alzheimer's disease (AD) is slowly but steadily undergoing a profound reshaping of the definition and approach caused by the frustrating gap between poorly controlled AD epidemiology and repeated lack of success in finding a cure. The frequently reported and currently accepted role of vascular pathology and vascular risk factors in AD pathophysiology in recent years is one major aspect of this need for a severe adjustment in the modus operandi in AD. A clue into the importance that the interdependence between AD and vascularity has gained in scientific opinion is the large amount of recent reviews, almost reaching that of original papers, on the topic.

Elderly patients with community-acquired pneumonia: optimal treatment strategies.

Community-acquired pneumonia (CAP) is a common infectious disease that still causes substantial morbidity and mortality. Elderly people are frequently affected, and several issues related to care of this condition in the elderly have to be considered. This article reviews current recommendations of guidelines with a special focus on aspects of the care of elderly patients with CAP.

Prevention of dementia: focus on lifestyle.

The objective of this paper is to summarize current knowledge on the possible advantages of lifestyle interventions, with particular attention to physical fitness, cognitive activity, leisure and social activity as well as nutrition. There is a large amount of published papers providing partial evidence and asserting the need for immediate, appropriate preventive lifestyle measures against dementia and AD development. Nevertheless, there are currently great difficulties in drafting effective guidelines in this field.

Modulation of cholesterol in midlife affords cognitive advantage during ageing - a role for altered redox balance.

General practitioners, geriatricians, neurologists and health care professionals all over the world will be facing by 2040 the diagnostic, therapeutic and socioeconomic challenges of over 80 million people with dementia. Dementia is one of the most common diseases in the elderly which drastically affects daily life and everyday personal activities, is often associated with behavioural symptoms, personality change and numerous clinical complications and increases the risk for urinary incontinence, hip fracture, and - most markedly - the dependence on nursing care. The costs of care for patients with dementia are therefore immense.

Bone T-scores and functional status: a cross-sectional study on German elderly.

Background: We explore the association between bone T-scores, used in osteoporosis diagnosis, and functional status since we hypothesized that bone health can impact elderly functional status and indirectly independence.

Methods: In a cross-sectional study (2005-2006) on community dwelling elderly (> = 75 years) from Herne, Germany we measured bone T-scores with Dual-energy X-ray Absorptiometry, and functional status indexed by five geriatric tests: activities of daily living, instrumental activities of daily living, test of dementia, geriatric depression score and the timed-up-and-go test, and two pooled indexes: raw and standardized. Generalized linear regression was used to determine the relationship between T-scores and functional status.

Association of polymorphisms in CYP19A1 and CYP3A4 genes with lower urinary tract symptoms, prostate volume, uroflow and PSA in a population-based sample.

Purpose: The known importance of testosterone for the development of benign prostatic hyperplasia (BPH) prompted us to test the hypothesis whether polymorphisms of two genes (CYP19A1 and CYP3A4) involved in testosterone metabolism are associated with clinical BPH-parameters.

Methods: A random sample of the population-based Herne lower urinary tract symptoms cohort was analysed. All these men underwent a detailed urological work-up.

[The geriatric assessment].

Due to demographic changes there is an increasing number of elderly and old patients with cancer. This group of patients shows a significant heterogeneity and differs from the average young patient. Identification of relevant functional deficits and comorbidities remains crucial for an efficient treatment strategy of this patient group.

C-reactive protein, severity of pneumonia and mortality in elderly, hospitalised patients with community-acquired pneumonia.

Background: increasingly, markers of systemic inflammation like C-reactive protein (CRP) levels and white blood count (WBC) are being used for assessing the prognosis of patients with community-acquired pneumonia (CAP). However, their predictive value has not been validated in populations of elderly patients.

Objective: to evaluate the prognostic value of CRP and WBC in comparison with the CURB score and the pneumonia severity index (PSI) in elderly, hospitalised patients with CAP.

High fruit and vegetable intake is positively correlated with antioxidant status and cognitive performance in healthy subjects.

A higher daily intake of fruits and vegetables in healthy elderly is associated with an improved antioxidant status in comparison to subjects consuming diets poor in fruits and vegetables, but the impact on cognitive performance is unclear. Healthy community dwellers (45 to 102 years old, n=193) underwent cognitive testing and blood withdrawal for the measurement of antioxidant micronutrients and biomarkers of oxidative stress as well as administration of a food frequency questionnaire to assess the daily intake of fruits and vegetables (high intake HI, low intake LI). Ninety-four subjects of the HI group had significantly higher cognitive test scores, higher levels of carotenoids, alpha- and gamma-tocopherol as well as lower levels of F2 alpha isoprostanes than the 99 subjects of the LI group.

[Health services research activities in North Rhine-Westphalia. An analysis of the project database health services research NRW].

Background And Purpose: Health services research is gaining increasing importance in the field of public health. To present its activities and findings more clearly, the "Clearingstelle Versorgungsforschung NRW" (clearinghouse health services research North Rhine-Westphalia) has set up a database of projects in the field of health services research in North Rhine-Westphalia. This article is evaluating these projects assigning them to specific medical fields, funding resources, methods of data acquisition and key words.

The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures.

Background: Whether reducing time-to-surgery for elderly patients suffering from hip fracture results in better outcomes remains subject to controversial debates.

Methods: As part of a prospective observational study conducted between January 2002 and September 2003 on hip-fracture patients from 268 acute-care hospitals all over Germany, we investigated the relationship of time-to-surgery with frequency of post-operative complications and one-year mortality in elderly patients (age > or =65) with isolated proximal femoral fracture (femoral neck fracture or pertrochanteric femoral fracture). Patients with short (< or =12 h), medium (> 12 h to < or =36 h) and long (> 36 h) times-to-surgery, counting from the time of the fracture event, were compared for patient characteristics, operative procedures, post-operative complications and one-year mortality.

Guidelines or state civil codes in the management of femoral neck fracture? An analysis of the reality of care provision in North Rhine-Westphalia.

Introduction: This study analyzes healthcare management patterns in the German Federal State of North Rhine-Westphalia, with regard to time-to-surgery and operative technique in the management of femoral neck fracture.

Methods: Analysis of external quality assurance data relating to inpatient episodes of femoral neck fracture for North Rhine-Westphalia in the years 2004 and 2005. The study included data on 19 767 patients.

[Uncertainties regarding the ambulatory health care for patients suffering from osteoarthritis of the knee: a review].

Joint complaints and pain due to osteoarthritis are among the most common symptoms in the adult population. In elderly patients the osteoarthritis of the knee demands special attention since the resulting mobility impairment may exceed the impact of complaints in other joints and threaten the patients' daily living independence. The aim of this review is to provide an overview of the health care actually provided to patients with osteoarthritis of the knee.

[Osteoporosis and falls in Germany: health care for the elderly with an increased risk for fractures].

Fractures are a considerable risk, especially in older patients. The fracture of the proximal femur is of particular relevance. Functional deficiency, an increased need for care and assistance and a limitation of the quality of life after a fracture lead to an increase in morbidity and mortality among patients who lived independently prior to the event in most cases.

[Health services research and geriatrics: deficits and research approaches using the example of colorectal carcinoma and anaemia].

The number of elderly people with cancer will increase within the next decades. Cancer will surpass cardiovascular diseases as the leading cause of death. In comparison to younger patients elderly patients with cancer are less often treated within the scope of clinical trials.

[Health services research and geriatrics].

Providing health care to elderly people is a complex and challenging task. The aim of health services research is to deliver a valid data base for decisions that determine the quality of care. A combination of methods from both medical research and the social sciences is necessary to assess the actual situation and to develop ways for improving the care provided to elderly people.