Der Internist
-
Review Meta Analysis
[Age and osteoporosis. Effects of aging on osteoporosis, the diagnostics and therapy].
Osteoporosis is an age-associated disease, which is influenced by genetic, epigenetic and environmental factors. ⋯ Treating osteoporosis in the elderly is strongly recommended. Multimodal management and medication according to guidelines can be very successful, given that interdisciplinary and geriatric concepts consider the specific needs of the elderly population.
-
The number of patients with dementia is increasing. There is often uncertainty about adequate treatment. ⋯ Dementia can not be cured, but current treatment can achieve relief of disease burden and improve quality of life for patients and caregivers.
-
With increasing life expectancy, the incidence rate of epilepsy in the elderly has considerably increased in recent decades. This leads to new diagnostic and therapeutic challenges. ⋯ Epilepsy in the elderly has diagnostic and therapeutic features that require careful clinical assessment and differentiated therapy.
-
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. ⋯ 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.
-
Primary motility disorders of the upper gastrointestinal (GI) tract result from an impairment of the motor function of the esophagus, stomach, and duodenum by malfunction of the enteric nervous system or degeneration of the gastrointestinal muscle layer. Other forms of upper GI motility disorders occur secondary to underlying systemic diseases. The exact pathophysiology of the disturbances within the enteric nervous system of the upper GI tract is not yet clearly understood. ⋯ The efficacy of medicinal therapy of upper GI motility disorders is low due to the lack of understanding of the pathophysiology. Therefore, endoscopic and other interventional therapies have to be applied also in the elderly patient group. The restrictions for metoclopramide published by the European Medicines Agency (EMA) in July 2013 have limited the armentarium of medicinal therapy of chronic motility disorders of the upper GI tract.