Zeitschrift für Gerontologie und Geriatrie
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Advance directives allow competent persons to extend their right of self-determination into the future, by recording choices that are intended to influence their future care should they become unable to make choices. They are considered tools to facilitate end-of-life decision making. Advance directives are a form of anticipatory decision-making. ⋯ Very few persons create an advance directive. Furthermore, of the created directives only some are accessible when patients are admitted to hospital. However, when directives are available they usually influence medical treatment decisions.
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Comparative Study
[Screening of fall risk in frail, but still independently living senior citizens].
Mobility is one of the most important factors for well-being and autonomy in old age. Impairments in mobility, falls and fear of falling are, therefore, of prognostic value. Falls generally result from an interaction of multiple risk factors. ⋯ Cohen's kappa was good (2/13 questions) to excellent (10/13 questions) with one exception (balance question kappa=0.20). The study results confirm good test-retest reliability of the fall risk screening Senior Citizen Risk of Falling Check. At the moment we are working on the validation of this questionnaire to provide it to senior citizens throughout Hamburg in cooperation with the City of Hamburg.
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Comparative Study
[Geriatrics in Bavaria-Database (GiB-DAT): Conception, structure and results of implementation (part I)].
In the year 2000, a database was implemented in Bavaria, covering the majority of geriatric clinics. Benchmarking statistics are generated in quarterly periods and scientifically analyzed. Actually, 41 of the 57 geriatric clinics in Bavaria participate in the project 'Geriatrics in Bavaria-Database' (GiB-DAT). ⋯ To make documentation more effective and easy, new software (GERIDOCTM) has been generated which is integrated in the process of daily treatment. GiB-DAT offers good data quality, especially concerning completeness of items. This manuscript describes conception and construction of GiB-DAT and identifies differences compared to the Geriatric Minimum-Dataset (GEMIDAS), a nationwide geriatric database in Germany.
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It is well known that problems with compliance rise exponentially when more that 4 drugs are prescribed. The rising use of prescription medicine forces the GP to balance the benefit of evidence group-based appropriate drug use against the problems arising when medication is given to older people and to consider different approaches when evaluating evidence of risk and benefit for the individual. Old people are facing a considerable risk of adverse drug reactions and recent initiatives, including the Continuous Medical Educational Efforts Programme, address issues of inappropriate prescribing practices. ⋯ The logistics to optimise medication including compliance, the use of modern IT and better collaboration and communication between primary and secondary care are in focus. Since medication review is recommended at every encounter, and time consuming comprehensive follow-up will be demanded, 'polypharmacy consultations' surely will be built into GP contracts in the future. The authors state that a number of pharmacological regimens for older people are outperformed by non-pharmacological treatment alternatives involving competent individualised counselling and public provision of easy (transportation) possibilities for joining centres offering staff and equipment for physical and social activity (including basal aids for hearing and sight).
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Geriatric medicine is challenged by new ethical questions with regard to demographic changes and medical progress. Aged patients deserve the full range of modern medical care, but they also have the right to die in dignity when their time has come. ⋯ Despite the geriatrician's personal responsibility for all medical measures, his decisions should be explained and accepted by the geriatric team and the patient's family. Patient's welfare clearly needs to be preferred to disease management or economic considerations.