Zeitschrift für Gerontologie und Geriatrie
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Clinical Trial Controlled Clinical Trial
[Basal metabolic rate and energy expenditure in the elderly].
The purpose of this study was to investigate energy requirements in healthy elderly subjects. Total daily energy expenditure (TEE) and resting metabolic rate (RMR) were measured by the doubly labeled water technique and indirect calorimetry in 36 healthy free living elderly men and women. Over a 15 day period additional measurements were made of dietary intake, physical activity and body composition. ⋯ The TEE data were compared to the food diaries. Women and men underestimated their food intake significantly. TEE varies greatly within elderly subjects due to the variation in body weight and physical activity.
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A special short-term care (KZP) in a nursing home is offered to patients who are not yet able to live independently after hospitalization. It was institutionalized in 1989. But its basic conditions changed in 1996 with the new Pflegeversicherungsgesetz (nursing insurance law): the maximal stay was limited to 4 weeks and cost were turned over to the new insurance system. ⋯ After the stay in KZP, 39.1% moved to nursing homes, 36.0% returned home. Predictors for nursing home admission are long-lasting hospitalization, predicted need of long-term care by physicians, and nervous disorders. The results show that short-term care is a useful concept in health care maintenance of patients with special diseases und complicates re-convalescence.
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Comparative Study
[Causes for in-hospital treatment of nursing home residents].
The high rates of hospitalization in nursing home residents are as well known as the hazards of in-hospital treatment especially in this group of frail older people. Moreover, hospital admissions cause considerable costs. The objective of the study was to analyze why nursing home residents are admitted for in-hospital geriatric care, and to form hypotheses of how to prevent these admissions without loss of quality of care. ⋯ Most of the leading causes of admission of nursing home residents to in-hospital geriatric care might be affected by improvements in nursing home care. Thus, data suggest that hospitalization rates might be substantially reduced by targeted prevention and therapy as well as by structural measures to improve case management in the nursing homes. Such interventions should be developed and proved in controlled studies.
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A fall in old age is known as a common consequence of frailty and decline as well as a risk factor for further falls. Studies identifying hip fracture patients who are at risk of a further fall are lacking. Therefore it was of interest to evaluate the risk factors for falling in a high-risk population, i.e., patients during rehabilitation after recent proximal femur fracture. ⋯ It was possible to compose a risk profile for future falls. Those identified as 'at risk of a further fall' should be selectively offered protective devices and special training programs in order to prevent future fractures. As for the surgical intervention, the type of surgery in relation to age and long-term outcome is of particular interest since the use of the more expensive total hip arthroplasty procedure may be more cost effective in the long term.
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Comparative Study
[Prevalence and incidence of dementia among nursing home residents and residents in homes for the aged in comparison to private homes].
Based on a representative epidemiological study on dementia, prevalence and incidence rates of institutionalized individuals aged 75 years and older in comparison to those living in private homes are presented. The study was conducted between 1997 and 1999. Core component assessing cognitive function was the SIDAM (Structured Interview for the diagnosis of Dementia of the Alzheimer type, Multi-infarct dementia and dementias of other etiology according to ICD-10 and DSM-III-R, DSM-IV). ⋯ Prevalence and incidence rates in institutions were four times higher than in private homes. A prevalence rate of dementia for institutionalized individuals 75+ according to DSM-III-R of 47.6% was found; the annual incidence rate was 17.2%. This high proportion of people with dementia in institutions requires the development of new concepts of care to meet the demands of this changing situation in residential and nursing homes.