Zeitschrift für Gerontologie und Geriatrie
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Age-related morphological changes in the cardiovascular system refer to a thickening of the arterial wall as well as a diffuse increase in the wall thickness of the myocardium. In terms of function, this leads to a decrease of the myocardial contractility in systole and to a delay of the diastolic myocardial relaxation. At the arterial wall, an impairment of wall elasticity as well as a decrease of the vasoreagibility can be observed. ⋯ In older, trained individuals a reduced stiffness of the arterial vessel walls and an improved maximum exercise-induced muscular blood supply occurs. In other training studies performed with older subjects, a positive influence of regular endurance training on the carbohydrate metabolism along with an improvement of the primarily reduced insulin sensitivity could be demonstrated. In older men and women who regularly underwent muscular strength training, a significant increase in maximum strength with a significant increase in the proportion of type II muscle fibers was found.
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Geriatric oncology concentrates on the field of cancer in the expanding aging population. Therapeutic goals are based on individual risk-assessment, comorbidities, and the specific tumor-biology. Good management of older cancer patients requires a multidimensional risk profile. ⋯ Possible conflicts between beneficence and autonomy are discussed and specific problems of the elderly patients are given. Informed consent requires competence, which might be lacking to some degree. It is the task of a responsible physician to promote autonomous decision-making as far as possible.
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Comparative Study
[Test-retest reliability of a German language multidimensional assessment instrument in elderly probands].
Most geriatric assessment instruments have been developed in the English language. Translated versions might differ in their psychometric properties. We analyzed the test-retest reliability and internal consistency of a German instrument for multidimensional geriatric assessment that was based on a newly developed English version. ⋯ Cronbach alpha (internal consistency) was good to excellent for all domains (0.76 < or = alpha < or = 0.95). The study results confirm good test-retest reliability of the German version of this multidimensional geriatric assessment instrument. Adapted versions of this instrument can be used for different purposes, e.g., preventive home visits, outpatient geriatric assessments or epidemiological studies in older persons.
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Comprehensive geriatric assessment was developed in the Anglo-American countries as a diagnostic process to better understand the effects of diseases and interactions of multiple chronic conditions. To standardize the use of assessment instruments, a working group of the two German geriatric societies has elaborated recommendations. As the first step, an expanded version of the screening according to Lachs should be used, followed by performing the Barthel-ADL, the Mini-Mental State Examination, the Geriatric Depression Scale, the 'Timed Up and Go' and the (Semi-) Tandem Stance. ⋯ No instrument satisfactorily fulfills all test criteria, which include validity, reliability, sensitivity, practicability and repeatability, and, in part, these dimensions are not investigated at all. All test instruments are diagnostic tools for functional status and capabilities but do not give information about resource needs. No instrument covers the new concept of ICIDH completely.
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Hypertension increases in prevalence with age. Population based studies suggest that more than 50% of people over the age of 65 years may have chronic hypertension. Hypertension, especially systolic hypertension, is the single most common, powerful, however, treatable risk factor for cardiovascular morbidity and mortality in the elderly. ⋯ Cardiovascular benefits of treatment with low dose diuretics or beta-blockers are cleared for elderly subjects with either diastolic or isolated systolic hypertension. Treatment with a long-acting dihydropyridine calcium channel blocker shows beneficial effects in reducing cardiovascular morbidity and mortality for elderly people with isolated systolic hypertension. Due to inconsistent findings in a subgroup meta-analysis of antihypertensive drug treatment in very old people, the efficacy of antihypertensive treatment in these subjects still remains unclear.