Subject(s)
Delirium/prevention & control , Dementia/therapy , Diabetes Mellitus/therapy , Epilepsy/drug therapy , Geriatric Assessment , Osteoporosis/prevention & control , Aged , Aged, 80 and over , Chronic Disease , Dementia/diagnosis , Diabetes Mellitus/diagnosis , Epilepsy/diagnosis , Exercise Therapy , Female , Humans , Osteoporosis/diagnosisABSTRACT
BACKGROUND: Type 2 diabetes is a disease which occurs more frequently with increasing age and is particularly influenced by the lifestyle of those affected in addition to a genetic disposition and age-related alterations. AIM: The purpose of this article is to discuss the evidence for special characteristics of the therapy of type 2 diabetes in elderly patients. MATERIAL AND METHODS: The study is based on a literature survey and the guidelines of the"Deutsche Diabetes-Gesellschaft" (DDG, German Diabetes Society). RESULTS: There is increasingly more awareness of diabetes in advanced age not least due to the expected demographic changes. The therapeutic options in older patients with diabetes must be assessed depending on the achievable targets of therapy and comorbidities, in particular limited renal function.
Subject(s)
Diabetes Mellitus, Type 2/therapy , Diabetic Nephropathies/prevention & control , Diet Therapy/standards , Exercise Therapy/standards , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Practice Guidelines as Topic , Aged , Aged, 80 and over , Diabetes Mellitus, Type 2/diagnosis , Diabetic Nephropathies/diagnosis , Female , Geriatric Assessment , Germany , Humans , Treatment OutcomeSubject(s)
Accidental Falls/statistics & numerical data , Cardiovascular Diseases/epidemiology , Geriatric Assessment/statistics & numerical data , Hyponatremia/epidemiology , Accidental Falls/mortality , Aged , Aged, 80 and over , Comorbidity , Female , Humans , Hyponatremia/diagnosis , Hyponatremia/therapy , Male , Prevalence , Risk Factors , Survival RateABSTRACT
Contrasting the relatively abrupt hormonal changes during female menopause, male reproductive function gradually declines during aging. This leads to the formal diagnosis of androgen deficiency in many apparently healthy 80-year-old men, when conventional thresholds are applied, and consequently to the question of androgen substitution in geriatric medicine. Although many clinical studies have documented a correlation between low plasma testosterone levels and mortality a clear causal relationship - which would imply immanent substitution therapy - has not been demonstrated. With this in mind, the diagnosis of late-onset hypogonadism (LOH) should only be made when testosterone-deficiency related symptoms concur with low testosterone levels. Which exact symptoms justify the diagnosis of LOH, however, is not sharply defined. Using criteria defined in the recent EMAS study, LOH might even be an over-diagnosed entity without huge relevance in geriatrics. Low testosterone levels are associated with frailty, but testosterone supplementation has only shown limited effects on age-related sarcopenia. Moreover: the increased incidence of cardiovascular events in the TOM study should be a caveat and lead to a moratorium for uncritical testosterone supplementation in aging men with cardiovascular diseases.
