Thermoregulatory disorders and their significance in the elderly.

Our treatise is aimed at providing a brief survey on ethiology, pathogenesis, risks of inception, clinical picture, treatment pitfalls and prognosis of hypothermia and hyperthermia and possible interactions of these thermoregulation disorders with some other co-morbidities. It deals also with drugs and medicines including their potential unwanted side effects in these thermally abnormal conditions. The problems of hypothermia and hyperthermia in the senium (especially the late one) will be closely connected with labile homeostasis and the occurence of frailty syndrome which increases with the age. Permanently growing number of patients with polymorbidity of higher age tending to suffer from thermoregulation disorders and relatively small awareness of this issue in wider specialist (including medical) community have led us to come out with this topic in the form of survey treatise. Key words: drugs - hyperthermia - hypothermia - interactions - polymorbidity - senium - thermoregulation disorders.

[Polypharmacy viewed not only through the prism of multi-morbidity, but also as an independent geriatric syndrome]. / Polyfarmakoterapie nahlízená nejen prizmatem multimorbidity, ale jako dalsí geriatrický syndrom.

Polypharmacy is common in the elderly, especially in the late age (over 75 years). Usually it is closely related to the geriatric multi-morbidity. The authors highlight the medication used in the anticipated positive and potential negative potential. While physicians often must make difficult trade-offs between the guidelines on one hand and complicated multi-morbidity, on the other hand, while trying to avoid polypharmacy ( 5 drugs), especially excessive polypharmacy ( 10 drugs). Multimorbid elderly patients who are treated in accordance with guidelines typically use large amounts of medicaments. This polypharmacy increases the risk of adverse drug reactions and drug interactions. The authors point out the pitfalls of performance of large clinical studies and EBM on one side and the daily clinical practice at the risk of their indiscriminate application, albeit with good intentions to improve the health of seniors.Key words: evidence based medicine - geriatrisation of medicine - multi-morbidity - old age - polypharmacy - prescription - randomized clinical trials.

Can we improve the therapy of Clostridium difficile infection in elderly patients?

BACKGROUND: Clostridium difficile infection (CDI) is becoming a serious problem predominantly in geriatric patients, who are a significant risk group. The goal of this study was to evaluate the risk factors for mortality in CDI patients and to construct a binary logistic regression model that describes the probability of mortality in geriatric patients suffering from CDI. METHODS: In this retrospective study, we evaluated a group of 235 patients over 65 years of age with confirmed diagnoses of CDI, hospitalized at the Department of Internal Medicine, Geriatrics and General Practice, Brno, from January 2008 to December 2013. The examined group comprised 148 women (63 %) and 87 men (37 %). For the diagnosis of CDI, confirmation of A and B toxins in the patients' stool or an autopsy confirmation was crucial. RESULTS: The impact of antibiotic therapy on the increased incidence of CDI was clearly confirmed in our study group when examining patients' histories. Other risk factors included cerebrovascular disease, dementia, the presence of pressure ulcers, and immobility. Our new model consisted of a combination of the following parameters: the number of antibiotics used (from patients' history), nutritional status (Mini Nutritional Assessment short-form test), presence of pressure ulcers, and occurrence of fever. CONCLUSION: Our logistic regression model may predict mortality in geriatric patients suffering from CDI. This could help improve the therapeutic process.

[Geriatric multimorbidity--one of the key problem of contemporary medicine]. / Geriatrická multimorbidita--jeden z klícových problému soucasné medicíny.

In the elderly population there are common permanent decrease of functional capacity, gradual emergence of various diseases leading to the wider multimorbidity and increased problems in the social sphere, which can develop frailty and social dependency. The paper analyzes the complex issue of geriatric multimorbidity and emphasizes its pitfalls, the need of an interdisciplinary approach and thinking of doctors, including the risks of modern pharmacotherapy. The aim of geriatric medicine is to optimize residual functions despite the decline in total functional capacity with increasing multimorbidity. The authors want to direct the attention of the professional community to the permanently growing numbers of the elderly and to emphasize the need of awareness of the problem so that they could understand and cope with this absolutely new reality.