[Reactive dynamic balance in the geriatric setting : Possibilities for evaluation and quantification in functionally heterogeneous persons]. / Reaktive dynamische Balance im geriatrischen Setting : Möglichkeiten zu Bewertung und Quantifizierung bei funktionell heterogenen Personen.

BACKGROUND: Most falls in older persons occur during walking and are often due to maladaptation in response to gait perturbations. Therefore, the assessment of reactive dynamic balance is highly relevant for determining the individual risk of falling and could enable an early initiation of interventions. OBJECTIVE: The methods available for perturbation of gait and for evaluating the corresponding reaction patterns are critically discussed in order to approach the assessment of reactive dynamic balance. MATERIAL AND METHODS: A diagnostic protocol for perturbation of gait on a treadmill was developed based on the literature. The application of the protocol to map reactive dynamic balance as comprehensively as possible is presented. RESULTS: After the initial determination of the individually preferred gait speed over ~ 6 min, the participant's gait is disrupted with 9 different types of perturbations over a time period of ~ 4:30 min. The evaluation options include spatiotemporal parameters and their variability, the margin of stability and the Lyapunov exponent. CONCLUSION: Dynamic reactive balance is a promising and specific parameter for quantifying the risk of falling in older persons. The comprehensive evaluation of the documented parameters is currently insufficient because there are no established methods or references. The development of a unified method for the sensitive determination of reactive dynamic balance is essential for its use in assessment of the risk of falling in the clinical context and for measuring the success of training.

Time-series analysis of heart rate and blood pressure in response to changes in work rate before and after 60 days of 6° head down tilt bed rest.

PURPOSE: Cardiovascular regulation during exercise, described using time series analysis, is expected to be attenuated after bed rest (BR) and this effect will be dampened by a reactive jumps countermeasure. METHODS: Twenty subjects (29 ± 6 years, 23.6 ± 1.7 kg m-2) were tested on a cycle ergometer 9 days (BDC-9) before the beginning of BR as well as 2 (R + 2) and 13 days (R + 13) after the end of BR, applying moderate pseudo-random binary (PRBS) work rate changes. Heart rate (HR) and mean arterial blood pressure (mBP) were measured beat-to-beat and interpolated to 1 s intervals. HR and mBP were cross-correlated [CCF(HR-mBP)] during the PRBS. Eleven subjects participated in a reactive jump countermeasure (JUMP) during the BR period, the other part of the group served as control group (CTRL). RESULTS: In the CTRL group, significantly lower CCF(HR-mBP) values during BDC-9 were observed compared to R + 2 during the lags 20-25 s and significantly higher values during the lags - 39 s to - 35 s. In the JUMP group, significantly lower CCFs were only observed at R + 2 compared with BDC-9 during the lags 23 s and 24 s, whereas the CCFs for BDC-9 were significantly higher at several lags compared with R + 13. CONCLUSION: Attenuations in the regulation of the cardiovascular system during cycling exercise after BR were found in the CTRL group of the RSL study. Cardiovascular regulation in the JUMP group was improved compared to values before the beginning of BR, suggesting the effectiveness of the reactive jumps countermeasure to mitigate the deleterious effects of prolonged BR.

Minimizing comprehensive geriatric assessment to identify deterioration of physical performance in a healthy community-dwelling older cohort: longitudinal data of the AEQUIPA Versa study.

BACKGROUND: It is important to identify the relevant parameters of physical performance to prevent early functional decline and to prolong independent living. The aim of this study is to describe the development of physical performance in a healthy community-dwelling older cohort aged 70+ years using comprehensive assessment over two years and to subsequently identify the most relevant predictive tests for physical decline to minimize assessment. METHODS: Physical performance was measured by comprehensive geriatric assessment. Predictors for the individual decline of physical performance by Principal Component and k-means Cluster Analysis were developed, and sensitivity and specificity determined accordingly. RESULTS: 251 subjects (Ø 75.4 years) participated in the study. Handgrip strength was low in 21.1%. The follow-up results of tests were divergent. Handgrip strength [- 16.95 (SD 11.55)] and the stair climb power test (power) [- 9.15 (SD 16.84)] yielded the highest percentage changes. Four most relevant tests (handgrip strength, stair climb power time, timed up & go and 4-m gait speed) were identified. A predictor based on baseline data was determined (sensitivity 82%, specificity 96%) to identify subjects characterized by a high degree of physical decline within two years. DISCUSSION: Although the cohort of older adults is heterogeneous, most of the individuals in the study exhibited high levels of physical performance; only a few subjects suffered a relevant decline within the 2-year follow-up. Four most relevant tests were identified to predict relevant decline of physical function. CONCLUSION: In spite of ceiling effects of the geriatric assessment in high-performers, we assume that it is possible to predict an individual's risk of physical decline within 2 years with four tests of a comprehensive geriatric assessment.

[Dementia-friendly hospital wards : Expert recommendations for planning and design]. / Demenzsensible Krankenhausstationen : Expertenempfehlungen zu Planung und Gestaltung.

BACKGROUND: Hospitals face great challenges in the necessity of providing care for the rising number of elderly patients with dementia. The adaptation of the spatial environment represents an important component to improve the care situation of patients with dementia. For more than 30 years research results from long-term care have provided evidence on the therapeutic effect of numerous architectural features on people with dementia. Due to specific medical and organizational requirements in hospitals, the transferability of these findings is, however, limited. MATERIAL AND METHODS: An interdisciplinary workshop with experts from the fields of medicine, nursing, gerontology, self-help and architecture was conducted in July 2015. Based on existing research findings and experiences from pilot projects, the spatial requirements for dementia-friendly hospital wards were collated, suggested solutions were discussed from different perspectives and finally design recommendations were derived. RESULTS: The article gives a first comprehensive overview of architectural measures that are required for the design of dementia-friendly hospital wards. The recommendations provided range from architectural criteria, such as the size and spatial structure of hospital wards, to interior design elements, including orientation and navigation aids and the use of light and colors. Furthermore, information about the planning process are given.

Development of a standard fall data format for signals from body-worn sensors : the FARSEEING consensus.

Objective measurement of real-world fall events by using body-worn sensor devices can improve the understanding of falls in older people and enable new technology to prevent, predict, and automatically recognize falls. However, these events are rare and hence challenging to capture. The FARSEEING (FAll Repository for the design of Smart and sElf-adapaive Environments prolonging INdependent livinG) consortium and associated partners strongly argue that a sufficient dataset of real-world falls can only be acquired through a collaboration of many research groups. Therefore, the major aim of the FARSEEING project is to build a meta-database of real-world falls. To establish this meta-database, standardization of data is necessary to make it possible to combine different sources for analysis and to guarantee data quality. A consensus process was started in January 2012 to propose a standard fall data format, involving 40 experts from different countries and different disciplines working in the field of fall recording and fall prevention. During a web-based Delphi process, possible variables to describe participants, falls, and fall signals were collected and rated by the experts. The summarized results were presented and finally discussed during a workshop at the 20th Conference of the International Society of Posture and Gait Research 2012, in Trondheim, Norway. The consensus includes recommendations for a fall definition, fall reporting (including fall reporting frequency, and fall reporting variables), a minimum clinical dataset, a sensor configuration, and variables to describe the signal characteristics.

[Acute illness and depression in the elderly and the influence of cognitive impairment : AIDE-cog trial]. / Komorbidität von Depression und Demenz bei geriatrischen Patienten mit akuter körperlicher Erkrankung: AIDE-cog-Studie.

Geriatric patients with acute somatic illness have a high comorbidity of depression and dementia. The following differential diagnoses have to be discerned: pseudodementia in acute depressive states, depression as a risk factor for dementia, and a depressive episode in the early stage of dementia. For both the symptoms and the trigger factors of these differential diagnoses the overlap and the particularities were qualitatively examined in the AIDE-cog (Acute Illness and Depression in Elderly cognition) trial. A second prospective randomized controlled part of the AIDE-cog trial quantitatively evaluated the influence of cognitive impairment in geriatric patients with an acute somatic illness and comorbid depression on the therapeutic effect of cognitive behavioral therapy. A preliminary analysis shows that already in early dementia the therapeutic effects are inferior. Other psychotherapeutic methods that address the remaining cognitive and emotional functions in dementia must be evaluated.

[Palliative care for patients with dementia]. / Palliativversorgung von Menschen mit Demenz.

Patients with dementia are an important target group for palliative care since particularly in advanced stages and at the end of life they often have complex health care and psychosocial needs. However, people with dementia have inappropriate access to palliative care. So far, palliative care focuses on cancer patients. Among other reasons, this is due to the different illness trajectories: while in cancer a relatively clear terminal phase is typical, in dementia functional decline is gradual without a clear terminal phase, making advanced care planning more difficult. Good communication among health care providers and with the patient and his/her family is essential to avoid unnecessary or even harmful interventions at the end of life (e.g., inserting a percutaneous endoscopic gastrostomy, PEG). To maintain the patient's autonomy and to deliver health care according to the individual preferences, it is important to appropriately inform the patient and the family at an early stage about the disease and problems that may occur. In this context, advanced directives can be helpful.

[Treatment quality in geriatric patients with diabetes mellitus in various home environments]. / Behandlungsqualität bei geriatrischen Patienten mit Diabetes mellitus in verschiedenen häuslichen Versorgungsstrukturen.

OBJECTIVE: The goal of the present study was to systematically assess treatment quality, perceptions, and cognitive function of elderly patients with diabetes admitted to an acute geriatric hospital from different home environments (nursing home residents, home care, assisted living, family caregivers, self-sufficient). METHODS: Quality of diabetes treatment, metabolic control (HbA(1c)), nutrition, treatment satisfaction, cognition, disability, and level of dependency were assessed in 128 patients with diabetes. RESULTS: Out of 128 patients, 87 patients (68%) showed an HbA1c≤8% according to the guidelines for aging people with diabetes of the German Diabetes Association (DDG). Compared to patients living independently at home, the metabolic control in nursing home residents and their treatment satisfaction were as good. They had a higher degree of dependency though (Barthel, p<0.001), more strongly impaired mobility (Tinetti, p<0.01), less diabetes knowledge (p<0.001), inferior cognitive performance (MMSE, SPMSQ, p<0.01), and a higher prevalence of depression (GDS) (p<0.01). Better cognitive function correlated with better diabetes knowledge (r=0.49; p<0.001), but not with better metabolic control. CONCLUSION: The treatment of geriatric patients with diabetes mellitus requires individual considerations and interdisciplinary care. Particularly the continuing education of geriatric nurses could contribute to improved diabetes treatment quality in nursing home residents.

Designing studies on the effectiveness of physical training in patients with cognitive impairment.

The literature provides conflicting results on the effectiveness of physical training in cognitively impaired older individuals. Cognitive impairment has been shown to be a negative predictor of rehabilitation outcome in these persons. However, the evidence on which this discussion is based is scarce. The methodology used in previous studies shows substantial shortcomings. The presented study protocol documents the methodology of one of the largest intervention studies worldwide in this research field with a standardized specific training program in cognitively impaired subjects including short- and long-term follow-up examinations. The selected sensitive evaluation tools for motor, cognitive and emotional status have all been validated for use in older persons. Most of these tests have been validated in cognitively impaired persons. In contrast to most previously published RCTs only study participants within a comparable level of cognitive impairment will be included in the study. The primary aim of the study is to evaluate a specific training program to improve motor performance (strength and functional performance) in persons with cognitive impairment. Secondary study endpoints include the reduction of falls, improvement of cognitive as well as psychological status and the documentation of physical activity. The training program is based on previous successful intervention studies of the research group, was complemented and modified with respect to specific deficits of cognitively impaired persons and focuses on motor improvements. The article gives a rationale for interventions using physical training and study methodology in persons with dementia.