Elisabeth Steinhagen-Thiessen

The Berlin Aging Study (BASE): Overview and Design

This article, the introduction to a collection of six related articles, describes the general rationale and design of the Berlin Aging Study (BASE). The distinguishing features of BASE are: (1) a special focus on the very old (70–105 years), (2) broad inter-diciplinarity (medicine, psychiatry, psychology, sociology and economics), and (3) sample heterogeneity achieved by local (West Berlin) representativeness. In addition to discipline-specific topics, four theoretical orientations guide the study: (1) differential ageing, (2) continuity versus discontinuity of ageing, (3) range and limits of plasticity and reserve capacity, and (4) ageing as an inter-disciplinary and systemic phenomenon. To provide a foundation and framework for the remaining articles, this paper outlines the protocols, designs, and measurement procedures of fourteen data collection sessions. In addition, information is given on the samples used for empirical analysis. Two samples from the first wave of the Berlin Aging Study are addressed in this collection of articles. The first (N = 360), uses data from the BASE Intake Assessment Protocol (Session 1). The second (N = 156), employs data from the entire 14-session full protocol of BASE. Selectivity analyses involving 22 comparison variables are reported in this paper and demonstrate that, with the exception of 12-month mortality, these two samples displayed the intended sample heterogeneity. Those results suggest that data from BASE hold high generalizability.

Carotid atherosclerosis, vascular risk profile and mortality in a population-based sample of functionally healthy elderly subjects: the Berlin ageing study.

Abstract. Hillen T, Nieczaj R, Münzberg H, Schaub R, Borchelt M, Steinhagen‐Thiessen E (Humboldt‐University Berlin, Berlin; Department of Public Health Medicine/King’s College London, London; and Klinikum der Hansestadt Stralsund, Stralsund, Germany). Carotid atherosclerosis, vascular risk profile and mortality in a population‐based sample of functionally healthy elderly subjects: the Berlin Ageing Study. J Intern Med 2000; 247: 679–688.

In an epidemiological sample the apolipoprotein E4 allele is associated to dementia and loss of memory function only in the very old

The apolipoprotein E4 allele has been reported to be associated with late onset Alzheimers disease. Here we report the relation of several neuropsychological test parameters and the diagnosis of dementia to the apolipoprotein E polymorphism in an epidemiological sample of 477 subjects aged 70-103 years. The apolipoprotein E4 allele was found to be associated with reduced performance in several sensitive neuropsychological memory tests and with diagnosis of dementia only in the oldest subjects (> 84 years). The association with dementia in this population based sample was much weaker than previously described and became only significant in a logistic regression analysis when age was included in the model.

Health differences in advanced old age

The first part of this paper provides a general outline of objectives and methods of the Internal Medicine and Geriatrics Unit of the Berlin Aging Study (BASE). Based on a multi-dimensional conceptualization of health, objective and laboratory data collected about different organ systems, e.g. cardiovascular and musculoskeletal, and functional capacity are complemented by qualitative clinical diagnoses and judgements as well as self-reported health problems and functional limitations. Some of the central questions that can be addressed using these data relate to understanding the nature and processes of differential ageing. The second part of the paper includes initial analyses of inter-individual health differences in advanced old age (70 to 105 years). Initial findings indicated that heterogeneity in somatic morbidity and functional capacity was at least as large in old adults (70 to 84 years) as in very old adults (85 to 105 years), even though higher rates of somatic morbidity and lower levels of functional capacity were observed in the very old. Chronological age and morbidity as well as psychosocial and demographic factors were found to be independent predictors of functional capacity in advanced old age. Additionally, the relative importance of psychosocial factors was found to be a function of age with lower predictive ability among the very old. In conclusion, these initial findings support the hypothesis of significant health differences in advanced old age due to differential ageing.

Combined whole body vibration and balance training using Vibrosphere®: improvement of trunk stability, muscle tone, and postural control in stroke patients during early geriatric rehabilitation.

Strokes are a leading cause of disability, immobility, and reduced ability to perform activities of daily living (ADLs) among the elderly. Balance and postural control are often affected in stroke patients. Physical therapy for the lower back to improve posture, mobility, and ADLs can be very time consuming. In this randomized, controlled study of 66xa0geriatric patients (mean age 74.5xa0years) with stroke-related paresis or hemiplegia, it was demonstrated that stroke patients may benefit more from 3xa0additional weeks of combined whole body vibration and balance training than from a comprehensive inpatient geriatric rehabilitation program in terms of trunk stability, postural control, and muscle tone.ZusammenfassungSchlaganfälle sind in besonderem Maße für Funktionseinschränkungen sowie Einschränkungen in den Aktivitäten des täglichen Lebens älterer Menschen bis hin zur Immobilität verantwortlich. Häufig zeigt sich ein Verlust der Balancefähigkeit und posturalen Kontrolle. Die Behandlung des unteren Rumpfs als stabilisierende Basis für die aufrechte Haltung, die Mobilität und die Ausführung jeglicher Aktivität bedeutet im therapeutischen Setting der Ergo- und Physiotherapie einen hohen Zeitaufwand. Die hier vorgestellte randomisierte, kontrollierte Studie an 66 Schlaganfallpatienten (mittleres Alter 74,5xa0Jahre) zeigt, dass durch ein zusätzliches kombiniertes Vibrations- und Balancetraining über einen Zeitraum von 3xa0Wochen im Vergleich zum üblichen geriatrischen Behandlungsstandard auf neurophysiologischer Basis effizienter und schneller eine Verbesserung der Stabilität, Haltungskontrolle und des Tonus im unteren Rumpf sowie der posturalen Kontrolle und Funktion erreicht werden kann.

Telematik in der Geriatrie – Potentiale, Probleme und Anwendungserfahrungen

Zusammenfassung Die Darstellung der modernen Kommunikations- und Informationstechnologie in den Medien verspricht auch älteren Menschen eine Chance zur Verbesserung der Lebensqualität. Mit „Neuen Medien” wie Bildtelefon oder PC, dem Internet und der elektronischen Post können geriatrische Patienten mit Beratungseinrichtungen, Ärzten, Therapeuten oder Pflegekräften, aber auch ihren eigenen Angehörigen oder Selbsthilfeeinrichtungen so vernetzt werden, dass sie bildgestützt kommunizieren und Informationen elektronisch erhalten oder übermitteln können. In der vorliegenden Arbeit wird untersucht, ob Versorgungsstrukturen in der Altersmedizin und Altenhilfe durch moderne Informations- und Kommunikationstechnologie („Telematik”) sinnvoll ergänzt oder sogar substituiert werden können. Trotz einer Vielzahl von Untersuchungen zur Telemedizin und zu Telematikanwendungen existieren nur wenige Studien, die eine Eignung für geriatrisch-rehabilitative Belange belegen. Eigene Anwendungserfahrungen aus einem geriatrischen Telematik-Projekt („TeleReha”) am Evangelischen Geriatriezentrum Berlin, in dem geriatrische Patienten und deren Angehörige mit professionellen Kräften aus dem Geriatriezentrum unter der Maßgabe des Erhalts eines Rehabilitationserfolges vernetzt wurden, zeigen aber, dass Telematik-gestützte Dienste von geriatrischen Patienten und deren Angehörigen als eine wertvolle zusätzliche Ressource angesehen werden, wenn sie mit einem qualifizierten Dienstleistungskonzept einhergehen. Abschließend werden die Potentiale, aber auch die Probleme von Telematikanwendungen in der Geriatrie diskutiert. Obwohl sich ein Bedarf beim geriatrischen Klientel identifizieren lässt, fehlt es in der Geriatrie noch an Initiativen, die notwendigen Konzepte und tragfähige Strukturen zu entwickeln. Das beachtliche Potential der telematischen Anwendungen für Geriatrie und Altenhilfe wird noch zu wenig beachtet. Gerade die Geriatrie kann und muss hier ihre spezifische Expertise einbringen, über die andere Disziplinen nicht gleichermaßen verfügen.Summary Modern telecommunication technology (telematics) has the potential to improve the quality of life for elders with physical and mental impairments as well as for their care giving relatives. Videophones, internet resources, and multimedia computers can be used for networking them together with social workers, nurse practitioners, physicians and therapeutic staff in service-centers. This can be viewed as a unique opportunity to establish and maintain instant and personalized access to various medical services in a situation where increasing needs are opposed to decreasing resources. However, it is not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Some studies already showed its applicability and feasibility, but there are still no larger trials showing that maintenance or enhancement of autonomy can be achieved effectively by using new technologies. u2009u2009u2002This article reviews the literature on telematics in geriatrics and presents data of a tele-rehabilitation project (“TeleReha”, conducted at the Berlin Geriatric Center) which comprised mobility-impaired patients (N=13, mean age 72 yrs), care giving relatives (N=8), and geriatric professionals. Networking was established using ISDN technology with videophones or PC-based videoconferencing systems. Results showed that participants regard telecommunication devices as a valuable resource for their informational and communicational needs. Use of telecommunication systems was inversely related to physical mobility. Having access to professional service and counselling was rated highly important but also the opportunity to establish reliable contacts with non-professionals (relatives, other participants). Despite experienced technical problems, use of telecommunication systems was evaluated more positively in the post-test as compared to the pre-test. u2009u2009u2002In summary, current experience suggests that telematics can be used efficiently by geriatric patients and by relatives and professionals caring for them. However, evidence for a medically and economically effective use is still scarce. A lack of structural and organizational concepts for geriatric telematics initiatives can be identified which in part may be due to the fact that the considerable potentials of telematics applications are still largely unrecognized by geriatricians.

Autosomal recessive hypercholesterolemia in three sisters with phenotypic homozygous familial hypercholesterolemia: diagnostic and therapeutic procedures.

Abstract:u2002 Familial hypercholesterolemia is an autosomal‐dominant inherited disorder caused by mutations in the low‐density lipoprotein (LDL) receptor gene. The homozygous form is characterized by high‐serum LDL cholesterol concentrations, xanthoma formation and premature atherosclerosis. Recently, another molecular defect that also results in severely elevated LDL cholesterol levels was identified: autosomal recessive hypercholesterolemia. This inherited disorder is caused by a mutation in a putative LDL receptor adaptor protein. In our lipid clinic, three sisters with phenotypic homozygous hypercholesterolemia were recently diagnosed as having autosomal recessive hypercholesterolemia. They presented in 1990 with massive tuberous xanthomas at the knees, thighs, elbows and buttocks. LDL receptor and apolipoprotein B gene defects were excluded through mutation analysis. From 1992 onward they underwent LDL‐apheresis on a weekly basis. To date the clinical outcome is very satisfying with no evidence of coronary heart disease or aortic valve lesionsu200a andu200a almostu200a completeu200a regressionu200a ofu200a xanthomatosis.

Polypharmacy and drug prescription in the elderly. Strategies for optimization

ZusammenfassungHintergrundBei adäquater Anwendung stellen Arzneimittel eine effektive und effiziente Intervention in der Versorgung von Patienten dar. Gerade bei älteren, multimorbiden Patienten kann es aber durch die gleichzeitige Einnahme vieler Arzneimittel, die sog. Polypharmazie, zu Risiken in der Verträglichkeit kommen. Zudem treten bei älteren Menschen infolge von altersspezifischen Veränderungen sowie Adhärenzproblemen häufiger unerwünschte Arzneimittelwirkungen auf als bei jüngeren. Daher sollte gerade bei älteren Menschen die Indikation für eine Medikation individuell und sorgfältig nach einer realistischen Nutzen-Risiko-Abwägung sowie unter Berücksichtigung von Lebensqualität und Lebenserwartung gestellt werden.Material und MethodenIn diesem Beitrag werden einleitend die aktuelle medikamentöse Versorgungssituation von älteren Menschen dargestellt sowie Probleme identifiziert und analysiert.ErgebnisseGestützt auf eine selektive Literaturrecherche werden Empfehlungen zur Erhöhung der Arzneimitteltherapiesicherheit zusammenfassend dargestellt.AbstractBackgroundWhen used appropriately, drugs are an effective and efficient intervention in the care of patients. However, elderly, multimorbid patients are especially prone to adverse side effects caused by the simultaneous intake of many drugs—this effect is called polypharmacy. Furthermore, adverse medical effects occur more frequently with elderly people compared to younger patients. This is due to age-specific metabolic changes and issues with compliance and adherence. Therefore, the indication for medication should be taken carefully and individually especially for elderly patients, in order to develop a realistic risk–benefit ratio, taking into consideration questions like quality of life and life expectancy.Materials and methodsIn this paper, the current medical care situation of elderly people is presented; problems are identified and analyzed.ResultsSupported by a selected literature search, recommendations for improving medication safety are summarized.BACKGROUNDnWhen used appropriately, drugs are an effective and efficient intervention in the care of patients. However, elderly, multimorbid patients are especially prone to adverse side effects caused by the simultaneous intake of many drugs--this effect is called polypharmacy. Furthermore, adverse medical effects occur more frequently with elderly people compared to younger patients. This is due to age-specific metabolic changes and issues with compliance and adherence. Therefore, the indication for medication should be taken carefully and individually especially for elderly patients, in order to develop a realistic risk-benefit ratio, taking into consideration questions like quality of life and life expectancy.nnnMATERIALS AND METHODSnIn this paper, the current medical care situation of elderly people is presented; problems are identified and analyzed.nnnRESULTSnSupported by a selected literature search, recommendations for improving medication safety are summarized.

Prevalence of skin diseases in hospitalized geriatric patients : Association with gender, duration of hospitalization and geriatric assessment.

BackgroundImprovement of quality of life in old age and prevention of age-associated diseases have become the main focus of research into aging; however, information regarding the skin health status of geriatric patients still remains sparse.GoalTo investigate the extent of dermatological diseases in hospitalized geriatric patients, map the most prevalent ones, check for any gender differences and document any correlations with duration of hospitalization and results of geriatric assessments.Patients and methodsA total of 110 hospitalized geriatric patients underwent a complete dermatological examination at the Evangelical Geriatric Hospital (Evangelisches Geriatriezentrum) Berlin. The collected information was stratified according to dermatological diagnosis, results of geriatric assessments, duration of hospitalization, age and gender of the patients.ResultsThe average number of diagnosed skin diseases per patient was 3.7xa0± 1.8 for the female population and 4.3xa0± 2.0 for the male population. After categorizing all diagnosed skin diseases, infectious diseases were found to be most common in both female and male patients (55u2009% and 58u2009%, respectively) followed by vascular diseases (46.7u2009% and 54u2009%, respectively). Precancerous skin lesions and epithelial skin cancer were more frequent in men than in women (20u2009% vs. 6.7u2009%, pxa0< 0.037 and 34u2009% vs. 13.3u2009%, pxa0< 0.010, respectively). Pruritus showed a positive correlation with the duration of hospitalization and a negative correlation with the Barthel index and Tinetti score on the day of discharge, indicating that pruritus may have a significant impact on the physical condition of elderly multimorbid patients and on the static and dynamic balance abilities.ConclusionOur results demonstrate that skin health in the elderly is compromised and disregarded and this should constitute one of the top priorities of healthcare specialists and physicians in the future.ZusammenfassungHintergrundDie Verbesserung der Lebensqualität im hohen Alter und die Prävention altersbedingter Krankheiten haben in den letzten Jahren an Bedeutung gewonnen. Trotzdem liegen bisher wenige Daten zu dermatologischen Erkrankungen bei geriatrischen Patienten vor.ZielDas Ziel unserer Studie lag darin die Prävalenz von altersassoziierten Hauterkrankungen bei hospitalisierten geriatrischen Patienten zu dokumentieren und jegliche Korrelationen mit der Verweildauer sowie mit Ergebnissen von geriatrischen Assessments zu analysieren.MethodikInsgesamt 110 hospitalisierte geriatrische Patienten unterzogen sich einer klinisch-dermatologischen Untersuchung im Evangelischen Geriatriezentrum Berlin. Die gewonnenen Informationen wurden anhand von dermatologischen Diagnosen, Ergebnissen der geriatrischen Assessments, Verweildauer, Alter und Geschlecht des Patienten dokumentiert.ErgebnisseDie Anzahl der diagnostizierten Hauterkrankungen pro Patienten betrug für die weibliche Population 3,7xa0± 1,8 und für die männliche 4,3xa0± 2,0. Von allen diagnostizierten Hauterkrankungen zeigten die Infektionskrankheiten sowohl bei Frauen als auch bei Männern die höchste Prävalenz (55xa0vs. 58u2009%), gefolgt von Gefäßerkrankungen (46,7xa0vs. 54u2009%). Präkanzerosen und epithelialer Hautkrebs traten häufiger bei Männern als bei Frauen auf (20xa0vs. 6,7u2009%, pxa0< 0,037 und 34xa0vs. 13,3u2009%, pxa0< 0,010). Pruritus korrelierte positiv mit der Dauer des Krankenhausaufenthalts und negativ mit dem Barthel-Index und Tinetti-Score. Dies könnte darauf hinweisen, dass Pruritus erhebliche Auswirkungen auf die alltäglichen Fähigkeiten sowie die Mobilität von geriatrischen Patienten haben kann.SchlussfolgerungUnsere Ergebnisse demonstrieren, dass der Gesundheitszustand der Haut bei älteren Menschen trotz vielfältiger Beeinträchtigungen ungenügend beachtet wird. Der Beurteilung und Beobachtung des Hautzustands sollte daher insbesondere bei Männern mehr Priorität eingeräumt werden.

Ambulante geriatrische Rehabilitation – Standortbestimmung und Perspektiven

Zusammenfassung Die klinische Geriatrie in Deutschland hat sich in den letzten 10 Jahren deutlich weiterentwickelt, insbesondere im voll- und teilstationären Bereich. Dennoch sind die Pläne, die ebenfalls kurz nach 1990 entstanden und eine Verbesserung der geriatrischen Versorgung im ambulanten Bereich zum Ziel hatten, im selben Zeitraum nicht über das Planungsstadium hinaus gekommen. Im Zusammenhang mit der jetzt anstehenden Einführung eines neuen Entgeltsystems im Krankenhausbereich, das aller Voraussicht nach zu einer Verkürzung der Verweildauer führen wird, wird aber gerade im ambulanten Bereich der Bedarf an zusätzlichen spezifischen Behandlungsmöglichkeiten steigen. Der Artikel zeigt deshalb noch einmal die enge Verzahnung der geriatrischen Versorgungskette auf und diskutiert die Notwendigkeit und die Möglichkeiten der Einbindung und Ausgestaltung einer ambulanten geriatrischen Rehabilitation (AGR), wobei insbesondere auf explizite Unterscheidungsmerkmale zum stationären Bereich, auf Indikationskriterien, Ziele und mögliche Organisationsformen der AGR abgehoben wird.Summary Clinical geriatrics in Germany has evolved remarkably since 1990, when first concepts had been developed for establishing structures and facilities for the ambulatory rehabilitation of geriatric patients. However, achievements during the last 10 years were made only for inpatient geriatrics and geriatric day clinics. Geriatric outpatient rehabilitation (GOR) is still a “missing link” in the networked care for elderly patients in Germany and remains until today in a planning phase. The article is aimed at describing the current organisational status of geriatric rehabilitation in Germany and focuses on the question of where and how to fit in geriatric outpatient rehabilitation. Distinction criteria between the different types of geriatric rehabilitation as well as indications, goals, and organisational aspects of GOR are discussed.