Ludger Pientka

High Fruit and Vegetable Intake is Positively Correlated with Antioxidant Status and Cognitive Performance in Healthy Subjects

A higher daily intake of fruits and vegetables in healthy elderly is associated with an improved antioxidant status in comparison to subjects consuming diets poor in fruits and vegetables, but the impact on cognitive performance is unclear. Healthy community dwellers (45 to 102 years old, n=193) underwent cognitive testing and blood withdrawal for the measurement of antioxidant micronutrients and biomarkers of oxidative stress as well as administration of a food frequency questionnaire to assess the daily intake of fruits and vegetables (high intake HI, low intake LI). Ninety-four subjects of the HI group had significantly higher cognitive test scores, higher levels of carotenoids, alpha- and gamma-tocopherol as well as lower levels of F2 alpha isoprostanes than the 99 subjects of the LI group. Cognitive scores were directly correlated with blood levels of alpha-tocopherol and lycopene and negatively correlated with F2 alpha isoprostanes and protein carbonyls. The results were independent of age, gender, body mass index, education, total cholesterol, LDL- and HDL-cholesterol, triglycerides, and albumin. Healthy subjects of any age with a high daily intake of fruits and vegetables have higher antioxidant levels, lower levels of biomarkers of oxidative stress, and better cognitive performance than healthy subjects of any age consuming low amounts of fruits and vegetables. Modification of nutritional habits aimed at increasing intake of fruits and vegetables should be encouraged to lower prevalence of cognitive impairment in later life.

Male lower urinary tract symptoms and related health care seeking in Germany

Objectives: To investigate the prevalence of lower urinary tract symptoms (LUTS) and LUTS– related health care issues in the male population between the ages of 50 and 80 in Germany. Methods: 8,973 randomly chosen men in the age group of interest received by mail a self–administered questionnaire addressing voiding symptoms and bother, common health status, and social demographic as well as health care resources related issues. Results: Of 6,031 (67.2%) returned questionnaires, 5,404 (60.2%) were properly filled out and entered into the database. Of these, 5,004 (56%) completed all IPSS questions. 3,539 (70.7%) of the men presented with no or mild LUTS (IPSS 0–7), 1,465 (29,3%) with moderate to severe voiding symptoms (IPSS >7), respectively. From logistic regression analysis it appears that mainly bother from voiding symptoms as well as incomplete emptying and week stream induced a visit to the doctor. Of men with moderate symptoms (IPSS 8–19), 40% did not report any bother. Conclusion: LUTS is a common condition among German elderly males. In general, bother from LUTS seem to have more effects on health care seeking behavior than symptoms themselves or physical health status. Bother scores may discriminate between those individuals with moderate symptoms (IPSS 8–19), who may be followed through watchful waiting instead of active therapy.

Tolerance to Chemotherapy in Elderly Patients With Cancer

BACKGROUND Due to demographic changes, the number of elderly people with cancer will increase in the next decades. In the past, elderly patients with cancer were often excluded from clinical trials. Chronological age has been considered a risk factor for increased toxicity and reduced tolerance to chemotherapy. METHODS We present a review on toxicity of chemotherapy and factors associated with toxicity in elderly patients with cancer, and we discuss chemotherapeutic agents and treatment options in treating this patient population. RESULTS Age is a risk factor for increased toxicity to chemotherapy and decreased tolerance. However, few trials have been reported with adjustment for age-associated changes such as impairment of functional status and increased comorbidity, which also show an independent association with increased toxicity. Published data may include several biases, such as referral and publication bias. CONCLUSIONS Decision making in elderly cancer patients should be based on the results of a geriatric assessment. Patients with few or no limitations should be treated as younger patients are treated. Data with a high level of evidence are unavailable for patients showing moderate or severe limitations in a geriatric assessment.

Management of the BPH Syndrome in Germany: Who Is Treated and How?

Objectives: To review the available data on contemporary management of symptomatic benign prostatic hyperplasia (BPH) within the German healthcare system. Methods: Information was obtained from articles published in scientific journals retrieved through searches in Medline and Embase. In addition, preliminary data from the first representative German survey on lower urinary tract symptoms (LUTS) were obtained (‘Herner LUTS-Study’, a community-based survey in Herne, a city within the industrial complex called the Ruhr Area). Finally, the recently established German guidelines for the diagnosis and treatment of the BPH-Syndrom (BPS) were reviewed. Results: Only few studies are published in the literature analysing the current concepts of management of BPH in Germany. These studies show that there is variation in the concepts of conservatory and surgical management of BPH. The German BPH guidelines suggest watchful waiting for patients with mild LUTS (total I-PSS ≤7) and medical therapy or surgery for those with moderate to severe LUTS (I-PSS >7). There was no final consensus on the role of phytotherapy in the German treatment guidelines, due to the lack of clinical data. α1-Blockers and finasteride (for prostates >40 ml) are recommended medical treatment approaches. Transurethral resection of the prostate (TUR-P) is considered to be the standard surgical procedure. Preliminary data from the Herner LUTS-Study show, that approximately 30% of men aged 50–80 years have moderate to severe LUTS (i.e. total I-PSS score >7). About a third of these men currently seek healthcare. Conclusions: LUTS and BPS are a highly prevalent condition in Germany. With the estimate that the number of men over the age of 65 will almost double in Germany within the next 30 years, it will be a challenge in the next millennium to find the healthcare resources for the management of BPS.

Patients with femoral or distal forearm fracture in Germany: a prospective observational study on health care situation and outcome

BackgroundDistal radius and proximal femoral fractures are typical injuries in later life, predominantly due to simple falls, but modulated by other relevant factors such as osteoporosis. Fracture incidence rates rise with age. Because of the growing proportion of elderly people in Western industrialized societies, the number of these fractures can be expected to increase further in the coming years, and with it the burden on healthcare resources. Our study therefore assessed the effects of these injuries on the health status of older people over time. The purpose of this paper is to describe the study method, clinical parameters of fracture patients during hospitalization, mortality up to one and a half years after discharge in relation to various factors such as type of fracture, and to describe changes in mobility and living situation.MethodsData were collected from all consecutive patients (no age limit) admitted to 423 hospitals throughout Germany with distal radius or femoral fractures (57% acute-care, femoral and forearm fractures; 43% rehabilitation, femoral fractures only) between January 2002 and September 2003. Polytrauma and coma patients were excluded. Demographic characteristics, exact fracture location, mobility and living situation, clinical and laboratory parameters were examined. Current health status was assessed in telephone interviews conducted on average 6–7 months after discharge. Where telephone contact could not be established, at least survival status (living/deceased/date of death) was determined.ResultsThe study population consisted of 12,520 femoral fracture patients (86.8% hip fractures), average age 77.5 years, 76.5% female, and 2,031 forearm fracture patients, average age 67.6 years, 81.6% female. Womens average age was 6.6 (femoral fracture) to 10 years (forearm fracture) older than mens (p < 0.0001). Only 4.6% of femoral fracture patients experienced changes in their living situation post-discharge (53% because of the fracture event), although less than half of subjects who were able to walk without assistive devices prior to the fracture event (76.7%) could still do so at time of interview (34.9%). At time of interview, 1.5% of subjects were bed-ridden (0.2% before fracture). Forearm fracture patients reported no change in living situation at all. Of the femoral fracture patients 119 (0.95%), and of the forearm fracture patients 3 (0.15%) died during hospital stay. Post-discharge (follow-up one and a half years) 1,463 femoral fracture patients died (19.2% acute-care patients, 8.5% rehabilitation patients), but only 60 forearm fracture patients (3.0%). Ninety percent of femoral fracture deaths happened within the first year, approximately 66% within the first 6 months. More acute-care patients with a pertrochanteric fracture died within one year post-discharge (20.6%) than patients with a cervical fracture (16.1%).ConclusionMortality after proximal femoral fracture is still alarmingly high and highest after pertrochanteric fracture. Although at time of interview more than half of femoral fracture patients reported reduced mobility, most patients (96%) attempt to live at home. Since forearm fracture patients were on average 10 years younger than femoral fracture patients, forearm fractures may be a means of diagnosing an increased risk of later hip fractures.

A review of the major vascular risk factors related to Alzheimer's disease.

The present review is dedicated to the epidemiology of vascular risk factors proven to play a role in facilitating onset and progression of cognitive impairment. These include hypertension, hypercholesterolemia, diabetes, obesity, atherosclerosis, and cardiac diseases. The targeted, chance-free identification and management of traditional vascular risk factors in midlife is a general public health strategy against the onset of mild to severe cognitive impairment in advanced age. This preventive action must be routinely carried out with outmost awareness by physicians in order to be effective. In advanced age, the individually shaped assessment and management of vascular risk factors assumes particular importance as some of them show a strong age-dependent pattern. The relative strategies with this purpose cannot be separated from a thorough lifestyle anamnesis including nutrition, physical exercise, and cognitive and social activities.

Depression and functional impairment independently contribute to decreased quality of life in cancer patients prior to chemotherapy

Background. An inverse association either between depression or impaired functional status and quality of life (QoL) has been reported for cancer patients, but the independent effect of depression or depressive symptoms and of functional impairment on QoL is unclear. Patients and methods. We investigated the prevalence of depression or depressive symptoms with the Beck Depression Inventory (BDI), the functional impairment with the ECOG-Performance-Status (ECOG-PS) and the QoL with the EORTC-QLQ-C30 questionnaire in a sample of 175 hospitalised cancer patients prior to the start of chemotherapy. Results. Sixteen of 175 patients (9.1%) screened positive for major depression, 29 (16.6%) had mild to moderate depressive symptoms. In 11 of 15 scales of the EORTC-QLQ-C30 questionnaire depression or depressive symptoms were significantly associated with worse QoL in univariate analysis and in 12 of 15 scales poor ECOG-PS was significantly associated with worse QoL. In multivariate analysis including ECOG-PS and BDI, the effect of depression and/or depressive symptoms on QoL was persistent in seven scales: global QoL, physical- and role functioning, fatigue, nausea & vomiting, pain, and constipation, that of ECOG-PS in five scales: global QoL, emotional functioning, nausea & vomiting, pain, and appetite loss. Conclusions. Signs of major depression or depressive symptoms and impaired functional status contribute independently to poorer QoL in cancer patients prior to chemotherapy.

C-reactive protein, severity of pneumonia and mortality in elderly, hospitalised patients with community-acquired pneumonia

BACKGROUND increasingly, markers of systemic inflammation like C-reactive protein (CRP) levels and white blood count (WBC) are being used for assessing the prognosis of patients with community-acquired pneumonia (CAP). However, their predictive value has not been validated in populations of elderly patients. OBJECTIVE to evaluate the prognostic value of CRP and WBC in comparison with the CURB score and the pneumonia severity index (PSI) in elderly, hospitalised patients with CAP. METHODS the charts of all patients, aged 65 years and older, who were consecutively admitted to the Department of Geriatrics, Marienhospital Herne, Germany, for treatment of CAP between January 2001 and September 2005, were reviewed. CRP, WBC, CURB and PSI were analysed in relation to 30-day mortality. RESULTS in a total of 391 patients, median age 80 years, no association was found between CRP or WBC and mortality. In contrast, the CURB score and PSI were significantly associated with mortality and treatment in the intensive care unit (ICU). CONCLUSION in elderly, hospitalised patients with CAP, admission CRP and WBC are not predictors of the prognosis.

Elderly Patients with Community-Acquired Pneumonia

Community-acquired pneumonia (CAP) is a common infectious disease that still causes substantial morbidity and mortality. Elderly people are frequently affected, and several issues related to care of this condition in the elderly have to be considered. This article reviews current recommendations of guidelines with a special focus on aspects of the care of elderly patients with CAP.The most common pathogen in CAP is still Streptococcus pneumoniae, followed by other pathogens such as Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella species. Antimicrobial resistance is an increasing problem, especially with regard to macrolide-resistant S. pneumoniae and fluoroquinolone-resistant strains. With regard to β-lactam antibacterials, resistance by H. influenzae and Moraxella catarrhalis is important, as is the emergence of multidrug-resistant Staphylococcus aureus. The main management decisions should be guided by the severity of disease, which can be assessed by validated clinical risk scores such as CURB-65, a tool for measuring the severity of pneumonia based on assessment of confusion, serum urea, respiratory rate and blood pressure in patients aged ≥65 years.For the treatment of low-risk pneumonia, an aminopenicillin such as amoxicillin with or without a β-lactamase inhibitor is frequently recommended. Monotherapy with macrolides is also possible, although macrolide resistance is of concern. When predisposing factors for special pathogens are present, a β-lactam antibacterial combined with a β-lactamase inhibitor, or the combination of a β-lactam antibacterial, a β-lactamase inhibitor and a macrolide, may be warranted. If possible, patients who have undergone previous antibacterial therapy should receive drug classes not previously used.For hospitalized patients with non-severe pneumonia, a common recommendation is empirical antibacterial therapy with an aminopenicillin in combination with a β-lactamase inhibitor, or with fluoroquinolone monotherapy. With proven Legionella pneumonia, a combination of β-lactams with a fluoroquinolone or a macrolide is beneficial. In severe pneumonia, ureidopenicillins with β-lactamase inhibitors, broad-spectrum cephalosporins, macrolides and fluoroquinolones are used. A combination of a broad-spectrum β-lactam antibacterial (e.g. cefotaxime or ceftriaxone), piperacillin/tazobactam and a macrolide is mostly recommended. In patients with a predisposition for Pseudomonas aeruginosa, a combination of piperacillin/tazobactam, cefepime, imipenem or meropenem and levofloxacin or ciprofloxacin is frequently used. Treatment duration of more than 7 days is not generally recommended, except for proven infections with P. aeruginosa, for which 15 days of treatment appears to be appropriate. Further care issues in all hospitalized patients are timely administration of antibacterials, oxygen supply in case of hypoxaemia, and fluid management and dose adjustments according to kidney function.The management of elderly patients with CAP is a challenge. Shifts in antimicrobial resistance and the availability of new antibacterials will change future clinical practice. Studies investigating new methods to detect pathogens, determine the optimal antimicrobial regimen and clarify the duration of treatment may assist in further optimizing the management of elderly patients with CAP.

Prerequisites for a new health care model for elderly people with multimorbidity: the PRISCUS research consortium.

Fragestellung Das gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbiditat stellt den betroffenen Patienten, seine Angehorigen sowie Arzte und Therapeuten vor grose Herausforderungen. Das Gesundheitssystem wird durch die steigende Zahl Betroffener und ihre komplexen Bedurfnisse, aber auch durch die Vielfalt haufig schlecht koordinierter Interventionen zunehmend belastet. Zur Verbesserung der medizinischen Versorgung bietet sich das fur chronisch Kranke entwickelte „Chronic Care Model“ an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen fur ein daran orientiertes, neues Versorgungsmodell fur multimorbide, altere Patienten zu schaffen.BackgroundMultimorbidity, the concurrent manifestation or presence of multiple chronic conditions, poses huge challenges to affected patients, their relatives, physicians, and practitioners alike. The growing number of affected persons and the complexity of their needs places just as much of a burden on the health care system as does the plethora of often poorly coordinated interventions. The Chronic Care Model developed for different chronic diseases is suited for improving medical care. The PRISCUS research consortium was established to create the prerequisites for a new care model for multimorbid, elderly patients oriented along those lines.MethodsThe research consortium utilizes data gathered in a large-scale epidemiological study on peripheral arterial disease (getABI study) and from the Dortmund and Münster stroke registries, by extracting epidemiologic and health economic data, quality-of-life parameters, and data on the extent and quality of medication. Additional projects evaluate the implementation of a multidimensional geriatric assessment in primary care, the functional consequences of multimorbidity in stroke patients along with options for prevention and therapy afforded by physical activity. Systematic reviews of the literature are used to describe quality of life and patient preferences. Experts will work on an initial draft treatment standard for patients with multimorbidity and a list of potentially inappropriate medication for the elderly in Germany.ConclusionThe results of the PRISCUS research consortium will enable an epidemiologic characterization and description of consequences of multimorbidity, while illustrating new approaches towards prevention, diagnosis, and management of multimorbid patients. With this, some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model will be fulfilled.ZusammenfassungFragestellungDas gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbidität stellt den betroffenen Patienten, seine Angehörigen sowie Ärzte und Therapeuten vor große Herausforderungen. Das Gesundheitssystem wird durch die steigende Zahl Betroffener und ihre komplexen Bedürfnisse, aber auch durch die Vielfalt häufig schlecht koordinierter Interventionen zunehmend belastet. Zur Verbesserung der medizinischen Versorgung bietet sich das für chronisch Kranke entwickelte „Chronic Care Model“ an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen für ein daran orientiertes, neues Versorgungsmodell für multimorbide, ältere Patienten zu schaffen.MethodikDer Verbund nutzt unter anderem Daten einer großen epidemiologischen Studie zur peripheren arteriellen Verschlusskrankheit (getABI-Studie) und Daten des Dortmunder und Münsteraner Schlaganfallregisters. Ermittelt werden epidemiologische und gesundheitsökonomische Daten, Parameter der Lebensqualität und Umfang und Qualität der medikamentösen Versorgung. In weiteren Projekten werden die Implementierung eines multidimensionalen Assessments in Hausarztpraxen, die funktionellen Auswirkungen von Multimorbidität bei Schlaganfallpatienten sowie Möglichkeiten der Prävention und Therapie mittels körperlicher Aktivität evaluiert. Über systematische Literaturübersichten werden Lebensqualität und Patientenpräferenzen dargestellt. Mit Hilfe von Experten wird ein erster Behandlungsstandard für Patienten mit Multimorbidität und eine Liste potentiell inadäquater Medikamente im Alter erarbeitet.FazitDie Ergebnisse des Forschungsverbunds werden eine epidemiologische Charakterisierung und eine Abschätzung der Krankheitsfolgen von Multimorbidität erlauben. Der Verbund wird neue Ansätze zu Prävention, Diagnostik und Therapie bei Multimorbidität aufzeigen können. Damit werden erste Voraussetzungen geschaffen, durch Anpassung der Versorgungsstruktur nach Vorbild des „Chronic Care Model“ ein verbessertes Management von Patienten mit Multimorbidität zu erreichen.