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Background: The presence of frailty in older patients increases the risk for adverse health events and for a loss of independence. Measures for the prevention of this geriatric syndrome should be incorporated into routine healthcare., Objective: What types of interventions could be effective in the prevention of frailty and how can preventive strategies be successfully implemented?, Method: Narrative review article., Results: The concept of frailty is multidimensional and potential starting points for a prevention of frailty can be found within different dimensions (e.g., dimensions of physical activity and nutrition, psychosocial dimension). Epidemiological analyses have identified factors that increase or decrease the risk for becoming frail. Evidence from randomized controlled trials that examined the effectiveness of specific interventions in the prevention of frailty is still limited. Based on the available data, interventions using physical exercise appear to be effective in preventing frailty. In primary care in Germany the frailty status of older patients is not yet routinely recorded, which impedes the identification of patients at risk (patients with pre-frailty) and the implementation of targeted preventive strategies. The Integrated Care for Older People (ICOPE) concept of the World Health Organization offers a potential approach to prevent frailty and to promote healthy ageing within the population., Conclusion: The prevention of frailty is possible and reasonable. Comprehensive and targeted preventive strategies are yet to be implemented., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

During the early stages of the COVID-19 pandemic, stringent measures were implemented in most countries to limit social contact between residents of long-term care facilities (LTCF) and visitors. The objective of this scoping review was to identify and map evidence of direct and indirect consequences of contact restrictions, guided by three conceptual perspectives: (1) stress and learned helplessness (i.e., failure to use coping behaviors even when they are available and actionalble); (2) social contact loss; and (3) 'total institution' (i.e., a facility operates following a fixed plan due to spelled-out rules and norms, controlled by institutional representatives). We used the framework for conducting a scoping review by Arksey and O'Malley; included were peer-reviewed manuscripts reporting on the outcomes of contact restrictions from the beginning of the pandemic until the end of 2020. After removing duplicates, 6,656 records were screened and 62 manuscripts included. Results pertaining to the stress and learned helplessness perspective primarily focused on depressive symptoms, showing substantial increases compared to the pre-pandemic period. Studies examining cognitive and functional decline, as well as non-COVID-19 related mortality, were limited in number and presented mixed findings. The majority of study outcomes related to the social contact loss perspective focused on loneliness, but the study designs did not adequately allow for comparisons with the pre-pandemic status. The evidence concerning outcomes related to the 'total Institution' perspective was inconclusive. Although detrimental effects of social isolation in the long-term care context found support particularly in the negative affect domain, other outcome areas did not allow for definitive conclusions due to considerable variations in findings and, in some cases, insufficient statistical power., (© 2023. Springer Nature B.V.)

The concept of frailty describes an older at-risk population, which has a higher probability for the occurrence of unfavorable health outcomes. It is in the interest of frail individuals as well as the healthcare system to improve the prognosis of these people by targeted interventions. Several systematic reviews and meta-analyses are now available comparing very different interventions in frail older adults. These studies came to the conclusion that training interventions were found to be the most effective. Compared to exercise interventions delivered at participants homes, exercise in groups was found to be more effective. The case finding for such interventions should be carried out with frailty instruments that focus on strength, endurance and/or physical activity. Particularly suitable for this are the frailty criteria of Fried, gait speed or the short physical performance battery (SPPB). From a geriatrics perspective, a comprehensive offer of group training seems to be urgently necessary; however, the implementation requires a large expansion of existing structures and new ways to reach older people with frailty., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Frailty is a multidimensional geriatric syndrome characterized by the loss of the individual reserve capacity and increased vulnerability to internal and external stressors. Frailty in older adults is associated with an increased risk for falls and loss of autonomy as well as an increased mortality. The identification of patients who suffer from frailty can trigger a comprehensive geriatric assessment and justify targeted treatment options. Furthermore, by the detection of frailty each patient with an increased risk of an unfavorable treatment outcome can be identified. There are a confusing number of instruments available for the detection of frailty but only a limited number of these instruments are available in a German version. The choice of an appropriate instrument is largely dependent on the clinical setting and the available resources.

Background: Hospital admissions resulting from traumatic intracranial haemorrhages (TIH) in older people are increasing. There are concerns regarding an increased risk of a TIH in people taking oral anticoagulants (OAC) like phenprocoumon., Aims: The aim of this study was to estimate the incremental risk of a TIH associated with OAC in older people. Furthermore, this study explored differences in risk according to functional status., Methods: The study took data from a large German health insurance provider and combined hospital diagnoses with data regarding drug dispensing to estimate rates of a TIH in people with and without exposure to phenprocoumon. Analyses were stratified by sex and by severe functional impairment as disclosed by the long-term care insurance provider., Results: Overall, exposure to OAC resulted in 2.7 times higher rates of TIH. People with severe functional impairment had a higher baseline risk of TIH than people without severe functional impairment. However, the incremental risk in those exposed to OAC was similar among people with and without severe functional impairment (standardised incidence rate difference 15.73 (95% CI 7.84; 23.61) and 12.10 (95% CI 9.63; 14.57) per 10,000 person-years, respectively)., Conclusions: OAC increases the risk of TIH considerably. The incremental risk of TIH in those exposed to OAC is comparable between people with and without severe functional impairment. The presence of severe functional impairment per se should not exclude such patients from the potential benefits of OAC. For now, the prescription should be personalized based on individual fall risk factors and risk-taking behaviour.

Background: Hip fractures are regarded as a worldwide epidemic and a major public health concern. Changing risk factors, local differences and temporal trends contribute to the particular epidemiology of hip fractures. This overview gives a comprehensive insight into the epidemiology of hip fractures and reviews where German data have contributed to the literature., Methods: The review of the epidemiology of hip fractures in Germany is based on a systematic literature search in PubMed. Information about the global epidemiology of hip fractures was provided by a selective literature review focusing on specific aspects of the epidemiology of hip fractures., Results: Hip fracture rates vary more than 100-fold between different countries. In most high-income countries, a rise in age-standardized hip fracture rates was observed until the 1980s and 1990s and a decrease thereafter. Such a decrease has not been observed for Germany so far. Many factors, diseases and drugs have been found to be associated with hip fractures and there is some evidence that fracture risk in later life is already programmed during fetal life and early childhood. Of the hip fracture burden 50% occur in people with disability and in need of care. In nursing homes approximately 4 fractures can be expected in 100 women per year. In people with intellectual or developmental disabilities comparable risks of hip fracture occur 10-40 years earlier than in the general population. Incidence of disability, institutionalization and death are frequent consequences of hip fractures., Conclusion: The epidemiology of hip fractures is characterized by a high burden of disease, local differences, temporal trends, well-defined high-risk populations and many established risk factors.

Background and Aims: Several tests of physical performance like gait speed or standing balance are part of the geriatric assessment. Measures of physical activity like daily walking duration are more difficult to assess but may be of higher relevance for daily requirements. It is therefore of interest to what extent physical performance measures are associated with physical activity., Methods: In a cohort study, baseline screening was performed in 1271 community-living people aged 65-90 years from Ulm, Germany. Average daily walking duration was assessed in all participants by accelerometers over a one-week period. Habitual gait speed, 5-Chair-Rise test, standing balance and handgrip strength served as measures of physical performance. The association between measures of physical performance and physical activity was calculated by linear regression analysis., Results: The mean daily walking duration was 104.8 minutes in men and 103.0 minutes in women. A positive relationship between gait speed and walking duration was observed in men and women with low gait speed (≤0.8 m/s) but not in participants above this threshold. Standing balance and hand grip strength were positively and 5-Chair-Rise test inversely related with average daily walking duration. A relationship between hand grip strength and walking duration was only observed in women aged 75 years and more., Conclusions: Physical performance measures and objectively measured walking duration are related with each other but only a small percentage of the variance of daily walking duration was explained by physical performance measures. Therefore, factors other than physical performance seem to influence daily walking duration to a great extent.

Background and Aims: Depression and fear of falling are common problems following proximal femoral fracture. The role of fear of falling in depressive symptoms after such a fracture has not yet been investigated. The aim of this study was to establish possible changes during recovery in fear of falling and depressive symptoms following rehabilitation in this population and to explore their association., Methods: Observational study with pre-post design at a single geriatric rehabilitation hospital in Germany. Data were collected during in-hospital rehabilitation and four months later at participants' home. The data of 51 participants living in the community at the time of fracture could be analysed., Main Measures: Fear of falling, depressive symptoms, cognition, pain, ADL functioning, and physical performance., Results: Although physical and ADL performance improved between admission to rehabilitation and follow-up four months later, the prevalence of depressive symptoms increased, and levels of fear of falling remained at the same level. There was a significant correlation between fear of falling and depressive symptoms at follow-up, but the two were not significantly correlated at baseline. Fear of falling and depressive symptoms were not significantly associated in a path analysis model., Conclusions: Fear of falling and depressive symptoms are highly prevalent after proximal femoral fracture. Yet there seems to be no simple association between either psychological parameter in older persons recovering from fall-related fractures. Further research is warranted, in order to develop interventions targeting these psychological outcomes.