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This experiment aimed to investigate the effect of including Clitoria ternatea and Ulva lactuca in the complete feed on the concentration of blood metabolites of male kacang goats. Four male kacang goats were involved in this experiment arranged following a Latin Square Design with 4 treatments and 4 periods as replication. The treatments were R0= native grass hay 60%+concentrate 40%, R1= native grass hay 30%+concentrate 40%+ Clitoria ternatea 30%, R2= native grass hay 30%+concentrate 40%+ Clitoria ternatea 15%+ Ulva lactuca 15% and R3= native grass hay 30%+ concentrate 40%+Ulva lactuca 30%. Data were analyzed using analysis of variance (ANOVA) and followed by the Duncan Multiple Range Test when significant differences were found. The results showed that feeding a complete feed containing Clitoria ternatea and Ulva lactuca did not significantly (P>0,05) affect the concentration of urea, glucose and plasm total protein in the blood of male kacang goats. Therefore, it can be concluded the inclusion of Clitoria ternatea and Ulva lactuca has no effect on the concentration of blood metabolites in male kacang goats.

Penelitian ini bertujuan untuk mengetahui pengaruh perbedaan konsentrat dan limbah jagung terhadap konsentrasi VFA, NH3 protein kasar dan serat kasar in-Vitro silase pakan komplit. Metode yang digunakan dalam penelitian ini adalah metode eksperimental dengan menggunakan rancangan acak lengkap (RAL) terdiri dari 5 perlakuan 3 ulangan. Perlakuan yang dimaksud adalah P0 = limbah jagung muda 100% : 0 % konsentrat + 80 ml starter; P1 = P0 90% : 10% konsentrat + 80 ml starter; P2 = P0 80% : 20% konsentrat + 80 ml starter; P3 : P0 70% : 30% konsentrat + 80 ml starter; P4 = P0 60% : 40% konsentrat + 80 ml starter. Variabel yang diukur adalah PK, SK, VFA, dan NH3. Data analisis menggunakan SPSS 25 for windows menggunakan level signifikansi P

Effect of rejected Eucheuma cottonii level in complete feed on nutrient intake and digestion, blood metabolites, and body weight gain of early weaned Bali calves was studied. Twelve Bali calves aged 4 months with average early body weight 40 kg and standard error 1.3 kg were used in this experiment. Completely randomized design was applied with four treatments and three replications. The treatments were CT0 (complete feed without Eucheuma cottonii, CT5 (complete feed plus Eucheuma cottonii 5%), CT10 (complete feed plus Eucheuma cottonii 10%), and CT15 (complete feed plus Eucheuma cottonii 15%). The results on nutrient intake indicated that there were no significantly differences (p>0.05) among treatments by Bali calves. There were also no significant differences (p>0.05) of treatments on crude protein and fiber digestibility, however, digestibility of DM, OM, EE, and NFE were same among 5, 10, and 15 % level of rejected E. cottonii in complete feed. There were significantly different (p0.05) of treatments on body weight gain and body linear measures of Bali calves. It was concluded that 1) dry matter and other nutrient intake were the same between early weaned Bali calves consumed complete feed with or without rejected E. cottonii, 2) digestibility of DM, OM, EE, and NFE of complete feed differed among treatments. The lowest digestibility of DM, OM, EE, and NFE were at early weaned Bali calves consumed complete feed without rejected E. cottonii. Digestibility of CP and CF were same among early weaned Bali calves consumed both with and without rejected E. cottonii, 3) blood urea, glucose, protein, Mg, and K concentration differed among treatments. The lowest blood urea, glucose, protein, Mg, and K concentration were at early weaned Bali calves consumed complete feed without rejected E. cottonii. The highest blood urea, glucose, protein, Mg, and K concentration were general at early weaned Bali calves consumed complete feed with 15% rejected E. cottonii, 4) daily body weight gain and linear body measures were same among early weaned Bali calves consumed both with or without rejected E. cottonii.

This research aimed to study the effect of feeding silage of kume grass and Pasiflora foetida leaves differing in their ratio on fiber intake and digestibility, rumen VFA and blood glucose concentration of male kacang goats. This study used four male kacang goats with the average body wight of 10,5 kg. This experiment followed a 4x4 Latin Square design with four treatments in four 21-day periods as replications. The treatments were M0 : silage made of 100 % kume grass, M20 : silage made of 80% kume grass + 20% Passiflora foetida, M40 : 60% kume grass + passiflora foetida 40%, M60 : 40% kume grass + 60% Passiflora foetida. Result showed that feeding silage made of different ratio of kume grass and Passiflora foetida leaves did not significantly (P>0,05) affect the length and frequency of eating, the length of rumination period as well as the length and frequency of resting period. Therefore, it can be concluded that inclusion of P. foetida in the silage mix with kume grass up to 60% is considered save as it did not affect the feeding behaviour of Kacang goats., Penelitian ini bertujuan untuk mengetahui pengaruh pemberian pakan lengkap silase berbasis rumput kume dan daun markisa hutan dengan rasio yang berbeda terhadap tingkah laku makan ternak kambing kacang. Penelitian ini menggunakan Rancangan Bujur Sangkar Latin (RBSL) dengan empat perlakuan pemberian campuran silase rumput kume dan daun markisa hutan serta empat periode pengambilan data sebagai ulangan. Keempat perlakuan tersebut adalah M0 : 100 % silase Rumput Kume, M20 : Rumput Kume 80% + Markisa Hutan 20 %, M40 : Rumput Kume 60% + Markisa Hutan 40 %, M60 : Rumput Kume 40 % + Markisa Hutan 60 %. Parameter yang diukur terdiri dari frekuensidan lama makan,frekuensidanlama ruminasi serta frekuensi dan lama istirahat. Hasil penelitian menunjukan bahwa pemberian silase campuran rumput kume dan daun markisa hutandalam proporsi yang berbeda tidak berpengaruh nyata ( P>0,05) terhadap lama dan frekuensi makan, lama ruminasi serta lama dan frekuensi istirahat kambing kacang. Disimpulkan bahwa pemberian silase campuran rumput kume dan daun markisa hutan dengan proporsi yang berbeda tidak berpengaruh nyata terhadap tingkah laku makan kambing kacang.

The present experiment aimed to investigate the effect of introducing different pasture legumes on the growth profile and forage production of the selected native pasture grass species at different stages of growth. In a completely randomized design with 5 treatments and 5 replications, the mixture of Sorghum plumosum (SP) and Bothriochloa pertusa (BP) was introduced respectively with one of the forage legumes ie. Alysicarpus vaginalis (AV), Pueraria phasoloides (PP), Desmodium incanum (DI), and Clitoria ternatea (CT). Growth profile and forage production were measured at 40, 60, and 80 days after planting. Results showed that CT and PP significantly improved the growth and DM production of SP and suppressed (PBP during the early vegetative stage but did not during the late vegetative stage. Introduction of legumes reduced (PSP and the total forage production but improved (PB. pertusa as well as a leaf:stem ratio of both types of grass at the generative stage. PP had the highest (PP. phasoloides provide the highest foliage during the vegetative stage and A. vaginalis and D. incanum during the generative stage.

Penelitian dilaksanakan dengan tujuan untuk mengkaji produksi dan nilai nutrisi C. ternatea yang dipanen pada umur 60, 75 dan 90 hari setelah panen. C. ternatea ditanam pada 18 petak dengan ukuran 3 × 3 m2 dengan jarak tanam 40 × 20 cm dengan 3-4 biji per lubang tanam. Hijauan dipanen pada umur 60, 75 dan 90 hari setelah tanam sebagai perlakuan dengan masing-masing 6 ulangan. Variabel yang diukur adalah produksi hijauan, komposisi kimia hijauan dan kecernaan in vitro bahan kering dan bahan organik. Hasil penelitian menunjukkan bahwa tidak ada perbedaan signifikan (P>0,05) produksi hijauan C.ternatea yang dipanen pada umur 60, 75 dan 90 hari setelah tanam. Sementara itu, rasio daun:batang menurun (P

ObjectivesApathy is a neuropsychiatric symptom in mild cognitive impairment (MCI) and dementia. This study examines correlations between Apathy Evaluation Scale (AES) ratings and actigraphic measures of daytime activity. The aim of this study is to determine the value of ambulatory actigraphy in the assessment of locomotor deficits as a correlate of apathy in geriatric patients with cognitive impairment.Patients and methodsIn this cross-sectional study a total of 82 participants were recruited, 32 patients with dementia, 21 patients with MCI and 23 elderly controls. Rating scales for apathy (AES) and depression (Beck Depression Inventory, BDI) were completed. To measure daytime activity a wrist-worn actigraph and an established protocol were used. A single measure of mean daytime activity per participant was calculated for further statistical analysis.ResultsIn the two groups of patients with MCI and dementia, apathy is associated with reduced daytime activity, independent of diagnosis (no group by apathy interaction). AES scores correlate significantly with daytime activity. Cognitive impairment reduces daytime activity (effect greater in dementia than in MCI). Daytime activity is negatively correlated with memory deficits.ConclusionAmbulatory actigraphy is a promising method to evaluate self-initiated action as a correlate of apathy in patients with cognitive impairment.

OBJECTIVE: To investigate prospectively the prognostic power of various demographic and diagnostic parameters, as well as of medical history, for evaluating in elderly patients the probability of their requiring care and of their risk of dying soon. PATIENTS AND METHOD: All the elderly patients (> or = 70 years) of one general practitioner were included. Of 178 patients who fulfilled the inclusion criteria, 144 participated (93 women, 49 men; mean age 78.7 +/- 5.8 years). Demographic, basic diagnostic and medical history data of the kind that can be easily collected in general practice were recorded. The general practitioner was also asked to assess the probability of each patient requiring care and the likelihood of their dying soon. Several functional tests that record or measure daily activity were conducted. After 18 months all admissions to care, homes for the elderly or hospital and deaths were recorded. The different groups were compared. RESULTS: The probability of requiring care and of dying within the observation period were predicted more accurately by functional tests and questions than by conventional diagnostic methods. This was particularly so for functional investigations of basic daily activity, cognitive ability and manual skills. There were significant differences between the groups in the results of tests (P < 0.01). CONCLUSION: Functional tests can be rapidly performed and have high diagnostic and prognostic power. They are therefore recommended for use by general practitioners for assessing the probability of a given patient requiring care and for estimating the likelihood of early death.

The causes of early rehospitalization (within 3 weeks) of very elderly patients, its possible avoidance and appropriate preventive measures were analysed retrospectively in patients of a geriatric hospital. Included were all those patients who had been admitted to the hospital from their home several (mean: five) times between 1987 and 1990 (48 women, 19 men; mean age 81.3 +/- 7.2 years--a total of 331 re-admissions). The most frequent diagnoses were heart failure (38.8%), acute cerebrovascular accident or its sequelae (31.3%), dementia (23.9%), fall or its sequelae (22.3%) and diabetes (20.9%). Of the 331 re-admissions 87 (26.3%) occurred during the first 3 weeks after discharge. The most important reasons of this early re-admissions were inadequate home care (41.4%), undesirable drug effects and non-compliance (25.3%), as well as rapid progression of the basic disease (14.9%). In the judgement of the hospital team more than 40% of the early re-admissions were avoidable, among those re-admitted because of inadequate home care and those in connection with drug intake even more than half. Early hospitalization is frequently avoidable, if individual geriatric assessment is undertaken and discharge carefully planned.

Das geriatrische Assessment wurde in den angloamerikanischen Landern als primar diagnostischer Prozess entwickelt, um die Krankheitsfolgen und Interaktionen bei multiplen Erkrankungen besser erfassen zu konnen. Um eine Vereinheitlichung der angewendeten Assessment-Instrumente zu erreichen, haben die beiden deutschen Fachgesellschaften (Deutsche Gesellschaft fur Geriatrie und Deutsche Gesellschaft fur Gerontologie und Geriatrie) eine Kommission gebildet, die Empfehlungen zur Auswahl geeigneter Instrumente erarbeitet hat. Es handelt sich dabei in der ersten Stufe um eine erweiterte Form des Screenings nach Lachs. Im nachsten Schritt wird der Barthel-ADL, der Mini-Mental-Status Test (MMSE), die Geriatrische Depressionsskala (GDS), der Aufsteh- und Gehtest und der (Semi-) Tandemstand erhoben. Das erweiterte Screening nach Lachs ermoglicht eine Patientenidentifikation und -platzierung. Die ubrigen Testinstrumente sind dafur nicht geeignet. Kein Verfahren erfullt alle Testgutekriterien wie Validitat, Reliabilitat, Unterschiedssensitivitat, Praktikabilitat und Wiederholbarkeit in ausreichender Form; teilweise wurden die Kriterien nicht untersucht (Screening nach Lachs, Tandemstand). Die beschriebenen Assessmentinstrumente sind zur Diagnostik von Funktionen (Alltag, Kognition, Emotion, Mobilitat) geeignet, erlauben aber keine Aussage uber den Ressourcenbedarf. Kein Instrument bildet das neue Konzept der ICIDH vollstandig ab.

This prospective study in elderly showed that kidney function plays a minor role in explaining the high prevalence of vitamin D deficiency seen in noninstitutionalized elderly subjects. However, 25-hydroxyvitamin D levels were clearly inversely associated with risk for first fall, which was especially seen in subjects with calcium levels above median.Few prospective studies in elderly exist that have investigated the association of renal dysfunction and vitamin D status on risk of falls. The aim of this study is to evaluate the association of renal function with 25-hydroxyvitamin D (25-OH-D) levels and, secondly, to assess the role of both factors on the risk of falls and subsequent bone fractures.This is a prospective population-based cohort study among noninstitutionalized elderly subjects during a 1-year follow-up. 25-OH-D levels and renal function were estimated, the latter by cystatin C-based equations. Information on falls was assessed prospectively.Overall, 1,385 subjects aged 65 and older were included in the study (mean age 75.6 years), of whom 9.2 % had a 25-OH-D serum level above 75 nmol/L (US units 30 ng/mL); 41.4 %, between 50 and 75 nmol/L (US units 20 to 29 ng/mL, insufficiency); and 49.4 %,50 nmol/L (US units20 ng/mL, deficiency). We found no association of chronic kidney disease with risk of first fall. In contrast, 25-OH-D serum categories were clearly associated with risk of first fall and we found evidence of effect modification with calcium levels. In the group with a calcium level above the median (≥ 9.6 mg/dL), subjects with 25-OH-D serum level between 50 and 75 nmol/L and with concentrations50 nmol/L had a hazard rate ratio (HRR) of 1.75 (1.03-2.87) and 1.93 (1.10-3.37) for risk of first fall. 25-OH-D serum levels were also associated with several markers of inflammation and hemodynamic stress.We demonstrated an association of 25-OH-D serum levels and risk of first fall, which was especially evident in subjects with serum calcium in upper normal, independent of renal function.

To determine predictors of death, nursing home placement and hospital admission, a prospective study was carried out in a university-affiliated geriatric hospital and a general practice. One hundred and thirty-five patients consecutively admitted from home to the geriatric hospital and discharged home again (site 1), and 144 patients, aged 70 years and over, of a general practice (site 2) were recruited for a comprehensive geriatric assessment program. At baseline, none was completely dependent on others, or severely demented. At follow-up after 18 months, 46 subjects (17%) had died, 20 subjects (7%) had been institutionalized, and 79 had been admitted to hospital (28 %) in the interim. Univariate analysis demonstrated a significant association between Barthel Activities of Daily Living (ADL), Lawton-Brody Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Balance and Gait Evaluation, Timed “Up and Go”, Timed Test of Money Counting, Grip-Strength and Williams Board Test, and death as well as nursing home placement. Barthel-ADL were significantly correlated with hospital admission. In a logistic regression analysis, Barthel-ADL were independent predictors for death; Barthel-ADL, Timed “Up and Go”, Timed Test of Money Counting, and Williams Board Test were independent predictors for nursing home placement. No independent predictor was found for hospital admission. It is concluded that self-report and performance-based measures of functional capabilities are useful instruments to identify patients at risk for nursing home placement and death. Factors contributing to hospital admissions are other than those measured by the applied tests.

Objectives: To examine medication problems during a stay in hospital and after discharge and to identify risk factors that contribute to poor compliance with medication a prospective observational study was carried out in an university-affiliated geriatic hospital and a patients' home. Patients: One hundred and nineteen patients admitted from home to the geriatric hospital underwent a comprehensive geriatric assessment. They were also tested in opening and removing tablets from various common medicine containers. Drug prescriptions before, during and after the hospital stay were recorded. Medication use at home was observed by a member of a hospital-based home intervention team. The patients' reports of their drug therapy was compared with those by their family doctors. Results: Of all tested patients 10.1% failed to open at least one container. This inability was associated with poor vision, impaired cognitive function and low manual dexterity. Compliance with prescribed medication was associated with cognitive function, ability to handle medication containers, number of prescribed drugs and recent changes in drug prescriptions. Of the patients only 39.5% had stable drug prescriptions during the 3-month study period. Doctor/patient agreement concerning drug therapy was low in all age groups. The agreement rate and patients' knowledge of their treatment was correlated with cognitive function and the number of prescribed drugs. Conclusion: Patients' ability to open and remove tablets from common commercial packages/containers should be tested routinely during a stay in hospital. Management of medication should be taught and supervised within the first few days after discharge from hospital.

When facing the well-known demographic development with an increasing number of people suffering from dementia, there is a need of programmes to support nursing relatives and care at home. Many support services have been established in the past few years but they are rarely used by the relatives and the patients. The purpose of the Lighthouse Project Ulm (ULTDEM Study) was to prove the effectiveness of a single advisory approach in order to provide support services after care level classification and to relieve the burden placed on relatives caring for family members suffering from dementia ("initial case management").The ULTDEM Study is a prospective, open, randomized, controlled, interventional study with different parallel outcome measures (burden of caring, quality of life and mood). After the randomization, the interventional group was given comprehensive, individual advice about available treatment possibilities for dementia patients. Control group participants received standard treatment. Inclusion criteria were application of a care level (0 or 1) as well as dementia diagnosis. All participants (patients/relatives) underwent an initial and a 6 month comprehensive assessment.Our results show that a single advisory approach does not lead to a significant difference in outcome measures in interventional and control groups. Those tendencies described have to be interpreted as clinically not relevant. Although utilization of support services increases, it remains similar in both study groups. A confirmatory interpretation has not been possible due to a lack of adjustment to the findings regarding multiple testing and an insufficient degree of recruitment. Possible causes will be discussed such as premature intervention during the course of the disease, a lack of intervention blinding, recruitment bias and lack of an influence on adherence with regard to the use of support services.The study demonstrates that there is a substantial information deficit for persons affected by dementia and their relatives. Innovative ways still have to be developed to ensure that this information actually reaches the target audience.

The objective of the study was to compare compliance with and the hypocholesterolaemic effect of lovastatin given once daily as a morning or an evening dose. Twenty-four out-patients with familial hypercholesterolaemia were randomly assigned to receive placebo first, then lovastatin 20 mg, to be taken once daily for 4 weeks, either with the breakfast or evening meal, in a single-blind fashion. Drug compliance was assessed by pill counts and continuous electronic monitoring. Two compliance parameters were evaluated, consumption, defined as percentage of prescribed doses taken, and time compliance, the percentage of total dosing events recorded within defined intervals (6.00-10.00 h, and 17.00-21.00 h), for the morning and evening regimes. Both regimes satisfactorily reduced the total and LDL-cholesterol concentrations, and there was no significant difference in the extent of the reductions. Pill counts overestimated compliance, as revealed by the monitoring method. The times of actual consumption of doses by the patients often differed from that prescribed, predominantly in patients who were told to take the evening dose. Partial time compliance may have confounded the efficacy of the drugs. Electronic compliance monitoring appears to be particularly useful in chronopharmacological studies.

To integrate palliative care patients into an acute geriatric ward requires extensive and continuous education and preparation of all participating professionals. It can be a lengthy process to integrate palliative care concepts despite cooperation of the hospital administration. The group of patients to be integrated differs from the patients of regular geriatric wards because of a higher percentage of relatively young oncologic patients and they differ from a regular palliative ward because about 50% are non-oncologic patients, while the average age is much higher than in normal palliative care. It is possible to integrate specialized palliative care into a regular geriatric ward. Patients admitted without palliative intention will benefit the most from ward-integrated palliative care if the treatment aim turns this way. Ward-integrated palliative care can be an integral part of treating geriatric patients in addition to acute geriatric medicine, rehabilitation, and prevention. It can also provide caretakers and patients with the benefits from continuity of treatment and care.

The effects of low fat diet and intensive physical exercise were examined in a randomized prospective study in patients with angiographically documented coronary heart disease. In addition to supervised regular physical exercise, patients of the intervention group (n = 18) were subjected to intensive dietary counselling with the aim of a low fat, low cholesterol diet to be maintained for at least 12 months. The control group (n = 27) received relevant advise only and usual care by private physicians. In the intervention group there was significant lowering of plasma triglycerides (202 +/- 82/141 +/- 74 mg/dl) and body weight (78.2 +/- 9.5/73.7 +/- 10.4 kg) while total and LDL cholesterol did not change significantly. There was a tendency for a rise of HDL-cholesterol (35.6 +/- 9.0/40.4 +/- 14.8 mg/dl, p = 0.07). According to 24-hour diet protocols there was a significant lowering of energy intake (2.298 +/- 697/1.602 +/- 758 kcal/day), of fat intake (111.7 +/- 44.4/52.0 +/- 23.9 g/day) and of intake of dietary cholesterol (402.8 +/- 186/161.3 +/- 100.3 mg/day) as well as of saturated fatty acids (42.5 +/- 20.4/14.3 +/- 8.1 g/day). Fatty acid composition of adipose tissue was not correlated with the patients' 24-hour dietary protocols. In the control group there were no changes of plasma lipids, body weight or diet composition according to 24-hour protocols after 1 year compared to data at the beginning of the study. There was, however, a marked correlation of adipose tissue composition and dietary information given by the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

In many acute or chronic vestibular diseases in old age, the risk of falling is increased. A fear of falling often develops together with further limitations to physical activity and subsequent physical and psychological consequences. Falls represent a substantial health-related risk factor. A regular balance, walking and muscle training is an effective prophylaxis. Components of the treatment of vestibular diseases in old age are counselling and encouragement (psychotherapy), treatment of the specific organic disease, specific vestibular rehabilitation and a symptomatic medication therapy. Vertigo in old age is a multifactorial process. The differential diagnosis of disorders of the equilibrium function in old age represents a challenge which can only be overcome by interdisciplinary cooperation.

Disorders of the equilibrium function in the elderly will increase in the coming years due to demographic changes in Germany. In addition to a reduction in the quality of life of affected patients, the risk of suffering from a fall increases with age. At the morphological level age-specific changes of the peripheral vestibular structures, somatosensory pathways and vision can be found, such as degenerative alterations, reduced number of cells and receptors and an accumulation of lipofuscin. Disorders of the equilibrium function in old age are individual-specific, complex procedures which develop from age-related physiological, degenerative alterations in the components of the sensomotor system which maintain equilibrium and can come into being together with vestibular and non-vestibular accompanying diseases as well as psychological factors.

Eine 82-jahrige, allein lebende Frau wurde in die Notfall-Ambulanz gebracht, nachdem sie zuhause im Bad gesturzt war und es nicht mehr schaffte, alleine aufzustehen. Erst nach Stunden konnte sie sich bei ihren Nachbarn durch anhaltendes Klopfen bemerkbar machen.

The early assessment of prevalent disability and functional decline is of increasing importance for prevention issues and for the evaluation of change in clinical studies. The assessment of common daily tasks and resulting disability is essential for a complete impression of a patient's capabilities. There are plenty of instruments that cover basic and instrumental activities of daily living by assessing the person's dependence at a specific functional task. However, the early stages of everyday life limitations and functional decline are usually not being captured. In this article we have examined psychometric properties of the German adaptation of the abbreviated "late life function and disability instrument", a promising tool that is capable of capturing early aspects of functional decline and disability.Older Caucasian men and women (Median=82 years) with a wide range of functional status (Short Physical Performance Battery: Median=6, Min.=0, Max.=12) completed the abbreviated version of the LLFDI once (n=173). A subgroup was assessed twice to examine interrater (n=13) and intrarater (n=10) reliability. Cognitive and functional status was assessed at baseline.Internal consistency (Cronbach's ) was acceptable for the personal role and social role of the frequency items of the disability component (0.55 to 0.62) and very good for all other parts of the instrument (0.78 to 0.89) without a significant difference when compared for overall cognitive performance or executive function. Test-retest reliability was very good (0.81 to 0.96) and interrater reliability was acceptable to very good (0.62 to 0.96) with only acceptable results for the limitation items of the disability component. The total scores of the two components did not demonstrate significant floor or ceiling effects and the interview lasted on average 17 minutes (range 8 to 35 min).The German adaptation of the abbreviated version of the "Late Life Function and Disability Instrument" has minimal ceiling and floor effects, acceptable to good internal consistency and interrater reliability, and very good test-retest reliability. Hence, it constitutes an excellent alternative to common self-rating instruments for the assessment of functional capacities in everyday activities.

The observation scale PAINAD (pain assessment in advanced dementia) is composed of five behavioral categories: breathing, vocalization, facial expression, body language, and consolability. The present study investigates the construct validity of the German version.We conducted a prospective one-dimensional observation study with repeated measurements (t(1)=pretreatment, t(2)=2 h posttreatment, t(3)=24 h posttreatment). The sample consisted of 12 verbally noncommunicative demented inpatients with severe comorbidity treated in three geriatric clinics. Their age was M=84.3 years (SD=4.4) on the average. Ten of them were female. Inclusion criteria were pain-related physical illness and observed pain behavior. Every patient was treated with analgesics after t(1). After t(2) the medication was discontinued in five patients until t(3). Nurses documented the PAINAD scores after an observation period of 2 min during routine care.Pain behavior at t(2) diminished considerably displaying a large effect size. Scores continued to be low at t(3) only in the sample with continued medication. Scores in the other part of the sample returned to initial values.The data demonstrate that pain medication strongly impacts the pain behavior of demented patients. The outcome supports the assumption that PAINAD really measures pain.

Objective: To investigate the correlation between objective and subjective evaluation of patients with total hip replacement. Design: Prospective preliminary trial comparing the Western Ontario and McMaster University questionnaire (WOMAC) and gait analysis preoperatively and three months postoperatively. Setting: A German academic orthopaedic centre specializing in total hip replacement surgery. Subjects: Seventeen patients (median age 70 years) with hip osteoarthritis. Intervention: All patients had had a primary unilateral total hip replacement. Main measures: WOMAC questionnaire to assess self-perceived health status and gait analysis to determine objective gait parameters. Results: Performance of walking as well as subjective judgement of health status improved following surgery (gait speed P = 0.0222; stride length P = 0.038; stance phase ratio P = 0.0466; WOMAC P < 0.0001). However, the correlation between gait parameters and WOMAC was poor ( r = -0.27 or less). Correlation between changes of walking parameters and WOMAC was bad to good ( r = 0.01 to r = -0.72). Conclusion: The WOMAC questionnaire might not reflect walking performance. The addition of gait analysis is recommended to gain objective information about the quality of gait.

A primary goal of pain treatment in geriatric patients is the maintenance of physical and mental functions. This is a precondition for activity and participation. In patients with chronic pain, multidisciplinary treatment, without excluding invasive procedures, is the most effective approach. The medication ladder, initially suggested by the WHO for cancer pain, provides a guideline for pharmacological treatment. Due to age-dependent alterations in the kinetics and dynamics of pharmaceuticals, the titration of the medication follows the rule "start low-go slow". The same principle holds true for the maintenance or augmentation of physical activity in order to escape from the activity-deconditioning cycle. Training should be based on learning theories, include pain management strategies, and incorporate psychological approaches to facilitate the active participation of the patient in the treatment program. In hospitals and nursing homes, nurses play an important role in defining the need for pain treatment and in supervising the patient in the treatment process. Despite these endeavours, a significant number of patients remain whose pain cannot be controlled sufficiently. Euthanasia on demand for a patient with untreatable pain is not admitted in Germany.

Surgical treatment, discharge planning and rehabilitation procedures are rarely based upon defined assessment procedures. It might therefore be useful to develop simple and reliable screening tools to identify patients for early discharge, intensified rehabilitation and limited treatment.234 patients were initially contacted. From these 217 gave informed consent. The reported study included the 134 home dwelling elderly. All patients could be contacted or died after six month. Thus,data from more than 90% could be used for the analysis. The six month mortality was 10%. A population based cohort of elderly patients referred to five local hospitals was tested. Mortality, institutionalisation and mobility were defined as major outcome criteria. Only information that was available during the first week of treatment was used in the model. Predictors expressed as odd ratios (OR) were calculated using logistic regression with variable selection.The most important predictors for institutionalisation were age, inability to eat without assistance, postoperative night time confusion, stroke history, cognitive deficit and fear of falling. Outdoor mobility was strongly associated to the preoperative ADL performance measured as the Barthel-Index, history of malignancy and fear of falling. Six month mortality was associated with male sex, the Barthel-Index and fear of falling.It seems feasible to improve postoperative resource allocation by predictor led stratification. This need to be tested in intervention trials under the specific condition of the German health care system.

For a dietary anti-aging concept that "gives life to years and adds years to life" we recommend a low-fat, carbohydrate and fiber-rich diet containing plenty of fruits and vegetables and moderate amounts of protein (in particular of vegetable origin). Prolonging the fasting state by cancelling dinner is also of benefit. Five servings of fruits and vegetables (preferentially red, yellow and green) daily and whole-grain products provide sufficient amounts of vitamins C and E and the provitamin A beta-carotene, as well as secondary phytochemicals. Also to be recommended are low-fat dairy products, fish once or twice a week, little meat and eggs, and a maximum of 4-8 fl oz (1/8 to 1/4 liter) of red wine per day.

The main objective of the study was to examine the prevalence of problems and resources of an unselected cohort of nursing home residents. The sample includes residents (n=769) of an urban area in Southern Germany. The assessment definitions were used according to the Minimum Data Set of the Resident Assessment Instruments (Version 2.0).The mean age was 84.2 years, 608 of the residents were female. Dementia (446) and stroke (185) were the most common main diagnosis. Syndrome prevalences are reported for depressive symptoms (323), mobility impairments (608), urinary incontinence (461), decubitus (54), use of restraints (54), disruptive behavior (185), psychopharmacy (377), severe visual impairment (123) and severe hearing impairment (123).

In old age, assessment of pain often is hampered by sensory and cognitive deficits that do not allow the patients to fill in standardized questionnaires without help from significant others. Therefore, as an alternative, we developed a structured pain interview, and examined its properties and acceptance in a sample of geriatric patients with pain.The interview covers site of pain, intensity of pain, its duration and persistency, pain related disability and, finally, emotional and cognitive variables. In addition, the interviewer addresses significant others to get information about medication, previous treatment, and residence, and administers the Mini-Mental-State-Examination (MMSE). The analysis includes 128 patients of pain centers older than 74 years, of whom 80% are female.Forty percent of the subjects score below the critical MMSE valueor =23 indicative of cognitive impairment. These patients are responsible for 36 out of a total of 39 missing values. A significant increase of missing values is observed in patients with a MMSE score below 10. Cognitive impairment goes along with greater functional and social disability. On the other hand, cognitive impairment is unrelated to localization, intensity, and duration of pain. The memory item of the MMSE can be used as a screening tool for cognitive impairment. Patients, who are unable to recall any of the three objects, comprise 80% of the total of missing values and demonstrate a low MMSE score.As long as geriatric patients are able to communicate verbally, they are most likely to profit from the structured pain interview in spite of existing cognitive impairment. A MMSE score10 indicates that the interpretation of the data obtained may be difficult, especially due to a high frequency of missing values.

In comparison with younger patients, the elderly are at an appreciably higher risk of contracting an infectious disease. Such infections can be prevented or ameliorated by appropriate vaccination, in particular in the case of pneumococcal pneumonia, influenza and tetanus. Older individuals may have an attenuated response to immunization, presumably because of inadequate thymus gland function and the weakening of cell-mediated immunity and, secondarily, of the humoral immune response to antigens. Studies have shown that the immunization rate among the elderly in Germany is inadequate; this applies in particular to the high-risk population living in nursing homes. Campaigns aimed at increasing awareness of the need for immunization are therefore urgently required.

Most geriatric assessment instruments have been developed in the English language. Translated versions might differ in their psychometric properties. We analyzed the test-retest reliability and internal consistency of a German instrument for multidimensional geriatric assessment that was based on a newly developed English version. A group of 100 over 75-year-old community-dwelling persons (mean age 83.0 years, 81% women) in Hamburg (n = 26) and Ulm (n = 51), Germany, and Berne (n = 23), Switzerland was interviewed twice by the same trained interviewers with a one week interval. We administered questions on general health, chronic disorders, basic and instrumental activities of daily living, urinary incontinence, nutrition, falls, pain, the social support/network and preventive care measures. In addition, the Functional Status Questionnaire, the Physical Activity Scale for the Elderly, the Geriatric Oral Health Assessment Index, the Visual Function Questionnaire, the Hearing Handicap Inventory for the Elderly and the Geriatric Depression Scale were administered. Cohen's kappa was good to excellent (0.64or = kappaor = 0.89) with only three exceptions (pain questions, kappa = 0.53; questions on preventive care services, kappa = 0.51; and one of the questions on recent falls, kappa = 0.44). Cronbach alpha (internal consistency) was good to excellent for all domains (0.76or = alphaor = 0.95). The study results confirm good test-retest reliability of the German version of this multidimensional geriatric assessment instrument. Adapted versions of this instrument can be used for different purposes, e.g., preventive home visits, outpatient geriatric assessments or epidemiological studies in older persons.

Comprehensive geriatric assessment was developed in the Anglo-American countries as a diagnostic process to better understand the effects of diseases and interactions of multiple chronic conditions. To standardize the use of assessment instruments, a working group of the two German geriatric societies has elaborated recommendations. As the first step, an expanded version of the screening according to Lachs should be used, followed by performing the Barthel-ADL, the Mini-Mental State Examination, the Geriatric Depression Scale, the 'Timed Up and Go' and the (Semi-) Tandem Stance. The expanded version of the screening of Lachs is helpful for targeting patients and for placement; the others are not useful for that purpose. No instrument satisfactorily fulfills all test criteria, which include validity, reliability, sensitivity, practicability and repeatability, and, in part, these dimensions are not investigated at all. All test instruments are diagnostic tools for functional status and capabilities but do not give information about resource needs. No instrument covers the new concept of ICIDH completely.

Some 25-50% of all elderly persons living at home suffer from chronic pain. Among nursing home residents, the figures are appreciably higher, ranging between 45% and 80%. The major causes of pain in old age are degenerative joint disease, lower back pain, cancer, osteoporosis and herpes zoster, polymyalgia rheumatica, and arterial occlusive disease. In many cases, chronic pain goes undiagnosed and is not properly treated. When a correct diagnosis is established, however, it is almost always possible to achieve adequate pain relief by a combination of non-drug treatment and analgesics, and thus to improve the patient's quality of life.

Nursing homes are important, but often neglected, facilities for the care of frail older people. The demand for nursing home capacity in Germany will continue to increase over the next decade despite improvements in infrastructure of home care and day care centers. The leading medical reason for this is the growing number of elderly persons suffering from neurodegenerative diseases, depression, and stroke. Currently, more than 650,000 residents are in various forms of institutionalized care in Germany. To date, the medical profession has shown little interest in establishing an efficient medical care system for such patients, nor are care-providing physicians required to undergo special training in Germany. The article describes current practice and future principles of geriatric treatment.

In Germany the implementation of specialized wards for the care of stroke patients is proposed. However, which type of organized inpatient stroke unit care is most effective and which group of patients will benefit most remains unclear.Based on the analyses of the Stroke Unit Trialists' Collaboration this paper reports results of randomized and quasi-randomized trials that compared organized inpatient (stroke unit) care with contemporary conventional care. The primary analyses examined death, dependency and institutionalization. Secondary outcome measures included patient quality of life, patient and carer satisfaction and length of stay in hospital and/or institution.The analysis of twenty trails with 3864 patients showed a reduction in the rate of deaths in the stroke unit group as compared with the control group (OR 0.83, 95% CI 0.71-0.97). The odds of death or institutionalized care were lower (OR 0.76, 95% CI 0.65-0.90) as were death or dependency (OR 0.75, 95% CI 0.65-0.87). The results were independent of patient age, sex, stroke severity, and type of stroke unit organization.Organized care in stroke units resulted in benefits for stroke patients with regard to survival, independence, and probability of living at home. However, these results refer exclusively to Anglo-American and Scandinavian trials. German stroke unit services are organized in a different way. No data about the effectiveness of the German model is yet available.