Welche Coping-Strategien und Ressourcen tragen zur Erhaltung der Lebenszufriedenheit bei Geriatriepatienten bei?

Hintergrund: Aufgrund der zunehmenden Anzahl alter Menschen in der Bevölkerung, legte die bisherige gerontologische Forschung ihren Fokus hauptsächlich auf einzelne Faktoren, die erfolgreiches Altern gewährleisten sollen, wodurch alte Menschen mit altersbedingten Beeinträchtigungen weniger Berücksichtigung fanden. In Anbetracht der erhöhten Wahrscheinlichkeit mit dem Alter physische und kognitive Beeinträchtigungen zu erleiden, kommt der Erforschung präventiver Maßnahmen, die zur Erhaltung der Lebenszufriedenheit im hohen Alter beitragen, eine wesentliche Bedeutung zu. Daher richtet sich die Aufmerksamkeit in dieser Arbeit auf Coping-Strategien und Ressourcen, die zur Erhaltung der Lebenszufriedenheit bei Menschen mit altersbedingten Beeinträchtigungen und Einbußen beitragen. Ziel: Das Ziel dieser Studie stellte die Erforschung einzelner Coping-Strategien und Ressourcen hinsichtlich ihres Beitrags an der Erhaltung der Lebenszufriedenheit bei Menschen mit altersbedingten Beeinträchtigungen dar. Methode: Um die Höhe der Lebenszufriedenheit, als auch den Einfluss präventiver und proaktiver Coping-Strategien und einzelner Ressourcen auf die Lebenszufriedenheit zu untersuchen wurden 41 Bewohner des Geriatriezentrums Donaustadt und 43 Personen, welche zuhause leben und diverse Hilfsdienste in Anspruch nehmen mithilfe eines standardisierten Fragebogens interviewt. Ergebnisse: Die gefundenen Resultate zeigen, dass sich Geriatriebewohner und Personen die zuhause leben in der Höhe der Lebenszufriedenheit nicht unterscheiden. Hinsichtlich angewandter Coping-Strategien und Ressourcen zeigte sich ein signifikanter Einfluss beider Konstrukte auf die Lebenszufriedenheit, wobei ein stärkerer Einfluss von präventiven als proaktiven Coping-Strategien auf die Lebenszufriedenheit beobachtet wurde, als auch, dass persönlichkeitsbezogene Ressourcen einen höheren Einfluss auf die Lebenszufriedenheit zeigen als umweltbezogene und soziale Ressourcen. Konklusion: Die Höhe der Lebenszufriedenheit bei Geriatriepatienten unterscheidet sich nicht von jener der Personen, welche zuhause leben und Hilfsdienste in Anspruch nehmen. Präventive Coping-Strategien und vorhandene persönlichkeitsbezogene Ressourcen zeigen einen signifikanten positiven Einfluss auf die Höhe der Lebenszufriedenheit und können daher als signifikante Prädiktoren für die Lebenszufriedenheit angenommen werden.Background: Based on the increasing older population previous research has mainly focused on several aspects leading to sucessfull aging, without paying regard to the needs of older people who suffer from physical, cognitive and social losses. Since these age-related losses become more probable with increasing age and possibly influences older people´s life satisfaction, their is a need for its prevention. Aim: This study aimed at investigating coping-strategies and several resources which show an influence on life satisfaction and account for its preservation. Method: On the Basis of a questionaire structured interviews were conducted with 41 older people living in a nursing home and 43 people living in private households who were receiving home care services concerning their live satisfaction, use of coping-strategies and available resources. Results: The study found that people who live in a nursing home and people living in private households show a relatively high life satisfaction and there were no between group differences (distinctíon) found. Concerning coping-strategies and resources a significant effekt was found for both constructs, whereupon preventive coping-strategies show a stronger impact on life satisfaction than proactive coping strategies. Furthermore internal resources where more related to a higher level of life satisfaction than external ones. Conclusion: Life satisfaction in older people living in nursing homes and older people living in private households was relatively high and there were no differences found between those two groups.Preventive coping-strategies and internal resources show a significant influence on the level of life satisfaction and can be assumed as predicting live satisfaction in older people

Multivalvular Disease: Percutaneous Management in 2019 and Beyond

Patients with multivalvular disease (MVD) are common and often present with heterogeneous valve defects. Evaluation is complicated by interactions among various valve pathologies. Trials and guidelines focus primarily on single-valve disease, providing few recommendations for the treatment of patients with MVD. This article provides an insight into percutaneous treatment possibilities for this heterogeneous patient population

Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve

OBJECTIVE We aimed to analyse the incidence of prosthesis-patient mismatch (PPM) and elevated gradients after aortic valve in valve (ViV), and to evaluate predictors and associations with clinical outcomes of this adverse event. METHODS A total of 910 aortic ViV patients were investigated. Elevated residual gradients were defined as ≥20 mm Hg. PPM was identified based on the indexed effective orifice area (EOA), measured by echocardiography, and patient body mass index (BMI). Moderate and severe PPM (cases) were defined by European Association of Cardiovascular Imaging (EACVI) criteria and compared with patients without PPM (controls). RESULTS Moderate or greater PPM was found in 61% of the patients, and severe in 24.6%. Elevated residual gradients were found in 27.9%. Independent risk factors for the occurrence of lower indexed EOA and therefore severe PPM were higher gradients of the failed bioprosthesis at baseline (unstandardised beta -0.023; 95% CI -0.032 to -0.014; P<0.001), a stented (vs a stentless) surgical bioprosthesis (unstandardised beta -0.11; 95% CI -0.161 to -0.071; P<0.001), higher BMI (unstandardised beta -0.01; 95% CI -0.013 to -0.007; P<0.001) and implantation of a SAPIEN/SAPIEN XT/SAPIEN 3 transcatheter device (unstandardised beta -0.064; 95% CI -0.095 to -0.032; P<0.001). Neither severe PPM nor elevated gradients had an association with VARC II-defined outcomes or 1-year survival (90.9% severe vs 91.5% moderate vs 89.3% none, P=0.44). CONCLUSIONS Severe PPM and elevated gradients after aortic ViV are very common but were not associated with short-term survival and clinical outcomes. The long-term effect of poor post-ViV haemodynamics on clinical outcomes requires further evaluation

VARC endpoint definition compliance rates in contemporary transcatheter aortic valve implantation studies.

AIMS The Valve Academic Research Consortium (VARC) endpoint definitions were established to standardise the reporting of clinical outcomes following transcatheter aortic valve implantation (TAVI). It remains unclear, however, to what extent and in which manner these definitions are applied. Therefore, we sought to investigate the utilisation and adherence to VARC guidelines since their introduction in 2011 across peerreviewed TAVI-related publications. METHODS AND RESULTS We performed a systematic literature review to identify TAVI-related manuscripts published between February 2011 and February 2014. Manuscripts were categorised into three groups: a "compliant" group of manuscripts using only VARC-defined endpoints, a "non-compliant" group of manu scripts with only non-VARC-defined endpoints, and a "mixed compliant" group of manuscripts with both VARC- and non-VARC-defined endpoints. Multivariate analyses were performed to identify predictors of VARC use. Among 5,023 published manuscripts, 498 were included in the final analysis. At least one VARC definition was used in 275 (54%), while 223 (43%) did not use any VARC definitions. After publication of the first VARC manuscript (VARC-1, January 2011), VARC use increased from 31% (n=15) at six months to 69% (n=84) at 36 months. Following the publication of VARC-2 (October 2012), VARC-1 use declined (from 58% [n=47] to 36% [n=24]), while VARC-2 use increased from 4% (n=3) at six months to 35% (n=23) at 18 months. Of the manuscripts using VARC, 49 (10%) were classified as compliant and 226 (46%) as mixed compliant. The following endpoints were more often defined using VARC vs. non-VARC: myocardial infarction (64% vs. 36%); stroke (56% vs. 44%); bleeding (79% vs. 21%); vascular complications (70% vs. 30%); acute kidney injury (63% vs. 37%); reintervention (67% vs. 33%); and composite endpoints (52% vs. 48%). Mortality, valve dysfunction, TAVI-related complications, and quality of life were more often defined using non-VARC criteria. CONCLUSIONS Implementation of VARC criteria in peer-reviewed manuscripts has increased over time. There remain, however, a considerable number (43%) of publications that do not report outcomes according to VARC. These data will inform the future development of VARC criteria

Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve

Objective We aimed to analyse the incidence of prosthesis-patient mismatch (PPM) and elevated gradients after aortic valve in valve (ViV), and to evaluate predictors and associations with clinical outcomes of this adverse event. Methods A total of 910 aortic ViV patients were investigated. Elevated residual gradients were defined as >= 20mm Hg. PPM was identified based on the indexed effective orifice area (EOA), measured by echocardiography, and patient body mass index (BMI). Moderate and severe PPM (cases) were defined by European Association of Cardiovascular Imaging (EACVI) criteria and compared with patients without PPM (controls). Results Moderate or greater PPM was found in 61% of the patients, and severe in 24.6%. Elevated residual gradients were found in 27.9%. Independent risk factors for the occurrence of lower indexed EOA and therefore severe PPM were higher gradients of the failed bioprosthesis at baseline (unstandardised beta -0.023; 95% CI -0.032 to -0.014; P<0.001), a stented (vs a stentless) surgical bioprosthesis (unstandardised beta -0.11; 95% CI -0.161 to -0.071; P<0.001), higher BMI (unstandardised beta -0.01; 95% CI -0.013 to -0.007; P<0.001) and implantation of a SAPIEN/SAPIEN XT/SAPIEN 3 transcatheter device (unstandardised beta -0.064; 95% CI -0.095 to -0.032; P<0.001). Neither severe PPM nor elevated gradients had an association with VARC II-defined outcomes or 1-year survival (90.9% severe vs 91.5% moderate vs 89.3% none, P=0.44). Conclusions Severe PPM and elevated gradients after aortic ViV are very common but were not associated with short-term survival and clinical outcomes. The long-term effect of poor post-ViV haemodynamics on clinical outcomes requires further evaluation