Geriatric intensive care patients. Perspectives and limits of geriatric intensive care medicine

Critically ill geriatric patients are vitally endangered due to the aging processes of organs, the frequently existing multimorbidity with subsequent polypharmacy and the typical geriatric syndrome of functional impairments. Aging processes in organs lower the clinical threshold for organ dysfunction and organ failure. Physiological organ aging processes with practical consequences for intensive care medicine are atypical manifestion of sepsis in immunosenescence, altered pharmacokinetics, reduced tolerance to hypovolemia due to proportionally reduced water compartment of the body in old age, the frequently only apparently normal function of the kidneys and the continuous reduction in pulmonary function in old age. The main reasons for changes in therapeutic targets are the will of the patient and risk-benefit considerations. The guidelines of the ethics section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) provide assistance and suggestions for a structured decision-making process

Influence of Music Therapy and Music-based Interventions on Dementia: A Pilot Study

According to national dementia plan in many countries, the music implementation into the daily routine as an adjunctive therapy to medication treatment is common. However, the ability of long-term care facilities to implement individualized music therapy (MT) and music-based interventions is not sufficiently taken into account. This pilot study examined the frequency of use and acceptance of MT and technology-based music interventions (TBMI) as well as the influence of high and low usage of both interventions of dementia on behavioral and psychological symptoms (BPSD) at two timepoints. Furthermore, the influence on the combination of MT and TBMI of dementia within the nursing home setting on BPSD with a focus on agitation, apathy, depression, and quality of life at all timepoints was considered. In the present study, data from 30 people with dementia (PwD) aged on average 81 years were analyzed within an eight-week noncontrolled intervention study, including four-week follow-up. Initial outcome data indicated significant decreases at times T2 and T3 in agitation and apathy among PwD with a high usage of MT and TBMI than among those with a low usage. In general, reductions were obtained from all observed BPSD at all timepoints. Significant results were found only for agitation over time. Considering the demonstrated results, a long-term implementation of music within daily routines in nursing homes for PwD should be strived for

Dry skin in home care : a representative prevalence study

Aims and objectives: To measure the prevalence and severity of dry skin in the home care nursing setting in Germany and to determine demographic and health characteristics associated with skin dryness. Background: Advanced age and skin care dependency are risk factors for the development of skin dryness. Dry skin has a negative impact on the quality of life and increases the risk for secondary cutaneous infections and other adverse skin conditions. The prevalence of dry skin in home care is unknown. Design: A representative multicenter prevalence study was conducted in home care services in Germany during July 2015. Methods: A random selection of home care services and clients was performed. Nurses, who were instructed how to perform the data collection using standardized forms, performed data collection. Demographic, functional and health variables were documented and analyzed. Results: More than half of all participating clients (n = 923; median age 83 years (range 21-104)) were affected by dry skin (51.7 (95% CI 48.5 to 54.9). The most often affected skin areas were the distal extremities. Males and immobile clients were more often affected than females and mobile clients. In the adjusted analysis pruritus and the presence of incontinence-associated dermatitis were most strongly associated with dry skin. Conclusion: Dry skin occurs widely in home care and is strongly associated with pruritus. Fundamental skin care is an easy but powerful nursing intervention to treat this condition successfully. Preventive skin care strategies need to be implemented in the home care setting to improve skin health and integrity either by nurses and/or informal caregivers

Role of LDL receptor-related protein (LRP) in coronary atherosclerosis

The development and progression of coronary atherosclerosis is influenced by a variety of genetic and environmental factors. Among the genetic factors, the cell surface receptor LRP/A2MR (LDL receptor-related protein/alpha2- macroglobulin receptor) was shown to be involved in a variety of biological processes leading to atherosclerotic plaque formation. That is why the individual expression of this receptor may, therefore, be considered as an evident predictor for coronary atherosclerosis. In this clinical ex vivo study the expression was measured by competitive RT-PCR and macroarray analysis in native monocytes. Both methods were first tested in an in vitro model using different human cells and cell lines (fibroblasts: chorion, skin; endothelial cells from umbilical cord vein; monocyte cell line: Mono-Mac-6): after stimulation with an LRP/A2MR ligand, leptin, the anticipated direct effect of this ligand, namely an increase in both receptor mRNA and protein expression, was confirmed. In disease-related ex vivo studies the mRNA and protein-expression of LRP/A2MR was investigated in 36 male patients suffering from myocardial infarction. In comparison to the control group (36 healthy male blood donors), a significant up-regulation of mRNA was detected in the myocardial infarction patient group (control: 122.3 ag/cell versus patients: 223 ag/cell; P<0.001). Investigating the LRP/A2MR protein expression a significant down-regulation of protein expression was determined in the patient group (control: 6 pg/cell versus patients: 1.6 pg/cell; P<0.001). The ratio of LRP/A2MR mRNA and protein expression is obviously an evident marker for coronary atherosclerosis, recommendable for the assessment of the individual coronary risk profile