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M Borchelt

Publications and source records attributed to M Borchelt.

At least 19 recordsLinked to original sources
PubMed2006

[Patient satisfaction and geriatric care - an empirical study].

Patients' satisfaction has become a central concept in quality assurance. Despite progress in research in this area is still a lack of data for geriatric patients. Referring to the consumer model, satisfaction can be described as a difference between expectations and assessed performance. The aim of this study is to analyze satisfaction among geriatric patients in an in-patient setting. A personal interview was performed 1-2 days before discharge. Patients suffering for dementia or with problems to communicate were excluded. 124 of 268 geriatric patients who were discharged in 2003 were included (inclusion rate 46.3%). 119 were willing to participate (response rate 96.0%). Respondents were between 61 and 96 years old, 39% were male and 42% had serious functional limitations at time of admission. Multiple linear regression analysis revealed three significant predictors of a combined index of satisfaction and expectations: a) quality of hotel services; b) experience of neglect; c) provision of medical information and skills. In summary, standardized personal questionnaires can provide valid and reliable data of geriatric patients. Satisfaction of elderly patients is negatively affected by neglect and positively influenced by provision of medical information and a good hotel services.

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PubMed2005

[Important aspects of geriatric pharmacotherapy].

Drug prescription for geriatric patients is one of the most prevalent yet also one of the most difficult interventions in geriatrics. Although this article focuses solely on specific important aspects of geriatric pharmacotherapy, medication in clinical practice is only one type of geriatric intervention that needs to be embedded in a well-coordinated bundle of multidimensional interventions addressing functional and psychosocial aspects alike. Not every older patient is per se a geriatric patient, nor is each geriatric patient per se of very old age. Therefore, this article initially proposes a clinical definition of the geriatric patient before summarizing the most significant physiological age changes affecting pharmacokinetics and pharmacodynamics as well as summarizing the most prevalent risks associated with the age-correlated increase in multiple drug use in order to describe the background from which general principles of geriatric pharmacotherapy have evolved. The quality of geriatric pharmacotherapy must not only be determined by avoidance of any kind of over medication, but also by the avoidance of under medication as well as the avoidance of inappropriate drugs for elderly patients. Treatment failures do not only result from mere polypharmacy, but can also be due to under utilization of drugs as well as due to the prescription of inappropriate medications. In fact, the problem of under medication in certain age-correlated diseases (e. g. depression, dementia, pain) has rarely been addressed systematically in clinical or epidemiological studies until now. In order to improve quality and safety of geriatric pharmacotherapy, a group of experts in the field developed a set of explicit age-adjusted criteria for potentially inappropriate drugs in 1991. These criteria have been regularly updated thereafter until 2003 and focus on age-related aspects of specific drugs and dosages as well as on co-morbid states and co-medications. As long as geriatric patients are rarely included in clinical trials on drug effectiveness and drug safety, these criteria should be applied and used in clinical practice at least to identify any demand for a detailed explicit justification of a therapeutic decision not in line with the explicit criteria in order to enhance safety of drug treatment in geriatric patients.

Age Factors↗
PubMed2002

[Agreement on the Barthel Index. A rapid analysis of other and self-assessment in elderly stroke patients].

The relationship between staff and patient ratings of activity restrictions (Barthel Index, BI) was investigated in 120 elderly stroke patients (on average 78 years old) using the Rasch model and the rating scale analysis. In addition, the relationship between the rated activity restrictions and measures from the Geriatric Assessment was analyzed. We found good patient-staff agreement (r = 0.90) with the poorest agreement in the item "bathing" of the BI. There was also a highly significant correlation between staff and patient ratings and the Tinetti Gait and Balance Scales (r = 0.72 and r = 0.76, respectively). Correlations between other measures of the Geriatric Assessment and the rated activity restrictions were low explaining less than 8% of variance. Our findings merit the use of patient ratings of activity restrictions in stroke outcome research. However, self-ratings of activity restrictions were measured by an unstructured interview and it cannot be ruled out that this method had an influence on the correlation between self-rating and staff rating.

Activities of Daily Living↗
PubMed2002

[Primary and secondary prevention in dyslipidemia in the elderly].

Cardiovascular disease (CVD) is the leading cause of mortality and a major cause of disability in advanced age. The relationship between coronary heart disease (CHD) and dyslipoproteinaemia is well known. The fact, however, that atherosclerosis is a systemic disease leads also to the consideration that patients suffering from cerebrovascular and peripheral arterial disease should benefit similarly from lipid lowering therapy as do patients with CHD. There is already growing evidence that the incidence of stroke may be markedly decreased by statin therapy. Though overall, the clinical significance of hypercholesterolaemia seems to decrease with increasing age, patients at age 65 to 75 tend to benefit even more than younger patients when elevated LDL-cholesterol is treated effectively. It should be noticed that prevention or postponement of cardiovascular events may also prevent premature functional limitations and disability in old age. Hence, it is suggested to screen elderly people with CVD for dyslipoproteinaemia and to treat elevated cholesterol levels by means of life style changes, nutritional therapy, and drug therapy. Treatment regimes should be considered depending upon complete risk stratification and geriatric assessment. Chronological age alone cannot be an argument to withhold a proven effective therapy from a growing segment of the population at risk.

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PubMed2002

[Telereha--special challenges for telemedicine in geriatric rehabilitation].

Modern telecommunication technology has the potential to improve the quality of life for elders with physical and mental impairments as well as for their caregiving relatives. This can be viewed as an opportunity to establish and maintain instant and personalized access to various medical services in a situation where increasing needs are opposed to decreasing resources. However, it is not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Results of a tele-rehabilitation project ("TeleReha", conducted at the Berlin Geriatric Center) which comprised mobility-impaired patients caregiving relatives and geriatric professionals, showed that participants regard telecommunicational and communicational needs.

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PubMed2001

[Ambulatory geriatric rehabilitation--assessment of current status and prospects].

Clinical geriatrics in Germany has evolved remarkably since 1990, when first concepts had been developed for establishing structures and facilities for the ambulatory rehabilitation of geriatric patients. However, achievements during the last 10 years were made only for inpatient geriatrics and geriatric day clinics. Geriatric outpatient rehabilitation (GOR) is still a "missing link" in the networked care for elderly patients in Germany and remains until today in a planning phase. The article is aimed at describing the current organisational status of geriatric rehabilitation in Germany and focuses on the question of where and how to fit in geriatric outpatient rehabilitation. Distinction criteria between the different types of geriatric rehabilitation as well as indications, goals, and organisational aspects of GOR are discussed.

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PubMed2000

DHEA-S plasma levels and incidence of Alzheimer's disease.

BACKGROUND: Cross-sectional studies controlling for age and gender reported a relationship between Alzheimer's disease and low dehydroepiandrosterone sulphate (DHEA-S) plasma levels. Prospective data with sufficient control for confounding factors are lacking. METHODS: A nested case-control study examined baseline DHEA-S in participants of the Berlin Aging Study. Cases (n = 14) developed dementia of the Alzheimer type within 3 years. Control group A (n = 14) was matched for gender, age, multimorbidity, and immobility. Control group B (n = 13) was matched for gender and age and comprised participants free from multimorbidity, immobility, multimedication, need of help, incontinence, visual impairment, hearing impairment, and depression. RESULTS: The mean plasma DHEA-S concentration of case subjects was 1.02 +/- 0.61 mumol/L. Both control groups had higher mean DEHA-S levels, in control group A, it was 1.89 +/- 1.24 mumol/L (p = .012) and in control group B 1.70 +/- 1.38 mumol/L (p = .093). CONCLUSIONS: This population-based prospective study supports the role of DHEA-S as a risk factor for Alzheimer's disease.

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PubMed2000

[Telematics in geriatrics--potentials, problems and application experiences].

Modern telecommunication technology (telematics) has the potential to improve the quality of life for elders with physical and mental impairments as well as for their care giving relatives. Videophones, internet resources, and multimedia computers can be used for networking them together with social workers, nurse practitioners, physicians and therapeutic staff in service-centers. This can be viewed as a unique opportunity to establish and maintain instant and personalized access to various medical services in a situation where increasing needs are opposed to decreasing resources. However, it is not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Some studies already showed its applicability and feasibility, but there are still no larger trials showing that maintenance or enhancement of autonomy can be achieved effectively by using new technologies. This article reviews the literature on telematics in geriatrics and presents data of a tele-rehabilitation project ("TeleReha", conducted at the Berlin Geriatric Center) which comprised mobility-impaired patients (N = 13, mean age 72 yrs), care giving relatives (N = 8), and geriatric professionals. Networking was established using ISDN technology with videophones or PC-based videoconferencing systems. Results showed that participants regard telecommunication devices as a valuable resource for their informational and communicational needs. Use of telecommunication systems was inversely related to physical mobility. Having access to professional service and counselling was rated highly important but also the opportunity to establish reliable contacts with non-professionals (relatives, other participants). Despite experienced technical problems, use of telecommunication systems was evaluated more positively in the post-test as compared to the pre-test. In summary, current experience suggests that telematics can be used efficiently by geriatric patients and by relatives and professionals caring for them. However, evidence for a medically and economically effective use is still scarce. A lack of structural and organizational concepts for geriatric telematics initiatives can be identified which in part may be due to the fact that the considerable potentials of telematics applications are still largely unrecognized by geriatricians.

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PubMed2000

Carotid atherosclerosis, vascular risk profile and mortality in a population-based sample of functionally healthy elderly subjects: the Berlin ageing study.

OBJECTIVES: Studies on extracranial carotid atherosclerosis have predominately been undertaken on middle-aged subjects. This study examines the prevalence of extracranial carotid atherosclerosis, its relation to vascular risk factors and its significance for survival in elderly subjects. DESIGN: Population-based cross-sectional survey. Non-modifiable vascular risk factors examined were family history of atherosclerotic disease, sex and apolipoprotein E (apoE) genotype. Potentially modifiable risk factors assessed were smoking, fibrinogen, fasting lipids, body mass index, hypertension and diabetes. SETTING AND SUBJECTS: Two hundred and twenty-five functionally healthy volunteers of the Berlin Ageing Study, aged 70-100. MAIN OUTCOME MEASURES: Presence of carotid stenosis and plaque ascertained by ultrasound imaging; 5-year mortality. RESULTS: At least one plaque was found in 144 (64%) of the volunteers; 34 (15%) had a stenosis over 50%; and nine (4%) had a stenosis over 75%. Total cholesterol > 6.5 mmol L-1, LDL cholesterol > 4.6 mmol L-1 and total cholesterol/HDL cholesterol ratio > 5 were significantly associated with presence of plaque in 70- to 80-year-old subjects, as was diabetes in subjects over 80 years. Log-linear analyses showed significant three-way interactions for high LDL cholesterol and diabetes with plaques and age. Family history, sex, apoE genotype, smoking and fibrinogen were not related to presence of plaque in the study population. Cox regression analysis revealed increased 5-year mortality rates for subjects with plaques (OR = 2. 88; 95% CI = 1.30-6.35), whereas the vascular risk profile was not associated with mortality. CONCLUSIONS: In a population-based sample of functionally healthy elderly subjects, the significance of the vascular risk profile seemed to be diminished. It had no impact on survival and only modifiable risk factors showed an age-dependent association with carotid disease.

Age Factors↗
PubMed2000

Ventilatory capacity and risk for dementia.

BACKGROUND: Previous studies have found a relationship between single indicators of ventilatory capacity and measures of cognitive function, but have not addressed dementia specifically. This study examined the relationship between different indicators of ventilatory capacity and dementia, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, controlling for important confounding factors. METHODS: Cross-sectional data on participants (n = 437) of the Berlin Aging Study (BASE), which are representative of former West Berlin's living population aged 70 years and older, were analyzed. Ventilatory capacity was measured by spirometry as peak expiratory flow rate (PEF-R), forced expiratory volume in 1 second (FEV-1), maximal expiratory flow at 50% of forced vital capacity (MEF50%FVC), and maximal expiratory flow at 25% of forced vital capacity (MEF25%FVC). Odds ratios (OR) for dementia associated with ventilatory capacity were obtained by logistic regression, adjusting for age, gender, education, ApoE4 status, chronic obstructive pulmonary disease, smoking, heart failure, visual and auditory functioning, grip strength, and former physical activity. RESULTS: Separate analyses for PEF-R, FEV-1, MEF50%FVC, and MEF25%FVC revealed significantly increased odds for dementia among subjects in the lowest compared with the best functioning group in ventilatory testing. The OR associated with PEF-R > or = 2 l/s was found to be 20.4 (confidence interval [CI] 5.1-82.7). For FEV-1, MEF50%FVC, and MEF25%FVC ORs of 7.5 (CI 2.1-27.9), 4.3 (CI 1.5-12.5), and 4.7 (CI 1.3-17) were obtained, respectively. CONCLUSIONS: Ventilatory capacity, measured by spirometry in a representative sample of very elderly people, is cross-sectionally related to dementia. Taking evidence from longitudinal studies into account, this result suggests that decreased respiratory function may increase the risk for dementia, independent from already known risk factors.

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PubMed1999

[The Geriatric Minimum Data Set (Gemidas) of the Federal Association of Clinical Geriatric Facilities e. V. as an instrument for quality assurance in inpatient geriatrics].

BACKGROUND: Geriatric medicine in Germany is faced with an increasing demand for continuous documentation and evaluation of its effectiveness and efficiency. Hence, the Federal Association (FA) of Clinical Geriatric Departments (Bundesarbeitsgemeinschaft der Klinisch-Geriatrischen Einrichtungen e.V.) has funded a working group on improving quality management in geriatrics by developing criteria for quality standards. METHODS: In 1996, the FA working group achieved consensus on the definition of the Geriatric Minimum Data Set (Gemidas) which covered (i) core information about a patient's age, sex, living arrangement, and (ii) basic characteristics of the hospital course such as location prior to admission and past discharge, leading and accompanying diagnoses, newly prescribed technical aids, objective functional status on admission and at discharge (e.g., Barthel Index (BI), Timed Up & Go (TUG), and intensity of professional care (PPR)), as well as subjectively evaluated attainment of treatment goals. This initial report describes the instrument and presents analyses of its feasibility for routine clinical practice and data consistency. RESULTS: Twenty out of 27 hospitals (74%) integrated Gemidas successfully in daily routine, 75% of which (15 hospitals, total n = 10,567 patients) instantaneously collected data on constant numbers of patients per month. Multivariate regression analyses used to decompose variances of the instrument's central indicators (e.g., BI, TUG, PPR) revealed a satisfactory dimensionality and high consistency (e.g., covering 59% of variance in BI with 53% of variance uniquely attributable to patient characteristics), as well as sensitivity to differences between hospitals (e.g., 12% of variance in duration of stay uniquely attributable to hospital differences after controlling for patients' characteristics). CONCLUSION: Gemidas appears to be a feasible quality assurance instrument in geriatrics, suitable for compiling its data into a central registry database, which may then be used for analyses across and between hospitals. However, some modifications are still necessary and more detailed analyses needed, before final recommendations can be made.

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PubMed1997

In an epidemiological sample the apolipoprotein E4 allele is associated to dementia and loss of memory function only in the very old.

The apolipoprotein E4 allele has been reported to be associated with late onset Alzheimer's disease. Here we report the relation of several neuropsychological test parameters and the diagnosis of dementia to the apolipoprotein E polymorphism in an epidemiological sample of 477 subjects aged 70-103 years. The apolipoprotein E4 allele was found to be associated with reduced performance in several sensitive neuropsychological memory tests and with diagnosis of dementia only in the oldest subjects (> 84 years). The association with dementia in this population based sample was much weaker than previously described and became only significant in a logistic regression analysis when age was included in the model.

Age Factors↗
PubMed1997

[Quality assurance in geriatric rehabilitation--approaches and methods].

It did not take the provisions of the 5th Book of the Social Code for quality assurance issues to gain significance in the field of geriatric rehabilitation as well. While in the surgical specialties, experience in particular with external quality assurance have already been gathered over several years now, suitable concepts and methods for the new Geriatric Rehabilitation specialty are still in the initial stages of development. Proven methods from the industrial and service sectors, such as auditing, monitoring and quality circles, can in principle be drawn on for devising geriatric rehabilitation quality assurance schemes; these in particular need to take into account the multiple factors influencing the course and outcome of rehabilitation entailed by multimorbidity and multi-drug use; the eminent role of the social environment; therapeutic interventions by a multidisciplinary team; as well as the multi-dimensional nature of rehabilitation outcomes. Moreover, the specific conditions of geriatric rehabilitation require development not only of quality standards unique to this domain but also of quality assurance procedures specific to geriatrics. Along with a number of other methods, standardized geriatric assessment will play a crucial role in this respect.

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PubMed1995

The impact of somatic morbidity on the Hamilton Depression Rating Scale in the very old.

The Hamilton Depression Rating Scale (HDRS) is world-wide the most important observer rating scale for depression. Many items of this scale refer to somatic symptoms of depression which cast doubt on the validity of HDRS scores in the presence of somatic comorbidity as, for example, in elderly patients. The present study, therefore, was planned to investigate the validity of the HDRS in cases in which the patient is suffering from a depressive illness together with somatic illnesses. The study population (n = 516) is a representative sample of citizens aged 70 years and older in West Berlin. They were assessed independently by internists and psychiatrists. Each positive item of the HDRS scale was then rated by the internists as to what degree it reflects somatic morbidity. Results show that multimorbidity interferes with the validity of the HDRS. There were 8 items for which more than half of all positive scores as rated by psychiatrists were seen by the internists as being possibly related to somatic disorders. Patients with corrections in the HDRS score showed a somewhat increased rate of medicines and cardiovascular diagnoses. There was less ambiguity for items with greater severity.

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PubMed1994

Screening an elderly population for verifiable adverse drug reactions. Methodological approach and initial data of the Berlin Aging Study (BASE).

Older adults are known to carry the largest risk for potential adverse drug reactions (ADR) due to the increased number of diseases and concurrent drug therapies. Prevalence rates of the most frequently used drugs in this population have already been evaluated, but the actual rates of specific drug-related risks (e.g., renal dysfunction) have not. Precise estimates of specific ADR risks rely on careful evaluation of the complete drug regimen for potential adverse effects, especially for elderly subjects. In addition, evaluations of manifest ADR have generally been based on reviews of individual medical records of self-reported symptoms. Systematic screening of a representative sample of elders for verifiable potential ADR has not been performed to date and is methodologically challenging. However, the present study attempts to assess both the prevalence of explicitly defined risks for known ADR and the corresponding co-occurrence of laboratory parameter alterations using a new approach. Initial findings are reported for a nearly-representative, age and sex stratified sample of 70 to 100+ year old subjects (n = 336) who participated in the Berlin Aging Study (BASE). Analyses focused on adverse drug effects on fluid and electrolyte balance and renal function. The results indicated an overall prevalence rate of 50% for selected ADR risks and a rate of 26% for the co-occurrence of corresponding laboratory alterations. By taking age into account, preliminary multivariate analyses did not support the hypothesis of increasing ADR susceptibility with advancing age.

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