OBJECTIVES: This study aimed to assess the effectiveness of Comprehensive Geriatric Assessment (CGA) compared to standard of care in improving pain, physical function, and stiffness in older adults with knee osteoarthritis (OA) over six months. Secondary outcomes included multidimensional frailty and quality of life. DESIGN: An exploratory, multicentre, randomized controlled trial (RCT). SETTING: Five European geriatric centres in Italy, Germany, Turkiye and the Czech Republic. PARTICIPANTS: Seventy older adults (mean age 76.1 ± 6.8 years; 80% female) with knee OA (Kellgren-Lawrence Grades 1-2) were randomized into two groups: CGA (n = 35) or standard of care (n = 35). INTERVENTION: The CGA group underwent a multidimensional geriatric assessment and intervention, identifying impairments and tailoring interventions accordingly, while the control group received standard of care. MAIN OUTCOME MEASURES: The primary endpoint was improvement in pain, stiffness, and functional limitations measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) over six months. Secondary outcomes included changes in multidimensional frailty (Multidimensional Prognostic Index, MPI), quality of life (SF-36), and adherence to interventions. RESULTS: The CGA group showed a non-significant improvement in total WOMAC scores (-4.49 ± 3.40, p = 0.19), with slight reductions in pain (-1.12 ± 0.96) and functional limitations (-3.26 ± 2.21). MPI slightly improved (-0.02 ± 0.04, p = 0.69), but no significant changes were observed in SF-36 scores. No falls, hospitalizations, or severe adverse events were reported. CONCLUSIONS: CGA may offer potential benefits for managing knee OA in older adults, particularly for pain and function, though statistical significance was not achieved. Larger studies with longer follow-up are warranted to confirm these findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05659979.

• MeSH
• artróza kolenních kloubů * terapie   patofyziologie   diagnóza   MeSH
• geriatrické hodnocení * metody   MeSH
• kvalita života MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Reminiscence therapy (RT) is a widely used approach to promote well-being among older adults and is an effective intervention method for older adults with diverse health conditions, including community-dwelling older adults. OBJECTIVES: The aim of the study was to determine the impact of group RT on assessments of depression, anxiety and self-esteem in older adults living in the community. METHODS: We implemented sessions of group simple RT. The sample consisted of 24 older adults living in the community who attended a 12-week RT course. The duration of each reminiscence session was 60 min. The average age of the sample was 74.7 years. We used the Geriatric Depression Scale, the Geriatric Anxiety Inventory, the Rosenberg self-esteem scale, the Older adults' Quality of Life-Brief version and the Sense of Coherence scale to assess mental health outcomes before and after intervention. RESULTS: After intervention, we observed statistically significant improvements in assessments of depression (p < 0.001), anxiety (p = 0.011), self-esteem (p = 0.007) and the comprehensibility dimension of the sense of coherence scale (p = 0.039). Depression showed the largest effect size (Cohen's d = 0.870; 95% CI: 0.392 to 1.335), indicating a large effect, followed by self-esteem (Cohen's d = 0.612; 95% CI: -1.044 to -0.170) and anxiety (Cohen's d = 0.543; 95% CI: 0.108 to 0.967), both of which demonstrated a moderate effect. CONCLUSIONS: We found group RT to be effective for several outcomes among older adults. Reminiscence is a good non-invasive treatment for the promotion of mental health in community-dwelling older adults. IMPLICATIONS FOR PRACTICE: As research has now established RT to be an essential component of activities for older adults in senior care facilities, we should also offer it to those living in the community as an effective activity for the promotion of healthy aging among older adults.

• MeSH
• deprese * terapie   psychologie   MeSH
• geriatrické hodnocení MeSH
• kvalita života MeSH
• lidé MeSH
• samostatný způsob života * MeSH
• sebepojetí * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• skupinová psychoterapie metody   MeSH
• úzkost * terapie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: This study investigates the association between frailty and mortality in Eastern European populations, which remains largely unexplored compared with Western Europe. The aim is to assess the risk of all-cause and cardiovascular mortality associated with varying levels of frailty. METHODS: A prospective multicentre cohort study was conducted, involving random population samples from the Czech Republic, Poland and Lithuania. The baseline survey (2002-2005) included 26 746 individuals aged 45-69 years, with an average follow-up of 13 years. Frailty was measured using a Comprehensive Geriatric Assessment (CGA)-based Frailty Index (FI), calculating the number of deficits in each domain. Cox proportional regression models and inverse probability weighting (IPW) were employed to account for risk factor differences among the frailty groups: robust, prefrail, mild, moderate and severe. RESULTS: The study included 14 287 people, among whom 891 were frail, with a total of 2402 deaths.Compared with non-frail persons, those with mild (IPW HR 2.06, 95% CI 1.60 to 2.66) and severe (IPW HR 2.71, 95% CI 1.45 to 5.07) frailty had more than twofold elevated risk of all-cause mortality. For cardiovascular mortality, the corresponding HRs were (IPW HR 3.05, 95% CI 2.14 to 4.35) and (IPW HR 3.88, 95% CI 1.95 to 7.74). Men exhibited a higher mortality risk at all frailty levels only in unweighted analysis. Country-specific differences were not significant. CONCLUSIONS: A CGA-based FI is an independent predictor of all-cause and cardiovascular mortality, with even mild frailty increasing the risk. Implementing frailty assessments can improve health risk prediction in older adults from Eastern Europe.

• MeSH
• geriatrické hodnocení * MeSH
• kardiovaskulární nemoci * mortalita   MeSH
• křehkost * mortalita   MeSH
• křehký senior * statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• příčina smrti MeSH
• proporcionální rizikové modely MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Česká republika MeSH
• Litva MeSH
• Polsko MeSH
• východní Evropa MeSH

Transplantace ledviny představuje optimální terapeutickou možnost nezvratného renálního selhání. S přibývajícím počtem kandidátů vyššího věku narůstá také pozornost věnovaná frailty, resp. funkčnímu stavu kandidátů. K hodnocení frailty lze použít různé metody. Na příkladu studie CoGeriaTx je ukázáno využití komplexního geriatrického hodnocení (comprehensive geriatric assessment, CGA) v hodnocení frailty u kandidátů transplantace ledviny. Dva příklady porovnávají metodu a výsledky hodnocení frailty podle epidemiologických kritérií fenotypu frailty podle Friedové a podle komplexního geriatrického hodnocení. Další výzkum může přinést nové poznatky ohledně prediktivní hodnoty CGA u této cílové skupiny. Korespondenční adresa: MUDr. Hana Vaňková, Ph.D. Interní klinika 3. LF UK a FNKV Šrobárova 50 100 34 Praha 10 e-mail: hana.vankova@lf3.cuni.cz

Kidney transplantation represents the best therapeutical option in patients in end-stage kidney disease. At present, increasing number of older patients are referred for kidney transplantation. The comprehensive geriatric assessment (CGA) of functional status in older kidney transplant candidates might play an important and supportive role in the pre-transplant evaluation process. In the CoGeriaTx study, frailty is evaluated by CGA while Fried Frailty Phenotype (FFP) criteria are considered as one part of the comprehensive evaluation. Two examples compare the method and the results of frailty evaluation according to CGA and when using FFP alone. Further research may provide new insights into the predictive value of CGA in this target group.

• MeSH
• geriatrické hodnocení metody   MeSH
• křehkost * diagnóza   MeSH
• lidé MeSH
• senioři MeSH
• transplantace ledvin * MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE: Non-pharmacological interventions (NPIs) play an important role in the management of older people receiving homecare. However, little is known about how often specific NPIs are being used and to what extent usage varies between countries. The aim of the current study was to investigate the prevalence of NPIs in older homecare recipients in six European countries. METHODS: This is a cross-sectional study of older homecare recipients (65+) using baseline data from the longitudinal cohort study 'Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care' (IBenC). The analyzed NPIs are based on the interRAI Home Care instrument, a comprehensive geriatric assessment instrument. The prevalence of 24 NPIs was analyzed in Belgium, Germany, Finland, Iceland, Italy and the Netherlands. NPIs from seven groups were considered: psychosocial interventions, physical activity, regular care interventions, special therapies, preventive measures, special aids and environmental interventions. RESULTS: A total of 2884 homecare recipients were included. The mean age at baseline was 82.9 years and of all participants, 66.9% were female. The intervention with the highest prevalence in the study sample was 'emergency assistance available' (74%). Two other highly prevalent interventions were 'physical activity' (69%) and 'home nurse' (62%). Large differences between countries in the use of NPIs were observed and included, for example, 'going outside' (range 7-82%), 'home health aids' (range 12-93%), and 'physician visit' (range 24-94%). CONCLUSIONS: The use of NPIs varied considerably between homecare users in different European countries. It is important to better understand the barriers and facilitators of use of these potentially beneficial interventions in order to design successful uptake strategies.

• MeSH
• kohortové studie MeSH
• lidé MeSH
• longitudinální studie * MeSH
• prevalence MeSH
• průřezové studie MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

Urgentní příjmy se v Česku budují až v posledních letech. Senioři jsou typickými pacienty těchto oddělení. Přístup v urgentní medicíně je založen na vyhodnocení příznaků a na stanovení priority ošetření pacienta. Přístup k pacientům vyššího věku má mnohá specifika v diagnostice i v léčbě. Triáž geriatrických pacientů se zpřesní zhodnocením kognice, škály geriatrické křehkosti a screeningových nástrojů pro posouzení přítomnosti deliria. Komplexní geriatrické hodnocení je pro časovou náročnost pro urgentní příjem nevhodné, ale je nutné zachovat jeho základní komponenty. Léčebný přístup musí být komplexní a musí obsahovat aspekty biologické, psychologické i sociální a analýzu rizik prostředí. Management úrazů seniorů vyžaduje vyhodnocení odlišných kritických hodnot vitálních funkcí oproti kritériím běžné triáže, vlivu medikace na adaptační mechanismy a rizika nízkoenergetických mechanismů traumat. Léčba úrazů musí být včasná a komplexní a je nutné zajistit kontinuitu při přechodu z intenzivní do standardní péče a dále do péče rehabilitační. U pacientů v terminálním stadiu nevyléčitelného onemocnění je na místě paliativní přístup.

Emergency departments in the Czech Republic have been established in recent years. Seniors are typical patients of these departments. Emergency medicine´s approach is based on symptoms’ evaluation and on deciding about the priority of the care needed. The approach to older patients is specific both in diagnostics and in therapy. The triage of geriatric patients is more accurate when we also evaluate patient´s cognition, when we use geriatric frailty scales and screening tools for detection of delirium. Comprehensive geriatric evaluation is a time demanding process and thus inadequate for emergency department however we must maintain its basic components. The therapeutical approach must be complex, and it must include biological, psychological, and social aspects and environmental risk analysis. Trauma management in seniors requires evaluation of different vital function´s values compared to common triage criteria, the influence of medication on adaptive mechanisms and the risk of low energy trauma mechanisms. Therapy of trauma must be timely and complex and the continuity of care between intensive and standard level and then rehabilitation must be ensured. Palliative approach is appropriate for terminally ill patients.

• MeSH
• geriatrické hodnocení MeSH
• křehký senior * MeSH
• lidé MeSH
• paliativní péče MeSH
• třídění pacientů MeSH
• urgentní služby nemocnice * MeSH
• Check Tag
• lidé MeSH

Polymorbidní pacientka ve věku 86 let byla po pádu hospitalizována na oddělení traumatologie pro zlomeninu krčku kosti stehenní, byla provedena osteosyntéza. Poté byla pacientka přeložena na oddělení následné péče k doléčení a rehabilitaci. Zde u ní byl diagnostikován syndrom demence a malnutrice. I přes nastavenou nutriční podporu došlo během hospitalizace k výraznému poklesu její tělesné hmotnosti. Při propuštění byla s rodinou pacientky naplánována pravidelná návštěva geriatrické ambulance pro snazší management léčby demence a nutriční podpory. V rámci komplexního geriatrického vyšetření byl ve spolupráci s nutričním terapeutem vypracován plán cílené nutriční podpory přizpůsobený pečlivě zorganizovanému systému domácí péče. Ve spolupráci s ambulancí výživy byl plán nutriční podpory mírně optimalizován podle stravovacích preferencí pacientky. Při dalším kontrolním vyšetření v geriatrické ambulanci byl již tři měsíce po propuštění z hospitalizace zaznamenán pozitivní efekt terapie v navýšení tělesné hmotnosti, zlepšení syndromu frailty, stavu nutrice i sarkopenie. Popisovaný případ ukazuje praktický přínos pravidelného nutričního screeningu seniorů a case managementu geriatra s nutričním terapeutem, nutricionistou, rodinou pacienta a pracovníky domácí péče.

An 86-year-old polymorbid woman was hospitalized in the trauma ward for a femoral neck fracture, osteosynthesis performed. The patient was then transferred to the aftercare department for further treatment and rehabilitation. Here she was diagnosed with dementia and malnutrition syndrome. Despite the set nutritional support, the patient‘s body weight decreased significantly during the hospitalization. At discharge, regular visits to the geriatric outpatient clinic were scheduled with the patient‘s family for easier management of dementia treatment and nutritional support. As part of a comprehensive geriatric assessment, a targeted nutritional support plan adapted to the patient‘s carefully organized home care system was developed in cooperation with a nutritional therapist. In cooperation with the nutrition clinic, the nutritional support plan was slightly optimized according to the patient‘s dietary preferences. During the next control examination in the geriatric outpatient clinic, a positive effect of the therapy in increasing body weight, improvement of frailty syndrome, nutritional status and sarcopenia was noted as early as three months after discharge from hospital. The described case shows the practical benefit of regular nutritional screening of seniors and case management by a geriatrician with a nutritional therapist, nutritionist, patient‘s family and home care workers.

• MeSH
• demence MeSH
• fraktury krčku femuru chirurgie   MeSH
• komorbidita MeSH
• křehký senior * MeSH
• lidé MeSH
• nutriční podpora * MeSH
• podvýživa terapie   MeSH
• senioři nad 80 let MeSH
• služby domácí péče MeSH
• úrazy pádem MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Článek je zaměřený na celostní péči o lidi žijící s Alzheimerovou nemocí a obdobnými onemocněními. Akcentuje aktivní medicínskou péči o funkční stav i nutnost diferenciální diagnostiky etiologie syndromu demence. Obohacením je právní pohled a reflexe přínosu dokumentu Evropské asociace pro paliativní péči pro sdílené rozhodování. Jedná se o téma procházející velkým rozvojem z pohledu klinické medicíny i mezioborové spolupráce. Současně předkládáme čtenářům překlad metody a výsledků Delphi konsenzu nazvaného Bílá kniha definující optimální paliativní péči u lidí s demencí. Publikována byla Evropskou asociací paliativní péče v roce 2014, ucelený český překlad dosud chyběl. Doplňujeme tento dluh a současně k němu přidáváme aktuální kontext v původním článku.

The article is focused on person-centred care for people living with Alzheimer‘s disease and similar illnesses. Active medical support of functional status using comprehensive geriatric assessment is emphasised as well as the need for appropriate differential diagnosis of the etiology of dementia syndrome. It is enriched by a legal perspective and a reflection on the contribution of the European Association for Palliative Care document to shared decision-making. This topic is undergoing major development from the perspective of clinical medicine and interdisciplinary collaboration. At the same time, readers are provided with a translation of methods and results of the Delphi consensus entitled „White Paper defining optimal palliative care for older people with dementia“. Published by the European Association of Palliative Care in 2014, a comprehensive Czech translation has been missing. Now it is available to readers together with an original article which reflects context of the topic in the Czech Republic.

• Klíčová slova
• Bílá kniha,
• MeSH
• Alzheimerova nemoc * terapie   MeSH
• delfská metoda MeSH
• dříve vyslovené přání MeSH
• komorbidita MeSH
• lidé MeSH
• paliativní péče * MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Evropa MeSH

PURPOSE: There is variation in organization of geriatric rehabilitation across Europe. The purpose of this study was to describe the selection criteria for referral to geriatric rehabilitation, care provided, and recovery trajectories of post-COVID-19 patients referred to geriatric rehabilitation in Europe. METHODS: This observational cohort study included 723 patients in 59 care facilities for geriatric rehabilitation across 10 countries. Patient data were collected from medical records on admission to geriatric rehabilitation (between September 2020 and October 2021), discharge, 6 weeks and 6 months follow-up. The primary and secondary outcomes were recovery in daily functioning (Barthel Index) and Quality of Life (EQ-5D-5L) from admission to discharge. These were examined using linear mixed models with two levels (measurements nested in patients) and country as an independent variable. Random intercept and random linear slope parameters were added when they improved model fit. A survey about organization of geriatric rehabilitation for post-COVID-19 patients was filled out by country coordinators and data were analyzed using descriptive statistics and inductive coding of answers to open questions. RESULTS: Patients had a mean age of 75.7 years old and 52.4% were male. Many countries used various combinations of the selection criteria, such as functional status, age, frailty, Comprehensive Geriatric Assessment, comorbidities, and cognitive impairments. Most patients received physiotherapy (88.8%) and occupational therapy (69.7%), but there was substantial variance between countries in the percentages of patients that received protein or calorie enriched diets, oxygen therapy, and other treatment components. In all countries, patients showed recovery in daily functioning and quality of life, although there was variation in between countries in rate of recovery. Daily functioning seemed to increase most rapidly in the Czech Republic, Germany, and Russia. The steepest increases in quality of life were seen in the Czech Republic, Germany, and Spain. CONCLUSION: Post-COVID-19 patients showed recovery during geriatric rehabilitation, albeit at variable rates. The observed variation may be explained by the heterogeneity in selection criteria and care provided. This study highlights the need for harmonization of measurements in geriatric rehabilitation order to perform explanatory research and optimize geriatric rehabilitation throughout Europe to ensure optimal patient recovery.

• MeSH
• činnosti denního života MeSH
• COVID-19 * rehabilitace   epidemiologie   MeSH
• geriatrické hodnocení MeSH
• kohortové studie MeSH
• kvalita života MeSH
• lidé MeSH
• obnova funkce MeSH
• SARS-CoV-2 fyziologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Evropa MeSH

Cieľ: Zistiť stav výživy u hospitalizovaných geriatrických pacientov na internom oddelení; zistiť, či existujú štatisticky významné korelácie medzi vybranými socio-demografickými údajmi, zdravotnými charakteristikami a meracím nástrojom. Súbor a metódy. Geriatrickí pacienti vo veku ≥ 65 rokov hospitalizovaní na internom oddelení. Dizajn štúdie kvantitatívny, deskriptívny, korelačný. Výskumný protokol obsahoval sledované premenné: demografické údaje, zdravotné charakteristiky, laboratórne parametre a merací nástroj na posúdenie stavu výživy MNA®. Empirické údaje boli spracované metódami deskriptívnej a induktívnej štatistiky. Výsledky: V súbore n = 137 (100 %) pacientov bolo 48 % mužov a 52 % žien, priemerný vek súboru bol 76,2 roka. Podľa MNA®-FF malo 9 % pacientov normálny nutričný stav, až 74 % malo riziko podvýživy a 17 % malo podvýživu. Polymorbiditu malo 99 % a polyfarmakoterapiu 96 % pacientov. Štatistickú významnosť sme zistili medzi výsledným skóre MNA®-FF a BMI (p < 0,001) a úbytkom na hmotnosti za posledných 6 mesiacov (p < 0,001) a hodnotou hemoglobínu (p = 0,033). Záver: Hospitalizovaní geriatrickí pacienti majú vo zvýšenej miere prítomné riziko malnutrície alebo už prítomnú malnutríciu. Súčasťou komplexného posudzovania stavu výživy je aj administrácia valídneho a reliabilného meracieho nástroja, ktorý je schopný rýchlo detekovať poruchu výživy už pri príjme pacienta na hospitalizáciu. Včasná identifikácia tejto poruchy je východiskom pre cielenú nutričnú intervenciu.

Aim: To find out the nutritional status in hospitalized geriatric patients in the internal ward, and to find out if there is a statistically significant correlation between selected demographic data, health characteristics, and measurement tool. Sample and methods. Geriatric patients aged ≥ 65 years hospitalized in the internal department. The design of the study is quantitative, descriptive, and correlational. The research protocol included monitored variables: demographic data, health characteristics, laboratory parameters, and a measurement tool to assess the nutritional status of MNA®. Empirical data was processed using of descriptive and inductive statistics methods. Results: In the sample of n = 137 (100%) patients, 48% were men and 52% were women, the average age of the sample was 76.2 years. According to MNA®-FF, 9% of patients had normal nutritional status, up to 74% were at risk of malnutrition and 17% were malnourished; 99% had polymorbidity and 96% had polypharmacotherapy. We found statistical significance between the resulting MNA®-FF score and BMI (p < 0.001) and weight loss in the last 6 months (p < 0.001) and haemoglobin value (p = 0.033). Conclusions: Hospitalized geriatric patients have an increased risk of malnutrition or already present malnutrition. Part of the comprehensive assessment of nutritional status is also the administration of a valid and reliable measuring tool that can quickly detect nutritional disorders when the patient is admitted to the hospital. Early identification of the disorder is the starting point for a targeted nutritional intervention.

• MeSH
• geriatrické hodnocení MeSH
• hospitalizace MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• nutriční stav * MeSH
• podvýživa diagnóza   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH