Integrující role vnitřního lékařství a geriatrie

Eva Topinková

Vnitr Lek 2018, 64(11):981 | DOI: 10.36290/vnl.2018.140  

Poruchy termoregulace a jejich význam ve vyšším věku - editorial

Božena Jurašková

Vnitr Lek 2018, 64(11):984  

Souvisí stav zásobení organizmu vitaminem D s výsledky testování kognitivních funkcí a aktivity denního života seniorů? - editorial

Božena Kalvachová

Vnitr Lek 2018, 64(11):985  

Do the test results of cognitive function and activities of daily life of seniors correlate with the state of vitamin D supply to the organism?

Emmanuela Fernandová, Hana Matějovská Kubešová

Vnitr Lek 2018, 64(11):1107-1114 | DOI: 10.36290/vnl.2018.158  

Introduction:Till recently, the main effect of Vitamin D (calcitriol) was accounted for its role in regulation of calcium levels. But at the present time several other important functions of this vitamin have been unfolding in human organism, which currently ascribe to the properties of hormone. It also effects among other functions such as cognitive functions, immune system and muscle mass. In the resent past there are rising number of scientific publications on possible consequences of the long term deficit of Calcitriol, not only in the older generation. Aim: The aim of our study was to establish the relationship between the supply of...

Arterial hypertension in the elderly

Jan Filipovský

Vnitr Lek 2018, 64(11):987-992 | DOI: 10.36290/vnl.2018.143  

Hypertension is one of the most common problems at higher age and belongs to the most important cardiovascular risk factors. Subjects aged 65 years and more have typically isolated systolic hypertension with increased pulse pressure as a consequence of decreased elasticity of central arteries. With increasing age, the prevalence of cardiovascular/ renal diseases and diabetes is higher. Therefore, we use drugs that have cardiprotective effect and do not affect negatively concomitant diseases. Diuretics have the largest data from prospective studies, calcium channels blockers are suitable especially in isolated systolic hypertension, and ACE inhibitors...

Thyroid disease in the elderly

Zdeňka Límanová

Vnitr Lek 2018, 64(11):993-1002 | DOI: 10.36290/vnl.2018.144  

The incidence of most thyroid diseases are prevalent in women in ratio 8 : 1 to men, and especially hypothyroidism arises with age. Unrecognized thyroid dysfunction leads to increased: cardiovascular risk, bone fractures, cognitive impairment, depression, and mortality. The symptoms of thyroid diseases can be nonspecific or common in seniors with ageing complaints. The interpretation of thyroid function tests, the physiological changes in secretion and metabolism of thyrotropin (TSH) and thyroid hormones must be considered, as well as the influence of comorbidities, certain drugs, and individual "set point" of pituitary gland. According to many observations...

Diabetes mellitus in complex older patients

Alena Šmahelová

Vnitr Lek 2018, 64(11):1005-1008 | DOI: 10.36290/vnl.2018.145  

Care of the elderly diabetic patients requires a special approach. What must be considered is not only individualization, and in more fragile elderly patients easing the targets for long-term compensation of diabetes, but also appropriate antidiabetic therapy needs to be chosen. Most patients suffer from polymorbidity and are at a greater risk for occurrence and consequences of hypoglycemia and cognitive impairment. The treatment procedure for sturdy elderly patients with diabetes is not any different from younger patients, while appropriate drugs for fragile patients are gliptins, possibly in combination with a long-term insulin analogue.

Anticoagulant therapy in the elderly

Debora Karetová, Jan Bultas

Vnitr Lek 2018, 64(11):1011-1020 | DOI: 10.36290/vnl.2018.146  

Elderly and fragile patients have a higher risk of atrial fibrillation, a higher risk of systemic embolism. They are therefore often candidates for long-term anticoagulation medication. At the same time, they have an increased risk of bleeding due to age and co-morbidities, which anticoagulation therapy necessarily potentiates. New Oral Direct Anticoagulants (NOAC) registered in the Czech Republic - dabigatran, rivaroxaban, apixaban or edoxaban - are a good alternative to the currently dominant warfarin in many of these indications. Their great advantage is that they do not need to be regularly monitored on a laboratory basis and are considered to...

Statin therapy in elderly patients

Jan Piťha, Eva Topinková, Vladimír Blaha, Božena Jurašková, Ivo Bureš, Iva Holmerová, Michal Vrablík

Vnitr Lek 2018, 64(11):1021-1027 | DOI: 10.36290/vnl.2018.147  

Cardiovascular events occur most frequently in patients at higher age groups. The elderly suffer not only more advanced and complex changes of cardiovascular system but, also, other chronic conditions. Moreover, compared to middle-age, different therapeutic response is often observed due to changes of pharmaco-kinetics and -dynamics; these patients use other medications, which may trigger drug interactions. The situation is further complicated by non-adherence related to frequent cognitive impairment. On one hand the elderly enjoy the greatest absolute benefit from adequate cardiovascular treatment while on the other they might be more susceptible...

Specific features of rational geriatric pharmacotherapy: the role of clinical pharmacists in individualized drug treatment in older age

Daniela Fialová

Vnitr Lek 2018, 64(11):1028-1037 | DOI: 10.36290/vnl.2018.148  

Polypharmacy and polymorbidity are frequent phenomena in the older age and the complexity of prescribed drug regimens often lead to prescribing problems and indication of drugs, doses and drug schemes inappropriate in older adults. Also, physiological and pathological changes accompanied aging are not sufficiently respected. The articles summarized results of previous European projects conducted in the Czech Republic in the area of potentially inappropriate prescribing in older patients. It refers to the most often used explicit criteria, supporting safety and efficacy of pharmacotherapy in older age and refers to importance of clinical-pharmacy services...

Sarcopenia as a severe organ failure, its diagnosing and present therapeutic possibilities

Eva Topinková

Vnitr Lek 2018, 64(11):1038-1052 | DOI: 10.36290/vnl.2018.149  

Sarcopenia is defined as generalized and progressive age-related loss of skeletal muscle mass, muscle strength and physical performance below a defined threshold. In sarcopenia skeletal muscle mass - the largest body organ - is failing in its function and the term "muscle failure" was suggested. Sarcopeniat is now recognized as a serious clinical problem compromising healthy aging concept and quality of life of affected older people. Sarcopenia has a complex multifactorial pathogenesis, which involves not only age-related changes in neuromuscular function, muscle protein turnover, and hormone levels and sensitivity, but also a chronic pro-inflammatory...

Nutritional support in geriatric patients: the ESPEN new recommended guidelines

Luboš Sobotka

Vnitr Lek 2018, 64(11):1053-1058 | DOI: 10.36290/vnl.2018.150  

Malnutrition is frequent problems in older people, especially if combined with muscle loss. It is usually consequence of combination of acute or chronic disease, low food intake and inactivity. Evidence-based strategy to counteract this problem is difficult because of this health threat complexity. The last recommendations for nutritional support and in older persons were published recently. According to these guidelines all older persons shall be screened for malnutrition. Oral, enteral or parenteral nutrition should always be connected with treatment of on-going disease and physical exercise. The effect of this multimodal approach must be controlled...

Electrolyte and water disorders in old age

Zdeněk Zadák, Alena Tichá, Radomír Hyšpler

Vnitr Lek 2018, 64(11):1059-1066 | DOI: 10.36290/vnl.2018.151  

Changes in the volume and composition of body fluids are among the essential and limiting parameters both in health and illness. These parameters gain in importance with increasing age. Within the concept of a geriatric patient, disturbances in water and mineral metabolism are the cause of circulatory collapse, stroke, and further instability, falls and delirium. The body can, in the broad range of balance within internal environment, compensate for variations, however always for a limited length of time only, and this compensation ability decreases in particular in older age. Maintaining of water and mineral balance in the elderly is also complicated...

The geriatric patient and surgery

Luboš Kotík

Vnitr Lek 2018, 64(11):1067-1069 | DOI: 10.36290/vnl.2018.152  

Number of patients older than 65 years indicated for surgery is growing. Estimation of the surgery risk in this age has its specific aspects not present in younger patients. Beside organ dysfunctions is necessary to estimate function reserves of geriatric patients, especially presence of frailty syndrome, because those seniors have very high surgery risk.

Risk factors for hospitalization among older persons

Hana Matějovská Kubešová, Ondřej Výška, Jiří Nakládal, Emmanuela Fernandová, Petra Vacková

Vnitr Lek 2018, 64(11):1070-1075 | DOI: 10.36290/vnl.2018.153  

The hospitalization of older patients involves, in addition to treating of acute illness or acute worsening of chronic disease, the risk of a number of age-specific complications. Deliria are one of the most common events at the onset of the hospital stay. As the ethiology of deliria in addition to the underlying disease we have to consider the deteriorated adaptability to environmental change. Another serious complication is the emergence of immobilization syndrome, which can start the irreversible unfavourable outcome. Infection complications with a high tendency to develop sepsis are a frequent primary cause of hospitalization, but also a frequent...

Falls: a significant cause of morbidity and mortality in elderly people

Marie Berková, Zdeněk Berka

Vnitr Lek 2018, 64(11):1076-1083 | DOI: 10.36290/vnl.2018.154  

The incidence of falls of older people is increasing. Falls are the most common cause of injuries of older adults. Costs for the treatment of injuries caused by falls are constantly increasing too. In fragile and polymorbid individuals, falls are most often of multifactorial ethiology; age-related frailty, coinciding chronic diseases and interactions with the external environment. The most serious consequences of falls include hip fractures and intracranial injury. The American Geriatric Society recommends an annual falls and instability screening in people ≥ 65 years of age. Multifactorial interventions should be targeted primarily at people with...

Overactive urinary bladder in elderly female patients: treatment specificities and drug interactions

Lukáš Horčička, Eva Topinková

Vnitr Lek 2018, 64(11):1085-1090 | DOI: 10.36290/vnl.2018.155  

Aging is an inevitable process in the life of each organism and it is no different in the human world. According to the world statistics and demographic data, an ever increasing group in our population live to a ripe old age. The paper deals with pharmacological therapy for overactive bladder (OAB) in older women while also considering frequent comorbidities in older age. The prevalence of OAB at this life stage is greater as compared to other, more serious diseases. There are less clinical studies on geriatric patients than those focusing on younger age categories. The effect of pharmacotherapy with antimuscarinics against placebo is demonstrable...

Thermoregulatory disorders and their significance in the elderly

Pavel Weber, Hana Meluzínová, Dana Prudius, Katarína Bielaková

Vnitr Lek 2018, 64(11):1091-1097 | DOI: 10.36290/vnl.2018.156  

Our treatise is aimed at providing a brief survey on ethiology, pathogenesis, risks of inception, clinical picture, treatment pitfalls and prognosis of hypothermia and hyperthermia and possible interactions of these thermoregulation disorders with some other co-morbidities. It deals also with drugs and medicines including their potential unwanted side effects in these thermally abnormal conditions. The problems of hypothermia and hyperthermia in the senium (especially the late one) will be closely connected with labile homeostasis and the occurence of frailty syndrome which increases with the age. Permanently growing number of patients with polymorbidity...

Chronic non-healing wounds in geriatrics

Vojtěch Mezera, Ivo Bureš

Vnitr Lek 2018, 64(11):1098-1104 | DOI: 10.36290/vnl.2018.157  

Chronic non-healing wounds represent a frequent comorbidity among geriatric patients. Non-healing wounds increase patients' morbidity and mortality and significantly decrease their quality of life. Prognosis of these wounds depends on etiology, overall health condition of the patient and also on the proper treatment. In this review we outline the classification of non-healing wounds and focus in more detail on the most frequent types: venous and arterial leg ulcers, diabetic foot syndrome and pressure ulcers.