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Pharmakotherapie und geriatrische Syndrome

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Arzneitherapie für Ältere

Zusammenfassung

Posturale Stabilität ist, bedingt durch den aufrechten Gang des Menschen, eine komplexe Aufgabe des Gesamtorganismus und daher per se anfällig für Störungen, die in Stürzen resultieren können. Stürze aus dem Stand oder dem Gehen mit geringer Geschwindigkeit sind, anders als bei jüngeren Erwachsenen oder Kindern, bei älteren Patienten häufig ein klinisch bedeutsames Ereignis. Mit zunehmendem Alter nimmt nämlich nicht nur allgemein die Inzidenz der Sturzereignisse zu, sie sind auch stärker mit erheblichen Traumata verbunden. Man schätzt, dass etwa ein Drittel der zu Hause lebenden älteren Menschen über 65 Jahre im Durchschnitt einmal pro Jahr stürzt, von den über 80-Jährigen sind es bereits ca. die Hälfte (Tinetti et al. 1988). Für ältere Menschen entsteht aus diesen Sturzereignissen ein erhebliches Risiko für Morbidität und Mortalität (Stel et al. 2004). Dies gilt besonders für in Institutionen lebenden Menschen (Kron et al. 2003). Bei etwa 5% der Sturzereignisse bei älteren Menschen kommt es zu einer Fraktur (hier besonders häufig die Radius- und die proximale Femurfraktur), deren Mortalitätsrate mit höherem Lebensalter ansteigt. Die größte klinische Bedeutung aufgrund der assoziierten Morbidität und Mortalität hat hierbei die proximale Femurfraktur. In einer Erhebung der US-Regierung (US Congress, Office of Technology Assessment 1994) zu diesem Thema wurde 1994 festgestellt, dass die 12-Monats-Mortalitätsraten der proximalen Hüftfraktur mit höherem Lebensalter deutlich ansteigen und bei den über 65-Jährigen bis zu 24% erreichen. Darüber hinaus konnte von den zuvor zu Hause lebenden Personen über 40% nach der proximalen Femurfraktur nicht wieder in ihr häusliches Umfeld zurückkehren und mussten in einer stationären Pflegeeinrichtung aufgenommen werden. Begünstigt wird dies durch eine zunehmende Prävalenz an Osteoporose mit höherem Lebensalter aber auch durch den abnehmenden Schutz durch Reflexe bzw. kompensierende Reaktionen. Wichtige altersassoziierte Veränderungen des Organismus in diesem Zusammenhang sind

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Authors and Affiliations

  1. Klinikdirektor der IV. Medizinischen Klinik (Schwerpunkt Geriatrie), Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Germany

    Heinrich Burkhardt

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  1. Heinrich Burkhardt
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Editors and Affiliations

  1. Klin PHarm Mannheim, University of Heidelberg, Mannheim, Germany

    Martin Wehling

  2. Geriatrisches Zentrum, Mannheim, Germany

    Heinrich Burkhardt

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Burkhardt, H. (2016). Pharmakotherapie und geriatrische Syndrome. In: Wehling, M., Burkhardt, H. (eds) Arzneitherapie für Ältere. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48126-4_3

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  • DOI: https://doi.org/10.1007/978-3-662-48126-4_3

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