Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Sep 2024
ReviewPalliative care in terminally ill advanced chronic liver disease patients.
While mortality rates from advanced chronic liver disease (ACLD) are rapidly increasing, patients with an advanced disease stage have a comparable or even higher symptom burden than those with other life-limiting diseases. Although evidence is limited there is increasing recognition of the need to improve care for patients with ACLD; however, there are many limiting factors to providing good palliative care for these patients, including unpredictable disease progression, the misconception of palliative care and end of life care as being equivalent, a lack of confidence in prescribing medication and a lack of time and resources. Health professionals working with these patients need to develop the skills to ensure effective palliative care, while referral to specialized palliative care centers should be reserved for patients with complex needs. ⋯ Liver disease is closely associated with significant social, psychological, and financial burdens for patients and their caregivers. Strategies to engage the discussion in multidisciplinary teams early in disease progression help to ensure addressing these issues proactively. This review summarizes the evidence on palliative care for patients with ACLD, provides examples of current best practice and offers suggestions on how disease-modifying and palliative care can coexist, to ensure that patients do not miss opportunities for quality of life improving interventions.
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Wien. Klin. Wochenschr. · Sep 2024
Review Meta AnalysisThe prevalence of presbyphagia in older adults: a systematic review and meta-analysis.
Presbyphagia is defined as structural, physiological and innervational alterations in the swallowing process as a result of aging and is considered to be involved in the etiology of dysphagia. This systematic review and meta-analysis aimed to estimate the prevalence of presbyphagia in older adults without disease-related dysphagia. ⋯ Although the pooled prevalence of presbyphagia in older adults was 17.3%, the lack of large representative studies limited the interpretation of these findings. In the future, further large studies that diagnose presbyphagia using standardized assessment tools would facilitate new avenues to reduce the risk of dysphagia in older adults.
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Wien. Klin. Wochenschr. · Sep 2024
Review Meta AnalysisThe prevalence of presbyphagia in older adults: a systematic review and meta-analysis.
Presbyphagia is defined as structural, physiological and innervational alterations in the swallowing process as a result of aging and is considered to be involved in the etiology of dysphagia. This systematic review and meta-analysis aimed to estimate the prevalence of presbyphagia in older adults without disease-related dysphagia. ⋯ Although the pooled prevalence of presbyphagia in older adults was 17.3%, the lack of large representative studies limited the interpretation of these findings. In the future, further large studies that diagnose presbyphagia using standardized assessment tools would facilitate new avenues to reduce the risk of dysphagia in older adults.
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Wien. Klin. Wochenschr. · Sep 2024
Review Practice GuidelineRenal sympathetic denervation 2024 in Austria: recommendations from the Austrian Society of Hypertension : Endorsed by the Austrian Society of Nephrology and the Working Group of Interventional Cardiology of the Austrian Society of Cardiology.
Renal sympathetic denervation (RDN) is an interventional supplement to medical treatment in patients with arterial hypertension. While the first sham-controlled trial, SYMPLICITY HTN‑3 was neutral, with improved procedural details, patient selection and follow-up, recent randomized sham-controlled trials of second-generation devices show a consistent blood pressure lowering effect of RDN, as compared to sham controls. These new data and the recent U. ⋯ Food and Drug Administration (FDA) premarket approval of two RDN devices are the basis for the present recommendations update. This joint position paper from the Austrian Society of Hypertension, together with the Austrian Society of Nephrology and the Working Group of Interventional Cardiology from the Austrian Society of Cardiology includes an overview about the available evidence on RDN and gives specific recommendations for the work-up, patient selection, pretreatment, procedural management and follow-up in patients undergoing RDN in Austria. Specifically, RDN may be used in clinical routine care, together with lifestyle measures and antihypertensive drugs, in patients with resistant hypertension (i.e. uncontrolled blood pressure on 3 antihypertensive drugs) and in those with uncontrolled hypertension, after adequate work-up, if institutional, patient-related and procedural conditions are fulfilled.
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Wien. Klin. Wochenschr. · Sep 2024
ReviewHeat vulnerability: health impacts of heat on older people in urban and rural areas in Europe.
Exposure to extreme heat is associated with both increased morbidity and mortality, especially in older people. Health burdens associated with heat include heat stroke, diabetes mellitus, hypertension, ischemic heart diseases, heart failure and arrhythmia, pulmonary diseases but also injuries, problems with activities of daily living, and mental disorders. In Europe, there are remarkable spatial differences in heat exposure between urban and less populated areas. ⋯ Older people living in urban areas are particularly at risk, due to the urban heat island effect, the heat-promoting interplay between conditions typically found in cities, such as a lack of vegetation combined with a high proportion of built-up areas; however, older people living in rural regions often have less infrastructure to cope with extreme heat, such as fewer cooling centers and emergency services. Additionally, older adults still engaged in agricultural or forestry activities may be exposed to high temperatures without adequate protection or hydration. More research is required to examine factors responsible for heat vulnerability in older adults and the interactions and possibilities for increasing resilience in older urban and rural populations to the health consequences of heat.