OBJECTIVE: Peripheral neuropathies perturbate the sensorimotor system, causing difficulties in walking-related motor tasks and, eventually, falls. Falls result in functional dependency and reliance on healthcare, especially in older persons. We investigated if peripheral neuropathy is a genuine risk factor for falls in the elderly and if quantification of postural control via posturography is helpful in identifying subjects at risk of falls.
METHODS: Seventeen older persons with a clinical polyneuropathic syndrome of the lower limbs and converging electrophysiology were compared with 14 older persons without polyneuropathy. All participants were characterized via quantitative motor and sensory testing, neuropsychological assessment, and self-questionnaires. Video-nystagmography and caloric test excluded vestibulocochlear dysfunction. For further analysis, all subjects were stratified into fallers and non-fallers. Overall, 28 patients underwent computerized dynamic posturography for individual fall risk assessment. Regression analyses were performed to identify risk factors and predictive posturography parameters.
RESULTS: Neuropathy is an independent risk factor for falls in the elderly, while no differences were observed for age, gender, weight, frailty, DemTect test, timed \"Up & Go\" test, and dizziness-related handicap score. In computerized dynamic posturography, fallers stepped more often to regain postural control in challenging conditions, while the Rhythmic Weight Shift test showed a lack of anterior-posterior bidirectional voluntary control.
CONCLUSIONS: Our study confirms peripheral neuropathy as a risk factor for older persons\' falls. Fallers frequently used stepping to regain postural control. The voluntary control of this coping movement was impaired. Further investigations into these parameters\' value in predicting the risk of falls in the elderly are warranted.

Geriatrics can enable and monitor a holistic care of older people through a comprehensive geriatric assessment in a structured way. Therefore, it must be integrated much more closely with preventive, rehabilitative and acute care units. Geriatrics are not seen in any aspects as a replacement for general practitioners or in-hospital structures but much more as a supplement to them. With its function-oriented concept, geriatrics can best coordinate the demographically necessary triage between prevention, acute treatment, rehabilitation and palliative care, thus avoiding undertreatment and overtreatment. This can only succeed in collaboration with general practitioners and specialist colleagues. The article categorizes geriatric care structures, such as preventive home visits, acute complex medical treatment, delirium prevention, outpatient and inpatient rehabilitation services based on a case example and makes proposals for structural changes that urgently need to be considered in the current healthcare reform, such as outpatient geriatric centers (AGZ).
UNASSIGNED: Die Geriatrie kann über ein umfassendes geriatrisches Assessment eine ganzheitliche Versorgung älterer Menschen ermöglichen und strukturiert überwachen. Sie müsste damit deutlich mehr in den präventiven, rehabilitativen und akuten Versorgungseinheiten integriert werden. Die Geriatrie sieht sich in keinem Bereich als Ersatz für hausärztliche oder stationäre Strukturen, sondern vielmehr als Ergänzung zu diesen. Sie kann mit ihrem funktionsorientierten Konzept die demografisch notwendige Triage zwischen Prävention, Akuttherapie, Rehabilitation und Palliation koordinieren und damit Unter- und Überversorgung vermeiden. Dies kann nur gemeinsam mit den haus- und fachärztlichen Kolleg:innen gelingen. Der vorliegende Beitrag ordnet geriatrische Versorgungsstrukturen wie präventive Hausbesuche, akutmedizinische Komplexbehandlungen, Delirprävention sowie ambulante und stationäre Rehabilitationsangebote anhand eines Fallbeispiels ein und macht Vorschläge für strukturelle Veränderungen, die in der aktuellen Gesundheitsreform dringend mitgedacht werden sollten, wie etwa ambulante geriatrische Zentren (AGZ).

Bisphosphonates are widely used for a number of metabolic bone conditions. Orbital inflammation is a very rare side effect of bisphosphonate therapy that can risk permanent visual loss. We describe the complex case and successful treatment of a 79-year-old man who developed orbital cellulitis following the use of intravenous pamidronate disodium for severe hypercalcaemia. The challenges regarding the diagnosis of parathyroid carcinoma are also discussed.

Fractures of the odontoid apophysis are one of the most frequent lesions in the elderly population, and an increasingly preponderant problem with the progressive aging of the world population. In the present work, we report a clinical case of an 88-year-old male patient who suffered a fall resulting in a type-II fracture of the odontoid apophysis on the Anderson-D\'Alonzo classification. Given the age and comorbidities of the patient, we decided to perform osteosynthesis of the fracture through anterior fixation with a transarticular screw in combination with fixation with an odontoid screw. This technique enables the necessary stability for the consolidation of Anderson-D\'Alonzo\'s type II odontoid apophysis fracture, with the advantage of the lower levels of dissection of the cervical extensor musculature and hemorrhage resulting from this aggression when compared with the posterior approach; moreover, it is a readily-available technique that yields clear benefits in the treatment of this pathology in the geriatric population.

In this report, we present the case of an older adult with severe obesity and multiple comorbidities, including heart failure with preserved ejection fraction (HFpEF), who experienced a prolonged decline complicated by recurrent hospitalizations and skilled nursing facility stays during the two years preceding death. This case highlights challenges in prognostication attributed to severe obesity complicated by HFpEF, which likely delayed goals of care conversations, and access to palliative care and hospice, despite high symptom burden. We discuss prognostic uncertainty among those with severe obesity and outline potential future directions.

This case report details the diagnostic challenge and management of an 88-year-old man who presented to a rural Japanese community hospital with sepsis-like symptoms, initially suspected of acute bacterial cholangitis based on his physical and laboratory findings. Despite the antibiotic treatment of tazobactam and piperacillin, the patient\'s symptoms persisted, leading to further investigations that revealed no signs of infection but notable aortic arch wall thickening on contrast-enhanced computed tomography scans. These findings, combined with the patient\'s clinical presentation and lack of antibiotic response, redirected the diagnosis toward giant cell arteritis (GCA). The administration of prednisolone of 60 mg daily significantly alleviated symptoms and prevented potential severe complications such as blindness and irreversible neurological damage. This case underscores the importance of considering GCA in elderly patients presenting with systemic inflammatory symptoms and the necessity of timely intervention. It also highlights the challenges in managing high-dose steroid therapy in elderly patients and suggests the potential benefits of integrating immunosuppressants to reduce steroid dependency. This report emphasizes the need for heightened awareness and a comprehensive diagnostic approach in atypical presentations of GCA, particularly in geriatric populations within resource-limited healthcare settings.

Malnutrition, inflammation, comorbid diseases, and inactivity are known causes of sarcopenia. It results in clinical consequences like fractures, falls, low quality of life, cognitive dysfunction, and mortality. Especially in the treatment of patients with prolonged immobilization syndrome, management should not only focus on functional limitations but patients should also be evaluated and followed up for sarcopenia. In this case report, we present the management of probable secondary sarcopenia in the intensive care unit as a result of urosepsis and discuss it in the light of the literature.

Hypothermia is defined as a core body temperature of less than 35°C. This report centers on the case of an older adult who presented to the emergency department (ED) with mild hypothermia, bradycardia, and electrolyte abnormalities during the summer in a warm climate. The patient was an 82-year-old man who was found to be hypothermic (33.6°C rectally), hypotensive, and bradycardic. He was treated with intravenous (IV) fluid resuscitation, active external rewarming (AER), and empiric antibiotics for his left lower lobe pneumonia. He was admitted to the intensive care unit and ultimately discharged home with physical therapy. Older adults are at an increased risk for hypothermia, even in a tropical climate. Early recognition of hypothermia is essential to achieve good outcomes.

This case report details the assessment and interdisciplinary collaboration in the management of an 81-year-old patient presenting with acute visual impairment, dizziness, general weakness, gait disturbances and fear of falling. A holistic geriatric evaluation revealed orthostatic dysregulation and an underlying multifactorial gait disorder exacerbated by visual impairment. Ophthalmological findings included left central retinal artery branch occlusion and cataracts. A comprehensive geriatric assessment showed frailty, impaired mobility and decreased functional abilities. Subsequent patient-centered interdisciplinary approaches included treatment for retinal ischemia, orthostatic testing, medication reconciliation, physiotherapy and occupational therapy. This case emphasizes how interdisciplinary collaboration between ophthalmology and geriatrics enables proactive assessment and intervention to reduce the risk of functional decline and loss of autonomy in visually impaired patients, which is of particular relevance considering the increasing prevalence of visual impairment in the ageing population.
UNASSIGNED: Dieser Fallbericht beschreibt einen 81-jährigen Patienten, der aufgrund akuter Visusminderung, Schwindel, allgemeiner Schwäche, Gangstörung und Sturzangst in eine Klinik für Augenheilkunde aufgenommen wurde. Zu den ophthalmologischen Befunden gehörten ein reperfundierter Arterienastverschluss links und eine Cataracta corticonuclearis provecta beidseits. Ein umfassendes geriatrisches Assessment ergab zusätzlich geringgradige Frailty, eingeschränkte Mobilität und verringerte Selbsthilfefähigkeit. Die interdisziplinäre Behandlung erfolgte patientenzentriert und umfasste neben der Behandlung und Abklärung der retinalen Ischämie u. a. eine Schwindelabklärung, Medikationsanalyse und -änderung, Physio- sowie Ergotherapie. Sehkraftminderungen gehen bei älteren Menschen mit erhöhtem Risiko für Autonomieverlust, Mobilitätseinschränkung, funktionellen Abbau und verminderter Lebensqualität einher. Das Sturzrisiko und die Mortalität sind erhöht. Dieser Fallbericht verdeutlicht, wie interdisziplinäre Zusammenarbeit zwischen Augenheilkunde und Geriatrie eine frühzeitige Identifikation des individuellen Risikos und geeigneter Interventionen ermöglicht.

UNASSIGNED: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of 2019 caused the global pandemic. Oral and dermatological manifestations of coronavirus disease 2019 (COVID-19) such as xerostomia, aphthous-like lesions, ulcers, tongue depapillation, necrotizing gingivitis, and taste disorders, including the loss of taste and salivary gland infections are being reported. This study aims to describe a case of oral ulcers following COVID-19 infection.
UNASSIGNED: We present the case of a 95-year-old male patient hospitalized in follow-up care and rehabilitation unit, of Minimes Geriatric Clinic, Toulouse, France. He had an alteration in his general health in the context of COVID-19 infection detected by reverse transcription polymerase chain reaction (RT-PCR). Six days after the admission, the patient complained of a strong burning sensation of the mouth, especially on the tongue and the lips\' mucosa. Intraoral examination revealed painful erosive areas on the lateral edges of the tongue and the mucous side of the lower lip. The proposed treatment to reduce the burning sensation was based on general analgesics (morphine sulfate), mouthwash with sodium bicarbonate, the application of a lidocaine-based oral anesthetic and healing gel and a comfort-oriented diet. Thirteen days later, the patient reported a gradual improvement.
UNASSIGNED: A diverse range of oral manifestations has been observed in patients with a history of COVID-19 infection. These oral ulcers significantly impact the quality of life of the individual, causing intense pain, stress, and difficulties in eating, with repercussions on nutritional status, especially in older individuals. Our case underscores the importance of oral examinations and the role of dentists in the management of patients with SARS-CoV-2.