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Demografischer Wandel

Veränderungen in Gesellschaft und Medizin und Entwicklungstendenzen in der Geriatrie

Demographic change

Changes in society and medicine and developmental trends in geriatrics

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Zusammenfassung

Hintergrund

Die zunehmende Lebenserwartung schafft viele Alte nach Überstehen des kritischen Alters für Herz- und Gefäßerkrankungen ihren Tumor und später die Demenz erleben.

Fragestellung

Unter den Tumoren des Mannes dominiert das Prostatakarzinom (PCa), dessen Inzidenz und Prävalenz durch die Ausweitung der Früherkennung in den letzten Jahren PSA-getriggert (prostataspezifisches Antigen) fortlaufend zugenommen haben. Werden klinische Relevanz und Lebensqualität der Betroffenen kritisch eingeschätzt, führt das zu der Forderung, die Früherkennung wie auch die Indikation zur einer Therapie an die Lebenserwartung und an die PSA-Werte zu adaptieren. So können Überdiagnosen und Übertherapie vermieden werden. Während hier Einsicht hilft, gilt es für 2030 ca. 1,8 Mio. Demenzkranke hinzunehmen.

Schlussfolgerung

In unserem Gesundheitswesen wird es zu einer Geriatrisierung kommen, die eine größere Zahl Geriatrischer Abteilungen an den Kliniken und Kooperationsmodelle zwischen Geriatrie und anderen Fachabteilungen schaffen wird. Die Ausbildungsinhalte der Studenten und Altersaspekte in der Fort- und Weiterbildung müssen einen qualifizierten Nachwuchs entstehen lassen. Nur so kann die durch den demografischen Wandel bedingte Herausforderung in dem Fach Geriatrie angenommen und bewältigt werden, indem bei Ärzten und Pflegenden für Nachwuchs gesorgt wird.

Abstract

Background

Increasing life expectancy means growing numbers of elderly survive the critical age for cardiac and vascular diseases only to later experience cancer and dementia.

Objectives

Of the types of cancer affecting men, prostate cancer continues to be diagnosed early by prostate-specific antigen (PSA) screening. The clinical relevance and quality of life of those affected must be critically judged. Depending on life expectancy, active surveillance (AS) and watchful waiting (WW) will be increasingly used in geriatric patients. Risk stratification as guided by CGA facilitates the therapeutic decisions of urologists and spares metastatic castration-resistant prostate cancer patients from unnecessary and adverse overtreatment. By 2030, approximately 1.8 million people will have dementia.

Conclusions

Thus, in the future, the health care system will have to treat an aging population, which will require the creation of increasing numbers of geriatric hospital departments and cooperative models between geriatrics and other specialties. The future training of medical students and continuing medical education must also be further developed to include aspects on aging. Only in this manner will it be possible to effectively confront the challenges associated with demographic change in the specialty of geriatrics.

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Literatur

  1. Aguirreche E, Zeppenfeld G, Kolb GF (2003) „Memory-clinics“ in German-speaking countries. Z Gerontol Geriatr 36:183–188

    PubMed  CAS  Google Scholar 

  2. Balducci L, Extermann M (2000) Management of cancer in the older person: a practical approach. Oncologist 5:224–237

    Article  PubMed  CAS  Google Scholar 

  3. Beermann S, Chakkalakal D, Muckelbauer R et al (2014) „We talk it over“–mixed-method study of interdisciplinary collaborations in private practice among urologists and oncologists in Germany. BMC Cancer 14:746

    Article  PubMed  PubMed Central  Google Scholar 

  4. Beermann S, Weissbach L (2012) Interdisciplinary treatment of urological tumors: a mixed-method study. Urologe A 51:1085–1088

    Article  PubMed  CAS  Google Scholar 

  5. Cerny T, Gallen KS (2011) Jahrestagung der DGHO, OeGHO, SGMO und SGH. Basel

  6. O Neil D, Hastie I, Williams B (2004) Developing specialist healthcare for older people: a challenge for the European Union. J Nutr Health Aging 8:109–112

    Google Scholar 

  7. Dall’Era MA, Albertsen PC, Bangma C et al (2012) Active surveillance for prostate cancer: a systematic review of the literature. Eur Urol 62:976–983

    Article  Google Scholar 

  8. Droz JP, Aapro M, Balducci L et al (2014) Management of prostate cancer in older patients: updated recommendations of a working group of the International Society of Geriatric Oncology. Lancet Oncol 15:404–414

    Article  Google Scholar 

  9. Droz JP, Balducci L, Bolla M et al (2010) Management of prostate cancer in older men: recommendations of a working group of the International Society of Geriatric Oncology. BJU Int 106:462–469

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ekdahl A, Fiorini A, Maggi S et al (2012) Geriatric Care in Europe – the EUGMS Survey Part II: Malta, Sweden and Austria. Eur Geriatr Med (EGM) 3:388–391

    Article  Google Scholar 

  11. Elshaug AG, Watt AM, Mundy L, Willis CD (2012) Over 150 potentially low-value health care practices: an Australian study. Med J Aust 197:556–560

    Article  PubMed  Google Scholar 

  12. Extermann M, Aapro M, Bernabei R et al (2005) Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 55:241–252

    Article  PubMed  Google Scholar 

  13. Extermann M, Boler I, Reich RR et al (2011) Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer 118:3377–3386

    Article  PubMed  Google Scholar 

  14. Kolb G, Andersen-Ranberg K, Cruz-Jentoft A et al (2011) Geriatric Care in Europe – the EUGMS Survey part I: Belgium, Czech Republic, Denmark, Germany, Ireland, Spain, Switzerland, United Kingdom. Eur Geriatr Med (EGM) 2:290–295

    Article  Google Scholar 

  15. GEK B (2010) Pflegereport 2010. Asgard, St. Augustin

  16. Hurria A, Wong FL, Villaluna D et al (2008) Role of age and health in treatment recommendations for older adults with breast cancer: the perspective of oncologists and primary care providers. J Clin Oncol 26:5386–5392

    Article  PubMed  PubMed Central  Google Scholar 

  17. Klotz L (2005) Active surveillance for prostate cancer: for whom? J Clin Oncol 23:8165–8169

    Article  PubMed  Google Scholar 

  18. Klotz L, Vesprini D, Sethukavalan P et al (2015) Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 33:272–277

    Article  PubMed  Google Scholar 

  19. Kolb G (2009) Versorgungsdichte mit geriatrischer Fachkompetenz in Deutschland. G Kolb für und im Auftrag des Dachverbandes der Gerontologischen und Geriatrischen Gesellschaften Deutschland e. V. (DVGG). Euro J Ger 11:11–13

    Google Scholar 

  20. Kolb G, Rehmann P, Karbe-Voigt N, Wöstmann B (2015) Are old patients not fit for clinical trials, or do clinical trials not fit to old patients? – A survey in 35 pharmaceutical companies. Eur Geriatr Med (EGM) 6:354–357

    Article  Google Scholar 

  21. Kolb G, Breuninger K, Gronemeyer S et al (2014) Ten years of early complex geriatric rehabilitation therapy in the DRG system. Z Gerontol Geriatr 47:6–12

    Article  PubMed  CAS  Google Scholar 

  22. Kolb GF (2002) Malignant diseases in the elderly. The elderly tumor patient. Internist (Berl) 43:959–964

  23. Kornblith AB, Kemeny M, Peterson BL et al (2002) Survey of oncologists‘ perceptions of barriers to accrual of older patients with breast carcinoma to clinical trials. Cancer 95:989–996

    Article  PubMed  Google Scholar 

  24. Krebsinformationsdienst (2013) Prostatakrebs: Früherkennung, Untersuchung, Behandlung, Nachsorge. Eine Übersicht für Patienten, Interessierte und Fachkreise. Krebsforschungszentrum, Heidelberg

  25. Loeb S, Bjurlin MA, Nicholson J et al (2014) Overdiagnosis and overtreatment of prostate cancer. Eur Urol 65:1046–1055

    Article  PubMed  PubMed Central  Google Scholar 

  26. Monfardini S, Basso U (2007) Oncological causes of frailty in older cancer patients. Eur J Cancer 43:1230–1231

    Article  PubMed  Google Scholar 

  27. Pallis AG, Wedding U, Lacombe D et al (2010) Questionnaires and instruments for a multidimensional assessment of the older cancer patient: what clinicians need to know? Eur J Cancer 46:1019–1025

    Article  PubMed  CAS  Google Scholar 

  28. Parkin DM, Laara E, Muir CS (1988) Estimates of the worldwide frequency of sixteen major cancers in 1980. Int J Cancer 41:184–197

    Article  PubMed  CAS  Google Scholar 

  29. Simpkin AJ, Tilling K, Martin RM et al (2015) Systematic review and meta-analysis of factors determining change to radical treatment in active surveillance for localized prostate cancer. Eur Urol 67:993–1005

    Article  PubMed  Google Scholar 

  30. Solomon D, Sue Brown A, Brummel-Smith K et al (2003) Best paper of the 1980s: National Institutes of Health Consensus Development Conference Statement: geriatric assessment methods for clinical decision-making. 1988. J Am Geriatr Soc 51:1490–1494

    Article  PubMed  Google Scholar 

  31. Soubeyran P, Fonck M, Blanc-Bisson C et al (2012) Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol 30:1829–1834

    Article  PubMed  Google Scholar 

  32. Thomsen FB, Brasso K, Klotz LH et al (2014) Active surveillance for clinically localized prostate cancer – a systematic review. J Surg Oncol 109:830–835

    Article  PubMed  Google Scholar 

  33. Bergh RC van den, Albertsen PC, Bangma CH et al (2013) Timing of curative treatment for prostate cancer: a systematic review. Eur Urol64:204–215

    Google Scholar 

  34. Vickers AJ, Cronin AM, Bjork T et al (2010) Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: case-control study. BMJ 341:4521

    Article  Google Scholar 

  35. Weissbach L, Stuerzebecher S, Mumperow E et al (2015) HAROW: the first comprehensive prospective observational study comparing treatment options in localized prostate cancer. World J Urol (Epub ahead of print)

  36. Haux R, Hein A, Kolb G et al (2014) Information and Communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies – outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL). Inform Health Soc Care 39(3–4):166–187

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Kolb und L. Weißbach geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Medizinische Klinik, Abteilung für Innere Medizin, Fachbereich Geriatrie, Geriatrische Onkologie, Bonifatius-Hospital Lingen, Akademisches Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Wilhelmstraße 13, 49808, Lingen (Ems), Deutschland

    G.F. Kolb

  2. Stiftung Männergesundheit, Berlin, Deutschland

    L. Weißbach

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  2. L. Weißbach
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Correspondence to G.F. Kolb.

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Kolb, G., Weißbach, L. Demografischer Wandel. Urologe 54, 1701–1709 (2015). https://doi.org/10.1007/s00120-015-4004-z

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