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Literatur und weiterführende Links (EXPERT 01-06)

Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med. 1997;157:1531–6.

Fick DM, Semla TP. American Geriatrics Society Beers Criteria: new year, new criteria, new perspective. J Am Geriatr Soc. 2012;60:614–5.

Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the Priscus List. Dtsch Ärztebl Int. 2010;107:543–51.

Gallagher P, Ryan C, Byrne S, et al. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.

Wehling M. Drug therapy in the elderly: too much or too little, what to do? A new assessment system: fit for the aged (FORTA). Dtsch Med Wochenschr. 2008;133:2289–91

Wehling M. Multimorbidity and polypharmacy: how to reduce the harmful drug load and yet add needed drugs in the elderly? Proposal of a new drug classification: fit for the aged. J Am Geriatr Soc. 2009;57:560–1.

Kuhn-Thiel AM, Weiß C, Wehling M; FORTA authors/expert panel members.. Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014 Feb;31(2):131-40.


Grundkrenntnisse Geriatrie (EXPERT 01)

[i] http://www.dggeriatrie.de/nachwuchs/91-was-ist-geriatrie.html

[ii] Peters E , Pritzkuleit R , Beske F , Katalinic A . Demographic change and disease rates: a projection until 2050 . Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010 ; May; 53 (5): 417 – 426

[iii] Scherbov S, Sanderson W. Negative Folgen der Alterung bislang überbewertet. Demografische Forschung aus erster Hand 2010; 7 (4):1 – 2

[iv] Fendrich K , Hoff mann W . More than just aging societies: the demographic change has an impact on actual numbers of patients . J Public Health 2007 ; 15 : 345 – 351

[v] Moineddin R , Nie J X , Wang L et al. Measuring change in health status of older adults at the population level: the transition probability model. BMC Health Serv Res 2010 ; 10 : 306

[vi] Rosen M , Haglund B . From healthy survivors to sick survivors – implications for the twenty-first century. Scand J Public Health 2005;33 (2): 151 – 155

[vii] Böhm K, Tesch-Römer C , Ziese T . Gesundheit und Krankheit im Alter . Beiträge zur Gesundheitsberichterstattung des Bundes http://www.gbe-bund.de/gbe10/owards.prc_show_pdf?p_id = 11828&p_sprache =D&p_uid = gast&p_aid = 40816727&p_lfd_nr = 7 2009 Robert Koch-Institut, Statistisches Bundesamt, Deutsches Zentrum für Altersfragen.12-1-2011


Physiologische Veränderungen im Alter (EXPERT 01)

[i] Ibanez C, Shields SA, El-Etr M et al. Steroids and the reversal of ageassociated changes in myelination and remyelination. Prog Neurobiol 2003; 71: 49–56

[ii] Raz N, Lindenberger U, Rodrigue KM et al. Regional brain changes in aging healthy adults: general trends, individual differences and modifiers. Cereb Cortex 2005; 15: 1676–1689

[iii] Hinman JD, Abraham CR. Whatʼs behind the decline? The role of white matter in brain aging. Neurochem Res 2007; 32: 2023– 2031

[iv] Dickstein DL, Kabaso D, Rocher AB et al. Changes in the structural complexity of the aged brain. Aging Cell 2007; 6: 275–284

[v] Peters A. Structural changes in the normally aging cortex of primates. Prog Brain Res 2002; 136: 455–465

[vi] Seals DR, Esler MD. Human ageing and the sympathoadrenal system. J Physiol 2000; 528: 407–417

[vii] Foster TC. Calcium homoeostasis and modulation of synaptic plasticicty in the aged brain. Aging Cell 2007; 6: 319–325

[viii] Craik FIM, Morris LW, Morris RG et al. Aging, source, amnesia and frontal lobe functioning. Psychol Aging 1990; 5: 148–151

[ix] Grady CL, Craik FI. Changes in memory processing with age. Curr Opin Neurobiol 2000; 10: 224–231

[x] Wickremaratchi MM, Llewelyn JG. Effects of aging on touch. Postgrad Med J 2006; 82: 301–304

[xi] Ishikawa M, Matsumoto M, Fujimura Y et al. Changes of cervical spinal cord and cervical spinal canal with age in asymptomatic subjects. Spinal Cord 2003; 41: 159–163

[xii] Najjar SS, Scuteri A, Lakatta EG. Arterial aging: is it an immutable cardiovascular risk factor? Hypertension 2005; 46: 454–462

[xiii] Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part II: the aging heart in health: links to heart disease. Circulation 2003b; 107: 346–354

[xiv] Lakatta EG. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part III: cellular and molecular clues to heart and arterial aging. Circulation 2003; 107: 490–497

[xv] Vaz FG, Seymour DG. A prospective study of elderly general surgical patients: I. Pre-operative medical problems. Age Ageing 1989; 18: 309–315

[xvi] Bulpitt CJ, Rajkumar C, Cameron JD. Vascular compliance as a measure of biological age. J Am Geriatr Soc 1999; 47: 657–663

[xvii] Thom T, Haase N, Rosamond W et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics – 2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006; 113: 85–151

[xviii] Sutton-Tyrrell K, Najjar SS, Boudreau RM et al., for the Health ABC Study. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation 2005; 111: 3384–3390

[xix] Aronson S, Fontes ML, Miao Y et al. Investigators of the Multicenter Study of Perioperative Ischemia Research Group; Ischemia Research and Education Foundation. Risk index for perioperative renal dysfunction/failure: critical dependence on pulse pressure hypertension. Circulation 2007; 115: 733–742

[xx] Mottram PM, Haluska BA, Leano R et al. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart 2005; 91: 1551–1556

[xxi] Ebert TJ, Rooke GA. Alterations in circulatory function. In: Silverstein JH, Rooke GA, Reves JG, McLeskey CH. Geriatric Anesthesiology, 2nd ed. New York: Springer; 2008; 137–148

[xxii] Kass DA, Bronzwaer JG, Paulus WJ. What mechanisms underlie diastolic dysfunction in heart failure? Circ Res 2004; 94: 1533–1542

[xxiii] Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I: aging arteries: a „set up“ for vascular disease. Circulation 2003a; 107: 139–146

[xxiv] Wessells RJ, Bodmer R. Cardiac aging. Semin Cell Dev Biol 2007; 18: 111–116

[xxv] Ebert TJ, Morgan BJ, Barney JA et al. Effects of aging on baroreflex regulation of sympathetic activity in humans. Am J Physiol 1992; 263: H798–803

[xxvi] Brodde OE, Konschak U, Becker K et al. Cardiac muscarinic receptors decrease with age. In vitro and in vivo studies. J Clin Invest 1998; 101: 471–478

[xxvii] Ferrari AU. Modifications of the cardiovascular system with aging. Am J Geriatr Cardiol 2002; 11: 30–33

[xxviii] Gupta AK, Maheshwari A, Tresch DD et al. Cardiac arrhythmias in the elderly. Card Electrophysiol Rev 2002; 6: 120–128

[xxix] Janssens JP, Pache JC, Nicod L. Physiological changes in respiratory function associated with ageing. Eur Respir J 1999; 13: 197– 205

[xxx] Johnson BD, Reddan WG, Pegelow DF et al. Flow limitation and regulation of functional residual capacity during exercise in a physically active aging population. Am Rev Respir Dis 1991; 143 (5 Pt 1): 960–967

[xxxi] Davidson WR jr., Fee EC. Influence of aging on pulmonary hemodynamics in a population free of coronary artery disease. Am J Cardiol 1990; 65: 1454–1458

[xxxii] Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S.population. Am J Respir Crit Care Med 1999; 159: 179–187

[xxxiii] Carskadon MA, Dement WC. Respiration during sleep in the aged human. J Gerontol 1981; 36(4): 420–423

[xxxiv] Ebihara S, Saito H, Kanda A et al. Impaired efficacy of cough in patients with Parkinson disease. Chest 2003; 124: 1009–1015

[xxxv] Gilbert GH, Heft MW, Duncan RP. Mouth dryness as reported by older Floridians. Community Dent Oral Epidemiol 1993; 21: 390–397

[xxxvi] Bardan E, Kern M, Arndorfer RC et al. Effect of aging on bolus kinematics during the pharyngeal phase of swallowing. Am J Physiol Gastrointest Liver Physiol 2006; 290: G458–465

[xxxvii] Ekberg O, Feinberg MJ. Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases. Am J Roentgenol 1991; 156: 1181–1184

[xxxviii] Fass R, Pulliam G, Johnson C et al. Symptom severity and oesophageal chemosensitivity to acid in older and young patients with gastro-oesophageal reflux. Age Ageing 2000; 29: 125–130

[xxxix] Haruma K, Kamada T, Kawaguchi H et al. Effect of age and Helicobacter pylori infection on gastric acid secretion. J Gastroenterol Hepatol 2000; 15: 277–283

[xl] Shimamoto C, Hirata I, Hiraike Y et al. Evaluation of gastric motor activity in the elderly by electrogastrography and the (13)C-acetate breath test. Gerontology 2002; 48: 381–386

[xli] Annibale B, Lahner E, Bordi C et al. Role of Helicobacter pylori infection in pernicious anaemia. Dig Liver Dis 2000; 32: 756–762

[xlii] Liu L, Bopp MM, Roberson PK et al. Undernutrition and risk of mortality in elderly patients within 1 year of hospital discharge. J Gerontol A Biol Sci Med Sci 2002; 57: M741–746

[xliii] Dzankic S, Pastor D, Gonzalez C et al. The prevalence and predictive value of abnormal preoperative laboratory tests in elderly surgical patients. Anesth Analg 2001; 93: 301–308

[xliv] Zeeh J, Platt D. The aging liver:structural and functional  changes and their consequences for drug treatment in old age. Gerontology 2002; 48: 121– 127

[xlv] Ohtake Y, Maruko A, Ohishi N et al. Effect of aging on EGF-induced proliferative response in primary cultured periportal and perivenous hepatocytes. J Hepatol 2008; 48(2): 246–254

[xlvi] Bowker LK, Price JD, Smith SC (2006) Oxford Handbook of Geriatric Medicine


Pharmakokinetik und Pharmakodynamik (EXPERT 01)

[i]  Drewlow B et al. Pharmakokinetik und Pharmakodynamik. In: Paul-Ehrlich-Gesellschaft für Chemotherapie e. V. (Hrsg) Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen bei Erwachsenen – Update 2010. Rheinbach: PEG 19–25

[ii] Berthold HK, Steinhagen-Thiessen E. Arzneimitteltherapie im Alter. Internist 2009; 50:1415–1424

[iii] Fick DM. Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Intern Med 2003; 163:2716–2724

[iv] Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev 2009; 41:67–76

[v] Zoli M, Magalotti D, Bianchi G et al. Total and functional hepatic blood flow decrease in parallel with ageing. Age Ageing 1999; 28: 29–33

[vi] Schwartz JB. The current state of knowledge on age, sex, and their interactions on clinical pharmacology. Clin Pharmacol Ther 2007; 82: 87–96.

[vii]  Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev 2009; 41(2):67–76

[viii] Thürmann PA, Schmiedl S. Pharmakotherapie alter Patienten. Med Klin Intensivmed 2011; 106:16–23

[ix] Siegmund W, May K Arzneitherapie im Alter. In: Lemmer B, Brune K (Hrsg) Pharmakotherapie. Klinische Pharmakologie. Springer, Berlin 2010, S 461–464


Medikationsmanagement im Alter – Multimorbidität und Polypharmazie (EXPERT 01)

[i] Fulton MM, Allen E. Polypharmacy in the Elderly: A Literature Review. Journal of the American Academy of Nurse Practitioners 2005; 17(4):123-132.

[ii] Bushardt RL, Massey EB, Simpson TW et al. Polypharmacy: misleading, but manageable. Clin Interv Aging 2008; 3(2):383–389

[iii] Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol. 2007; 63:187–195.

[iv] Hiemke, C., A. Dragicevic, J. Sachse und S. Härrter.  Wechselwirkungen bei der Psychopharmakotherapie. AMTArzneimitteltherapie 2003; 21:331-335.

[v] Bjerrum L, Sogaard J, Hallas J, Kragstrup J. Polypharmacy: correlations with sex, age and drug regimen. A prescription database study. Eur J Clin Pharmacol 1998; 54:197-202.

[vi] Campion EW, Avorn J, Reder VA et al. Overmedication of the lowweight elderly. Arch Intern Med 1987; 147: 945– 947

[vii] Jörgensen T, Johansson S, Kennerfalk A, Wallander MA, Svärdsudd K. Prescription drug use, diagnoses, and healthcare utilization among the elderly. Ann Pharmacother 2001; 35(9):1004–1009

[viii] Frühwald T (2007) Krankheiten im Alter – Einige Aspekte der Geriatrie. In: Gatterer G (Hrsg) Multiprofessionelle Altenbetreuung, Part 2. Springer, Wien, S 145–158

[ix] Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ 1997, 315:1096– 1099


Arzneimittelkategorien (EXPERT 01)

[i] DöserS, Marz W, Reinecke Mfet al.Empfehlungen zur Statintherapie im Alter, Daten und Konsensus. Internist 2004; 45: 1053– 1062

[ii] Beckett NS, Peters R, Fletcher AE et al.Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887– 1898

[iii] Wehling M.Arzneimitteltherapie im Alter: Zu viel und zu wenig, was tun? Ein neues Bewertungssystem: fit for the aged (FORTA). Dtsch Med Wochenschr 2008; 133: 2289– 2291

[iv] Frohnhofen H, Michalek C, Wehling M. Bewertung von Medikamenten in der Geriatrie mit der neuen FORTA-Klassifikation. Dtsch Med Wochenschr 2011; 136: 1417– 1421


Patientenvulnerabilität (EXPERT 01)

[i] Gillick M. Choosing medical Care in the old Age. Harvard University Press; 1998


Adhärenz und Compliance (EXPERT 01)

[i] Ansell BJ. Not getting to goal: the clinical costs of noncompliance. J Manag Care Pharm 2008; 14: 9–15

[ii] Klemperer D. Entscheidung über Therapie muss gemeinsam getroffen werden. Dtsch Ärztebl 2003; 100:


[iii] Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK. Medication compliance and persistence: terminology and definitions. Value Health 2008; 11: 44–7

[iv] Kern S, Reichmann H, Ziemssen T. Therapieadhärenz in der neurologischen Praxis. Nervenarzt 2008; 79: 877–8, 880–2, 884–6


Arzneimittelwechselwirkungen (EXPERT 01)

[i] Lipp HP. Klinische Bedeutung der Cytochrom-P450-Isoenzyme bei Arzneimittel-Interaktionen. Krankenhauspharmazie 1999; 20: 465–466.


Medikationsfehler (Expert 01)

[i] Peron EP et al. Year in review: medication mishaps in the elderly. Am J Geriatr Pharmacother 2011; 9:1–10


ACE-Hemmer (EXPERT 02)

[i] Fernandez-Vega F, Abellan J, Sanz de Castro S, Cucalon JM, Maceira B, Gomez de la Camara A. A study on the efficacy and safety of losartan in elderly patients with mild to moderate essential hypertension. Int Urol Nephrol 2001; 32: 519–523

[ii] Izzo JL Jr, Weir MR. Angiotensin-converting enzyme inhibitors. J Clin Hypertens (Greenwich) 2011; 13(9):667-75.

[iii] Desai AS, Swedberg K, McMurray JJ, Granger CB, Yusuf S, Young JB, Dunlap ME, Solomon SD, Hainer JW, Olofsson B, Michelson EL, Pfeffer MA; CHARM Program Investigators. Incidence and predictors of hyperkalemia in patients with heart failure: an analysis of the CHARM Program. J Am Coll Cardiol 2007;50:1959-66.

[iv] Tomlinson B (1996) Optimal dosage of ACE inhibitors in older patients. Drugs Aging 1996; 9: 262–273

[v] Fletcher AE, Palmer AJ, Bulpitt CJ. Cough with angiotensin converting enzyme inhibitors: how much of a problem? J Hypertens Suppl 1994;12: S43–47


AT1-Rezeptorantagonisten (EXPERT 02)

[i]  Pitt B, Poole-Wilson PA, Segal R et al. (2000) Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial—the Losartan Heart Failure Survival Study ELITE II. Lancet 2000; 355: 1582–1587


Betablocker (EXPERT 02)

[i] Edoute Y, Nagachandran P, Svirski B, Ben-Ami H. Cardiovascular adverse drug reaction associated with combined beta-adrenergic and calcium entry-blocking agents. J Cardiovasc Pharmacol. 2000 Apr;35:556-9.

[ii] Lee DW, Cohan B. Refractory cardiogenic shock and complete heart block after verapamil SR and metoprolol treatment. A case report. Angiology 1995; 46: 517-9.

[iii] United Kingdom Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes.BMJ 1998;317: 713–720

[iv] Shorr RI,Ray WA,Daugherty JR, Griffin MR  Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas.JAMA 1997; 278: 40–43

[v] Smith PJ,Talbert RL. Sexual dysfunction with antihypertensive and antipsychotic agents. Clin Pharm 1986;5:373–384

[vi] Fogari R,Zoppi A,Poletti L,Marasi G, Mugellini A,Corradi L Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study.Am J Hypertens 2001; 14: 27–31

[vii] Ko DT,Hebert PR,Coffey CS, Sedrakyan A,Curtis JP, Krumholz HM (2002) Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA 2002;288: 351–357


Diuretika (EXPERT 02)

[i] Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, Sever PS, Thom SM; BHS guidelines working party, for the British Hypertension Society. British Hypertension Society guidelines for hypertension management 2004(BHS-IV): summary. BMJ 2004; 328:634-40.

[ii] Sica DA, Carter B, Cushman W, Hamm L. Thiazide and loop diuretics. J Clin Hypertens (Greenwich) 2011; 13: 639-43.

[iii] Sarafidis PA, Georgianos PI, Lasaridis AN. Diuretics in clinical practice. Part I: mechanisms of action, pharmacological effects and clinical indications of diuretic compounds. Expert Opin Drug Saf 2010; 9:243-57.

[iv] Wehling M. Morbus diureticus in the elderly: epidemic overuse of a widely applied group of drugs. J Am Med Dir Assoc 2013; 14: 437-42.

[v] Gurwitz JH, Kalish SC, Bohn RL, Glynn RJ, Monane M, Mogun H, Avorn J. Thiazide diuretics and the initiation of anti-gout therapy. J ClinEpidemiol1997; 50: 953-9.

[vi] Zannad F, Alla F,Dousset B,Perez A, Pitt B. Limitation of excessive extracellular matrix turnover may contribute to survival benefit of spironolactone therapy in patients with congestive heart failure: insights from the Randomized Aldactone Evaluation Study (RALES). Rales Investigators.Circulation 2000; 102: 2700–2706

[vii] Scholz H. Behandlung von kardiovaskulären Erkrankungen im Alter.Pharmazeut Z 1988; 41: 50–65


Herzglykoside (EXPERT 02)

[i] Cheng JW and Rybak I, “Use of Digoxin for Heart Failure and Atrial Fibrillation in Elderly Patients,” Am J Geriatr Pharmacother, 2010, 8:419-27.

[ii] Yancy CW, Jessup M, Bozkurt B, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:e240-e327


Kalziumkanalblocker (EXPERT 02)

[i] Kungys G, Naujoks H, Wanner C. Pharmacokinetics of amlodipine in hypertensive patients undergoing haemodialysis. Eur J Clin Pharmacol. 2003;59:291-295.


HMG-CoA-Reduktasehemmer (Statine) (EXPERT 02)

[i] Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, Ford I, Gaw A, Hyland M, Jukema JW, Kamper AM, Macfarlane PW, Meinders AE, Norrie J, Packard CJ, Perry IJ, Stott DJ, Sweeney BJ, Twomey C, Westendorp RG. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360:1623–1630.


Antiarrhytmika (EXPER 02)

[i] Lafuente-Lafuente C, Mouly S, Longás-Tejero MA, Mahé I, Bergmann JF. Antiarrhythmic drugs for maintaining sinus rhythm after cardioversion of atrial fibrillation: a systematic review of randomized controlled trials. Arch Intern Med 2006; 166:719-28.

[ii] Piccini JP, Berger JS, O’Connor CM. Amiodarone for the prevention of sudden cardiac death: a meta-analysis of randomized controlled trials. Eur Heart J 2009; 30:1245-53.

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