Authors analyze actual situation in treatment of cardiovascular diseases in older patients. Different groups of recommended drugs are discussed separately; possible risks for elderly patients are stressed. Angiotensin converting enzyme inhibitors-this group is widely used in older patients because of their hypotensive effect, positive influence on cardiac failure, and positive modulation of endothelial dysfunction. The risk of hyperkalemia must be considered. Antiaggregants and anticoagulants are proved as potent prophylactic treatment, but the associated risk of gastrointestinal bleeding must be weighed very carefully. Bradycardia related to β-blockers, especially in combination with other medications lowering the heart rate must be taken into account. Otherwise, this group brings the highest profit in cardiovascular diseases as for morbidity and mortality. Attention is paid to calcium channel blockers, statins, diuretics, nitrates, and digoxin. A table listing the possible side effects and clinical symptoms of overdose by medications most frequently used in the elderly concludes the article.

OBJECTIVES: With advancing age, the degree of dependency and occurrence of great geriatric syndromes (GS), also referred to as geriatric giants, grow substantially. DESIGN: The prospective cohort study was aimed at conducting an analysis and comparison of geriatric syndromes (geriatric giants) among different age groups at admission to the acute geriatric department. SETTING, PARTICIPANTS: Between 1995 and 2012, we had altogether 12,210 elderly patients at an average age of 80.5 ± 7.0 y (range 65-103 y) hospitalised at the Department of Geriatrics. We divided the patient set into three different age subgroups (65-74 y; 75-84 y and ≥ 85 y; e.g. 21.4 %; 47.9 % and 30.7 %) and compared the results among them. RESULTS: 3,787 persons (31.0 %) were without any GS. The growing tendency of the occurrence of all geriatric syndromes in combinations with increased age (p < 0.001) is obvious. Their occurrence in the above mentioned different age sets was examined in relation to individual geriatric syndromes and sex (female and male), namely falls 22.0 %, 27.8 %, 39.9 % and 20.5 %, 27.0 %, 36.1 %; immobility 26.4 %, 29.3 %, 42.5 % and 30.3 %, 30.1 % and 39.2 %; incontinence 38.4 %, 50.6 %, 69.5 % and 38.2 %, 47.4 %, 61.8 %; dementia and cognitive impairment 13.4 %, 23.4 %, 38.1 % and 15.8 %, 24.3 %, 33.2 % respectively. Age cut-off for geriatric syndromes occurrence based on ROC analysis is 83.5-84.5 y for females and 78.5-82.5 y for males. CONCLUSION: The occurrence of geriatric giants increasing with age and female gender is of crucial importance not only for individuals and families but also for demands on costs of health and social care in oncoming decades (Tab. 6, Fig. 3, Ref. 52). Text in PDF www.elis.sk.

Introduction: Pulmonary embolism (PE) in the elderly is an immediate threat of life. Especially in old age clinical signs of PE are non-specifi c and could be both underestimated and overestimated. Aim of the study: The retrospective long-term study was aimed at conducting an analysis and comparison of pertinent infl uence of age, gender and immobility on occurrence of PE and sudden death. Patients and method: Between 1995 and 2012 years we had altogether 12,746 elderly patients of an average age 80.6 ± 7.0 y (range 65-103 y) hospitalized at the Department of Geriatrics. All in-patients 65+ y were randomly admitted for internal hospitalization from the catchment area of Brno city (100,000 inhabitants). The subject of our interest was to study the documentation of deaths (including autopsy fi ndings), which was caused by PE. Out of this number there were 8,540 women (66.3 %) and 4,206 men (33.7 %). Among all hospitalized patients PE in 700 cases (5.5 % of all admitted patients) was shown in a medical report. Among them there were 424 survivors (60.6 %; 134 men and 290 women). Conclusion: The high occurrence of PE (particularly silent form) has crucial importance in the elderly mortality. Our recommendations would like to emphasize the need of no underestimation of this fact and to carry out preventive measures in all age groups (including the "oldest old" and frail persons) (Tab. 3, Ref. 41).

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Our operational results and postoperative follow-up show that laparoscopic Heller myotomy with Toupet partial fundoplication is a safe and effective treatment and can be recommended as the method of first choice for senior patients with no contraindication for laparoscopic operation.

Klinika interní, geriatrie a praktického lékařství LF MU a FN Brno, pracoviště Bohunice Souhrn Cílem naší práce je podat stručný přehled o etiologii, patogeneze, rizicích vzniku, klinickém obraze, úskalích léčby a prognóze hypotermie a hypertermie, možných interakcích těchto poruch termoregulace v interakci s některými komorbiditami, léky, a to včetně jejich možných nežádoucích účinků v těchto teplotně abnormálních stavech. Problematika hypotermie i hypertermie ve stáří (zejména pozdním) bude mít těsný vztah k labilní homeostáze a s věkem narůstajícím výskytem syndromu křehkosti (frailty). Neustále rostoucí počet nemocných s polymorbidi tou vyššího věku se sklonem k poruchám termoregulace a relativně malé povědomí této skutečnosti v širší odborné veřejnosti (včetně lékařské) nás vedlo ke zpracování této problematiky formou přehledného článku.Klíčová slova: hypertermie -hypotermie -interakce -léky -polymorbidita -poruchy termoregulace -stáří Thermoregulatory disorders and their significance in the elderly SummaryOur treatise is aimed at providing a brief survey on ethiology, pathogenesis, risks of inception, clinical picture, treat ment pitfalls and prognosis of hypothermia and hyperthermia and possible interactions of these thermoregula tion disorders with some other comorbidities. It deals also with drugs and medicines including their potential un wanted side effects in these thermally abnormal conditions. The problems of hypothermia and hyperthermia in the senium (especially the late one) will be closely connected with labile homeostasis and the occurence of frailty syn drome which increases with the age. Permanently growing number of patients with polymorbidity of higher age tending to suffer from thermoregulation disorders and relatively small awareness of this issue in wider specialist (including medical) community have led us to come out with this topic in the form of survey treatise.

The small-bowel ultrasound can be recommended as the first choice method. All complaints regarding the gastrointestinal tract should be verified. Older patients can be safely offered an elective laparoscopic surgery with acceptable morbidity and mortality.

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