RESUMEN
OBJECTIVE: There is an ongoing debate about the relationship between obesity and morbidity in the elderly, the clinical relevance of overweight and obesity in older patients and the need or harms of treatment. The main purpose of our study was to investigate whether a higher BMI is associated with a worse cardiovascular risk in all age groups, especially in the older ones. SUBJECTS AND DESIGN: We performed a retrospective evaluation of clinical data from 3926 patients who visited a medical outdoor center for diagnostic and/or therapeutic interventions in the period from January 1995 to July 2010. Patients were assigned to eight age groups of one decade from <20 years to ≥80 years. RESULTS: The Body Mass Index (BMI) of our patients showed a continuous increase with increasing age with peak values in the age decade 61-70 years (26.29 ±4.42 kg/m2). This was paralleled by an increase in cardiovascular events and need for continuous medication, demonstrating peak values in the age decade 61-70 years (22.3% in the female and 24.7% in the male group). In all age decades up to 80 years the BMI values were higher in patients with events compared to those without it. multivariable linear regression analysis - including confounding variables (blood pressure, fasting glucose, HDL-cholesterol, triglycerides, physical activity, smoking) - revealed for all age groups a strong positive relation of BMI and a negative relation of fat free mass (FFM) to the probability for a cardiovascular event and need for medication. CONCLUSION: In all age groups, the percentage of cardiovascular events was directly correlated with the BMI. Having in mind the transition to an aging society, therapeutic and preventive strategies should, therefore, include weight management strategies also for the elderly.
Asunto(s)
Composición Corporal , Índice de Masa Corporal , Enfermedades Cardiovasculares/etiología , Obesidad/complicaciones , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Compartimentos de Líquidos Corporales , Enfermedades Cardiovasculares/tratamiento farmacológico , Estudios de Cohortes , Factores de Confusión Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Adulto JovenRESUMEN
The health care systems in Austria, Germany and Switzerland owe their institutional structure to different historical developments. While Austria and Germany voted for the Bismarck-Model of social health insurance, Switzerland adopted a voluntary system of health insurance. In all three countries, until very recently, the different challenges which the health care sector faced were met by piecemeal approaches and by stop and go policies, which, in the long run were not very successful either in containing costs or in improving efficacy and efficiency. During the 1990 more fundamental reforms in the health care systems of all three countries took place. Germany and Switzerland chose the path of deregulation of the health insurance system, which consequently strengthened the competition between the insurance companies, and, to some extent between the suppliers of medical services. While this can be seen as an essential part of the reform process for these two countries. Austria favors a state-oriented and interventionist approach in order to meet the challenges.
Asunto(s)
Atención a la Salud/organización & administración , Reforma de la Atención de Salud , Austria , Atención a la Salud/economía , Competencia Económica , Alemania , Política de Salud , Humanos , SuizaRESUMEN
The application of economic rules of allocation to tragic situations, which are often given in the health care system, is confronted with the problem, that economic decision rules normally follow an act-consequential ethic while medical decision rules have a strong affinity to a result-consequential ethic. The limited willing-ness-to-pay for health care leads to the necessity to use economic rules of resource allocation both on a global and on a personal level. But differences in the structure of the decision call for different rules of resource allocation. On a global level the allocation rule should be dominated by economic efficiency, while on a personal level the allocation rule should be guided by ideas of equity and fairness.