Histochemische Untersuchungen in pathologisch veränderten Geweben

Ohne Zusammenfassung     

Misshandlung und Vernachlässigung älterer Menschen durch ambulante Pflegekräfte

Although some anecdotal evidence for the phenomenon of abuse and neglect of community-dwelling older care recipients by in-home care services exists, there is an almost complete lack of data on this topic. In order to determine extent and risk factors of abuse and neglect of older care recipients by nurses, we conducted a self-report study among in-home care workers in the German city of Hanover. A total of 503 nurses took part in the study; the response rate was 43.3%. Nearly 40% of all respondents reported having abused or neglected at least one patient within the last 12 months. Psychological abuse/verbal aggression and neglect were most common. Serious problem behavior could be predicted by patients' aggressive behavior, the number of clients suffering from dementia, subjects' use of alcohol as a means of alleviating work-related stress, and nurses' general judgments of quality of care delivered by the respective in-home service. The results of this study show that the problem of abuse and neglect of care recipients is not limited to nursing homes and care by family members. Findings point at opportunities for prevention and accentuate the need for further research in this field.     

Management älterer Patienten nach Organtransplantation

Due to a continuous expansion of transplantation registers, such as the old-for-old program in Europe, the number of older patients treated with transplantation is increasing. At the same time the perioperative survival rates show a clear increase even in this patient collective (older than 65 years); therefore, the probability that the care of older patients after organ transplantation will be undertaken in the routine practice increases. This article describes the medical characteristics of older patients following organ transplantation. Special emphasis is placed on the management of accompanying diseases as well as possible side effects and interactions of immunosuppressive therapy.     

Sexualität suizidaler Älterer

Sexuality and suicidality in the elderly seem to underlie a taboo in science and in therapeutic practice. It is urgent to find an understanding about both aspects of human experience and behaviour by explorative studies. In a sample (N=67), the narratives of 56 persons (suicidal=43 and non-suicidal=23) on questions concerning their sexuality were transcribed and ideal types were developed with the systematic qualitative method of forming types by understanding. Four of these types consist of clearly more suicidal persons, in two the non-suicidals predominate, the rest is more heterogeneous in this aspect. Some of these types can be interpreted unequivocally. One type was surprisingly clearly suicidal dynamic, while others were a "female narcissistic" or a "male narcissistic" type. This explorative typology may help the interested therapist/counsellor as a landmark to relate to sexuality as an important aspect of life, even in old age, and to use the discussion of sexuality to improve the understanding of patients, especially in suicidal crisis.     

Qualität der Versorgung älterer Menschen

Ohne Zusammenfassung     

Potentiale älterer Migranten und Migrantinnen

Re-migration and immigration are the causes for the continual fluctuation within the migrant population. It is, however, currently foreseeable that the elderly migrant population living in Germany will steadily increase. Because of the large degree of heterogeneity among the elderly migrant population in Germany, the following report will be limited to a discussion of those groups of migrant workers, who originate from former recruiting countries. These groups will constitute the majority of elderly migrants in the coming years. Among the first generation of migrants, some groups have extensive ethnic social networks. This is mostly the case with respect to the migrants from Turkey. These have access to their own ethnic infrastructure, and, due to this fact, there is little need for the initiation of social contacts outside their own ethnic context. Generally, they prefer, as do other elderly foreign workers, to remain in their cultural niches with their own religious institutions and migrant organizations. In comparison to the German population, the families of the first generation of migrants have more children and live more often in multigenerational households. Under the conditions of migration and in a foreign cultural context, the family fulfills a function of social-emotional support. Migrants possess a high potential for mobility. They commute between their homeland and the land of immigration. For some, this is a transitional strategy in order to reach a final decision, either to return to their homeland or to stay in Germany. For others, it is a long-term solution that enables them to make use of each country's respective advantages.     

Die emotionale Befindlichkeit älterer Menschen—

The German short version of the "Profile of Mood States (POMS)" with 35 items (seven-point response scale; rating related to the past 24 hours) was psychometrically tested in a sample of elderly people of 60 years of age and older (n=690; 57% female). The internal structure of the POMS with four factors (dejection, fatigue, displeasure, vigour) could largely be replicated, even though the first three factors are intercorrelated. Reliability of the scales appears to be very good. The convergent validity of the POMS scales could be proved by correlations with the Beck Depression Inventory and the SF-36. Specific norms are presented for four age groups, men and women and elderly living in Eastern and Western Germany. So it seems appropriate to use the German short version of the POMS as a valid and economic instrument for gerontological studies.     

Probleme bei der Pharmakotherapie älterer Patienten

Pharmacotherapy in the elderly is a challenge as the real risk-benefit ratio of many drugs and treatment strategies often remains unknown in these patients. Furthermore there are some special adverse drug reactions such as falls and delirium not only occurring more often but also causing an increased proportion of adverse outcomes. Finally there is the phenomenon of multimorbidity and polypharmacy responsible for treatment errors and inadequate drug treatment. A comprehensive risk-benefit analysis is needed to avoid both under- and over-treatment. This analysis should cover patients preferences, vulnerability, resources and functionality. Some simple treatment rules may improve drug treatment in the elderly, but an improved characterization of drugs and treatment strategies with regard to the elderly is essential.     

Versorgungssituation älterer Menschen hinsichtlich ambulanter Richtlinien-Psychotherapie

Ohne Zusammenfassung     

Motorische Handlungskompetenz und Lebensqualität älterer aktiver Menschen

Physical activity is a vital pre-condition for healthy aging and well-being. While the association between objective and subjective health in old age has extensively been investigated, the relationship between objective motor competence-the capability of mastering motor demands in everyday life adequately by using motor resources optimally-and subjective health-related quality of life has not been studied yet. In an interdisciplinary study, 168 active seniors (36 men) at the mean age of 67 (range: 59-89) underwent a test battery assessing motor resources and two objective domains of everyday life motor competence-"Perceiving and Reacting" and "Mastering Complex Situations". Subsequently, participants rated their mental, physical, social, functional health and life satisfaction by questionnaire. Motor competence domains were age-dependent; the strongest decrease was found for "Mastering Complex Situations". Only "Mastering Complex Situations" was predicted by motor resources: competent seniors in this domain were faster in motor activity, simple reactions, body movements following acoustic and optic signals, and showed a stronger handcraft and a higher mobility. Overall, health-related quality of life was contingent upon motor competence: physical and functional health and-to a lesser extent-mental health and life satisfaction showed a systematic but moderate relationship to both motor competence domains. The results emphasize the significance of age-compatible and everyday life-adjusted physical activity for the well-being of elderly persons. Even active elderly persons show deficits in motor competence and should be trained, taking into account individual resources and flaws.     

Arbeitsbelastungen und Gesundheit älterer Arbeitnehmer im Dienstleistungsbereich

Presented are the results of a representative survey of the German work force (N = 34,343) regarding work load and work-related diseases. The study comprises females and males aged 45 years and older, who are occupied in the service sector (N = 8310). The findings show that older workers in this economic sector have to bear considerable physical and mental work loads that are often higher than those for the total labor force. The results presented point to the need to encourage and practice a more comprehensive health promotion for older workers in the service sector.     

Behandlungsergebnisse stationärer psychosomatischer Rehabilitation Älterer

Zusammenfassung Mit Hilfe einer umfangreichen empirischen Untersuchung werden die differentiellen Effekte eines spezifischen psychosomatischen Therapieangebotes für ?ltere Menschen (ab 55 Jahre) in einer Rehabilitationsklinik dargestellt. Eine differenzierte Analyse zur Bewertung des Behandlungsangebotes definiert vier Patientengruppen (Somatopsychische Patienten, „Pseudonormale” Patienten, Patienten mit akuter Belastungsreaktion, Neurotische Patienten) mit unterschiedlichem Behandlungserfolg. Drei der vier gefundenen Patiententypen profitieren insgesamt von dem Behandlungsangebot und geben v.a. in einer 1-Jahres-Katamnese eine deutliche Reduzierung ihrer Belastungen in verschiedenen Problembereichen an. Auff?llig zeigte sich die Gruppe der „pseudonormalen” Patienten, die bereits zu Behandlungsbeginn eine geringe Belastung in allen befragten Problembereichen angaben und folglich nur geringe Effektst?rken im Outcome aufweisen k?nnen. Zum besseren Verst?ndnis dieser Gruppe sind fremdanamnestische Daten z.B. durch den Hausarzt hilfreich. Es werden konzeptuelle Ver?nderungen auf dem Hintergrund m?glicher sozialer Schwierigkeiten dieser Gruppe diskutiert. Eingegangen: 15. Oktober 2000 Akzeptiert: 20. Mai 2001     

Der Karotisdruckversuch beim Normalen,bei der Hypertonie und anderen veränderten Kreislauf-einstellungen im Zusammenhang mit der reflektorischen Selbststeuerung

Ohne ZusammenfassungMit 2 Abbildungen.Herrn Prof. Dr. F. Vothard zum 70. Geburtstag zugeeignet.     

Arzneimittelgebrauch und gesundheitliche Selbsteinschätzung selbstständig lebender, älterer Hamburger

Zusammenfassung Die gesundheitliche Selbsteinschätzung älterer Menschen korrespondiert mit der Morbidität und Mortalität und besitzt daher prognostischen Wert. In der vorliegenden Untersuchung wurden relevante Daten zur Verwendung von Arzneimitteln, zur Anzahl der jährlichen Arztbesuche und zum Gesundheitszustand in Form von Selbstauskünften anhand eines validierten Instruments erhoben. Die Stichprobe bildeten 804 selbstständig lebende, deutschsprachige Personen im Alter von 60 Jahren und älter, die über 14 kooperierende Hamburger Hausarztpraxen rekrutiert wurden. Ausschlusskriterien waren bekannte demenzielle Erkrankungen oder Pflegebedürftigkeit (Pflegestufe). Je Teilnehmer¹ wurden ca. drei ärztlich verordnete Medikamente benannt und ein frei verkäufliches Präparat als Selbstmedikation. Die Anzahl der verwendeten Medikamente korrespondiert mit der Häufigkeit von durchschnittlich mehr als 2 bekannten chronischen Erkrankungen. Erkrankungen. Fast die Hälfte der Befragten klagte über Schmerzen, mehr als ein Drittel der davon Betroffenen über mäßige bis starke Schmerzintensität. Ebensoviele Personen schätzten den eigenen gesundheitlichen Zustand als mäßig bis schlecht ein und ein Fünftel schilderte Anzeichen für eine gedrückte Stimmung. Insbesondere zwischen der Häufigkeit beklagter Schmerzen sowie depressiver Stimmung und dem angegebenen Medikamentengebrauch fanden sich Diskrepanzen. Die Ergebnisse sprechen dafür, die subjektive Einschätzung ihrer Gesundheit bei älteren Patienten sowie damit im Zusammenhang stehende körperliche und seelische Beschwerden bei der medikamentösen Behandlung stärker zu berücksichtigen.Förderung (in alphabetischer Folge) durch: Bundesministerium für Familie, Senioren, Frauen und Jugend Europäische Kommission (5. Rahmenplan QLK6-1999-02205) Robert Bosch Stiftung* Förderung als Stipendiatin im Forschungskolleg Geriatrie der Robert Bosch Stiftung ¹ Es wird zur besseren Lesbarkeit durchgehend die männliche Form genutzt. Für den jeweiligen Sachverhalt gilt, dass immer das männliche und das weibliche Geschlecht gemeint sind.     

Gesundheitsversorgung älterer Menschen mit türkischem Migrationshintergrund

Background

Older people with a Turkish migration background face various barriers in terms of access to and quality of health care. Providing health care according to their subjective and objective needs is of increasing importance considering demographic aging. The aim of this study was to illustrate challenges older migrants experience in the health care process from the viewpoint of health mediators.

Method

Construct interviews were conducted with six health mediators and were analyzed by means of content analysis.

Results

The interviews showed three different challenges in health care for people with a Turkish migration background. These were the patients’ coping with the disease, their health beliefs, and factors associated with the health care process and the doctor-patient relationship.

Conclusion

The study highlights that it is important to make health care institutions aware of the culture specific characteristics of illness and therapy beliefs among people with a Turkish migrations background. Diversity management is an adequate strategy to adjust health care to the needs and requirements of an increasingly diverse population.