Zeitschrift Fur Gerontologie Und Geriatrie最新文献

The principles of suicide prevention and easy access to assisted suicide are not compatible. Although suicide prevention does not aim to prevent suicide at all costs, it is fundamentally geared towards supporting people in existential crises and emergency situations in developing options for a successful life. Based on empirical facts on suicide and suicidal ideation in old age as well as clinical psychodynamic theories on the understanding of suicide, the corresponding foundations of assisted suicide are presented. After a brief introduction to the basic principles of suicide prevention, the relationship between suicide prevention and assisted suicide is explained and described. Based on the empirical knowledge of specific emergencies that can lead to a request for assisted suicide, possibilities of universal, selective and indicated suicide prevention are derived for this field.

Background: There has been noticeable research emphasis on the effects of museum-based programs as valuable community support for people with dementia and their primary caregivers.

Research question and aim: This umbrella review outlines the effects of museum-based community programs on health-related aspects of people with dementia and their primary caregivers and aims to synthesise existing evidence of museum-based programs and give directions for practice and implementation research.

Method and material: An umbrella review was undertaken following the guideline of the Joanna Briggs Institute (JBI). Therefore 6 databases (CINAHL Complete, PubMed, Medline Complete, SocINDEX, Psych & Behav Sci and the Cochrane Database for Systematic Reviews) were searched for systematic reviews and meta-analyses in April/May 2023 and as a follow-up in October 2023. The results were critically appraised by three reviewers.

Results: A total of five systematic reviews and one meta-analysis were identified. Due to the heterogeneity of the primary studies no consistent statistically robust proof of effects of museum-based community programs currently exists. Qualitative studies support the effects towards improvement of quality of life, mood and other noncognitive parameters.

Discussion and conclusion: While the heterogeneity of study designs prevents a critical evaluation of the effects and therefore a reliable comprehensible analysis, the results from different studies, including randomized controlled trials, support museum-based programs as a valuable resource for participation in day to day care and social prescribing. For future research adapted and extended methodological considerations and approaches, such as mixed methods designs are recommended.

Hyponatremia is the most frequent electrolyte imbalance in geriatric medicine. Causes of hyponatremia were retrospectively analyzed in all in-patients treated in 2016 (N = 2267, 1564 women, 703 men, mean age ± standard deviation 81.9 ± 7.6 years). Any form of hyponatremia on admission, during the stay or on discharge was noted in 308 patients (13.6%, 231 women, 77 men; mean age ± standard deviation 83.1 ± 7.3 years, p = 0.009 vs. age of all patients). Women had a higher probability of developing hyponatremia compared to men (p = 0.019), 131 patients were hypovolemic, and dyspnea as an indicator of hypervolemia was noted in 71 patients.Only 12 patients suffering from hyponatremia (3.9%) did not receive any of the potentially sodium-lowering drugs assessed (diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, antidepressants, neuroleptics, nonsteroidal antirheumatics, carbamazepine, oxcarbazepine). The median number of drugs per patient potentially lowering the plasma sodium level was 3 and the maximum number was 7.Hypovolemic hyponatremia and the syndrome of inadequate antidiuretic hormone secretion were the most important causes of hyponatremia. Adverse drug effects were the main origins of both conditions. In patients with hyponatremia the drug load influencing plasma sodium level should be minimized, thiazide diuretics should be avoided and older individuals should receive a diet with sufficient salt content.

Depressive disorders in older people are often accompanied by thoughts of their own death and the specific wish to die. Therefore, it can be assumed that depressive older people will express the wish for assisted suicide more frequently if legal provisions have been made. The following aspects must be taken into account when examining the decision-making capacity of those affected: depressive disorders can be reversible. Severe depressive disorders can be accompanied by an impaired capacity for judgment and making decisions, which rules out the possibility of making decisions of one's own free will. Particularly in old age, somatic comorbidities and an increased risk of loneliness are often found, which can additionally promote suicidal ideation. Without comprehensive assessments it will not be possible to clarify the actual autonomy of the will and it will be difficult to assess the permanence of the decisions made. It is also conceivable that the legal expert opinion could come to a different conclusion than the treating physician, who has followed the course of the illness during various phases of the patient's life and observed many changes in the patients will. In summary, it is currently not clearly recognizable in what form the assessment of free will could be organized in connection with possible legal regulations on assisted suicide, as long observation periods would be required for an adequate assessment.

The article deals with assisted suicide from a German legal perspective, focussing on criminal law and constitutional law and based on this to discuss possibilities for a further regulation. It is shown that assisted suicide is exempt from punishmed under the condition of a fully responsible decision to commit suicid and the final act leading to death is carried out by the suicidal person, which means that other acts of assistance are already punishable under current law. A further component of the considerations is how, independent of a legal regulation, free responsibility should be established and, in particular, how information and counselling about alternatives should be provided against the background of the different needs of people in different life and problem situations. Overall, further legal regulation is viewed critically. Practitioners are called upon to continuously develop recommendations for dealing with suicidal ideation.

Background: The increasing number of care-dependent individuals requires approaches to prevent care dependency or reduce the loss of independence. Long-term care assessments can provide valuable insights into this.

Objective: The aim of this article is to describe initial applicants with an identified need for long-term care as well as to provide a differentiated analysis of care-related diagnoses by age, gender, care level and federal state.

Material and methods: The nationwide database consists of long-term care assessments conducted by the Medical Service (MD) of individuals insured with the AOK aged 60 years and above who received a care level (PG) for the first time in 2021. Information relevant to long-term care was analyzed descriptively.

Results: In this study 339,486 individuals with an average age of 79.6 years (±8.4 years) and a female proportion of 59.0% were analyzed. Approximately one half received care level 2 and 32.4% received care level 1. Care levels 3-5 were assessed less frequently (16.2% vs. 4.8% vs. 1.7%, respectively). Individuals living alone were represented more strongly in lower care levels, while individuals not living alone had a higher proportion in care levels 3-5. The most frequent care-relevant diagnoses were senility (R54), polyarthritis (M15) and dementia (F03) with significant differences observed between federal states (ICD-10 R chapter: 0.8% Berlin and Brandenburg vs. 37.9% Saxony; M chapter: 13.6% Bavaria and Hamburg vs. 39.9% Mecklenburg-Western Pomerania).

Conclusion: Social determinants, such as age, gender, living alone, and region can play a role in the classification into a care level. Significant differences in care-related diagnoses between federal states warrant further investigation in future research.