Zeitschrift Fur Gerontologie Und Geriatrie最新文献

Many of the challenges facing ageing societies involve an interaction of factors from many domains and levels, including person-level age-related changes in function through to the physical environment, economy, urban design and social policies. The pace of change in our societies is accelerated by climate change and the rapid introduction of artificial intelligence and other technologies. When presented with practical challenges or problems to solve that are inherently due to an ageing society, it is not possible for any individual to have the expertise and capacity to address all the dimensions involved. Therefore, developing a multidisciplinary framework that signals the dimensions of influence that need to be considered in adaptive ageing, may assist in optimizing how complex issues in ageing are tackled. This paper proposes a holistic adaptive ageing framework (HAAF) as a starting point for multidisciplinary and multisectoral approaches to develop optimal solutions to complex problems. The five dimensions of the framework include lived experience, person-level adaptation, environmental context, technology and social and economic policy. Future research is needed to operationalize the framework and evaluate its application to complex problems.

Background: Frontotemporal dementia (FTD) accounts for around 5% of all forms of dementia and often starts at a relatively young age. It poses challenges for relatives and carers. This article focuses on changes with respect to sexuality. Studies have so far mainly focussed on neuronal changes and only marginally on the altered sexuality of people with FTD and the associated difficulties for partners. Sexuality and intimacy should be seen as a basic human need, even for people with dementia.

Aim of the work: The challenges of altered sexuality of people with FTD in their couple relationships were surveyed in order to identify forms of behavior of sufferers and derive conclusions for the practice.

Material and methods: The study comprises expert interviews (n = 8). These were analyzed using a content-structuring qualitative content analysis according to Kuckartz.

Results: The interviews clearly show that people with FTD experience a different sexuality as a result of the disease, both in the form of hypersexual and hyposexual behavior. Both forms of behavior lead to changes in couple relationships.

Discussion: The results indicate the need to destigmatize those affected as hypersexual per se and the relevance of professional support for those affected and organizations. An integrative approach is required in which protection and enabling a healthy sexuality with FTD are considered together.

Background: Geriatric patients in subacute inpatient care (SC) with rehabilitation needs after hospitalization seldom utilize rehabilitative services and are often transitioned to long-term care (LTC), suggesting that their care in SC can be optimized.

Objective: To evaluate the effectiveness of rehabilitative subacute inpatient care (REKUP) in improving the care of geriatric patients in SC with rehabilitation needs after hospitalization.

Methods: The study was conducted as a nonrandomized intervention trial with an historical control group (CG). The intervention group (IG: n = 49) received REKUP (activating therapeutic care, functional rehabilitative therapy, psychosocial services, medical care), while the CG (n = 57) received usual care during SC. Primary outcomes were transition to inpatient rehabilitation, home, and LTC, deteriorated care setting, care level, and mortality within 3 months after SC. Secondary outcomes were functional, motor and psychological variables.

Results: The transition rate to inpatient rehabilitation (82% vs. 37%) and home (86% vs. 65%) was higher (p < 0.05) in the IG than in the CG. The proportion of persons utilizing LTC (12% vs. 35%) and with deteriorated care setting (35% vs. 60%) was lower (p < 0.01) in the IG than in the CG. The Barthel Index, visual analogue scale of the EQ-5D, and numerical pain scale improved (p < 0.05) during the SC stay in the IG but not in the CG.

Discussion: REKUP as a new care model for SC promotes the transition to inpatient rehabilitation, reduces the utilization of LTC and improves the chances of returning home and achieving greater independence in geriatric patients with rehabilitation needs after hospitalization.

Androgen deprivation therapy (ADT) for prostate cancer is carried out in a palliative approach in symptomatic geriatric patients. Testosterone synthesis is suppressed using a dual therapy principle with luteinising hormone-releasing hormone (LH-RH) analogues or antagonists of LH-RH, in addition to modern antiandrogens. Additional administration of taxanes is initially possible in cases of high tumor burden and aggressive tumor biology, which is otherwise reserved for castration-resistant prostate cancer. The ADT is a systemic therapy for all testosterone-dependent processes and can lead to hot flushes, gynecomastia, osteoporosis, sarcopenia, anemia, falls, cognitive decline, depression, metabolic syndrome, increased cardiovascular events and many drug interactions. In patients identified as geriatric, ADT should therefore only be used after a thorough risk-benefit analysis.

Background: Rehabilitative short-term care (REKUP) is aimed at geriatric patients in need of rehabilitation but not (yet) capable of rehabilitation after acute inpatient hospitalization with a positive rehabilitation prognosis. It was tested at two geriatric rehabilitation clinics from October 2020 to March 2022.

Objective: Qualitative process evaluation with respect to acceptance (service providers, health insurance), adoption (implementation at the start of the project), practicability (processes, contents, structures) and observed patient satisfaction.

Methods: A focus group and 14 semi-structured interviews with a total of 18 employees of both rehabilitation clinics and a health insurance provider were recorded, transcribed and qualitatively analyzed for content.

Results: The survey of service providers (acute care, model clinics) and the health insurance provider revealed a high level of acceptance and good practicability (processes, contents, structures). Due to the high level of acceptance and the familiar service content in the geriatric rehabilitation clinics, the implementation was feasible and patient satisfaction was rated as very good.

Conclusion: The acceptance of REKUP was high because the basic idea was easy to understand. Nevertheless, a careful patient selection is crucial. There is a risk that REKUP could be used as a quick discharge option to avoid capacity problems. The success of treatment perceived by the service provider is based on early exercises, psychosocial care and a longer period of time before rehabilitation, which avoids excessive demands and strengthens self-efficacy. Admission to the long-term nursing home sector is avoided, which has a positive psychological and motivational effect on patients. A transfer of REKUP to other geriatric rehabilitation clinics seems to be easily possible.