Zeitschrift Fur Gerontologie Und Geriatrie最新文献

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.

Background: The majority of people in need of care in Germany are cared for at home by relatives or other close individuals. Many informal caregivers are also in paid employment and face the challenge of juggling the demands of both areas of life. This can adversely affect the caregiver's own health.

Objectives: (1) To what extent is informal caregiving related to health complaints among people in paid employment? (2) Within the group of working caregivers, how are the amounts of informal care and work related to health complaints?

Material and methods: This secondary data analysis is based on the BIBB/BAuA employment survey 2018. To account for systematic differences between caregivers and non-caregivers in the analyses, propensity score matching was applied.

Results: Working caregivers more frequently experience psychosomatic and physical complaints compared to people in paid employment without caregiving responsibilities. The working hours and the extent of caregiving are interrelated and a high burden in both areas of life is associated with poorer health.

Conclusion: People who provide informal care in addition to their work are often burdened with health problems. Targeted health promotion interventions are therefore necessary to support this vulnerable group and improve their health.

Urban areas face complex challenges, such as climate change, environmental stressors, urbanization and demographic change. Vulnerable individuals, including older people are particularly affected. In old age health risks increase during heat periods due to multiple burdens resulting from dynamic person-environment interactions. How differently older adults perceive extreme heat and the behavioral adaptations they make in response were investigated in a field study conducted in Stuttgart. The aim of the present work was to form segments using cluster analyses that clearly differed in terms of heat stress levels and independent daily living outside the home. The sample included 211 community dwelling individuals (57% female) aged 65-92 years. Data collection was conducted through personal, standardized interviews. Of the four clusters identified one exhibited an accumulation of vulnerability factors, manifesting in particularly high perception of heat stress, impaired independence in daily life and a greater reduction in outdoor activities during heat compared to the other clusters. While the latter could provide protection from heat-related effects, it also poses risks of supply shortages and reduced social participation during heatwaves. Such segmentation beyond chronological age highlights the need for targeted heat protection and prevention measures, which are addressed in municipal heat action plans. Although the development of such plans has already progressed in Germany, the proposed measures must be implemented on a broader and cross-sectoral basis to strengthen health equity for all.

Background: In the last 4 years some countries, such as Arizona (USA), India, Saudi Arabia, Australia and British Columbia (Canada), have experienced extremely long heat waves of 40 °C and more. The duration of the episodes ranged from 14 days in Canada to more than 3 months in Arizona. The heat dome in the Vancouver region showed that similar events can occur in our latitudes but these are not adequately taken into account in the planning in Germany.

Methods: So far only peer-reviewed data from Canada are available and data on other events have not yet been comprehensively processed. Governmental information and other trustworthy sources were used for the research. The aim was to identify areas which have so far not been sufficiently considered in the ongoing planning discourse in Germany.

Results: Numerous measures were identified that have not or only insufficiently been considered in Germany, such as the establishment of crisis management teams, determination of prior planning of a communications strategy and predefined responsibilities for measures, such as bans on outdoor activities, evacuation and holiday restrictions for healthcare workers. Extreme heat events must be defined as natural disasters in order to initiate these and other measures in Germany due to legal requirements. Many of the measures that are now being planned on a voluntary basis would then have to be mandated and, if necessary, made compulsory.

Conclusion: The planning of measures for extreme heat events must be revised in many places in Germany. These are not stipulated in the 25 action plans for heat events published so far. Many regions are not adequately prepared. It is potentially about preventing tens of thousands of deaths that could occur in one single event.