Zeitschrift Fur Gerontologie Und Geriatrie最新文献

Against the background of demographic ageing in cities, it becomes increasingly more important to study the living conditions of old persons. Using municipal statistical data from the Inner City Monitoring System and geodata, the study examined the number of facilities for the provision of services of general interest in the areas of health and the needs of daily living in urban districts of major German cities. The focus is on districts with a high proportion of people aged 65 years and over in order to assess if there is sufficient provision of infrastructure for older people. In addition, survey data are combined with municipal statistical data in order to examine self-assessments of the distances to such facilities. The results show small-scale disparities as there are significant differences between old and young districts (few people aged 65 years and older). There are fewer pharmacies and post offices in older districts. The accessibility of the infrastructure within walking distance is rated worse in old districts than in young districts. This can be particularly problematic for very old and less mobile people whose radius of mobility is limited to the residential area. It can be concluded that small-scale municipal monitoring is crucial to detect gaps in the infrastructure. In further studies, the actual use of infrastructures and the diversity in the group of older people are taken into account.

Background: Rehabilitation measures in short-term care (KuP), e.g., in the form of mobile geriatric rehabilitation (MoGeRe), are rarely carried out. One of the reasons for this is that the need for rehabilitation is not identified in advance.

Research question and objective: The MosaiK (mobile geriatric rehabilitation in short-term care) project aimed to identify the rehabilitation needs of people registered for a KuP at an early stage, initiate a MoGeRe and improve the quality of the two health service areas.

Material and methods: A checklist was used to identify the need for rehabilitation by the KuP admission management. If the results were positive, referring physicians were asked to apply for a MoGeRe for the future KuP guest. If the MoGeRe was approved, case conferences were held in which KuP personnel participated. Video visits between the MoGeRe and the patients and an arm and leg trainer for self-training during the therapy-free period supplemented the program. The processes were evaluated qualitatively in the form of focus groups as well as descriptively and quantitatively.

Results: In 40 cases a review of the need for rehabilitation was suggested by the KuP admission management based on the results of the checklist. The MoGeRe was approved in 27 out of 28 applications. The joint case conference was held at least once for 70.0% of MosaiK patients and a video visit was carried out for 75.0%; the arm and leg trainer was used in 64% of cases.

Conclusion: The implementation of the newly implemented processes was largely successful and required relatively little additional effort compared to (remunerated) routine care. The approach should therefore also be transferable to other forms of MoGeRe.

In view of the rapidly growing number of older and very old people, geriatric rehabilitation is becoming increasingly more important. The aim is not primarily to cure illnesses but more to maintain or restore functional abilities in order to ensure participation, autonomy and quality of life. The article conveys the concepts of geriatric rehabilitation, including the approach based on the International Classification of Functioning, Disability and Health (ICF), participatory goal definition and basic geriatric rehabilitation management. Access routes and access prerequisites in accordance with the German Social Security Statutes V (SGB V) are presented and the differences between the four forms of care, inpatient, outpatient, mobile and early rehabilitation, are clarified. Particular attention is paid to individualized goal planning and the selection of suitable rehabilitation strategies (restitution, compensation, adaptation). Finally, challenges and future prospects are discussed.

Background: Family caregivers (FC) rarely utilize formal and informal help, which affects their burden and quality of life. Factors that result in rejection are often psychosocial (shame, guilt, heteronomy and social expectations). Previous studies on psychosocial reasons neglected the spiritual dimension. This study aims to identify the psychosociospiritual reasons for the (non)utílization of help from the perspective of FCs.

Methods: This qualitative study conducted semi-structured interviews with 24 FCs between August 2022 and July 2023 and analyzed according to Mayring.

Results: The FCs request formal and informal help to find a balance between their needs and those of the persons in need of care and to develop and maintain interpersonal boundaries. Help is rejected due to negative experiences with help offers as well as personal, familiar, and social role expectations. As long as nursing care is seen as the only meaning in life, help from outside can be perceived as a threat.

Conclusion: When utilizing help, it is not only about the quality of the offered help but also about its compatibility with one's own values and aims. Psychosociospiritual counselling should be provided before counselling for benefits.

Background: Falls are a significant health problem for seniors, often indicating increasing mobility impairment and risk of injury. Although necessary for the identification of seniors at risk, only few validated German questionnaires on falls risk exist.

Objective: To validate the German Fall Risk Check (FRC) in independently living, community-dwelling older people against objective measurement of standing and walking balance as assessed by the Short Physical Performance Battery (SPPB).

Material and methods: In a larger randomized controlled trial, evaluating home emergency call systems, we recruited 190 seniors in Hamburg, Germany, to fill in the FRC and pass a comprehensive geriatric assessment. The performance of FRC as a diagnostic test is described by typical measures, such as sensitivity (SN), specificity (SP), predictive values, positive/negative likelihood ratios (LR+/LR-), and area under the curve (AUC) in receiver operator characteristic (ROC) curve analysis, each with corresponding 95% confidence intervals (CI).

Results: In total, 190 seniors with an average age 80.5 years (± 5.5 years), 75.3% women could be analyzed. The sample showed advanced comorbidity and concerns about falling in about one third, and mobility and cognitive impairment in about one half. We calculated: SN 0.679 (95% CI 0.571-0.771); SP 0.743 (95% CI 0.654-0.816); LR+ 2.643 (95% CI 1.858-3.761); and LR- 0.432 (95% CI 0.309-0.604). The unadjusted AUC was 0.711 (95% CI 0.635-0.787), adjusted for sex and age 0.753 (95% CI 0.683-0.824).

Conclusion: The FRC appears to be a valid questionnaire, identifying impaired balance in community-dwelling seniors.

Background: Maintaining the autonomy, independence and social participation of older adults is a cornerstone of geriatric care. Against the background of demographic change and the stagnating expansion of inpatient rehabilitation capacities, new care models are of increasing interest. Telerehabilitation could be a promising supplementation to existing structures.

Objective: This article analyzes the potential, challenges and evidence for telerehabilitation in the home environment of older adults.

Methods: A comprehensive literature review is used to present applications and evidence of the effectiveness of telerehabilitation in older adults. In addition, factors that promote or hinder its implementation and utilization are identified.

Results: Telemedical services enable an extension of the rehabilitative range. To date, various communication media and rehabilitation contents have been applied. Telerehabilitation options for older people demonstrate functional and psychosocial benefits; however, only a few studies have investigated a multiprofessional program which would be transferable to the care structures of geriatrics in Germany.

Discussion: Adapted concepts are required for the nationwide integration of telerehabilitation into geriatric care. The feasibility and effectiveness must be studied within the context of the German care structures. In addition, legal and structural framework conditions need to be further developed.

Background: Despite there is evidence for the need for advance care planning for older people living alone (OPLA), especially if they want to stay at home until the end, utilization of measures for ACP remains rather scarce. The causes for this discrepancy have not yet been researched in this target group.

Objectives: Aim of this study was to get insight into the perspectives of OPLA in the community on planning ahead for the end of life.

Materials and methods: (Secondary) Analysis of 26 qualitative interviews. 17 were from the Austrian Survey on the very old (ÖIHS), and 9 additional interviews were conducted with a specific focus on advance care planning to enrich the data base. Verbatim transcripts were analysed by applying coding procedures.

Results: Not all people had specific concerns or a desire to deal with the end of life. In contrast to others, concerns about avoiding (unnecessary) life-prolonging measures resulted in a formal regulation, usually a living will. Staying at home or issues regarding burial and inheritance were often equally important concerns for OPLA. Numerous obstacles to formal arrangements were identified.

Conclusion: The heterogeneity of OPLA with regard to their willingness and form of planning ahead for staying at home shows the limits of standardized procedures. Comprehensive approaches to advance care planning that go beyond health issues are needed to meet the concerns of OPLA in the community.

Background: The Barthel Index is the most commonly used instrument for assessing basic self-care ability; however, it only records impairments first at the stage of needing personal support.

Objective: Based on the long version of the Hamburg Classification Manual (HEMB-L), the Barthel plus (Bplus) was developed in consultation with specialist nursing personnel as an operationalization that also depicts compensated impairments via point-neutral subscaling. The article presents the instrument and its quality characteristics.

Material and methods: For patients in acute geriatric care the Bplus was employed twice at an interval of more than 1 week and audio recordings were made. The Bplus was assessed by telephone 1, 12, 24 and 36 months after discharge. The effect size (Cohen's d) was calculated for the sensitivity to change during the inpatient course. The interrater reliability and agreement with the HEMB‑L were determined taking the evaluation of the audio files by blinded examiners into account.

Results: Between 29 April 2019 and 25 June 2021 a total of 124 patients were included in the study. The Barthel Index scores obtained using the Bplus and HEMB‑L did not show a significant difference. The interrater reliability, internal consistency and change sensitivity of the Bplus were high, each at > 0.9. For activities performed independently but with impairment, there was an increased risk of care dependency occurring over the course of the study.

Conclusion: While maintaining the same sum score as the HEMB‑L, the Bplus can highlight abilities prone to a high risk for loss of independence and thus facilitate the prevention of progressive care dependency.