Zeitschrift fur Gerontologie最新文献

This paper discusses different situations of family caregiving. It points to special tasks and stresses in the following situations: Help to stroke patients during rehabilitation at home, caregiving to patients who are suffering from a physical or a mental disease, and support of family members who have to cope with impending death. As the analysis makes clear, different situations of caregiving cause different tasks and stresses which should be regarded in discussing the psychic and social situation of caregivers.

Specialized gerontological discourse may promote misinterpretations of characteristic problems of old age as to their causes and effects. Existing quantitative relations tend to camouflage chances and risks; isolated analysis of old age does not make apparent the extent to which the elderly themselves share positions which ultimately lead to their relative neglect as a group in society. Equal opportunity for women seems bound to developments towards a market organization of service supply and demand for service and support, up to now widely informal or exchanged well below market value, with women as the main service providers as well as service recipients.

The results of studies concerning the mortality rates of both sexes are of great similarity in all industrial countries. For underdeveloped countries, little information is available, but analogue proportions can be supposed. In the nations of the industrialized world males have a significantly higher mortality rate, which shortens their life expectancy in comparison with that of woman. Since about 1970 a deceleration of this development has been observed. The diseases responsible for this fact are ischemic heart disease, lung cancer, accidents, and other traumatic incidences, but also infectious diseases. Concerning the origins of ischemic heart disease, the influence of sex hormones especially on the lipid profile are being discussed; nevertheless, for the enhanced coronary risk of males environmental and behavioral factors seem to be more important than biological reasons. As for carcinosis being a reason for the mortality of males, lung cancer is in the foremost position. Cigarette consumption, as well as the higher exposure to cancerogenic substances related to typically male professions, are held responsible for this. As for other types of cancer, environmental factors depending on gender are strongly considered as a reason for different rates of mortality. Furthermore, sociological explanations for these differing frequencies are being discussed. Occupational differences and the different positions held in working life by each gender are believed to be responsible for the higher rate of mortality among males. Also, risktaking behavior seems to be found more often among males, than among females. A variety of hypotheses based on genetics have been given to explain the different gender-specific rates of mortality, but none of them has yet been proven correct.(ABSTRACT TRUNCATED AT 250 WORDS)

The "depictions" of aging women by painters of different historical periods contain significant cues as far as general chances and restrictions of female development across the life-span is concerned. Generally, the supposition of elderly women's public invisibility holds true. By that, not only the popular but also the (pseudo-)scientific views appear rather contradictory. Thus, the termination of fertility could entail a new social freedom and an expansion of the women's life-space, but it could also stand for devaluation and complete restriction. A systematic screening of 85,000 Italian and 9000 non-Italian but European works of fine art (source: photo-archive of the Institute "Herziana" in Rome) resulted in a sample of altogether 1030 pictures that showed one or more elderly women (this is about 1% of the original screening). The analyses focused on social-psychological criteria rather than on iconographic aspects. Five categories were assessed: thematic aspects; range of visible behavior; women's position in the picture; aspects of mood; forms of social interaction. A trend could be found that points to the gradual disappearance of the formerly shown autonomy and competence. Thus, these "images" of aging women shed more light on the hidden agendas of female life-span development. Even viewers of our days might profit by looking at "old pictures" of "old ladies". Eyes might be opened and sharpened as far as the ever changing pitfalls of becoming older in a changing world is concerned.

In an ongoing study of sleep in aged seniors the relationship between physiological, pathophysiological changes of sleep parameters and cognitive function was studied. It will be argued that the Nuremberg gerontopsychological inventory is superior to commonly used psychometric test-batteries to assess cognitive function in the aged. Preliminary results on the application of the Nuremberg gerontopsychological inventory will be presented, which were achieved in 10, non-demented, independently living subjects aged 80 to 85 years. The relationship between subjective complaints on aging, everyday activities and psychometric assessed performance was analyzed in detail.

"Health" in the elderly describes an instable balance that exists between physical, psychological, and social factors as they pertain to the individual. The disruption of this balance can render the patient incapable of taking care of himself, thus requiring comprehensive care either at home or in an institution. Even the circumstance under which a transfer to an institution is made can have a negative effect on the subjects health; a careful analysis should be made of these factors before a decision to transfer is made. The following factors are critical in preventing or limiting the negative impact of either home or institutional care: architectural structuring of the environment organization of patient care type of medical care required type of physical therapy required It is a primary importance that the parties involved (patient and immediate family) be allowed to make and/or influence the decision on care and that they retain a feeling of personal responsibility for what happens. When a patient is institutionalized, he should be given the chance to continue his individual lifestyle whenever possible; his private sphere should be maintained. Disturbances that are caused by inappropriate changes in these structural factors should not be considered symptoms requiring psychopharmacological therapy.

In 1991, there existed 20 homes and nursing homes for the elderly in the district of Gütersloh (Nordrhein-Westfalen, Federal Republic of Germany) with a total of 1518 beds. 56,000 persons aged 60 years and more rsp. 41,000 persons aged 65 years and more are living in this area. This means 2.7 beds per 100 persons aged 60 years and more are provided, or 3.7 beds per 100 persons aged 65 years and more. 22.5% of the home residents are in need of care, grade II (care is necessary for some activities of daily living), 55.6% are in need of care, grade III (care is necessary in most or all activities of daily living). Only three of the homes have a special department or ward for residents with high grades of need of care; in all the other homes residents with high grades of need of care are supported together with residents with lower grades of need of care. One home has a special psychogeriatric department with two wards, another one a single psychogeriatric ward. The leading staff members of the homes assessed that 831 out of 1861 residents in the whole year 1991 were mentally disordered, i.e., a rate of 44.65% in which is similar to the results of comparable studies. 75% of the admissions of mentally disordered persons are arranged by family members or relatives. Only 7% come directly from the psychogeriatric department of the responsible psychiatric clinic in the area (Westfälische Klinik für Psychiatrie).(ABSTRACT TRUNCATED AT 250 WORDS)

Dementia is a clinical syndrome with many causes. Dementia of the Alzheimer type and vascular dementia account alone or in combination for the vast majority of the dementia in the elderly population. Primary prevention depends on the knowledge of etiopathogenetic mechanisms and the possibility to change contributing factors. In the case of dementia of the Alzheimer type (DAT) contributing factors (risk factors) are emerging. However, they are not easily altered. The protective effect of certain micronutrients, such as antioxidants, remains speculative. The well-established cardiovascular risk factors such as hypertension, diabetes, and overweight are effective in the etiopathogenesis of vascular dementia. Their treatment by diet and drugs is therefore indicated. The protective role of antioxidants is better established in vascular dementia. Antioxidant micronutrients could be an important part of the primary preventive strategy. Whether mental training is effective in primary prevention or not remains controversial. Better training allows the individuals to optimize their resources. In secondary prevention, mental training was shown to be effective in mild dementia (MMS > or = 23), maintaining or even improving function (vascular dementia) and maintaining function for a given time in DAT. In the population with advanced age, mixed forms of dementia become increasingly common. Hence, patients with mild dementia should receive mental training as well as a vigorous treatment of established risk factors.

The physiologic changes of the different organs in the elderly result in a diminishing efficiency of the organism and its capability of adapting to new and unusual conditions. Accordingly, physical exercise has to be seen and assessed as prevention of illness in old age. In terms of prevention exercise training is taking the first place within the five different types of physical activities. The other types (coordination, flexibility, strength, rapidity) have to be handled with special conditions, whose importance must be assessed individually. The importance of exercise, physical activities, and sports is increasing especially in preventing coronary artery disease. Metabolic diseases, hypertension, impairment of cerebral functions and also diseases of the musculoskeletal system are improving under suitable physical training. General training exercise training slows down the loss of cardiopulmonal efficiency due to progredient aging. Risks and benefits of physical training have to be deliberated very carefully in considering the state of health of the elderly.

A special significance is attached to stroke in geriatrics, because, with its complex clinical manifestation and the far-reaching consequences for the patient, the social surroundings, and for society, it is the diagnosis which is most in the foreground in both acute geriatrics and in rehabilitative geriatrics and care. The work presented gives an overview of the essential epidemiological aspects of stroke: mortality, lethality, incidence, prevalence, risk factors and predictors. Furthermore, the socio-epidemiological aspects are considered in the light of psychiatric and social risk factors, as there is a considerable lack of research in this area. And not least, the care aspect and the economical relevance of the care of stroke patients, as a logical consequence, are also dealt with.