Zeitschrift fur Gerontologie最新文献

A review is given on general aspects and specific indications of preventive drug treatment. Particularly in the elderly, drug prescription for preventive reasons has to be considered according to risk/benefit aspects. Quality of life is a major concern for patients on long-term treatment. However, relevant investigations have been few, and clear therapeutic guidelines are still lacking, especially for the old-old. Most important areas of preventive medication are cardio- and cerebrovascular diseases. Further topics of prevention include the prophylaxis of thromboembolic complications, osteoporosis, postmenopause, and vaccinations.

Secondary prevention is of importance when the patient is already suffering from a serious disease, e.g., from arterial obstruction causing a stroke or an amputation, from a hip fracture or other diseases that might threaten his independence. Secondary prevention covers a wide field of topics. First of all, the patient must recover from his acute disease. It is important to avoid complications which are not specific for the disease, but are typical for a bedridden old person (decubital ulcer, dehydration and others). Prevention also means to avoid recurrence of the same disease as well as complications that frequently occur during the clinical course and may influence the outcome (spasticity in stroke patients, muscular calcification following hip replacement). Frequently, old persons do not completely recover following serious disease, they are limited in their daily activities and their capability to leave home. Secondary prevention tries to fight isolation; the patient should live a meaningful life.

A study was performed in two groups of multimorbid longterm geriatric inpatients (n = 22 in each group). This compared the effects of re-activating occupational therapy (= study-group) on cognitive functions, subjective well-being, affectivity and social integration. The control group was monitored with a normal program of functional rehabilitation. The assessment of psychometric variables after 12 weeks and after 24 weeks of treatment revealed a significant (p < 0.01) improvement in cognitive functioning and subjective well-being in the study group. These results demonstrate the therapeutic benefit of re-activating occupational therapy in the treatment of cognitive impairment of geriatric patients, which is often aggravated by hospitalization.

Nutrition-related diseases are the primary health problem, not only of the aged, but also of the whole population in industrialized countries. While the health risks of overnutrition are well considered in prevention and medical care, the consequences of malnutrition are often disregarded. Nutritional counseling, early diagnosis, and therapy of nutritional risk factors are able to improve quality of life and prognosis of the aged and should be performed more intensively in medical care.

Preparation for old age is defined as the sum of all efforts at any point in the life-course for better coping with old age. Eight theoretical orientations are sketched from which conclusions for the preparation for old age may be deduced. Nine points of critique are formulated (ethical objections, compensatory function, provision for work, retarded beginning, partially false content, needy people are not reached, neglect of the information diffusion processes and of the interindividual differences, low results). Four postulates concerning a responsible preparation for old age conclude the article (professionalization, extended time perspective, diversification, continuous amelioration by evaluation).

From a psychosomatical view, one's present situation in life, previous experiences of conflict and uncoped with losses play, especially in old age, an important role in the development of, the course of, and the coping with the underlying physical disease. It is shown in the example of a 68-year-old patient with bronchial asthma that sickness in old age can be understood as an effort (certainly not an optimal one) to solve the psychosocial conflicts, and as an adjustment process to altered living conditions.

In this paper some trends of gerontology during the last 45 years in Germany are described. A survey of the development of gerontology in the former GDR is followed by an analysis of the "Zeitschrift für Alternsforschung" from 1980-1990. The main result is the predominance of publications on the care system since the middle of the 1980s. With regard to the development of gerontology in the western part of Germany, an analysis of publications in the "Zeitsschrift für Gerontologie" from 1968-1991 shows changes in the main topics during this period. Until the middle of the 1970s there was a predominance of publications in the field of: intelligence, learning, memory and perception. The emphasis of publications from 1977-1985 was on stress and coping. In the middle of the 1980s there was an increasing interest in the analysis of social network and competence in the elderly. The paper discusses these trends of gerontological research in the eastern and western parts of Germany.

Prejudices against the aged are called ageism. A case demonstrates its obscure effects. Ageism is seen as antipathy or hate, too. But a common societal reality of ageism is not being able to take different perspectives. Seeing the challenge of a concrete clinical situation means varying the ethical perspectives both care and fairness. According to that, "multidimensional" assessment characterizes geriatrics. Examples for not being able to take varying perspectives are given when adults are confronted with suicide, sexuality/tenderness, convictions, depression, religiosity, reduced memory capacity, quality of life, incontinence, dying etc. of the aged. The paper shows three ways of controlling cognitive and affective dimensions of prejudices in general.

The contribution deals with the role of lifestyle in changing residence from a private household to an old people's home. This transition not only terminates many of the household activities that had structured older women's everyday life, but also affects the lifestyle. Anticipation and evaluation of the life situation in an old people's home induce people to modify their lifestyles in certain dimension in order to compensate for restrictions in other dimensions that are expected to ensure from the discontinuation of living at home.

The percentage of older people in the population will permanently increase. An attendant phenomenon is a rising demand for special exercise programs. In 1991, a survey of those programs was done in the unified FRG. The investigation was ordered by the Sportministerkonferenz der Länder to substantiate further promotion. Organizers and sponsors of exercise programs for older people originate from public and private non-profit institutions in the fields of sports (administration), social welfare, public health, and educational work. Concerning the structure and the extent of special exercise programs there exist large regional differences between the eastern vs. western part of the FRG and rural vs. urban areas. People of over 50 years of age have to be separated into different groups corresponding to their age, physical condition, experience, and needs; not all of them find appropriate programs. The Deutsche Turner-Bund, private charitable institutions, and a few private health-care organizations preferentially serve untrained and/or inexperienced women over 60-65 years of age with recreationally oriented exercise programs. The younger, more athletic find more competitively oriented programs within the scope of other sports federations. Recreational sports programs in age-independent groups are often attended by older physically fit people.