Gerontologie最新文献

THe literature concerning the effects of different programs of physical education for the elderly on a number of medical-biological variables as well as social scientific variables is discussed. These variables are body weight and composition, mobility and motility of joints, muscle force, aerobic power, heart rate, blood pressure and ventilation on the one hand and body image (self concept of the body) and anxiety, cognitive and perceptive processes, motivation, personality variables, specific motor skills and general feeling of well being on the other hand. In addition to the discussion of some principles of training the recommendation is made that evaluative research on programs of physical education is started, in which the relationship between these variables and their effect on the ability of the elderly person to function independently are made subject of study as well.

For several years there has been a discussion on the function of nursing homes, often in the form of a lot of criticism. Nursing homes in the Netherlands were developed more by the circumstances than by planned policy. In this discussion paper the NZR gives a description of how the nursing homes have to innovate their care in the future. It made a good choice in the point of reference: the man or woman who consumes the care that nursing homes produce. The paper presents many modern ideas about the quality of care, the way to organize it and the physical environment it needs. Unfortunately the paper is not consistent in the elaboration of the concept. It does not make a real choice for the future, because it tries to mix contradictory views as a geriatric hospital as well as a home for people who need continuous (nursing) care. That kind of ambivalence does not contribute to a good circuit of care-organizations in the future.

This study describes test-retest data for the BOP, a Dutch Geriatric Rating Scale which has been modeled upon the Stockton Geriatric Rating Scale. This so called BOP (Beoordelingsschaal voor Oudere Patiënten) contains 35 items pertaining to six aspects of the patient's daily behaviour on the ward: helplessness, aggressiveness, physical disability, depressive behaviour, mental disability and inactivity. These six aspects (subscales) were derived from factor analysis. Normative data, inter-rater reliability and validity have been determined for Dutch samples of elderly patients in nursing homes and psychiatric hospitals. Since 1971 the BOP is used extensively in Holland and Belgium. In this study test-retest correlation coefficients could be computed for 556 patients from four different psychogeriatric nursing homes. The correlations between test and retest over an interval of three months were for the six subscales resp.: .91, .68, .88, .59, .81 and .83. By determination of the standard error of measurement, statistical norms could be developed to estimate the significance of individual change, for example in experimental studies of single cases.

The responsibility and the duties of a geriatrician are completely different from the duties of a medical doctor in a 'nursing-home'. This term 'nursing-home' does not exactly coincide with the term 'verpleeghuis'. Primarily the geriatrician is in charge of diagnostics and therapy and works together with various consulting medical specialists and in the setting of a general hospital. Geriatrics have grown out of internal medicine, and the 'verpleeghuisgeneeskunde' finds its roots in general practice. The medical doctor of a 'nursing-home' exercises general medical practice, in particular symptomatic treatment and functional medical care with the assistance of and in co-operation with nurses and the para-medical departments. Both geriatrics and 'verpleeghuisgeneeskunde' should get their own education and acknowledgement.

In this article the author makes a number of theoretical comments on role conception and role behaviour in the therapeutic milieu of the nursing home for the somatically ill. To begin with he draws a comparison between this milieu and that in a psychiatric hospital, where the notion of the therapeutic living environment has already been put into practice. A conspicuous feature is the difference in the nature of the inhabitants of the two milieus and the reason for their admission. The patient at a psychiatric hospital is there in order to learn to manage a role in society in a new way, the nursing home patient has to try, in an appropriate manner, to learn again to give meaning to the role which he has been deprived of by his physical disability. In this article the author hopes that he has demonstrated that the inmate of the nursing home is doomed to fail without the real and active help of his family or other people who are important to him. Through adequate reflection on their own role behaviour, the staff must try to provide a response to the subjective experience of reality encountered by the patient and his relatives and friends.

The future education for a geriatrician in the Netherlands will have to take into account both the scientific-gerontological character (physically, mentally and socially) and the clinical character of clinical geriatrics. The education will have to take place in the geriatric department of an academic hospital. It should include geriatrics, internal medicine, neurology, and long term care of chronically ill elderly. It will be necessary to find a professor who is an expert both clinically and scientifically abroad, e.g. in Great Britain. The author argues for relatively extensive 'medium stay' departments for geriatrics in hospitals in order to provide enough possibilities for training geriatricians and a better connection between hospitals, nursing homes and homes for the aged.

The Dutch Central Advisory Committee on Homes for the Aged has now published a commentary on government propositions regarding democratization in these homes. The Committee, while in general agreeing with those propositions, regrets the delay since 1976, and pleads for a more gradual perspective for the influence of the inmates. The independence of inmates' boards should be better implemented. The progress of democratization should be closely followed by evaluative research and experimented with. The present writer indicates a lack of socio-psychological approaches in the commentary.

Since 1979 daycare facilities are formally established in nursing homes. In this paper an elaboration is presented of the admission of visitors to daycare and of what is comprised in it. In the paper there is no discussion about whether the nursing home is the right place for daycare. That makes the admission rules somewhat artificial, because they depend on the possibilities of the other care-giving organizations. The main substance of daycare seems to be behavioural, although a nursing-, paramedical or medical necessity must at least formally be present. The paper gives within this framework a good picture of the possibilities of daycare in the Netherlands.

This article comprises a systematic ans schematic survey of neuroleptics and antidepressants, their mode of action in the central nervous system, indications and side-effects. Psychic disorders in the aged may be due to anatomical cerebral lesions, but they may be also "functional'. Both types of disorders are concisely described. The possibilities and limitations of treatment with psychotropic drugs are reviewed and special attention is given to the specific problems of this type of therapy in patients of advanced age. It is pointed out that psychic disorders in the aged are multiconditional and that psychopharmacotherapy is just one component of the treatment. The neuropeptide concept is described. The putative clinical significances of neuropeptides derived from ACTH, vasopressin and beta-endorphin (e.g. DTgammaE) are mentioned with respect to learning- and memory processes and schizophrenia.

This article describes the way in which an instrument has been developed to measure the need for help of patients in the nursing homes of the Netherlands. The instrument is an important variable in the so-called Basic Research into the cost structure of the Dutch nursing homes (in Dutch BKV). The need for help is expressed as an index ('help-index') per patient. The index is based on the strong hierarchical relations between a number of patient-variables: washing, clothing, feeding, toileting, transferring (in and out of bed, walking, standing, wheelchair-activities), continence (urine and/or faeces) and contact function (speech). The 'help-indices' of the individual patients of a specific nursing home can be summarized in the average 'help-index' of that nursing home. The averages of the individual nursing homes differ to a great extent. The average 'help-index' per nursing home is considered to be of great importance as an independent variable with respect to staff per 100 beds and costs (total or per patient day) in the nursing homes. The latter is the subject of further research.