Gerontologie最新文献

The need to differentiate between dementia and the so-called functional psychiatric diseases of old age is of therapeutic as well as social importance. The main symptoms of dementia--lack of memory, disorientation and cognitive disturbances--are much less clearly defined than would be desirable, despite the neuropathological changes regarded as underlying senile dementia. The disease does not always have a progressive course. Confusion is also possible with other forms of dementia, while the symptoms of dementia can also be found in so-called functional psychiatric diseases. On the basis of the literature and/of our own research, it appears that a sharper definition of senile dementia is possible. Besides clinical criteria one can make use of--partly recently introduced--diagnostic techniques, specifically a structured psychiatric interview for old people, a neuropsychological testbattery, EEG, visual evoked response techniques and CT-brain scanning. The value of these diagnostic techniques for the diagnosis and the assessment of the prognosis of senile dementia can only be determined in a follow-up study. The set-up of such a follow-up study is described.

Terms as sociotherapy, environment therapy and the therapeutical environment have their origin in psychiatry and from there influenced various other treatment settings. The basic philosophy however is still the same: people live and are treated in social organizations which have an influence on their feeling of well-being and chances on recovery. Depending on the specific characteristics, each treatment setting has developed different ways of interpreting and practicing this philosophy. One of the ways of defining the psychogeriatric interpretation of sociotherapy is the analysis of the behavior of the nurse in a psychogeriatric nursing-home, with a sociotherapeutic treatment philosophy, in relation to the patients. Evaluation of behavior in terms of its sociotherapeutic characteristics is not necessarily equivalent to sociotherapeutic behavior. It however gives a clearer view of the way a philosophy is practiced and the conditions under which this is done.

In this paper the author tries to give a summary of interests in and opinions on pressure sores. Some answers to the question why so far research-projects on pressure sores are performed, are formulated. The author suggests that an unanimous definition and classification of pressure sores ought to be made, both acceptable to all workers in this field. Medication, often used on geriatric patients, may contribute to the origin and eventual cure of pressure sores. Reasons, aims and methods of this research-project are discussed.

In a population sample of 'healthy' males (N = 136; age 39-41) the classifications on the Jenkins Activity Survey (JAS) for assessing the Type A/B coronary-prone behavior pattern, and on the Maastricht Questionnaire (MQ), measuring emotional drain and subsequent depression, were investigated in relation to retrospective reporting of life changes on a newly developed Middle Adulthood Life Changes Questionnaire (MALC). In ANOVA, Type A subjects (N = 70) did report significantly more life changes in their work environment and family situation over the last two years than their Type B counterparts (N = 66). For subjects reporting clearcut manifestations of vital exhaustion and depression (N = 32) the same statistical associations do hold. Also, these latter subjects did evaluate their life changes as significantly 'more distressing' or as 'requiring more adjustment'. A group of male myocardial infarction (MI) patients (N = 35; average age 52) was compared with this control group on the MQ and the MALC. The MI-group showed a significantly lower average MQ-score than the section of the control group with clearcut manifestations of emotional drain and depression. Mean 'adjustment' scores, however, were significantly higher in the MI-group. In the discussion, the requirements for a dynamic life-span developmental model for explaining the assumedly different life-courses of MI-cases and controls are enunciated.

This report is discussed from the viewpoint of a Belgian psychiatrist. For Belgium too, it is called important and useful. It may contribute to a more complete and better screening and treatment of the psychogeriatric patient and besides it will stimulate the formulation of national policy recommendations. Minor shortcomings are: the examination of the tractus respiratorius is not mentioned, nor the importance of an orienting neurological examination. The author wonders whether the extramural examination must be stressed that strongly as is preferred in the report.

Since long there is a discussion in the Netherlands about the definition of assessment and the place where observation of psychogeriatric patients could take place: geriatric department general hospital, psychogeriatric unit, psychiatric hospital or psychogeriatric nursing-home. The report gives a very good description of an assessment program by a multidisplinary team with a social, psychiatric, somatic, psychological screening and behaviour observation. Conditions for quality and assessment are developed and seen as conditions for official recognition by the authorities, wherever it may be in a hospital, psychiatric hospital or nursing home. This report fails however to elucidate the term 'screening' and the responsibility of the proposed team. The central role of ambulant services like the social psychogeriatric services is underestimated. Uncertainly about the place of assessment in the system of health care in the Netherlands makes the proposed uniform financing of assessment an illusion.

In this study with 161 elderly patients (mean age: 80 years), recently admitted to a psychogeriatric nursinghome, one-year survival was correlated with ratings derived from the Beoordelingsschaal voor Oudere Patiënten (BOP), i.e. Rating Scale for Elderly Patients. This rating scale, which has been adapted from the Stockton Geriatric Rating Scale and put into use in the Netherlands since 1971, has proven to be a reliable and valid method to study the behaviour of psychogeriatric patients. Variables associated with one-year survival (62 patients died within one year) were: helplessness, physical disability and inactivity. After partial correlation analysis controlling for the effects of sex and age, the following items showed a significant relationship to survival: eats without help, is not incontinent, does not need special support to prevent falling out of chair or bed, walks without aid, is cooperative, enters into conversation, is not incontinent and/or restless at night. In this study 78 patients could be tested by a newly devised method which consists of presenting a series of slides to assess spontaneous speech, naming, reading, comprehension, free recall, delayed recognition, visual perception and clockreading. These cognitive functions however did not show any, significant, relationship with survival, though the 25 patients dying within one year were significantly more disabled and more depressed than the 53 patients who survived more than one year. Ratings of psychomotor function thus proved to be of more prognostic value than assessments of cognitive functions.

The pilot-study 'The aged in old people's homes and their sexuality' indicates, that very old people still have all kinds of sexual feelings and want to express these feelings. Living in a home for the aged has an inhibiting effect upon people's feelings, but also the attitude of the fellow-residents, staff and relations exerts pressure on the old people's sexuality. In the opinion of the investigator, there are three work areas, in which improvement of the present situation is possible: 1. training, education and influencing of all the people, who, in their sphere of activity, are in contact with the aged; 2. to change, by means of information, the mentality with regard to the acceptance of old people's sexuality; 3. everyone who is engaged in care for the aged in institutions should be attentive to developments in society. According to the author, a more extensive investigation would be very desirable.

A national organization of residential homes for the elderly has sponsored a program of training groups to help improve the functioning of directors of the homes. Staff members from the department of social gerontology of the Catholic University Nijmegen are involved as trainers of the group, in cooperation with the main office of the organization. The motivation for setting up this program is reported, along with some demographic characteristics of the directors and a description of the complicated structure in which the director must function. The training groups are then discussed: the folowing aspects of the groups receive attention: a. the recruitment of participants and intake; b. the participants; c. the trainers; d. the methods used; e. topics and issues discussed; and f. the effects of participation in the group, according to preliminary results of research.