Gerontologie最新文献

At present the position of the Dutch homes for the aged is characterized by the increasing influence of external agents (esp. the government) and the increasing dependency of the residents. Disadvantages of a merely surveying and of an overruling board are illustrated and a careful participation of boards in managing the home is pleaded. Clear regulations of the competence of board and warden are important. It is a task of the board to develop a well-defined philosophy of the kind of services to be rendered by the home and of communication structures within the organization. The social-psychological position of the warden is illustrated with regard to residents, personnel, board and committees of residents and personnel. A model of a clear, comprehensive and effective network of communication and deliberation throughout the entire organization is sketched. Finally, the importance that residents have a real say in daily matters and in services to be redered is stressed.

In the report: Task and function of the service-home (advice of the central committee on residential homes for the elderly with regard to task and function, february 1980) this home is defined as one of the services covered by the legal concept residence for the elderly. The need for care is not sharply definable, because of its individual character. Due to this strong individual exponent the service-home should offer a supporting living environment, in which mental and social aspects, and material care receive equal attention. The commitee does not pay sufficient attention to the home as a new living environment. A full-time pastoral caregiver is recommended, for the general service-homes as well. On the other hand a medical advisor with clear task-descriptions is found as a necessity by the committee. A clear-cut description regarding several other institutionalized services is not given. Nor is the cooperation between services discussed. The special value of the report is its contribution of ideas for further reflection.

In this contribution some aspects of the evaluation of the well-being of the residents of an old peoples' home and a scheme of sheltered housing are described, namely the preparation and the motives for admission, the space of their own room, the freedom to act and speak, the sense of security, the opportunities for activities and mutual contacts and the appreciation by tenants of the activities and the attitude of the staff. Beside a high degree of satisfaction, some people present a certain degree of resignation.

In this article we stress three different aspects of the social relations of older people. First: the existing social relationships of older people with their children are an expression of a spontaneously grown contact as well as an expression of the societal expectations or social norms. Second: these societal expectations are in a state of transition, not only because of changes in the family system, but, third, also by important demographic changes in the structure of the population. The changes of and around marriage and sexuality are in the centre of these trends. One of the consequences is the following. The inter-generational relationships should be at least partly replaced and completed by more intra-generational relations (friends, acquaintances). An additional problem is, how to develop a program to improve the social skills of older people themselves.

In an earlier publication we reported on the incidence of developmental reflexes and symptoms of parkinsonism in 100 psychogeriatric patients with a mean age of 81 years. This article deals with the follow-up, one year later. The 24 patients who had deceased between the two investigatins appeared to have had a higher incidence of the palmomental reflex than those surviving. In the 75 patients who could be reinvestigated, the following findings were made. No developmental reflexes or symptoms of parkinsonism were found in 11 patients during the first and in 15 during the second investigation, 5 of these had the same results in both. The number of developmental reflexes had increased 34% and the number of symptoms of parkinsonism 29% from the first to the second investigation. The BOP (a Dutch derivative of the Stockton Geriatric Rating Scale, in which the higher score indicates the higher need of care) in those having two examinations was lower in the first. There were considerable changes in the number and the kind of reflexes and symptoms of parkinsonism from the first investigation to the second.

During a term of probation for the doctoral course in sociology at the university of Nijmegen a research was made for the relatinship between patients and staff on the ward of a nursing home. This relation was investigated with the use of Elias and Scotson's model of an established and outsiders figuration. In this figuaration are several sources of power, as fysical capacities, knowledge, key-positions and cohesion, important. These are considered more thoroughly. Some of the central problems of a nursing home are becoming more clear in the elaboratin of processes as exclusion and stigmatization. The questions efficiency or humanity and the normality or abnormality of the behaviour of the patients are considered against the background of the contrast between living environment for the patients and work environment for the staff. One of the conclusions is that because of the central place of medical and nursing-technical thinking there isn't much room left for the living of the patients, in spite of the fact this being an explicit care of the investigated home.

After a short discussion of the changed situation of the elderly in society, the question is taken up whether old age has a value of its own. Is it only a period of life in which all capacities diminish or are there perhaps fundamental human values which specifically belong to old age. The author answers that, although there are no such values, it nevertheless can be said that some values which are important in each period of life have more chance to be realized in old age. Discussed are in this connection values such as love, friendship, resignation, realistic attitude, religion, gratitude and wisdom. Some of these values are neglected in modern society with its 'activistic' culture, and of some of them the full meaning is narrowed down. This leads to the conclusion that not only the elderly would profit from the cultivation of the said values, but also society as a whole.

The article starts with a brief discussion of the modernization of welfare, using two constructed types as heuristic devices: welfare as religious charity and welfare as a legal right. In the process of modernization the second type has become ever more prominent. The result was the emergence of the welfare state, whose qualitative and quantitative development lagged behind in North-America if compared to North-Western Europe. The welfare-state has been characterized as being without ideology and as being technocratic. It is argued in the present article that yet an ethos can be discerned which functions as a cultural binding agency in the welfare state. Some essential elements of this ethos are discussed, in particular 'consumentism' and 'immoralism'. Next, the consequences of the present stagnation of the welfare-state for this ethos are briefly mentioned. Finally, the article concludes with a few notes on the relationship between the former reflections and social issue of the aged in contemporary society.

This report shows a good picture od the assessment of psychogeriatric patients. The way in whch the assessmentteam deals with the problem is a good one. In my opinion, however, the approach is still too strongly connected with the view of a psychiatric hospital and shows too little of an own and independant psychogeriatric view. This becomes especially clear in the terminology used, such as geronto-psychiatry and nursinghomes for demented aged. Before being able to judge about the positive results of the described way of psychogeriatric assessment I look forward to a report in which quantitative as well as qualitative data on the assessed patients are carefully analysed.