Zeitschrift für Gerontologie und Geriatrie
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Delirium is a common, serious medical and often life-threatening condition in elderly in-patients. Delirium can develop primarily or secondarily related to other medical conditions and lead to hospital admission. The pathogenesis is still not fully known and is usually addressed as multifactorial. ⋯ Delirium is also associated with longer hospital stays, higher hospital and total health system costs, and an increasing rate of nursing home admissions. A structured diagnostic and therapeutic process is recommended. Delirium should become a quality indicator for hospital medicine; however, many research questions still exist.
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All states of confusion with acute onset and alteration of thinking, perception and awareness are defined as "delirium". Delirium is a common problem in older patients admitted to the hospital. It is combined with a negative prognosis and complications (falls, infections, etc.). ⋯ Often medical intervention in the acute state is necessary to prevent further alteration of the patient. Beside an adequate medical strategy, it is important to create a safe environment for the affected patient. The article gives suggestions for a systematic diagnostic and therapeutic strategy of delirium.
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Due to increasing life expectancy, the number of elderly patients needing surgical care is increasing. Improvements in surgical techniques and anesthetic procedures offer the opportunity of surgical intervention even in frail patients. Delirium on admission to the hospital or in the perioperative setting is a common and often serious complication. ⋯ Co-operation between all professions involved throughout hospitalization of the patient was emphasized. The low incidence of delirium in elderly surgical patients resulting from our efforts indicate that - for this setting in a general hospital - the strategy was effective for the prevention of delirium. Nowadays, geriatric nurses are an essential part of the perioperative team and delirium has lost much of its imminence.
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Trying to analyse the effects of the paradigm shift in the old age social security system in Germany (GRV) from a life cycle gender perspective yields light and shade - it is a conglomeration of individual- and family-specific transfers, financed by a mix of contributions and taxes, and with measures of explicit and implicit, intended and not intended ex-post and ex-ante redistribution and discrimination. The paradigm shift has increased the complexity of the system and created additional elements of gender specific discrimination as well as reduced established elements of the so called "social compensation". Furthermore, the relevance of complementary private and occupational pensions will increase absolute and relative due to the reduction of the pension level. ⋯ The analysis shows that the paradigm shift primarily brings disadvantages to women. They disproportionally depend on statutory pension system benefits, and therefore also on compensating benefits of the negative consequences of private and occupational pension systems. For the future an increase in poverty of older people - and especially women - can be seen to emerge because of pension privatisation and the reduction of the pension level in the German social security system.
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The assessment of patient satisfaction using mailed questionnaires is an established method of quality management in acute care hospitals in our health care system. The needs of aged patients and the inter-professional approach of geriatric medicine are, however, not taken into account by such surveys. To date, validated German instruments to assess patient opinions in geriatric in-hospital care are rare. We report the results of a multi-center feasibility study of a questionnaire developed especially for such needs. We examined 1918 patients with a median age of 82 years and a mean Mini- Mental Score (MMS) of 25 points in 3 Swiss geriatric hospitals. We examined the results of all completed written questionnaires for their psychometric properties. In parallel, we assessed the satisfaction of the patient's spouses or family members applying the same instrument. The return rate was 32% when the instrument was applied as a questionnaire and 60% when applied as an interview. In questionnaires, the return rate was dependent on cognition with lower return in patients with low MMS scores. The return rate of questionnaires mailed to family members was 35%. The theoretical construct patient satisfaction was reliable and valid. The Cronbach-Alpha values in different item areas ranked between 0.67 (hotel services, room quality) and 0.92 (physicians). We were not able to assess the quality of medical therapies and of pain treatment due to low answer frequencies. Overall, patients were satisfied with all medical services in the participating hospitals. In contrast, satisfaction was low in family members regarding the quality of information flow between family members and physicians or nurses. ⋯ An instrument to assess patient opinions can easily be introduced into a geriatric hospital. Such an instrument can provide important information for the improvement of quality in different areas of geriatric care such as medical, nursing care or guest services.