Zeitschrift für Gerontologie und Geriatrie
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Rehabilitation increasingly focuses on patients' chronic diseases and a restricted efficiency in job and everyday life. In Germany, the specialized rehabilitation system has been adapted to this development and produced particular successful, holistic, and interdisciplinary concepts which involve medical, occupational, and social benefits. Medical rehabilitation as a field discipline and treatment method has been advanced continuously and can not be compared with acute or curative care. ⋯ On the one hand, it is to be expected that benefits for pensions and care will rise in the medium term. On the other hand, economy in rehabilitation will produce additional expenses in other health care sectors without being more effective. Since the need for rehabilitation benefits will further increase due to demographic development, new priorities should be set in favor of patients with chronic diseases.
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The quantifying of care needed is an important issue of the long-term care insurance act in Germany. In the last three decades limits of self-sufficiency have been defined in the context of law, medicine, social science and nursing science. ⋯ Arriving at non-optimal results can only be understood in terms of briefly explained background material. One solution could lie in the use or further development of existing models which determine the limits of self-sufficiency on the basis of ADL scales.
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We report on 7 nursing home or hospital patients who died suddenly and unexpectedly during physical restraint. Four of the patients were found dead hanging beside their beds, with their waist restraints displaced to the thorax. In spite of a variety of preexisting diseases, asphyxia by thorax compression was the most probable cause of death. ⋯ In all instances the fatal accidents resulted from improper handling of the restraint devices, namely from the omission of bed rails as well as of the obligatory waist belt lateral fixations. The bedcover type involved in three fatalities is destined for care purposes but not licensed as a restraint device. Physical restraint fatalities can be avoided to a large extent if the producers' instructions are strictly observed, and only especially trained and supervised personnel is admitted to this field of duties.
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The increasing interest in research on burden and health risks of family caregivers was furthered by the increasing prevalence rate of dementias in the elderly and by the fact that 80-90% of the demented are cared for by near family members. The present paper presents some results of a study investigating stress-related symptoms of family caregivers. From a clinical perspective these results point to needed interventions for supporting the caregivers. ⋯ A substantial degree of social isolation, depressive disorders, and physical complaints could be found. The level of burden experienced was not directly related to severity of dementia and to impairment of the demented or to structural conditions of the care (degree and length of care). Differences were observed between spouse caregivers and other relatives; spouses suffer more psychosomatic complaints and depression.
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Chronic pain is one of the most common complaints in the elderly, associated with much impairment of quality of life. Up to now clinical research has focused little attention on pain in old age. ⋯ The studies also make evident that proved psychological pain management is transferable to elderly patients. The knowledge of effective psychological treatment in case of chronic pain in the elderly has been seldom realized in clinical practice.