Zeitschrift für Gerontologie
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The suicidal behavior in 155 patients older than 60 years is analyzed. Patients were treated for endogenous, neurotic, or reactive depression. Differences between diagnostic categories and sex are discussed in detail. ⋯ Psychopathological symptoms correlating with suicidal behavior in endogenous depression in the elderly are depicted. The social environment of and the therapeutic approach to suicidal elderly patients are discussed. The problem of rational suicide and the demand for voluntary death are mentioned.
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Manners of coping with dying were studied in sixty patients with terminal diseases using explorative interviews. The reaction to impending death is commonly described in the literature as being reduced to only a few global dimensions. ⋯ The manner of dealing with death and dying was also influenced by its proximity. Patients expecting to die soon or those with longer survival times (greater than 1 year) at the time of evaluation, hardly acknowledged or did not initiate discussion of their situation.
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Between 1982 and 1990 724 patients aged between 85 and 102 years were hospitalized (average age: 88.7 years). Operations were performed on 482 of them (66.6%). ⋯ The mortality in conjunction with emergency operation was as high as 28.2%, or as low as 11.4% in the context of elective operations. X-ray findings recorded from heart and lung, and ECG provided reliable criteria for assessment of the surgical risk.
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The term "depressive pseudodementia" introduced 20 to 30 years ago by Madden and coworkers and by Kiloh is critically evaluated. This originally descriptive term is not unequivocal due to its diagnostic and therapeutic connotations. Even by omitting the negative prefix "pseudo" it cannot be distinguished whether a psychopathological description of symptoms or a clinical diagnosis is meant. ⋯ At the syndromal level it is suggested to use the term "dementia syndrome" according to Folstein and McHugh or to use the term "cognitive impairment" according to Caine. At the diagnostic-nosological level this procedure should include the information as to whether the "cognitive impairment" of an elderly patient coincides with a depression, a certain type of dementia or a combination of both. Such a positive terminology may promote the qualitative differentiation and quantification of the "cognitive impairment" which are scientifically necessary.
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The present analysis confirms the advantage of costs of mobilee health care services compared to nursing homes as well as the user-preference of this form of services. Nevertheless, mobil health care services offer the individual needed care only to a special target-group of cases. It seems to be necessary to create objective instruments for a unique extensive differential diagnostic of care needs including - in addition to the medical indication - all essential life conditions within the personal and social surroundings of nursing cases.