Eine unmögliche Herausforderung?! Die Pflege von älteren Menschen mit

psychischen Krankheiten aus deutscher Sicht.

Prof. Dr. Erika Feldhaus-Plumin

Evangelische Hochschule Berlin

An impossible challenge?! Care for elderly people with mental disorders – the German point of view

Overview

Definitions and Disambiguations Facts

– Epidemiology– Tools– Health Care Settings– Qualification– Political Dimension

Phenomens around mental disorders– Stigma– Violence

Conclusion Literature

Definitions and Disambiguations

A mental disorder or mental illness is a psychological pattern, potentially reflected in behavior, that is generally associated with distress or disability,...

Mental disorders are generally defined by a combination of how a person feels, acts, thinks or perceives.

Gesundheitsberichterstattung des Bundes 2009:Gesundheit und Krankheit im Alter S. 32

Definitions and Disambiguations

The biological age

The social age

The subjective apperception

Gesundheitsberichterstattung des Bundes 2009:Gesundheit und Krankheit im Alter S. 32

In 2050 about 30% of the European population will be aged ≥ 65.

The old-old are the fastest growing population group in Europe.

The United States Department of Health and Human Services 2012: Mental Health - A Report of the Surgeon General. p 39

Facts about elderly people

8 million germans with mental disorders, nearly 10 % of the

population.

Mental disorders are the fourth-frequent reason for inability

to work. Fink, W., Haidinger, G. 2007: Die Häufigkeit von

Gesundheitsstörungen in 10 Jahren Allgemeinpraxis. Z.

Allg. Med. 83/200, S.102–108.

The disease pattern depression is the most frequent disease of the mental disorders in Germany – between 16 and 20 % of all people are in their life-span once a time depressive.

Immer mehr Depressive. Die tageszeitung, 7. Mai 2009

Statistisches Bundesamt 2009: Gesundheit auf einen Blick, S.12-13

Facts about mental disorders

A quarter of the 65 year-aged and older people are living with a mental disorder.

In nursing homes nearly 40 to 50 % of the patients are having a depression. 2/3 are having a dementia.

Over 1/3 of all suicides are committed from people over 65 years old.

The rate of the addiction diseases in the cohort of the elderly people rised up:

– between 207 % (70 to 75 years) – and 230 % (80 to 84 years)

Gesundheitsberichterstattung des Bundes 2009: Gesundheit und Krankheit im Alter S. 32

Facts about elderly people with mental disorders in Germany

Berliner Altersstudie (N = 514)

Gesundheitsberichterstattung des Bundes( 2009), Gesundheit und Krankheit im Alter S. 35

Research E. Feldhaus-Plumin 2012

Nursing home N = 160

70%

40%

13%1% 1% 1%

0%10%20%30%40%50%60%70%80%

Tools für detection...

Family Patient Institutional standards Doctor Psychiatrist/Psychologist Medication ...

Statistic about Psychiatric drugs in the years 2000 to 2006 in Berlin

05

101520253035404550

60-64 70-74 80-84 90 andolder

2000

2006

Health Care Settings

Out-Patient structures In-Patient structures Nursing homes Various settings like living-groups etc.

Out-Patient structures

Nearly 70 % from patients at home Support from

– community care system– day care; night care– Gerontological-psychiatrical ambulatories

In-Patient structures

Specialized clinics– f.e. gerontopsychiatrical departments or wards

hospital structures

especially for diagnosis and patients with multimorbidity

Structures of Nursing Homes

Big change in the last 10 years – from hierarchial structures and big wards– to spezialised smaller wards, living groups,

specialised areas and various concepts start into a new decade of nursing homes

BUT: lack of nurses is contraproductive

Networking

System for caring with networking structures

Cross-link the different offerings for elderly people

Best practise f.e. in Berlin, Hamburg, Augsburg, Würzburg

“Aktionsbündnis Seelische Gesundheit” - acting network for mental disorders

Psychotherapy for elderly people

Special psychotherapy for elderly people rare in Germany

Psychotherapy qualificatiosn are starting to focus the target group „elderly people“

in nursing homes no psychotherapy! Concepts like validation, biographical

work, day-structuring and other therapeutical concepts

Qualification for nurses

Pflegefachkraft für Psychiatrie (education specialized for psychiatry)

Pflegefachkraft für Gerontopsychiatrie (education specialized for psychiatry with the target group elderly people)

Bachelor of Nursing

Political dimension

Reforms in the health care system Integrated care system (Integrierte

Versorgung) Casemanagement Clinical Pathways topics: Demographic change, dementia, need

of care

Phenomens around mental disorders

Stigma

Violence

Phenomen Stigma

„... stigma prevents people from acknowledging their own mental health problems...“

Categories– Individual discrimination – Structural discrimination– Discrimination due to self-stigmatisation

Especially the less social distance to people with mental disorders can let us reach anti-stigma.

Phenomen Violence

Violence according to mental disorders– Just a few psychiatric disease patterns are reasons

for a higher rate of acting violent (Steiner 1995). Violence from nurses against people with

mental disorders– area of conflict– The possible spiral of violence– selfreflecting– structural violence– different roles of a nurse

Conclusions

Why? Phenomens Stigma and Violence Goals

– Professionalizing the nursing– Research– Political responsibility– Awareness rising

Literature

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Surgeon General. Chapter 2: The Fundamentals of Mental Health and Mental Illness. pp 39 Retrieved May 21, 2012

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