Elderly migrants in outpatient and inpatient care services in Baden-Württemberg/Germany.

OBJECTIVE: Given the expected underrepresentation of elderly migrant populations in healthcare utilization we examined their proportion in nursing homes and care services for the elderly. We expected that cultural aspects were rarely addressed in the services´ concepts. METHODS: A questionnaire was administered to all care providers; 66.3% of 2724 in- and outpatient services in Baden-Württemberg, Germany participated. RESULTS: 78% of the services provided healthcare to migrants, who accounted for 14.1% of the clientele. This proportion was higher in urban (e.g. Heilbronn: 16.1%) than in rural areas (e.g. Lake Constance: 7.7%) and was significantly (r = 0.545, p < .05) correlated with the proportion of migrants in the general population. 39.1% of the migrants came from Russia, Poland and Turkey. Migrants from Turkey preferred outpatients´ rather than inpatients´ services. While 87.4% of services employed migrants, only 20% of services provided measures to increase intercultural competency to their employees. CONCLUSIONS: Migrants utilize inpatient and outpatient services regularly as their proportion was closely associated to that of the general population. Although their number will likely increase in the near future, the vast majority of nursing facilities did not provide specialized measures to better meet the demands of residents with a migration background.

Professional caregivers' knowledge in dermatology : Improving knowledge and communication to dermatologists in geriatric facilities.

BACKGROUND: Research regarding effective collaboration and communication between professional caregivers and dermatologists and the need for further education and training for caregivers in the field of geriatric dermatology still remains relatively scarce. OBJECTIVE: To document the state of knowledge of professional caregivers in the field of geriatric dermatology and make recommendations for dermatological education and postgraduate training. METHODS: A questionnaire with open and closed questions was used to evaluate the level of knowledge and current need for information in geriatric dermatology. A total of 58 professional caregivers from several hospital departments, including geriatric wards and nursing homes participated in this study. Quantitative and qualitative data were generated and responses to open questions were categorized according to the most quoted contents. The study was approved by the Charité University in Berlin ethics committee. RESULTS: The study demonstrates that there is a lack of dermatological knowledge. Participants indicated a huge information need regarding skin tumors (77.2 %), prevention of skin diseases (50.0 %) and pruritus (41.4 %). According to the caregivers, communication problems with physicians arise in view of using standardized terms of skin diseases (22.9 %) and formulating unclear care records of skin diseases (20.8 %). CONCLUSION: Difficulties in communication between professional caregivers and physicians can influence patients' punctual and well-founded treatment; therefore, further education must be mediated vividly and practically. Moreover, training should focus on learning standardized terms and descriptions for optimizing the flow of information with physicians and written communication, such as care records.

Carers' education improves oral health of older people suffering from dementia - results of an intervention study.

AIM: The aim of this study was to evaluate the effectiveness of carers' education on improvements in oral health and denture hygiene of care-dependent and cognitively impaired older people in nursing homes compared to those without intervention. METHODS: A total of 219 seniors living in 14 nursing homes in southwest Germany (intervention: n=144; control: n=75) were enrolled in this study. For each participant, Plaque Control Record (PCR), Gingival Bleeding Index (GBI), Denture Hygiene Index (DHI) and Community Periodontal Index of Treatment Needs (CPITN) were assessed at baseline and six months following the interventions. In addition, demographic parameters such as age, sex, chronic diseases, permanent medications, level of dependency and cognitive state were recorded. In the intervention homes, education for caregivers was provided and ultrasound baths for denture cleaning were implemented. Changes in the dental target variables PCR, GBI, CPITN and DHI during the six-month study period were compared between subjects in the intervention and the control groups as well as between subjects with and without dementia. Additionally, multivariate models were compiled for each dental index to evaluate possible confounders. RESULTS: In the intervention group, PCR and DHI significantly improved during the study period (P<0.001). Oral health and denture hygiene improved likewise in subjects with and without dementia. In the control group, no significant improvements were observed (P>0.05). CONCLUSION: Carers' education improves oral health of people in nursing homes over a clinically relevant period of time. Implementation of ultrasound baths is a simple and effective measure to improve denture hygiene of both institutionalized elderly people and seniors with dementia and in severe need of care. From a clinical standpoint, it is noteworthy that the respective interventions can be easily implemented in everyday care routine.

Neurocognitive Deficits and Effects of Cognitive Reserve in Mild Cognitive Impairment.

BACKGROUND/AIMS: Mild cognitive impairment (MCI) is a frequent syndrome in the older population, which involves an increased risk to develop Alzheimer's disease (AD). The latter can be modified by the cognitive reserve, which can be operationalized by the length of school education. MCI can be differentiated into four subtypes according to the cognitive domains involved: amnestic MCI, multiple-domain amnestic MCI, non-amnestic MCI and multiple-domain non-amnestic MCI. While neurocognitive deficits are a constituent of the diagnosis of these subtypes, the question of how they refer to the cognitive reserve still needs to be clarified. METHODS: We examined neuropsychological deficits in healthy controls, patients with MCI and patients with mild AD (n = 485) derived from a memory clinic. To reduce the number of neuropsychological variables, a factor analysis with varimax rotation was calculated. In a second step, diagnostic groups including MCI subtypes were compared with respect to their clinical and neuropsychological characteristics including cognitive reserve. RESULTS: Most MCI patients showed the amnestic multiple-domain subtype followed by the pure amnestic subtype, while the non-amnestic subtypes were rare. The amnestic subtype displayed a significantly higher level of cognitive reserve and higher MMSE scores than the amnestic multiple-domain subtype, which was in most cases characterized by additional psychomotor and executive deficits. CONCLUSIONS: These findings confirm earlier reports revealing that the amnestic multiple-domain subtype is the most frequent one and indicating that a high cognitive reserve may primarily prevent psychomotor and executive deficits in MCI.

[Communication training MultiTANDEMplus ­ A contribution to improve communication between professional caregivers and physicians]. / Kommunikationstraining MultiTANDEMplus - Ein Beitrag zur Verbesserung der Kommunikation zwischen Pflegenden und Ärzten.

BACKGROUND: Failures of communication between professional caregivers and physicians affect the quality of supply of nursing home residents. AIM: As part of a model project it was aimed to develop a training for caregivers to improve communication and promote cooperation with physicians. METHODS: For the needs assessment as a basis to develop the training 56 professional caregivers and 40 physicians engaged in nursing home care answered questionnaires regarding their cooperation. Based on these results a module for communication between professional caregivers and physicians was developed and adapted the TANDEM communication training for caregivers by Haberstroh and Pantel (2011). 25 professional caregivers in leading positions have been trained as multipliers in order to provide their colleagues the communication training with the additional element (TANDEMplus). TANDEMplus was evaluated in forms of reflection rounds and feedback questionnaires. RESULTS: 254 professional caregivers, housekeeping staff and daytime companions participated in a complete TANDEMplus training by the multipliers until July 2014. The implementation of their developed communication strategies into practice was experienced positively by the participants. CONCLUSIONS: The module "communication with physicians" is relevant for professional caregivers to raise awareness of their own competence and facilitate a structured information exchange at eye level. The training of multipliers was executed in order to ensure transfer effects and sustainability.