[Palliative geriatrics. What are the differences between oncologic and non-oncologic palliative geriatric inpatients?]. / Palliative Geriatrie. Wie unterscheiden sich onkologische von nichtonkologischen geriatrischen Palliativpatienten im Krankenhaus?

AIM OF THE STUDY: Analysis of differences between oncologic and non-oncologic patients in the first German hospital-based special care unit for palliative geriatrics. METHODS: Systematic analysis of patients' records according to a standardized protocol. RESULTS: A total of 217 patients from a hospital-based special care unit for palliative geriatrics (56.7% women, 43.4% men) were included over a retrospective period of 1.5 years. Patients were categorized as non-oncologic (53.4%, n=116) or oncologic (46.5%, n=101). Non-oncologic patients were older than oncologic patients (84.0 vs. 76.8 years, p=0.02), and showed a higher degree of functional dependence (p<0.001) and mortality (87.1% vs. 53.3%, p<0.001). The two most common non-oncologic categories of primary diagnoses were pulmonary and neurologic diseases: 19% each. Certain secondary diagnoses had a higher incidence with non-oncologic than oncologic patients, such as pulmonary disease (39% vs. 24%, p=0.02) and dementia (38% vs. 8%, p<0.001). The Charlson comorbidity index was found to be higher for oncologic patients than for non-oncologic patients (6.6 vs. 4.1, p=0.001). Non-oncologic patients also experienced more dysphagia (57% vs. 17%, p<0.001), NPO (43% vs. 12%, p<0.001), and tube or parenteral feeding (31% vs. 9%, p=0.001). Oncologic patients experienced more often symptoms of pain, constipation, agitation, diarrhea, vomiting, and nausea. CONCLUSION: There are clinically relevant differences between oncologic and non-oncologic palliative geriatric inpatients regarding the constellation of symptoms, care, mortality, and the prevalence of concerns about hydration and feeding. These differences ought to be taken into account for further education, as well as further improvement of the healthcare system, to enable an appropriate standard of palliative care for geriatric patients.

[Situation of nursing home residents with continence problems: a study in two German nursing homes]. / Die Situation von PflegeheimbewohnerInnen mit Kontinenzproblemen: eine Studie in 2 deutschen Pflegeheimen.

AIM OF THE STUDY: To describe the situation of residents with continence problems (CP) in two German nursing homes. METHODS: Medical and nursing records of all residents were reviewed and categorised according to a standardised protocol. Structured interviews were performed with the responsible nursing staff of each resident. Qualitative methods like focus groups and participating observations were used to collect further information. RESULTS: In the investigated nursing homes 177 residents with and 70 without CP were identified (81.5% women; mean age 83.7 years). For these 247 residents 57 physicians and 116 nurses or nurses-aides were in charge. 71% of female and 76% of male residents had at least one CP. The three most common CP among residents were combined urinary and faecal incontinence (32%), urinary incontinence (21%), and urinary catheters (17%). Residents with CP were significantly more dependent in functional abilities like toileting, dressing or cognitive function than those without CP (P<0.01). In a high proportion of residents with CP physicians (64%) were not consulted nor were relatives (86%) involved in continence related activities. CONCLUSION: Nursing home residents are commonly affected by continence problems which are associated with functional dependency and relevant co-morbidity. The public and expert debate on continence problems of nursing home residents has to be promoted to achieve long-term changes.