[The care of obese persons from the perspective of executives of inpatient care facilities. Results of qualitative expert interviews]. / Versorgung adipöser Menschen aus der Perspektive von Leitungskräften vollstationärer Pflegeeinrichtungen. Ergebnisse qualitativer Experteninterviews.

BACKGROUND: Although nursing home residents are increasingly suffering from obesity, little research has been done on the appropriate care for them. The present study examines how executives of long-term care facilities perceive obese residents, which meaning does obesity have for them, and whether they associate the care of the obese with additional expenditures. MATERIALS AND METHODS: In all, 15 guideline-based interviews were conducted with executive managers of nursing homes in Berlin, Saxony and Bavaria. The analysis of the interviews was based on the method of Meuser and Nagel. RESULTS: The results demonstrate that obese nursing home residents are hardly noticed by executives. This results from the fact that they attribute only minor significance to obesity as a nutritional and health problem. The care of obese residents is associated with additional instrumental and personnel-related expenditures. However, facilities do not have sufficient resources to provide them. Obesity is a serious, but unrecognized problem in long-term care. CONCLUSION: To improve the awareness of obesity, intense professional discussions are required. The provision of additional instrumental and human resources becomes necessary to ensure appropriate care of obese nursing home residents.

[Resident Assessment Instrument (RAI): a system for client evaluation and documentation in long-term care--an overview]. / Resident Assessment Instrument (RAI): System zur Klientenbeurteilung und Dokumentation in der Langzeitpflege--eine Ubersicht.

This article describes the interdisciplinary care planning system "Resident Assessment Instrument" (RAI) for nursing homes with its parts, the Health Care Financing Administration mandated "Minimum Data Set" (MDS) and the "Resident Assessment Protocols" (RAPs). The MDS-derived case mix system for resource allocation, the Resource Utilization Groups (RUGs), are mentioned. The prerequisites for an implementation of the F.R.G. are discussed.

[Unmerited inflation of health service use. Analysis of utilization of health care and services by the elderly]. / Die unverschuldete Anspruchsinflation. Analyse der Inanspruchnahme von Versorgung und Diensten durch alte Menschen.

This contribution deals with a burning issue of the "inadequate utilization" of services, especially with the phenomenon of so-called excessive use of services by certain old individuals. We investigate to what extent particular patterns of negotiation between the client and service provider may favour the increase of utilization. The contribution bases on an analysis of cases documented by the staff in two counseling institutions for old citizens in the course of one year. We could identify four patterns of interaction ("lagging", "keeping contact", "reassuring", and "symptom therapy") which predispose increase of utilization frequently. Two examples of these patterns--"lagging" and "keeping contact"--are explained in every detail. The contribution shows that not only structural factors of the care system but also the face-to-face interaction between clients and service providers may produce unwanted effects. The elimination of such effects must start with better understanding of the dynamics of the helping interaction.

[Do the elderly receive adequate dental care? Determinants of the use of dental services by 60-to 90-year-old city dwellers. II]. / Sind ältere Menschen zahnärztlich adäquat versorgt? Determinanten der Inanspruchnahme zahnärztlicher Versorgung durch die 60- bis 90jährige Grossstadtbevölkerung--Teil II.

The article is a continuation of the analysis of the use of dental services by residents of a metropolitan area born between 1890 and 1919, published in issue 3 of this periodical. It involves a comparison of two different groups: the first--24.8% of the population under study--comprises "the users" of dental care without chewing difficulties; group 2 comprises test persons who, despite chewing complaints, do not seek treatment (10.4% of the population under study). While the first group presents in every respect the positive picture of aging, the second constitutes the real problem group. In its case the effects of poor social and economic living conditions are intensified by health as well as functional impairments. The absence of dental care seems to point in the first instance to problems of access to treatment.

[Do the elderly receive adequate dental care? Determinants of the use of dental services by urban dwellers aged between 60 and 90 - Part I (author's transl)]. / Sind ältere Menschen zahnärztlich adäquat versorgt? Determinanten der Inanspruchnahme zahnärztlicher Versorgung durch 60- bis 90jährige Grossstadtbevölkerung - Teil I.

The paper constitutes an extract from a field study carried out in Berlin (West), in which 1,512 persons aged between 60 and 90 were questioned and medically examined. One of the aims was to determine the relations obtaining between environmental conditions and the capacity of the elderly to preserve their own health. Part of this is the use of health services. The following presentation is an examination of the factors determining the use of dental care. Included were - chewing capacity (subjective chewing difficulties, medical assessment of chewing capacity, and of the dentures) - accessibility of dentists - socio-economic status health well-being - life satisfaction In the second part groups of test persons are compared, which differ from one another both in regard to utilization behavior, and to chewing capacity.