[Aging and dying in diversity-implications of an intersectional perspective for analyzing care policy discourses]. / Altern und Sterben in Diversität ­ Implikationen einer intersektionalen Perspektive für die Analyse pflegepolitischer Diskurse.

In view of the growing population, which is increasingly aging in diversity, questions of social justice and of avoiding discrimination in end of life nursing care become increasingly more relevant from an ethical point of view. This article addresses the discrepancies between normative claims of an equitable approach to provision of nursing services and the sources of structural barriers. In particular at the end of life, often already vulnerable groups are subjected to discrimination in nursing care. Further reflections refer to implications of intersectionality for care-ethical approaches and for the methodology of discourse analysis. This study investigated how diversity and justice are formed in the care policy discourse. It becomes evident how parts of the care policy discourse largely ignore individual ethical implications. Accordingly, critical reflections on inequalities in nursing care remain unconsidered in the discourses. Starting points for processes of change that begin from concepts of individual care ethics are presented.

Advance directives, dementia, and withholding food and water by mouth.

People with dementia who are no longer competent have limited control over how their lives end. But an advance directive to withhold food and water by mouth could be used to ensure that one does not live for years in severe dementia. Such directives are arguably already legal.

[Pain assessment in elderly nursing home residents: methods paper for the S3-guideline development]. / Schmerzassessment bei älteren Menschen in der vollstationären Altenhilfe : Methodenpapier zur S3-Leitlinie.

In Germany, there is currently no guideline for pain assessment in elderly people. Pain management in nursing home residents is, however, legally required. For this particular group, especially for people with dementia, suitable interdisciplinary orientations for health care are lacking in Germany. The working group "Pain and Age" of the German Pain Society ("Deutschen Schmerzgesellschaft") in conjunction with the German Centre for Neurodegenerative Diseases ("Deutschen Zentrum für Neurodegenerative Erkrankungen"), Witten, has embarked on the development of interdisciplinary S3-Guideline for "Pain Assessment in Elderly People in Nursing Homes", based on the methodology suggested by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V."), the German Agency for Quality in Medicine ("Ärztliche Zentrum für Qualität in der Medizin"), and that described in the DELBI ("Deutschen Leitlinien-Bewertungsinstrument"). Delegates of the 38 scientific societies and interest groups currently participating can contribute to the contents on three different levels. The present article outlines the methods for developing the guideline.

[Alzheimer's disease and related disorders: specificity of young onset patients, including ethical aspects]. / Maladie d'Alzheimer et syndromes apparentés : spécificités des « malades jeunes ¼, réflexions cliniques et éthiques.

The number of patients with young onset dementia (YOD) (that is before age 65) is estimated at 32,000 in France, and 5000 with onset dementia before 60 years. These patients differ from older ones by the greater number of rares causes (29%), heterogeneity of the presentation among the usual diseases, such as non-amnestic phenotypes of Alzheimer's disease, high frequency of frontal symptoms, and possible genetic origin. These aspects must be taken into account for the diagnosis, often more difficult than in older ones because patients have a little knowledge of the YOD, excepted in the genetics forms. YOD patients can still work or drive a car, and we should choose between the respect for autonomy and the security for the patient and their carers. YOD patients can be more often included in pharmacological trials because they have lower associated disorders. Individual non-pharmacological treatment should be priviledged because they don't easily accept collective activities with other patients over 60 years of age. Excepted for the very young patients (onset before 45), the survival is longer than in late onset dementia, with sometimes severe behavioral problems related to frontal syndrome. In France, the caregiving at home has been improved since the possibility for the YOD patients to receive a financial assistance reserved for the disabled patients, but admission to a nursing home before 60 is very difficult and increases the caregiver burden and perception of unfairness. There is a discrimination between young or older demented patients related to the great difficulty to meet the needs of younger patients, due to the rigidity of the medical and social systems. The presentation of a limited offer for the YOD patients must initiate reflections on our capacities to respect the autonomy and the dignity of the Alzheimer's patients regardless of age.

Productivity and employees' organizational justice perceptions in long-term care for the elderly.

We examined the associations between productivity, employer characteristics, and context variables, and the organizational justice perceptions of 330 female employees in long-term institutional elderly people care. The productivity measure used was the proportion of the inpatient days to total costs. Employees working in high productivity units experienced higher procedural justice than those working in low productivity units. Hostile employees experienced both the procedures and management as less fair than non-hostile employees. Unit size and resident turnover were negatively and registered nurses percentage positively associated with procedural justice perceptions.

The Judaic-Christian origin of nursing homes.

Many nursing homes today have a religious heritage. While governmental regulations control how much of the care is delivered, the foundations and goals of many homes predate governmental rules and payment policies. This paper explores the basis of Jewish and Christian thought in providing groundwork for religiously based nursing homes. Although the underlying principles are similar, differences in approach and execution for the formation of these homes exist.