[Geragogic support for status passages in old age : Challenge and opportunity of a new care for older people]. / Geragogische Begleitung bei Statuspassagen im Alter : Herausforderung und Chance einer neuen Altenhilfe.

BACKGROUND: With the continuous increase in the average age, the temporal perspective for the phase of old age is also significantly expanding. This results in an individual need for reorientation for the aging person with respect to a meaningful shaping of this long period of time, which as a progressive process leads to the end of life. In the context of the status passages to the third, fourth and fifth ages, there is a special relevance for this; however, the so-called care for older people (§ 71 Social Security Code, SGB XII) has so far largely ignored these important aspects. Rethinking in a needs-oriented way, the facilitation of the necessary reorientation of life in old age through learning and education must therefore be given greater consideration. AIM OF THE ARTICLE: The article gives a necessary update of the existing care for older persons, which takes greater account of a needs-oriented design of a society of long life. Furthermore, the role and significance of the necessary educational processes in the sense of geragogy are outlined and also how they can contribute to successful aging. MATERIAL AND METHODS: With reference to current research work and publications on the topic, the possibilities of geragogic support as a challenge and opportunity for new care for older persons are worked out. RESULTS AND DISCUSSION: The learning and educational processes of the aging person can be aimed at various concerns, if nothing else differentiated according to the challenges associated with the social age categories, i.e., the third, fourth or fifth age; however, learning and educational processes also address very different dimensions, each focusing on the question of how older people can tackle and cope with such necessary adaptation and change processes.

[Interprofessional team building-An interuniversity qualification program]. / Interprofessionelle Teambildung ­ ein hochschulübergreifendes Qualifizierungsprogramm.

BACKGROUND: With the growing number of older and old patients as well as patients affected by multimorbidity, cognitive impairments and frailty in hospital and expansion of long-term care, the challenges in the various geriatric and gerontological care settings are also increasing. Social networks and resources become fragile due to the changing family structures. A strong interprofessional team building and networking of the main actors in the nursing and healthcare systems become necessary. OBJECTIVE: A qualification program for students of medicine, social work and relevant study courses for nursing was established. In this program participants should collectively learn to deal with the concerns and needs of geriatric patients in a case-related manner and to develop suitable plans for treatment and interventions. METHOD: The qualification program for interprofessional team building was evaluated during the development phase as a pilot project and scientifically evaluated (n = 78) using the Freiburg questionnaire on interprofessional learning evaluation (FILE). RESULTS: The program experienced a high level of approval by approximately 98% of the participants. The measurement of change showed an improvement in team skills and ability to work in a team. CONCLUSION: Opening up a learning field for interprofessional learning and working to students of different disciplines and professions during their studies creates a good basis for successful interprofessional team building in the subsequent professional practice. The interuniversity and interprofessional teaching project presented is now firmly anchored in the curriculum at the participating universities with the teaching module "The geriatric patient". It is therefore a possible model for similar projects.

[Health care and care for the elderly in the future : Insights from the corona pandemic]. / Gesundheitsversorgung und Pflege für ältere Menschen in der Zukunft : Erkenntnisse aus der Corona-Pandemie.

Health care and especially care of the elderly have come under massive pressure from the corona pandemic. Structural deficits and weak points that are not really new are now more apparent because COVID-19 has brought these back into focus. In the entire healthcare system new questions arise in the face of the current challenges. Problems and gaps now become obvious in the health care services and in the provision of care for the elderly-some of them specifically related to one area, but to a greater extent these are cross-sectoral. Based on relevant national and international studies and publications and from the perspective of social gerontology, this article focuses on the current situation in the 'long-term nursing care in Germany' in the context of the SARS-CoV­2 virus. The results of this analysis are used to derive and outline what a new professional orientation can look like with a view to the future and what possible knowledge can be gained from the corona pandemic.

What makes them happy? Professional care-givers' job satisfaction.

BACKGROUND: Nurses' job dissatisfaction can be seen as an early warning indicator of occupational change and (early) termination intentions. A better understanding of job satisfaction and its determinants can help to prevent nurses from leaving their profession. AIM: We assessed the impact of nurses' perception of job characteristics on their overall job satisfaction in order to identify the most relevant factors. We also investigated the potential mechanisms through which the most relevant factor influences job satisfaction. METHOD: We used multiple regression analysis based on a standardized survey of about 800 registered nurses (in long-term care facilities) in both inpatient care and outpatient care in Germany as well as qualitative content analysis of about 50 semi-structured interviews with nurses. RESULTS: We found that collaboration with the team and supervisor to be the most relevant factor associated with job satisfaction. A good team can create professional support and ideational support for professional caregivers and enhance their professional development and the quality of care. DISCUSSION: Our results point to the importance of leadership training, team building methods and other measures for establishing and cultivating a pleasant working atmosphere with flexible shift handovers and team meetings.

[Trained volunteers to support patients after hospitalization-national implications from international findings]. / Qualifizierte Freiwillige als Patientenbegleiter nach einem Krankenhausaufenthalt ­ nationale Implikationen aus internationalen Erkenntnissen.

BACKGROUND: In Germany people over 65 years old are treated in hospital almost twice as often as younger people. Special attention needs to be paid to the transition from inpatient to outpatient care. In recent years, volunteers have been increasingly involved in the care of older patients during and after the hospitalization phase. OBJECTIVE: This article presents the results of empirical studies, which evaluated one-to-one approaches with trained volunteers to support chronically ill, multimorbid older patients at the interface between hospital and domestic care. Implications for the German care system are derived for the first time. MATERIAL AND METHODS: The results of a systematic search for randomized controlled studies, controlled studies and studies in a one-group pre-post design are presented. The identified interventions are presented, a cautious assessment of the need for care based on representative national surveys is made and the added value of the interventions is assessed against the background of the existing care structures. RESULTS: In the international context, trained volunteers are active in psychosocial coordinative support (n = 2), physical cognitive activation (n = 4) and assistance with medication intake (n = 2). These interventions show short-term effects with small and medium effect sizes. Psychosocial coordinative support and physical cognitive activation are basically transferable to national circumstances. DISCUSSION: Before a broad implementation, the approaches would first have to be adapted to national circumstances, tested for feasibility and the effectiveness must be examined in high-quality studies.

Trained volunteers to support chronically ill, multimorbid elderly between hospital and domesticity - a systematic review of one-on-one-intervention types, effects, and underlying training concepts.

BACKGROUND: New approaches are needed to address the challenges of demographic change, staff shortages, and societal change in the care of the elderly. While volunteering has barely been established as a pillar of the welfare state in several countries, legislators and nonprofit or community-based organizations in some countries favor the increased integration of volunteers, as they can rely on many dedicated people. When caring for the multimorbid elderly, the transition from hospital to domesticity involves certain risks. Currently, no systematic knowledge exists on whether and how elderly benefit from volunteer support after a hospital stay. Objectives of this systematic review were to (1) identify evaluated approaches with trained volunteers supporting chronically ill, multimorbid elderly one-on-one at the interface between hospital and domesticity; (2) investigate the patient-related effectiveness of the approaches; (3) present the characteristics of the supporting volunteers; and (4) present the underlying teaching and training concepts for the volunteers. METHODS: A systematic search of the following online databases was conducted in April 2017: the Cochrane Library, Medline (PubMed), CINAHL, and PsycINFO (Ebscohost). We included (cluster/quasi-) randomized controlled trials, controlled clinical trials and single-group pre-post design. An institutional search was conducted on eight national institutions from research and practice in Germany. Screening was conducted by one researcher, risk of bias was assessed. Study authors were contacted for study and training details. RESULTS: We identified a total of twelve studies, eight of which evaluated treatment following hospital stay: psychosocial-coordinative support (n = 2), physical-cognitive activation (n = 4), and assistance with medication intake (n = 2). We saw short-term effects with small and medium effect sizes. Most volunteers were women aged between 45 and 61 years. Their training lasted 12-26 h and took place prior to first patient contact. During the intervention, volunteers could rely on permanent supporting structures. CONCLUSIONS: Few studies exist that have evaluated one-on-one-volunteer support following hospitalization, and the effects are inconsistent. As such, further, well-designed studies are needed. The suitability and transferability of the interventions in country-specific settings should be examined in feasibility studies. Furthermore, an international discussion on the appropriate theoretical backgrounds of volunteer training is needed.

Local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro): study protocol of a randomised comparative effectiveness trial.

BACKGROUND: Multimorbid older adults suffering from a long-term health condition like depression, diabetes mellitus type 2, dementia or frailty are at high risk of losing their autonomy. Disability and multimorbidity in the older population are associated with social inequality and lead to soaring costs. Our local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro-Care) aims at improving outcomes for older multimorbid patients with chronic conditions whose social and medical care must be improved. METHODS: The study will evaluate the effects of LoChro-Care on functional health, depressive symptoms and satisfaction with care, resource utilisation as well as health costs in older persons with long-term conditions. The trial will compare the effectiveness of LoChro-Care and usual care in a cross-sectoral setting from hospital to community care. We will recruit 606 older adults (65+) admitted to local hospital inpatient or outpatient departments who are at risk of loss of independence. Half of them will be randomised to receive the LoChro-Care intervention, comprising seven to 16 contacts with chronic care managers (CCM) within 12 months. The hypothesis that LoChro-Care will result in better patient-centred outcomes will be tested through mixed-method process and outcome evaluation and valid measures completed at baseline and at 12 and 18 months. Cost-effectiveness analyses from the healthcare perspective will include incremental cost-effectiveness ratios. DISCUSSION: The trial will provide evidence about the effectiveness of local, collaborative, stepped and personalised care management for multimorbid patients with more than one functional impairment or chronic condition. Positive results will be a first step towards the implementation of a systematic cross-sectoral chronic care management to facilitate the appropriate use of available medical and nursing services and to enhance self-management of older people. TRIAL REGISTRATION: German Clinical Trials Register (DRKS): DRKS00013904 ; Trial registration date: 02. February 2018.

[Educational gerontology and social work]. / Altersbildung und Soziale Arbeit.

Educational gerontology has become established over the past 40 years in a multifaceted, differentiated practice which, against the background of social change processes, combined with the phenomena of demographic change, takes up and creates room for accompanying irritations, learning requirements and opportunities. A corresponding theoretical foundation exists in the scientific discipline of geragogy, which is located at the interfaces between gerontology, educational science and social work. The close proximity between education of and social work with the elderly is meanwhile also evident in many recent research and development projects, in which theory formation for geragogy and social work as scientific disciplines take place at the same time. Against this background, the core developmental lines of geragogy are briefly sketched in this article and linked with the exemplary scientific discourse within gerontology and social work sciences. The result is a form of synthesis of central theoretical premises of social gerontology in the field of educational gerontology. This claim becomes more concrete by a recourse to the results of relevant research and development projects, which refer to different facets of educational work in different gerontological fields or as a conscious approach to methodological integration, also in the sense of participatory procedures. Theoretical and didactic approaches to educational gerontology are of increasing importance in terms of enabling integration and participation and also in the context of research and development projects. This also involves participation of the elderly as experts in their own field as well as participatory procedures and approaches. Willingness to learn and openness to educational approaches will also be the basic prerequisites for older people in the future, creating orientation in a rapidly changing world and social participation. One important task for educational gerontology in this context is to reach and to involve older people who are not very well educated and to open them up to the necessary room for social integration and participation. Methods of social work can therefore be very helpful.

[Family companions. New facets in accompanying relatives caring for people with dementia]. / Familienbegleitung. Neue Facette in der Begleitung pflegender Angehöriger von Menschen mit Demenz.

BACKGROUND: Support and relief options in the context of homecare settings where people with dementia are cared for by friends or relatives have become highly differentiated; however, there are significant shortcomings in networking between the various types of offers within the context of mixed care (Pflegemix). Family caregivers often feel overwhelmed and find it difficult to identify and utilize the appropriate forms and services for their individual situation. Against this background companion models seem to be an appropriate solution to provide psychosocial support for caring families and to function in the role of bridge building in the assistance system. AIM: Within the framework of the Future Workshop Dementia (Zukunftswerkstatt Demenz) program funded by the German Federal Ministry of Health during the time period 2012-2015, the new intervention was developed in the family companion for dementia in rural areas (FABEL) project carried out by volunteers. These volunteers take up the needs of caring families for a low-threshold support structure and promote networking among the various groups of participants in individual homecare settings. The preparatory training for the volunteers, which is the focus of this article, provides special knowledge about dementia and the basic principles of systemic understanding of the typical dynamics in caring families. MATERIAL AND METHODS: In the model phase the newly developed training program was aimed at qualified volunteers trained in the logistics of the model project Care Companion (Pflegebegleitung), which was successfully established from 2003 to 2008 in more than 100 pilot locations throughout Germany and is now integrated into the healthcare system. This proven model is linked to the new qualification and consists of 68 units involving thematic modules of knowledge about dementia and systemic solution-oriented thinking, for networking and the development of an understanding of the personal role. RESULTS: During the 3-year project period 27 volunteers became qualified and accompanied at least 73 families in rural areas, which was the special focus of the model project. The developed qualification enabled the volunteers to carry out the activities in a very relationship-oriented way and in a direct form of communication with the family carers and also to encourage self-care activities. This led to a significant improvement in the health-related quality of life (QoL) of family carers and stabilized the homecare setting. As part of a health economic model calculation on the effects of the new approach, the pecuniary gains outweighed the costs caused by the qualification. DISCUSSION: The concept of family companions (Familienbegleiter) has proven to be a cost-covering model of an effective intervention based on the needs of caring families, which should become more widespread in the future.