Building Bridges between Gerontology and Elder Law.

BACKGROUND: Academics have long called for greater interaction between gerontologists and legal scholars. However, prior studies have suggested that disciplinary borders remain a barrier to such interaction, hampering gerontology's ability to function as a truly multi- or interdisciplinary field. OBJECTIVE: This study was designed to understand the nature of current interactions between legal scholars and gerontologists, and to identify opportunities to advance scientific dialogue and cooperation between the two. METHODS: Semi-structured, open-ended interviews with 27 participants (12 elder law scholars, 15 gerontologists) were conducted by phone, recorded, and analyzed by an interdisciplinary team. RESULTS: Both elder law scholars and gerontologists indicate that their field would benefit from research collaboration and cross-disciplinary teaching with the other field, but the fields remain distinct with little cross-disciplinary learning. Participants identified a series of opportunities, however, for increasing such learning and collaboration. CONCLUSIONS: The authors identify ways gerontologists can be encouraged to integrate elder law into their teaching and research, and suggest how this integration could enhance understanding of the aging experience.

Teaching legal competencies through an individualized elective in medicine and law.

Medical education, including education intended to prepare future physicians to care to older individuals, should include development and implementation of competencies relating to a physician's ability to understand and interact with the legal environment and legal actors who will affect the practice of medicine. The wisdom of integrating legal knowledge into the medical curriculum has been documented, and literature discusses the content and methods of teaching medical students and residents about law and the legal system. This article describes one unique but replicable, pedagogical approach to preparing future physicians to thrive in their inevitably interprofessional careers as they fulfill the fiduciary responsibilities that lie at the heart of their therapeutic and advocacy relationships with older patients.

Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies.

Background: frailty impacts older adults' ability to recover from an acute illness, injuries and other stresses. Currently, a systematic synthesis of available interventions to prevent or reduce frailty does not exist. Therefore, we conducted a scoping review of interventions and international policies designed to prevent or reduce the level of frailty in community-dwelling older adults. Methods and analysis: we conducted a scoping review using the framework of Arksey and O'Malley. We systematically searched articles and grey literature to identify interventions and policies that aimed to prevent or reduce the level of frailty. Results: fourteen studies were included: 12 randomised controlled trials and 2 cohort studies (mean number of participants 260 (range 51-610)), with most research conducted in USA and Japan. The study quality was moderate to good. The interventions included physical activity; physical activity combined with nutrition; physical activity plus nutrition plus memory training; home modifications; prehabilitation (physical therapy plus exercise plus home modifications) and comprehensive geriatric assessment (CGA). Our review showed that the interventions that significantly reduced the number of frailty markers present or the prevalence of frailty included the physical activity interventions (all types and combinations), and prehabilitation. The CGA studies had mixed findings. Conclusion: nine of the 14 studies reported that the intervention reduced the level of frailty. The results need to be interpreted with caution, as only 14 studies using 6 different definitions of frailty were retained. Future research could combine interventions targeting more frailty markers including cognitive or psychosocial well-being.

The legal appearances of dementia in court rulings: mapping the terrain.

BACKGROUND: Individuals with dementia may appear before the court in different roles: as victims, as witnesses, and as those standing up for their rights. While there is growing interest in the rights of older persons with dementia, relatively little empirical data exists regarding their actual interactions in courts. Therefore, the goal of this study was to empirically map this legal terrain. METHODS: This study used a descriptive quantitative method. A computerized search of a national legal database limited to the period 2004-2014 and a screening process for the results were used to establish a sample of 280 court rulings that directly addressed dementia. All cases were analyzed and categorized into the following four criteria groups: characteristics of the person with dementia; characteristics of the legal procedure; the legal substance of the case; and the legal outcome. RESULTS: The majority of cases involved a single, very-elderly (i.e. over 80 years) woman, living in the community, with unspecified dementia. The majority of cases were heard and decided in lower level courts, addressing a broad range of primarily non-criminal legal issues. Finally, in the majority of non-criminal cases, the person with dementia was found to be legally capable, whereas in the majority of criminal cases, the person with dementia was found incapable. CONCLUSIONS: The legal needs and rights of persons with dementia are much broader than issues of legal capacity or social protection. Deeper knowledge and more research is needed in order to fully understand the contexts in which dementia is constructed under the law.

[A new stage of development of gerontology and geriatrics in Russia: problems of creation of a geriatric care system. Part 1. Relevance, regulatory infrastructure].

This article is a 1st part of the analytical review, focused on a new step in development of geriatrics in Russia. Creation of state system geriatric care as important part of state politics in the area of enhancement of quality of life was proved. General aspects of improvement of social support of disable elderly persons in condition of restricted budget and interagency separation was presented. Establishment of unified system of medical social support and gerotechnologies for the elderly was substantiated, as a mechanism facilitated life activity and decreasing of demographic loading on economic status of regions of Russian Federation. Legislative and normative regulations of gerontology and geriatric development were observed as well. Accepted legislative and normative acts were analyzed for period since 1977 to 2014. The necessity of approaches to regulation modernization for elderly was demonstrated. Analytical review on number of legislative state documents issued after meeting of Presidium of State Council of the Russian Federation being in August 2014 was also presented. Applicability of these documents for realization new strategy of gerontology and geriatrics development in Russia was proved.

[10-year anniversary of the Long-term Care Charter : Time to take stock]. / 10 Jahre Pflege-Charta : Zeit, Bilanz zu ziehen.

Ten years ago, the Charter for People in Need of Long-term Care was published in Germany. The Charter contains a series of basic rights for people in need of long-term care. At the initiative of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ), this was developed in a complex consensus process together with the Federal Ministry of Health (BMG) and representatives from all areas of care. Since then, the Charter has gained practical relevance in various areas of care and has entered into legislation. The article looks at the dissemination and impact of the Charter following a review of the social and legal environment. Further implementation requirements and the revision of the charter are discussed.

[What is the situation with human rights of the elderly? : UN Open-ended Working Group on Ageing - review and prospects]. / Wie steht es um die Menschenrechte Älterer? : UN Open-ended Working Group on Ageing ­ Rück- und Ausblick.

In November 2010 the United Nations General Assembly set up a working group to strengthen the protection of human rights for older persons (UN Open-ended Working Group on Ageing) with the United Nations Resolution A/C.3/65/L.8/Rev.1. In December 2016 the members of the working group met for the seventh time and discussed how they can approach the fulfillment of the mandate. In addition to better implementation, the strengthening of rights can consist of closing existing gaps or further differentiation of the rights in order to give the member states better guidance on how to implement them. To improve the human rights of older persons a task of the members of the working group would be to examine the existing rights and, where possible, adjust them to the real needs of the group. One of the major challenges facing the working group is already apparent: who belongs to the group of older persons and how could the group be described? This article deals with the presentation of the international process, new developments at the regional level and the attitudes of the member states and the civil society. A further aim is to present the possibilities and effects of a comprehensive legally binding instrument.

[Law and the phase of life old age]. / Das Recht und die Lebensphase Alter.

In spite of the greatly increased role, which the law attributes to the design of individual life styles and living of elderly people, there is no special legal area known in the German legal system, such as "rights of the elderly", which is the case in the field of the youth law. Special legal regulations covering the concerns/issues of elderly people were always considered to be in danger, as they may have the potential to discrimination, either in a positive or negative way. Due to this fact, the rights of the elderly can be described as synthetic and are subject to constant changes, as can be observed within the pension act. The legal areas and legal regulations, which are of particular importance for the life style and living situations of elderly people are presented. The legal need for action regarding the special protection of vulnerable elderly people is discussed and in the further course utilized for a conception of "rights of the elderly".

[Current legal and jurisdictional questions from the perspective of the German Federal Association for Geriatrics : Practical report]. / Aktuelle rechtliche und rechtspolitische Fragestellungen aus Sicht des Bundesverbands Geriatrie : Praxisbericht.

The article discusses the questions of the arbitration bodies according to § 111b SGB V (Volume V of the Social Insurance Code) in the individual federal states from the perspective of geriatric rehabilitation hospitals. The content of the agreement of reimbursement between a rehabilitation hospital and health insurance will be targeted as well as the question whether the entire content of the agreements of reimbursement can be negotiated at the arbitration body. In addition, the authors describe the consequences of the jurisprudence of the Federal Social Court on § 301 I. S. 1 no. 8 SGB V and the reaction of the lawgiver. Furthermore the authors describe the effects of the jurisprudence of the Federal Social Court regarding the minimum age associated with complex geriatric treatment (OPS 8-550).

Responding to the 2015 CMS Proposed Rule Changes for LTC Facilities: A Call to Redouble Efforts to Prepare Students and Practitioners for Nursing Homes.

In July of 2015, the Federal Register published for public comment proposed rule changes for nursing homes certified to receive Medicare and/or Medicaid. If the final rules are similar to the proposed rules, they will represent the largest change in federal rules governing nursing homes since the Nursing Home Reform Act which was part of OBRA 1987. The proposed changes have the potential to enhance the quality of care and quality of life of nursing home residents. Many of the proposed changes would directly affect the practice of social work and would likely expand the role for nursing home social workers. This article discusses the role that members of the National Nursing Home Social Work Network (NNHSW Network) played in developing and submitting a response to CMS. The article provides the context for the publication of the proposed rules, describes the process used by the NNHSW Network to develop and build support for comments on these rules, and also includes the actual comments submitted to CMS. Social work education programs and continuing education programs throughout the country will continue to have an important role to play in helping to prepare social work students and practitioners for a career in long-term care.

Crossing boundaries: the design of an interdisciplinary training program to improve care for the frail elderly.

The Technology Evaluation in the Elderly Network (TVN) was funded in July 2012 under the Canadian Networks of Centres of Excellence program. This article highlights the development and preliminary evaluation of the TVN Interdisciplinary Training Program. This program is based on an experiential learning approach that crosses a multitude of disciplines including health sciences, law, social sciences, and ethical aspects of working with the frail elderly. Opportunities within the program include mentorship, interdisciplinary online collaborative projects, external placements, academic products, pre-grant submission, trainee-driven requirements, Network meetings, online modules/webinars, and most importantly active involvement with patients, families, and their support systems. The authors have 120 trainees from approximately 23 different disciplines including law, ethics, public policy, social work, and engineering engaged in the program. Based on our evaluation this program has been perceived as highly valuable by the participants and the community.

Ethical and legal aspects of anaesthesia for the elderly.

The elderly have the ethical and legal equivalence of younger adults, yet are treated differently by society. Numerous recent reports have exposed poor inpatient care resulting in part from institutional ageism, which has moral and legal implications for healthcare providers. Morally, there is an argument for positive 'exceptionalism' in elderly peri-operative care, pursuing quality improvement through use of a dignity agenda. Legally, numerous changes in human rights, equality, consent, capacity, and end-of-life laws and professional guidance have consistently re-emphasised the need for greater communication between doctors, patients, their relatives and carers. This review describes current ethical thinking and legal precedent (in England and Wales), and directs readers to consider areas in which the law might change in the near future, particularly with regard to the end-of-life care of elderly surgical patients.

[Indicators of patient care in Psychiatric and Psychosomatic Facilities (VIPP project)--a database project]. / Versorgungsindikatoren in der Psychiatrie und Psychosomatik (VIPP)--Ein Datenbank-Projekt.

INTRODUCTION: In Germany a new and unique remuneration system for psychiatric and psychosomatic stationary treatments (PEPP system) was introduced in 2013 on an optional basis. From 2015 it will be mandatory for psychiatric and psychosomatic facilities. The introduction of the PEPP system brings up different questions regarding the possible incentives of the new remuneration system and its effects on the supply of psychiatric and psychosomatic treatments. To conduct these necessary analyses a reliable database is needed. MATERIAL AND METHODS: The goal of the project "Indicators of patient care in Psychiatric and Psychosomatic Facilities" (VIPP project) is to gather a representative database which reflects the situation of day-to-day patient care performed by German psychiatric and psychosomatic facilities. The §â€Š21 data set represents the basis of this database which will be complemented by other data sources (i. e., financial statements and other economic data). A number of more than 100 ,000 cases per year has already been exceeded. These case data were provided by a wide range of psychiatric hospitals, departments and universities that participate in this project. The dataset is anonymised and by pooling the data it is not possible to identify the cases of a specific clinic. Participants receive a web-based access and have the possibility to analyse the data independently. RESULTS: Using the examples of coding accuracy and rehospitalisation rates the variety as well as the enormous potential of this database can be demonstrated. DISCUSSION: On the base of the VIPP database valid patient care indicators can be identified and cross-sectional analyses can be conducted. From such results key data on health economic strategies can be derived and the incentives, strengths and limitations of this constantly changing system can be identified.

European courts and old people.

There are two major European Courts, the European Court of Justice (ECJ) and the European Court of Human Rights (ECHR). The ECJ deals with legal matters, mainly involving the interpretation of EU law and ensuring that the law is applied evenly across all 27 EU member states. The ECHR aims to make certain that civil and political rights of citizens in the 46 member states of the Council of Europe are observed. Most cases involving older citizens are about social policy (such as pension arrangements, equality, age discrimination and mandatory retirement). There have been few cases dealing with patients' rights, long-term care or housing. Referrals of selected cases involving old people should be considered if their rights are not being protected. In this Commentary, there is an account of how these Courts have evolved, together with guidance on whom to refer, to which Court, and when and how referrals should be made.

Older Europeans and the European Court of Justice.

BACKGROUND: the European Court of Justice (ECJ) is considered by many to be the most important judicial institution of the European Union today. Despite the potential importance and relevance of the ECJ rulings to the lives and rights of older Europeans, no research has attempted to analyse or to study the ECJ rulings in this field. OBJECTIVE: to describe the ECJ case-law in the field of elder rights. METHODS: using a computerised search of the ECJ database, between the years 1994 and 2010, 123 cases directly dealing with legal rights of older persons were analysed. RESULTS: on average, only 1-2% of the annual ECJ case-load addresses rights of older persons. Unlike the clear trend in the increase of the total ECJ case load, there was no similar trend of increase in the number of cases directly involving older persons' rights. However, in the majority of the elder-rights cases, the ECJ decision was in support of the older person's rights. CONCLUSIONS: the ECJ can potentially serve as an important protector of rights of older Europeans, if and to the extent that these cases reach its jurisdiction.