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2.
Z Gerontol Geriatr ; 2019 Jul 12.
Artigo em Alemão | MEDLINE | ID: mdl-31300832

RESUMO

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.

4.
BMC Geriatr ; 19(1): 126, 2019 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046693

RESUMO

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.


Assuntos
Doença Crônica/psicologia , Doença Crônica/terapia , Serviços de Assistência Domiciliar/tendências , Hospitalização/tendências , Transferência de Pacientes/tendências , Voluntários/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Multimorbidade , Transferência de Pacientes/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento , Voluntários/educação
5.
BMC Geriatr ; 19(1): 64, 2019 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832609

RESUMO

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.


Assuntos
Doença Crônica/terapia , Pesquisa Comparativa da Efetividade , Comunicação Interdisciplinar , Colaboração Intersetorial , Medicina de Precisão , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Redes Comunitárias , Análise Custo-Benefício , Avaliação da Deficiência , Feminino , Alemanha , Hospitalização , Humanos , Masculino , Multimorbidade , Fatores de Tempo
8.
Z Gerontol Geriatr ; 50(5): 434-438, 2017 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-28593354

RESUMO

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.


Assuntos
Geriatria/educação , Geriatria/história , Aprendizagem , Serviço Social/educação , Idoso , Idoso de 80 Anos ou mais , Assistência à Saúde , História do Século XX , História do Século XXI , Humanos
11.
Dtsch Arztebl Int ; 113(41): 681-687, 2016 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-27839534

RESUMO

BACKGROUND: Family members caring for persons with dementia are subject to multiple types of stress. Psychosocial help is recommended to lighten the emotional burden of care and can be of use in stabilizing the home-care situation. In this study conducted in rural areas in Germany, we tested whether volunteers with a special qualification for the assistance of families caring for dementia patients can support family members more effectively than conventional care companions. METHODS: In a randomized, controlled trial, 63 family members caring for persons with dementia were aided by specially qualified family companions (experimental intervention) or by conventional care companions (control intervention). The family members' quality of life was the primary endpoint and was evaluated at the end of the study in an intention-to-treat (ITT) analysis with t-tests. In an additional per-protocol (PP) analysis, differences that arose between groups at the outset of the study were accounted for. Secondary endpoints included reduced stress and better integration into the support system. RESULTS: The ITT analysis revealed no differences between groups in healthrelated quality of life on either the emotional or the somatic scale. The PP analysis, however, showed that the experimental intervention improved the emotional health-related quality of life of the patients' family members compared to the control group. The effect strength was intermediate (d = 0.57; p = 0.047). CONCLUSION: The difference between the findings of the PP and ITT analyses may be explained in part by the different distribution of severity of dementia in the two groups (experimental and control).


Assuntos
Cuidadores , Demência/enfermagem , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Família , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social
13.
Z Gerontol Geriatr ; 49(3): 201-8, 2016 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-26926149

RESUMO

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.


Assuntos
Cuidadores/psicologia , Demência/enfermagem , Demência/psicologia , Qualidade de Vida/psicologia , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha , Serviços de Assistência Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social
14.
Z Gerontol Geriatr ; 48(8): 747-8; quiz 759-60, 2015 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-26496913

RESUMO

Social gerontology is seen as a science-based but application-oriented subdiscipline of gerontology. It focuses particularly on social relationships in old age, social participation of elderly and old people and the protection of their individual needs. Self-determination and autonomy are important value orientations. Central issues are the quality of life and life satisfaction from the perspective of personal resources and biographical influences and the conditions of individual aging in the sense of differential gerontology. Against this background, in the first part of this article Kirsten Aner discusses the social construction of aging and in part two Ines Himmelsbach describes the typical life events and developmental tasks in the process of aging. The article concludes with a theoretical basis in which Cornelia Kricheldorff outlines social aging theories and derives a brief description of approaches and interventions.


Assuntos
Envelhecimento/psicologia , Geriatria/organização & administração , Qualidade de Vida/psicologia , Comportamento Social , Medicina Social/organização & administração , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Feminino , Geriatria/métodos , Humanos , Masculino , Pessoa de Meia-Idade
15.
Z Gerontol Geriatr ; 48(5): 408-14, 2015 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-26115743

RESUMO

BACKGROUND: This article reports on two projects both concerned with how to initiate and support independent and satisfying aging in community settings and how to promote social participation in neighborhood solidarity in the future. The community plays an important role in this context, supporting independent living, social connectedness and individual well-being in old age. AIM: Against the background of demographic and social changes and the related social challenges, the pilot projects focused on the problems of how the process of aging, which from an individual perspective can be seen as a life period with declining mobility and reduced options for action, can be influenced in a positive way. MATERIAL AND METHODS: The article describes the key experiences in the context of the two pilot projects entitled "VEGA-locally responsible communities and individual well-being in old age" and "Care mix in locally responsible communities". It focuses on the process results and identifies potential barriers to the implementation of the projects. In addition, this article also emphasizes the opportunities and advantages of social networking in local communities. RESULTS AND CONCLUSION: Based on the action research approach, neighborhood-specific results and need-based concepts have been developed, which have led to various subproject pathways for implementation. Among other results it was important that social networking and supportive neighborhood structures could be established, which are important conditions for sustainable anchoring in the residential quarter. Another important result was the fact that the communities as well as the different generations in the residential quarter were sensitized and activated for the topic "aging and well-being with social connectedness in local communities".


Assuntos
Envelhecimento/psicologia , Características de Residência , Meio Social , Participação Social/psicologia , Apoio Social , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/organização & administração , Feminino , Alemanha , Promoção da Saúde , Humanos , Relações Interpessoais , Masculino , Modelos Organizacionais , Projetos Piloto , Identificação Social
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