Facts about elderly people with mental disorders in - Kon-tact
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Transcript Facts about elderly people with mental disorders in - Kon-tact
Eine unmögliche Herausforderung?!
Die Pflege von älteren Menschen mit
psychischen Krankheiten aus deutscher Sicht.
An impossible challenge?! Care for
elderly people with mental disorders
– the German point of view
Prof. Dr. Erika Feldhaus-Plumin
Evangelische Hochschule Berlin
Overview
Definitions and Disambiguations
Facts
– Epidemiology
– Tools
– Health Care Settings
– Qualification
– Political Dimension
Phenomens around mental disorders
– Stigma
– Violence
Conclusion
Literature
Definitions and Disambiguations
A mental disorder or mental illness is a
psychological pattern, potentially reflected in
behavior, that is generally associated with
distress or disability,...
Mental disorders are generally defined by a
combination of how a person feels, acts,
thinks or perceives.
Gesundheitsberichterstattung des Bundes 2009:Gesundheit und
Krankheit im Alter S. 32
Definitions and Disambiguations
The biological age
The social age
The subjective apperception
Gesundheitsberichterstattung des Bundes 2009:Gesundheit und
Krankheit im Alter S. 32
Facts about elderly people
In 2050 about 30% of the European
population will be aged ≥ 65.
The old-old are the fastest growing
population group in Europe.
The United States Department of Health and Human Services
2012: Mental Health - A Report of the Surgeon General. p 39
Facts about mental disorders
8 million germans with mental disorders, nearly 10 % of the
population.
Statistisches Bundesamt 2009: Gesundheit auf einen Blick, S.12-13
Mental disorders are the fourth-frequent reason for inability to
work.
Fink, W., Haidinger, G. 2007: Die Häufigkeit von
Gesundheitsstörungen in 10 Jahren Allgemeinpraxis. Z.
Allg. Med. 83/200, S.102–108.
The disease pattern depression is the most frequent disease of
the mental disorders in Germany – between 16 and 20 % of all
people are in their life-span once a time depressive.
Immer mehr Depressive. Die tageszeitung, 7. Mai 2009
Facts about elderly people with
mental disorders in Germany
A quarter of the 65 year-aged and older people are living with a
mental disorder.
In nursing homes nearly 40 to 50 % of the patients are having
a depression. 2/3 are having a dementia.
Over 1/3 of all suicides are committed from people over 65
years old.
The rate of the addiction diseases in the cohort of the elderly
people rised up:
–
–
between 207 % (70 to 75 years)
and 230 % (80 to 84 years)
Gesundheitsberichterstattung des Bundes 2009: Gesundheit und Krankheit im Alter S. 32
Berliner Altersstudie (N = 514)
Gesundheitsberichterstattung des Bundes( 2009), Gesundheit und Krankheit im Alter S. 35
Research E. Feldhaus-Plumin 2012
Nursing home N = 160
70%
80%
70%
60%
50%
40%
30%
20%
10%
0%
40%
...
1%
Hu
n
or
ea
Ch
m
an
ic-
re
ni
ph
hiz
o
Sc
1%
de
p.
..
1%
a
rsa
ko
w
Ko
n
es
sio
De
pr
De
m
en
tia
13%
Tools für detection...
Family
Patient
Institutional standards
Doctor
Psychiatrist/Psychologist
Medication
...
Statistic about Psychiatric drugs in
the years 2000 to 2006 in Berlin
50
45
40
35
30
25
20
15
10
5
0
2000
2006
60-64
70-74
80-84
90 and
older
Health Care Settings
Out-Patient structures
In-Patient structures
Nursing homes
Various settings like living-groups etc.
Out-Patient structures
Nearly 70 % from patients at home
Support from
– community care system
– day care; night care
– Gerontological-psychiatrical ambulatories
In-Patient structures
Specialized clinics
–
f.e. gerontopsychiatrical departments or wards
hospital structures
especially for diagnosis and patients with
multimorbidity
Structures of Nursing Homes
Big change in the last 10 years
–
–
from hierarchial structures and big wards
to spezialised smaller wards, living groups, specialised areas
and various concepts
start into a new decade of nursing homes
BUT:
lack of nurses is contraproductive
Networking
System for caring with networking structures
Cross-link the different offerings for elderly
people
Best practise f.e. in Berlin, Hamburg,
Augsburg, Würzburg
“Aktionsbündnis Seelische Gesundheit” acting network for mental disorders
Psychotherapy for elderly people
Special psychotherapy for elderly people rare
in Germany
Psychotherapy qualificatiosn are starting to
focus the target group „elderly people“
in nursing homes no psychotherapy!
Concepts like validation, biographical work,
day-structuring and other therapeutical
concepts
Qualification for nurses
Pflegefachkraft für Psychiatrie (education
specialized for psychiatry)
Pflegefachkraft für Gerontopsychiatrie
(education specialized for psychiatry with the
target group elderly people)
Bachelor of Nursing
Political dimension
Reforms in the health care system
Integrated care system (Integrierte
Versorgung)
Casemanagement
Clinical Pathways
topics: Demographic change, dementia,
need of care
Phenomens around mental disorders
Stigma
Violence
Phenomen Stigma
„... stigma prevents people from acknowledging their
own mental health problems...“
Categories
– Individual discrimination
– Structural discrimination
– Discrimination due to self-stigmatisation
Especially the less social distance to people with
mental disorders can let us reach anti-stigma.
Phenomen Violence
Violence according to mental disorders
–
Just a few psychiatric disease patterns are reasons for a
higher rate of acting violent (Steiner 1995).
Violence from nurses against people with mental
disorders
–
–
–
–
–
area of conflict
The possible spiral of violence
selfreflecting
structural violence
different roles of a nurse
Conclusions
Why?
Phenomens Stigma and Violence
Goals
–
–
–
–
Professionalizing the nursing
Research
Political responsibility
Awareness rising
Literature
[1] Gesundheitsberichterstattung des Bundes 2009: Gesundheit und Krankheit im Alter S. 32
[2] The United States Department of Health and Human Services 2012: Mental Health - A Report of the Surgeon
General. Chapter 2: The Fundamentals of Mental Health and Mental Illness. pp 39 Retrieved May 21, 2012
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[7] Immer mehr Depressive. Die tageszeitung, 7. Mai 2009
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