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Versorgungsleistungen in der Pflege
Abstract
Derzeit leben in Deutschland rund 3 Mio. Pflegebedürftige, deren Zahl durch eine steigende Zahl Hochaltriger mit höherer Pflegewahrscheinlichkeit bis 2050 voraussichtlich auf rund 5 Mio. steigen wird. Dieser Beitrag gibt einen Überblick über wesentliche Kennzahlen der Pflegestatistik und zeigt mit der Pflege assoziierte demografische Entwicklungen auf. Neben dem Begriff der Pflegebedürftigkeit und dem Neuen Begutachtungsassessment werden Pflegeleistungen der stationären und häuslichen Pflege nach SGB XI im Überblick dargestellt. Besonders berücksichtigt werden dabei Leistungen, die Pflegebedürftigen ein selbstbestimmtes Leben im heimischen Umfeld ermöglichen, relevante Aspekte altersgerechter Wohnumgebungen sowie die soziale Sicherung von Pflegepersonen. Darüber hinaus werden Defizite im Bereich der Health Literacy in der Pflege beleuchtet und abschließend das Thema Demenz als häufigster Grund für eine eingeschränkte Alltagskompetenz aufgegriffen.
... Elke Peters et al. have estimated in [2] the number of people living in Germany requesting nursing care to 3 million and to 5 million by 2050. The authors present a recent assessment of the nursing care services at nursing homes and at patient'shome and point out the needs for patients to live at home despite the benefit of all care services. ...
Hospitals and Nursing care Homes are facing severe challenges such as lack of skilled-workforces, cost explosion, among others. Especially, the western healthcare systems are headed over a cliff.
German Nursing care houses, Hospitals, and politics are being worked hard on solutions to overcome the crucial workforce’s crises. Therefore, they are planning to hire nursing-workforces from abroad. They would also like to motivate families with monetary incentives, such tax-reduction if they can care for their elderly and/or dementia family members at home. However, caring for a sick person at home is challenging for a working family member especially in the case the patient requests around the clock nursing care since elderly with cognitive impairments, people with physical disabilities, and people with dementia need (medical) assistance round the clock.
The present study reveals an increasing tendency for family members to care for their sick family member at home despite the challenges and issues faced like the lack of time to intensively care for the sick person due to the today family lifestyle, challenging employment market, financial constraints, etc.
The study reported in this chapter aims at providing family members willing to care for their sick member at home as long as possible with smart home automation enabled Patient@Home solution to effectively and efficiently care for their sick member despite working full time. People living in nursing care homes can also take benefit of the proposed system.
Evidence shows the potential of the proposed system to effectively and efficiently assist in caring for people requesting nursing care round the clock. Though the health-related quality of Live is positively impacted. Patient’s satisfaction is increased (better quality of Experience).
Keywords:
Remote care, Dementia, Parkison, Elderly patient, Internet of Things, Smart, Home Automation, Age-related impairments, Cognitive impairments, Health-related quality of life, Patient’s satisfaction and quality of Experience
Background:
Numerous epidemiological studies among health care staff have documented associations of adverse psychosocial working conditions with poorer health-related outcomes, a reduced quality of patient care and intentions to leave the profession. The evidence for physician assistants in Germany remains limited though.
Methods:
We surveyed a total of 994 physician assistants between September 2016 and April 2017. Psychosocial working conditions were measured by the established effort-reward imbalance (ERI) questionnaire and by a questionnaire specifically developed to capture psychosocial working conditions among physicians. Health outcomes (i.e., self-rated health, depression, anxiety), self-rated quality of care and the intention to leave the profession were assessed by established measures. We ran multivariable logistic regression analyses.
Results:
The prevalence of work stress in terms of ERI equalled 73.77%. Work stress according to the ERI model was associated with significantly poorer self-rated health [odds ratio (OR) 3.62], elevated symptoms of depression (OR 8.83) and anxiety (OR 4.95), poorer quality of care (OR for medical errors 4.04; OR for interference of work with patient care 3.88) and an increased intention to leave one's current profession (OR 3.74). The PA-specific questionnaire showed similar, albeit weaker, associations (all ORs > 1.22).
Conclusions:
Our results are in line with previous findings among health care staff and provide specific and novel evidence for physician assistants. Interventions aiming at the improvement of working conditions seem needed given their potential adverse consequences in terms of employee health, quality of care, and personnel policy.
Unter Gesundheitskompetenz wird das Wissen, die Motivation und die Fähigkeit verstanden,
gesundheitsrelevante Informationen ausfindig zu machen, zu verstehen, zu beurteilen
und zu nutzen, um die Gesundheit erhalten, sich bei Krankheiten die nötige Unterstützung
durch das Gesundheitssystem sichern oder sich kooperativ an der Behandlung
und Versorgung beteiligen und die dazu nötigen Entscheidung treffen zu können.
International wird diese basale Kompetenz als ‚Health Literacy’ bezeichnet (u.a. Sørensen
et al. 2012) und ist seit langem Gegenstand der Forschung. In Deutschland wird der
Begriff mit Gesundheitskompetenz übersetzt.
Bislang ist das empirische Wissen über die Gesundheitskompetenz der Bevölkerung in
Deutschland recht gering. Das zeigt sich unter anderem daran, dass die Zahl an Studien
zur Gesundheitskompetenz noch übersichtlich ist. Auch an der ersten Europäischen Studie,
dem European Health Literacy Survey (HLS-EU), hat Deutschland nur mit einem
Bundesland (NRW) teilgenommen. Mit der hier vorgestellten Studie (HLS-GER) werden
erste repräsentative Daten zur Gesundheitskompetenz der Bevölkerung in Deutschland
vorgelegt. Damit wird zugleich die in der Europäischen Studie (HLS-EU Consortium
2012) für Deutschland bestehende Datenlücke geschlossen. Außerdem wird mit ihr eine
Grundlage für die Entwicklung von empirisch fundierten Interventionen zur Förderung
der Gesundheitskompetenz geschaffen.
Erhoben wurde die Gesundheitskompetenz in dieser Studie mit einem international vielfach
erprobten Fragebogen, dem HLS-EU-Q47, mit dem 2.000 Menschen persönlich
befragt wurden.
Die Ergebnisse der Studie zeigen: 54,3 Prozent der Deutschen verfügen über eine eingeschränkte
Gesundheitskompetenz. Mehr als die Hälfte der Deutschen sieht sich somit
vor erhebliche Schwierigkeiten gestellt, wenn es darum geht, mit gesundheitsrelevanten
Informationen umzugehen, um gesundheitliche Belastungen und Krankheiten zu bewältigen,
sich im Alltag stellende Herausforderungen der Gesundheitserhaltung anzugehen
und dazu erforderliche Entscheidungen zu treffen. Über eine eingeschränkte Gesundheitskompetenz
zu verfügen bedeutet außerdem, größere Orientierungsschwierigkeiten
im Gesundheitssystem zu haben, häufiger nicht zu wissen, an wen man sich bei gesundheitlichen
Problemen wenden soll, häufiger in das Krankenhaus eingewiesen zu werden,
öfter den ärztlichen Notfalldienst in Anspruch zu nehmen und häufiger vor Kommunikationsschwierigkeiten
mit den Gesundheitsprofessionen gestellt zu sein. Zudem verfügen
Menschen mit geringer Gesundheitskompetenz nach ihrer eigenen Einschätzung häufiger
über einen schlechten Gesundheitszustand.
Die Studie macht auf soziale Ungleichheiten zwischen Bevölkerungsgruppen aufmerksam.
Vor allem Menschen mit Migrationshintergrund (71 %), mit geringem Bildungsniveau
(62 %), mit niedrigem Sozialstatus (78%), mit chronischer Krankheit (73 %) und in
höherem Alter (66 %) weisen eine vergleichsweise eingeschränkte Gesundheitskompetenz
auf.
Die Ergebnisse unterstreichen, wie wichtig die Förderung der Gesundheitskompetenz
der Bevölkerung in Deutschland ist und dazu eine gesamtgesellschaftliche Strategie gefordert
ist. Zugleich bilden sie eine Grundlage dafür, passgenaue und auf einzelne Bevölkerungsgruppen
zugeschnittene Interventionsmaßnahmen entwickeln zu können,
denn sie lieferen wichtige Erkenntnisse über die Informations- und Kompetenzvoraussetzungen
der Bevölkerung. Aus ihnen lassen sich wichtige Hinweise darüber ableiten,
welche Interventionsmaßnahmen besonders aussichtsreich sein dürften. Dass Interventionen
auf die Verbesserung der persönlichen Gesundheitskompetenz zielen sollten,
steht außer Frage – doch ebenso, dass dies allein nicht ausreichend ist. Vielmehr ist
erforderlich, auch das Gesundheitssystem viel stärker als bisher auf die Stärkung von
Gesundheitskompetenz auszurichten und es informations- und nutzerfreundlicher zu gestalten.
Auf der Basis der Studienergebnisse wurde als ein erster Schritt bereits eine
Material- und Methodensammlung erarbeitet, die Patienten- und Verbraucherberater,
aber auch die Gesundheitsprofessionen nutzen können, um zu einem besseren und fördernden
Umgang mit Menschen mit niedriger Gesundheitskompetenz zu gelangen
(Schmidt-Kaehler et al. 2017).
Objectives
Detection of dementia is essential for improving the lives of patients but the extent of underdetection worldwide and its causes are not known. This study aimed to quantify the prevalence of undetected dementia and to examine its correlates.
Methods/setting/participants
A systematic search was conducted until October 2016 for studies reporting the proportion of undetected dementia and/or its determinants in either the community or in residential care settings worldwide. Random-effects models calculated the pooled rate of undetected dementia and subgroup analyses were conducted to identify determinants of the variation.
Primary and secondary outcome measures
The outcome measures of interest were the prevalence and determinants of undetected dementia.
Results
23 studies were eligible for inclusion in this review. The pooled rate of undetected dementia was 61.7% (95% CI 55.0% to 68.0%). The rate of underdetection was higher in China and India (vs Europe and North America), in the community setting (vs residential/nursing care), age of <70 years, male gender and diagnosis by general practitioner. However, it was lower in the studies using Mini-Mental State Examination (MMSE) diagnosis criteria.
Conclusions
The prevalence of undetected dementia is high globally. Wide variations in detecting dementia need to be urgently examined, particularly in populations with low socioeconomic status. Efforts are required to reduce diagnostic inequality and to improve early diagnosis in the community.
Background
Health literacy is of increasing importance in public health research. It is a necessary pre-condition for the involvement in decisions about health and health care and related to health outcomes. Knowledge about limited health literacy in different age groups is crucial to better target public health interventions for subgroups of the population. However, little is known about health literacy in Germany. The study therefore assesses the prevalence of limited health literacy and associated factors among different age groups.
Methods
The Health Literacy Survey Germany is a cross-sectional study with 2,000 participants aged 15 years or older in private households. Perceived health literacy was assessed via computer-assisted personal interviews using the HLS-EU-Q-47 questionnaire. Descriptive analyses, chi-square tests and odds ratios were performed stratified for different age groups.
Results
The population affected by limited perceived health literacy increases by age. Of the respondents aged 15–29 years, 47.3 % had limited perceived health literacy and 47.2 % of those aged 30–45 years, whereas 55.2 % of the respondents aged 46–64 years and 66.4 % aged 65 years and older showed limited perceived health literacy. In all age groups, limited perceived health literacy was associated with limited functional health literacy, low social status, and a high frequency of doctor visits.
Conclusions
The results suggest a need to further investigate perceived health literacy in all phases of the life-course. Particular attention should be devoted to persons with lower social status, limited functional health literacy and/or a high number of doctor visits in all age groups.
Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations.
The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews.
The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model.
Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.
© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association.
The decision to institutionalize a patient with dementia is complex and is based on patient and caregiver characteristics and the sociocultural context of patients and caregivers. Most studies have determined predictors of nursing home placement primarily according to patient or caregiver characteristics alone.
To develop and validate a prognostic model to determine the comprehensive predictors of placement among an ethnically diverse population of patients with dementia.
The Medicare Alzheimer's Disease Demonstration and Evaluation study, a prospective study at 8 sites in the United States, with enrollment between December 1989 and December 1994 of 5788 community-living persons with advanced dementia.
Time to nursing home placement throughout a 36-month follow-up period, assessed by interview and review of Medicare records, and its association with patient and caregiver characteristics, obtained by interview at enrollment.
Patients were divided into a development (n = 3859) and validation (n = 1929) cohort. In the development cohort, the Kaplan-Meier estimates of nursing home placement throughout 1, 2, and 3 years were 22%, 40%, and 52%, respectively. After multivariate adjustment, patient characteristics that were associated with nursing home placement were as follows: black ethnicity (hazard ratio, 0.60; 95% confidence interval [CI], 0.48-0.74), Hispanic ethnicity (HR, 0.40; 95% CI, 0.28-0.56) (both ethnicities were inversely associated with placement), living alone (HR, 1.74; 95% CI, 1.49-2.02), 1 or more dependencies in activities of daily living (HR, 1.38; 95% CI, 1.20-1.60), high cognitive impairment (for Mini-Mental Status Examination score < or =20: HR, 1.52; 95% CI, 1.33-1.73), and 1 or more difficult behaviors (HR, 1.30; 95% CI, 1.11-1.52). Caregiver characteristics associated with patient placement were age 65 to 74 years (HR, 1.17; 95% CI, 1.01-1.37), age 75 years or older (HR, 1.55; 95% CI, 1.31-1.84), and high Zarit Burden Scale score (for highest quartile: HR, 1.73; 95% CI, 1.49-2.00). Patients were assigned to quartiles of risk based on this model. In the development cohort, patients in the first, second, third, and fourth quartile had a 25%, 42%, 64%, and 91% rate of nursing home placement at 3 years, respectively. In the validation cohort, the respective rates were 21%, 50%, 64%, and 89%. The C statistic for 3-year nursing home placement was 0.66 in the development cohort and 0.63 in the validation cohort.
Patient and caregiver characteristics are both important determinants of long-term care placement for patients with dementia. Interventions directed at delaying placement, such as reduction of caregiver burden or difficult patient behaviors, need to take into account the patient and caregiver as a unit.
Health-care services need to maximise the potential of technology to enhance patient care. The improved digital literacy of the workforce is vital in this. Technology enhanced learning, applied to all aspects of education and training, including the development of digital capabilities in all learners, can offer greater flexibility, accessibility, collaboration, innovation and more effective communication and participation. The health and social care workforce need both the digital skills and confidence across a range of domains. Increasingly, citizens are digitally enabled and empowered; raising expectations of capability and innovation, relating to their health and wellbeing aspirations. Working with a national definition and digital capabilities framework, staff working in health and social care can begin to think about how they might want to improve their own digital literacy. In addition, organisations require the leadership, strategy and culture to support the acquisition of digital capabilities in their staff, as well as more general technology enhanced learning. Rewarding and valuing staff, and working in partnership with them in their learning, organisations need to be working to build a digitally ready workforce.
Die Aufteilung der Lebenserwartung in Jahre außerhalb von Pflege und in die Pflegdauer bedeutet für den Altersbereich über 60 Jahre in Deutschland im Jahr 2013 eine durchschnittliche Pflegdauer von 3,5 Jahren bei Frauen und 2,1 bei Männern. Die dazugehörige Zeitspanne von Lebenszeit ohne Pflege (Long-Term Care-Free Life-Expectancy (LTCF) beträgt bei Frauen 25,0 und bei Männern 21,4 Jahre. Die Zunahme der Lebenserwartung der letzten Jahrzehnte resultiert vor allem aus der pflegefreien Zeit. Mit hoher Wahrscheinlichkeit werden fast alle Personen, welche ein sehr hohes Alter erreichen, auch pflegebedürftig. Die persönlichen Erfahrungen verbunden mit hohem Alter sind oft nur über das Erleben der eigenen Großeltern gegeben. Dieses Bild von Alter ist unvollständig, weil das eigene erreichbare Alter zwei Generationen später etwa 15 Jahre höher sein wird. Pflege wird in Zukunft öfter auftreten und mehr Personen der Bevölkerung betreffen, weil viele Personen ein höheres Alter erreichen.
Aging in a neighborhood environment is considered to be important for well-being particularly in very old age.
The project "This is my place" - On the importance of a place in the neighborhood for healthy aging (German acronym BEWOHNT) emphasises the role of out of home activities, neighborhood experiences and urban-related identity on well-being. The aim of this paper is to test the impact of person-environment exchange processes of "agency" (e.g., out-of-home activity) and "belonging" (e.g., urban related identity, social cohesion) on well-being (valuation of life) in addition to health effects MATERIAL AND METHODS: Data are based on domestic diaries, mobility diaries and a survey including 595 community-dwelling elderly people from 3 urban districts of Frankfurt (Germany) stratified by age (70-79 years vs. 80-89 years) and household situation (e.g. living alone versus living with partner).
The findings indicate substantial associations for "agency" and "belonging" indicators on well-being and differentiated effects for both age groups. Multigroup analyses show that particularly in very old age, out of home activities, social cohesion and urban-related identity considerably buffer the negative impacts of health on well-being.
The findings underline the need for an age-differentiated understanding of person-environment interchange processes in later life and in particular the importance of the neighborhood in very old age in this respect.
Recent studies have been cautiously optimistic about declining trends in dementia prevalence and incidence. Newly available claims data from a German public health insurance company covering 30% of the total population permitted us to explore short-term trends based on millions of observations up to the highest ages. Diagnoses stemmed from the inpatient and outpatient services and covered both the community-dwelling population and those living in nursing homes. Data spanning more than 3 years were examined, and the examination revealed a significant yearly reduction between 1% and 2% in the prevalence of dementia among women aged 75 to 84 years. The extent of the reduction was comparable with reports from earlier studies. A similar tendency existed among men, however, statistically not significant. Trends in medical, lifestyle, and societal risk factors of dementia may have contributed to this decline.
Described in the early 1980s as "The Silent Epidemic," dementia in the elderly will soon become a clarion call for public health experts worldwide. The epidemic is largely explained by the prevalence of dementia in persons 80 years of age or older. In most countries around the world, especially wealthy ones, this "old old" population will continue to grow, and since it accounts for the largest proportion of dementia cases, the dementia epidemic will grow worldwide. The combined effects of longer lives and the dramatic bulge of baby boomers reaching old age will magnify the epidemic in future decades. Although . . .
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