H. van den Bussche

Medizin des Alterns und des alten Menschen

ZusammenfassungInhalte der Altersmedizin wurden bislang im Medizinstudium in Deutschland nur vereinzelt und fakultativ an Universitäten und Medizinischen Hochschulen angeboten. Die reformierte Approbationsordnung enthält als einen neuen Querschnittsbereich die „Medizin des Alterns und des alten Menschen“ obligatorisch im klinischen Studienabschnitt. Verbindliche Lerninhalte liegen für diesen Querschnittsbereich jedoch nicht vor. Dieser Bericht beschreibt deshalb ein neu entwickeltes Curriculum mit seinem Schwerpunkt auf Seminaren in kleinen Gruppen, die ersten Erfahrungen sowie die Ergebnisse der Evaluation des Unterrichts durch Studierende an der Universität Hamburg. Die Ergebnisse belegen eine hohe Akzeptanz von Inhalt und Form des Unterrichts, der von den befragten Studierenden als interessant und lehrreich eingeschätzt wurde.SummaryUntil very recently, medicine in old age was not an obligatory part of the medical students’ education in Germany. This has been changed by an educational reform. However, there are no obliging recommendations or procedures on which issues of medicine in old age should be taught. Therefore, we describe the development of a new curriculum, first experiences with the teaching, and the results of its evaluation by the students at the University of Hamburg. As a result, the subjects and the didactical teaching were both well accepted by the students and judged as interesting and instructive.

Das Verbundvorhaben „Komorbidität und Multimorbidität in der hausärztlichen Versorgung“ (MultiCare)

MultiCare is the acronym for a multidisciplinary and multicenter research network on multimorbidity and comorbidity in the primary care/family medicine setting, which is coordinated by the Institute of Primary Medical Care of the University Medical Center Hamburg-Eppendorf. Multimorbidity is one of the most difficult problems in primary medical care as little is known about the interaction of several diseases in a person with regard to etiology and disease progress. Also, guidelines for the treatment of multimorbid patients are largely lacking. Therefore, the aims of the MultiCare network include: the identification of multimorbidity patterns in the elderly primary care population, analysis of incidence and prevalence and of interactions within clusters, the investigation of severity and consequences for patients, as well as trials to improve physician-patient interaction in the case of multimorbidity. During the first funding period (2008-2010) the network consisted of two observational and two interventional studies. Their results as of summer 2011 are presented in the following article.

Fragen und Thesen zu medikamentösen Behandlungsoptionen der Alzheimer-Demenz mit Acetylcholinesterase-Hemmern

ZusammenfassungUntersucht werden die möglichen Gründe für die Diskrepanz zwischen der wissenschaftlichen Evidenz für den Einsatz von Acetylcholinesterase-Hemmern in der Behandlung der Alzheimer-Demenz und den Empfehlungen oder Leitlinien vieler wissenschaftlicher Fachgesellschaften. Ferner wird die These der Unterversorgung mit diesen Präparaten einer kritischen Betrachtung unterzogen.SummaryThe paper reviews the evidence for the recommendation of cholinesterase inhibitors and asks critical questions concerning the reasons for the discrepancy between the weak evidence and the recommendation of these drugs in therapy guidelines. Furthermore, the argument of the severe underuse of these drugs is examined.

Morbiditätsunterschiede bei Pflegebedürftigen in Abhängigkeit von Pflegesektor und Pflegestufe

BACKGROUND We analyzed the differences in morbidity patterns of chronic diseases between long-term care dependent persons in nursing homes compared to those dwelling in the community. We also investigated morbidity differences between long-term care need stages in Germany. MATERIALS AND METHODS The study included claims data of one nationwide operating statutory health insurance in 2006. Inclusion criteria were age ≥ 65 years, minimum 1 out of 46 diagnoses in at least 3 quarters of the year (n = 8,670). A comparison population was formed with n = 114,962. Prevalences, relative risks, and odds ratios for the risk of nursing home care were calculated. RESULTS In the bivariate analysis, only three chronic diseases - dementia, urinary incontinence, and chronic heart failure - showed a higher risk for nursing home care. Regression analysis revealed that only dementia showed higher odds related to the stage of nursing needs. CONCLUSION Among the chronic diseases, only dementia shows a substantially elevated risk for nursing home care. Risk studies on other chronic diseases associated with higher risks of long-term care dependency and specific intervention strategies aiming at delaying or preventing nursing home admission should be developed.

Die Epidemiologie von chronischen Krankheiten und Pflegebedürftigkeit

BACKGROUND It is generally assumed that chronic diseases and multimorbidity increase the risk of long-term care. Nevertheless, a systematic study on the nature and the prevalence of those diseases associated with long-term care has not been yet undertaken in Germany. MATERIALS AND METHODS The study was perfomed using claims data of one nationwide operating statutory health insurance company in 2006. Inclusion criteria were age ≥ 65 years, minimum of 1 out of 46 diagnoses in a minimum of three quarters of the year (n = 8,678). A comparison group was formed with n = 114,962. We calculated prevalences and relative risks -using nominal regression- to determine influential factors on long-term care. RESULTS A small number of diseases (e.g. dementia, urinary incontinence, chronic stroke and cardiac insufficiency) show high prevalences (> 20%) among long-term care users and at the same time great prevalence differences between users and non-users CONCLUSION These data are important for improving medical and nursing care of long-term care users. Further research is needed with regard to the question by which mechanisms those diseases produce disability and frailty, thus leading to long-term care requirements.

Morbiditätsunterschiede bei Pflegebedürftigen in Abhängigkeit von Pflegesektor und Pflegestufe@@@Morbidity differences according to nursing stage and nursing setting in long-term care patients: Eine Untersuchung auf der Basis von Abrechnungsdaten der Gesetzlichen Krankenversicherung@@@Results of a claims data based study

BACKGROUND We analyzed the differences in morbidity patterns of chronic diseases between long-term care dependent persons in nursing homes compared to those dwelling in the community. We also investigated morbidity differences between long-term care need stages in Germany. MATERIALS AND METHODS The study included claims data of one nationwide operating statutory health insurance in 2006. Inclusion criteria were age ≥ 65 years, minimum 1 out of 46 diagnoses in at least 3 quarters of the year (n = 8,670). A comparison population was formed with n = 114,962. Prevalences, relative risks, and odds ratios for the risk of nursing home care were calculated. RESULTS In the bivariate analysis, only three chronic diseases - dementia, urinary incontinence, and chronic heart failure - showed a higher risk for nursing home care. Regression analysis revealed that only dementia showed higher odds related to the stage of nursing needs. CONCLUSION Among the chronic diseases, only dementia shows a substantially elevated risk for nursing home care. Risk studies on other chronic diseases associated with higher risks of long-term care dependency and specific intervention strategies aiming at delaying or preventing nursing home admission should be developed.

Die Epidemiologie von chronischen Krankheiten und Pflegebedürftigkeit@@@The epidemiology of chronic diseases and long-term care: Eine Untersuchung auf der Basis von Abrechnungsdaten der gesetzlichen Krankenversicherung@@@Results of a claims data-based study

BACKGROUND It is generally assumed that chronic diseases and multimorbidity increase the risk of long-term care. Nevertheless, a systematic study on the nature and the prevalence of those diseases associated with long-term care has not been yet undertaken in Germany. MATERIALS AND METHODS The study was perfomed using claims data of one nationwide operating statutory health insurance company in 2006. Inclusion criteria were age ≥ 65 years, minimum of 1 out of 46 diagnoses in a minimum of three quarters of the year (n = 8,678). A comparison group was formed with n = 114,962. We calculated prevalences and relative risks -using nominal regression- to determine influential factors on long-term care. RESULTS A small number of diseases (e.g. dementia, urinary incontinence, chronic stroke and cardiac insufficiency) show high prevalences (> 20%) among long-term care users and at the same time great prevalence differences between users and non-users CONCLUSION These data are important for improving medical and nursing care of long-term care users. Further research is needed with regard to the question by which mechanisms those diseases produce disability and frailty, thus leading to long-term care requirements.

Die Epidemiologie von chronischen Krankheiten und PflegebedürftigkeitThe epidemiology of chronic diseases and long-term care

BACKGROUND It is generally assumed that chronic diseases and multimorbidity increase the risk of long-term care. Nevertheless, a systematic study on the nature and the prevalence of those diseases associated with long-term care has not been yet undertaken in Germany. MATERIALS AND METHODS The study was perfomed using claims data of one nationwide operating statutory health insurance company in 2006. Inclusion criteria were age ≥ 65 years, minimum of 1 out of 46 diagnoses in a minimum of three quarters of the year (n = 8,678). A comparison group was formed with n = 114,962. We calculated prevalences and relative risks -using nominal regression- to determine influential factors on long-term care. RESULTS A small number of diseases (e.g. dementia, urinary incontinence, chronic stroke and cardiac insufficiency) show high prevalences (> 20%) among long-term care users and at the same time great prevalence differences between users and non-users CONCLUSION These data are important for improving medical and nursing care of long-term care users. Further research is needed with regard to the question by which mechanisms those diseases produce disability and frailty, thus leading to long-term care requirements.

Fragen und Thesen zu medikamentösen Behandlungsoptionen der Alzheimer-Demenz mit Acetylcholinesterase-Hemmern@@@Problems and questions of pharmacological therapy of Alzheimer’s disease with cholinesterase inhibitors

ZusammenfassungUntersucht werden die möglichen Gründe für die Diskrepanz zwischen der wissenschaftlichen Evidenz für den Einsatz von Acetylcholinesterase-Hemmern in der Behandlung der Alzheimer-Demenz und den Empfehlungen oder Leitlinien vieler wissenschaftlicher Fachgesellschaften. Ferner wird die These der Unterversorgung mit diesen Präparaten einer kritischen Betrachtung unterzogen.SummaryThe paper reviews the evidence for the recommendation of cholinesterase inhibitors and asks critical questions concerning the reasons for the discrepancy between the weak evidence and the recommendation of these drugs in therapy guidelines. Furthermore, the argument of the severe underuse of these drugs is examined.