K. Kummer

Autonomie trotz Multimorbidität im Alter – Der Berliner Forschungsverbund AMA

The proportion of the population with multiple illnesses increases with age and growing numbers of people are now living to a very old age. Despite medical progress and improved living conditions, many old people have to deal with physical, psychological, and social impairments. It is a crucial challenge for health and social policy to support the elderly with health-related impairments in their desire to lead as independent a life as possible. Against this background the research consortium Autonomy Despite Multimorbidity in Old Age (AMA I) examined the extent to which the self-determined life style of multimorbid old and very old persons can be supported and maintained. In order to reflect the diversity of life worlds of the elderly, the study sample included participants who were not notably impaired in their everyday functioning, participants in need of nursing care and participants with cognitive impairments. Moreover, the sample comprised both older persons who were still living in their own homes and nursing home residents. The studies conducted within the AMA framework focused on the resources available to old persons living in different situations and on how these resources can be strengthened. This article presents findings from the first phase of funding of the AMA research consortium. In a second phase of funding (2011-2013, AMA II), sustainable practice-based interventions are being developed to mobilize resources which can help multimorbid older persons to maintain their autonomy and the practical viability of these interventions will be tested.

[Communication about incontinence between affected individuals and health care providers - the patients' perspective].

ZusammenfassungIn dieser Forschungsarbeit wurde die Kommunikation der Ärzte und Pflegenden mit Patienten, die an Inkontinenz erkrankt sind, beleuchtet. Ziel der Untersuchung war die Deskription der Wahrnehmungen, Erwartungen und Wünsche an das Kommunikationsverhalten der Professionellen aus Patientenperspektive über Inkontinenz. In die qualitative Fallstudie konnten 22 inkontinente Patienten mit einem Altersdurchschnitt von 81 Jahren, fünf ärztliche und fünf pflegerische Professionelle eingeschlossen werden. Die Analyse der Patienteninterviews liefert Hinweise dafür, dass inkontinente Patienten sich eine persönliche und vertrauensvolle Beziehung zu den Professionellen wünschen. Aus Patientensicht sind Empathie, Respekt, Interesse und Verständnis Aspekte, die gelungene Kommunikation kennzeichnet. Mängel beschreiben Patienten bezüglich des direktiven Gesprächsstils der Ärzte. Als beziehungshemmend seitens der Pflegenden heben Patienten Distanzbrüche hervor. Diese Befunde verweisen auf eine patientenzentrierte und kongruente Kommunikation der Ärzte und Pflegenden, um den Bedürfnissen inkontinenter Patienten zu begegnen.AbstractCommunication is a key competence for medical and nursing health care providers alike. However, there appear to be areas of “speechlessness” regarding specific medical problems, including the “taboo” disease incontinence. There is a lack of scientific data regarding incontinence in the context of communication among patients and health care professionals.The descriptive study was designed to provide insights how female and male patients alike perceive communications about incontinence with doctors and nurses, respectively. 22 structured interviews were conducted and taped with 16 elderly female and 6 male patients (age ≥ 60 years, mean: 81 years, demented patients excluded, n = 19 analysable), and five interviews each with doctors and nurses within the setting of a rehabilitation hospital for geriatric patients (not reported here). We used published methodology to interpret the diversity of patients’ verbal communications to the female interviewer.Results suggest that patients wish to find a relationship based on sympathy, empathy and trust. If incontinence is addressed, it is by doctors, not patients. Statements by patients suggest that they differentiate between expectations addressing the professional level of medical care, and a level perhaps best described as the quality of the personal relationship between the patient and doctor. However, these twofold expectations were not distinguishable regarding nursing professionals, they were perceived on a “personal care level” only, not the professional level regarding incontinence. Independent of professional affiliation, patients expect empathy, understanding, and respect. They selectively criticize manners of (some) nurses and lack of understandable transfer of information by doctors. The gender of the care providers was not an issue for patients regarding communication about incontinence. The preliminary results show that there is room for improvement for better communication regarding incontinence. However, areas affected appear to differ between nursing and medical professionals.

Kommunikation der Ärzte und Pflegenden über Inkontinenz – eine Patientenperspektive

ZusammenfassungIn dieser Forschungsarbeit wurde die Kommunikation der Ärzte und Pflegenden mit Patienten, die an Inkontinenz erkrankt sind, beleuchtet. Ziel der Untersuchung war die Deskription der Wahrnehmungen, Erwartungen und Wünsche an das Kommunikationsverhalten der Professionellen aus Patientenperspektive über Inkontinenz. In die qualitative Fallstudie konnten 22 inkontinente Patienten mit einem Altersdurchschnitt von 81 Jahren, fünf ärztliche und fünf pflegerische Professionelle eingeschlossen werden. Die Analyse der Patienteninterviews liefert Hinweise dafür, dass inkontinente Patienten sich eine persönliche und vertrauensvolle Beziehung zu den Professionellen wünschen. Aus Patientensicht sind Empathie, Respekt, Interesse und Verständnis Aspekte, die gelungene Kommunikation kennzeichnet. Mängel beschreiben Patienten bezüglich des direktiven Gesprächsstils der Ärzte. Als beziehungshemmend seitens der Pflegenden heben Patienten Distanzbrüche hervor. Diese Befunde verweisen auf eine patientenzentrierte und kongruente Kommunikation der Ärzte und Pflegenden, um den Bedürfnissen inkontinenter Patienten zu begegnen.AbstractCommunication is a key competence for medical and nursing health care providers alike. However, there appear to be areas of “speechlessness” regarding specific medical problems, including the “taboo” disease incontinence. There is a lack of scientific data regarding incontinence in the context of communication among patients and health care professionals.The descriptive study was designed to provide insights how female and male patients alike perceive communications about incontinence with doctors and nurses, respectively. 22 structured interviews were conducted and taped with 16 elderly female and 6 male patients (age ≥ 60 years, mean: 81 years, demented patients excluded, n = 19 analysable), and five interviews each with doctors and nurses within the setting of a rehabilitation hospital for geriatric patients (not reported here). We used published methodology to interpret the diversity of patients’ verbal communications to the female interviewer.Results suggest that patients wish to find a relationship based on sympathy, empathy and trust. If incontinence is addressed, it is by doctors, not patients. Statements by patients suggest that they differentiate between expectations addressing the professional level of medical care, and a level perhaps best described as the quality of the personal relationship between the patient and doctor. However, these twofold expectations were not distinguishable regarding nursing professionals, they were perceived on a “personal care level” only, not the professional level regarding incontinence. Independent of professional affiliation, patients expect empathy, understanding, and respect. They selectively criticize manners of (some) nurses and lack of understandable transfer of information by doctors. The gender of the care providers was not an issue for patients regarding communication about incontinence. The preliminary results show that there is room for improvement for better communication regarding incontinence. However, areas affected appear to differ between nursing and medical professionals.

Family caregivers and health promotion. Pilot study to validate a German assessment to survey resources and risks of elderly family caregivers (ARR)

The ARR is a German assessment instrument to survey physical and psychological resources and risks of elderly family caregivers (50+). Factor structure, reliability, and validity were investigated using a sample of 202 caregivers from a national health insurance company. The factorial validity was confirmed for the physical profile (PHP) and the psychological profile (PSP). Reliability is good (PHP: Cronbachs α=0.73; PSP: Cronbachs α=0.71) for the shortness of the profiles. The correlation with self-efficacy constitutes an indicator for construct validity. The psychometric qualities allow the conclusion that the ARR is a reliable and valid instrument which is of interest for family caregivers. Nevertheless, further testing of validity is required.

Pflegende Angehörige und Gesundheitsförderung

The ARR is a German assessment instrument to survey physical and psychological resources and risks of elderly family caregivers (50+). Factor structure, reliability, and validity were investigated using a sample of 202 caregivers from a national health insurance company. The factorial validity was confirmed for the physical profile (PHP) and the psychological profile (PSP). Reliability is good (PHP: Cronbachs α=0.73; PSP: Cronbachs α=0.71) for the shortness of the profiles. The correlation with self-efficacy constitutes an indicator for construct validity. The psychometric qualities allow the conclusion that the ARR is a reliable and valid instrument which is of interest for family caregivers. Nevertheless, further testing of validity is required.

Pflegende Angehörige und Gesundheitsförderung@@@Family caregivers and health promotion: Pilotstudie zur Validität eines deutschsprachigen Assessments zur Erfassung von Ressourcen und Risiken älterer pflegender Angehöriger (ARR)@@@Pilot study to validate a German assessment to survey resources and risks of elderly family caregivers (ARR)

The ARR is a German assessment instrument to survey physical and psychological resources and risks of elderly family caregivers (50+). Factor structure, reliability, and validity were investigated using a sample of 202 caregivers from a national health insurance company. The factorial validity was confirmed for the physical profile (PHP) and the psychological profile (PSP). Reliability is good (PHP: Cronbachs α=0.73; PSP: Cronbachs α=0.71) for the shortness of the profiles. The correlation with self-efficacy constitutes an indicator for construct validity. The psychometric qualities allow the conclusion that the ARR is a reliable and valid instrument which is of interest for family caregivers. Nevertheless, further testing of validity is required.

Möglichkeiten und Grenzen der Erfassung von gesundheilichen Ressourcen und Risiken älterer pflegender Angehöriger@@@Possibilities and limits in assessing health resources and risks of elderly family caregivers

ZusammenfassungIm Rahmen des Forschungsprojekts „Gesundheitsförderung für ältere pflegende Angehörige“ wurde ein Assessment-Instrument zur Ermittlung individueller gesundheitsbezogener physischer und psychischer Ressourcen und Risiken pflegender Angehöriger entwickelt. Daraus wird der persönliche Bedarf an Gesundheitsförderung ableitbar und ein entsprechendes Angebot unterbreitet. Die Implementierung des softwaregestützten Assessments erfolgte in die Strukturen der gesetzlichen Krankenkasse Deutsche BKK in Wolfsburg.Im Zentrum der Studie stehen ältere pflegende Angehörige (50 +), mit denen das Assessment durchgeführt wurde. Als standardisiertes Verfahren erstellt es Ressourcen- und Risikoprofile und differenziert nach 9 Typen. Jedem Typ ist ein Angebot der Gesundheitsförderung zugeordnet. Dieser Beitrag präsentiert Befunde aus der einjährigen Implementierungsphase.Das Assessment konnte mit 202 pflegenden Angehörigen (Altersdurchschnitt 64,8 Jahre) durchgeführt werden. Bei knapp 80 % der Befragten ließen sich mittlere bis niedrige Ressourcen im physischen und psychischen Bereich ermitteln. Damit wies diese Personengruppe einen hohen Bedarf an Gesundheitsförderung auf. Obgleich im Assessment 94 % der Angehörigen angaben, Interesse an einem Angebot zu haben, blieb die Inanspruchnahme hinter den Erwartungen zurück.Das Projekt „Gesundheitsförderung für ältere pflegende Angehörige“ zeichnete sich durch einen direkten Theorie-Praxis-Transfer aus. Zukünftig ist zu überlegen, ob das Instrument auch in anderen Einrichtungen eingesetzt werden kann.AbstractWithin the research project “Health Promotion for Elderly Family Caregivers” an assessment instrument was developed which determines individual health resources and risks of family caregivers concerning physical and mental aspects. It is possible to derive the personal needs for health promotion and a corresponding recommendation for relaxation or exercise. The implementation of the assessment instrument was carried out in the structure of a German health insurance company, the Deutsche BKK Wolfsburg.This study focused on elderly family caregivers (50 + years old) who participated in the assessment. As a standardized procedure resources and risk profileswere differentiated into nine types and each type of caregiver is assigned to an offer of health promotion (e. g. relaxation or exercise).The following article presents the results from the 1 year phase of implementation. The study was conducted with 202 family caregivers (age average 64.8 years). Almost 80 % of the interviewees had low to medium physical and mental resources. Therefore, a high need of health promotion for this group was derived. Although, 94 % of the caregivers reported an interest in health promotion, the utilization of offers remained below expectations.The project “Health Promotion for Elderly Family Caregivers” is characterized by a theory practice transfer. In the future it should be considered whether the assessment can be used in other institutions.

[Autonomy despite multimorbidity in old age--the Berlin-based AMA research consortium].

The proportion of the population with multiple illnesses increases with age and growing numbers of people are now living to a very old age. Despite medical progress and improved living conditions, many old people have to deal with physical, psychological, and social impairments. It is a crucial challenge for health and social policy to support the elderly with health-related impairments in their desire to lead as independent a life as possible. Against this background the research consortium Autonomy Despite Multimorbidity in Old Age (AMA I) examined the extent to which the self-determined life style of multimorbid old and very old persons can be supported and maintained. In order to reflect the diversity of life worlds of the elderly, the study sample included participants who were not notably impaired in their everyday functioning, participants in need of nursing care and participants with cognitive impairments. Moreover, the sample comprised both older persons who were still living in their own homes and nursing home residents. The studies conducted within the AMA framework focused on the resources available to old persons living in different situations and on how these resources can be strengthened. This article presents findings from the first phase of funding of the AMA research consortium. In a second phase of funding (2011-2013, AMA II), sustainable practice-based interventions are being developed to mobilize resources which can help multimorbid older persons to maintain their autonomy and the practical viability of these interventions will be tested.

Autonomie trotz Multimorbidität im Alter – Der Berliner Forschungsverbund AMA@@@Autonomy despite multimorbidity in old age – The Berlin-based AMA research consortium

The proportion of the population with multiple illnesses increases with age and growing numbers of people are now living to a very old age. Despite medical progress and improved living conditions, many old people have to deal with physical, psychological, and social impairments. It is a crucial challenge for health and social policy to support the elderly with health-related impairments in their desire to lead as independent a life as possible. Against this background the research consortium Autonomy Despite Multimorbidity in Old Age (AMA I) examined the extent to which the self-determined life style of multimorbid old and very old persons can be supported and maintained. In order to reflect the diversity of life worlds of the elderly, the study sample included participants who were not notably impaired in their everyday functioning, participants in need of nursing care and participants with cognitive impairments. Moreover, the sample comprised both older persons who were still living in their own homes and nursing home residents. The studies conducted within the AMA framework focused on the resources available to old persons living in different situations and on how these resources can be strengthened. This article presents findings from the first phase of funding of the AMA research consortium. In a second phase of funding (2011-2013, AMA II), sustainable practice-based interventions are being developed to mobilize resources which can help multimorbid older persons to maintain their autonomy and the practical viability of these interventions will be tested.

Kommunikation der Ärzte und Pflegenden über Inkontinenz – eine Patientenperspektive@@@Communication about incontinence between affected individuals and health care providers – the patients’ perspective

ZusammenfassungIn dieser Forschungsarbeit wurde die Kommunikation der Ärzte und Pflegenden mit Patienten, die an Inkontinenz erkrankt sind, beleuchtet. Ziel der Untersuchung war die Deskription der Wahrnehmungen, Erwartungen und Wünsche an das Kommunikationsverhalten der Professionellen aus Patientenperspektive über Inkontinenz. In die qualitative Fallstudie konnten 22 inkontinente Patienten mit einem Altersdurchschnitt von 81 Jahren, fünf ärztliche und fünf pflegerische Professionelle eingeschlossen werden. Die Analyse der Patienteninterviews liefert Hinweise dafür, dass inkontinente Patienten sich eine persönliche und vertrauensvolle Beziehung zu den Professionellen wünschen. Aus Patientensicht sind Empathie, Respekt, Interesse und Verständnis Aspekte, die gelungene Kommunikation kennzeichnet. Mängel beschreiben Patienten bezüglich des direktiven Gesprächsstils der Ärzte. Als beziehungshemmend seitens der Pflegenden heben Patienten Distanzbrüche hervor. Diese Befunde verweisen auf eine patientenzentrierte und kongruente Kommunikation der Ärzte und Pflegenden, um den Bedürfnissen inkontinenter Patienten zu begegnen.AbstractCommunication is a key competence for medical and nursing health care providers alike. However, there appear to be areas of “speechlessness” regarding specific medical problems, including the “taboo” disease incontinence. There is a lack of scientific data regarding incontinence in the context of communication among patients and health care professionals.The descriptive study was designed to provide insights how female and male patients alike perceive communications about incontinence with doctors and nurses, respectively. 22 structured interviews were conducted and taped with 16 elderly female and 6 male patients (age ≥ 60 years, mean: 81 years, demented patients excluded, n = 19 analysable), and five interviews each with doctors and nurses within the setting of a rehabilitation hospital for geriatric patients (not reported here). We used published methodology to interpret the diversity of patients’ verbal communications to the female interviewer.Results suggest that patients wish to find a relationship based on sympathy, empathy and trust. If incontinence is addressed, it is by doctors, not patients. Statements by patients suggest that they differentiate between expectations addressing the professional level of medical care, and a level perhaps best described as the quality of the personal relationship between the patient and doctor. However, these twofold expectations were not distinguishable regarding nursing professionals, they were perceived on a “personal care level” only, not the professional level regarding incontinence. Independent of professional affiliation, patients expect empathy, understanding, and respect. They selectively criticize manners of (some) nurses and lack of understandable transfer of information by doctors. The gender of the care providers was not an issue for patients regarding communication about incontinence. The preliminary results show that there is room for improvement for better communication regarding incontinence. However, areas affected appear to differ between nursing and medical professionals.