Norbert Specht-Leible

Improving care for patients with dementia hospitalized for acute somatic illness in a specialized care unit: a feasibility study.

BACKGROUND Persons with dementia hospitalized for an acute illness have a high risk of poor outcomes and add to the burden on acute care systems. We developed a segregated Special Care Unit (SCU) in a somatic hospital for patients with challenging behavior resulting from dementia and/or delirium. This pilot study evaluates the feasibility and patient outcomes. METHODS The SCU was established with environmental features that allow for safe and unrestricted ambulation within the unit and create a home-like atmosphere. Daytime activities structure the day and assure additional professional presence. The staff received intensive specialized training. Feasibility criteria were: acceptance by the staff, avoidance of transfers to geriatric psychiatry, lack of serious falls and mortality. Patient outcome criteria were ADL (Barthel index), mobility scores and behavior scores (Wilcoxons, McNemar tests, pre-post design). RESULTS 332 consecutively admitted patients were enrolled. The SCU has been well received by the staff. Length of hospital stay did not differ from other hospital patients (15.3 +/- 8.3 vs. 15.0 +/- 10.3 days, p = 0.54). Six patients were transferred to geriatric psychiatry. Two patients suffered a fall-related hip fracture. The median Barthel Index improved significantly (admission 30, discharge 45, p < 0.001), with only 8.5% of patients suffering functional loss. Wandering, aggression and agitation were significantly reduced (p < 0.001). CONCLUSIONS The SCU has improved the care of patients with challenging behavior. Decline in ADL function and institutionalization occurred to a lesser degree than would be expected in this group of patients. Despite the selection of patients with behavioral problems, transfer to psychiatry was rare.

A special care unit for acutely ill patients with dementia and challenging behaviour as a model of geriatric care

ZusammenfassungDieser Artikel beschreibt die Entwicklung eines innovativen Versorgungskonzepts zu Behandlung von Menschen mit Demenz, die in einem somatischen geriatrischen Krankenhaus stationär behandelt werden. Es wurde ein halb-geschlossener geschützter Spezialbereich für Patienten mit herausforderndem Verhalten eingerichtet, welches durch eine Demenz, eine Delir oder ein Delir bei Demenz bedingt ist. Innerhalb des Bereiches sind die Patienten in ihrer Mobilität nicht eingeschränkt. Die Milieugestaltung erzeugt eine möglichst wohnliche Atmosphäre. Tagesstrukturierende Maßnahmen führen zu Aktivierung und gewährleisten zusätzliche professionelle Präsenz. Es erfolgte eine intensives Schulungsprogramm für die Mitarbeiter. GISAD ist im Krankenhaus gut angenommen und wird als eine Verbesserung der Patientenversorgung angesehen. Die psychologische Belastung der Pflegenden hat trotz Selektion dieser schwierigen Patienten im Verlauf eines Jahres nicht zugenommen.AbstractThis paper describes the development and management of a new model of care for hospitalized patients with challenging behaviour evoked by dementia and/or delirium. To ameliorate care for patients with dementia in a geriatric acute care hospital a segregated Special Care Unit for patients with challenging behaviour was created. Environmental features allow for safe and unrestricted ambulation within the unit and create a home-like atmosphere. Day-time activities structure the day and assure additional professional presence in the unit. An intensive training program for the staff was provided. The SCU has been well accepted by the staff and is considered to be an improvement in care. Psychological burden of the nurses did not increase over a time period of one year in caring for these difficult patients.

Treatment quality in geriatric patients with diabetes mellitus in various home environments

OBJECTIVE The goal of the present study was to systematically assess treatment quality, perceptions, and cognitive function of elderly patients with diabetes admitted to an acute geriatric hospital from different home environments (nursing home residents, home care, assisted living, family caregivers, self-sufficient). METHODS Quality of diabetes treatment, metabolic control (HbA(1c)), nutrition, treatment satisfaction, cognition, disability, and level of dependency were assessed in 128 patients with diabetes. RESULTS Out of 128 patients, 87 patients (68%) showed an HbA1c≤8% according to the guidelines for aging people with diabetes of the German Diabetes Association (DDG). Compared to patients living independently at home, the metabolic control in nursing home residents and their treatment satisfaction were as good. They had a higher degree of dependency though (Barthel, p<0.001), more strongly impaired mobility (Tinetti, p<0.01), less diabetes knowledge (p<0.001), inferior cognitive performance (MMSE, SPMSQ, p<0.01), and a higher prevalence of depression (GDS) (p<0.01). Better cognitive function correlated with better diabetes knowledge (r=0.49; p<0.001), but not with better metabolic control. CONCLUSION The treatment of geriatric patients with diabetes mellitus requires individual considerations and interdisciplinary care. Particularly the continuing education of geriatric nurses could contribute to improved diabetes treatment quality in nursing home residents.

Behandlungsqualität bei geriatrischen Patienten mit Diabetes mellitus in verschiedenen häuslichen Versorgungsstrukturen

OBJECTIVE The goal of the present study was to systematically assess treatment quality, perceptions, and cognitive function of elderly patients with diabetes admitted to an acute geriatric hospital from different home environments (nursing home residents, home care, assisted living, family caregivers, self-sufficient). METHODS Quality of diabetes treatment, metabolic control (HbA(1c)), nutrition, treatment satisfaction, cognition, disability, and level of dependency were assessed in 128 patients with diabetes. RESULTS Out of 128 patients, 87 patients (68%) showed an HbA1c≤8% according to the guidelines for aging people with diabetes of the German Diabetes Association (DDG). Compared to patients living independently at home, the metabolic control in nursing home residents and their treatment satisfaction were as good. They had a higher degree of dependency though (Barthel, p<0.001), more strongly impaired mobility (Tinetti, p<0.01), less diabetes knowledge (p<0.001), inferior cognitive performance (MMSE, SPMSQ, p<0.01), and a higher prevalence of depression (GDS) (p<0.01). Better cognitive function correlated with better diabetes knowledge (r=0.49; p<0.001), but not with better metabolic control. CONCLUSION The treatment of geriatric patients with diabetes mellitus requires individual considerations and interdisciplinary care. Particularly the continuing education of geriatric nurses could contribute to improved diabetes treatment quality in nursing home residents.

[Diabetes care and incidence of severe hypoglycemia in nursing home facilities and nursing services: The Heidelberg Diabetes Study].

AIM The goal of this study was to perform a structured analysis of the treatment quality and acute complications of geriatric patients with diabetes mellitus (DM) cared for by nursing services and nursing home facilities. Secondly, structural problems and potentials for improvement in the care of multimorbid older people with DM treated by nursing homes and nursing services were analysed from the viewpoint of geriatric nurses, managers of nursing homes and general practitioners. METHODS In all, 77 older persons with DM from 13 nursing homes and 3 nursing services were included in the analysis (76.6% female, HbA1c 6.9 ± 1.4%, age 81.6 ± 9.9 years). Structural problems and potentials for improvement were collected from 95 geriatric nurses, 9 managers of nursing homes and 6 general practitioners using semistandardized questionnaires. RESULTS Metabolic control was too strict in care-dependent older people with DM (mean HbA1c value: 6.9 ± 1.4 %; recommended by guidelines: 7-8%). The measurement of HbA1c was performed in 16 of 77 people (20.8%) within the last year despite a high visitation frequency of the general practitioners (12.7 ± 7.7 within the last 6 months). The incidence of severe hypoglycemia was 7.8%/patient/year. Regarding the management in case of diabetes-related acute complications 33 geriatric nurses (34.7%) stated not having any written standard (nursing home 39%, geriatric services 16.7%). CONCLUSION Complex insulin therapies are still used in older people with DM with the consequence of a high incidence of severe hypoglycemia. Concrete management standards in the case of diabetes-related acute complications for geriatric nurses are lacking for more than one third of the nursing services.

Medikamentengebrauch als Gesundheitsindikator im mittleren und höheren Erwachsenenalter

Ein wesentlicher Bestandteil vieler gerontologischer Studien ist die Beurteilung der Gesundheit von Probanden (Pbn) und die anschliesende Untersuchung von Zusammenhangen zwischen diesem Gesundheitszustand und verschiedenen anderen, vor allem psychologischen Variablen. Haufig wird der Gesundheitszustand auch zur Ergebnismessung bei Interventionsstudien eingesetzt. Die herkommlichen Instrumente zur Erfassung des Gesundheitszustandes sind aber mit einer Reihe von Nachteilen behaftet. So befassen sich die meisten bekannten Messinstrumente zur Feststellung der Gesundheit lediglich mit Teilaspekten der Gesundheit oder mit bestimmten Probandengruppen. Im Rahmen der Basler interdisziplinaren Altersstudie IDA (PerrigChiello et al. 1996) wurden beispielsweise zur Beurteilung der objektiven Gesundheit 20 rein internistische Indikatoren herangezogen, andere Erkrankungen aber auser Acht gelassen. Dadurch sind die Befunde nicht fur ein breites Spektrum von Altersgruppen und Erkrankungen zu verallgemeinern. Um dem Problem der Einschrankung auf einzelne Krankheitsbilder zu entgehen, wird fur die Cumulative-Illness-Rating-Scale (Linn BS, Linn MW u. Gurel 1968) das Vorliegen einer ganzen Reihe von Erkrankungen aus allen Organsystemen abgefragt und deren Schwere eingeschatzt. Allerdings werden keine Befunde oder andere Gesundheitsdimensionen einbezogen.

Behandlungsqualität des Diabetes mellitus und Inzidenz schwerer Hypoglykämien in stationären und ambulanten Versorgungseinrichtungen

AIM The goal of this study was to perform a structured analysis of the treatment quality and acute complications of geriatric patients with diabetes mellitus (DM) cared for by nursing services and nursing home facilities. Secondly, structural problems and potentials for improvement in the care of multimorbid older people with DM treated by nursing homes and nursing services were analysed from the viewpoint of geriatric nurses, managers of nursing homes and general practitioners. METHODS In all, 77 older persons with DM from 13 nursing homes and 3 nursing services were included in the analysis (76.6% female, HbA1c 6.9 ± 1.4%, age 81.6 ± 9.9 years). Structural problems and potentials for improvement were collected from 95 geriatric nurses, 9 managers of nursing homes and 6 general practitioners using semistandardized questionnaires. RESULTS Metabolic control was too strict in care-dependent older people with DM (mean HbA1c value: 6.9 ± 1.4 %; recommended by guidelines: 7-8%). The measurement of HbA1c was performed in 16 of 77 people (20.8%) within the last year despite a high visitation frequency of the general practitioners (12.7 ± 7.7 within the last 6 months). The incidence of severe hypoglycemia was 7.8%/patient/year. Regarding the management in case of diabetes-related acute complications 33 geriatric nurses (34.7%) stated not having any written standard (nursing home 39%, geriatric services 16.7%). CONCLUSION Complex insulin therapies are still used in older people with DM with the consequence of a high incidence of severe hypoglycemia. Concrete management standards in the case of diabetes-related acute complications for geriatric nurses are lacking for more than one third of the nursing services.

Behandlungsqualität des Diabetes mellitus und Inzidenz schwerer Hypoglykämien in stationären und ambulanten Versorgungseinrichtungen@@@Diabetes care and incidence of severe hypoglycemia in nursing home facilities and nursing services: Heidelberger Diabetesstudie@@@The Heidelberg Diabetes Study

AIM The goal of this study was to perform a structured analysis of the treatment quality and acute complications of geriatric patients with diabetes mellitus (DM) cared for by nursing services and nursing home facilities. Secondly, structural problems and potentials for improvement in the care of multimorbid older people with DM treated by nursing homes and nursing services were analysed from the viewpoint of geriatric nurses, managers of nursing homes and general practitioners. METHODS In all, 77 older persons with DM from 13 nursing homes and 3 nursing services were included in the analysis (76.6% female, HbA1c 6.9 ± 1.4%, age 81.6 ± 9.9 years). Structural problems and potentials for improvement were collected from 95 geriatric nurses, 9 managers of nursing homes and 6 general practitioners using semistandardized questionnaires. RESULTS Metabolic control was too strict in care-dependent older people with DM (mean HbA1c value: 6.9 ± 1.4 %; recommended by guidelines: 7-8%). The measurement of HbA1c was performed in 16 of 77 people (20.8%) within the last year despite a high visitation frequency of the general practitioners (12.7 ± 7.7 within the last 6 months). The incidence of severe hypoglycemia was 7.8%/patient/year. Regarding the management in case of diabetes-related acute complications 33 geriatric nurses (34.7%) stated not having any written standard (nursing home 39%, geriatric services 16.7%). CONCLUSION Complex insulin therapies are still used in older people with DM with the consequence of a high incidence of severe hypoglycemia. Concrete management standards in the case of diabetes-related acute complications for geriatric nurses are lacking for more than one third of the nursing services.

Behandlungsqualität bei geriatrischen Patienten mit Diabetes mellitus in verschiedenen häuslichen Versorgungsstrukturen@@@Treatment quality in geriatric patients with diabetes mellitus in various home environments

OBJECTIVE The goal of the present study was to systematically assess treatment quality, perceptions, and cognitive function of elderly patients with diabetes admitted to an acute geriatric hospital from different home environments (nursing home residents, home care, assisted living, family caregivers, self-sufficient). METHODS Quality of diabetes treatment, metabolic control (HbA(1c)), nutrition, treatment satisfaction, cognition, disability, and level of dependency were assessed in 128 patients with diabetes. RESULTS Out of 128 patients, 87 patients (68%) showed an HbA1c≤8% according to the guidelines for aging people with diabetes of the German Diabetes Association (DDG). Compared to patients living independently at home, the metabolic control in nursing home residents and their treatment satisfaction were as good. They had a higher degree of dependency though (Barthel, p<0.001), more strongly impaired mobility (Tinetti, p<0.01), less diabetes knowledge (p<0.001), inferior cognitive performance (MMSE, SPMSQ, p<0.01), and a higher prevalence of depression (GDS) (p<0.01). Better cognitive function correlated with better diabetes knowledge (r=0.49; p<0.001), but not with better metabolic control. CONCLUSION The treatment of geriatric patients with diabetes mellitus requires individual considerations and interdisciplinary care. Particularly the continuing education of geriatric nurses could contribute to improved diabetes treatment quality in nursing home residents.

Struktur und Inhalte des geriatrischen Assessments

Jede diagnostische Masnahme verlangt gerade in der Geriatrie eine klare Indikation und mogliche therapeutische Konsequenzen. Das geriatrische Assessment ist zeitintensiv und fordert von den Patienten viel Geduld. Fur manche alteren Menschen kann es sehr belastend sein. In diesen Fallen sollte das geriatrische Assessment nicht an einem einzigen Tag durchgefuhrt werden, sondern verteilt uber mehrere Tage.