Elderly therapy

Situational physicality in elderly care

Elderly therapy is a new form of therapy that has been developing since around 2005, primarily against the background of demographics in Germany. She focuses her interest on so-called multimorbid geriatric patients, i.e. those over 70 years of age who also have at least two out of five typical geriatric clinical pictures. Such patients may be among those whose care needs require medical or therapeutic measures. Geriatrics as an interdisciplinary medical sub-discipline provides the frame of reference for therapy for the elderly through its task of mitigating or delaying the consequences of diseases in aging and old people in order to maintain their independence for as long as possible. The service of geriatric therapy consists in enabling these patients to make concrete, everyday improvements in their life situation.

history

The treatment of the elderly used to be called gerotherapy . The demographic change has meant that the type and quality of care and therapeutic needs have changed significantly in the population of older, old or very elderly.

Old people who (want to) live with or without relatives in their ancestral environment are particularly at risk of losing their independence in many areas of daily life. Elderly therapy always starts where it is a matter of maintaining and promoting practical life abilities and skills.

Therapy for the elderly is part of a series of attempts that began a few years ago to provide an appropriate response to social developments. The federal and state governments, funding agencies and social associations, churches and politics are trying in different ways to develop viable concepts for a long-known social challenge, the problem potential of which is considerable.

So they have reacted to this fact in the past by z. B. in 2005 developed the “ Framework Recommendations for Geriatric Rehabilitation ”, which in 2007/2008 then resulted in the recognition of a new concept in the range of statutory health insurance , the “mobile geriatric rehabilitation”. From a medical and therapeutic point of view, the general practitioner is given greater weight, outpatient treatment takes precedence over inpatient treatment and, above all, the aim is to use the rehabilitation potential of old people.

In large parts of the public dementia is seen as a typical disease of old age . Programs of the health insurance companies and the federal government, films and novels that describe dementia as the gradual loss of one's own personality have contributed to the fact that the actual age-typical diseases faded into the background. Nevertheless, it is diseases, especially in the fields of orthopedics , internal medicine and neurology , that burden the elderly and limit their independence.

Areas of application and measures

Elderly therapy measures are all services that relate to nursing, physiotherapeutic , occupational therapy and speech therapy to those patients who meet the indication-specific requirements for elderly therapy in the medical diagnosis.

Indication-specific outpatient therapy for the elderly can be used if the patient has the multimorbidity typical of geriatrics and is older (usually 70 years and older).

Geriatric-typical multimorbidity is present if the combination of multimorbidity and geriatric-typical findings or facts is diagnosed. A patient is multimorbid if he has multiple structural or functional damage (according to ICIDH ) in at least two diseases that require treatment.

Geriatric-typical multimorbidity is present if the following characteristics (even in combination) have been diagnosed as a geriatric syndrome:

immobility
Tendency to fall and dizziness
cognitive deficits
Incontinence (urinary incontinence, rarely fecal incontinence)
Pressure sores (decubitus ulcers)
Malnutrition and malnutrition
Disorders in fluid and electrolyte balance
Depression, anxiety disorder
chronic pain
Sensory disturbances
reduced physical resilience / frailty
severe visual impairment
severe hearing loss

Typical main diagnoses in geriatric patients are:

Post-stroke condition
Condition after fractures near the hip joint
Condition after surgical treatment with total hip and knee replacement
Condition after a limb amputation with peripheral arterial occlusive disease or diabetic vascular disease

Additional factors that indicate geriatric therapy are the relatively high risk of limiting independence in everyday life, including the need for care, as well as a relatively high risk of disease complications ( thromboses , intercurrent diseases , fractures , delayed convalescence, etc.). A patient with a condition after apoplexy e.g. B. The therapy must make it possible to find one's way in one's living environment again. So he not only needs treatment that takes place in isolation in the practice, but also time-consuming individual therapy in his immediate vicinity. B. Help with getting dressed, shopping, taking the bus, climbing stairs, etc. and, above all, providing continuity and sufficient time. The individual guidance and support by the elderly therapist during a certain time of the day in specific life situations of the patient offers the opportunity to improve therapy results and use the respective techniques in a target and situation-related manner. Through such targeted therapy for the elderly, an elderly person can develop the expected and desirable increase in physical, everyday practical, psychological and cognitive competence. This is done using and directly testing, practicing and consolidating the techniques taught by the elderly therapist in the patient's everyday situations. Elderly therapy is always related to the day / starting situation with regard to the time required. Whether occupational or physiotherapeutic work is to be done, whether work is done outside the home, whether dressing and eating training, wheelchair or endurance training is to be completed, or whether social activities are to be pursued, depends on the patient's daily and performance type.

Social relevance

The success of rehabilitation measures in older people has been proven by a large number of studies (see the overview in Meier-Baumgartner, Nerenheim-Duscha & Görres 1992). These studies indicate rehabilitation potential in old age, ie the physiological and psychological capacity to restore personal resources for an independent and responsible life. The empirically based evidence of rehabilitation potential has prompted the legislature to anchor the principle “rehabilitation before care” in the fifth and eleventh books of the social code. The unsatisfactory implementation of this principle can also be attributed to the fact that many participants do not have sufficient knowledge of the rehabilitation potential in old age and therefore cannot correctly assess the possible effects of rehabilitation in older people.

There is a need for geriatric therapy if the patient has impaired ability or impairment as a result of damage. The ability disorders must be relevant to the patient's everyday life, taking into account the social context factors (e.g. home living environment), ie they limit his independence and freedom in the areas that are part of the basic human needs. This includes:

Independence in eating and drinking
Independence in personal hygiene
Independence in mobility
Independence in communication
independent organization of adequate employment
Independence in shaping and maintaining social integration

Corresponding ability disorders and / or impairments are above all:

Disabilities in self-sufficiency (e.g. nutrition, personal hygiene, excretion) which can lead to dependence on outside help (need for care)
Impairments of ability to move that prevent the patient from living outside his home and thus lead to his social isolation
Ability disorders in behavior, e.g. B. as a result of temporary confusion, which can lead to disruptions in orientation and social integration
Ability disorders in communication (e.g. language comprehension, language ability, hearing, sight) with the consequence of impairing the local / spatial orientation
Ability disorders in physical mobility, e.g. B. can lead to impairment of self-sufficiency
Ability disorders in dexterity (e.g. in manual activities), which e.g. B. can lead to impairment of employment or housekeeping
Ability disorders in the structuring of the daily routine, which can lead to impairments in different areas

Therapy goals

The aim of therapy is to eliminate or reduce the ability disorders that are relevant to everyday life as early as possible or to prevent them from worsening. The therapy goal relevant to everyday life is derived from the ability disorders and impairments that impair the patient's ability to cope with and shape the areas of life that are described as the basic needs of human existence. The desired degree of independence results from everyday competence in the basic needs.

The primary therapeutic goal of geriatric therapy is the permanent recovery, improvement or maintenance of independence in everyday activities, so that long-term remaining in the desired environment is possible. This is aimed at, among other things:

Improving mobility
Improving social integration
Avoidance / reduction of dependency on caregivers

Everyday relevant can in this context z. B. be:

Achieving the ability to stand
Reaching the bed-wheelchair transfer
Improving wheelchair ability
Reaching the toilet / personal hygiene
Independent food intake
Independent dressing and undressing
Ability to walk over several steps, ability to walk inside and outside the apartment
Daily structuring
Independent coping with everyday situations such as shopping, using public transport, etc.

It is important that the transition from an already existing need for support to a care-related need is prevented as far as possible or delayed as long as possible so that people can stay in their home environment for as long as possible instead of in an old people's or nursing home to move. This is also a central requirement of the research project “Possibilities and Limits of Independent Living in Private Households”, with which the Federal Government stipulated in 2005 that the maintenance of self-determination and independence in everyday life for older patients should be the focus.

education

In contrast to the legally protected professional titles physiotherapist, occupational therapist, etc., elderly therapists are unprotected because they are not state-regulated training. This in turn means that there are now a large number of offers for training or further education to become a geriatric therapist, all of which have different focuses.

The Federal Association for Elderly Therapy has set binding standards for training. It tries to provide a uniform and secure basis for a new professional qualification through binding training and examination regulations and a final examination for which it is responsible. Technical schools certified by it offer the training and are also monitored by it. So far, such training can only be completed in Cologne and Heidelberg.

However, no other noteworthy initiatives have been developed so far, taking into account professional perspectives. Some federal states have supplemented the geriatric care training, which is now their responsibility, with some elements that result from demographic change, but cannot provide an adequate answer to new professional developments.

literature

Hans-Peter Meier-Baumgartner a. a .: Active health promotion in old age, 2nd edition 2006
Hans-Peter Meier-Baumgartner, Iris Nerenheim-Duscha, Stefan Göres: The effectiveness of rehabilitation in older people with special consideration of psychosocial components in outpatient, day-care and inpatient care, Stuttgart, 1992
Ulrich Schneekloth (Ed.), Hans Werner Wahl (Ed.): Possibilities and limits of independent living in private households (MuG III). Representative findings and in-depth studies on home care arrangements, dementia and professional care offers. Integrated final report. Federal Ministry for Family, Seniors, Women and Youth, Munich, 2005 ( online (PDF) Archived from the original on September 23, 2015.)
Training and qualification in elderly care - working aids for theory and practice - on behalf of the Ministry of Health, Social Affairs, Women and Family of the State of North Rhine-Westphalia June 2003
Framework recommendations for mobile geriatric rehabilitation from May 1, 2007
Third and fifth reports on the elderly by the federal government, 2001 and 2006 respectively, as well as "The previous reports on the elderly", a summary of the German center for aging issues

Web links

Individual evidence

^ Hand Franke: Very old and very old. Causes and Problems of Old Age. Springer-Verlag, Berlin / Heidelberg etc. 1987 (= Understandable Science. Volume 118), ISBN 3-540-18260-8 , p. 2.

[1] Hand Franke: Very old and very old. Causes and Problems of Old Age. Springer-Verlag, Berlin / Heidelberg etc. 1987 (= Understandable Science. Volume 118), ISBN 3-540-18260-8 , p. 2.