Eine unmögliche Herausforderung?!
Die Pflege von älteren Menschen mit
psychischen Krankheiten aus deutscher Sicht.
An impossible challenge?! Care for
elderly people with mental disorders
– the German point of view
Prof. Dr. Erika Feldhaus-Plumin
Evangelische Hochschule Berlin
Overview





Definitions and Disambiguations
Facts
– Epidemiology
– Tools
– Health Care Settings
– Qualification
– Political Dimension
Phenomens around mental disorders
– Stigma
– Violence
Conclusion
Literature
Definitions and Disambiguations


A mental disorder or mental illness is a
psychological pattern, potentially reflected in
behavior, that is generally associated with
distress or disability,...
Mental disorders are generally defined by a
combination of how a person feels, acts,
thinks or perceives.
Gesundheitsberichterstattung des Bundes 2009:Gesundheit und
Krankheit im Alter S. 32
Definitions and Disambiguations

The biological age

The social age

The subjective apperception
Gesundheitsberichterstattung des Bundes 2009:Gesundheit und
Krankheit im Alter S. 32
Facts about elderly people

In 2050 about 30% of the European
population will be aged ≥ 65.

The old-old are the fastest growing
population group in Europe.
The United States Department of Health and Human Services
2012: Mental Health - A Report of the Surgeon General. p 39
Facts about mental disorders

8 million germans with mental disorders, nearly 10 % of the
population.

Statistisches Bundesamt 2009: Gesundheit auf einen Blick, S.12-13
Mental disorders are the fourth-frequent reason for inability to
work.
Fink, W., Haidinger, G. 2007: Die Häufigkeit von
Gesundheitsstörungen in 10 Jahren Allgemeinpraxis. Z.
Allg. Med. 83/200, S.102–108.

The disease pattern depression is the most frequent disease of
the mental disorders in Germany – between 16 and 20 % of all
people are in their life-span once a time depressive.
Immer mehr Depressive. Die tageszeitung, 7. Mai 2009
Facts about elderly people with
mental disorders in Germany




A quarter of the 65 year-aged and older people are living with a
mental disorder.
In nursing homes nearly 40 to 50 % of the patients are having
a depression. 2/3 are having a dementia.
Over 1/3 of all suicides are committed from people over 65
years old.
The rate of the addiction diseases in the cohort of the elderly
people rised up:
–
–
between 207 % (70 to 75 years)
and 230 % (80 to 84 years)
Gesundheitsberichterstattung des Bundes 2009: Gesundheit und Krankheit im Alter S. 32
Berliner Altersstudie (N = 514)
Gesundheitsberichterstattung des Bundes( 2009), Gesundheit und Krankheit im Alter S. 35
Research E. Feldhaus-Plumin 2012
Nursing home N = 160
70%
80%
70%
60%
50%
40%
30%
20%
10%
0%
40%
...
1%
Hu
n
or
ea
Ch
m
an
ic-
re
ni
ph
hiz
o
Sc
1%
de
p.
..
1%
a
rsa
ko
w
Ko
n
es
sio
De
pr
De
m
en
tia
13%
Tools für detection...
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




Family
Patient
Institutional standards
Doctor
Psychiatrist/Psychologist
Medication
...
Statistic about Psychiatric drugs in
the years 2000 to 2006 in Berlin
50
45
40
35
30
25
20
15
10
5
0
2000
2006
60-64
70-74
80-84
90 and
older
Health Care Settings




Out-Patient structures
In-Patient structures
Nursing homes
Various settings like living-groups etc.
Out-Patient structures


Nearly 70 % from patients at home
Support from
– community care system
– day care; night care
– Gerontological-psychiatrical ambulatories
In-Patient structures

Specialized clinics
–
f.e. gerontopsychiatrical departments or wards

hospital structures

especially for diagnosis and patients with
multimorbidity
Structures of Nursing Homes

Big change in the last 10 years
–
–

from hierarchial structures and big wards
to spezialised smaller wards, living groups, specialised areas
and various concepts
start into a new decade of nursing homes
BUT:
 lack of nurses is contraproductive
Networking




System for caring with networking structures
Cross-link the different offerings for elderly
people
Best practise f.e. in Berlin, Hamburg,
Augsburg, Würzburg
“Aktionsbündnis Seelische Gesundheit” acting network for mental disorders
Psychotherapy for elderly people




Special psychotherapy for elderly people rare
in Germany
Psychotherapy qualificatiosn are starting to
focus the target group „elderly people“
in nursing homes no psychotherapy!
Concepts like validation, biographical work,
day-structuring and other therapeutical
concepts
Qualification for nurses



Pflegefachkraft für Psychiatrie (education
specialized for psychiatry)
Pflegefachkraft für Gerontopsychiatrie
(education specialized for psychiatry with the
target group elderly people)
Bachelor of Nursing
Political dimension





Reforms in the health care system
Integrated care system (Integrierte
Versorgung)
Casemanagement
Clinical Pathways
topics: Demographic change, dementia,
need of care
Phenomens around mental disorders

Stigma

Violence
Phenomen Stigma
„... stigma prevents people from acknowledging their
own mental health problems...“

Categories
– Individual discrimination
– Structural discrimination
– Discrimination due to self-stigmatisation

Especially the less social distance to people with
mental disorders can let us reach anti-stigma.
Phenomen Violence

Violence according to mental disorders
–

Just a few psychiatric disease patterns are reasons for a
higher rate of acting violent (Steiner 1995).
Violence from nurses against people with mental
disorders
–
–
–
–
–
area of conflict
The possible spiral of violence
selfreflecting
structural violence
different roles of a nurse
Conclusions



Why?
Phenomens Stigma and Violence
Goals
–
–
–
–
Professionalizing the nursing
Research
Political responsibility
Awareness rising
Literature
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