Skip to main content

Palliativmedizin im Pflegeheim – wie alte, schwer kranke Menschen leben und sterben

  • Chapter
Palliativmedizin

Zusammenfassung

Es besteht eine medizinische und soziale Ungerechtigkeit in der Behandlung alter Menschen. Die gesellschaftliche Entwicklung hat auch die ärztlichen Aufgaben verändert. Fest angestellte Heimärzte sorgen dafür, dass ein Standard für Behandlung und Kommunikation aufgebaut werden kann. Daraus resultierende Patientensicherheit verhindert, dass eine unnötige Verschlechterung des Gesundheitszustandes oder unnötige Aufnahmen in das Krankenhaus vermieden werden. Demenzverlauf, Funktionsniveau, neuropsychiatrische Symptome und Schmerzen bei Demenz stellen besondere Herausforderungen dar, wobei schon die Schmerzerfassung komplex ist. Der veränderte Schlaf im Alter und der Überverbrauch von Medikamenten sind weitere Schwerpunkte dieses Kapitels.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Literatur

  • Achterberg WP, Gambassi G, Finne-Soveri H et al (2010) Pain in European long-term care facilities: Cross-national study in Finland, Italy and the Netherlands. Pain 148(1):70–74

    Google Scholar 

  • AGS Panel (1998) The management of chronic pain in older persons. J Am Geriatr Soc 46:635–651

    Google Scholar 

  • AGS Panel (2009) Pharmacological Management of Persistent Pain in Older Persons. J Am Geriatr Soc 57:1331–1366

    Google Scholar 

  • Alldred DP, Raynor DK, Hughes C et al (2013) Interventions to optimise prescribing for older people in care homes. The Cochrane database of systematic reviews 2:Cd009095

    Google Scholar 

  • American Geriatrics Society (2012) Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60:616–631

    Google Scholar 

  • American Geriatrics Society Panel on Chronic Pain in Older Persons (1998) The Management of Chronic Pain in Older Persons. J Am Geriatr Soc 46:635–651

    Google Scholar 

  • Ancoli-Israel S, Cooke JR (2005) Prevalence and Comorbidity of Insomnia and Effect on Functioning in Elderly Populations. Journal of the American Geriatrics Society 53:S264–S271

    Google Scholar 

  • Anderson G (1997) Palliative care and the elderly. Rev Clin Gerontol 7:265–272

    Google Scholar 

  • Asolon CM (1998) Why? Pall Med12:195–196

    Google Scholar 

  • Benedetti F, Arduino C, Costa S et al (2006) Loss of expectation-related mechanisms in Alzheimer’s disease makes analgesic therapies less effective. Pain 121(1-2):133–144

    Google Scholar 

  • Bergh S, Engedal K, Roen I, Selbk G (2011) The course of neuropsychiatric symptoms in patients with dementia in Norwegian nursing homes. International Psychogeriatrics 23(8):1231–1239

    Google Scholar 

  • Bergh S, Selbaek G, Engedal K (2012) Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double blind, randomised, parallel group, placebo controlled trial. British Medical Journal 9:344

    Google Scholar 

  • Corbett A, Husebo B, Malcangio M et al (2012) Assessment and treatment of pain in people with dementia. Nat Rev Neurol 8(5):264–274

    Google Scholar 

  • Den Norske Legeforening (2002) Når du blir gammel og ingen vil ha deg. Oslo 109 pp

    Google Scholar 

  • Detering KM, Hancock AD, Reade MC, Silvester W. (2010) The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ 340:c1345. doi:10.1136/bmj.c1345

  • Fetveit A, Bjorvatn B. (2006) Sleep duration during the 24-hour day is associated with the severity of dementia in nursing home patients. Int J Geriatr Psychiatry 21:945–950

    Google Scholar 

  • Flo E, Gulla C, Husebo BS (2014) Effective pain management in patients with dementia: benefits beyond pain? Drugs Aging 31(12):863–871

    Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR. (1975) »Mini-mental state«. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Google Scholar 

  • Forbes S, Bern-Klug M, Gessert C (2000) End-of-Life Decision Making for Nursing Home Residents with Dementia. J Nurs Scholarsh 32:251–258. doi:10.1111/j.1547-5069.2000.00251.x

  • Froggatt K, Payne S (2006) A survey of end-of-life care in care homes: issues of definition and practice. Health Soc Care Community 14(4):341–348

    Google Scholar 

  • Hall S (2011) Palliative Care for Older People. Better Practices. World Health Organization. WHO Regional Office for Europe, Copenhagen, Denmark

    Google Scholar 

  • Hoffmann F, van den Bussche H, Wiese B et al (2014) Diagnoses indicating pain and analgesic drug prescription in patients with dementia: a comparison to age- and sex-matched controls. BMC Geriatr 14(1):20

    Google Scholar 

  • Houttekier D, Cohen J, Bilsen J et al (2010) Place of death of older persons with dementia. A study in five European countries. J Am Geriatr Soc 58(4):751–756

    Google Scholar 

  • Husebø BS, Achterberg WP, Lobbezoo F et al (2012) Pain Assessment and Treatment Challenges in Patients with Dementia. Zeitschr Neuropsychol 23 [4], 237–246

    Google Scholar 

  • Husebø BS, Ballard C, Aarsland D. (2011a) Pain treatment of agitation in patients with dementia: a systematic review. Int J Geriatr Psychiatry 2011 Feb 9

    Google Scholar 

  • Husebø BS, Ballard C, Cohen-Mansfield J, (2013a) The Response of Agitated Behavior to Pain Management in Persons with Dementia. Am J Geriatr Psychiatry 2013 Apr 20

    Google Scholar 

  • Husebø BS, Ballard C, Fritze F et al (2013b) Efficacy of pain treatment on mood syndrome in patients with dementia: a randomized clinical trial. Int J Geriatr Psychiatry 2013 Dec 19

    Google Scholar 

  • Husebø BS, Ballard C, Sandvik R et al (2011b) Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. British Medical Journal 343:1–10

    Google Scholar 

  • Husebø BS, Strand LI, Moe-Nilssen R et al (2007) Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (MOBID): Development and Validation of a Nurse-Administered Pain Assessment Tool for Use in Dementia. J Pain Sympt Manage 34(1):67–80

    Google Scholar 

  • Husebø BS, Strand LI, Moe-Nilssen R et al (2009) Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake. Scand J Caring Sci 24:380–391

    Google Scholar 

  • Husebø BS, Strand LI, Moe-Nilssen R et al (2010) Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) Pain Scale in a clinical setting. Scand J Caring Sci 24:380–391

    Google Scholar 

  • Husebø BS, Strand LI, Moe-Nilssen R et al (2008) Who suffers most? Dementia and pain in nursing home patients: A cross-sectional study. JAMDA 9(6):427–433

    Google Scholar 

  • Husebø Sandgathe B, Husebø S (2001) Palliativmedizin – auch im hohen Alter? Der Schmerz 5:350–357

    Google Scholar 

  • Husebø Sandgathe B, Husebø S (2002) Die letzten Tage und Stunden. Medlex Verlag, Oslo (zu beziehen von der Firma Grünenthal, Aachen)

    Google Scholar 

  • Husebø SB, Ostelo R, Strand LI (2014) The MOBID-2 Pain Scale: Reliability and Responsiveness to Pain in Patients with Dementia. Eur J Pain 18(10):1419-30. doi:10.1002/ejp.507. Epub 2014 May 5

  • Ingebretsen R, Solem PE (1998) Death, dying and bereavement. In: Nordhus IH, VandenBos GR, Berg S, Fromholt P (Hrsg) Clinical geropsychologie. American Psychological Association, Washington D

    Google Scholar 

  • Kendall M, Carduff E, Lloyd A et al (2014) Different dyings: living and dying with cancer, organ failure and physical frailty. BMJ Support Palliat Care Mar 4 Suppl 1:A12–A13

    Google Scholar 

  • Kunz M, Scharmann S, Hemmeter U et al (2007) The facial expression of pain in patients with dementia. Pain 133(1-3):221–228

    Google Scholar 

  • Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    Google Scholar 

  • Lynn J. (2001) Perspectives on care at the close of life. Serving patients who may die soon and their families: the role of hospice and other services. JAM 285:925–932

    Google Scholar 

  • Marschall VW, Levy JA (1990) Aging and dying. In Binstock RH (ed) Handbook of aging and the social sciences. Academic Press, San Diego, pp 245–260

    Google Scholar 

  • O’Mahony D, O’Sullivan D, Byrne S et al (2014) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing

    Google Scholar 

  • Rognstad S, Brekke M, Fetveit A et al (2009) The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. A modified Delphi study. Scand J Prim Health Care 27:153–159

    Google Scholar 

  • Sandvik RK, Selbaek G, Seifert R et al (2014) Impact of a stepwise protocol for treating pain on pain intensity in nursing home patients with dementia: A cluster randomized trial. Eur J Pain 13

    Google Scholar 

  • Saunders C (1999) Persönliche Mitteilung. Conference on Love, Bergen 26.6.99

    Google Scholar 

  • Sechster Bericht zur Lage der älteren Generation in der Bundesrepublik Deutschland: Risiken, Lebensqualität und die Versorgung Hochaltriger – unter besonderer Berücksichtigung demenzieller Erkrankungen, 17.04.2010, nur online

    Google Scholar 

  • Selbaek G, Engedal K. (2012) Stability of the factor structure of the Neuropsychiatric Inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia. International Psychogeriatrics 24(1):62–73

    Google Scholar 

  • Selbaek G, Kirkevold O, Engedal K (2007) The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. Int J Geriatr Psychiatry 22(9):843–849

    Google Scholar 

  • Selbaek G, Kirkevold O, Engedal K. (2008) The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes – A 12-month follow-up study. American Journal of Geriatric Psychiatry 16(7):528–536

    Google Scholar 

  • Sharp T, Moran E, Kuhn I, Barclay S (2013) Do the elderly have a voice? Advance care planning discussions with frail and older individuals: a systematic literature review and narrative synthesis. Br J Gen Pract 63:e657–68. doi:10.3399/bjgp13X673667

  • Soraas IA, Staurset HB, Slordal L et al (2014) Legemiddelinteraksjoner hos pasienter i sykehjem. Tidsskr Nor Legeforen 134:1041–1046

    Google Scholar 

  • Testad I, Corbett A, Aarsland D, (2014) The value of personalized psychosocial interventions to address behavioral and psychological symptoms in people with dementia living in care home settings: a systematic review. International Psychogeriatrics 26(7):1083–1098

    Google Scholar 

  • Tornstam G (1996) Gerotranscendence. J Aging Identity 1:37–50

    Google Scholar 

  • van der Steen JT, Radbruch L, Hertogh CMPM et al (2014) White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care. Palliative Medicine 28(3):197–209

    Google Scholar 

  • Vitiello MV, Borson S (2001) Sleep disturbances in patients with Alzheimer’s disease: epidemiology, pathophysiology and treatment. CNS Drugs. 2001 15:777–796

    Google Scholar 

  • Wallerstedt SM, Kindblom JM, Nylen K et al (2014) Medication reviews for nursing home residents to reduce mortality and hospitalization: systematic review and meta-analysis. Br J Clin Pharmacol 78:488–497

    Google Scholar 

  • Wilmsen-Neumann J, Husebø Sandgathe B (2002) Palliativmedizin auch für die sterbenden Alten! Klinikarzt, Stuttgart 257–261

    Google Scholar 

  • Zerzan J, Stearns S, Hanson L (2000) Access to palliative care and hospice in nursing homes. JAMA 284(19):2489–2494

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer-Verlag GmbH Deutschland

About this chapter

Cite this chapter

Sandgathe-Husebø, B., Husebø, S. (2017). Palliativmedizin im Pflegeheim – wie alte, schwer kranke Menschen leben und sterben. In: Husebø, S., Mathis, G. (eds) Palliativmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49039-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-49039-6_8

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-49038-9

  • Online ISBN: 978-3-662-49039-6

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics