Eine unmögliche Herausforderung

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1 Eine unmögliche Herausforderung
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

2 Overview Definitions and Disambiguations Facts Epidemiology Tools
Health Care Settings Qualification Political Dimension Phenomens around mental disorders Stigma Violence Conclusion Literature

3 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

4 Definitions and Disambiguations
The biological age The social age The subjective apperception Gesundheitsberichterstattung des Bundes 2009:Gesundheit und Krankheit im Alter S. 32

5 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

6 Facts about mental disorders
8 million germans with mental disorders, nearly 10 % of the population. 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 Statistisches Bundesamt 2009: Gesundheit auf einen Blick, S.12-13

7 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

8 Berliner Altersstudie (N = 514)
Gesundheitsberichterstattung des Bundes( 2009), Gesundheit und Krankheit im Alter S. 35

9 Research E. Feldhaus-Plumin 2012

10 Tools für detection... Family Patient Institutional standards Doctor
Psychiatrist/Psychologist Medication ...

11 Statistic about Psychiatric drugs in the years 2000 to 2006 in Berlin

12 Health Care Settings Out-Patient structures In-Patient structures
Nursing homes Various settings like living-groups etc.

13 Out-Patient structures
Nearly 70 % from patients at home Support from community care system day care; night care Gerontological-psychiatrical ambulatories

14 In-Patient structures
Specialized clinics f.e. gerontopsychiatrical departments or wards hospital structures especially for diagnosis and patients with multimorbidity

15 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

16 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

17 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

18 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

19 Political dimension Reforms in the health care system
Integrated care system (Integrierte Versorgung) Casemanagement Clinical Pathways topics: Demographic change, dementia, need of care

20 Phenomens around mental disorders
Stigma Violence

21 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.

22 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

23 Conclusions Why? Phenomens Stigma and Violence Goals
Professionalizing the nursing Research Political responsibility Awareness rising

24 Literature [1] Gesundheitsberichterstattung des Bundes 2009: Gesundheit und Krankheit im Alter S. 32 [2] The United States Department of Health and Human Services 2012: Mental Health - A Report of the Surgeon General. Chapter 2: The Fundamentals of Mental Health and Mental Illness. pp 39 Retrieved May 21, 2012 [3] Carone G, Costello D, Guardia ND, Mourre G, Pryzwara B, Salomaki A 2005: The economic impact of aging populations in the EU25 Member states. European Commission Economic Papers No. 236: December 2005; Brussels: Directorate General for Economic and Financial Affairs [4] WHO International Consortium in Psychiatric Epidemiology 2000: Cross-national comparisons of the prevalences and correlates of mental disorders, Bulletin of the World Health Organization v. 78 n. 4 [5] Statistisches Bundesamt 2009: Gesundheit auf einen Blick, S.12-13 [6] Fink, W., Haidinger, G. 2007: Die Häufigkeit von Gesundheitsstörungen in 10 Jahren Allgemeinpraxis. Z. Allg. Med. 83/200, S.102–108. Zit. N.: Womit sich Hausärzte hauptsächlich beschäftigen. MMW-Fortschr. Med. Nr. 16, 149. Jg. [7] Immer mehr Depressive. Die tageszeitung, 7. Mai 2009 [8] Mehr Fehltage durch psychische Leiden. Süddeutsche Zeitung, 3. Januar 2007, S. 20 [9] Gesundheitsberichterstattung des Bundes 2009: Gesundheit und Krankheit im Alter S. 35 [10] Gesundheitsberichterstattung Berlin 2008: Basisbericht [11] Winkler, Richter, Angermeyer: Gesundheitswesen Stuttgart: Thieme [12] Klie/Schuhmacher In: Gesundheitsberichterstattung des Bundes [13] Bundesgesundheitsministerium 2010: Seelische Gesundheit. DAK-Gesundheitsreport [14] The United States Department of Health and Human Services 2012: Mental Health - A Report of the Surgeon General. Chapter 8. Retrieved May 21, 2012

25 [15] Stuart H 2006: Mental illness and employment discrimination
[15] Stuart H 2006: Mental illness and employment discrimination. Curr Opin Psychiatry 19/5: 522–6. September [16] Lucas, Clay 2012: Stigma hurts job prospects. Retrieved 13 October 2012. [17] Read J, Haslam N, Sayce L, Davies E (November 2006). "Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach". Acta Psychiatr Scand 114 (5): 303–18. doi: /j x. PMID [18] Angermeyer M. 2004: Psychiatrische Praxis. Thieme. Stuttgart [19] , last access [20] Elbogen EB, Johnson SC 2009: The intricate link between violence and mental disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch. Gen. Psychiatry 66 (2): 152–61. doi: /archgenpsychiatry PMID [21] Stuart H., 2003: Violence and mental illness: an overview. World Psychiatry 2 (2), June: 121–124. PMC PMID [22] Brekke JS, Prindle C, Bae SW, Long JD 2001: Risks for individuals with schizophrenia who are living in the community. Psychiatr Serv 52 (10): 1358–66. doi: /appi.ps PMID [23] Solomon, PL., Cavanaugh, MM., Gelles, RJ. 2005: Family Violence among Adults with Severe Mental Illness. Trauma, Violence, & Abuse 6 (1): 40–54. doi: / PMID [24] Chou KR, Lu RB, Chang M "Assaultive behavior by psychiatric in-patients and its related factors". J Nurs Res 9 (5) December: 139–51. doi: /01.JNR PMID [25] B. Lögdberg, L.-L. Nilsson, M. T. Levander, S. Levander 2004: Schizophrenia, neighborhood, and crime. Acta Psychiatrica Scandinavica 110 (2): 92. doi: /j x/abs/. [26] Räsanen, P./Tiihonen, J./Isohanni, M. et al 1998: Schizophrenia, Alcohol Abuse and Violent Behaviour: A year followup study of an Unselected Birth Cohort. Schizophrenia Bulletin [27] Chou, K./Kaas, M./Richie, M.F. 1996: Assaultive Behaviour in Geriatric Patients. Journal of Gerontological Nursing. 22 (1), 30-38