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

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. 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

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

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

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

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

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