[The care of obese persons from the perspective of executives of inpatient care facilities. Results of qualitative expert interviews]. / Versorgung adipöser Menschen aus der Perspektive von Leitungskräften vollstationärer Pflegeeinrichtungen. Ergebnisse qualitativer Experteninterviews.

BACKGROUND: Although nursing home residents are increasingly suffering from obesity, little research has been done on the appropriate care for them. The present study examines how executives of long-term care facilities perceive obese residents, which meaning does obesity have for them, and whether they associate the care of the obese with additional expenditures. MATERIALS AND METHODS: In all, 15 guideline-based interviews were conducted with executive managers of nursing homes in Berlin, Saxony and Bavaria. The analysis of the interviews was based on the method of Meuser and Nagel. RESULTS: The results demonstrate that obese nursing home residents are hardly noticed by executives. This results from the fact that they attribute only minor significance to obesity as a nutritional and health problem. The care of obese residents is associated with additional instrumental and personnel-related expenditures. However, facilities do not have sufficient resources to provide them. Obesity is a serious, but unrecognized problem in long-term care. CONCLUSION: To improve the awareness of obesity, intense professional discussions are required. The provision of additional instrumental and human resources becomes necessary to ensure appropriate care of obese nursing home residents.

[Temporal and structural differences in the care of obese and non-obese people in nursing homes]. / Zeitliche und strukturelle Unterschiede in der Pflege adipöser und nicht-adipöser Bewohner(innen) vollstationärer Pflegeeinrichtungen.

Obesity is a common disease in Germany. Although care facilities are confronted with an increasing number of obese people, the care of them in nursing homes is barely investigated. The present study examines the amount of work using the example of the activity of dressing obese and non-obese nursing home residents and discloses with its temporal and structural differences. In five nursing homes in Berlin a fully structured observational study based on a convenience sample was conducted. 48 nurses were observed while performing the activity of dressing 70 residents aged 65 years and older. The residents' demographic data and medical diagnoses were taken from the nursing records. Information about the functional/cognitive status and pain events were collected by using the interRAI Contact Assessment. Further data regarding the nurses were obtained through face-to-face interviews. The results show a significant correlation between Body Mass Index and the required time of dressing. No correlations exist between age, qualifications and nurses' level of education and the time of dressing. Structural differences in the care of obese and non-obese residents appear by changes of, single activity sequences. The care of the obese residents is associated with increased time requirements and structurally differs from the care of the non-obese residents. This should lead to further research because it has implications for staffing in nursing homes.

[Resident Assessment Instrument (RAI): a system for client evaluation and documentation in long-term care--an overview]. / Resident Assessment Instrument (RAI): System zur Klientenbeurteilung und Dokumentation in der Langzeitpflege--eine Ubersicht.

This article describes the interdisciplinary care planning system "Resident Assessment Instrument" (RAI) for nursing homes with its parts, the Health Care Financing Administration mandated "Minimum Data Set" (MDS) and the "Resident Assessment Protocols" (RAPs). The MDS-derived case mix system for resource allocation, the Resource Utilization Groups (RUGs), are mentioned. The prerequisites for an implementation of the F.R.G. are discussed.

[Unmerited inflation of health service use. Analysis of utilization of health care and services by the elderly]. / Die unverschuldete Anspruchsinflation. Analyse der Inanspruchnahme von Versorgung und Diensten durch alte Menschen.

This contribution deals with a burning issue of the "inadequate utilization" of services, especially with the phenomenon of so-called excessive use of services by certain old individuals. We investigate to what extent particular patterns of negotiation between the client and service provider may favour the increase of utilization. The contribution bases on an analysis of cases documented by the staff in two counseling institutions for old citizens in the course of one year. We could identify four patterns of interaction ("lagging", "keeping contact", "reassuring", and "symptom therapy") which predispose increase of utilization frequently. Two examples of these patterns--"lagging" and "keeping contact"--are explained in every detail. The contribution shows that not only structural factors of the care system but also the face-to-face interaction between clients and service providers may produce unwanted effects. The elimination of such effects must start with better understanding of the dynamics of the helping interaction.

[Significance of self-help groups for psychosocial rehabilitation in cancer]. / Die Bedeutung der Selbsthilfegruppen für die psychosoziale Rehabilitation bei Krebs.

Experiences of cancer patients' self-help groups can provide impulses for the programming of rehabilitation measures. Exemplary is the information work (information procurement and distribution) of these groups. Problems emanating from disturbed interpersonal relationships and the stigma of the disease are dealt with implicitly rather than explicitly, with only certain patients, however, benefitting selectively from this kind of coping, depending on the stage of the disease and on their social context. The groups succeed in substituting missing or disturbed interpersonal relationships, they sometimes however find it difficult to ward off those aspects of isolation that have arisen with the onset of the disease. These difficulties weigh on other parts of the informal network, especially on the families.

[Motor performance and motor handicaps in the 60 to 90-year-old urban population]. / Motorische Leistungsfähigkeit und motorische Behinderungen 60- bis 90jähriger Grossstadtbevölkerung.

The motor performance and ADL-abilities of 770 individuals age 60 to 90 were examined within a population study carried out in Berlin West. The results of the "Test for Measuring Motor Impairment in Prevalence Studies" (Jefferys et al. 1969) show the distribution of motor disabilities, impairments, and handicaps in the population and how it depends on the area of residence, sex, and age. The question to what extent the motor malfunction affects the capabilities in everyday self-maintenance (ADL-Index, self rating) is traced. Finally, the prevalence of different degrees of dependency is estimated for various age groups.

[Do the elderly receive adequate dental care? Determinants of the use of dental services by 60-to 90-year-old city dwellers. II]. / Sind ältere Menschen zahnärztlich adäquat versorgt? Determinanten der Inanspruchnahme zahnärztlicher Versorgung durch die 60- bis 90jährige Grossstadtbevölkerung--Teil II.

The article is a continuation of the analysis of the use of dental services by residents of a metropolitan area born between 1890 and 1919, published in issue 3 of this periodical. It involves a comparison of two different groups: the first--24.8% of the population under study--comprises "the users" of dental care without chewing difficulties; group 2 comprises test persons who, despite chewing complaints, do not seek treatment (10.4% of the population under study). While the first group presents in every respect the positive picture of aging, the second constitutes the real problem group. In its case the effects of poor social and economic living conditions are intensified by health as well as functional impairments. The absence of dental care seems to point in the first instance to problems of access to treatment.

[Do the elderly receive adequate dental care? Determinants of the use of dental services by urban dwellers aged between 60 and 90 - Part I (author's transl)]. / Sind ältere Menschen zahnärztlich adäquat versorgt? Determinanten der Inanspruchnahme zahnärztlicher Versorgung durch 60- bis 90jährige Grossstadtbevölkerung - Teil I.

The paper constitutes an extract from a field study carried out in Berlin (West), in which 1,512 persons aged between 60 and 90 were questioned and medically examined. One of the aims was to determine the relations obtaining between environmental conditions and the capacity of the elderly to preserve their own health. Part of this is the use of health services. The following presentation is an examination of the factors determining the use of dental care. Included were - chewing capacity (subjective chewing difficulties, medical assessment of chewing capacity, and of the dentures) - accessibility of dentists - socio-economic status health well-being - life satisfaction In the second part groups of test persons are compared, which differ from one another both in regard to utilization behavior, and to chewing capacity.

[Housing conditions and self care with the aged]. / Wohnbedingungen und Selbstversorgung im Alter.

The spatial and architectural characteristics as well as the facilities of flats and buildings occupied by the sixty-to-ninety-year-old metropolitan population are investigated, in order to determine a) the conditions under which the aged perform their basic household maintenance as well as their activities of every-day life; b) the (working) conditions under which specific ambulant services could be performed. The data were obtained from residents of different urban environments: 1. an inner-city area with predominantly old buildings, 2. a suburban new housing development. The control group was a sample of aged persons from the entire West Berlin area. The old urban region provides conditions, which place very high demands on the physical capabilities and constitute definite health hazards. Self-care under such conditions means "muddling through". The risk that even a minor physical disability would imply total dependence on care is considerable.