[Outpatient and inpatient medical care of the elderly]. / Ambulante und stationäre medizinische Versorgung im Alter.

This contribution discusses the outpatient and inpatient medical care of elderly patients in Germany. The paper first focuses on the increasing utilization of the two care sectors especially by the very old in the sense of a "geriatrization" of the system followed by a detailed analysis of the costs associated with a higher frequency of contact with the medical care system. On the one hand, the determining factor for outpatient treatment costs is more likely to be the patient's age rather than the type of disease. On the other hand it was found that inpatient treatment costs are associated more with closeness to death than with patient's age. A third central point beside these quantitative aspects continues to be the discussion about current deficits in the care of elderly patients. While the discussion on the outpatient medical care centers on physician-related factors and their influence on the quality of care exemplified by depression and dementia, the discussion on inpatient care focuses on structural problems. This is followed by the discussion of central organizational and research needs in the medical care of the elderly.

[High utilization of health care services by older adults]. / Alte Frauen und Männer mit starker Inanspruchnahme des Gesundheitswesens--Ein Beitrag zur altersspezifischen Versorgungsforschung.

Present discussions on health-care policy focus on fundamental restructuring, which will supposedly enable a more efficient provision of health care to patients with chronic ailments and also to elderly persons. Apart from increasing health care expenditure, the need for reform arises from demographically determined aging of the German population. A total of 54% of the 'GKV's' turnover in medical drugs is attributed to the health insurance agency's enrollees, who are aged 60 years and older, although they make up just 25% of total membership. Elderly men and women are therefore a significant group of health care users. In spite of its enormous political relevance, the provision of health care for the elderly has seen only marginal examination in Germany. This study on the "high utilization of health care services by older men and women" focuses on the examination of health care utilization by people aged 60 years and over. The following article will first introduce the study design. It will then review the literature on aging and health and on health care utilization by the elderly. The article goes on to present interim findings on the characteristics of the examined cohort and on ist consumption of medical drugs. The analysis is based on data regularly recorded by a North German health insurance agency. The examined cohort consists of 54% men and 46% women, whereby the average age is 68.3 years. The data analysis shows that 73,454 of the enrollees aged 60 years and older consumed 1,395,515 prescribed drugs in 2000. Each enrollee received an average of 19 medications annually; 5% of all those men and women examined received more than 58 medicines and were thus responsible for approximately a fifth of the volume in prescriptions. Of the drugs prescribed, 28.4% were for the treatment of cardio-vascular diseases, 13.9% for alimentary and metabolic disorders and 13.1% for the treatment of neurological diseases. Men and women aged 60 years and over are responsible for expenditure on medical drugs of 81,856,139 Deutsche Mark (41,926,298 Euro). On the average each enrollee generates costs of 1,114,00 Deutsche Mark (570 Euro), whereby every second one is responsible for an amount of less than 570 Deutsche Mark (291 Euro). A mere 5% of all enrollees is responsible for one third (32.1%) of the total drug expenditure. In closing the article will outline this research project's further course of action.

[Developoment of qualifications in German nursing care--results of current data analysis]. / Qualifikationsentwicklung in der deutschen Pflege--Ergebnisse einer aktuellen Datenanalyse.

Nursing provides a service catering to the needs of the individual and, as such, makes its own contribution towards community health care. Apart from organizational and instrumental determinants, manpower resources are of central significance in this context. The number of staff employed in nursing, their qualifications and competences are all factors which fundamentally influence the quality and efficiency of nursing care. Based on current data, the following article will first describe which manpower resources are available in the individual nursing sectors. It will then articulate as a central theme some of the main problems in professional training at the various levels (general, advanced and further education), including Germany's comparatively new university and college degrees in nursing. The results of our analysis indicate, on the one hand, that there is movement towards an improved professional profile in nursing, which could be classified as optimizing manpower resources. For example, far more than two thirds of all nursing staff and other care workers have completed three-year professional training courses. In addition, nursing trainees overproportionately graduate from junior levels of secondary schools. It may, furthermore, be noted that nursing continues to be in high demand as a vocational profession and that there has been a professional upgrade in particular at the teaching and leadership levels. On the other hand, however, we can make out anti-professional developments which contribute to an impairment of manpower resources in nursing. A comparison of 1996 and 1999 figures shows that the number of qualified staff in the care of the elderly has decreased whereas the number of untrained staff has increased by six times. In spite of heavier work loads there has been no increase in the number of staff and trainees in hospital nursing over the past few years. And, with the introduction of statutory insurance covering ongoing nursing care, various semi-professional trainee programs have emerged, leading to a partial displacement of qualified staff. In conclusion, the authors will reflect on how to overcome such developments and further optimize manpower resources in nursing.

Occurrence of 14 cases of bovine spongiform encephalopathy in a closed dairy herd.

Fourteen cases of bovine spongiform encephalopathy (BSE) were diagnosed on the basis of clinical examination in a closed herd of British Friesian cows during a 9-month period from October 1987 until June 1988. The diagnosis was confirmed on histopathological examination of brain tissue from five of the six samples submitted. The main presenting clinical signs were of altered behaviour: apprehension, anxiety and hyperaesthesia. One cow was euthanized after a short period of recumbency; the remaining 13 cows were slaughtered on humane or economic grounds. No protein of animal origin had been fed to either heifers or cows in this herd during the past 5 years and there had been no direct contact with sheep. The epidemiology of BSE in this report suggests that, if the postulate of Morgan (1988) is correct, infection is ingested within the first 6 months of life and there then follows a 4-5-year period before clinical signs appear.