COVID-19 aus Sicht der Geriatrie

AbstractThe pandemic due to the SARS-CoV-2 virus challenges all of us in the many areas of life. Our health systems are tested for their sustainability and load capacity. SARS-CoV-2 virus-infections will become part of our lives, but they mainly threaten vulnerable and multimorbid older adults. Older people with a frailty-syndrome are challenged not only in physical, but also psychological and social domains. Adapted caring structures are required and the pandemic will introduce important ethical discussions. As examples, distribution of limited resources, requests for more Advance Care Planning as well as balancing between infection protection versus the drawbacks of long-lasting social isolation should be named. This article therefore focuses on ethical questions for older adults in times of the SARS-CoV-2 virus pandemic.

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Preparing Spanish-speaking Older Adults for Advance Care Planning and Medical Decision-Making—The PREPARE Trial

10.25302/05.2020.cdr.130601500 ◽

2020 ◽

Author(s):

Rebecca Sudore ◽

Dean Schillinger ◽

Aiesha Volow ◽

Ying Shi ◽

John Boscardin ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Advance Care Planning ◽

Medical Decision Making ◽

Medical Decision ◽

Care Planning ◽

Spanish Speaking ◽

Advance Care

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Engagement in Advance Care Planning: The Association With Cognitive Impairment and Care Preferences

Innovation in Aging ◽

10.1093/geroni/igaa057.1347 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 417-418

Author(s):

Hyo Jung Lee ◽

Giyeon Kim

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Relative Risk ◽

End Of Life ◽

Advance Care Planning ◽

Multinomial Logistic Regression ◽

Quality Care ◽

Care Planning ◽

Advance Care ◽

Four Levels

Abstract Although there has been growing evidence that Advance care planning (ACP) benefits people with cognitive impairment nearing death, our understanding about this issue is still limited. This study examines whether cognitive impairment is associated with ACP engagement and end-of-life care preferences among older adults in the U.S. Using data from the 2012 National Health and Trends Study (n=1798, aged 65 to 101), we identified four levels of ACP engagement: None (28%), Informal ACP conversation only (12%), Formal ACP only (14%), and Both informal and formal ACP (46%). Older adults with None showed the highest prevalence of having cognitive impairment (17%), followed by those with Formal ACP only (15%) and the other two (6%, 6%). The results of Multinomial Logistic Regression showed that, compared to those without, respondents with cognitive impairment had 143% increased relative risk of having None (RR = 2.43, CI: 1.58-3.73) and 81% increased relative risk of completing Formal ACP only (RR = 1.81, CI: 1.11-2.95) relative to completing Both informal and formal ACP. In addition, respondents with None were more likely to prefer to receive all treatments available nearing death than those with any ACP engagement. Achieving high quality care at the end of life can be more challenging for older adults with cognitive impairment and their family caregivers due to the limited capacity. Although encouraged, informal ACP conversation with loved ones does not necessarily occur before the formal ACP, especially, for those with cognitive impairment. Therefore, they may merit more attention such as early ACP engagement.

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7 Exploring healthcare professionals’ attitudes to future care planning with older adults in hospital: qualitative research co-design through multi-professional patient and carer involvement

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-mariecurie.7 ◽

2018 ◽

Vol 8 (3) ◽

pp. 362.2-362

Author(s):

Anna-Maria Bielinska ◽

Stephanie Archer ◽

Catherine Urch ◽

Ara Darzi

Keyword(s):

Older Adults ◽

Decision Making ◽

End Of Life Care ◽

Healthcare Professionals ◽

List Type ◽

Care Planning ◽

Life Care ◽

Topic Guide ◽

Future Care ◽

Advance Care

IntroductionDespite evidence that advance care planning in older hospital inpatients improves the quality of end-of-life care (Detering 2010) future care planning (FCP) with older adults remains to be normalised in hospital culture. It is therefore crucial to understand the attitudes of healthcare professionals to FCP in older patients in the hospital setting. Co-design with patients carers and healthcare professionals can generate more detailed meaningful data through better conversations.AimsTo co-design a semi-structured interview (SSI) topic guide to explore healthcare professionals’ attitudes to FCP with older adults in hospital.MethodsA multi-professional research group including a panel of patient and carer representatives co-designed an in-depth topic guide for a SSI exploring healthcare professionals’ attitudes to FCP with older adults in hospital.ResultsThe co-designed topic guide encourages participants to explore personal and system-level factors that may influence attitudes to FCP and practice in hospital amongst healthcare staff. Co-designed topics for inclusion in the SSI schedule include:Potential differences between specialist and generalist approaches to FCPThe influence of perceived hierarchy and emergency–decision making ability in professionals on FCP discussionsThe relevance to transitions of careAttitudes to FCP beyond the biomedical paradigm including perceived well–being and psychosocial aspects of careDigital FCP tools including patient–led FCP.ConclusionCo-designing qualitative research with older people and multi-disciplinary professionals may narrow translational gaps in implementing FCP by setting joint research priorities. Data generated from a co-designed study may expand understanding of hospital-based anticipatory decision-making with older adults.Reference. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ23 March 2010;340:c1345.

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The PREPARE for Your Care program increases advance care planning engagement among diverse older adults with cancer

Cancer ◽

10.1002/cncr.33676 ◽

2021 ◽

Author(s):

Sarah S. Nouri ◽

Deborah E. Barnes ◽

Ying Shi ◽

Aiesha M. Volow ◽

Nikita Shirsat ◽

...

Keyword(s):

Older Adults ◽

Advance Care Planning ◽

Care Program ◽

Care Planning ◽

Advance Care

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The ‘loneliness pandemic’: implications for gerontological nursing

British Journal of Nursing ◽

10.12968/bjon.2021.30.11.652 ◽

2021 ◽

Vol 30 (11) ◽

pp. 652-655

Author(s):

Carlos Laranjeira

Keyword(s):

Mental Health ◽

Older Adults ◽

Older People ◽

Chronic Diseases ◽

Old Age ◽

Social Isolation ◽

Social Relationships ◽

Vulnerable Groups ◽

Negative Consequences ◽

Gerontological Nursing

The COVID-19 pandemic compelled states to limit free movement, in order to protect at-risk and more vulnerable groups, particularly older adults. Due to old age or debilitating chronic diseases, this group is also more vulnerable to loneliness (perceived discrepancy between actual and desired social relationships) and social isolation (feeling that one does not belong to society). This forced isolation has negative consequences for the health of older people, particularly their mental health. This is an especially challenging time for gerontological nursing, but it is also an opportunity for professionals to combat age stereotypes reinforced with COVID-19, to urge the measurement of loneliness and social isolation, and to rethink how to further adjust interventions in times of crisis, such as considering technology-mediated interventions in these uncertain times.

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