3    People in geriatric settings

By Dorothee von Moreau& Michael Keßler

The geriatric setting in residential homes and nursing homes, senior citizens’ day care facilities, specialist hospitals and rehabilitation clinics includes senior citizens with illnesses and illness-related limitations, specialist staff such as nurses and specialist therapists, social workers, pastoral workers, doctors, and also the relatives of the patients, volunteers, everyday companions and housekeepers. Some of these groups of people will be described in more detail below with their respective individual challenges and needs and the possibilities for interdisciplinary cooperation.

3.1   The patient

The patient is typically 70 years and older. Because of the higher life expectancy of women, the proportion of female residents is often considerably higher. From the age of 80 onwards, seniors are particularly vulnerable to the onset of illness due to the risk of complications and their resulting conditions, the risk of chronic illness, and the increased risk of loss of both autonomy and of the ability to engage in self-help practices (Neubart, et al., 2015).

However, according to the German Society of Geriatrics, the German Society of Gerontology and Geriatrics and the Geriatrics Association (BV Geriatrics),geriatric-related multimorbidity is more important than biological age. This stage is reached as soon as at least three relevant diseases such as hypertension, fat metabolism disorders, stroke, pneumonia, osteoporosis, bone fractures, atrial fibrillation, Parkinson’s disease, delirium, dementia, incontinence, sleep disorders or certain tumour diseases (Neubart, 2015) present simultaneously.

Frequently, those affected believe that the consequences of the disease compromise their quality of life to a greater extent than the disease itself does. The International Classification of Impairments, Disabilities and Handicaps (ICIDH) describes here a so-calledcascade model: a disease (e. g. brain tumour) causes damage (e. g. paralysis), which leads to disruptions in everyday abilities (e. g. inability to walk) resulting in a participation disorder (e. g. no possibility to attend a social afternoon for senior citizens).Neubart (2015) cites disruptions in mobility, daily activities and communication as well as problems in the processing ofdisease as capability disruptions, which can have a particularly limiting effect on the quality of life of geriatric patients. Preserving or improving quality of life is currently an important criterion for the evaluation of therapeutic interventions in geriatrics, as many chronic diseases cannot be cured or treated as aggressively in old age (Dichter et al., 2011;Dröes et al., 2006).

The following sections describe the most common age-related diseases and their effects on those affected in more detail.

Figure 3.1: In old age, maintaining quality of life is of great importance.

3.1.1  The dementia patient

Dementia (F00-F03) is manifested by disorders of cortical functions in memory, thinking, orientation, perception, arithmetic, learning, language and judgment. Cognitive deficits can also affect emotional regulation, social behaviour and motivation. Dementia can occur in neurodegenerative diseases such as Alzheimer’s disease, cerebrovascular disorders (e. g. vascular dementia), as well as other primary or secondary brain diseases. Tumours, hematomas or other spatial events can also be associated with dementia (DIMDI, 2018). Mixed forms are not uncommon. Depending on the type of dementia, there are different presentations of dementia. The classification into severity levels has therefore proven to be valid across the various forms of progression (Möller et al., 2015