Skip to main content

Palliativmedizin im Pflegeheim – wie alte, schwerkranke Menschen leben und sterben

  • Chapter
  • First Online:
Palliativmedizin

Zusammenfassung

Es besteht eine medizinische und soziale Ungerechtigkeit in der Behandlung alter Menschen. Die gesellschaftliche Entwicklung hat auch die ärztlichen Aufgaben verändert. Fest angestellte Heimärzte sorgen dafür, dass ein Standard für Behandlung und Kommunikation aufgebaut werden kann. Daraus resultierende Patientensicherheit verhindert, dass eine unnötige Verschlechterung des Gesundheitszustandes oder unnötige Aufnahmen in das Krankenhaus vermieden werden. Demenzverlauf, Funktionsniveau, neuropsychiatrische Symptome und Schmerzen bei Demenz stellen besondere Herausforderungen dar, wobei schon die Schmerzerfassung komplex ist. Der veränderte Schlaf im Alter und der Überverbrauch von Medikamenten sind weitere Schwerpunkte dieses Kapitels.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 49.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Literatur

  • Aasmul I, Husebo BS, Sampson EL, Flo E (2018) Advance care planning in nursing homes–Improving the communication among patient, family, and staff: Results from a cluster randomized controlled trial (COSMOS). Front Psychol 9:2284

    Article  PubMed  PubMed Central  Google Scholar 

  • Achterberg WP, Erdal A, Husebo BS, Kunz M, Lautenbacher S (2021) Are chronic pain patients with dementia being undermedicated? J Pain Res 14:431–439

    Article  PubMed  PubMed Central  Google Scholar 

  • AGS Panel (1998) The management of chronic pain in older persons. J Am Geriatr Soc 46:635–651

    Article  Google Scholar 

  • AGS Panel (2009) Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 57:1331–1366

    Article  Google Scholar 

  • Alldred DP, Raynor DK, Hughes C et al (2013) Interventions to optimise prescribing for older people in care homes. Cochrane Database Systemat Rev 2:Cd009095

    Google Scholar 

  • American Geriatrics Society (2012) Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60:616–631

    Google Scholar 

  • American Geriatrics Society Panel on Chronic Pain in Older Persons (1998) The management of chronic pain in older persons. J Am Geriatr Soc 46:635–651

    Google Scholar 

  • Ancoli-Israel S, Cooke JR (2005) Prevalence and comorbidity of insomnia and effect on functioning in elderly populations. J Am Geriatr Soc 53:S264–S271

    Article  PubMed  Google Scholar 

  • Anderson G (1997) Palliative care and the elderly. Rev Clin Gerontol 7:265–272

    Google Scholar 

  • Asolon CM (1998) Why? Pall Med 12:195–196

    Google Scholar 

  • Benedetti F, Arduino C, Costa S et al (2006) Loss of expectation-related mechanisms in Alzheimer’s disease makes analgesic therapies less effective. Pain 121(1–2):133–144

    Article  CAS  PubMed  Google Scholar 

  • Bergh S, Engedal K, Roen I, Selbk G (2011) The course of neuropsychiatric symptoms in patients with dementia in Norwegian nursing homes. Int Psychogeriatr 23(8):1231–1239

    Article  PubMed  Google Scholar 

  • Bergh S, Selbaek G, Engedal K (2012) Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double blind, randomised, parallel group, placebo controlled trial. BMJ 9:344

    Google Scholar 

  • Corbett A, Husebo B, Malcangio M et al (2012) Assessment and treatment of pain in people with dementia. Nat Rev Neurol 8(5):264–274

    Article  CAS  PubMed  Google Scholar 

  • Den Norske Legeforening (2002) Når du blir gammel og ingen vil ha deg. Oslo S 109

    Google Scholar 

  • Detering KM, Hancock AD, Reade MC, Silvester W (2010) The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ 340:c1345. https://doi.org/10.1136/bmj.c1345

    Article  PubMed  PubMed Central  Google Scholar 

  • Erdal A, Flo E, Aarsland D, Ballard C, Slettebo DD, Husebo BS (2018a) Efficacy and safety of analgesic treatment for depression in people with advanced dementia: randomised, multicentre, double-blind, placebo-controlled trial (DEP.PAIN.DEM). Drugs Aging 35(6):545–558

    Google Scholar 

  • Erdal A, Flo E, Aarsland D, Selbaek G, Ballard C, Slettebo DD, et al (2018b) Tolerability of buprenorphine transdermal system in nursing home patients with advanced dementia: a randomized, placebo-controlled trial (DEP.PAIN.DEM). Clin Interv Aging 13:935–946

    Google Scholar 

  • Eriksen S, Grov EK, Lichtwarck B, Holmefoss I, Bohn K, Myrstad C, et al (2020) Palliative treatment and care for dying nursing home patients with COVID-19. Tidsskr Nor Laegeforen 140(8)

    Google Scholar 

  • Fetveit A, Bjorvatn B (2006) Sleep duration during the 24-hour day is associated with the severity of dementia in nursing home patients. Int J Geriatr Psychiatry 21:945–950

    Article  PubMed  Google Scholar 

  • Flo E, Gulla C, Husebo BS (2014) Effective pain management in patients with dementia: benefits beyond pain? Drugs Aging 31(12):863–871

    Article  CAS  PubMed  Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR (1975) »Mini-mental state«. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  • Forbes S, Bern-Klug M, Gessert C (2000) End-of-life decision making for nursing home residents with dementia. J Nurs Scholarsh 32:251–258. https://doi.org/10.1111/j.1547-5069.2000.00251.x

    Article  CAS  PubMed  Google Scholar 

  • Froggatt K, Payne S (2006) A survey of end-of-life care in care homes: issues of definition and practice. Health Soc Care Community 14(4):341–348

    Article  PubMed  Google Scholar 

  • Gulla C, Flo E, Kjome RL, Husebo BS (2018) Deprescribing antihypertensive treatment in nursing home patients and the effect on blood pressure. J Geriatr Cardiol 15(4):275–283

    PubMed  PubMed Central  Google Scholar 

  • Gulla C, Flo E, Kjome RLS, Husebo BS (2019) Implementing a novel strategy for interprofessional medication review using collegial mentoring and systematic clinical evaluation in nursing homes (COSMOS). BMC Geriatr 19(1):130

    Article  PubMed  PubMed Central  Google Scholar 

  • Gulla C, Selbaek G, Flo E, Kjome R, Kirkevold O, Husebo BS (2016) Multi-psychotropic drug prescription and the association to neuropsychiatric symptoms in three Norwegian nursing home cohorts between 2004 and 2011. BMC Geriatr 16:115

    Article  PubMed  PubMed Central  Google Scholar 

  • Hall S (2011) Palliative care for older people. Better practices. World Health Organization. WHO Regional Office for Europe, Copenhagen, Denmark

    Google Scholar 

  • Hoffmann F, van den Bussche H, Wiese B et al (2014) Diagnoses indicating pain and analgesic drug prescription in patients with dementia: a comparison to age- and sex-matched controls. BMC Geriatr 14(1):20

    Article  PubMed  PubMed Central  Google Scholar 

  • Houttekier D, Cohen J, Bilsen J et al (2010) Place of death of older persons with dementia. A study in five European countries. J Am Geriatr Soc 58(4):751–756

    Google Scholar 

  • Husebø BS, Achterberg WP, Lobbezoo F et al (2012) Pain assessment and treatment challenges in patients with dementia. Zeitschr Neuropsychol 23(4):237–246

    Google Scholar 

  • Husebo BS, Allore H, Achterberg W, Angeles RC, Ballard C, Bruvik FK, et al (2020) LIVE@Home.Path-innovating the clinical pathway for home-dwelling people with dementia and their caregivers: study protocol for a mixed-method, stepped-wedge, randomized controlled trial. Trials 21(1):510

    Google Scholar 

  • Husebo BS, Ballard C, Aarsland D, Selbaek G, Slettebo DD, Gulla C et al (2019a) The effect of a multicomponent intervention on quality of life in residents of nursing homes: A randomized controlled trial (COSMOS). J Am Med Dir Assoc 20(3):330–339

    Article  PubMed  Google Scholar 

  • Husebø BS, Ballard C, Aarsland D (2011a) Pain treatment of agitation in patients with dementia: a systematic review. Int J Geriatr Psychiatry 26(10):1012–1018

    Google Scholar 

  • Husebø BS, Ballard C, Cohen-Mansfield J (2013a) The response of agitated behavior to pain management in persons with dementia. Am J Geriatr Psychiatry 22(7):708–717

    Google Scholar 

  • Husebø BS, Ballard C, Fritze F et al (2013b) Efficacy of pain treatment on mood syndrome in patients with dementia: a randomized clinical trial. Int J Geriatr Psychiatry 29(8):828–836

    Google Scholar 

  • Husebø BS, Ballard C, Sandvik R et al (2011b) Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ 343:1–10

    Article  Google Scholar 

  • Husebo BS, Berge LI (2020) Intensive medicine and nursing home care in times of sars cov-2: a norwegian perspective. Am J Geriatr Psychiatry 28(7):792–793

    Article  PubMed  PubMed Central  Google Scholar 

  • Husebo BS, Heintz HL, Berge LI, Owoyemi P, Rahman AT, Vahia IV (2019b) Sensing technology to monitor behavioral and psychological symptoms and to assess treatment response in people with dementia a systematic review. Front Pharmacol 10:1699

    Article  PubMed  Google Scholar 

  • Husebø BS, Strand LI, Moe-Nilssen R et al (2007) Mobilization-observation-behavior-intensity-dementia pain scale (MOBID): Development and validation of a nurse-administered pain assessment tool for use in dementia. J Pain Sympt Manage 34(1):67–80

    Article  Google Scholar 

  • Husebø BS, Strand LI, Moe-Nilssen R et al (2008) Who suffers most? Dementia and pain in nursing home patients: A cross-sectional study. JAMDA 9(6):427–433

    PubMed  Google Scholar 

  • Husebø BS, Strand LI, Moe-Nilssen R et al (2009) Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID pain scale by video uptake. Scand J Caring Sci 24:380–391

    Google Scholar 

  • Husebø BS, Strand LI, Moe-Nilssen R et al (2010) Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) pain scale in a clinical setting. Scand J Caring Sci 24:380–391

    Article  PubMed  Google Scholar 

  • Husebø Sandgathe B, Husebø S (2001) Palliativmedizin – auch im hohen Alter? Der Schmerz 5:350–357

    Article  Google Scholar 

  • Husebø Sandgathe B, Husebø S (2002) Die letzten Tage und Stunden. Medlex Verlag, Oslo (zu beziehen von der Firma Grünenthal, Aachen)

    Google Scholar 

  • Husebø SB, Ostelo R, Strand LI (2014) The MOBID-2 pain scale: Reliability and responsiveness to pain in patients with dementia. Eur J Pain 18(10):1419–1430. https://doi.org/10.1002/ejp.507 Epub 2014 May 5

    Article  PubMed  PubMed Central  Google Scholar 

  • Ingebretsen R, Solem PE (1998) Death, dying and bereavement. In: Nordhus IH, VandenBos GR, Berg S, Fromholt P (Hrsg) Clinical geropsychologie. American Psychological Association, Washington D

    Google Scholar 

  • Kendall M, Carduff E, Lloyd A et al (2014) Different dyings: living and dying with cancer, organ failure and physical frailty. BMJ Support Palliat Care Suppl 1:A12–A13

    Google Scholar 

  • Kjellstadli C, Husebo BS, Sandvik H, Flo E, Hunskaar S (2018) Comparing unplanned and potentially planned home deaths: a population-based cross-sectional study. BMC Palliat Care 17(1):69

    Article  PubMed  PubMed Central  Google Scholar 

  • Kunz M, Scharmann S, Hemmeter U et al (2007) The facial expression of pain in patients with dementia. Pain 133(1–3):221–228

    Article  PubMed  Google Scholar 

  • Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    Article  CAS  PubMed  Google Scholar 

  • Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S et al (2020) Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 396(10248):413–446

    Article  PubMed  PubMed Central  Google Scholar 

  • Lynn J (2001) Perspectives on care at the close of life. Serving patients who may die soon and their families: the role of hospice and other services. JAM 285:925–932

    Article  CAS  Google Scholar 

  • MacNeil Vroomen JL, Kjellstadli C, Allore HG, van der Steen JT, Husebo B (2020) Reform influences location of death: Interrupted time-series analysis on older adults and persons with dementia. PLoS ONE 15(11):e0241132

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Marschall VW, Levy JA (1990) Aging and dying. In: Binstock RH (Hrsg) Handbook of aging and the social sciences. Academic, San Diego, S 245–260

    Google Scholar 

  • O’Mahony D, O’Sullivan D, Byrne S et al (2014) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing

    Google Scholar 

  • Puaschitz NG, Jacobsen FF, Mannseth J, Angeles RC, Berge LI, Gedde MH, et al (2021) Factors associated with access to assistive technology and telecare in home-dwelling people with dementia: baseline data from the LIVE@Home.Path trial. BMC Med Inform Decis Mak 21(1):264

    Google Scholar 

  • Rognstad S, Brekke M, Fetveit A et al (2009) The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. A modified Delphi study. Scand J Prim Health Care 27:153–159

    Article  PubMed  PubMed Central  Google Scholar 

  • Sallnow L, Smith R, Ahmedzai SH, Bhadelia A, Chamberlain C, Cong Y, et al. (2022) Report of the lancet commission on the value of death: bringing death back into life. Lancet 399(10327):837–884

    Google Scholar 

  • Sandvik R, Selbaek G, Kirkevold O, Aarsland D, Husebo BS (2016) Analgesic prescribing patterns in Norwegian nursing homes from 2000 to 2011: trend analyses of four data samples. Age Ageing 45(1):54–60

    Article  PubMed  Google Scholar 

  • Sandvik RK, Selbaek G, Seifert R et al (2014) Impact of a stepwise protocol for treating pain on pain intensity in nursing home patients with dementia: A cluster randomized trial. Eur J Pain 18(10):1490–1500

    Google Scholar 

  • Saunders C (1999) Persönliche Mitteilung. Conference on Love, Bergen 26. 06. 1999 Sechster Bericht zur Lage der älteren Generation in der Bundesrepublik Deutschland: Risiken, Lebensqualität und die Versorgung Hochaltriger – unter besonderer Berücksichtigung demenzieller Erkrankungen, 17.04.2010, nur online

    Google Scholar 

  • Selbaek G, Engedal K (2012) Stability of the factor structure of the Neuropsychiatric Inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia. Int Psychogeriatr 24(1):62–73

    Article  PubMed  Google Scholar 

  • Selbaek G, Kirkevold O, Engedal K (2007) The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. Int J Geriatr Psychiatry 22(9):843–849

    Article  PubMed  Google Scholar 

  • Selbaek G, Kirkevold O, Engedal K (2008) The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes – A 12-month follow-up study. American Journal of Geriatric Psychiatry 16(7):528–536

    Article  Google Scholar 

  • Sharp T, Moran E, Kuhn I, Barclay S (2013) Do the elderly have a voice? Advance care planning discussions with frail and older individuals: a systematic literature review and narrative synthesis. Br J Gen Pract 63:e657–e668. https://doi.org/10.3399/bjgp13X673667

    Article  PubMed  PubMed Central  Google Scholar 

  • Testad I, Corbett A, Aarsland D (2014) The value of personalized psychosocial interventions to address behavioral and psychological symptoms in people with dementia living in care home settings: a systematic review. Int Psychogeriatr 26(7):1083–1098

    Article  PubMed  Google Scholar 

  • Tornstam G (1996) Gerotranscendence. J Aging Identity 1:37–50

    Google Scholar 

  • van der Steen JT, Radbruch L, Hertogh CMPM et al (2014) White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care. Palliat Med 28(3):197–209

    Article  PubMed  Google Scholar 

  • Vitiello MV, Borson S (2001) Sleep disturbances in patients with Alzheimer’s disease: epidemiology, pathophysiology and treatment. CNS Drugs 15:777–796

    Google Scholar 

  • Wallerstedt SM, Kindblom JM, Nylen K et al (2014) Medication reviews for nursing home residents to reduce mortality and hospitalization: systematic review and meta-analysis. Br J Clin Pharmacol 78:488–497

    Article  PubMed  PubMed Central  Google Scholar 

  • Zerzan J, Stearns S, Hanson L (2000) Access to palliative care and hospice in nursing homes. JAMA 284(19):2489–2494

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bettina Sandgathe-Husebø .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Der/die Autor(en), exklusiv lizenziert an Springer-Verlag GmbH, DE, ein Teil von Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sandgathe-Husebø, B., Husebø, S. (2023). Palliativmedizin im Pflegeheim – wie alte, schwerkranke Menschen leben und sterben. In: Husebø, S., Mathis, G., Masel, E.K. (eds) Palliativmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-65768-3_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-65768-3_8

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-65767-6

  • Online ISBN: 978-3-662-65768-3

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics