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      Pflege-Report 2021 : Sicherstellung der Pflege: Bedarfslagen und Angebotsstrukturen 

      Vermeidung von Pflegebedürftigkeit – Herausforderungen für Forschung und Praxis

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          Zusammenfassung

          Die außergewöhnlich geburtenstarken Jahrgänge der 1955er bis 1965er Jahre werden in den kommenden zwei bis drei Jahrzehnten zu erheblichen Herausforderungen für das System pflegerischer Versorgung führen. So könnten sich etwa heute schon bestehende Versorgungslücken zwischen Angebotsstruktur und Nachfrage nach pflegerischen Leistungen deutlich verschärfen. Vor diesem Hintergrund ist es notwendig, nicht nur die Weiterentwicklung von Versorgungsstrukturen in den Blick zu nehmen, sondern auch Wege zu finden, die Nachfrage nach Pflegeleistungen zu reduzieren. Hierfür müssen präventive und rehabilitative Potenziale so weit ausgeschöpft werden, dass die Entstehung von Pflegebedürftigkeit vermieden, ihr Verlauf abgemildert oder ihr Eintritt verzögert werden kann.

          In diesem Zusammenhang muss die Forschung weitere Erkenntnisse zu den Entstehungsfaktoren einer Pflegebedürftigkeit liefern. Bislang fehlen vor allem Befunde zu sozialen Kontexten, in denen sich Verluste von funktionaler und kognitiver Gesundheit vollziehen, und Analysen, welche Rolle dabei einzelnen Faktoren für die Entstehung von Pflegebedarf zukommt. Ein vom Spitzenverband der gesetzlichen Krankenversicherung gefördertes Forschungsprojekt analysiert diese Zusammenhänge mit Blick auf präventive und rehabilitative Potenziale zur Vermeidung von Pflegebedürftigkeit. Ausgewählte Befunde zu Konstellationen in der Haushaltszusammensetzung und daran gebundener sozialer Unterstützung werden in diesem Beitrag skizziert und bezüglich ihrer Implikationen diskutiert. Ein markantes Ergebnis ist dabei die protektive Wirkung von Partnerschaften, respektive engen sozialen Beziehungen im Hinblick auf entstehende Pflegebedürftigkeit. Als eine wichtige Implikation ist hier die konsequente Stärkung von sozialen Unterstützungspotenzialen zu nennen, die insbesondere die Gruppe der Alleinlebenden fokussieren sollte, indem Wohn- und Lebenswelten zu fördern sind, die sich – äquivalent zu engen familialen Beziehungen – durch hohe protektive Potenziale für den Erhalt von Selbständigkeit auszeichnen.

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          Longitudinal Predictors of Functional Impairment in Older Adults in Europe – Evidence from the Survey of Health, Ageing and Retirement in Europe

          Objective To examine time-dependent predictors of functional impairment in older adults in Europe longitudinally. Methods Data were derived from the Survey of Health Ageing, and Retirement in Europe (2004–2013). Functional impairment was assessed by using activities of daily living (ADL) and instrumental activities of daily living (IADL) indices. Fixed effects regressions were used to estimate the effects of sociodemographic factors (age, marital status, living situation, and income deciles (median split)), lifestyle factors (smoking status and alcohol consumption per week), depression, cognitive function and chronic diseases on the outcome variables. Results Longitudinal regressions revealed that functional impairment increased significantly with age, the occurrence of depression, cognitive impairment, the number of chronic conditions, and less than daily alcohol consumption in the total sample and in both sexes. Moreover, the onset of smoking and living without a spouse/partner in household increased functional impairment in the total sample. The effect of depression on functional impairment was significantly more pronounced in men. Conclusion Our findings highlight the relevance of changes in age, depression, cognitive function, smoking and chronic diseases for functional impairment. Since particularly depression and smoking may be avoidable, developing strategies to prevent depression or stop smoking might be useful approaches to postpone functional impairment in older adults.
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            Multimorbidity and care dependence in older adults: a longitudinal analysis of findings from the 10/66 study

            Background In an ageing world facing an epidemic of chronic diseases, there is great interest in the burden of multimorbidity on individuals and caregivers, yet no studies have examined the longitudinal association between multimorbidity and care dependence in low and middle income countries. Mental and cognitive disorders are associated with dependence but little is known about their role in the pathway to dependence in the context of multimorbidity. This study aims to determine (1) the association of multimorbidity with the onset of care dependence in older adults, accounting for mortality and controlling for sociodemographic factors, and (2) the independent effects of physical multimorbidity, mental and cognitive disorders. Methods A population-based cohort study of people aged 65 years and older in six countries in Latin America, and China. Data on chronic conditions and sociodemographic factors were collected at baseline. Multimorbidity was ascertained as a count of up to 15 mental, cognitive and physical health conditions. Dependence was ascertained through informant interviews at baseline and follow-up. We used competing risk regression to assess the association between multimorbidity and the onset of care dependence, acknowledging the possibility of dependence-free death. We also assessed the independent effects of physical multimorbidity and depression, anxiety and dementia individually. Results 12,965 participants, with no needs for care at baseline, were followed up for a median of 3.0–4.9 years. Each unit increase in multimorbidity count increased the cumulative risk of dependence by 20% in the fully adjusted model. Age was the only variable to confound this relationship. Physical multimorbidity was associated with only a modest increased risk of care dependence. Dementia, depression and anxiety were independently associated with incident care dependence at every level of physical multimorbidity, and depression and anxiety attenuated the effect of physical multimorbidity. Conclusion Multimorbidity consistently predicts care dependence with little variation between countries. Physical multimorbidity imparts a lower risk than multimorbidity with mental and cognitive disorders included. Mental and cognitive disorders independently increase the risk of care dependence. Comprehensive and holistic assessment of disorders of body, brain and mind can help to identify older people at high risk of care dependence.
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              Can the higher risk of disability onset among older people who live alone be alleviated by strong social relations? A longitudinal study of non-disabled men and women.

              to investigate if the increased risk of disability onset among older people who live alone could possibly be moderated by either high social participation or by being satisfied with the social relations. logistic regression models were tested using two waves in a study population of 2,697 non-disabled older men and women from The Danish Longitudinal Study on Preventive Home Visits. living alone and low social participation were significant risk factors for later male disability onset. Not being satisfied with the social relations was significantly associated with onset of disability for both genders. Among men who lived alone low social participation was a significant predictor of disability onset [odds ratio, OR = 2.30 (1.00-5.29)]; for cohabiting men social participation was not associated with disability onset, [adjusted OR = 0.91 (0.49-1.71)]. Similar results were present concerning satisfaction with the social relations among men. There was no significant interaction for women. the study suggests that men who live alone can possibly alleviate their risk of disability onset by being socially active and by having access to satisfactory social relations. Women do not seem to benefit as much from cohabitation as men, although women who live alone and who are not satisfied with their social relations also constitute a significant risk category.
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                Author and book information

                Book Chapter
                2021
                June 29 2021
                : 91-102
                10.1007/978-3-662-63107-2_6
                a28f51f9-7239-4108-80a8-10896abe1f91
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