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A Kruse

Publications and source records attributed to A Kruse.

At least 19 recordsLinked to original sources
PubMed2006

[Old age policy and health].

Proceeding from a comprehensive definition of health which differentiates between personal and environmental aspects and which is explicitly not restricted to the absence of disease, age-related changes in functional capacity and characteristic diseases are discussed. To maintain or re-establish independency is said to be much more important than in the case of younger age groups because of the high prevalence of chronic diseases in old age. Discussing the development of costs in the health care system it is demonstrated that a considerable amount of the increasing costs for treatment in higher age groups is due to the higher portion of those who will die in the following years. As a consequence, an explosion of health care costs might be a too pessimistic scenario. The hypothesis of a compression of morbidity is discussed as a more optimistic perspective on cost development. Three additional parts deal with problems of German nursing care insurance, propositions for an integrative concept of preventive and rehabilitative care, and tasks and challenges of palliative care. The final part of this contribution inquires into priorities of future political action on the societal level, the level of public supplies, the personal level, and the family level.

Aged↗
PubMed2006

[Persons with dementia in individual everyday situations. First results of an intervention study].

First outcomes of a current intervention study focussing on emotions of nursing home residents with mild, moderate and severe dementia are discussed in the present contribution. The aim of the study was to prove the effect from an individual approach in the care of people with dementia. By promoting individual everyday situations for each resident, positive emotions should be stimulated and individual well-being should be improved. Findings show the possibility to gain such individual everyday-situations for people with mild, moderate and severe dementia, which stimulate positive reactions and may be integrated into the care process. Of particular importance are those positive situations which focus on the communication between nurses and residents or in which the residents receive personal attention from nurses.

Activities of Daily Living↗
PubMed2006

[The impact of different reference groups for the assessment of quality of life in people suffering from dementia-determination of competence groups with HILDE].

The HILDE project proceeds from a theoretical conception of quality of life which considers both the significance of objective living conditions claimed in the Swedish level of living approach and the significance of processes of subjective perceptions and judgements accentuated in the American quality of life approach. Since component definitions of quality of life regularly fail to reflect empirical relationships between the differentiated aspects, quality of life is defined as a constellation of personal and environmental material and immaterial resources and subjective wellbeing. Under the assumption that an adequate assessment of quality of life of people with dementia can not exclusively be based on their cognitive impairment, i.e. their stage of the disease, but must also reflect the realisation of individual preferences in a given life situation, the empirical portion of this contribution identifies and independently cross-validates in random subsamples four patterns of competence in a sample of 362 nursing home residents suffering from dementia. Each of these four different dementia syndrome groups is characterised by specific needs and values. They can be used as a point of reference within as well as between these competence groups, in order to plan individual interventions with competence-oriented expectations.

Aged↗
PubMed2006

[Rehabilitation processes and sustainability: first results of a rehabilitation study of geriatric stroke patients].

A rehabilitation care management oriented towards the severity of the disease, the individual competence and the patient's needs essentially improves the effectivity and the sustainability of inpatient rehabilitation. The Institute of Gerontology of the University of Heidelberg is developing an assessment for elderly stroke patients to optimize placement decision by an early rehabilitation prognosis. Data concerning functional, cognitive and psychological status were collected in 267 patients participating in a postacute rehabilitation program on admission, after two weeks and on discharge and six weeks later. In this article are presented the study design and patients' characteristics during the rehabilitation process. The first assessment at admission gives important information about the sustainability of the ADL-competence after discharge. Severe stroke, premorbid ADL-competence, cognitive impairment, communication problems, depression and higher age were found to be predictors for the outcome of the rehabilitation process.

Aged↗
PubMed2006

Frequent occurrence of pituitary apoplexy in patients with non-functioning pituitary adenoma.

BACKGROUND AND OBJECTIVE: There is agreement in the literature that pituitary apoplexy is a rare disorder. As our experience differs from this view, we analysed the incidence in patients operated on for a nonfunctioning pituitary adenoma. PATIENTS AND DESIGN: One hundred ninety-two consecutive patients with a suprasellar, clinically inactive adenoma operated on during the period 1985-1996 were retrospectively reviewed. A diagnosis of pituitary apoplexy was made from relevant neurological symptoms together with pertinent findings at operation. RESULTS: Pituitary apoplexy occurred in 41 patients (21%), in 23 patients within 12 days prior to the operation. The male/female ratio was 1.9. Median follow-up time was 13.7 years (range 8.9-19.9). During this period, 12 patients had died, yielding a standard mortality ratio of 1.09 (95% CI 0.62-1.92), similar to that in the patients who had not sustained pituitary apoplexy. Postoperatively, 24% of the patients had normal pituitary function, 38% were panhypopituitary and partial pituitary insufficiency was present in 38%. Subnormal GH secretion was present in virtually all patients tested. Two patients died within 60 days of surgery and in two no or incomplete data were available, although they most likely were panhypopituitary. CONCLUSION: Most of our findings add little to what is known about pituitary apoplexy. On one point, however, they are contrary to previously presented data. We found a much higher incidence of pituitary apoplexy despite rather rigorous criteria for the diagnosis. The outcome as regards survival and endocrine function was not different from that in patients with a nonfunctioning adenoma who did not suffer pituitary apoplexy.

Adenoma↗
PubMed2006

Hypopituitarism and mortality in pituitary adenoma.

BACKGROUND AND OBJECTIVE: Previous studies on hypopituitarism and mortality have concluded that insufficient pituitary function is associated with decreased survival. For several reasons the results are difficult to compare - particularly because definitions and treatment of hypopituitarism have varied and various underlying disorders have been included. The purpose was to assess the relationship between mortality and pituitary function. PATIENTS AND DESIGN: One hundred and sixty consecutive patients (99 men and 61 women) with functionless, suprasellar pituitary adenoma. All were operated on transsphenoidally during the period 1985-1996. Additional radiotherapy was given to 29 patients. Mortality was calculated 12.4 years (median, range 8.1-19.9) after operation. Postoperative hormonal deficits were treated in most, though GH substitution was given only to a minority of patients. RESULTS: Postoperatively 30% of the patients had normal pituitary function (normal adrenocortical, thyroid and gonadal function), 26% were panhypopituitary and 36% had partial pituitary insufficiency. Forty-one patients had died (34.7 expected) yielding a standard mortality ratio (SMR) of 1.18 (95% confidence limits (CI) 0.87-1.60). SMR was significantly increased in women (1.97, CI 1.20-3.21) but not in men (0.83, CI 0.55-1.26). SMR in patients with normal pituitary function, panhypopituitarism and partial insufficiency were not different from that in the general population. SMR in hypopituitary women was substantially higher than in men with pituitary insufficiency. Treatment with growth hormone in GH-deficient patients did not influence survival. CONCLUSION: Pituitary surgery for nonfunctioning adenoma and subsequent pituitary insufficiency had no effect on mortality in men, but was associated with significantly increased mortality in women. Suboptimal hormonal substitution in women may play a role.

Adenoma↗
PubMed2006

Diabetes and risk of acute infectious conjunctivitis--a population-based case-control study.

AIMS: To examine whether diabetes mellitus is associated with an increased risk of acute infectious conjunctivitis (AIC) in adults, as measured by treatment with topical ocular antibiotics. METHODS: A population-based, case-control study in North Jutland County, Denmark. Incident cases of AIC were defined as persons aged more than 15 years redeeming a first-time prescription for a topical ocular antibiotic during 1999 in the County Prescription Database. Five gender- and age-matched population control subjects per case were selected using a unique personal identifier, the Civil Registry Number. Diabetes prior to the ocular antibiotic prescription was determined by record-linkage with the Prescription Database and Hospital Discharge Registry in the county. Odds ratios (ORs) for acute infectious conjunctivitis among diabetic individuals and control subjects were estimated, adjusting for a range of potential risk factors. RESULTS: Among 16 193 adults treated with topical ocular antibiotics, 3.1% had diabetes as compared with 2.5% of the control subjects. The overall adjusted OR for acute infectious conjunctivitis in patients with diabetes was 1.24 [95% confidence interval (CI): 1.13-1.38]. Risk estimates of acute infectious conjunctivitis in individuals with diabetes were consistently increased for both women and men, for all age groups, and for different types of ocular antibiotics prescribed. CONCLUSIONS: This study suggests that diabetes is a risk factor for acute infectious conjunctivitis.

Acute Disease↗
PubMed2005

[The Heidelberg instrument for the assessment of quality of life in dementia (H. I. L. DE.)--dimensions of quality of life and methods of organization].

The contribution is intended to describe the theoretical background and measurement approach of H.I.L.DE., a research project aimed to develop and validate a comprehensive assessment of quality of life in nursing home residents suffering from dementia. Proceeding from the assumption that emotions are felt even in advanced stages of dementia and can be interpreted on the basis of peoples' mimic expressions, three samples of participants were recruited from 11 nursing homes of varying maintenance: 121 nursing home residents suffering from dementia, 97 professional caregivers and 101 relatives participated in the first wave of this study. Operational definition of quality of life in H.I.L.DE. proceeds from the differentiation of eight dimensions of quality of life: physical environment, social environment, quality of care, behavioral competence, medical and functional status, cognitive status, psychopathology and behavior disturbances, and subjective experiences of physical and social environment and emotional well-being. Measures of the eight dimensions involve data from medical examination, interviews with residents, professional caregivers and relatives, ecopsychological assessment of physical environment and analysis of care documents. First results from the H.I.L.DE.-study are used as an illustration of the potentials of such a comprehensive approach to the measurement of quality of life.

Aged↗
PubMed2005

[Independence, consciously accepted dependency, self-responsibility and shared responsibility as key categories of an ethical analysis of old age].

This contribution begins with a brief introduction into some seminal problems of ethics: the search for the essential being of things, the attitude of value consciousness in the context of ethical reflections, and the reflection on models of a 'good life' and on decisions as well as actions in significant moral situations. These introductory statements are illustrated by the example of stoic philosophy. In a second step, independence, consciously accepted dependency, self-responsibility and shared responsibility are discussed as highly significant categories for an ethical analysis of all ages. However these categories must be specified with reference to specific ages. In this contribution, such a specification is carried out for old age focussing on the particular relevance of the four categories for ethical analysis. In a third step, each of the four categories is discussed in detail in the context of basic ethical approaches. In this context, ethical analysis proceeds from the perspectives of the individual, the environment, and the society. Concerning the perspective of the society special interest is offered to societal models of good life in old age which might have an impact on the potential development of a pro-aging culture and shared responsibility in older people. Moreover, these models contribute to older people's ability to use the necessary means of support in cases of dependency and to consciously accept dependency.

Activities of Daily Living↗
PubMed2005

[Do we live in an ageist society? Results from an empirical study].

It is the starting-point of this contribution that--on the precondition that requirements for development and usage of older people's potentials for creativity are adequately met--population ageing does not necessarily imply a loss in society's capability for innovation. Following a brief sketch of central perspectives in public discourse on demographic change cognitive representations of ageing are described as an important factor in the realisation of potentials in old age. This realisation might not only threatened by an exaggeration of negative aspects of ageing but also by an exaggeration of positive aspects. By contrast, only a society which takes note of the magnitude of different abilities, needs, and lifestyles in older people is able to meet the challenges of demographic change and to increase productivity in old age. Results from an empirical study suggest that cognitive representations of ageing are less salient, more differentiated and more optimistic than might be expected from the popular notion of ageist western societies. Similarly, policy makers show an increasing consciousness for the potentials of old age. The latter point is illustrated by the leading perspectives of the German government's fifth report on old age and older people.

Aged↗
PubMed2005

Acute esophageal necrosis associated with alcoholic hepatitis: is it black or is it white?

Acute esophageal necrosis is an uncommon condition diagnosed during endoscopy from the black appearance of the esophagus. We report three cases of acute esophageal necrosis, associated with severe alcoholic hepatitis. The pathogenesis was multifactorial in our patients, with gastroesophageal reflux combined with hypoperfusion probably being the key factor for the esophageal lesions. The patients presented a continuum of endoscopic appearances, ranging from the characteristic black esophageal mucosa with ulcerations to a thick white exudate that peeled away (pseudomembranes). However, esophageal biopsy specimens from all three patients had the same histological pattern of severe inflammation and necrosis. Thus, the possibility of acute esophageal necrosis should also be considered in patients with extensive necrosis covered by a white exudate, but without the characteristic pattern of a "black esophagus"; and the diagnosis should subsequently be confirmed by mucosal biopsies. Our report showed that ethanol-induced acute esophageal necrosis can appear in patients with a high alcohol intake, especially in immunosupressed patients with alcoholic hepatitis.

Adult↗
PubMed2004

[Changes of a sample of aged > or = 60 years of age in-patients after five years: results from the ELDERMEN-Study].

METHOD: The ELDERMEN Study, which was funded by the German Research Association, comprises baseline assessment during 1994-1997 and a second assessment during 2000-2002. A total of 261 in-patients participated in an extensive examination at baseline assessment and were contacted again five years later. RESULTS: Five years after baseline assessment, 135 former participants had deceased, 29 newly fulfilled exclusion criteria. Of the 97 individuals who matched the study's inclusion criteria at the second assessment, 74 participated in the second evaluation. Baseline assessment revealed no significant differences between participants at second assessment and those persons who refused the second participation. However, participants in the extensive examination and longitudinal design were a positive selection when compared to the whole baseline sample. DISCUSSION: Because of increasing morbidity and mortality, longitudinal gerontological studies have to deal with the problem of selective diminishment of the sample, which can endanger the validity and generalizability of results. The problem has to be dealt with by careful documentation and evaluation of selectivity effects. We focus on the problems of longitudinal studies in gerontologic research and examine the longitudinal development of a sample of geriatric in-patients aged > or = 60 years.

Aged↗
PubMed2003

[Desire for death-results of a pilot study with acute geriatric patients].

Desire for death when expressed by patients is extremely demanding to the geriatric team. In an acute geriatric setting with its high proportion of multi morbid patients, decisions about diagnostic and therapeutic measures as well as decisions about restrictions of therapy have vital consequences. In this context, what is the significance of expressions of desire for death? A growing amount of literature has reported about studies on such questions with terminally ill patients. Studies in the field of acute geriatrics are still missing. In the present explorative pilot study, data of ten patients in an acute geriatric setting were collected within a two-month period. Data comprise various dimensions of the expressions of desire for death, and variables of their medical psychiatric, psychological, and psycho-social context. The dimensions of duration, intensity, and concreteness could be differentiated within the expressions of desire for death. In addition, they were each correlated to different context variables. Intensity was associated with experiences of pain. Subjective well-being and social support were relevant to concreteness. Duration was correlated with depression, hopelessness, experienced stress, and functional health. Physical health did not play a significant role. This means that expressions of desire for death do not only occur in the context of extreme health problems. The study has identified differentiated starting points for better understanding the expressions of desire for death and for better intervention. Further study is necessary to confirm these findings within a longitudinal design.

Acute Disease↗
PubMed2003

[Learning in old age: The importance of self-initiated structuring].

The purpose of the present study was to assess the role of memory, inhibition efficiency and self-initiated structuring of learning material in predicting age-related effects in learning performance. 47 young ( M = 23.3; SD = 3.8) and 52 old adults ( M = 64.5; SD = 5.2) took part in the current study. Tests assessing memory span, inhibition efficiency and a recall test requiring the participants to structure their learning material were administered. The results reveal that most of the age-related variance in learning performance can be explained by inhibition efficiency, memory span and-particularly-by the quality of structuring learning material. Furthermore, the results indicate that in order to recall the content of categories it is important to remember the categories formed during the learning period. The study emphasizes the importance of teaching strategies for organizing learning material in the context of cognitive trainings for the elderly.

Adult↗