Die Mehrheit der Pflegebedürftigen (PB) in Deutschland wird ambulant gepflegt. Niedrigschwellige Leistungen zur Unterstützung der PB und deren pflegenden Angehörigen können als Angebote zur Unterstützung im Alltag (AUA) über Leistungen nach dem Sozialgesetzbuch (SGB) XI finanziert werden. Alltagsbegleitung (AB) ist eine Form der AUA, die sozialer Isolation entgegenwirken und die Selbständigkeit von PB erhalten soll. Bislang fehlen empirische Befunde zu den Merkmalen der Personen, die Alltagsbegleitung erbringen, sowie zu deren Tätigkeiten. Explorative Beschreibung der AB sowie der im Rahmen der Alltagsbegleitung erfolgten Aktivitäten. Online-Befragung von 165 in Bayern tätigen AB sowie semistrukturierte Interviews mit neun AB. Die meisten Teilnehmenden der Online-Befragung (TN) waren weiblich, zwischen 40 und 65 Jahre alt und gaben an, Alltagsbegleitung als ehrenamtliche Tätigkeit auszuüben. Rund ein Drittel war oder ist in einem Gesundheits- oder sozialen Beruf tätig. Die AB betreuen überwiegend ältere PB ab 65 Jahren mit psychischen Einschränkungen. Psychosoziale und aktivierende Aktivitäten wurden am häufigsten berichtet. Daneben wurden auch hauswirtschaftliche Aktivitäten umgesetzt. Das Spektrum der in der Alltagsbegleitung erbrachten Aktivitäten zeigt das Potenzial, Mobilität, geistige Fähigkeiten und psychosoziales Wohlbefinden zu fördern, PB zu aktivieren und Einsamkeit entgegenzuwirken. Für den weiteren Ausbau solcher Angebote sollten die Merkmale, Qualifikationen und Kompetenzen der darin Tätigen berücksichtigt und gezielt genutzt werden.
Background: Around 800,000 older people live in approximately 16,500 nursing and old people's homes in Germany and this number will continue to rise due to demographic change. Visual impairment and eye diseases in need of treatment are among the most common yet most neglected health problems in this vulnerable population. This article summarizes the current state of ophthalmological care for nursing home residents in Germany, the barriers involved and the potential contribution of novel tele-ophthalmological care models to closing this care gap. Material and methods: Narrative review based on a selective literature search (PubMed, Google Scholar, professional society documents) on ophthalmological care of institutionalized older people with particular focus on the German OVIS and S & Auml;VIP studies, the international literature on prevalence and care models in nursing homes and both published reports on the TOVIS study (TeleOphthalmologische Versorgung In Seniorenheimen). Results: The OVIS study (2017; n = 600; 32 homes) found an ophthalmological result requiring treatment in 61% of residents, most frequently cataract (53%), age-related macular degeneration (AMD, 39%) and glaucoma (11% suspected); the last ophthalmologist visit occurred on average 4 years earlier. Comparable deficits are described across numerous other countries. The TOVIS pilot study (2023; n = 109 of 139 enrolled residents) tested a telemedical shared-eye-care model in which trained nonmedical personnel performed on-site examinations while ophthalmologists provided remote assessment. A vision-relevant cataract was found in 48.5%, typical AMD lesions in 34.1% and inadequately fitted eyeglasses in 60.6%; only 31.2% of the examined residents were aware of their diagnosis. At 6-month follow-up only 14 of 52 residents (26.9%) with a referral recommendation actually attended a specialist appointment, despite over 80% rating the tele-examination positively. Conclusion: Ophthalmological care in German nursing homes has been insufficient for years, a pattern that is consistently mirrored across numerous other healthcare systems in the international literature. Tele-ophthalmological shared-eye-care models such as TOVIS are feasible and well accepted but do not by themselves solve the aftercare problem. A substantial gap remains between diagnosis and actual specialist treatment, which requires structured appointment management, transport and accompaniment solutions and closer collaboration between nursing staff, primary care and ophthalmology.
Geriatrics and neurosurgery have several points of contact, which require a close cooperation. In this context, diseases frequently affecting old people include chronic subdural hematomas, benign and malignant brain tumors, normal pressure hydrocephalus, spinal compression syndromes, spinal nerve root and peripheral nerve affections. In the case of absolute indications for surgery (e.g., symptomatic subdural hematoma, paraparesis or tetraparesis due to compression of the myelon), no alternative conservative treatment option is available to prevent death or irreversible damage. Such interventions should not be withheld from geriatric patients, as long as there is a realistic chance to prolong their lives with a satisfactory quality and if they truly wish this intervention. With respect to relative indications for surgery (e.g., pain without paresis as a consequence of an affection of a nerve root or a peripheral nerve), surgery should only be considered once all options for conservative therapy have been exhausted.
