Prävalenz von Demenz bei Menschen mit Migrationshintergrund in Deutschland

Hintergrund: In Deutschland lebten 2013 16,5 Mio. Menschen mit Migrationshintergrund, wovon schätzungsweise 9 % älter als 65 Jahre sind. Sie zeigen häufig schlechtere Gesundheitsoutcomes als Menschen ohne Migrationshintergrund, aber aus verschiedenen Gründen werden Gesundheits- und Pflegeleistungen kaum genutzt. Für diese Population gibt es keine systematischen Angaben zur Anzahl Demenzerkrankter. Dies hat zur Folge, dass das Gesundheitssystem vor einer Herausforderung steht, dessen Dimension kaum einzuschätzen ist. Ziel: Darstellung der Prävalenz von Demenz bei Menschen mit Migrationshintergrund für Deutschland und die einzelnen Bundesländer. Methode: Länderspezifische Daten zu Bevölkerung, Demenzerkrankten und altersspezifischen Prävalenzen wurden genutzt, um länderspezifische Prävalenzen für verschiedene Ethnien zu berechnen. Daraus wurde die Anzahl von Menschen mit Migrationshintergrund und Demenz in Deutschland geschätzt, und wie diese sich auf die Bundesländer verteilen. Ergebnisse: Von 1,86 Mio. Menschen mit Migrationshintergrund in Deutschland, die 65 Jahre oder älter sind, sind schätzungsweise 96.500 Personen (5,2 %) an Demenz erkrankt. Der Großteil entfällt auf Menschen mit polnischem (13.960), italienischem (8920) und türkischem (8840) bzw. europäischem Hintergrund (84.490). Die vermutlich höchsten Erkrankungszahlen zeigen Nordrhein-Westfalen (26.000), Baden-Württemberg (18.080) und Bayern (16.710). Diskussion: Unsere Analysen zeigen die Anzahl an Demenz erkrankter Menschen mit Migrationshintergrund separat für ausgewählte Herkunftsländer als auch die deutschen Bundesländer. Dies bildet eine erste Grundlage für eine länderspezifische Handlungssteuerung und die Planung kultursensibler Angebote zur Versorgungsverbesserung der an Demenz erkrankten Menschen mit Migrationshintergrund.Background: In Germany the number of people with a migration background was 16.5 million people in 2013 with 9% being older than 65 years. In this population utilization of health services is low, especially in older people, although they often display worse health outcomes. Little is known about the number of people with dementia and migration background in Germany and their distribution on the state level, resulting in a challenge that is barely assessable for the healthcare system. Objective: The depiction of the prevalence of dementia in people with a migration background for Germany and the individual federal states. Method: The number of people with a migration background and dementia living in Germany and the individual federal states was estimated for different ethnic groups using country and state-specific data on the population, dementia frequency and age-specific prevalence. Results: Out of 1.86 million people with a migration background who are 65 years or older, approximately 96,500 persons (5.2%) have dementia. The majority are of European (84,490), more specifically Polish (13,960), Italian (8920) and Turkish (8840) heritage. North Rhine-Westphalia (26,000), Baden-Wuerttemberg (18,080) and Bavaria (16,710) are presumed to show the highest rates of people affected. Conclusion: In Germany people with a migration background and dementia represent a large target group for health care; however, the numbers and ethnic populations affected differ considerably between states. These analyses can be used for state-specific healthcare planning of culture-specific and culture-sensitive services and care so that specific healthcare improvements can be achieved

Dementia and migration in Germany. An estimate of the number of people with a migration background with dementia and an analysis of the caregiving situation, current information and healthcare services and measures to improve the healthcare situation of those affected.

Literature shows that people with a migration background (PwM) with dementia are an especially vulnerable group. Data on the number of PwM with dementia in Germany is scarce meaning the healthcare system faces a challenge of an unknown magnitude. They are mostly not part of the healthcare landscape and lack knowledge about dementia and healthcare services. Healthcare professionals and services do not seem to be culturally sensitive enough and not adequately equipped to take care of PwM with dementia. Therefore, this work focuses on a) estimating the number of PwM with dementia broken down by country of origin and federal state; b) exploring the caregiving experience, barriers of healthcare utilisation and measures to increase utilisation; and c) determining the scope of culturally sensitive information and healthcare services as well as projects on dementia and migration in Germany. A combination of quantitative and qualitative research methods as well as a scoping review are applied to examine the research focus. Calculations show that an estimated 96,500 PwM have dementia, presumably mostly originating from Poland, Italy, Turkey, Romania, and the Russian Federation. The majority of affected PwM live in North Rhine-Westphalia, Baden-Württemberg, and Bavaria. Family members experience similar challenges and consequences as non-migrants in the care of a person with dementia. PwM lack sufficient knowledge of dementia and information regarding the available healthcare services. These are only two of the reasons why the healthcare system is not utilised. To increase utilisation, services should be culturally sensitive and information easily accessible. In addition, easier navigation and the expansion of existing healthcare structures is needed. The scoping review identified 48 culturally sensitive healthcare and information services and projects for PwM with dementia. The majority are located in North Rhine-Westphalia, Baden-Württemberg, Bavaria, and Hesse, which mirrors the distribution of PwM with dementia in Germany. For the most part, these services offer counselling in different languages. These results confirm that PwM (with dementia) and healthcare professionals need in-depth education on this topic. There should be a focus on the design of information and healthcare services that are tailored in a culturally sensitive way. This dissertation further indicates that culturally sensitive healthcare services, personalised for individual situations on site, should be expanded and also facilitated by not only healthcare professionals and service providers but also by law- and decision-makers. Furthermore, there is a need for cooperation between researchers, healthcare professionals, service providers, healthcare systems, law-makers, and other stakeholders in the field on a national and an international level.Die Literatur zeigt, dass Menschen mit Migrationshintergrund (PwM) mit einer Demenz eine besonders vulnerable Gruppe sind. Es gibt nur wenige Daten über die Anzahl von PwM mit einer Demenz in Deutschland, was bedeutet, dass das Gesundheitssystem vor einer Herausforderung unbekannten Ausmaßes steht. Die Betroffenen sind meist nicht Teil der Gesundheitslandschaft und wissen nicht viel über Demenz und Versorgungsangebote. Das Gesundheitspersonal und die Versorgungsangebote scheinen nicht kultursensibel genug zu sein und sind nicht angemessen ausgestattet, um sich um PwM mit Demenz zu kümmern. Daher konzentriert sich diese Arbeit auf a) die Schätzung der Anzahl von PwM mit Demenz, aufgeschlüsselt nach Herkunftsland und Bundesland; b) die Erforschung der Versorgungserfahrungen, der Barrieren bei der Inanspruchnahme von Versorgungsangebote und der Maßnahmen zur Erhöhung der Inanspruchnahme; und c) die Bestimmung des Umfangs kultursensibler Informationen und Versorgungsangebote sowie von Projekten zu Demenz und Migration in Deutschland. Zur Untersuchung des Forschungsschwerpunkts wird eine Kombination aus quantitativen und qualitativen Forschungsmethoden sowie ein Scoping Review eingesetzt. Berechnungen zeigen, dass schätzungsweise 96.500 PwM an Demenz erkrankt sind, die vermutlich überwiegend aus Polen, Italien, der Türkei, Rumänien und der Russischen Föderation stammen. Der Großteil der betroffenen PwM lebt in Nordrhein-Westfalen, Baden-Württemberg und Bayern. Angehörige erleben bei der Versorgung einer Person mit Demenz ähnliche Herausforderungen und Konsequenzen wie Nicht-Migranten. Es mangelt ihnen an ausreichendem Wissen über Demenz und an Informationen über die verfügbaren Versorgungsleistungen. Dies sind nur zwei der Gründe, warum Leistungen des Gesundheitssystems nicht in Anspruch genommen werden. Um die Inanspruchnahme zu erhöhen, sollten die Versorgungsangebote kultursensibel und die Informationen leicht zugänglich sein. Darüber hinaus sind eine einfachere Navigation und der Ausbau der bestehenden Versorgungsstrukturen erforderlich. Im Rahmen des Scoping Reviews wurden 48 kultursensible Informations- und Versorgungsangebote sowie Projekte für PwM mit Demenz identifiziert. Die meisten befinden sich in Nordrhein-Westfalen, Baden-Württemberg, Bayern und Hessen, was die Verteilung von PwM mit Demenz in Deutschland widerspiegelt. Die meisten dieser Angebote bieten Beratung in verschiedenen Sprachen an. Diese Ergebnisse bestätigen, dass PwM (mit Demenz) und Fachkräfte im Gesundheitswesen eine vertiefte Aufklärung zu diesem Thema benötigen. Der Schwerpunkt sollte auf der Gestaltung von Informations- und Versorgungsleistungen liegen, die auf eine kultursensible Weise zugeschnitten sind. Diese Dissertation zeigt außerdem, dass kultursensible Versorgungsangebote, die auf die individuelle Situation vor Ort zugeschnitten sind, ausgebaut und nicht nur von den Mitarbeitenden im Gesundheits- und Versorgungssystems und den Anbietenden von Versorgungsleistungen, sondern auch von den Gesetzgeber:innen und Entscheidungsträger:innen unterstützt werden sollten. Darüber hinaus bedarf es der Zusammenarbeit zwischen Forschenden, Mitarbeitenden im Gesundheits- und Versorgungssystems, Anbietenden von Versorgungsleistungen, sonstige Vertreter:innen des Gesundheits- und Versorgungssystems, politischen Entscheidungsträger:innen und anderen Akteur:inneen in diesem Bereich auf nationaler und internationaler Ebene

What elements are important in current treatment and care guidelines to provide culturally sensitive care for people with a migration background and dementia? A systematic analysis

Aim!#!Telemedicine is a promising solution to extend traditional health care services. Even though mainly discussed during the past two decades, its roots go back into the past century and even further, considering the use of bonfires to warn other villages of diseases. Insights from historical cases can therefore be useful for the ongoing discussion regarding the successful implementation of telemedicine.!##!Subject and methods!#!We analyzed three historical telemedicine cases (varying regarding time and place) and extracted their success factors and barriers as well as assessed their maturity by using the Telemedicine Community Readiness Model (TCRM). Evidence-based categories of success factors and barriers as well as the TCRM's dimensions were used as deductive categories to analyze the study material's content.!##!Results!#!The analysis showed that the readiness for telemedicine is higher when the technology is the only option to access health care services. In all three cases, core readiness played a central role. However, the health sector, existing technology, and finance were barriers present at all times, while during pandemics, some barriers are only temporarily removed, for example, by putting legal issues on hold. The analyzed cases were all on lower levels of maturity as they mainly represent pilot tests or exceptional circumstances.!##!Conclusion!#!Results indicate the important core functions in telemedicine initiatives as well as the diversity of their circumstances. Insights from such historical meta-perspectives can, for example, help to strengthen the sustainability of the increased use of telemedicine during the COVID-19 pandemic and scale up current telemedicine projects

Die Prävalenz an Demenz erkrankter Menschen in Deutschland – eine bundesweite Analyse auf Kreisebene

Post-acute inpatient neurorehabilitation facilities are increasingly treating patients who are not only severely ill and multimorbid but who are also referred from non-neurological departments. These patients are still often medically unstable so that the previous diagnostics and treatment must be reevaluated and when necessary adapted or supplemented. Certain interdisciplinary diagnostic and therapeutic problems, such as antithrombotic therapy, regularly reoccur. This article presents these problems in a checklist fashion, which should provide indications in individual cases when previously carried out measures need to be questioned and adapted

Intersectionality and its relevance for research in dementia care of people with a migration background

BACKGROUND: Despite the care and support needs of migrants affected by dementia differing from the population of the country where they live now, most European countries do not provide specific strategies to address migration in their national dementia plans. The concept of intersectionality provides an innovative approach to dementia care perspectives and methodologies. OBJECTIVE: The aim is to define intersectionality and to provide examples of applying the concept to dementia care research, focusing on people with a migration background. METHODS: This article was conceptualized and discussed during virtual INTERDEM taskforce meetings in 2020/2021, while discussing identified literature on intersectionality, migration, and dementia care research. RESULTS: Using an intersectionality framework allows understanding of a person's lived experience by considering the dimensionality, co-occurrence and interlocking of factors (e.g., sex/gender, socioeconomic status, ethnicity, migration status, geographic location/place). CONCLUSION: Intersectionality can be applied as a conceptual and methodological approach to identify and address gaps in perspectives and in (dementia care) research to overcome the threat of ignorance, exclusion and discrimination

Identifying Unmet Needs of Family Dementia Caregivers: Results of the Baseline Assessment of a Cluster-Randomized Controlled Intervention Trial

Background: Caregivers providing informal care for people with dementia (PwD) often report unmet needs, burden, and health impairments. Optimal support for family dementia caregivers will likely benefit from better understanding and assessment of the prevalence and types of caregivers’ unmet needs and associated socio-demographic and clinical characteristics. Objective: The present study investigates 1) the number and types of caregivers’ unmet needs, 2) socio-demographic and clinical characteristics of both PwD and caregivers, and 3) caregivers’ burden and health-related outcomes that are related to caregivers’ unmet needs. Methods: The present analyses are based on cross-sectional data of n?=?226 dyads of caregivers and their community-dwelling PwD participating in a comprehensive standardized, computer-based caregivers’ needs assessment within a general practitioner (GP)-based, cluster-randomized intervention trial. Results: A total of n?=?505 unmet needs were identified for n?=?171 caregivers from the intervention group at baseline. Only 24.3% caregivers reported no unmet need (n?=?55), whereas 75.7% caregivers had at least one unmet need (n?=?171). Caregivers had on average 2.19 unmet needs (mean?=?2.19, SD?=?2.15). Specifically, 53.1% of caregivers had one up to three unmet needs (n?=?120), 18.6% (n?=?42) had three up to six unmet needs, and 4.0% (n?=?9) had more than six unmet needs. Discussion: Our results underline the importance of a comprehensive needs assessment for family dementia caregivers to develop and implement concepts that can provide family dementia caregivers with optimal support