Sterben mit Demenz

H. Förstl; H. Bickel; A. Kurz; G. D. Borasio

doi:10.1055/s-0029-1245260

Fortschritte der Neurologie · Psychiatrie, Table of Contents

Fortschr Neurol Psychiatr 2010; 78(4): 203-212
DOI: 10.1055/s-0029-1245260

Übersicht

Sterben mit Demenz

Versorgungssituation und palliativmedizinischer AusblickDying DementedConcepts of Care and Palliative MedicineH. Förstl¹ , H. Bickel¹ , A. Kurz^1, ² , G. D. Borasio³

¹Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München
²Zentrum für kognitive Störungen, Psychiatrie, Technische Universität München
³Interdisziplinäres Zentrum für Palliativmedizin, Klinikum Großhadern der LMU München

Abstract

Zusammenfassung

Etwa ein Drittel aller älteren Menschen stirbt mit einer Demenz; dies stellt besondere Anforderungen an Angehörige, Pflege und medizinische Versorgung, die bisher nur teilweise erfüllt werden. In dieser Übersicht zur aktuellen Literatur stellen wir epidemiologische Risikofaktoren der Mortalität dementer Patienten dar (z. B. Alter, somatische Komorbidität, neuropsychiatrische Symptome), die aktuelle Versorgungssituation (Sterbeorte, Weichenstellungen, Komplikationen, Therapie, Sterbeverlauf, unmittelbare Todesursachen, Suizide, hinterbliebene Angehörige) und Instrumente zur Beurteilung von Schmerzen, Belastung, Lebensqualität, Prognose und Therapie-Planung bei dementen Patienten im letzten Krankheitsstadium. Wir schlagen einen problemorientierten Algorithmus für Therapie-Entscheidungen vor, der Bezug nimmt auf Lebensqualität und Lebensverlängerung. Danach benennen wir einige Bereiche, in denen eine Optimierung möglich erscheint.

Abstract

A third of the elderly population dies with dementia. This poses major and partly unmet needs on relatives, professional carers and medical specialists. Our review summarizes epidemiological risk factors for the increased mortality in demented patients (age, somatic co-morbidity, neuropsychiatric symptoms), current practice (place of death, decision making, complications, medical treatment, course of dying, cause of death, suicide, bereaved relatives), and instruments for the assessment of pain, burden, prognosis and treatment planning in the terminal stage of illness. We describe the current legal situation in Germany and present a brief outline of practical management issues. We also list a number of areas offering leeway for improvement regarding research, training, psycho-education, preparation, diagnosis, treatment and support.

Schlüsselwörter

Sterben - Alzheimer - Demenz - Mortalität - Patientenverfügung - Todesursachen - Suizid - Schmerz - Palliativmedizin

Keywords

dying - Alzheimer - dementia - mortality - cause of death - suicide - pain - palliative care

Full Text

References

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Prof. Dr. Hans Förstl

Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München

Ismaningerstr. 22

81675 München

Email: hans.foerstl@lrz.tu-muenchen.de