Hintergrund: Menschen mit Demenz zählen zu einer wichtigen, aber bislang vernachlässigten Zielgruppe in der palliativen Pflege und Betreuung. Viele dieser Personen haben palliative Versorgungserfordernisse, die in der stationären Langzeitpflege häufig weder wahrgenommen noch angemessen erfüllt werden. Das Versorgungskonzept Palliative Care gewinnt vor diesem Hintergrund zunehmend an Bedeutung für die Begleitung von Menschen mit Demenz. Es existieren normative Vorgaben und theoretische Überlegungen zur palliativen Versorgungspraxis, ohne dass näher konkretisiert wird, wie dies in der pflegerischen Alltagspraxis in Einrichtungen der stationären Al-tenhilfe umgesetzt werden soll. Hinzu kommt, dass die pflegerische Einschätzung zu palli-ativen Bedarfen anspruchsvoller wird, da die Demenzspezifik im fortgeschrittenen Stadium der Erkrankung verbale Kommunikationsräume verringert. Leibliche Kommunikation, Intuition, Erfahrungswissen und die Kontextualisierung im Sinne eines hermeneutischen Fallverstehens (Remmers, 2000) können bei Demenz als Zugang für die Bedürfniserfassung und das spezifische Situationsverstehen bedeutsamer sein als objektiv ermittelte Parameter. Unklar ist bislang, wie sich die hier dargestellten Dimensionen pflegerischer Handlungen in der Begleitung von demenzerkrankten Personen in stationären Pflegeeinrichtungen gestalten und wie Kontextfaktoren die palliative Pflegepraxis beeinflussen. Ziele: Ziel der vorliegenden Studie ist es, einen Beitrag zu einem vertieften Verständnis von Merkmalen, Ausdrucksformen und Wirkungsweisen in der palliativpflegerischen Ver-sorgungspraxis von Menschen mit Demenz im Handlungsfeld der stationären Langzeit-pflege zu leisten. Studiendesign und Methode: Um die subjektiven Vorstellungen von Palliative Care bei Demenz, Kontextfaktoren und Ausdrucksformen alltäglicher pflegerischer Handlungen im Kontext von palliativen Erfor-dernissen bei Demenz zu erfassen und nachzuzeichnen, wurde ein offenes, qualitatives Verfahren gewählt. In Anlehnung an die Grounded-Theory-Methodology (vgl. Corbin & Strauss, 2008) wurden 22 leitfadengestützte Interviews mit professionellen Akteuren aus vier Pflegeheimen durchgeführt und Bedingungsfaktoren und Handlungsorientierungen im Hinblick auf Palliative Care bei Demenz identifiziert. Ergebnisse: Es existiert ein heterogenes Verständnis von Palliative Care bei Demenz und es zeigen sich widersprüchliche Ausdrucksformen pflegerischen Handelns in der palliativen Versorgungspraxis von Menschen mit Demenz in der Langzeitpflege. In der zentralen Kernkategorie „Sich zwischen Gewissheit und Ungewissheit arrangieren“ lassen sich die pflege-spezifischen komplexen Deutungsprozesse und Handlungsorientierungen zur Gestaltung einer palliativen Versorgungspraxis von Menschen mit Demenz abbilden. Die palliativ-pflegerischen Handlungsorientierungen werden von den angewendeten Strategien der Pflegenden maßgeblich beeinflusst. Aufbauend auf dem subjektiven Verständnis von Palliative Care bei Demenz gruppieren sich die Ergebnisse palliativpflegerischer Handlungen um das identifizierte Phänomen. Verschiedene intervenierende Bedingungen (u. a. Charakteristika von Pflegenden, Zuschreibungsprozesse als Sterbende, Arten der Bedürfnisermittlung in der Pflegebeziehung sowie spezifische Versorgungsformen) bilden im Kontext des beruflichen Pflegehandelns die Voraussetzungen und Hindernisse für Palliative Care bei Menschen mit Demenz. Deutlich wurde, dass proaktiv-steuernde Strategien wahrscheinlicher und frühzeitiger zu einem an palliativen Maßstäben orientierten Pflegehandeln führen. Umgekehrt führen passiv-reaktive Verhaltensweisen von Pflegenden tendenziell zu einem verzögerten oder ausbleibenden Übergang hin zu palliativen Versorgungskonzepten. Diskussion und Schlussfolgerungen: Auf Grundlage der Diskussion der Ergebnisse wurden fundierte Handlungsempfehlungen und praxisbezogene Anforderungen an eine demenzspezifische Palliative Care in der stationären Langzeitpflege abgeleitet.

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This diploma thesis is theoretical and is dedicated to old age and ageing. The aim of this diploma thesis is to summarize existing knowledge of old age and to view this final stage of human life from different perspectives and in various context. It is based on periodization of human life. It deals with the process of ageing and its progress, it lists definitions and theories on ageing and also discusses possible premises of longevity. It attempts to define old age and lists myths and prejudices associated with old age. It describes old age from different perspectives of multiple science fields, such as philosophy, biology, medicine, psychiatry, psychology, demography, sociology and social work. It depicts science fields concerned with old age and points out selected aspects of life that can influence elderly person, such as financial situation, housing situation, education, leisure activies, interpersonal relations. It also mentions possible crisis situations during old age, violence against elderly people and system of care of elderly people in the Czech republic. It explains the importance of adaptation during old age and outlines possible image of end of life. At the end of the thesis a set of recommendations for happy old age is included.

In this thesis, "Stages of social work with clients with Alzheimer's disease", I focused on the analysis of the most effective stages of social work. I found out that most respondents prefer a domestic informal care, corresponding to the stages of provided social work and unconditional acceptance of the patient. The sick person requires a sensitive holistic approach, accepting his individuality and ensuring dignity in all stages of the disease. The thesis was structured on the theoretical part, based on the findings of scientific literature dealing with the symptomatology and processes of Alzheimer's disease, characterized by basic treatment and care approaches. The theoretical part is followed by an own joint investigation, divided in a qualitative and a quantitative approach. The qualitative approach is based on a detailed case study which uses the methods of observation and interviews. Anonymous questionnaires were used for the quantitative method. The obtained data were summarized and analyzed. Due to the lack of data I concluded that the considered results can be obtained as irrelevant.

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Background Creutzfeldt–Jakob disease is a rare and rapidly fatal neurodegenerative disease. Since clinicians may see only very few cases during their professional career, it is important to be familiar with the clinical presentation and progression, to perform appropriate investigations, and allow for quick diagnosis. Case presentation A 73-year-old British Caucasian woman presented with acute confusion of 2 weeks’ duration on a background of low mood following a recent bereavement. Her symptoms included behavioral change, visual hallucinations, vertigo, and recent falls. She was mildly confused, with left-sided hyperreflexia, a wide-based gait, and intention tremor in her left upper limb. Initial blood tests, computed tomography, and magnetic resonance imaging of her brain showed no significant abnormality. Following admission, she had rapid cognitive decline and developed florid and progressive neurological signs; a diagnosis of prion disease was suspected. A lumbar puncture was performed; cerebrospinal fluid was positive for 14–3-3 protein, real-time quaking-induced conversion, and raised levels of s-100b proteins were detected. An electroencephalogram showed bilateral periodic triphasic waves on a slow background. The diagnosis of probable Creutzfeldt–Jakob disease was made. Conclusions This case report highlights key features in the initial presentation and clinical development of a rare but invariably rapidly progressive and fatal disease. It emphasizes the importance of considering a unifying diagnosis for multifaceted clinical presentations. Although it is very rare, Creutzfeldt–Jakob disease should be considered a diagnosis for a mixed neuropsychiatric presentation, particularly with rapid progressive cognitive decline and development of neurological signs. However, to avoid overlooking early signal change on magnetic resonance imaging, it is important to take diffusion-weighted magnetic resonance imaging for all patients with neuropsychological symptoms. Importantly, early diagnosis also ensures the arrangement of suitable contamination control measures to minimize the risk of infection to health care professionals and other patients.

Information and education of senior patients in the frame of health care. This thesis focuses on informations providing by health care professionals to the seniors age patients/clients. I describe the contemporary situation in this field in the Czech republic, and define main attributes and conditions according to the historical, social, cultural and moral context in the theoretical part of thesis. I introduce the transmission and the acceptation of the information during the dialogue between a layperson and an expert in two basic levels: level of rules, especially an Inform consent, and level of an ethical discourse. I compare an atmosphere created by law and rules with human reactions, either as medical professionals, or as a patient. For the empirical section of the thesis, I describe and evaluate experiences of patients with information-giving by health care professionals. I have chosen qualitative method for the main body of my empirical research, which consists of semi-structured interviews with 20 patients. The collected data were cathegorised, analysed and then quantified and prepared for interpretation. The thesis includes not only the results of my research, but also examples of encounters with patients during my day-to-day nursing practice. Because the main goal of my thesis was to find...

The most characteristic feature of the demographic development in the Czech Republic and other developed countries is population ageing. The aim of the thesis "The process and rate of disability among seniors" was to determine the extent to which disability interferes with the lives of the seniors and to map the development, progress and conditions of the pension system. After an introductory overview of basic concepts, a part of the thesis deals with a theoretical analysis of the European framework of social security of seniors and another part is concerned with the reform of disability pensions in the Czech Republic. The focus is also on the forms of care for disabled pensioners. The empirical part analyzes the areas related to the development of population structure, administrative agenda, overview of pensions according to the WHO diagnosis groups, total overview of disability pensions, the development of the structure of pensions, financing of pension administration, and the average age of retired people. The economic side is also included, where pensions are compared with average salary and also the economic activity of seniors. The research is quantitative and confirms the current global phenomenon of population ageing as one of the most important problems of developed countries. With this, old-age...