Medizinische Rehabilitation bei älteren Versicherten (55plus)

OBJECTIVE: Due to the demographic aging process of Germany's population, the development of morbidity and limited resources, a rethinking is needed in the fields of healthcare and social policy. The medical rehabilitation system will be of particular importance because of the increase of chronic and multiple illnesses in older age groups and the postponement of the retirement age. As the composition of rehabilitation patients will reflect broader demographic changes the question arises whether treatment plans of rehabilitation clinics will meet the demands and needs of older rehabilitation patients and which changes in rehabilitation processes might be required.

METHODS: In 18 semi-structured focus groups, 62 rehabilitation patients with different indications aged over 55 years were asked about their needs, expectations and suggestions for improvement of the rehabilitation process. In contrast to previous quantitative research focusing on a comparison of rehabilitation needs and treatment offers of different age groups, only older rehabilitation patients were interviewed in this qualitative study. The results were discussed with health care experts in 3 multi-disciplinary focus groups. The conversations were recorded, transcribed and analysed using the content analysis approach.

RESULTS: The study showed a wide range of needs of rehabilitation patients concerning the treatment process. The desire for more patient-centred care, especially through improved provision of information and patient participation rights in therapeutic decisions, was an important aspect. A detailed individual plan of aftercare and following-up patients regularly can facilitate the integration of rehabilitation-related aims into everyday life and therefore enhance the sustainability of rehabilitation. According to the experts, many of the needs mentioned were comprehensible and legitimate. Under the present circumstances (restrictions of time and personnel, guidelines), however, implementation of the proposals made by the rehabilitation patients was considered difficult to realize. Rehabilitation patients and experts ­agreed in that elements of occupational therapy should be expanded and transferred into real occupational setting and that intensified aftercare is needed. Contrary to our expectations, age-related aspects played a subordinate role according to both groups. Nevertheless, older rehabilitation patients saw a need for improvement in several areas of the rehabilitation process. Although the problems related to the rehabilitation process ­generally may not be directly age-related they might constitute a heavier burden for older patients.

CONCLUSIONS: Optimizing various aspects of medical rehabilitation to reach sustainable outcomes in older rehabilitation patients appears to be necessary. Encouraging patients' individual responsibility for coping with the disease plays a key role in this process. Offering information tailored to patients' needs and provision of well-structured aftercare seem to be required especially for those older than 55.