[Prevention before care. Prevention by care].
BACKGROUND
Maintaining the independence of old people is an issue in the third and fourth decade of life determining the quality of life of the elderly. Its stabilisation helps to save money in the health care system. However, in the debate about efficiency of the German health care system and of the long-term care system respectively, aspects of prevention in old age are of subordinate importance. In other countries, strategies for avoiding, retarding or moderating care are successfully integrated into nursing care prevention. The proposals for the further development of the long-term care insurance eliminate these issues to a large extent.


OBJECTIVE
What are the conditions to establish these preventative programmes in the German long-term care system? What should be the contents of these programmes? Which have tasks to be done by the nursing profession in the future German health and longterm care system?


METHODS
Systematic search of the Internet and data-bases. Evaluation of the present proposals of various commissions concerning the subject. Analysis and evaluation of the available approaches in nursing care prevention with regard to their conversion to the German care structures.


RESULTS
Before the long-term care insurance was implemented in Germany in the year 1995 rudiments of long-term care prevention existed. These approaches have meanwhile been sacrificed because of economic restrictions in the municipalities. In states like Australia, the UK, and some Scandinavian countries programmes of nursing care prevention have been established as a regular element in the service.


CONCLUSIONS
Concepts for prevention in the long-term care for old and very old people have been implemented quite successfully in several states. In order to employ similar programmes in Germany one should refer to available international experience. This should be combined with the former experiences in Germany itself.
Brucker
U
U
Fachgebietsleiter Pflege, Medizinischer Dienst der Spitzenverbände der Krankenkassen e. V. (MDS), Essen. u.brucker@mds-ev.de
Hutzler
D
D
Hasseler
M
M
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics / Q000451:nursing*; D003362:Cost-Benefit Analysis; D003431:Cross-Cultural Comparison; D005060:Europe; D005858:Germany; D006801:Humans; D007353:Insurance, Long-Term Care / Q000191:economics; D008134:Long-Term Care / Q000191:economics*; D009313:National Health Programs / Q000191:economics*; D011314:Preventive Health Services / Q000191:economics*; D011788:Quality of Life