Prof. Dr. Peter Oster
Director of Bethanien Hospital, Geriatric Center Heidelberg
Interview of February 28, 2008 with Dr. Birgit Teichmann
Professor Oster, you are medical director of the Geriatric Center, Bethanien hospital and you deal mostly with older patients. When does a person become old?
There are many definitions. One is old, if one feels old, meaning the subjective perception is very important. There are some nice stories about it. Some say that is the case, if half of an age group has died. One can think about it and there is some truth to it. Or when one realizes that the parents were mostly correct and the young ones say you have no idea, then one has become old. The subjective perception plays a big role. We know today that many people, who are relatively ill, feel subjectively young and are not very affected in their daily activities.
Why is there a special medicine for the older person, the geriatric medicine?
Because medicine for the elderly is different. Older people have different needs than younger people and we have to consider the functional restrictions and what has to be exercised, may it be the movement, the memory or the mood. These things have to be checked and treated accordingly. The disease, which people have sometimes, is the key to the treatment. By improving the stabilization of diabetes with Insulin, we can improve other ailments. Other diseases do not offer this possibility, in these cases exercise is the key, but science is advancing more and more. Only a few years ago, there were 15 publications per year with the subject of frailty and in the meantime there are 1000 each year. This is an area which is just now developing and new approaches are sought after, also differential diagnoses of frailty. What used to be a simple phenomenon of age, one has become old, “frailty” accepted as a certain final stage and today one has to realize, that some of these frailties can be treated. There are other forms, which are in fact a final stage and we have to accept it.
What role does multi morbidity play, meaning that in other hospitals, one specific disease is being treated, but considering that the older person has usually more than one disease, is your hospital in a better position to treat all ailments together?
It is a catastrophe for instance how the political health policies work, because we have the DRG system “diagnosis related groups”, which is very contra productive. What we from the geriatric medicine want, is a treatment which is patient oriented and as you were saying, the older people have many different diseases. Unfortunately, this is not in demand, one has to focus on one particular diagnosis, which we may treat and the rest falls more or less under the table.
Are care concepts a major point in your clinic, meaning that the patients experience a different kind of care, which concentrates on the needs of older patients?
Care is necessary when dealing with older people and we talk about an inter- or multi disciplinary team, and that is indeed the case with nursing personnel, therapy, social workers, and doctors of course, but also other professional groups belong to this concept and it is interesting to see which other approaches of multi disciplinarity exist. When you talk about multi disciplinarity in medical terms, then this always deals with several medical specialists, specialists like urologists, gynecologists, internal medicine and surgeons work together, e.g. in a continence center. When geriatrician talk about multi disciplinarity, then they mean the cooperation of nursing care with therapy, this is a different approach.
You also have a palliative ward. When does a patient decide to come to you? Does this depend upon his age, if one decides on a university hospital or for a geriatric center or can he expect something different here?
I would say, he can expect something different here. We question the value of the therapy more often. Unfortunately, in medicine, certain programs are carried out or some programs are administered according to guidelines and also some unnecessary examinations are done, if I may say so. We try to consider what benefits the individual patient and what his goal is. If you talk about palliative medicine, this is only a minor part of our hospital, but I believe we have, in Germany, brought the palliative-medical geriatrics on the agenda. Palliative medicine was considered as an oncological speciality up to two or three years ago with a focal point on pain therapy, maybe in addition a few aids patients who were cared for. We have tried here in this hospital, and in general in geriatrics, expanded the spectrum to include stroke patients, who can no longer be rehabilitated and are now in a palliative- medical situation, patients with grave heart problems, which get worse over the years and with weakening vitality, or patients with dementia, in addition with dysphagia. We always have to ask if a parenteral nutrition is in order and makes sense and would the patient, if he was still able to decide himself, would have wanted this. These are often very upsetting discussions, necessary and connected with great responsibility.
I find your idea of an internal ward for dementia patients, very interesting. Can you tell us more about it?
That was a model project, which was financed by the Robert Bosch Foundation up to last year, a geriatric internal ward for acutely diseased dementia patients. Based on the fact that some dementia patients have behavioural problems, especially those that like to run away, are restless and disturb the order of the ward, the nurses have to deal with it, we have decided to have a separate closed ward. We have a door with a lock protected by a code and there is a sign next to it reading “to open the door, please type the date of the year”. This way we have a protected area, which includes a living room equipped with old furniture, a place where the patient can feel comfortable and space to walk. It is amazing to see how patients, who were restless and could not be controlled, come to this area and calm down and seem satisfied, they don’t even need psycho drugs. Before, we were forced to calm down these patients medically.
You are a member of the Network Aging Research. What does the membership in this network mean to you with regard to your work?
Primarily, suggestions, cooperation, further development of concepts, ideas to new concepts and as a hospital, not belonging to the University, we are depend upon financial support. We do not have the slightest research infrastructure, but yet we have demonstrated in the last years that we have been innovative in practical manners as for instance the continence consultation, which has widely spread in the meantime, as also the medical training therapy with weights and coordination training and other concepts, which we have discussed before.
Personal Data
Peter Oster was born in 1946 in Frankfurt Hoechst. He studied at the Institute of Pharmacology in Heidelberg with the focus on experimental hypertension research, lipid metabolism and nutrition. He practiced medicine in Berlin, Heidelberg and Bern. In 1981 he joined the Geriatric Center of the Bethanien Hospital, University Clinic, Heidelberg and since studies the problems of aging. He became Medical Chief in 1999.
Unbelievable as it may sound, Peter Oster plays soccer since 30 years and he emphasizes that his University Sports Club has never missed a single training. For him this is not only a sports activity, but a continuous social experiment that brings young and old together. He is a big fan of the Heidelberg Culture-Comedy "Zungenschlag".
