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No empirical data about the topic "Mental Disability and Dementia" in Germany exist. The aim of this survey was to obtain current data about mentally disabled people with dementia. Therefore, the following questions need to be clarified: how many mentally disabled people are affected with dementia, which difficulties occur regarding the diagnosis of dementia and what challenges have to be solved in upcoming years. In all, 45 organisations for the mentally disabled took part in the survey, showing that dementia amongst people with mental disabilities appeared largely starting at the age of 50. Standardized diagnostics are seldom used by these organisations. Instead, observation of behaviour by care attendants plays a central role, due to the fact that speaking and introspection are not possible for a majority of the patients. In general, institutions for people with mental disabilities do not have specific offers for people with dementia, occasionally there are offers regarding their living situation and free time activities.

People with learning and physical disabilities require special attention and nursing care during hospitalisation. A systematic literature research in the databases PUBMED, CINAHL and Cochrane Library (1990-2011) was conducted, 17 relevant publications could be found. The following problems were identified. The situation of people with learning disabilities in hospital is characterised by communication barriers between patients and health care professionals. Furthermore, the emotional situation of patients has to be emphasised. In the foreign environment of a hospital, they suffer from fear and uncertainty. Both phenomena interact with each other and are influenced by conditions such as time, continuity of care, professional competence, and attitudes towards disabled people. Family members are able to calm the patients. They take on the task of translating. Clinical Nurse Specialists are familiar with these problems. They improve the situation of learning disabled patients in the hospital. The studies show small samples and the results need further verification. Results out of Germany, Austria and Switzerland are not available. Therefore, in these countries further empirical research on this topic is strongly recommended. The results indicate the importance of obtaining comprehensive information about needs of disabled patients before their hospital stay. Family members should be involved in nursing care during a hospital stay.

Objective: To bring the data from the Federal German Health report about work disability and pensioning into context with current knowledge about the course and etiology of depression., Methods: The report data about first-time recipients of a disability pension were analysed by year, illness and gender. Resulting data were interpreted and were compared with international publications., Results: The percentage of applications for disability pensions due to psychiatric illnesses have been rising steadily for two decades. Among these, depression (31%) and neurotic disorders (23%) are most frequently responsible, while most other causes of disability have been declining. Current treatment of depressive disorders does not seem to have had any effect in terms of reducing the number of disabled persons per year., Conclusions: Although the risk factors associated with developing a depressive disorder have been extensively studied, data explaining the progression into disability is scarce but essential. More research in the psychodynamics of depression and work participation might be helpful.

Data on the prevalence of mental health disorders among children and youth with hearing disorders, blindness, physical handicaps or intellectual disabilities are reviewed. Problems in parent-child relations and issues in the development of social competence and social participation are discussed as risk factors for emotional social maladjustment. The differentiation between developmental problems resulting from the handicap and mental health problems is a challenging task in practice. Some conclusions for psychopathological assessment of handicapped children and youth are presented.

Objective: Vocational rehabilitation is an important component of community-oriented mental health care. How is the situation of supply with vocational rehabilitation facilities in Germany offering their services to mentally challenged persons?, Method: Search of a Germany-wide rehabilitation database, supplemented by information from the Federal Working Groups on Vocational Rehabilitation. Cartographical classification of the identified facilities. Analysis of the results in a comparison of the situation in the 16 German States (Länder)., Results: The Länder of North Rhine Westphalia, Bavaria, Baden-Wuerttemberg and Lower Saxony offer the greatest number of vocational rehabilitation facilities to mentally challenged persons. In all East German and in some of the West German Länder vocational rehabilitation facilities are restricted to some areas and to certain vocational preconditions. Many of the facilities in these areas are structured as centres and situated in rural areas. Hence, they lack community-orientation. Only North-Rhine Westphalia offers country-wide community-oriented vocational rehabilitation facilities to mentally challenged persons, which are not restricted to certain vocational preconditions., Discussion and Conclusions: The supply with vocational rehabilitation facilities for mentally challenged persons has improved during recent years. Nevertheless, the situation in many of the German Länder needs to be improved, particularly in respect of the availability of rehabilitation facilities for younger mentally challenged persons without prior working experience. The implementation of decentralised community-oriented facilities should be favoured in centres, especially in larger sparsely populated areas.

The article focuses on the results of vocational integration over the last two decades and on actual results from client-surveys as presented by the Arbeitsgemeinschaft Deutscher Berufsförderungswerke (ADB) (working group of the German vocational retraining centres) and the Berufsförderungswerk Heidelberg (BFW Heidelberg, the vocational retraining centre in Heidelberg). Process quality of vocational rehabilitation can be indicated by data like the number of persons dropping out of their training - the ratio to be found in the vocational retraining centres is on a lower level than in other institutions of vocational training. Clients have changed: during the last decade the average age of the clients in the BFW Heidelberg has increased by 3 years, there is a higher proportion of women, but there also are more clients with psychological disorders. A new group of clients is growing - non-handicapped persons who pay for their training themselves. Process quality has improved, with graduates of the BFW Heidelberg saying significantly more often that they can use much or very much of the training courses' contents within their later occupational activities -- the proportion increases with the level of training they had undergone. Additionally the proportion of those is growing who see themselves in an -- according to their training -- adequate occupational situation. These are certainly positive results referring to the indicators of process quality. Concerning outcome quality one has to take the levels of occupational integration into account. Compared with the results of German vocational retraining centres overall, graduates of the Heidelberg centre constantly had a higher level of vocational integration over the last 20 years, one of the reasons being that the vocational training offered in Heidelberg reaches up to the level of degree of a university of applied sciences. The situation on the job market strongly influences occupational integration: it is evident that a high rate of unemployment will extend the time span necessary for placement. But in the long run occupational integration proves to be amazingly high. Variables that influence the results are: level of disability, sex, age and marital status. The level of vocational qualification is a characteristic with high evidence: integration of graduates at the level of "Fachschule" (highly skilled technician or the like) is 10 % higher and that of graduates at the level of "Fachhochschule" (university of applied sciences) another 10 %. Participation in vocational rehabilitation generally is highly estimated -- estimation as given two years after the training increases with the level of qualification. In the Heidelberg centre progress is seen in expanding the proportions of special target groups (which of course is politically aimed at): women now account for some 30 %, there are more elderly clients and for example also more clients with psychological disorders. The vocational integration of these various groups has to be regarded under different aspects. For example, the situation of severely disabled clients is quite ambivalent: their proportion is falling and their rate of occupational integration is relatively low -- yet there are effects that may compensate. So the importance of the disability decreases with a rising level of vocational training. The data presented may permit the conclusion that vocational rehabilitation at the Heidelberg centre has become more successful over the last decade.

Severe constipation is a well recognized symptom amongst disabled or mentally ill patients. Characteristically, these patients live without bowel movements for days and present themselves with abdominal distension and fecal impaction. Inpatient treatment is necessary frequently. Due to intestinal obstruction, diagnostic approaches are often delayed because of lack of cooperation. Data of 94 disabled patients with severe obstipation are presented. 54 patients were admitted to inpatient treatment of constipation or bowel obstruction, 40 were treated for another diagnosis but had severe constipation which required intervention. Ileus or conservatively untreatable constipation led to 16 operations in 14 patients (polypectomy 2, rectopexy 1, cecostoma 5, left hemicolectomy 3, subtotal colectomy 5). Cecostomata are considered not to be effective as definite treatment whereas colonic resection resulted in daily bowel movements.