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Morales AL, Figueroa MI, Navarro P, Chaves ER, Ruderman A, Dipierri JE, Ramallo V. Volga German surnames and Alzheimer's disease in Argentina: an epidemiological perspective. J Biosoc Sci 2024; 56:625-638. [PMID: 38682701 DOI: 10.1017/s002193202400018x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The N141I variant (PSEN1 gene) is associated with familial forms of early-onset Alzheimer's disease (AD) in descendants of Volga Germans, whose migration to Argentina is well documented. As a proxy for geographic origin, surnames can be a valuable tool in population studies. The 2015 Argentine Electoral Registry provided geographic data for 30,530,194 individuals, including 326,922 with Volga German surnames. Between 2005 and 2017, the Ministry of Health recorded 4,115,216 deaths, of which 17,226 were attributed to AD and related causes. The study used both diachronic and synchronic data to identify patterns of territorial distribution and co-spatiality, using Moran's I and generalised linear model statistics. The frequency of surnames of Volga German origin accounts for 43.53% of the variation in deaths from AD and three clusters of high non-random frequency were found. Almost 150 years later, people descending from the Volga migration remain highly concentrated and may have a different risk of developing AD. The identification of spatial patterns provides reliable guidance for medical research and highlights the importance of specific health policies for particular populations.
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Affiliation(s)
- Arturo Leonardo Morales
- Instituto Patagónico de Ciencias Sociales y Humanas (IPCSH), Centro Nacional Patagónico, Consejo Nacional de Investigaciones Científicas y Técnicas, Puerto Madryn, Argentina
- Laboratorio de Ciencias de las Imágenes, Departamento de Ingeniería Eléctrica y Computadoras, Universidad Nacional del Sur, Bahía Blanca, Argentina
- Departamento de Informática, Facultad de Ingeniería, Universidad Nacional de la Patagonia San Juan Bosco, Trelew, Argentina
- Programa de Referencia y Biobanco Genómico de la Población Argentina (PoblAr), Buenos Aires, Argentina
| | - Marcelo Isidro Figueroa
- Unidad de Genética, Hospital Materno Infantil Doctor Hector Quintana, San Salvador de Jujuy, Argentina
- Instituto de Ecorregiones Andinas, Universidad Nacional de Jujuy-CONICET, San Salvador de Jujuy, Argentina
| | - Pablo Navarro
- Instituto Patagónico de Ciencias Sociales y Humanas (IPCSH), Centro Nacional Patagónico, Consejo Nacional de Investigaciones Científicas y Técnicas, Puerto Madryn, Argentina
- Laboratorio de Ciencias de las Imágenes, Departamento de Ingeniería Eléctrica y Computadoras, Universidad Nacional del Sur, Bahía Blanca, Argentina
- Departamento de Informática, Facultad de Ingeniería, Universidad Nacional de la Patagonia San Juan Bosco, Trelew, Argentina
- Programa de Referencia y Biobanco Genómico de la Población Argentina (PoblAr), Buenos Aires, Argentina
| | - Estela Raquel Chaves
- Instituto de Biología de la Altura, Universidad Nacional de Jujuy, San Salvador de Jujuy, Argentina
| | - Anahí Ruderman
- Instituto Patagónico de Ciencias Sociales y Humanas (IPCSH), Centro Nacional Patagónico, Consejo Nacional de Investigaciones Científicas y Técnicas, Puerto Madryn, Argentina
- Programa de Referencia y Biobanco Genómico de la Población Argentina (PoblAr), Buenos Aires, Argentina
| | - José Edgardo Dipierri
- Programa de Referencia y Biobanco Genómico de la Población Argentina (PoblAr), Buenos Aires, Argentina
- Unidad de Genética, Hospital Materno Infantil Doctor Hector Quintana, San Salvador de Jujuy, Argentina
| | - Virginia Ramallo
- Instituto Patagónico de Ciencias Sociales y Humanas (IPCSH), Centro Nacional Patagónico, Consejo Nacional de Investigaciones Científicas y Técnicas, Puerto Madryn, Argentina
- Programa de Referencia y Biobanco Genómico de la Población Argentina (PoblAr), Buenos Aires, Argentina
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Tokaj A, Lehrner J. Drawing a line?-Visuo-constructive function as discriminator between healthy individuals, subjective cognitive decline, mild cognitive impairment and Alzheimer's disease and predictor of disease progress compared to a multimodal approach. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:71-81. [PMID: 36723802 PMCID: PMC11143003 DOI: 10.1007/s40211-022-00455-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE One cognitive domain impaired in Alzheimer's disease (AD) is visuo-construction. The Vienna Visuo-constructional Test 3.0 Screening (VVT 3.0 Screening) measures this cognitive domain. This study examines how it works in the differentiation of AD from healthy controls (HC) and the prodromal stages subjective cognitive decline (SCD) and mild cognitive impairment (MCI) and also how it performs in prediction of progress compared to the Mini Mental State Examination (MMSE) and the Sunderland Clock Drawing Test (CDT). METHODS Data from 622 patients (33 HC, 68 SCD, 301 MCI, 220 AD) who completed all three tests were obtained. Furthermore, 117 patients were examined in a follow-up. Data were analyzed in a retrospective analysis comparing the validity of tests in diagnosis and prediction using receiver operator characteristic (ROC) curves and multinominal logistic regression. RESULTS The VVT 3.0 Screening shows some ability to discriminate between AD and all other participants (sensitivity: 62.1%, specificity: 83.1%), while of the three examined tests none was able to predict membership to all experimental groups or to predict disease-progress adequately. As the VVT 3.0 Screening is short, easy to apply and largely language independent, it can be considered an alternative to the MMSE in certain situations. CONCLUSIONS The VVT 3.0 Screening is useful to discriminate between AD and all other participants and can be an alternative to the MMSE in certain situations.
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Affiliation(s)
- Amelie Tokaj
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria.
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Thiel A, Hermanns C, Lauer AA, Reichrath J, Erhardt T, Hartmann T, Grimm MOW, Grimm HS. Vitamin D and Its Analogues: From Differences in Molecular Mechanisms to Potential Benefits of Adapted Use in the Treatment of Alzheimer’s Disease. Nutrients 2023; 15:nu15071684. [PMID: 37049524 PMCID: PMC10096957 DOI: 10.3390/nu15071684] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/15/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Lifestyle habits and insufficient sunlight exposure lead to a high prevalence of vitamin D hypovitaminosis, especially in the elderly. Recent studies suggest that in central Europe more than 50% of people over 60 years are not sufficiently supplied with vitamin D. Since vitamin D hypovitaminosis is associated with many diseases, such as Alzheimer’s disease (AD), vitamin D supplementation seems to be particularly useful for this vulnerable age population. Importantly, in addition to vitamin D, several analogues are known and used for different medical purposes. These vitamin D analogues differ not only in their pharmacokinetics and binding affinity to the vitamin D receptor, but also in their potential side effects. Here, we discuss these aspects, especially those of the commonly used vitamin D analogues alfacalcidol, paricalcitol, doxercalciferol, tacalcitol, calcipotriol, and eldecalcitol. In addition to their pleiotropic effects on mechanisms relevant to AD, potential effects of vitamin D analogues on comorbidities common in the context of geriatric diseases are summarized. AD is defined as a complex neurodegenerative disease of the central nervous system and is commonly represented in the elderly population. It is usually caused by extracellular accumulation of amyloidogenic plaques, consisting of amyloid (Aβ) peptides. Furthermore, the formation of intracellular neurofibrillary tangles involving hyperphosphorylated tau proteins contributes to the pathology of AD. In conclusion, this review emphasizes the importance of an adequate vitamin D supply and discusses the specifics of administering various vitamin D analogues compared with vitamin D in geriatric patients, especially those suffering from AD.
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Loosen SH, Krieg S, Eschrich J, Luedde M, Krieg A, Schallenburger M, Schwartz J, Neukirchen M, Luedde T, Kostev K, Roderburg C. The Landscape of Outpatient Palliative Care in Germany: Results from a Retrospective Analysis of 14,792 Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14885. [PMID: 36429604 PMCID: PMC9691170 DOI: 10.3390/ijerph192214885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Palliative care comprises multiprofessional, integrated, person-centered healthcare services for patients and their families facing problems related to progressive or advanced diseases and limited life expectancy. Although non-oncology patients' needs are similar to those of tumor patients, they are often underestimated. The purpose of our study was to investigate the actual utilization of palliative care services in Germany, especially in the outpatient setting. METHODS Using the IQVIA Disease Analyzer database, a total of 14,792 outpatients from 805 primary care practices in Germany with documented palliative care and related diagnosis between 2018 and 2021 were analyzed. Proportions of different diagnoses among patients receiving outpatient palliative care were stratified by gender and different age groups. RESULTS The most common underlying diagnosis for outpatient palliative care was cancer (55%), followed by heart failure (16%) and dementia (8%), with age- and sex-specific differences found in the proportion of diagnoses for utilization. While the relative proportions of cancers decreased with age (87% in the 18- to 50-year-old age group versus 37% in the 80-plus age group), the proportion of palliative care related to heart failure increased in the older population (2% in the 18- to 50-year-old age group versus 25% in the 80-plus age group). CONCLUSIONS This study provides an overview of the situation of outpatient palliative care in Germany and shows age- and gender-specific trends regarding the underlying medical diagnoses. Based on these data, palliative care should be adapted to current demographic developments.
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Affiliation(s)
- Sven H. Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | - Sarah Krieg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | - Johannes Eschrich
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | | | - Andreas Krieg
- Department of Surgery (A), University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | - Manuela Schallenburger
- Interdisciplinary Center of Palliative Medicine, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | - Jacqueline Schwartz
- Interdisciplinary Center of Palliative Medicine, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | - Martin Neukirchen
- Interdisciplinary Center of Palliative Medicine, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
- Department of Anesthesiology, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Duesseldorf, Germany
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
| | | | - Christoph Roderburg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany
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Strong JV, Arnold M, Schneider L, Perschl J, Villringer A, Fritz TH. Enhanced Short-Term Memory Function in Older Adults with Dementia Following Music-Feedback Physical Training: A Pilot Study. Brain Sci 2022; 12:brainsci12091260. [PMID: 36138996 PMCID: PMC9496686 DOI: 10.3390/brainsci12091260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Prior research demonstrates that music making, physical exercise, and social activity have unique, positive effects on cognition and mood. One intervention, “Jymmin®”, was developed incorporating these approaches and found effective for decreased pain perception and increased endurance, self-efficacy, mood, and muscle efficiency. Previously, Jymmin was not piloted with older adults with dementia. The current study is a randomized pilot study of the Jymmin® with an older adult population in a long-term care facility (n = 38), evaluated across dementia levels (mild, moderate, or severe). Results found significant improvements in scores on a confrontation naming task across all conditions (p = 0.047) and a significant interaction effect for short-term memory scores (p = 0.046), suggesting higher scores at Time 2 for the experimental group and at Time 3 for the control group. There were no significant changes in mood ratings. Findings are discussed in the context of neural activity and musical agency.
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Affiliation(s)
- Jessica V. Strong
- Department of Psychology, University of Prince Edward Island, Charlottetown, PE C1A 4P3, Canada
| | - Maria Arnold
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1A, 04103 Leipzig, Germany
| | - Lydia Schneider
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1A, 04103 Leipzig, Germany
| | - Johanna Perschl
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1A, 04103 Leipzig, Germany
| | - Arno Villringer
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1A, 04103 Leipzig, Germany
| | - Thomas Hans Fritz
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1A, 04103 Leipzig, Germany
- Institute for Psychoacoustics and Electronic Music (IPEM), Blandijnberg 2, 9000 Ghent, Belgium
- Correspondence:
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Schinle M, Erler C, Kaliciak M, Milde C, Stock S, Gerdes M, Stork W. Digital Health Apps in the Context of Dementia: Questionnaire Study to Assess the Likelihood of Use Among Physicians. JMIR Form Res 2022; 6:e35961. [PMID: 35731567 PMCID: PMC9260525 DOI: 10.2196/35961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/08/2022] [Accepted: 04/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Age-related diseases such as dementia are playing an increasingly important role in global population development. Thus, prevention, diagnostics, and interventions require more accessibility, which can be realized through digital health apps. With the app on prescription, Germany made history by being the first country worldwide to offer physicians the possibility to prescribe and reimburse digital health apps as of the end of the year 2020. OBJECTIVE Considering the lack of knowledge about correlations with the likelihood of use among physicians, this study aimed to address the question of what makes the use of a digital health app by physicians more likely. METHODS We developed and validated a novel measurement tool-the Digital Health Compliance Questionnaire (DHCQ)-in an interdisciplinary collaboration of experts to assess the role of proposed factors in the likelihood of using a health app. Therefore, a web-based survey was conducted to evaluate the likelihood of using a digital app called DemPredict to screen for Alzheimer dementia. Within this survey, 5 latent dimensions (acceptance, attitude toward technology, technology experience, payment for time of use, and effort of collection), the dependent variable likelihood of use, and answers to exploratory questions were recorded and tested within directed correlations. Following a non-probability-sampling strategy, the study was completed by 331 physicians from Germany in the German language, of whom 301 (90.9%) fulfilled the study criteria (eg, being in regular contact with patients with dementia). These data were analyzed using a range of statistical methods to validate the dimensions of the DHCQ. RESULTS The DHCQ revealed good test theoretical measures-it showed excellent fit indexes (Tucker-Lewis index=0.98; comparative fit index=0.982; standardized root mean square residual=0.073; root mean square error of approximation=0.037), good internal consistency (Cronbach α=.83), and signs of moderate to large correlations between the DHCQ dimensions and the dependent variable. The correlations between the variables acceptance, attitude toward technology, technology experience, and payment for the time of use and the dependent variable likelihood of use ranged from 0.29 to 0.79, and the correlation between effort of the collection and likelihood of use was -0.80. In addition, we found high levels of skepticism regarding data protection, and the age of the participants was found to be negatively related to their technical experience and attitude toward technology. CONCLUSIONS In the context of the results, increased communication between the medical and technology sectors and significantly more awareness raising are recommended to make the use of digital health apps more attractive to physicians as they can be adjusted to their everyday needs. Further research could explore the connection between areas such as adherence on the patient side and its impact on the likelihood of use by physicians.
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Affiliation(s)
- Markus Schinle
- Medical Information Technology, Embedded Systems and Sensors Engineering, FZI Research Center for Information Technology, Karlsruhe, Germany
| | - Christina Erler
- Medical Information Technology, Embedded Systems and Sensors Engineering, FZI Research Center for Information Technology, Karlsruhe, Germany
| | - Mayumi Kaliciak
- Biological Psychology, Department of Psychology, University of Koblenz and Landau, Landau, Germany
| | - Christopher Milde
- Biological Psychology, Department of Psychology, University of Koblenz and Landau, Landau, Germany
| | - Simon Stock
- Institut fuer Technik der Informationsverarbeitung, Department of Electrical Engineering & Information Technology, KIT Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Marius Gerdes
- Institut fuer Technik der Informationsverarbeitung, Department of Electrical Engineering & Information Technology, KIT Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Wilhelm Stork
- Institut fuer Technik der Informationsverarbeitung, Department of Electrical Engineering & Information Technology, KIT Karlsruhe Institute of Technology, Karlsruhe, Germany
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Hendriks S, Peetoom K, Bakker C, van der Flier WM, Papma JM, Koopmans R, Verhey FRJ, de Vugt M, Köhler S. Global Prevalence of Young-Onset Dementia: A Systematic Review and Meta-analysis. JAMA Neurol 2021; 78:1080-1090. [PMID: 34279544 PMCID: PMC8290331 DOI: 10.1001/jamaneurol.2021.2161] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/24/2021] [Indexed: 12/22/2022]
Abstract
Importance Reliable prevalence estimates are lacking for young-onset dementia (YOD), in which symptoms of dementia start before the age of 65 years. Such estimates are needed for policy makers to organize appropriate health care. Objective To determine the global prevalence of YOD. Data Sources The PubMed, Embase, CINAHL, and PsycInfo databases were systematically searched for population-based studies on the prevalence of YOD published between January 1, 1990, and March 31, 2020. Study Selection Studies containing data on the prevalence of dementia in individuals younger than 65 years were screened by 2 researchers for inclusion in a systematic review and meta-analysis. Data Extraction and Synthesis Prevalence estimates on 5-year age bands, from 30 to 34 years to 60 to 64 years, were extracted. Random-effects meta-analyses were conducted to pool prevalence estimates. Results were age standardized for the World Standard Population. Heterogeneity was assessed by subgroup analyses for sex, dementia subtype, study design, and economic status based on the World Bank classification and by meta-regression. Main Outcomes and Measures Prevalence estimates of YOD for 5-year age bands. Results A total of 95 unique studies were included in this systematic review, of which 74 with 2 760 379 unique patients were also included in 5-year age band meta-analyses. Studies were mostly conducted in Europe and in older groups in Asia, North America, and Oceania. Age-standardized prevalence estimates increased from 1.1 per 100 000 population in the group aged 30 to 34 years to 77.4 per 100 000 population in the group aged 60 to 64 years. This gives an overall global age-standardized prevalence of 119.0 per 100 000 population in the age range of 30 to 64 years, corresponding to 3.9 million people aged 30 to 64 years living with YOD in the world. Subgroup analyses showed prevalence between men and women to be similar (crude estimates for men, 216.5 per 100 000 population; for women, 293.1 per 100 000 population), whereas prevalence was lower in high-income countries (crude estimate, 663.9 per 100 000 population) compared with upper-middle-income (crude estimate, 1873.6 per 100 000 population) and lower-middle-income (crude estimate, 764.2 per 100 000 population) countries. Meta-regression showed that age range (P < .001), sample size (P < .001), and study methodology (P = .02) significantly influenced heterogeneity between studies. Conclusions and Relevance This systematic review and meta-analysis found an age-standardized prevalence of YOD of 119.0 per 100 000 population, although estimates of the prevalence in low-income countries and younger age ranges remain scarce. These results should help policy makers organize sufficient health care for this subgroup of individuals with dementia. Study Registration PROSPERO CRD42019119288.
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Affiliation(s)
- Stevie Hendriks
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Center, Radboud, the Netherlands
- Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Wiesje M. van der Flier
- Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC (University Medical Center), Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Janne M. Papma
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Radboud, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Frans R. J. Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
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Dichter MN, Berg A, Hylla J, Eggers D, Wilfling D, Möhler R, Haastert B, Meyer G, Halek M, Köpke S. Evaluation of a multi-component, non-pharmacological intervention to prevent and reduce sleep disturbances in people with dementia living in nursing homes (MoNoPol-sleep): study protocol for a cluster-randomized exploratory trial. BMC Geriatr 2021; 21:40. [PMID: 33430785 PMCID: PMC7802225 DOI: 10.1186/s12877-020-01997-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sleep problems are highly prevalent in people with dementia. Nevertheless, there is no "gold standard" intervention to prevent or reduce sleep problems in people with dementia. Existing interventions are characterized by a pronounced heterogeneity as well as insufficient knowledge about the possibilities and challenges of implementation. The aim of this study is to pilot and evaluate the effectiveness of a newly developed complex intervention to prevent and reduce sleep problems in people with dementia living in nursing homes. METHODS This study is a parallel group cluster-randomized controlled trial. The intervention consists of six components: (1) the assessment of established sleep-promoting interventions and an appropriate environment in the participating nursing homes, (2) the implementation of two "sleep nurses" as change agents per nursing home, (3) a basic education course for nursing staff: "Sleep problems in dementia", (4) an advanced education course for nursing staff: "Tailored problem-solving" (two workshops), (5) workshops: "Development of an institutional sleep-promoting concept" (two workshops with nursing management and sleep nurses) and (6) written information and education material (e.g. brochure and "One Minute Wonder" poster). The intervention will be performed over a period of 16 weeks and compared with usual care in the control group. Overall, 24 nursing homes in North, East and West Germany will be included and randomized in a 1:1 ratio. The primary outcome is the prevalence of sleep problems in people with dementia living in nursing homes. Secondary outcomes are quality of life, quality of sleep, daytime sleepiness and agitated behavior of people with dementia, as well as safety parameters like psychotropic medication, falls and physical restraints. The outcomes will be assessed using a mix of instruments based on self- and proxy-rating. A cost analysis and a process evaluation will be performed in conjunction with the study. CONCLUSIONS It is expected that the intervention will reduce the prevalence of sleep problems in people with dementia, thus not only improving the quality of life for people with dementia, but also relieving the burden on nursing staff caused by sleep problems. TRIAL REGISTRATION Current controlled trials: ISRCTN36015309 . Date of registration: 06/11/2020.
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Affiliation(s)
- Martin N Dichter
- Institute of Nursing Science, University Hospital of Cologne, Gleuler Straße 176-178, D-50935, Cologne, Germany.
- Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany.
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany.
| | - Almuth Berg
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112, Halle (Saale), Germany
| | - Jonas Hylla
- Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany
| | - Daniela Eggers
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Denise Wilfling
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- School of Public health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | | | - Gabriele Meyer
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112, Halle (Saale), Germany
| | - Margareta Halek
- Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University Hospital of Cologne, Gleuler Straße 176-178, D-50935, Cologne, Germany
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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How is migration background considered in the treatment and care of people? A comparison of national dementia care guidelines in Europe. BMC Public Health 2020; 20:1555. [PMID: 33059649 PMCID: PMC7559782 DOI: 10.1186/s12889-020-09668-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
Background People with a migration background are vulnerable to dementia. Due to problems such as underdiagnosis or access barriers, the care of this population is a public health challenge in Europe. Many countries are issuing care guidelines, but a systematic overview of their references to migration groups is lacking. This study aims to analyze national dementia care guidelines regarding their focus on people with a migration background, what specific actions to ensure healthcare have been undertaken at the national level, and whether recommendations for action are made for this population. Methods This study is a systematic analysis of national dementia care guidelines of the EU and EFTA (European Free Trade Association) countries. Using the discourse analysis model by Keller (2011), 43 documents from 24 EU and 3 EFTA countries were systematically screened for migration references via keyword and context analysis. The content of the migration-related section was paraphrased, memos and comments were added, and the individual text passages were coded using the strategy of open coding. Results Twenty-seven of the 35 EU and EFTA countries have guidelines or similar documents on care for people with dementia, and 12 refer to migration. Norway, Sweden, and Northern Ireland refer to this topic in detail. The focus of the migration-related guidelines is on the early detection and diagnosis of dementia. The main message is that standardized diagnostic tools such as the MMSE (Mini-Mental State Examination) or the clock test are not suitable for linguistic minorities. Nine countries make recommendations for the care of people with a migration background and dementia, but only Norway, Sweden, and Denmark point to available healthcare services. A key recommendation is that the linguistic and cultural background of people should be considered when selecting diagnostic tests. Several countries refer to the validity of the RUDAS (Rowland Universal Dementia Assessment Scale) for migrants. Conclusions The topic of migration plays a subordinate role in the dementia care guidelines of European countries. Almost all countries lack appropriate diagnostic tools and healthcare services for people with a migration background. Consequently, this group is vulnerable to underdiagnosis and a lower level of care.
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Völter C, Götze L, Bruene-Cohrs U, Dazert S, Thomas JP. [Hearing and cognition: neurocognitive test batteries in otorhinolaryngology]. HNO 2019; 68:155-163. [PMID: 31628531 DOI: 10.1007/s00106-019-00762-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hearing and cognition are closely related to each other. Particularly in suboptimal listening situations, cognitive abilities become important to enable speech comprehension. Besides, studies have indicated that hearing impairment is associated with a more rapid mental decline compared to persons with normal hearing. However, hearing loss also has an impact on neurocognitive testing, which is generally based on auditive stimuli. With increasing age, the risk of sensory but also of cognitive impairments increases. So far this comorbidity receives little consideration in otorhinolaryngology. MATERIALS AND METHODS The paper presents an overview and evaluation of widely used German neurocognitive test batteries for older patients, with regard to the different test modalities and their focus. RESULTS A multitude of different neurocognitive screening tests and detailed test batteries are available, particularly in the field of dementia. So far, sensory deficits have not been considered in neurocognitive testing, neither concerning application nor interpretation. Normative data adapted to the hearing impaired are still missing. CONCLUSION With regard to demographic changes and the well-known bias between hearing and cognition, screening of neurocognitive functions should be implemented in basic otorhinolaryngologic diagnostics. More comprehensive test batteries might be useful for research purposes or speech therapy.
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Affiliation(s)
- C Völter
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Bleichstr. 15, 44787, Bochum, Deutschland.
| | - L Götze
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Bleichstr. 15, 44787, Bochum, Deutschland
| | - U Bruene-Cohrs
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum Bochum, Alexandrinentrasse 1, 44791, Bochum, Deutschland
| | - S Dazert
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Bleichstr. 15, 44787, Bochum, Deutschland
| | - J P Thomas
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Bleichstr. 15, 44787, Bochum, Deutschland
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Abstract
Neurodegenerative diseases are sporadic and rare hereditary disorders of the central nervous system, which cause a slowly progressive loss of function of specific neuron populations and their connections. Severe impairments and care dependency can be the sequelae. Neurodegenerative disorders are diseases of older people; therefore, the demographic shift leads to an increase in the number of affected patients. Radiologists will also become more involved. For this reason important neurodegenerative diseases are presented in this article. In addition to Alzheimer's and Parkinson's diseases these also include frontotemporal lobar degeneration, Lewy body dementia, vascular dementia, Creutzfeldt-Jakob disease and Huntington's chorea. The clinical symptoms and diagnostics are described, whereby the focus lies on typical results of morphological imaging.
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Lohmann H, Kulessa F, Holling H, Johnen A, Reul S, Lueg G, Duning T. [Implementation of the German S3 guidelines on dementia in clinical practice: wish or reality?]. DER NERVENARZT 2018; 88:895-904. [PMID: 28429077 DOI: 10.1007/s00115-017-0325-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Published in 2009, the German S3 guidelines on dementia define a milestone in quality improvement of the diagnostics and treatment of dementia. In clinical practice patients suffering from dementia are primarily treated by physicians in private practice; therefore, this study examined how the guidelines are implemented in outpatient clinical settings. Furthermore, it aimed at the identification of behavioral determinants that govern the actual diagnostic and therapeutic approach in clinical practice. METHODS Physicians involved in the primary care of dementia patients were asked to participate in a nationwide internet survey. The questionnaire covered aspects on the diagnostic and therapeutic care of dementia patients as recommended by the S3 guidelines. Behavioral determinants of the implementation of the guidelines (e. g. treatment decisions) were derived from an established psychological prediction model. RESULTS Out of a total of 2755 physicians contacted, the data of 225 participants could be used in this study. The diagnostic recommendations of the S3 guidelines were implemented in satisfactory measures (e.g. combined cognitive screening in at least 68%, cerebral neuroimaging in at least 93% and specific laboratory diagnostics in at least 27% of cases); however, only two thirds of the patients with indications for a guideline-conform therapy were treated in accordance with the S3 guidelines. There was a substantial prescription of non-recommended drugs and a notable long-term use of antipsychotic drugs (prescription by at least 14% of non-neurological medical specialists and by 8% of neurologists and psychiatrists). When considering the behavioral determinants in the implementation of the guidelines, normative assumptions ("my colleagues and patients expect me to comply with the guidelines") surprisingly had the highest impact, which was then followed by attitudes towards the behavior ("utilization of the guidelines improves diagnostics and therapy"). CONCLUSION The German S3 guidelines on dementia were satisfactorily implemented in outpatient clinical practice; however, deficits existed in the frequency of the pharmaceutical treatment of patients with indications for therapy, the prescription of non-recommended drugs and the relatively common use of permanent neuroleptic medications. Interestingly, the motivation for implementation of the guidelines was not primarily influenced by the physicians' personal convictions but mainly stimulated by the expectations of others.
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Affiliation(s)
- H Lohmann
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
| | - F Kulessa
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
- Institut für Psychologie, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - H Holling
- Institut für Psychologie, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - A Johnen
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - S Reul
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - G Lueg
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - T Duning
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
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Continuity of treatment with benzodiazepines in dementia patients: an analysis of German health insurance claims data. Int Clin Psychopharmacol 2018; 33:282-289. [PMID: 29952800 DOI: 10.1097/yic.0000000000000230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Long-term treatment with benzodiazepines (BZD) should be avoided in dementia patients because of an increased risk of adverse events. We evaluated how continuously dementia patients were prescribed BZD over 12 months. For this observational study, we used claims data from a large German public sickness fund for 2014 and 2015, including patients with an incident diagnosis of dementia in 2014. The aim was to evaluate the continuity of treatment, the frequency of BZD prescriptions and defined daily doses were evaluated. In total, 1298 (5.6%) patients received 4.7±5.2 BZD prescriptions in 2015 on average. Thereof, lorazepam (47.5%), oxazepam (18.6%), diazepam (14.5%), and bromazepam (12.2%) were most often prescribed. 30.7% of the patients received at least one BZD prescription in each quarter of 2015. Although the total number of patients receiving BZD decreased in 2015, defined daily doses for single substances remained mainly unchanged. The incident diagnosis of dementia was not associated with modifications of prescription behavior. The treatment with BZD was not discontinued in a large proportion of dementia patients, increasing the risk of adverse events. Physicians' awareness of avoiding BZD should be improved and further evidence for the appropriate treatment of psychiatric symptoms in dementia (e.g. sleep disturbances, anxiety) is required.
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Vogelgsang J, Wolff-Menzler C, Kis B, Abdel-Hamid M, Wiltfang J, Hessmann P. Cardiovascular and metabolic comorbidities in patients with Alzheimer's disease and vascular dementia compared to a psychiatric control cohort. Psychogeriatrics 2018; 18:393-401. [PMID: 29993172 DOI: 10.1111/psyg.12338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multimorbidity in dementia is associated with an increased risk of complications and a higher need for care. Having knowledge of cardiovascular and metabolic comorbidities is crucial when making decisions about diagnostic procedures and therapies. We compared the prevalence of comorbidities in hospitalized patients with Alzheimer's disease (AD), vascular dementia, and psychiatric diseases other than dementia. Additionally, we compared clinically relevant health-care indicators (length of hospital stay, rate of re-hospitalization) between these groups. METHODS We used information from a database of treatment-relevant indicators from psychiatric and psychosomatic hospitals throughout Germany. This database contains routinely recorded data collected from 85 German hospitals from 2011 to 2015. In total, 14 411 AD cases, 7156 vascular dementia cases, and 34 534 cases involving non-demented psychiatric patients (used as controls) were included. To analyze comorbidities and health-care indicators, χ2 tests and t-tests were used. RESULTS Diabetes mellitus, lipoprotein disorders, coronary artery diseases, cardiac arrhythmia and insufficiency, and atherosclerosis were significantly more prevalent in patients with vascular dementia than in those with AD and psychiatric controls. Hypertension and coronary artery diseases were less frequently associated with AD than with non-demented psychiatric controls (P < 0.001). Additionally, dementia patients with cardiovascular or metabolic diseases exhibited longer hospital stays (+ 1.4 days, P < 0.001) and were more often re-hospitalized within 3 weeks (P < 0.001) and 1 year (P < 0.001) compared to dementia patients without these comorbidities. CONCLUSIONS Awareness of somatic comorbidities in patients with dementia is crucial to avoid complications during inpatient treatment. The occurrence of comorbid disorders was associated with longer and more frequent hospital stays, which potentially lead to higher health-care costs. Further studies should evaluate the causative association between somatic comorbidities and inpatient costs in dementia patients.
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Affiliation(s)
- Jonathan Vogelgsang
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
| | - Claus Wolff-Menzler
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany.,Institute for Research in Biomedicine (iBiMED), Medical Science Department, University of Aveiro, Aveiro, Portugal
| | - Philipp Hessmann
- Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany
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[Prevalence of dementia in university hospitals : Analysis of ICD-10 coding in 5 university hospitals in Germany over a 2-year period]. Z Gerontol Geriatr 2018; 52:575-581. [PMID: 30076440 DOI: 10.1007/s00391-018-1433-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/30/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Demographic changes result in a higher prevalence of patients suffering from dementia in hospital. In Germany, epidemiological data of this target group are scarce and prevalence rates from university hospitals (UH) are not available. The prevalence rates and distribution were analyzed on the basis of ICD-10-GM (German modification) routine data METHOD: A secondary analysis on ICD-10-GM main and secondary diagnoses of dementia from 2014 and 2015 from 5 UH was performed. All patients admitted to hospital for at least 24 h and ≥18 years old (2014 n = 187,168; 2015 n = 189,040) were included. A descriptive analysis for the >69-year-old group was carried out (2014, n = 67,111; 2015; n = 67,824). RESULTS The 1‑year prevalence (2014/2015) for all 5 UH for patients ≥18 years old was 1.3%/1.4% and for the >69-year-old group, 3.3%/3.5%. The prevalence rates between the five UH varied: for patients ≥18 years the range was 0.44-2.16% (2014) and 0.44-2.77% (2015) and for >69-year-olds 1.16-5.52% (2014) and 1.16-7.06% (2015). Most cases were correlated with major diagnostic categories of traumatology, cardiology, gastroenterology and neurology. CONCLUSION Analysis of ICD-10-GM routine data can provide an indication of the prevalence of dementia in UH. Results of the >69-year-olds varied greatly between participating UH. The reasons for this might be different healthcare tasks, especially with respect to geriatric patients; however, it is also possible that assessment procedures are not standardized and unreliable and therefore the coding is invalid. A standardized procedure for the identification of people suffering from dementia is necessary.
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Who is where at risk for Chronic Obstructive Pulmonary Disease? A spatial epidemiological analysis of health insurance claims for COPD in Northeastern Germany. PLoS One 2018; 13:e0190865. [PMID: 29414997 PMCID: PMC5802453 DOI: 10.1371/journal.pone.0190865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) has a high prevalence rate in Germany and a further increase is expected within the next years. Although risk factors on an individual level are widely understood, only little is known about the spatial heterogeneity and population-based risk factors of COPD. Background knowledge about broader, population-based processes could help to plan the future provision of healthcare and prevention strategies more aligned to the expected demand. The aim of this study is to analyze how the prevalence of COPD varies across northeastern Germany on the smallest spatial-scale possible and to identify the location-specific population-based risk factors using health insurance claims of the AOK Nordost. Methods To visualize the spatial distribution of COPD prevalence at the level of municipalities and urban districts, we used the conditional autoregressive Besag–York–Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific ecological risk factors for COPD. Results The sex- and age-adjusted prevalence of COPD was 6.5% in 2012 and varied widely across northeastern Germany. Population-based risk factors consist of the proportions of insurants aged 65 and older, insurants with migration background, household size and area deprivation. The results of the GWR model revealed that the population at risk for COPD varies considerably across northeastern Germany. Conclusion Area deprivation has a direct and an indirect influence on the prevalence of COPD. Persons ageing in socially disadvantaged areas have a higher chance of developing COPD, even when they are not necessarily directly affected by deprivation on an individual level. This underlines the importance of considering the impact of area deprivation on health for planning of healthcare. Additionally, our results reveal that in some parts of the study area, insurants with migration background and persons living in multi-persons households are at elevated risk of COPD.
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Kauhl B, Maier W, Schweikart J, Keste A, Moskwyn M. Exploring the small-scale spatial distribution of hypertension and its association to area deprivation based on health insurance claims in Northeastern Germany. BMC Public Health 2018; 18:121. [PMID: 29321032 PMCID: PMC5761146 DOI: 10.1186/s12889-017-5017-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 12/21/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hypertension is one of the most frequently diagnosed chronic conditions in Germany. Targeted prevention strategies and allocation of general practitioners where they are needed most are necessary to prevent severe complications arising from high blood pressure. However, data on chronic diseases in Germany are mostly available through survey data, which do not only underestimate the actual prevalence but are also only available on coarse spatial scales. The discussion of including area deprivation for planning of healthcare is still relatively young in Germany, although previous studies have shown that area deprivation is associated with adverse health outcomes, irrespective of individual characteristics. The aim of this study is therefore to analyze the spatial distribution of hypertension at very fine geographic scales and to assess location-specific associations between hypertension, socio-demographic population characteristics and area deprivation based on health insurance claims of the AOK Nordost. METHODS To visualize the spatial distribution of hypertension prevalence at very fine geographic scales, we used the conditional autoregressive Besag-York-Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific association of hypertension to area deprivation and further socio-demographic population characteristics. RESULTS The sex- and age-adjusted prevalence of hypertension was 33.1% in 2012 and varied widely across northeastern Germany. The main risk factors for hypertension were proportions of insurants aged 45-64, 65 and older, area deprivation and proportion of persons commuting to work outside their residential municipality. The GWR model revealed important regional variations in the strength of the examined associations. CONCLUSION Area deprivation has only a significant and therefore direct influence in large parts of Mecklenburg-West Pomerania. However, the spatially varying strength of the association between demographic variables and hypertension indicates that there also exists an indirect effect of area deprivation on the prevalence of hypertension. It can therefore be expected that persons ageing in deprived areas will be at greater risk of hypertension, irrespective of their individual characteristics. The future planning and allocation of primary healthcare in northeastern Germany would therefore greatly benefit from considering the effect of area deprivation.
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Affiliation(s)
- B. Kauhl
- AOK Nordost – Die Gesundheitskasse, Department of Medical Care, Berlin, Germany
- Beuth University of Applied Sciences, Department III, Civil Engineering and Geoinformatics, Berlin, Germany
| | - W. Maier
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - J. Schweikart
- Beuth University of Applied Sciences, Department III, Civil Engineering and Geoinformatics, Berlin, Germany
| | - A. Keste
- AOK Nordost – Die Gesundheitskasse, Department of Medical Care, Berlin, Germany
| | - M. Moskwyn
- AOK Nordost – Die Gesundheitskasse, Department of Medical Care, Berlin, Germany
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Indikatoren einer gestiegenen Demenzdiagnoserate in Hausarztpraxen. Z Gerontol Geriatr 2017; 51:517-522. [DOI: 10.1007/s00391-017-1336-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Thyrian JR, Eichler T, Michalowsky B, Wucherer D, Reimann M, Hertel J, Richter S, Dreier A, Hoffmann W. Community-Dwelling People Screened Positive for Dementia in Primary Care: A Comprehensive, Multivariate Descriptive Analysis Using Data from the DelpHi-Study. J Alzheimers Dis 2017; 52:609-17. [PMID: 27031481 DOI: 10.3233/jad-151076] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Efficient help and care for people with dementia (PWD) is dependent on knowledge about PWD in primary care. OBJECTIVE This analysis comprehensively describes community-dwelling PWD in primary care with respect to various dementia care specific variables. METHODS The analyses are based on baseline data of the ongoing general practitioner-based, randomized, controlled intervention trial DelpHi-MV (Dementia: life- and person-centered help). 6,838 patients were screened for dementia in 136 GP practices; 17.1% were screened positive, 54.4% of those agreed to participate and data could be assessed in n = 516 subjects. We assessed age, sex, living situation, cognitive status, functional status, level of impairment, comorbidities, formal diagnosis of dementia, depression, neuropsychiatric symptoms, quality of life, utilization of medical support, and pharmacological therapy. RESULTS Concerning clinical-, dementia-, and health-related variables, the sample under examination was on average mildly cognitively and functionally impaired (MMSE, m = 22.2; BADL, m = 3.7). A level of care was assigned in 38.0%. Depression was identified in 15.4% and other frequent comorbidities were high blood pressure (83.3%), coronary heart diseases (37.1%), cerebrovascular diseases (22.3%), among others. In 48.6%, neuropsychiatric symptoms were present in a clinically relevant severity. Pharmacological treatment with antidementia medication was received by 25.8% and antidepressant medication by 14.0%. Utilization of services was generally low. CONCLUSION The comprehensive description of people screened positive for dementia in primary care reveals a complex and unique population of patients. They are considerably underdiagnosed and in their majority mildly to moderately affected. More in-depth analyses are needed to study relations, associations and interactions between different variables.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Melanie Reimann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Steffen Richter
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier
- Institute for Community Medicine, University of Greifswald, Epidemiology of Health Care and Community Health, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University of Greifswald, Epidemiology of Health Care and Community Health, Greifswald, Germany
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Polak T, Herrmann MJ, Müller LD, Zeller JBM, Katzorke A, Fischer M, Spielmann F, Weinmann E, Hommers L, Lauer M, Fallgatter AJ, Deckert J. Near-infrared spectroscopy (NIRS) and vagus somatosensory evoked potentials (VSEP) in the early diagnosis of Alzheimer’s disease: rationale, design, methods, and first baseline data of the Vogel study. J Neural Transm (Vienna) 2017; 124:1473-1488. [DOI: 10.1007/s00702-017-1781-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 08/23/2017] [Indexed: 01/06/2023]
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Schwarzkopf L, Holle R, Schunk M. Effects of Nursing Home Residency on Diabetes Care in Individuals with Dementia: An Explorative Analysis Based on German Claims Data. Dement Geriatr Cogn Dis Extra 2017; 7:41-51. [PMID: 28413415 PMCID: PMC5346922 DOI: 10.1159/000455071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/12/2016] [Indexed: 01/21/2023] Open
Abstract
Aims This claims data-based study compares the intensity of diabetes care in community dwellers and nursing home residents with dementia. Methods Delivery of diabetes-related medical examinations (DRMEs) was compared via logistic regression in 1,604 community dwellers and 1,010 nursing home residents with dementia. The intra-individual effect of nursing home transfer was evaluated within mixed models. Results Delivery of DRMEs decreases with increasing care dependency, with more community-living individuals receiving DRMEs. Moreover, DRME provision decreases after nursing home transfer. Conclusion Dementia patients receive fewer DRMEs than recommended, especially in cases of higher care dependency and particularly in nursing homes. This suggests lacking awareness regarding the specific challenges of combined diabetes and dementia care.
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Affiliation(s)
- Larissa Schwarzkopf
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Rolf Holle
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Michaela Schunk
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
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Brinks R, Hoyer A, Weber S, Fischer-Betz R, Sander O, Richter JG, Chehab G, Schneider M. Age-specific and sex-specific incidence of systemic lupus erythematosus: an estimate from cross-sectional claims data of 2.3 million people in the German statutory health insurance 2002. Lupus Sci Med 2016; 3:e000181. [PMID: 27933200 PMCID: PMC5133401 DOI: 10.1136/lupus-2016-000181] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/28/2016] [Accepted: 11/05/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To provide an estimate of age-specific incidence rate of physician-diagnosed systemic lupus erythematosus (SLE) for German men and women. METHODS The age-specific and sex-specific prevalence of diagnosed SLE in claims data is used to estimate the incidence in the German male and female population. The claims data set stems from a representative sample of the statutory health insurance in 2002 and comprises 2.3 million people. The statutory health insurance covers >85% of the German population. RESULTS The estimated incidence rates are 0.9 (95% CI 0.7 to 1.1) per 100 000 person-years for men and 1.9 (95% CI 1.7 to 2.2) per 100 000 person-years for women. The age-specific incidence rate of SLE in the male population has a maximum of 2.2 (95% CI 1.0 to 3.4) per 100 000 person-years at the age of 65-70 years. In women, the incidence is peaking at the rate of 3.6 (95% CI 2.9 to 4.3) cases per 100 000 person-years at the age of 20-25 years, but has a second local maximum (2.6, 95% CI 1.5 to 3.8) at menopausal age. CONCLUSIONS For the first time, representative data on the incidence of SLE in Germany are provided. The estimated incidence rates of SLE for men and women in Germany are at the lower end of other estimates from comparable European countries.
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Affiliation(s)
- Ralph Brinks
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; German Diabetes Center, Institute for Biometry and Epidemiology, Duesseldorf, Germany
| | - Annika Hoyer
- German Diabetes Center, Institute for Biometry and Epidemiology , Duesseldorf , Germany
| | - Sergej Weber
- Hiller Research Unit for Rheumatology , University Hospital Duesseldorf , Duesseldorf , Germany
| | - Rebecca Fischer-Betz
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; Policlinics for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Oliver Sander
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; Policlinics for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Jutta G Richter
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; Policlinics for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Gamal Chehab
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; Policlinics for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Matthias Schneider
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; Policlinics for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
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Kauhl B, Schweikart J, Krafft T, Keste A, Moskwyn M. Do the risk factors for type 2 diabetes mellitus vary by location? A spatial analysis of health insurance claims in Northeastern Germany using kernel density estimation and geographically weighted regression. Int J Health Geogr 2016; 15:38. [PMID: 27809861 PMCID: PMC5094025 DOI: 10.1186/s12942-016-0068-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/21/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The provision of general practitioners (GPs) in Germany still relies mainly on the ratio of inhabitants to GPs at relatively large scales and barely accounts for an increased prevalence of chronic diseases among the elderly and socially underprivileged populations. Type 2 Diabetes Mellitus (T2DM) is one of the major cost-intensive diseases with high rates of potentially preventable complications. Provision of healthcare and access to preventive measures is necessary to reduce the burden of T2DM. However, current studies on the spatial variation of T2DM in Germany are mostly based on survey data, which do not only underestimate the true prevalence of T2DM, but are also only available on large spatial scales. The aim of this study is therefore to analyse the spatial distribution of T2DM at fine geographic scales and to assess location-specific risk factors based on data of the AOK health insurance. METHODS To display the spatial heterogeneity of T2DM, a bivariate, adaptive kernel density estimation (KDE) was applied. The spatial scan statistic (SaTScan) was used to detect areas of high risk. Global and local spatial regression models were then constructed to analyze socio-demographic risk factors of T2DM. RESULTS T2DM is especially concentrated in rural areas surrounding Berlin. The risk factors for T2DM consist of proportions of 65-79 year olds, 80 + year olds, unemployment rate among the 55-65 year olds, proportion of employees covered by mandatory social security insurance, mean income tax, and proportion of non-married couples. However, the strength of the association between T2DM and the examined socio-demographic variables displayed strong regional variations. CONCLUSION The prevalence of T2DM varies at the very local level. Analyzing point data on T2DM of northeastern Germany's largest health insurance provider thus allows very detailed, location-specific knowledge about increased medical needs. Risk factors associated with T2DM depend largely on the place of residence of the respective person. Future allocation of GPs and current prevention strategies should therefore reflect the location-specific higher healthcare demand among the elderly and socially underprivileged populations.
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Affiliation(s)
- Boris Kauhl
- Department of Medical Care, AOK Nordost - Die Gesundheitskasse, Berlin, Germany.
- Department III, Civil Engineering and Geoinformatics, Beuth University of Applied Sciences, Berlin, Germany.
- Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Jürgen Schweikart
- Department III, Civil Engineering and Geoinformatics, Beuth University of Applied Sciences, Berlin, Germany
| | - Thomas Krafft
- Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Andrea Keste
- Department of Medical Care, AOK Nordost - Die Gesundheitskasse, Berlin, Germany
| | - Marita Moskwyn
- Department of Medical Care, AOK Nordost - Die Gesundheitskasse, Berlin, Germany
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24
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Brüggenjürgen B, Andersohn F, Burkowitz J, Ezzat N, Gaudig M, Willich SN. Cohort Study on Predictors of Need for Nursing Care in Alzheimer's Disease: An Analysis of Healthcare Data. J Alzheimers Dis 2016; 54:1365-1372. [PMID: 27662286 DOI: 10.3233/jad-160137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The individual and societal burden of Alzheimer's disease (AD) is substantial. Identifying relevant factors deteriorating AD and inducing need for nursing care would be of high relevance for healthcare planning. OBJECTIVE The main objective of this study was the identification of predictors of first assignment of a level of long-term care in AD, used as an approximation for disease progression. METHODS In a retrospective cohort study using data from a large German statutory health and long-term care insurance (SHI) company, co-morbidities and drug exposure were evaluated with respect to their predictive value for disease progression (first day the amount of daily nursing care exceeded 1.5 hours). Time to disease progression was modeled using COX-proportional hazard regression with stepwise selection of predictor variables. RESULTS The risk of nursing care need increased substantially with increasing age. Number of hospitalizations and number of different drugs used were significant indicators for progression, whereas outpatient visits were associated with a reduced need for care. Gender did not indicate significant influence on progression. Malignant neoplasms of ill-defined, secondary, and unspecified sites, malnutrition, renal failure, and injuries increased the risk of need for nursing care most significantly. Among prescribed drugs, significant increased risks were associated with drugs used in diabetes, preparations for treatment of wounds and ulcers, antiseptics and disinfectants, and analgesics. CONCLUSIONS Physical comorbidities are relevant contributors to an increase in need for nursing care. Some medical predicting conditions may be linked to cognition, while others may be directly linked to demand for care. AD patients with these comorbidities should be monitored with special attention, as they may be under an increased risk of care dependency.
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Affiliation(s)
- Bernd Brüggenjürgen
- Institute for Social Medicine, Epidemiology and Health Economics at Charité University Medical Center, Berlin, Germany.,Boston Healthcare Associates International GmbH, Berlin, Germany
| | - Frank Andersohn
- Institute for Social Medicine, Epidemiology and Health Economics at Charité University Medical Center, Berlin, Germany.,Frank Andersohn Consulting & Research Services, Berlin, Germany
| | - Jörg Burkowitz
- Boston Healthcare Associates International GmbH, Berlin, Germany
| | - Nadja Ezzat
- Boston Healthcare Associates International GmbH, Berlin, Germany
| | - Maren Gaudig
- Janssen Alzheimer Immunotherapy, Dublin, Ireland
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics at Charité University Medical Center, Berlin, Germany
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25
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[Guideline-adherent inpatient psychiatric psychotherapeutic treatment of behavioral and psychological symptoms of dementia : Normative definition of personnel requirements]. DER NERVENARZT 2016; 88:1010-1019. [PMID: 27581115 DOI: 10.1007/s00115-016-0195-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Dementia is of increasing medical and societal relevance. Hospitalization of dementia patients is mostly due to behavioral and psychological symptoms of dementia (BPSD). There is a need for sufficient qualified personnel in hospitals in order to be able to effectively treat these symptoms. OBJECTIVES This study aims at identifying the personnel requirements for guideline-conform, evidence-based inpatient treatment concepts for patients with BPSD and to compare these with the resources defined by the German psychiatric personnel regulations (Psych-PV). Furthermore, it was the aim to identify how often patients with dementia received non-pharmacological therapy during inpatient treatment. METHODS Based on the current scientific evidence for treatment of BPSD, a schedule for a multimodal non-pharmacological treatment was defined and based on this the corresponding personnel requirements were calculated. Using the treatment indicators in psychiatry and psychosomatics (VIPP) database as a reference, it was calculated on what proportion of treatment days patients were classified into G1 according to the German Psych-PV and at least once received more than two treatment units per week. RESULTS For the implementation of a guideline-oriented and evidence-based treatment plan, a higher need for personnel resources than that provided by the Psych-PV was detected in all areas. Currently patients with dementia who received at least more than two treatment units per week during inpatient hospitalization, were classified into G1 according to German Psych-PV on 17.9 % of treatment days. CONCLUSION Despite evidence for the efficacy of non-pharmacological treatment measures on BPSD, these forms of treatment cannot be sufficiently provided under the current conditions. The realization of a new quality controlled therapeutic concept is necessary to enable optimized treatment of patients with BPSD.
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Prinz N, Stingl J, Dapp A, Denkinger MD, Fasching P, Jehle PM, Merger S, Mühldorfer S, Pieper U, Schuler A, Zeyfang A, Holl RW. High rate of hypoglycemia in 6770 type 2 diabetes patients with comorbid dementia: A multicenter cohort study on 215,932 patients from the German/Austrian diabetes registry. Diabetes Res Clin Pract 2016; 112:73-81. [PMID: 26563590 DOI: 10.1016/j.diabres.2015.10.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/13/2015] [Accepted: 10/20/2015] [Indexed: 12/14/2022]
Abstract
AIMS Dementia and type 2 diabetes (T2D) are two major phenomena in older people. To compare anti-hyperglycemic therapy and diabetes-related comorbidities between elderly T2D patients with or without comorbid dementia. METHODS 215,932 type 2 diabetes patients aged ≥ 40 years (median [Q1;Q3]: 70.4 [61.2;77.7] years) from the standardized, multicenter German/Austrian diabetes patient registry, DPV, were studied. To identify patients with comorbid dementia, the registry was searched by ICD-10 codes, DSM-IV/-5 codes, respective search terms and/or disease-specific medication. For group comparisons, multiple hierarchic regression modeling with adjustments for age, sex, and duration of diabetes was applied. RESULTS 3.1% (n=6770; 57% females) of the eligible T2D patients had clinically recognized comorbid dementia. After adjustment for demographics, severe hypoglycemia (insulin group: 14.8 ± 0.6 vs. 10.4 ± 0.2 events per 100 patient-years, p<0.001), hypoglycemia with coma (insulin group: 7.6 ± 0.4 vs. 3.9 ± 0.1 events per 100 patient-years, p<0.001), depression (9.9 vs. 4.7%, p<0.001), hypertension (74.7 vs. 72.2%, p<0.001), stroke (25.3 vs. 6.5%, p<0.001), diabetic foot syndrome (6.0 vs. 5.2%, p=0.004), and microalbuminuria (34.7 vs. 32.2%, p<0.001) were more common in dementia patients compared to T2D without dementia. Moreover, patients with dementia received insulin therapy more frequently (59.3 vs. 54.7%, p<0.001), but metabolic control (7.7 ± 0.1 vs. 7.7 ± 0.1%) was comparable to T2D without dementia. CONCLUSIONS In T2D with dementia, higher rates of hypoglycemia and other diabetes-related comorbidities were observed. Hence, the risks of a glucocentric and intense diabetes management with insulin and a focus on tight glycemic control without considering other factors may outweigh the benefits in elderly T2D patients with comorbid dementia.
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Affiliation(s)
- Nicole Prinz
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm and German Center for Diabetes Research (DZD), Ulm, Germany.
| | - Julia Stingl
- Federal Institute for Drugs and Medical Devices, and Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Albrecht Dapp
- Diabetes Center, Hospital District Tuttlingen, Medical Clinic Spaichingen, Spaichingen, Germany
| | - Michael D Denkinger
- Geriatric Center Ulm/Alb-Donau, Geriatric Medicine at Ulm University, Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Peter Fasching
- 5th Medical Department, Wilhelminenspital, Vienna, Austria
| | - Peter M Jehle
- Department of Internal Medicine, Paul-Gerhardt-Stift, Academic hospital of the Martin-Luther-University Halle-Wittenberg, Lutherstadt Wittenberg, Germany
| | - Sigrun Merger
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | | | - Urte Pieper
- Department of Internal Medicine, Hospital Wolgast, Wolgast, Germany
| | - Andreas Schuler
- Department of Internal Medicine, Helfenstein Hospital Geislingen/Steige, Geislingen/Steige, Germany
| | - Andrej Zeyfang
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm and German Center for Diabetes Research (DZD), Ulm, Germany; Agaplesion Bethesda Hospital Stuttgart, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm and German Center for Diabetes Research (DZD), Ulm, Germany
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27
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Brinks R, Bardenheier BH, Hoyer A, Lin J, Landwehr S, Gregg EW. Development and demonstration of a state model for the estimation of incidence of partly undetected chronic diseases. BMC Med Res Methodol 2015; 15:98. [PMID: 26560517 PMCID: PMC4642685 DOI: 10.1186/s12874-015-0094-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/06/2015] [Indexed: 01/08/2023] Open
Abstract
Background Estimation of incidence of the state of undiagnosed chronic disease provides a crucial missing link for the monitoring of chronic disease epidemics and determining the degree to which changes in prevalence are affected or biased by detection. Methods We developed a four-part compartment model for undiagnosed cases of irreversible chronic diseases with a preclinical state that precedes the diagnosis. Applicability of the model is tested in a simulation study of a hypothetical chronic disease and using diabetes data from the Health and Retirement Study (HRS). Results A two dimensional system of partial differential equations forms the basis for estimating incidence of the undiagnosed and diagnosed disease states from the prevalence of the associated states. In the simulation study we reach very good agreement between the estimates and the true values. Application to the HRS data demonstrates practical relevance of the methods. Discussion We have demonstrated the applicability of the modeling framework in a simulation study and in the analysis of the Health and Retirement Study. The model provides insight into the epidemiology of undiagnosed chronic diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0094-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ralph Brinks
- German Diabetes Center, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, Düsseldorf, 40225, Germany.
| | - Barbara H Bardenheier
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
| | - Annika Hoyer
- German Diabetes Center, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, Düsseldorf, 40225, Germany.
| | - Ji Lin
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
| | - Sandra Landwehr
- University Hospital, Department for Statistics in Medicine, Düsseldorf, Germany.
| | - Edward W Gregg
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
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28
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[Who exactly are these "persons with limitations in daily living skills"? : Survey of insured persons based on health insurance data]. Z Gerontol Geriatr 2015; 49:714-720. [PMID: 26514144 DOI: 10.1007/s00391-015-0967-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/21/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In recent years German long-term care insurance coverage has gradually been extended to include services for people with limitations in daily living skills. Until now, however, it was unclear who exactly people with limited daily living skills are. AIM The study aimed to characterize people with limited daily living skills who use additional support services as defined by § 45b of the Social Services Code XI (SGB XI). MATERIAL AND METHODS This study was based on a survey of 1284 people with limited daily living skills who used additional support services (§ 45b SGB XI). The data were analyzed descriptively. RESULTS The average recipient was 81 years old, mainly in care level I and the majority of them were exclusively cared for by relatives. Of these recipients 61 % were diagnosed with dementia, 73.4 % had medium cognitive impairments while more than half could no longer carry out the instrumental activities of daily living (IADL). CONCLUSION Statistics on people with limited daily living skills should be included in publications and reports so that the need for care and assistance can be estimated more precisely.
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Landwehr S, Brinks R. A comparative study of prevalence-based incidence estimation techniques with application to dementia data in Germany. Stat Med 2015; 35:768-81. [PMID: 26376995 DOI: 10.1002/sim.6736] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/29/2015] [Accepted: 08/27/2015] [Indexed: 11/07/2022]
Abstract
Dementia is becoming a major health burden, which is mainly due to the increasing life expectancy in many developed countries. To describe the disease progression of individuals, multistate models are generally appropriate tools. These models allow the individuals to move along a path consisting of a finite number of disease states. We consider a simplifying illness-death model in which the subjects progress through the states healthy, diseased and dead. We use this model to study analytic relationships between the prevalence, incidence and mortality rates of irreversible diseases that have been applied in the past. One of these approaches is a rather recently proposed technique based on an ordinary differential equation (ODE). We conduct a simulation study to compare the performance of two suggested numerical approximations of this ODE with three alternative techniques, the common goal of which is to estimate age-specific incidence from cross-sectional information. The quality of the estimation methods is further explored using data on dementia in Germany. In the simulation scenarios as well as in the dementia data setting, the ODE method turns out to be the predominant technique with regard to the quality of the estimation of the known incidence regimes.
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Affiliation(s)
- Sandra Landwehr
- Department of Statistics in Medicine, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Ralph Brinks
- German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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30
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Haenisch B, von Holt K, Wiese B, Prokein J, Lange C, Ernst A, Brettschneider C, König HH, Werle J, Weyerer S, Luppa M, Riedel-Heller SG, Fuchs A, Pentzek M, Weeg D, Bickel H, Broich K, Jessen F, Maier W, Scherer M. Risk of dementia in elderly patients with the use of proton pump inhibitors. Eur Arch Psychiatry Clin Neurosci 2015; 265:419-28. [PMID: 25341874 DOI: 10.1007/s00406-014-0554-0] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/11/2014] [Indexed: 01/05/2023]
Abstract
Drugs that modify the risk of dementia in the elderly are of potential interest for dementia prevention. Proton pump inhibitors (PPIs) are widely used to reduce gastric acid production, but information on the risk of dementia is lacking. We assessed association between the use of PPIs and the risk of dementia in elderly people. Data were derived from a longitudinal, multicenter cohort study in elderly primary care patients, the German Study on Aging, Cognition and Dementia in Primary Care Patients (AgeCoDe), including 3,327 community-dwelling persons aged ≥ 75 years. From follow-up 1 to follow-up 4 (follow-up interval 18 months), we identified a total of 431 patients with incident any dementia, including 260 patients with Alzheimer's disease. We used time-dependent Cox regression to estimate hazard ratios of incident any dementia and Alzheimer's disease. Potential confounders included in the analysis comprised age, sex, education, the Apolipoprotein E4 (ApoE4) allele status, polypharmacy, and the comorbidities depression, diabetes, ischemic heart disease, and stroke. Patients receiving PPI medication had a significantly increased risk of any dementia [Hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.04-1.83] and Alzheimer's disease (HR 1.44, 95% CI 1.01-2.06) compared with nonusers. Due to the major burden of dementia on public health and the lack of curative medication, this finding is of high interest to research on dementia and provides indication for dementia prevention.
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Affiliation(s)
- Britta Haenisch
- German Center for Neurodegenerative Diseases (DZNE), c/o Federal Institute for Drugs and Medical Devices (BfArM), Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany,
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Teipel S, Fritze T, Ovari A, Buhr A, Kilimann I, Witt G, Pau HW, Doblhammer G. Regional Pattern of Dementia and Prevalence of Hearing Impairment in Germany. J Am Geriatr Soc 2015. [PMID: 26200134 DOI: 10.1111/jgs.13561] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the association between hearing impairment and dementia. DESIGN Cross-sectional study. SETTING Claims data of the Allgemeine Ortskrankenkasse, the largest public health insurance company in Germany. PARTICIPANTS Age-stratified sample of all insured persons aged 65 and above in the first quarter of 2007 (N = 1,338,462). MEASUREMENTS Metaregression analysis on the association between regional prevalence of dementia and hearing impairment controlled for major vascular risk factors, including hypertension, hypercholesterolemia, diabetes mellitus, and cerebrovascular disease. Dementia and hearing impairment diagnoses were defined according to International Classification of Diseases, Tenth Revision, codes. Ninety-five regions were distinguished according to the two-digit postal code of the place of residence. RESULTS A significant association was found between regional prevalences of dementia and hearing impairment that was preserved when controlling for major vascular risk factors (P = .003). Regional dementia prevalence increased by approximately 0.23% when the prevalence of hearing impairment increased by 1 standard deviation. CONCLUSION The relationship between hearing impairment and dementia has been repeatedly demonstrated on the individual level. The results of the current study confirm that this relationship also exists on a regional level. These findings underscore the potential role of hearing impairment as a risk factor for dementia that will be relevant for the management of elderly patients in general practice.
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Affiliation(s)
- Stefan Teipel
- Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Thomas Fritze
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Rostock Center for the Study of Demographic Change, Rostock, Germany
| | - Attila Ovari
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Rostock, Rostock, Germany
| | - Anne Buhr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Rostock, Rostock, Germany
| | - Ingo Kilimann
- Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Gabriele Witt
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Rostock, Rostock, Germany
| | - Hans-Wilhelm Pau
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Rostock, Rostock, Germany
| | - Gabriele Doblhammer
- Rostock Center for the Study of Demographic Change, Rostock, Germany.,Institute for Sociology and Demography, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany.,Max Planck Institute for Demographic Research, Rostock, Germany
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32
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Public knowledge about dementia in Germany—results of a population survey. Int J Public Health 2015; 61:9-16. [DOI: 10.1007/s00038-015-0703-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 05/20/2015] [Accepted: 06/17/2015] [Indexed: 11/25/2022] Open
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Abstract
Dementia remains the most common neuropsychiatric disease in elderly people. This is not only a great burden for the affected person, but also for the entire society. Currently, it is estimated that more than one million people in Germany suffer from dementia. The incidence is about 244,000 people per year. There are different forms of dementia. Primary dementia is caused by neurodegenerative or vascular diseases. Approximately 90% of all dementia types in people over 65 years of age are primary. Secondary dementia includes organic illness, which leads to dementing syndromes. Traumatic brain injury, tumor, medication and toxic substances, for instance, belong to these. Usually, if the underlying disease can be treated effectively, mental performance and cognition can be returned to normal.
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Brinks R, Landwehr S. Change rates and prevalence of a dichotomous variable: simulations and applications. PLoS One 2015; 10:e0118955. [PMID: 25749133 PMCID: PMC4352043 DOI: 10.1371/journal.pone.0118955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/26/2015] [Indexed: 11/18/2022] Open
Abstract
A common modelling approach in public health and epidemiology divides the population under study into compartments containing persons that share the same status. Here we consider a three-state model with the compartments: A, B and Dead. States A and B may be the states of any dichotomous variable, for example, Healthy and Ill, respectively. The transitions between the states are described by change rates, which depend on calendar time and on age. So far, a rigorous mathematical calculation of the prevalence of property B has been difficult, which has limited the use of the model in epidemiology and public health. We develop a partial differential equation (PDE) that simplifies the use of the three-state model. To demonstrate the validity of the PDE, it is applied to two simulation studies, one about a hypothetical chronic disease and one about dementia in Germany. In two further applications, the PDE may provide insights into smoking behaviour of males in Germany and the knowledge about the ovulatory cycle in Egyptian women.
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Affiliation(s)
- Ralph Brinks
- Institute for Biometry and Epidemiology, German Diabetes Center, Duesseldorf, Germany
- * E-mail:
| | - Sandra Landwehr
- Institute for Biometry and Epidemiology, German Diabetes Center, Duesseldorf, Germany
- Department of Medical Statistics, Heinrich-Heine-University, Duesseldorf, Germany
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Köhler L, Meinke-Franze C, Hein J, Fendrich K, Heymann R, Thyrian JR, Hoffmann W. Does an interdisciplinary network improve dementia care? Results from the IDemUck-study. Curr Alzheimer Res 2015; 11:538-48. [PMID: 24938504 PMCID: PMC4150489 DOI: 10.2174/1567205011666140618100727] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Most persons with dementia live at home and are treated in the primary care. However, the ambulatory health care system in Germany contains a lot of "interface problems" and is not optimized for the future challenges. Innovative concepts like regional networks in dementia care exist on a project level and need to be tested for efficacy to encourage implementation. The goal of the study is the scientific evaluation of an already existing regional dementia network. METHODS Prospective randomized controlled trial of 235 community-living elderly with dementia and their family caregivers of network treatment (n=117) compared to usual care (n=118) in a predominantly rural region. The allocation to intervention or control group was based on network membership of their General Practitioner. Intervention patients received diagnostic evaluation and subsequent treatment according to network guidelines. Main outcome measures were the early contact with a neurologic or psychiatric specialist and dementia-specific medication as well as quality of life of the patients, and as secondary outcomes caregiver burden and caregiver health-related quality of life. RESULTS Network patients were more likely to receive antidementive drugs (50.5 % vs. 35.8 %; p=0.035) and had more often contact to a neurologist (18.6 % vs. 2.8 %; p<0.001). No group differences were found on patient's quality of life nor overall effects or treatment by time effects. Intervention caregivers reported no significant improvements in health related quality of life measured by SF-36 and EQ-5D. CONCLUSION The management of dementia patients in an interdisciplinary regional network solelyprovides measurable advantages with respect to the provision of dementia-specific medication and utilization of medical treatment i.e. referral rates to specialists. Further evaluation research is needed to identify relevant mechanismsof collaborative processes with respect to their impact on patient and caregiver related outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Wolfgang Hoffmann
- German Centre for Neurodegenerative Diseases (DZNE) Greifswald, Ellernholzstrasse 1-2, Greifswald, D-17489, Germany.
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Gambichler T, Segert H, Höxtermann S, Schmitz L, Altmeyer P, Teegen B. Neurological disorders in patients with bullous pemphigoid: clinical and experimental investigations. J Eur Acad Dermatol Venereol 2015; 29:1758-62. [PMID: 25651418 DOI: 10.1111/jdv.12995] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/07/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Previous studies have shown that patients with bullous pemphigoid (BP) are more likely to have neurological diseases (ND). OBJECTIVES To compare clinical findings in BP patients with and without ND and to investigate BP180 autoantibody binding in different neuronal tissues of mammalians. METHODS Our database was searched for clinical findings of in-patients with the definitive diagnosis of BP. Moreover, brain tissue of mammalians was treated with serum of BP patients with elevated BP180 autoantibodies using biochip mosaics. RESULTS Of 85/161 (52.8%) patients had a history of at least one ND (BP+ND). BP180 (P = 0.018), eosinophils (P = 0.043) and patients' accommodation in nursing homes (P < 0.0001) remained in the logistic regression model as significant independent predictors for the presence of ND in patients with BP. Subgroup analysis of community-dwelling BP patients revealed 25/93 (26.9%) patients with ND. In this population, the presence of ND also significantly correlated with BP180 (r = 0.26; P = 0.0003) and eosinophils (r = 0.19; P = 0.0087). In the animal model, no BP180-specific immunofluorescence could be detected. CONCLUSIONS Our data support results of previous studies detecting significantly increased frequency of ND in BP patients. We have shown that raised BP180 titres and blood eosinophils are independent predictors for the presence of ND in BP patients. However, our experimental data do not support previous results indicating that specific binding of BP180 antibodies in neuronal tissue plays a pathogenetic role in ND.
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Affiliation(s)
- T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - H Segert
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - S Höxtermann
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Schmitz
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - P Altmeyer
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - B Teegen
- Institute for Experimental Immunology, Euroimmun, Lübeck, Germany
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Brinks R, Landwehr S. A new relation between prevalence and incidence of a chronic disease. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2015; 32:425-35. [PMID: 25576933 PMCID: PMC4684690 DOI: 10.1093/imammb/dqu024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 11/23/2014] [Indexed: 01/19/2023]
Abstract
In 1991 Keiding published a relation between the age-specific prevalence and incidence of a chronic disease (in Age-specific incidence and prevalence: a statistical perspective. J. Roy. Stat. Soc. A, 154, 371-412). For special cases alternative formulations by differential equations were given recently in Brinks et al. (2013, Deriving age-specific incidence from prevalence with an ordinary differential equation. Statist. Med., 32, 2070-2078) and in Brinks & Landwehr (2014, Age- and time-dependent model of the prevalence of non-communicable diseases and application to dementia in Germany, Theor. Popul. Biol., 92, 62-68). From these works, we generalize formulations and discuss the advantages of the novel approach. As an implication, we obtain a new way of estimating the incidence rate of a chronic disease from prevalence data. This enables us to employ cross-sectional studies where otherwise expensive and lengthy follow-up studies are needed. This article illustrates and validates the novel method in a simulation study about dementia in Germany.
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Affiliation(s)
- Ralph Brinks
- German Diabetes Centre, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, 40225 Duesseldorf, Germany
| | - Sandra Landwehr
- German Diabetes Centre, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, 40225 Duesseldorf, Germany
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Hoffmann F, Kaduszkiewicz H, Glaeske G, van den Bussche H, Koller D. Prevalence of dementia in nursing home and community-dwelling older adults in Germany. Aging Clin Exp Res 2014; 26:555-9. [PMID: 24647931 DOI: 10.1007/s40520-014-0210-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/28/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM We compared the prevalence of dementia in nursing home residents and community-dwelling older adults . METHODS Using health insurance claims data for the year 2009, we estimated the prevalence of at least three of four quarters with a diagnosis of dementia in persons aged ≥65 years. RESULTS Of 213,694 persons aged 65+ years, 4,584 (2.2 %) lived in nursing homes. The prevalence of dementia was 51.8 % (95 % CI 50.4-53.3) in nursing home residents and 2.7 % (95 % CI 2.6-2.8) in community-dwelling elderly. Increasing prevalences with age were found in both sexes in community-dwelling elderly. These trends were not seen in nursing home residents where prevalences were already high for the age group 65-69 years (35.7 % in males and 40.9 % in females, respectively). CONCLUSIONS More than half of nursing home residents suffer from dementia, which is about 19-fold higher than the prevalence in insured living in the community.
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Affiliation(s)
- Falk Hoffmann
- Division Health Economics, Health Policy and Outcomes Research, Centre for Social Policy Research, University of Bremen, Postfach 33 04 40, 28334, Bremen, Germany,
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Kostro D, Abdulkadir A, Durr A, Roos R, Leavitt BR, Johnson H, Cash D, Tabrizi SJ, Scahill RI, Ronneberger O, Klöppel S. Correction of inter-scanner and within-subject variance in structural MRI based automated diagnosing. Neuroimage 2014; 98:405-15. [PMID: 24791746 DOI: 10.1016/j.neuroimage.2014.04.057] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/11/2014] [Accepted: 04/21/2014] [Indexed: 01/11/2023] Open
Abstract
Automated analysis of structural magnetic resonance images is a promising way to improve early detection of neurodegenerative brain diseases. Clinical applications of such methods involve multiple scanners with potentially different hardware and/or acquisition sequences and demographically heterogeneous groups. To improve classification performance, we propose to correct effects of subject-specific covariates (such as age, total intracranial volume, and sex) as well as effects of scanner by using a non-linear Gaussian process model. To test the efficacy of the correction, we performed classification of carriers of the genetic mutation leading to Huntington's disease (HD) versus healthy controls. Half of the HD carriers were free of typical HD symptoms and had an estimated 5 to 20years before onset of clinical symptoms, thus providing a model for preclinical diagnosis of a neurodegenerative disease. Structural magnetic resonance brain images were acquired at four sites with pairs of sites which had the identical scanner type, equipment, and acquisition parameters. For automatic classification, we used spatially normalized probabilistic maps of gray matter, then removed confounding effects by Gaussian process regression, and then performed classification with a support vector machine. Voxel-based morphometry of gray matter maps showed disease effects that were spatially wider spread than effects of scanner, but no significant interactions between scanner and disease were found. A model trained with data from a single scanner generalized well to data from a different scanner. When confounding diagnostics groups and scanner during training, e.g. by using controls from one scanner and gene carriers from another, classification accuracy dropped significantly in many cases. By regressing out confounds with Gaussian process regression, the performance levels were comparable to those obtained in scenarios without confound. We conclude that models trained on data acquired with a single scanner generalized well to data acquired with a different same-generation scanner even when the vendor differed. When confounding grouping and scanner during training is unavoidable to gather training data, regressing out inter-scanner and between-subject variability can reduce the loss in accuracy due to the confound.
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Affiliation(s)
- Daniel Kostro
- Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany; Surgical Planning Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Ahmed Abdulkadir
- Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany; Department of Computer Science, University of Freiburg, Freiburg, Germany.
| | | | - Raymund Roos
- Department of Neurology, Leiden University Medical Center, The Netherlands
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Canada
| | - Hans Johnson
- Iowa Mental Health Clinical Research Center, University of IA, USA
| | - David Cash
- Centre for Medical Imaging Computing, UCL, London, UK; Dementia Research Centre, Analysis Lab, Institute of Neurology, UCL, London, UK
| | - Sarah J Tabrizi
- UCL Institute of Neurology, University College London, Queen Square, London, UK
| | - Rachael I Scahill
- UCL Institute of Neurology, University College London, Queen Square, London, UK
| | - Olaf Ronneberger
- Department of Computer Science, University of Freiburg, Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, University of Freiburg, Germany
| | - Stefan Klöppel
- Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany; Department of Neurology, University Medical Center Freiburg, Freiburg, Germany
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Increased healthcare service utilizations for patients with dementia: a population-based study. PLoS One 2014; 9:e105789. [PMID: 25157405 PMCID: PMC4144915 DOI: 10.1371/journal.pone.0105789] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/23/2014] [Indexed: 11/19/2022] Open
Abstract
Background The majority of previous studies investigating the health care utilization of people with dementia were conducted in Western societies. There is little information on the economic burden on the healthcare system attributable to dementia in Asian countries. This study thus investigated differences in utilization of healthcare services between subjects with and those without a diagnosis of dementia using Taiwan’s National Health Insurance population-based database. Methods This study comprised 5,666 subjects with a dementia diagnosis and 5,666 age- and gender-matched comparison subjects without a dementia diagnosis. We individually followed each subject for a 1-year period starting from their index date to evaluate their healthcare resource utilization. Healthcare resource utilization included the number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatments. In addition, we divided healthcare resource utilization into psychiatric and non-psychiatric services. Results As for utilization of psychiatric services, subjects with a dementia diagnosis had significantly more outpatient visits (2.2 vs. 0.3, p<0.001) and significantly higher outpatient costs (US$124 vs. US$16, p<0.001) than comparison subjects. For non-psychiatric services, subjects with a dementia diagnosis also had significantly more outpatient visits (34.4 vs. 31.6, p<0.001) and significantly higher outpatient costs (US$1754 vs. US$1322, p<0.001) than comparison subjects. For all healthcare services, subjects with a dementia diagnosis had significantly more outpatient visits (36.7 vs. 32.0, p<0.001) and significantly higher outpatient costs (US$1878 vs. US$1338, p<0.001) than comparison subjects. Furthermore, the total cost was about 2-fold greater for subjects with a dementia diagnosis than for comparison subjects (US$3997 vs. US$2409, p<0.001). Conclusions We concluded that subjects who had received a clinical dementia diagnosis had significantly higher utilization of all healthcare services than comparison subjects.
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Brinks R, Fischer-Betz R, Sander O, Richter JG, Chehab G, Schneider M. Age-specific prevalence of diagnosed systemic lupus erythematosus in Germany 2002 and projection to 2030. Lupus 2014; 23:1407-11. [DOI: 10.1177/0961203314540352] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective The objective of this report is to estimate the prevalence and future number of cases of systemic lupus erythematosus (SLE) in Germany. Methods Data from a representative sample of all insurants from the statutory health insurance in Germany comprising more than 2.3 million individuals have been screened for SLE diagnoses. The gender- and age-specific prevalence of SLE is calculated. The case definition is based on at least one recorded diagnosis of SLE during 2002. The stratum-specific prevalence is applied to the current and the future population of Germany in order to estimate and predict the number of people with SLE until 2030. Results The overall prevalence of diagnosed SLE in 2002 was 15.4 (95% CI: 13.1–17.9) and 55.4 (51.4, 59.8) per 100,000 in the male and female German population. This corresponds to an estimated 30,000 and 31,000 people with diagnosed SLE in 2002 and 2010, respectively. This number will slightly increase until 2020 and decrease thereafter. Conclusions Compared with health insurance data from France, the prevalence in our data is similar. Under the assumption that the gender- and age-specific prevalence of SLE in Germany will not change considerably, the number of cases in the next two decades will change only slightly.
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Affiliation(s)
- R Brinks
- Policlinic of Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
- Institute for Biometry and Epidemiology at the German Diabetes Center, Düsseldorf, Germany
| | - R Fischer-Betz
- Policlinic of Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - O Sander
- Policlinic of Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - J G Richter
- Policlinic of Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - G Chehab
- Policlinic of Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - M Schneider
- Policlinic of Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
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Dreier A, Hoffmann W. [Dementia Care Manager for patients with dementia. Determination of the requirements and qualifications contents for nurses in the DelpHi-MV study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 56:1398-409. [PMID: 23978981 DOI: 10.1007/s00103-013-1796-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dementia is one of the most prevalent chronic progressive diseases in older age. The progression of dementia is associated with an increasing demand for patient care. Thus, the nursing profession fulfills important tasks in the supply of care in dementia. Care of dementia patients requires nurses with more specialized professional knowledge. Consequently, the development of new qualification concepts in dementia is needed. Therefore, the German Center for Neurodegenerative Diseases, Rostock/Greifswald, has developed a qualification according to the Dementia Care Management concept. A prospective cross-sectional study identified the tasks and qualifications of nurses as Dementia Care Managers. Overall, 27 tasks and 28 qualification items were identified for a nurse to qualify as a Dementia Care Manager. In the next step, the first version of the Dementia Care Management Curriculum was developed.
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Affiliation(s)
- A Dreier
- Institut für Community Medicine, Abt. Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Deutschland,
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Franzmann (These authors contributed equally to this work.) J, Krause (These authors contributed equally to this work.) K, Haberstroh J, Pantel J. Assessment of Self Perceived Social Competencies of Caregivers in Dementia Care. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2014. [DOI: 10.1024/1662-9647/a000103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report on the development and psychometric testing of the Self-Perceived Social Competence in Dementia Care (SOKO dementia) questionnaire, a self-report instrument to assess geriatric caregivers’ perceptions of their specific social competencies in dementia care. Confirmatory factor analysis was used to verify that three factors were captured. Convergent and discriminatory validity of the instrument was demonstrated using measures of self-reported occupational mental stress, conscientiousness, and sensitivity. The measure captured specific self-perceived social competencies in professional interactions with dementia patients, colleagues, and patients’ relatives, and showed appropriate psychometric properties. The SOKO dementia is useful for estimating caregivers’ self-perceptions prior to continuous education. It may also help to measure the specific effects of training programs that focus on social-communicative skills in dementia care.
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Affiliation(s)
| | | | - Julia Haberstroh
- Institute of General Practice, Goethe University Frankfurt, Germany
- Interdisciplinary Ageing Research, Goethe University Frankfurt, Germany
| | - Johannes Pantel
- Institute of General Practice, Goethe University Frankfurt, Germany
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Brinks R, Landwehr S. Age- and time-dependent model of the prevalence of non-communicable diseases and application to dementia in Germany. Theor Popul Biol 2013; 92:62-8. [PMID: 24333220 DOI: 10.1016/j.tpb.2013.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 11/19/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
We derive a partial differential equation (PDE) that models the age-specific prevalence of a disease as a function of the incidence, remission and mortality rates. The main focus is on non-communicable diseases (NCDs), although the PDE is not restricted to NCDs. As an application of the PDE, the number of persons with dementia in Germany until the year 2050 is estimated based on German incidence data and official population projections. Uncertainty is treated by different scenarios about life expectancy, number of migrants, prevalence of the disease in migrants, and scenarios about the future incidence, and mortality of demented persons. Life expectancy and incidence of dementia have the strongest impact on the future number of persons with dementia. In nearly all scenarios, our estimated case numbers exceed former estimates. Furthermore, we use an example to show that the PDE method yields more accurate results than a common alternative approach.
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Affiliation(s)
- Ralph Brinks
- Institute for Biometry and Epidemiology, German Diabetes Center, Auf'm Hennekamp 65, D-40225 Duesseldorf, Germany.
| | - Sandra Landwehr
- Institute for Biometry and Epidemiology, German Diabetes Center, Auf'm Hennekamp 65, D-40225 Duesseldorf, Germany
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Reuther S, van Nie N, Meijers J, Halfens R, Bartholomeyczik S. [Malnutrition and dementia in the elderly in German nursing homes. Results of a prevalence survey from the years 2008 and 2009]. Z Gerontol Geriatr 2013; 46:260-7. [PMID: 23283395 DOI: 10.1007/s00391-012-0346-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Dementia is one of most challenging problems for the care of older people in Germany. Although malnutrition in nursing homes is also associated with dementia, few systematic studies have described health care structures in German nursing homes for people with dementia and their individual nutritional status. Therefore, the aim of this study was to determine dementia-specific differences concerning the nutrition situation for the elderly in German nursing homes. METHODS A cross-sectional multicenter study was performed using a standardized multilevel instrument (observation, questionnaire) developed at the University of Maastricht. Variables are indicators for malnutrition and its risks, quality indicators, care dependency and types of interventions. RESULTS In the 2008 and 2009 surveys, 53% of 4,777 participants (77.9% women, 22.1% men, mean age 82 years) were identified (based on care documentation) as having dementia. More than one third of this population (n = 759, 85.1% women, 14.1% men, mean age 85 years) was probably malnourished; thus, the prevalence rate in the group of people with dementia was 10% higher compared to the group without dementia. People with dementia showed a higher risk in all relevant risk indicators (weight history, body mass index, and food intake) for malnutrition compared to those without dementia. Furthermore, people with dementia had higher care dependency rates and required more assistance for eating and drinking. CONCLUSION The study results confirm the relationship between malnutrition and dementia. The use of standardized nutrition screening tools is not common practice in German nursing homes yet. However, the results suggest that with an increasing risk for malnutrition combined with dementia the proportion of nursing interventions also increases, which means that nurses must react adequately. Nevertheless, the interventions concerning malnutrition should be improved especially with respect to preventive measurements.
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Affiliation(s)
- S Reuther
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Stockumer Str. 12, 58453, Witten, Deutschland.
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Brinks R, Landwehr S, Waldeyer R. Age of onset in chronic diseases: new method and application to dementia in Germany. Popul Health Metr 2013; 11:6. [PMID: 23638981 PMCID: PMC3665482 DOI: 10.1186/1478-7954-11-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 04/30/2013] [Indexed: 12/01/2022] Open
Abstract
Background Age of onset is an important outcome to characterize a population with a chronic disease. With respect to social, cognitive, and physical aspects for patients and families, dementia is especially burdensome. In Germany, like in many other countries, it is highly prevalent in the older population and imposes enormous efforts for caregivers and society. Methods We develop an incidence-prevalence-mortality model to derive the mean and variance of the age of onset in chronic diseases. Age- and sex-specific incidence and prevalence of dementia is taken from published values based on health insurance data from 2002. Data about the age distribution in Germany in 2002 comes from the Federal Statistical Office. Results Mean age of onset of a chronic disease depends on a) the age-specific incidence of the disease, b) the prevalence of the disease, and c) the age distribution of the population. The resulting age of onset of dementia in Germany in 2002 is 78.8 ± 8.1 years (mean ± standard deviation) for men and 81.9 ± 7.6 years for women. Conclusions Although incidence and prevalence of dementia in men are not greater than in women, men contract dementia approximately three years earlier than women. The reason lies in the different age distributions of the male and the female population in Germany.
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Affiliation(s)
- Ralph Brinks
- Institute for Biometry and Epidemiology, German Diabetes Center, Auf'm Hennekamp 65, Duesseldorf, 40225, Germany
| | - Sandra Landwehr
- Institute for Biometry and Epidemiology, German Diabetes Center, Auf'm Hennekamp 65, Duesseldorf, 40225, Germany
| | - Regina Waldeyer
- Institute for Biometry and Epidemiology, German Diabetes Center, Auf'm Hennekamp 65, Duesseldorf, 40225, Germany ; Department of Public Health, Heinrich Heine University, Duesseldorf, 40225, Germany
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Wolf-Ostermann K, Worch A, Fischer T, Wulff I, Gräske J. Health outcomes and quality of life of residents of shared-housing arrangements compared to residents of special care units - results of the Berlin DeWeGE-study. J Clin Nurs 2013; 21:3047-60. [PMID: 23083386 DOI: 10.1111/j.1365-2702.2012.04305.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To compare different health outcomes as well as quality of life (QoL) between people with dementia living in shared-housing arrangements (SHA) and special care units (SCU) in nursing homes. BACKGROUND Often situated in large apartments in mostly urban settings, SHA are a specific German kind of small-scale living facilities for older care-dependent persons, predominantly suffering from dementia. SHA are completely disconnected from traditional nursing homes. DESIGN In a longitudinal design, all new residents of SHA and SCU suffering with dementia in Berlin were surveyed for one year. They were assessed when they moved into the SHA or SCU and again 6 and 12 months later. METHODS We surveyed physical and psychological health outcomes including ADL-functioning (Barthel), neuropsychiatric symptoms of dementia (NPI) and challenging behaviour (Cohen-Mansfield agitation inventory) as well as QoL (Qualidem). RESULTS Fifty-six persons (43 women, 13 men) were recruited into the longitudinal study. The average age was 82·5 years at admission, participants mostly had a moderate level of cognitive impairment (mean Mini Mental State Examination = 13·3), prevalence of neuropsychiatric symptoms was high. During the one-year follow-up, analyses show a significant decrease in cognitive abilities but also of neuropsychiatric symptoms in both groups. In SHA, QoL increases on average during the one-year study period. CONCLUSIONS Both types of facilities attract slightly different populations according to our data. Comparison of SHA residents to SCU residents documented no significant beneficial effects of settings in terms of health outcomes. RELEVANCE TO CLINICAL PRACTICE As no clear advantage of either SHA or SCU in nursing homes can be demonstrated for residents with dementia who move in newly, it is impossible to give a clear evidence-based recommendation and the decision for one setting or the other can be made according solely to personal preference of the resident.
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Affiliation(s)
- Karin Wolf-Ostermann
- Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany.
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Schwarzkopf L, Menn P, Leidl R, Graessel E, Holle R. Are community-living and institutionalized dementia patients cared for differently? Evidence on service utilization and costs of care from German insurance claims data. BMC Health Serv Res 2013; 13:2. [PMID: 23286826 PMCID: PMC3543842 DOI: 10.1186/1472-6963-13-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 12/28/2012] [Indexed: 11/20/2022] Open
Abstract
Background Dementia patients are often cared for in institutional arrangements, which are associated with substantial spending on professional long-term care services. Nevertheless, there is little evidence on the exact cost differences between community-based and institutional dementia care, especially when it comes to the distinct health care services. Adopting the perspective of the German social security system, which combines Statutory Health Insurance and Compulsory Long-Term Care Insurance (payer perspective), our study aimed to compare community-living and institutionalized dementia patients regarding their health care service utilization profiles and to contrast the respective expenditures. Methods We analysed 2006 claims data for 2,934 institutionalized and 5,484 community-living individuals stratified by so-called care levels, which reflect different needs for support in activities of daily living. Concordant general linear models adjusting for clinical and demographic differences were run for each stratum separately to estimate mean per capita utilization and expenditures in both settings. Subsequently, spending for the community-living and the institutionalized population as a whole was compared within an extended overall model. Results Regarding both settings, health and long-term care expenditures rose the higher the care level. Thus, long-term care spending was always increased in nursing homes, but health care spending was comparable. However, the underlying service utilization profiles differed, with nursing home residents receiving more frequent visits from medical specialists but fewer in-hospital services and anti-dementia drug prescriptions. Altogether, institutional care required additional yearly per capita expenses of ca. €200 on health and ca. €11,200 on long-term care. Conclusion Community-based dementia care is cost saving from the payer perspective due to substantially lower long-term care expenditures. Health care spending is comparable but community-living and institutionalized individuals present characteristic service utilization patterns. This apparently reflects the existence of setting-specific care strategies. However, the bare economic figures do not indicate whether these different concepts affect the quality of care provision and disregard patient preferences and caregiver-related aspects. Hence, additional research combining primary and secondary data seems to be required to foster both, sound allocation of scarce resources and the development of patient-centred dementia care in each setting.
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Affiliation(s)
- Larissa Schwarzkopf
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Ingolstaedter Landstrasse, Neuherberg, Germany.
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[Costs of illness in dementia from a societal perspective. An overview]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:677-84. [PMID: 22526856 DOI: 10.1007/s00103-012-1472-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Dementias are one of the most expensive disease groups among the population aged 65 years and over. This is mainly due to the patients' deficits in activities of daily living which increase with the progression of dementia, leading to an increasing need for care. As a result, the costs of dementia may more than double over the course of the disease. The costs of medical care account for a relatively small share of total costs and are not greatly influenced by disease severity. By contrast, the costs of care make up at least three quarters of total costs in the majority of studies. When patients are cared for in the community, most of the care is often provided informally by relatives. Accordingly, up to 75 or 80% of the costs of illness in this setting, from a societal perspective, may be due to informal care. Additional professional home care accounts for a relatively small share of total costs. The costs of caring for patients who live in the community are directly related to the degree of functional impairment. By contrast, it can be difficult to estimate the costs which are specifically due to dementia in patients that are institutionalised.
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Rott C, Jopp DS. [The life of the oldest old. Well-being in the face of physical restrictions]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:474-80. [PMID: 22441517 DOI: 10.1007/s00103-012-1452-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Demographic change is increasingly determined by development associated with very old age. The reduction of mortality in very old age will continue, so that an age between 80 and 100 years will become common. Present research findings suggest that, with respect to their physical resources, humans are not well equipped for a very long life. Very old individuals are characterized by a high prevalence of chronic diseases and functional limitations that endanger independent living. Centenarians are faced with these restrictions to a large extent. In contrast to increasing physical constraints, old and very old individuals' psyche seems to be rather robust. Well-being and valuation of life reveal only little decline up to the highest ages. Of particular importance are psychological strengths, which include adaptive strategies and self-referent convictions. They remain relatively stable even in very old age and seem to balance the effects of diseases, resource restrictions and loss.
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Affiliation(s)
- C Rott
- Institut für Gerontologie, Universität Heidelberg, Bergheimer Str. 20, 69115, Heidelberg, Deutschland.
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