The Longitudinal Association between Psychological Factors and Health Care Use

A Remote Patient Monitoring System with Feedback Mechanisms using a Smartwatch: Concept, Implementation and Evaluation based on the activeDCM Randomized Controlled Trial

BACKGROUND

Technological advances allow recording and sharing of health-related data in a patient-centric way using smartphones and wearables. Secure sharing of such patient-generated data with physicians would enable a dense management of individual health trajectories, monitoring of risk factors and asynchronous feedback. However, most Remote Patient Monitoring (RPM) systems currently available are not fully integrated into hospital IT systems or lack the patient-centric design.

OBJECTIVE

The objective was to conceptualize and implement a user-friendly, reusable, interoperable and secure RPM system incorporating asynchronous feedback mechanisms, using a broadly available consumer wearable (Apple Watch). Additionally, the study sought to evaluate factors influencing patient acceptance of such systems.

METHODS

The RPM system requirements were established through focus group sessions. Subsequently, a system concept was designed and implemented using an iterative approach, ensuring technical feasibility from the beginning. To assess clinical feasibility, the system was employed as part of the activeDCM prospective, randomized, interventional study focusing on Dilated Cardiomyopathy (DCM). Each patient used the system for at least 12 months. The System Usability Scale (SUS) was employed to measure usability from a subjective patient perspective. Additionally, an evaluation was conducted on the objective wearable interaction frequency as well as the completeness of transmitted data, classified into Sensor-based Health Data (SHD) and Patient Reported Outcome Measures (PROM). Descriptive statistics using boxplots, along bootstrapped multiple linear regression with a 95% confidence interval (CI) were utilized for evaluation, analyzing the influence of age, sex, device experience and intervention group membership.

RESULTS

The RPM system consists of four interoperable components: patient-devices, data-server, data-viewer and notification-service. The evaluation of the system was conducted with 95 consecutive DCM patients (female: 28 of 95 (29%), age: 50±12 years) completing the activeDCM study protocol. The wearable/ smartphone application of the system achieved a mean SUS score of 78±17, which was most influenced by device experience. 83 of 95 patients (87%) could integrate the wearable application (very) well into their daily routine and 67 of 95 (70%) saw a benefit of the RPM system for management of their health condition. Patients interacted on average with the wearable on 61%±26% of days enrolled in the study, corresponding to 239±99 of 396±39 days. SHD was available on average for 78%±23% of days and PROM data 64%±27% of weeks enrolled in the study, corresponding to 307±87 of 396±39 days and 35±15 of 56±5 weeks, respectively. Wearable interaction frequency, SHD and PROM completeness were most influenced by intervention group membership.

CONCLUSIONS

Our results mark a first step towards integrating RPM systems, based on a consumer wearable device for primary patient input, into standardized clinical workflows. They can serve as a blueprint for creating a user-friendly, reusable, interoperable and secure RPM system, that can be integrated into patients' daily routines.

CLINICALTRIAL

ClinicalTrials.gov-Identifier: NCT04359238.

Assessing self-reported public health emergency competencies for civil aviation personnel in China: a pilot study

INTRODUCTION

COVID-19 has demonstrated the importance of competent staff with expertise in public health emergency preparedness and response in the civil aviation system. The civil aviation system is a critical sentinel and checkpoint to prevent imported cases and slow the spread of communicable diseases. Understanding the current competencies of staff to deal with public health emergencies will help government agencies develop targeted training and evidence-based policies to improve their public health preparedness and response capabilities.

METHODS

This cross-sectional pilot study was conducted from November 2022 to October 2023, involving 118 staff members from various positions within China's civil aviation system. A 59-item questionnaire was translated and developed according to a competency profile. Data were collected using the self-report questionnaire to measure the workforce's self-perceptions of knowledge and skills associated with public health emergency proficiency, categorized into (1) general competency, (2) preparedness competency, (3) response competency, and (4) recovery competency. KMO & Bartlett test and Cronbach's α reliability analysis were used to test the reliability and validity of the questionnaire. Descriptive statistics, independent sample T-test, ANOVA, and linear regression models were performed to analyze the competencies.

RESULTS

A total of 107 staff members from the aviation system were surveyed in this study. The KMO & Bartlett test, (KMO = 0.919, P < 0.001) and Cronbach's α coefficients (α = 0.985) for this questionnaire were acceptable. The results suggested that respondents scored a mean of 6.48 out of 9 for the single question. However, the staff needed to acquire more knowledge in investigating epidemic information (5.92) and case managing (5.91) in the response stage. Overall, males scored higher (409.05 ± 81.39) than females (367.99 ± 84.97), with scores in the medical department (445.67 ± 72.01) higher than management (387.00 ± 70.87) and general department (362.32 ± 86.93). Additionally, those with completely subjective evaluation (425.79 ± 88.10) scored higher than the general group (374.39 ± 79.91). To predict the total score, female medical workers were more likely to have lower scores (β = -34.5, P = 0.041). Compared with those in the medical department, the management workers (β = -65.54, P = 0.008) and general workers (β = -78.06, P < 0.001) were associated with a lower total score.

CONCLUSIONS

There was still a gap between the public health emergency competencies of the civil aviation system and the demand. Staff in China's civil aviation systems demonstrated overall competence in public health emergency preparedness and response. However, there was a need to enhance the accumulation of practical experience. Implementing effective training programs for public health emergencies was recommended to mitigate knowledge gaps. Meanwhile, regular training evaluations were also recommended to give comprehensive feedback on the value of the training programs.

Music Therapy as a Topic in Medical Education: Course Concept and Student Evaluation of an Elective Course for Medical Students

OBJECTIVES

Music therapy has been proven as a safe and well-established intervention in healthcare to relieve symptoms and improve quality of life. While music therapy is already established in several settings to supplement medical care, there is a lack of integration in the field of medical education.

METHODS

We report on the implementation and evaluation of a teaching concept for a five-day-intensive-course on music therapy. The course was offered as an elective course for medical students at the University Duisburg-Essen. At the end of the course, students filled out a free text questionnaire to assess the students' perception of the course, and additionally answered standardized questions by the structured EVALuna online evaluation tool of the University of Duisburg-Essen.

RESULTS

All students (N = 35) who participated in the music therapy course between September 2019 and March 2023 completed the questionnaires and N = 21 students filled out the EVALuna. Most students (89%) chose the course because of their interest in alternative and supportive therapy options to improve patients' well-being. About 46% had previous musical experience and passion and fun with music and 37% of the students were interested in the interdisciplinary academic subject that combined music and medicine. EVALuna online evaluation reflected high satisfaction with the course.

CONCLUSION

Due to the well-proven effectiveness and evidence of music therapy as well as the positive perception of medical students, music therapy should be further established in medical care and medical education.

The Association of Loneliness With Health and Social Care Utilization in Older Adults in the General Population: A Systematic Review

BACKGROUND AND OBJECTIVES

Loneliness is proposed to be linked with increased service use. This review examined the association of loneliness and health and social care utilization (HSCU) in older adults from the general population.

RESEARCH DESIGN AND METHODS

Four databases were screened for studies that examined the association of loneliness (predictor) with HSCU (outcome) in older adults (defined as the majority of sample 60 or older). Study quality was assessed with the National Institutes for Health scale for observational cohorts and cross-sectional studies.

RESULTS

We identified 32 studies, of which 9 prospective studies were evaluated as being good or good-fair quality. Two good-fair quality studies found that loneliness at baseline was associated with subsequent admission to a residential care home. There was emerging evidence that loneliness was associated with emergency department use (n = 1) and cardiovascular disease-specific hospitalization (n = 1). Once adjusted for confounders, the highest quality studies found no association of baseline loneliness with physician utilization, outpatient service utilization, skilled nursing facility use, and planned or unplanned hospital admissions. The remaining studies were cross-sectional, or of fair to poor quality, and inadequate to reliably determine whether loneliness was associated with a subsequent change in HSCU.

DISCUSSION AND IMPLICATIONS

There was heterogeneity in study design, measurement, and study quality. This generated an inconsistent evidence base where we cannot determine clear inferences about the relationship between loneliness and HSCU. Only one consistent finding was observed between 2 good-fair quality studies regarding care home admission. To determine clinical implications and make reliable inferences, additional good quality longitudinal research is needed.

Pathways to reduced overnight hospitalizations in older adults: Evaluating 62 physical, behavioral, and psychosocial factors

As our society ages and healthcare costs escalate, researchers and policymakers urgently seek potentially modifiable predictors of reduced healthcare utilization. We aimed to determine whether changes in 62 candidate predictors were associated with reduced frequency, and duration, of overnight hospitalizations. We used data from 11,374 participants in the Health and Retirement Study—a national sample of adults aged >50 in the United States. Using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 62 predictors over four years (between t0;2006/2008 and t1;2010/2012) were associated with subsequent hospitalizations during the two years prior to t2 (2012–2014 (Cohort A) or 2014–2016 (Cohort B)). After robust covariate-adjustment, we observed that changes in some health behaviors (e.g., those engaging in frequent physical activity had 0.80 the rate of overnight hospital stays (95% CI [0.74, 0.87])), physical health conditions (e.g., those with cancer had 1.57 the rate of overnight hospital stays (95% CI [1.35, 1.82])), and psychosocial factors (e.g., those who helped friends/neighbors/relatives 100–199 hours/year had 0.73 the rate of overnight hospital stays (95% CI [0.63, 0.85])) were associated with subsequent hospitalizations. Findings for both the frequency, and duration, of hospitalizations were mostly similar. Changes in a number of diverse factors were associated with decreased frequency, and duration, of overnight hospitalizations. Notably, some psychosocial factors (e.g., informal helping) had effect sizes equivalent to or larger than some physical health conditions (e.g., diabetes) and health behaviors (e.g., smoking). These psychosocial factors are mostly modifiable and with further research could be novel intervention targets for reducing hospitalizations.

Patterns and Predictors of Preparation for Future Care Among Older Rural Chinese Adults: A Latent Profile Analysis

This study aimed to identify profiles of preparation for future care (PFC) among older rural Chinese adults. A total of 481 older adults were recruited. PFC was evaluated using Preparation for Future Care Needs and respondents' social services knowledge. Information on individual characteristics, physical health indicators, mental health, and support system was collected. Four profiles of PFC were identified: scarce-preparation (22.42%), high-avoidance/low-action (26.91%), moderate-preparation (44.17%), and high-avoidance/high-action (6.50%). The scarce-preparation and high-avoidance/low-action profiles had the lowest levels of social services knowledge. Multinomial logistic regression showed that older adults in moderate-preparation and high-avoidance/high-action profiles had fewer illnesses, exercised more frequently, and had higher loneliness levels compared with those in the scarce-preparation profile. Compared with high-avoidance/low-action persons, high-avoidance/high-action persons had fewer illnesses, exercised more frequently, and had lower self-esteem and higher loneliness levels. People who performed poorly in physical health indicators and well in mental health need to increase PFC.

A meta-analysis of loneliness and use of primary health care

Loneliness is a growing public health concern that is associated with a range of negative health outcomes. The extent to which loneliness may also be associated with greater use of primary health care remains unclear. The present meta-analysis aimed to address this gap by quantifying research on the association of loneliness to primary health care use. The database searches yielded 23 eligible studies with 25 effects, total N = 113,639. A random effects meta-analysis revealed a small positive average effect size (r_avg = .094; 95% CI [.07, .12])between loneliness and the use of primary care that increased in magnitude as the proportion of females in the samples increased. Studies that used objective measures of primary care use yielded effects that were significantly larger than those using self-report measures. The effects were robust to differences in age and type of health-care systems, and the type of loneliness scale (single versus multi-item). The findings from this first comprehensive meta-analysis of the association of loneliness with use of primary care indicate that people who experience loneliness make a greater number of visits to primary-care practitioners. This evidence highlights the practical impact of loneliness on health-care use when viewed at the population level.

Self-perceptions of ageing, GP visits and frequent attendance. Longitudinal findings from the German Ageing Survey

OBJECTIVES

The aim of this study was to clarify the link between self-perceptions of ageing and the number of general practitioner (GP) visits, as well as frequent GP visits, longitudinally.

METHODS

In this study, longitudinal data with n = 7,062 observations from 2014 (wave 5) to 2017 (wave 6) were taken from the German Ageing Survey (representative sample of middle aged and older individuals residing in private households). The five-item Attitudes Toward Own Ageing subscale of the Philadelphia Geriatric Center Morale Scale (PGCMS) was used to quantify self-perceptions of ageing. The frequency of GP visits in the past 12 months served as outcome measure (first model: measured continuously; second model: top 10% were defined as frequent attenders). To exploit the features of panel data, and to mitigate the problem of unobserved heterogeneity, fixed effects regressions were used.

RESULTS

Adjusting for predisposing characteristics, enabling resources and need-factors, regressions showed that an increase in self-perceptions of ageing was associated with decreases in the number of GP visits (IRR= .83 (95% CI: .77-.91)), and a decreased likelihood of becoming a frequent attender (OR= .44 (95% CI: .29-.66)).

CONCLUSIONS

Using data from a longitudinal study and exploiting the longitudinal data structure, the current study adds to our current knowledge by demonstrating that self-perceptions of ageing contribute to the frequency of GP visits as well as frequent attendance. Since self-perceptions of ageing are modifiable, this may help to manage health care use.

Understanding how psychosocial factors relate to seeking medical care among older adults using a new model of care seeking

RATIONALE

Research has identified psychosocial factors related to the use of health services among the older population; however, the specific roles by which these factors drive behavior have not been identified and empirically tested.

OBJECTIVE

This study tested whether previously identified psychosocial factors decrease or increase the motivational potential to seek care, the motivational sensitivity to perceived access, or the motivational sensitivity to perceived need.

METHODS

The 2014 U.S. Health and Retirement Study was used. Analysis was based on 2589 older noninstitutionalized respondents (age greater than 64). The dependent variable was the number of healthcare provider visits in the preceding two years. Psychosocial factors included were life satisfaction, social network indicators, optimism, pessimism, positive social support, hopelessness, loneliness, self-efficacy, health efficacy, positive affect, negative affect, and purpose in life. Covariates included age and sex. Maximum likelihood estimation of an interpretable structural model was used.

RESULTS

Results of the study provide evidence that psychosocial variables are related to health care seeking through both motivational potential and sensitivity parameters. Some psychosocial variables are related to multiple roles. For example, pessimism is related to a lower motivational potential and is more sensitive to access at higher levels of access, whereas hopelessness is related to a higher motivational potential and more sensitive to need and access at lower levels of each.

CONCLUSIONS

Findings imply psychosocial characteristics are related to health care seeking and utilization of older adults via different roles that can countervail each other, and therefore the influence of interventions can be complex. To address this, complex interventions may be required.

Determinants of healthcare use based on the Andersen model: a study protocol for a systematic review of longitudinal studies

INTRODUCTION

A previous systematic review published in 2012 focused on the use of health services based on the Andersen model. Extending this review, we will exclusively focus on systematically synthesising longitudinal studies examining the determinants of healthcare use based on the Andersen model. Therefore, our aim of this systematic review is to provide an overview of longitudinal observational studies investigating the predictors of healthcare use explicitly using this model.

METHODS AND ANALYSIS

We will search three electronic databases (Medline, PsycINFO and CINAHL). Furthermore, reference lists will be searched manually. Longitudinal observational studies will be investigating the determinants of healthcare use (in terms of use of outpatient physician services (like general practitioner's visits or specialist visits in total) and hospitalisation). We will exclude disease-specific samples. Data extraction will focus on methods (eg, assessment of healthcare use), sample characteristics and main findings. A suitable tool will be used to assess the study quality. Study selection, data extraction and evaluation of study quality will be conducted by two reviewers. The findings will be presented by means of figures, summary tables, narrative summaries and meta-analysis (if possible).

ETHICS AND DISSEMINATION

No primary data will be collected. Therefore, approval by an ethics committee is not required. Our findings are planned to be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42020193198.

Help-seeking behaviour and attitudes towards internet-administered psychological support among adolescent and young adults previously treated for cancer during childhood: protocol for a survey and embedded qualitative interview study in Sweden

INTRODUCTION

A subgroup of adolescent and young adult childhood cancer survivors (AYACCS) are at increased risk of psychological distress. Despite this, AYACCS experience difficulties accessing psychological support. E-mental health (e-MH) may offer a solution to reduce this treatment gap. However, research examining e-MH for AYACCS has experienced difficulties with recruitment, retention and adherence. Such difficulties may relate to: (1) help-seeking behaviour and/or (2) e-MH acceptability. The overall study aims are to: (1) examine potential associations between health service use factors, informed by Andersen's behavioural model of health services use, and help-seeking behaviour; (2) examine attitudes towards e-MH interventions; and (3) explore perceived need for mental health support; past experience of receiving mental health support; preferences for support; and barriers and facilitators to help-seeking.

METHODS AND ANALYSIS

An online and paper-based cross-sectional self-report survey (98 items) and embedded qualitative interview study across Sweden, with a target sample size of n=365. Participants are aged 16-39 years, diagnosed with cancer when 0-18 years and have completed successful cancer treatment. The survey examines sociodemographic and clinical characteristics, actual help-seeking behaviour, attitudes towards e-MH, stigma of mental illness, mental health literacy, social support and current symptoms of depression, anxiety, and stress. Survey respondents with past and/or current experience of mental health difficulties are invited into the qualitative interview study to explore: (1) perceived need for mental health support; (2) past experience of receiving mental health support; (3) preferences for support; and (4) barriers and facilitators to help-seeking. Potential associations between health service use factors and help-seeking behaviour are examined using univariable and multivariable logistic regressions. Qualitative interviews are analysed using content analysis.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Swedish Ethical Review Authority (Dnr: 2020-06271). Results will be disseminated in scientific publications and academic conference presentations.

TRIAL REGISTRATION NUMBER

ISRCTN70570236.

Determinants of health care use among homeless individuals: evidence from the Hamburg survey of homeless individuals

BACKGROUND

To identify the determinants of health care use among homeless individuals.

METHODS

Data were taken from the Hamburg survey of homeless individuals (n = 100 individuals in the here used model, mean age 44.8 years, SD 12.5) focusing on homeless individuals in Hamburg, Germany. The number of physician visits in the past 3 months and hospitalization in the preceding 12 months were used as outcome measures. Drawing on the Andersen model of health care use as a conceptual framework, predisposing characteristics, enabling resources and need factors as well as psychosocial variables were included as correlates.

RESULTS

Negative binomial regressions showed that increased physician visits were associated with being female (IRR: 4.02 [95% CI: 1.60-10.11]), absence of chronic alcohol consume (IRR: 0.26 [95% CI: 0.12-0.57]) and lower health-related quality of life (IRR: 0.97 [95% CI: 0.96-0.98]). Furthermore, logistic regressions showed that the likelihood of hospitalization was positively associated with lower age (OR: 0.93 [95% CI: 0.89-0.98]), having health insurance (OR: 8.11 [2.11-30.80]) and lower health-related quality of life (OR: 0.97 [95% CI: 0.94-0.99]).

CONCLUSIONS

Our study showed that predisposing characteristics (both age and sex), enabling resources (i.e., health insurance) and need factors in terms of health-related quality of life are main drivers of health care use among homeless individuals. This knowledge may assist in managing health care use.

The Association of Post-Materialism with Health Care Use. Findings of a General Population Survey in Germany

(1) The aim of this study was to identify the association between post-materialism and health care use (in terms of the frequency of doctor visits and the reason for doctor visits). (2) Data were taken from the German General Social Survey (a representative sample of individuals aged 18 years and over, n = 3338). The Inglehart's post-materialist index was used to quantify post-materialism. The doctor visits (self-reported) in the past three months served as an outcome measure. The reasons for seeing a doctor served as an additional outcome measure (acute illness; chronic illness; feeling unwell; requesting advice; visit to the doctor's office without consulting the doctor (e.g., need to get a prescription); preventive medical check-up/vaccination). (3) After adjusting for several covariates, negative binomial regressions revealed that compared with materialism, post-materialism was associated with decreased doctor visits (total sample; women). Moreover, the likelihood of visiting the doctor for reasons of chronic illnesses was lower in post-materialistic women, whereas the likelihood of visiting the doctor for reasons of preventive medical check-up/vaccination was higher in post-materialistic women. (4) Study findings identify an unexplored link between post-materialism and doctor visits in women. One may conclude that in the long-term, the increased likelihood of preventive medical check-ups in post-materialistic women will be beneficial in decreasing the need for doctor visits for reasons of chronic illnesses. However, future research is required to elucidate the underlying mechanisms.

Correlates of hospitalization among the oldest old: results of the AgeCoDe-AgeQualiDe prospective cohort study

BACKGROUND

Hospitalization is a key driver of health care costs. Thus far, there are only a few longitudinal studies investigating whether changes in explanatory variables lead to hospitalization. Moreover, these longitudinal studies did not focus on individuals in highest age.

AIM

The purpose of the current study was to examine the correlates of hospitalization among the oldest old in Germany longitudinally.

METHODS

A multicenter prospective cohort study ["Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)", AgeQualiDe]. Primary care patients ≥ 85 years took part [n = 861 at follow-up (FU) 7, average age of 89.0 years; 85-100 years]. Two waves were used. Hospitalization in the last 6 months was used as outcome measure. Well-established scales were used to quantify the independent variables such as Instrumental Activities of Daily Living Scale, Global Deterioration Scale or Geriatric Depression Scale.

RESULTS

Logistic random effects regressions showed that the probability of hospitalization in the preceding 6 months significantly increased with increases in the social network, more depressive symptoms, functional decline, and increase in chronic conditions, whereas it was not significantly associated with age, sex, marital status, education, and cognitive impairment. Social networks moderate the relationship between functional decline and hospitalization.

DISCUSSION

The results of the present longitudinal study emphasize the association of depressive symptoms, functional decline, more social networks, and chronic conditions with hospitalization among the oldest old.

CONCLUSIONS

Treatments with the aim to reduce or postpone these factors might also help to reduce hospitalization.

Personality traits and diabetes incidence among postmenopausal women

OBJECTIVE

We examined whether personality traits, including optimism, ambivalence over emotional expressiveness, negative emotional expressiveness, and hostility, were associated with risk of developing type 2 diabetes (hereafter diabetes) among postmenopausal women.

METHODS

A total of 139,924 postmenopausal women without diabetes at baseline (between 1993 and 1998) aged 50 to 79 years from the Women's Health Initiative were prospectively followed for a mean of 14 (range 0.1-23) years. Multivariable Cox proportional hazards regression models were used to assess associations between personality traits and diabetes incidence adjusting for common demographic factors, health behaviors, and depressive symptoms. Personality traits were gathered at baseline using questionnaires. Diabetes during follow-up was assessed via self-report of physician-diagnosed treated diabetes.

RESULTS

There were 19,240 cases of diabetes during follow-up. Compared with women in the lowest quartile of optimism (least optimistic), women in the highest quartile (most optimistic) had 12% (hazard ratio [HR], 0.88; 95% confidence interval [CI]: 0.84-0.92) lower risk of incident diabetes. Compared with women in the lowest quartile for negative emotional expressiveness or hostility, women in the highest quartile had 9% (HR, 1.09; 95% CI: 1.05-1.14) and 17% (HR, 1.17; 95% CI: 1.12-1.23) higher risk of diabetes, respectively. The association of hostility with risk of diabetes was stronger among nonobese than obese women.

CONCLUSIONS

Low optimism and high NEE and hostility were associated with increased risk of incident diabetes among postmenopausal women independent of major health behaviors and depressive symptoms. In addition to efforts to promote healthy behaviors, women's personality traits should be considered to guide clinical or programmatic intervention strategies in diabetes prevention.

Meaning in life and health care use: findings from a nationally representative study of older adults in Germany

Background

There is a lack of studies examining the link between meaning in life and health care use. Meaning in life refers to a sense of comprehension and significance in life. Consequently, the purpose of this study was to investigate the association between meaning in life and health care use.

Methods

Cross-sectional data from the German Ageing Survey, a nationally representative sample of older adults, was used for this study (in the analytical sample: n = 3850; year 2002). The frequency of GP and specialist visits in the past 12 months were used as outcome measures. Meaning in life was assessed using a single item measure. Based on Andersen’s model, covariates were selected. Sex, age, family status, occupational status, income, self-rated health, physical functioning, depressive symptoms, and the number of physical illnesses were adjusted for in a multiple regression analysis.

Results

After adjusting for various potential confounders, there was a positive association between meaning in life and GP (IRR: 1.04, 95%-CI: 1.01–1.08) as well as specialist visits (IRR: 1.07, 95%-CI: 1.02–1.12) in a multiple regression analysis. With the exception of employment status (retired vs. employed), income and need factors, no covariates were consistently associated with both outcome measures.

Conclusions

This study highlighted the association between meaning in life and health care use. Our results indicate that there are other factors that are associated with health care use, beyond need-variables. This might help to identify individuals at risk for under- or overuse of health care services.

Prevalence and determinants of dental visits among older adults: findings of a nationally representative longitudinal study

BACKGROUND

The first aim was to present descriptive data on the frequency of dental visits among older adults in Germany. The second aim was to identify the determinants of the number of dental visits using a longitudinal approach.

METHODS

Longitudinal data were derived from the German Ageing Survey, which is a nationally representative sample of community-dwelling individuals ≥40 years in Germany. The frequency of dental visits in the past 12 months was recorded in the years 2002, 2008 and 2011. In order to control for time-constant unobserved heterogeneity, Poisson fixed effects regressions were used.

RESULTS

While the mean number of dental visits was 2.3 (SD: 2.0) in 2002, it was 2.0 (SD: 1.7) in 2008 and 2.1 (SD: 1.7) in 2011. The frequency of dental visits declined with age (total sample and women), transitions from normal weight to overweight (total sample), changes from divorced/widowed/single/married, living separated from spouse to 'married, living together with spouse' in women and with a decrease in the number of physical illnesses (total sample and men).

CONCLUSIONS

The frequency of dental visits declines with age in older adults. While some of the determinants of frequency are non-modifiable (e.g., ageing and worsening of general health), others are modifiable (e.g., change in weight category).

Does transpersonal trust moderate the association between chronic conditions and general practitioner visits in the oldest old? Results of the AgeCoDe and AgeQualiDe study

AIM

The purpose of this study was to investigate whether transpersonal trust (TPT) moderates the relationship between chronic conditions and general practitioner (GP) visits among the oldest old in Germany.

METHODS

The multicenter prospective cohort Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients (85+) (AgeQualiDe) was carried out. Individuals were recruited through GP offices at six study centers in Germany (follow-up wave 7). Primary care patients were aged ≥85 years (n = 861, mean age 89.0 years; range 85-100 years). The self-reported number of outpatient visits to the GP was used as the outcome measure. To explore religious and spiritual beliefs, the short form of the Transpersonal Trust scale was used. The presence or absence of 36 chronic conditions was recorded by the GP.

RESULTS

Multiple Poisson regressions showed that GP visits were positively associated with the number of chronic conditions (incidence rate ratio 1.03, P < 0.05). TPT moderated the relationship between chronic conditions and GP visits (incidence rate ratio 1.01, P < 0.05). The association between chronic conditions and GP visits was significantly more pronounced when TPT was high.

CONCLUSION

Our findings highlight the importance of TPT in the relationship between chronic conditions and GP visits. Future longitudinal studies are required to clarify this subject further. Geriatr Gerontol Int 2019; 19: 705-710.

Optimism may moderate screening mammogram frequency in Medicare: A longitudinal study

Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005-2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.

The association between voluntary work and health care use among older adults in Germany

Objective

While most studies focused on the relation between volunteering and health-related outcomes, little attention has been given on the association between volunteering and the use of health care services. Thus, with this analysis we aimed at exploring whether and how the voluntary work of older adults is related to the utilization of health care services in Germany.

Methods

The analysis was based on data from the German Ageing Survey (DEAS), a nationally representative, longitudinal study of the German population aged 40 years and older. Focusing on volunteering, data from the waves 2002, 2008 and 2011 was used. Voluntary work in groups and organizations (yes/no) was used as explanatory variable. To quantify health care utilization, visits to general practitioners and specialists as well as nights in the hospital in the past 12 months were used. Fixed effects regressions were applied to estimate the association between volunteering and the outcome variables.

Results

Regressions revealed that the onset of volunteer involvement was associated with an increase in specialist visits, whereas volunteering did not affect visits to general practitioners and the probability of hospitalization significantly.

Conclusion

Our findings emphasize the relation between volunteering and specialist visits. Future research is needed to examine the impact of volunteering on health care use, taking more detailed information regarding the specific context of volunteering as well as personality factors and personal background into consideration. This might be reasonable in advancing the knowledge about this association and in developing planned interventions.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3867-x) contains supplementary material, which is available to authorized users.