The selection and definition of indicators in public health monitoring for the 65+ age group in Germany

Study on Health of Older People in Germany (Gesundheit 65+): objectives, design and implementation

Background

The longitudinal population-based study Gesundheit 65+ aimed to close data gaps on health and well-being of older adults in Germany in times of the COVID-19 pandemic.

Methods

The target population comprised persons 65 years and older permanently residing in Germany and with sufficient German language skills. Proxy interviews were possible and consent from legal representatives was obtained as necessary in order to enable participation of physically or cognitively impaired persons. A two-stage sampling process, was used to draw 128 primary sample points (PSUs) and within these PSUs sex- and age-stratified random samples were drawn from population registries. A mixed-mode design was applied to contact the study population and for data collection. Data were collected between June 2021 and April 2023. Participants were surveyed a total of four times at intervals of four months. At month 12 participants were offered a home visit including a non-invasive examination. Data on all-cause mortality and information on neighborhood social and built environment as well as health insurance data will be linked to primarily collected data at the individual level.

Discussion

Results will inform health politicians and other stakeholders in the care system on health and health care needs of older people in Germany.

Health status of the old and very old people in Germany: results of the Gesundheit 65+ study

Background

The demographic change makes comprehensive health reporting on health at older age an important topic.

Methods

Gesundheit 65+ is a longitudinal epidemiological study on the health status of persons aged 65 and older in Germany. Based on a two-stage stratified random sample from 128 local population registers, 3,694 persons participated in the baseline survey between June 2021 and April 2022 (47.9 % women, mean age 78.8 years). Weighted prevalences for 19 indicators of the baseline survey are presented overall and by age, sex, education and region of residence.

Results

Overall, 52.0 % of all participants of the baseline survey reported to be in good or very good health, and 78.5 % reported high or very high satisfaction with their life. This was in contrast to the large number of health/functional limitations whose prevalences ranged from 5.3 % for severe visual limitations to 69.2 % for multimorbidity. The health status of women was clearly worse than that of men, and the health status of persons aged 80 and older was worse than between 65 and 79 years of age. There was a clear educational gradient evident in the health status, but there were no differences between West and East Germany.

Conclusions

Gesundheit 65+ provides a comprehensive database for description of the health status of old and very old people in Germany, on the basis of which recommendations for action for policy and practice can be derived.

[Prevention and health promotion in dementia: motivation for change within preventive interventions-Empirical results]

BACKGROUND

Aging healthily and prevention of diseases are statutory and a national health target. There is convincing evidence that describes the modifiable risk factors, which are principally suitable for preventive measures.

OBJECTIVE

Definition of terms, presentation of the roots of prevention in laws, strategies and guidelines. Presentation of the risk factors for dementia, outline of effective preventive measures and their promising components.

MATERIAL AND METHODS

Prevention is systematically described. The available evidence on risk factors, health behavior and preventive measures is analyzed. A multimodal intervention is presented and the influence of motivation on a change in behavior is outlined, exemplified by physical activity.

RESULTS AND DISCUSSION

Aging healthily is a national health target and prevention of disease is rooted and defined in both the legislation and guidelines. The current evidence on modifiable risk factors for dementia originates from 12 factors. These include behavior-associated factors, such as inactivity, diabetes and smoking. The efficacy of preventive measures can be described by their effectiveness, the utilization when available and the principal availability for all people for whom they are indicated. Changing a health behavior is complex and dependent among other things on the motivation to want to change a behavior. Currently, multimodal prevention programs appear to be very promising for the prevention of cognitive disorders and dementia.

Indicator-based public health monitoring in old age in OECD member countries: a scoping review

BACKGROUND

The scoping review was conducted as part of the project "Improving Health Monitoring in Old Age" (IMOA) which aims at developing a conceptual framework with key indicators for a public health monitoring of the population aged 65 years and older in Germany. We systematically identified indicator-based monitoring systems that focus on health and wellbeing of older populations in member countries of the Organisation for Economic Co-operation and Development (OECD) and analysed them with regard to structure, development and content.

METHODS

A systematic search strategy included searching the websites of national public health institutes, an additional internet search and a MEDLINE search via PubMed. Indicator systems were included if they presented data on a national level, if they were published or updated after 01/01/2007, if they relied on more than one data source and if they were available in English or German. Data on the structure and development of the indicator sets were extracted using a standardized documentation form, and a content analysis of the indicators was conducted using a pre-defined conceptual framework with three health areas and 11 health domains that is based on the Worlds Health Organization's "World Report on Ageing and Health" and on the International Classification of Functioning, Disability and Health (ICF).

RESULTS

Ten indicator-based monitoring systems met our inclusion criteria. Of these, six systems focused exclusively on older populations, and four offer a specific subset of indicators for older age. The number of indicators varied between 22 and 53 (median 32.5). Four systems were directly related to national public health or healthy ageing strategies, and two systems had been developed in consensus processes involving multiple stakeholders. The highest numbers of indicators could be assigned to the domains "health care", "nursing and community care", "wealth and poverty" and "physical health". Overall, 47 different concepts could be identified in the monitoring systems.

CONCLUSION

Among indicator-based monitoring systems of health in older age identified in member countries of the OECD, there is considerable variation with regard to structure, development and content. The results will inspire the development of a public health monitoring of the older population in Germany.