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Schumacher-Schönert F, Boekholt M, Nikelski A, Chikhradze N, Lücker P, Kracht F, Vollmar HC, Hoffmann W, Kreisel S, Thyrian JR. [Closing care gaps after hospitalization: Study results [intersec-CM] on discharge and transfer management according to sect. 39 SGB V for people with cognitive impairments associated with dementia]. Z Evid Fortbild Qual Gesundhwes 2024; 185:35-44. [PMID: 38388280 DOI: 10.1016/j.zefq.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024]
Abstract
In Germany, there are 1.8 million people currently living with dementia, and the trend is rising. In particular, the health system at the transition from hospital to outpatient care is facing major challenges given the high increase in a difficult patient clientele. Legal efforts have been undertaken (sect. 39a of the Fifth Social Code Book [SGB V]) to close the care gaps in the discharge and transfer process. This article aims to provide an overview of the documentation process of the discharge and transfer management for people with cognitive impairments in everyday clinical practice according to SGB V sect. 39 para. 1a after the Discharge Management Act came into force. Furthermore, the manuscript answers the research question "How is the statutory discharge management of people with cognitive impairments (MmkB) aged 65 and over documented" and highlights further characteristics of the discharge documentation for MmkB starting with the transition from the inpatient setting to other care settings. In order to answer the research question(s), a qualitative content analysis of all discharge documents available at the time of discharge was carried out as part of the intervention study on cross-sector care management to support cognitively impaired people during and after a hospital stay [intersec-CM], which was funded by the Federal Ministry of Education and Research. The results of the analysis show that, despite legal efforts, there are currently no standardized, unified processes of discharge management for people with cognitive impairments that can be traced in writing. However, departments with a large proportion of vulnerable patient groups were able to offer valuable insights: for example, their discharge documents included a short social history. Further evidence-based research and development in the domain of discharge management for people with cognitive impairments remains essential.
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Affiliation(s)
- Fanny Schumacher-Schönert
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Deutschland.
| | - Melanie Boekholt
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Deutschland
| | - Angela Nikelski
- Evangelisches Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Universitätsklinik für Psychiatrie und Psychotherapie, Abteilung für Gerontopsychiatrie, Bielefeld, Deutschland
| | - Nino Chikhradze
- Ruhr-Universität Bochum, Abteilung für Allgemeinmedizin, Bochum, Deutschland
| | - Petra Lücker
- Institut für Community Medicine, Abteilung "Epidemiology of Health Care and Community Health", Universität Greifswald, Greifswald, Deutschland
| | - Friederike Kracht
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Deutschland
| | | | - Wolfgang Hoffmann
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Deutschland; Institut für Community Medicine, Abteilung "Epidemiology of Health Care and Community Health", Universität Greifswald, Greifswald, Deutschland
| | - Stefan Kreisel
- Evangelisches Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Universitätsklinik für Psychiatrie und Psychotherapie, Abteilung für Gerontopsychiatrie, Bielefeld, Deutschland
| | - Jochen René Thyrian
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Deutschland
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Blotenberg I, Boekholt M, Michalowsky B, Platen M, Rodriguez FS, Teipel S, Hoffmann W, Thyrian JR. What influences life expectancy in people with dementia? Social support as an emerging protective factor. Age Ageing 2024; 53:afae044. [PMID: 38497234 PMCID: PMC10945357 DOI: 10.1093/ageing/afae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/08/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The aim of this study was to investigate the role of support from the social environment for the life expectancy in people with dementia beyond well-established individual demographic and clinical predictors over a period of up to 8 years. METHODS The analyses are based on data from 500 community-dwelling individuals in Germany who tested positive for dementia and were followed up for up to 8 years. Life expectancy was examined in relation to perceived social support as well as well-established socio-demographic (age, sex) and clinical predictors (cognitive status, functional status, comorbidities), using Cox regressions. RESULTS Greater support from the social environment reduced the risk of mortality (hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.63-0.98), with the role of emotional support being particularly important. Furthermore, higher age was associated with an increased mortality risk (HR: 1.08; 95% CI: 1.05-1.11), while female sex (HR: 0.64; 95% CI: 0.48-0.85) and higher cognitive (HR: 0.96; 95% CI: 0.93-0.98) and functional status (HR: 0.91; 95% CI: 0.86-0.97) were associated with higher life expectancy. CONCLUSION Our study provides novel evidence that less support from the social environment, especially emotional support, is a risk factor for shorter life expectancy in people with dementia-beyond known clinical factors. Not only the clinical and caregiving needs but also their psychosocial needs of individuals with dementia should be emphasised.
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Affiliation(s)
- Iris Blotenberg
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Greifswald, Ellernholzstraße 1-2, 17489 Greifswald, Germany
| | - Melanie Boekholt
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Greifswald, Ellernholzstraße 1-2, 17489 Greifswald, Germany
| | - Bernhard Michalowsky
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Greifswald, Ellernholzstraße 1-2, 17489 Greifswald, Germany
| | - Moritz Platen
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Greifswald, Ellernholzstraße 1-2, 17489 Greifswald, Germany
| | - Francisca S Rodriguez
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Greifswald, Ellernholzstraße 1-2, 17489 Greifswald, Germany
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
- Department of Psychosomatic Medicine, University Hospital Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Wolfgang Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Greifswald, Ellernholzstraße 1-2, 17489 Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Greifswald, Ellernholzstraße 1-2, 17489 Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
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Nikelski A, Trompetter EM, Boekholt M, Schumacher-Schönert F, Rädke A, Michalowsky B, Vollmar HC, Hoffmann W, Driessen M, Thyrian JR, Kreisel SH. [Everyday Life and Mental Health of Elderly with Cognitive Impairment During the Covid-19 Pandemic]. Psychiatr Prax 2024. [PMID: 38272039 DOI: 10.1055/a-2230-2873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE The aim is to analyze pandemic-related effects on everyday life and psychosocial health in the understudied vulnerable group of cognitively impaired elderly people living at home. METHODS Structured telephone interviews in 2020 (n+=+141) and 2021 (n+=+107) were used to survey over-65s with cognitive impairment (MMSE Ø 23.4). The results from the 2021 survey presented here reflect experiences and attitudes, effects on daily life and health care, and psychosocial burdens and resources. Longitudinal analysis of selected indicators of burden is provided for n+=+66. RESULTS Even in the face of increasing concerns and moderate impacts on everyday life and health care, overall psychosocial health is proving to be good and largely stable over time. CONCLUSION Respondents have high levels of personal and social resources, and their coping with limitations is characterized by acceptance and willingness to adapt.
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Affiliation(s)
- Angela Nikelski
- Abteilung für Gerontopsychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL der Universität Bielefeld, Bielefeld
| | - Eva M Trompetter
- Abteilung für Gerontopsychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL der Universität Bielefeld, Bielefeld
| | - Melanie Boekholt
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), DZNE Rostock/Greifswald, Greifswald, Germany
| | - Fanny Schumacher-Schönert
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), DZNE Rostock/Greifswald, Greifswald, Germany
| | - Anika Rädke
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), DZNE Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), DZNE Rostock/Greifswald, Greifswald, Germany
| | | | - Wolfgang Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), DZNE Rostock/Greifswald, Greifswald, Germany
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Greifswald
| | - Martin Driessen
- Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL der Universität Bielefeld
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), DZNE Rostock/Greifswald, Greifswald, Germany
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Greifswald
| | - Stefan H Kreisel
- Abteilung für Gerontopsychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL der Universität Bielefeld, Bielefeld
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Zülke AE, Pabst A, Luppa M, Roehr S, Seidling H, Oey A, Cardona MI, Blotenberg I, Bauer A, Weise S, Zöllinger I, Sanftenberg L, Brettschneider C, Döhring J, Lunden L, Czock D, Haefeli WE, Wiese B, Hoffmann W, Frese T, Gensichen J, König H, Kaduszkiewicz H, Thyrian JR, Riedel‐Heller SG. A multidomain intervention against cognitive decline in an at-risk-population in Germany: Results from the cluster-randomized AgeWell.de trial. Alzheimers Dement 2024; 20:615-628. [PMID: 37768074 PMCID: PMC10917033 DOI: 10.1002/alz.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/22/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION We investigated the effectiveness of a multidomain intervention to preserve cognitive function in older adults at risk for dementia in Germany in a cluster-randomized trial. METHODS Individuals with a Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) risk score ≥ 9 aged 60 to 77 years were recruited. After randomization of their general practitioner (GP), patients received a multidomain intervention (including optimization of nutrition and medication, and physical, social, and cognitive activity) or general health advice and GP treatment as usual over 24 months. Primary outcome was global cognitive performance (composite z score, based on domain-specific neuropsychological tests). RESULTS Of 1030 participants at baseline, n = 819 completed the 24-month follow-up assessment. No differences regarding global cognitive performance (average marginal effect = 0.010, 95% confidence interval: -0.113, 0.133) were found between groups at follow-up. Perceived restrictions in intervention conduct by the COVID-19 pandemic did not impact intervention effectiveness. DISCUSSION The intervention did not improve global cognitive performance. HIGHLIGHTS Overall, no intervention effects on global cognitive performance were detected. The multidomain intervention improved health-related quality of life in the total sample. In women, the multidomain intervention reduced depressive symptoms. The intervention was completed during the COVID-19 pandemic.
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Affiliation(s)
- Andrea E. Zülke
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
| | - Alexander Pabst
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
| | - Melanie Luppa
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
| | - Susanne Roehr
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
- School of PsychologyMassey UniversityManawatū CampusPalmerston NorthNew Zealand
- Global Brain Health Institute (GBHI)Trinity College DublinDublinIreland
| | - Hanna Seidling
- Department of Clinical Pharmacology and PharmacoepidemiologyHeidelberg University HospitalHeidelbergGermany
| | - Anke Oey
- Institute for General PracticeWork Group Medical Statistics and IT‐InfrastructureHannover Medical SchoolHannoverGermany
| | - Maria Isabel Cardona
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
| | - Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
| | - Alexander Bauer
- Institute of General Practice and Family MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Solveig Weise
- Institute of General Practice and Family MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Isabel Zöllinger
- Institute of General Practice/Family MedicineUniversity Hospital of LMU MunichMunichGermany
| | - Linda Sanftenberg
- Institute of General Practice/Family MedicineUniversity Hospital of LMU MunichMunichGermany
| | - Christian Brettschneider
- University Medical Center Hamburg‐EppendorfDepartment of Health Economics and Health Service ResearchHamburgGermany
| | | | - Laura Lunden
- Institute of General PracticeUniversity of KielKielGermany
| | - David Czock
- Department of Clinical Pharmacology and PharmacoepidemiologyHeidelberg University HospitalHeidelbergGermany
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and PharmacoepidemiologyHeidelberg University HospitalHeidelbergGermany
| | - Birgitt Wiese
- Institute for General PracticeWork Group Medical Statistics and IT‐InfrastructureHannover Medical SchoolHannoverGermany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
- Institute for Community MedicineUniversity Medicine GreifswaldGreifswaldGermany
| | - Thomas Frese
- Institute of General Practice and Family MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Jochen Gensichen
- Institute of General Practice/Family MedicineUniversity Hospital of LMU MunichMunichGermany
| | - Hans‐Helmut König
- University Medical Center Hamburg‐EppendorfDepartment of Health Economics and Health Service ResearchHamburgGermany
| | | | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
- Institute for Community MedicineUniversity Medicine GreifswaldGreifswaldGermany
- Faculty V–Faculty of Life SciencesUniversity of SiegenSiegenGermany
| | - Steffi G. Riedel‐Heller
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
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Wittmann FG, Pabst A, Zülke A, Luppa M, Blotenberg I, Cardona MI, Bauer A, Fuchs S, Zöllinger I, Sanftenberg L, Brettschneider C, Döhring J, Lunden L, Czock D, Wiese B, Thyrian JR, Hoffmann W, Frese T, Gensichen J, König HH, Kaduszkiewicz H, Riedel-Heller SG. Who Benefited the Most? Effectiveness of a Lifestyle Intervention Against Cognitive Decline in Older Women and Men - Secondary Analysis of the AgeWell.de-trial. J Prev Alzheimers Dis 2024; 11:348-355. [PMID: 38374741 DOI: 10.14283/jpad.2024.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Differences between women and men matter in the prevalence and risk factors of dementia. We aimed to examine potential sex differences regarding the effectiveness by running a secondary analysis of the AgeWell.de trial, a cluster-randomized multicenter multi-domain lifestyle intervention to reduce cognitive decline. METHODS Intention-to-treat analyses of women (n=433) and men (n=386) aged 60 to 77 years were used for models including interactions between intervention group allocation and sex followed by subgroup analysis stratified by sex on primary and secondary outcomes. Further, the same procedure was repeated for age groups (60-69 vs. 70-77) within sex-specific subgroups to assess the effectiveness in different age groups. TRIAL REGISTRATION German Clinical Trials Register (ref. number: DRKS00013555). RESULTS No differences were found between women and men in the effectiveness of the intervention on cognitive performance. However, women benefitted from the intervention regarding depressive symptoms while men did not. Health-related quality of life was enhanced for younger intervention participants (60-69 years) in both women and men. CONCLUSION The AgeWell.de intervention was able to improve depressive symptoms in women and health-related quality of life in younger participants. Female participants between 60 and 69 years benefited the most. Results support the need of better individually targeted lifestyle interventions for older adults.
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Affiliation(s)
- F G Wittmann
- Felix G. Wittmann, Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Phillip-Rosenthal-Str. 55, 04103 Leipzig, Germany, E-Mail:
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6
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Buchholz M, Zöllinger I, Thyrian JR, Luppa M, Zülke A, Döhring J, Lunden L, Sanftenberg L, Brettschneider C, Czock D, Frese T, Gensichen J, Hoffmann W, Kaduszkiewicz H, König HH, Wiese B, Riedel-Heller SG, Blotenberg I. Factors Associated with Lower Social Activity in German Older Adults at Increased Risk of Dementia: A Cross-Sectional Analysis. J Alzheimers Dis 2024; 98:1443-1455. [PMID: 38607756 DOI: 10.3233/jad-231226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Background Studies demonstrate associations between low social activity in older adults and cognitive decline. Little has been investigated regarding which factors are associated with low social activity in older adults at increased risk of dementia. Objective We investigate which sociodemographic, psychological, health-related, and environmental factors are associated with low social activity in older adults at increased risk of dementia. Additionally, we describe the stages of health behavior change, the types of social activities, and the duration of the current level of social activity. Methods We used baseline data of 1,015 participants from the AgeWell.de trial. We conducted logistic and Poisson regression analyses to investigate factors associated with low social activity. We report descriptive statistics on the stages of change in the sample, the types of social activities most frequently pursued, and the duration of the current level of social activity. Results Lower income, non-usage of public transport, depressive symptoms, cognitive, mobility, and hearing impairment were negatively associated with social activity. The majority of the sample was in the maintenance stage, followed by the precontemplation stage. The most common social activities were traveling and hobbies with others. Participants have maintained their current level of social activity for several years. Conclusions We identified a lack of resources (income, transport), depressive symptoms and poorer health (cognitive, mobility and hearing impairment) as barriers to social activity. Interventions promoting social activity in older adults at risk of dementia may specifically target individuals with these risk factors. Low-threshold opportunities for social activity may be particularly beneficial.
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Affiliation(s)
- Maresa Buchholz
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Isabel Zöllinger
- Institute of General Practice and Family Medicine, Ludwig Maximilian University Hospital, Ludwig Maximilian University Munich (LMU), Munich, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
- University of Siegen, Faculty V: School of Life Sciences, Siegen, Germany
| | - Melanie Luppa
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Andrea Zülke
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, Kiel, Germany
| | - Laura Lunden
- Institute of General Practice, University of Kiel, Kiel, Germany
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, Ludwig Maximilian University Hospital, Ludwig Maximilian University Munich (LMU), Munich, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, Ludwig Maximilian University Hospital, Ludwig Maximilian University Munich (LMU), Munich, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- MHH Information Technology, Hannover Medical School, Hannover, Germany
| | - Steffi G Riedel-Heller
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
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7
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Zöllinger I, Bauer A, Blotenberg I, Brettschneider C, Buchholz M, Czock D, Döhring J, Escales C, Fankhaenel T, Frese T, Hoffmann W, Kaduszkiewicz H, König HH, Luppa M, Oey A, Pabst A, Sanftenberg L, Thyrian JR, Weiss J, Wendel F, Wiese B, Riedel-Heller SG, Gensichen J. Associations of Depressive Symptoms with Subjective Cognitive Decline in Elderly People-A Cross-Sectional Analysis from the AgeWell.de-Study. J Clin Med 2023; 12:5205. [PMID: 37629244 PMCID: PMC10455560 DOI: 10.3390/jcm12165205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
To develop effective dementia prevention strategies, it is necessary to understand risk factors, associated factors and early signs of dementia. Subjective cognitive decline (SCD) is the earliest form of dementia. The aim of this study is to assess depression as a factor that is significantly associated with SCD. The data of 1030 general practitioner patients from the AgeWell.de-study (60-77 years; CAIDE dementia risk score ≥ 9) were analysed. A descriptive analysis was conducted using validated instruments like the Geriatric depression scale (GDS), Lubben social network scale (LSNS-6) and education classes according to CASMIN (Comparative Analysis of Social Mobility in Industrial Nations). A multivariate regression model with the dependent variable SCD was calculated. Of the 1030 participants, 5.9% had depressive symptoms and 31.3% SCD. The group with depressive symptoms showed significantly higher body-mass-index (p = 0.005), lower education class (p = 0.022), lower LSNS-6 score (p < 0.001), higher sports activity (p < 0.001), and more sleeping problems (p = 0.026). In the regression model a higher GDS-score [Odds ratio (OR): 1.219 (p < 0.001)], more sleeping problems [OR: 1.550 (p = 0.017)] and higher education class [middle/high: OR: 1.474/1.875 (p = 0.037/0.004)] were significantly associated with SCD. This study identified depressive symptoms, sleeping problems, and higher education classes as factors associated with SCD, which can represent an early form of dementia.
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Affiliation(s)
- Isabel Zöllinger
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (L.S.); (J.W.); (F.W.); (J.G.)
| | - Alexander Bauer
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (A.B.); (T.F.); (T.F.)
| | - Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany; (I.B.); (M.B.); (W.H.); (J.R.T.)
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (C.B.); (H.-H.K.)
| | - Maresa Buchholz
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany; (I.B.); (M.B.); (W.H.); (J.R.T.)
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (C.E.); (H.K.)
| | - Catharina Escales
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (C.E.); (H.K.)
| | - Thomas Fankhaenel
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (A.B.); (T.F.); (T.F.)
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (A.B.); (T.F.); (T.F.)
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany; (I.B.); (M.B.); (W.H.); (J.R.T.)
- Institute for Community Medicine, University Medicine Greifswald, 17487 Greifswald, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (C.E.); (H.K.)
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (C.B.); (H.-H.K.)
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (M.L.); (A.P.); (S.G.R.-H.)
| | - Anke Oey
- State Health Department of Lower Saxony, 30449 Hannover, Germany;
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (M.L.); (A.P.); (S.G.R.-H.)
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (L.S.); (J.W.); (F.W.); (J.G.)
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany; (I.B.); (M.B.); (W.H.); (J.R.T.)
- Institute for Community Medicine, University Medicine Greifswald, 17487 Greifswald, Germany
| | - Julian Weiss
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (L.S.); (J.W.); (F.W.); (J.G.)
| | - Flora Wendel
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (L.S.); (J.W.); (F.W.); (J.G.)
| | - Birgitt Wiese
- Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, 30625 Hannover, Germany;
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (M.L.); (A.P.); (S.G.R.-H.)
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (L.S.); (J.W.); (F.W.); (J.G.)
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Cardona MI, Monsees J, Schmachtenberg T, Grünewald A, Thyrian JR. Implementing a physical activity project for people with dementia in Germany-Identification of barriers and facilitator using consolidated framework for implementation research (CFIR): A qualitative study. PLoS One 2023; 18:e0289737. [PMID: 37556503 PMCID: PMC10411781 DOI: 10.1371/journal.pone.0289737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/25/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Despite physical activity (PA) health benefits, people with dementia (PwD) continue to report low levels of PA engagement compared with healthy older adults. Evidencing that PA initiatives still not reflect effective practice and outcomes. Previous studies have shown that several factors can mediate PA initiatives implementation in this population. However, most prior research have not use implementation science frameworks to outline in-depth barriers and facilitators that enables improved PA strategies in PwD. Therefore, a more holistic understanding of mediating factors is still needed. OBJECTIVE To identify multilevel barriers and facilitator factors, applying the Consolidated Framework for Implementation Research (CFIR) to orient a systematic evaluation of one PA project in PwD and provide evidence-based evaluation results to enhance PA implementation efforts for PwD. METHOD A qualitative study implemented in 4 German sports associations that applied a PA project for PwD. A total of 13 semi-structured interviews were conducted with 21 participants, project leaders (PLs) and sports trainers (STs). The Consolidated Framework for Implementation Research (CFIR) was used as an evaluation framework to orient both the data collection and analysis. RESULTS A total of 13 interviews were conducted with 21 participants. The CFIR guided the identification of barriers and facilitating factors that need to be targeted at different levels for successful implementation. Barriers were identified, especially in the external level, as more solid networks and funding for sustainable proposals are still needed. Other barriers were low participation rates, stigma around the disease and the COVID 19 pandemic. On an individual and structural level facilitators were found like motivated appointed leaders, established planning process, and external organizations supporting sports associations in the implementation. CONCLUSION Sports projects for PwD can benefit from structuring their interventions based on the CFIR framework as it helps identify multilevel factors that may influence their success and promote PA among PwD. Future efforts should continue working on implementing frameworks that facilitate and reduce the complexity of implementing sustainable PA projects for PwD.
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Affiliation(s)
- Maria Isabel Cardona
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Tim Schmachtenberg
- Department of General Practice, University Medical Center Goettingen, Goettingen, Germany
| | - Anna Grünewald
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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9
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Michalowsky B, Afi A, Holle B, Thyrian JR, Hoffmann W. [Regional Health Care Networks in Germany: Characteristics and Financing Illustrated with Dementia Care Networks]. Gesundheitswesen 2023; 85:725-731. [PMID: 36084945 PMCID: PMC10444517 DOI: 10.1055/a-1901-8403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To describe the characteristics, financing structures and challenges of regional dementia care networks and the use of regional financial network support according to § 45c para. 9 SGB XI. METHODS The analysis was based on data from 120 dementia networks that provided information on the network characteristics (location, year of foundation, goals, organizational, personnel and financing structure), the challenges and the use of regional network funding according to § 45c Para. 9 SGB XI. Differences in the organizational, personnel and financing structure depending on the network characteristics were analyzed using t-Tests and ANOVA tests. The use of regional network funding (§ 45c Para. 9) were presented descriptively and discussed against the background of the planned amendment for 2022. RESULTS The majority of networks were established between 2011 and 2015. Most networks had educational and care goals and, on average, 28 stakeholders. Medically-associated and longer-established networks and networks with a legal form had significantly more network partners, persons actively involved in the work of the network and funding sources. The linking of stakeholders and the funding were seen as the most significant challenges. Every tenth network received regional network funding (§45c para. 9) but 28% decided not to receive funding. For most networks (50%), the funding was still unknown. CONCLUSION Regional dementia networks are very heterogeneously structured. Certain factors can significantly affect the number of partners and funding sources and should, therefore, be considered. Up to now, only one network per region could receive the maximum amount (€20,000) of funding according to §45c para. 9, which limits the usability of this funding, especially in densely populated regions. The amendment now increases the number of networks to be funded within one region and the funding level. It remains to be seen to what extent this amendment will increase the use of the regional network funding.
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Affiliation(s)
- Bernhard Michalowsky
- AG Translationale Versorgungsforschung, Deutsches Zentrum für
Neurodegenerative Erkrankungen e.V. (DZNE), Standort Rostock/Greifswald,
Greifswald, Germany
| | - Adel Afi
- AG Translationale Versorgungsforschung, Deutsches Zentrum für
Neurodegenerative Erkrankungen e.V. (DZNE), Standort Rostock/Greifswald,
Greifswald, Germany
| | - Bernhard Holle
- AG Versorgungsstrukturen, Deutsches Zentrum für
Neurodegenerative Erkrankungen (DZNE), Witten, Witten, Germany
- Fakultät für Gesundheit, Department für
Pflegewissenschaft, Universität Witten/Herdecke, Witten,
Germany
| | - Jochen René Thyrian
- Interventional Health Care Research, Deutsches Zentrum für
Neurodegenerative Erkrankungen (DZNE), Greifswald, Germany
| | - Wolfgang Hoffmann
- AG Translationale Versorgungsforschung, Deutsches Zentrum für
Neurodegenerative Erkrankungen e.V. (DZNE), Standort Rostock/Greifswald,
Greifswald, Germany
- Institut für Community Medicine, Universitätsmedizin
Greifswald, Greifswald, Germany
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Blotenberg I, Hoffmann W, René Thyrian J. Dementia in Germany: Epidemiology and Prevention Potential. Dtsch Arztebl Int 2023; 120:470-476. [PMID: 37226316 PMCID: PMC10487668 DOI: 10.3238/arztebl.m2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/13/2022] [Accepted: 04/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The further development of public-health approaches for the prevention of dementia requires estimates of the number of people with dementia, trends in incidence and prevalence, and the potential impact of preventive measures. METHODS The projections described here are based on incidence and prevalence data for Europe and on current and projected population figures from the German Federal Statistical Office. Four scenarios were calculated on the basis of two different population projections and the assumption of either stable or declining prevalence. Data from the German Aging Survey were used to estimate the prevention potential for eleven potentially modifiable risk factors for dementia. Weighting factors were determined to adjust for correlations between risk factors. RESULTS Approximately 1.8 million people were living with dementia in Germany as of December 31, 2021; the number of new dementia cases in 2021 is estimated at 360 000 to 440 000. In 2033, depending on the scenario, 1.65 to 2 million people aged 65 and older may be affected; we consider likelihood of the lower end of this range to be very low. It is estimated that 38% of these cases are associated with 11 potentially modifiable risk factors. A 15% reduction in the prevalence of risk factors could potentially decrease the number of cases by up to 138 000 in 2033. CONCLUSION We assume that the number of people with dementia in Germany will increase, but there is considerable prevention potential. Multimodal prevention approaches to promote healthy aging should be further developed and put into practice. Better data are needed on incidence and prevalence of dementia in Germany.
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Affiliation(s)
- Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE), Location Rostock/Greifswald
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Location Rostock/Greifswald
- Institute for Community Medicine, Greifswald University Medicine
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Location Rostock/Greifswald
- Institute for Community Medicine, Greifswald University Medicine
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11
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Wittmann FG, Zülke A, Pabst A, Luppa M, Thyrian JR, Kästner A, Hoffmann W, Kaduszkiewicz H, Döhring J, Escales C, Gensichen J, Zöllinger I, Kosilek RP, Wiese B, Oey A, König HH, Brettschneider C, Frese T, Riedel-Heller SG. COVID-19 government measures and their impact on mental health: a cross-sectional study of older primary care patients in Germany. Front Public Health 2023; 11:1141433. [PMID: 37283986 PMCID: PMC10239963 DOI: 10.3389/fpubh.2023.1141433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
Background With the outbreak of COVID-19, government measures including social distancing and restrictions of social contacts were imposed to slow the spread of the virus. Since older adults are at increased risk of severe disease, they were particularly affected by these restrictions. These may negatively affect mental health by loneliness and social isolation, which constitute risk factors for depressiveness. We aimed to analyse the impact of perceived restriction due to government measures on depressive symptoms and investigated stress as mediator in an at-risk-population in Germany. Methods Data were collected in April 2020 from the population of the AgeWell.de-study, including individuals with a Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score ≥9, using the depression subscale of the Brief Symptom Inventory (BSI-18) and the Perceived Stress Scale (PSS-4). Feeling restricted due to COVID-19 government measures was surveyed with a standardized questionnaire. Stepwise multivariate regressions using zero-inflated negative binomial models were applied to analyse depressive symptoms, followed by a general structural equation model to assess stress as mediator. Analysis were controlled for sociodemographic factors as well as social support. Results We analysed data from 810 older adults (mean age = 69.9, SD = 5). Feeling restricted due to COVID-19 government measures was linked to increased depressiveness (b = 0.19; p < 0.001). The association was no longer significant when adding stress and covariates (b = 0.04; p = 0.43), while stress was linked to increased depressive symptoms (b = 0.22; p < 0.001). A final model confirms the assumption that the feeling of restriction is mediated by stress (total effect: b = 0.26; p < 0.001). Conclusion We found evidence that feeling restricted due to COVID-19 government measures is associated with higher levels of depressive symptoms in older adults at increased risk for dementia. The association is mediated by perceived stress. Furthermore, social support was significantly associated with less depressive symptoms. Thus, it is of high relevance to consider possible adverse effects of government measures related to COVID-19 on mental health of older people.
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Affiliation(s)
- Felix G. Wittmann
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Andrea Zülke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Jochen René Thyrian
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
- Faculty V: School of Life Sciences, University of Siegen, Siegen, Germany
| | - Anika Kästner
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | | | - Juliane Döhring
- Institute of General Practice, University of Kiel, Kiel, Germany
| | | | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Isabel Zöllinger
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Robert Philipp Kosilek
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Birgitt Wiese
- Hannover Medical School, Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover, Germany
| | - Anke Oey
- Hannover Medical School, Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Service Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Service Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
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Düzel E, Thyrian JR. [Mobile everyday-life digital technologies for the prevention of Alzheimer's dementia: cognitive health and cognitive safety]. Nervenarzt 2023; 94:400-407. [PMID: 37115257 PMCID: PMC10160180 DOI: 10.1007/s00115-023-01478-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/29/2023]
Abstract
It is generally accepted that the treatment of Alzheimer's disease should be flanked by preventive measures for risk reduction in order to maintain cognitive functions for as long as possible; however, the research and development of treatment concepts are both faced with challenges. The preventive risk reduction necessitates a high level of coordination of neurology and psychiatry with other disciplines. Also, patients must develop a high level of health competence and summon up self-motivation and adherence. This concept article deals with the question of how mobile everyday-life digital technologies can help to address these challenges. The core prerequisite is the interdisciplinary coordinated structuring of prevention with the focus on cognitive health and cognitive safety. Cognitive health relates to a reduction of risk factors associated with lifestyle. Cognitive safety concerns the avoidance of iatrogenic side effects on cognitive functions. Digital technologies that are relevant in this context are mobile apps based on smartphones or tablets for everyday-life and high-frequency recording of cognitive functions, apps that can coach the implementation of lifestyle changes as companion technologies, apps that can assist in the reduction of iatrogenic risks and those that can improve the health competence of patients and relatives. The state of development of such medical products is at different stages of progress. Therefore, this concept article does not provide a review of existing products but rather deals with the fundamental interplay of potential solutions in the prevention of Alzheimer dementia in the areas of cognitive health and cognitive safety.
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Affiliation(s)
- Emrah Düzel
- Institut für Kognitive Neurologie und Demenzforschung, Medizinische Fakultät, Universität Magdeburg, Leipziger Str 44, 39120, Magdeburg, Deutschland.
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Standort Greifswald, Greifswald, Deutschland
- Lebenswissenschaftliche Fakultät (LWF), Universität Siegen, Siegen, Deutschland
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13
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Thyrian JR. [Prevention and health promotion in dementia: motivation for change within preventive interventions-Empirical results]. Nervenarzt 2023; 94:375-383. [PMID: 37010589 DOI: 10.1007/s00115-023-01480-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Abstract
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.
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Affiliation(s)
- Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Greifswald, MV GERMANY, Ellernholzstr. 1-2, 17489, Greifswald, Deutschland.
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland.
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14
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Giebel C, Talbot CV, Wharton E, Lorenz-Dant K, Suárez-González A, Cannon J, Tetlow H, Lion KM, Thyrian JR. The early impacts of COVID-19 on unpaid carers of people living with dementia: part II of a mixed-methods systematic review. Aging Ment Health 2023; 27:547-562. [PMID: 35818800 DOI: 10.1080/13607863.2022.2084510] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/14/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES With a lack of existing comprehensive reviews, the aim of this mixed-method systematic review was to synthesise the evidence on the early impacts of the pandemic on unpaid dementia carers across the globe. METHODS This review was registered on PROSPERO [CDR42021248050]. PubMed, CINAHL, Embase, Scopus and Web of Science were searched from 2020 to July 2021. Studies were included if they reported on the different impacts of the pandemic on unpaid dementia carers aged 18+, with papers published in English, German, Polish, or Spanish. A number of research team members were involved in the selection of studies following PRISMA guidance. RESULTS Thirty-six studies (43 papers) from 18 countries reported on the early impact of the pandemic on unpaid dementia carers. Impacts were noted on accessing care and support; carer burden; and well-being. Studies found that carers had limited access to care and support services, increased workload, enhanced feelings of social isolation, and reduced wellbeing. Specifically, reductions in access to care and support increased carer's unpaid caring tasks, removing any opportunities for temporary respite, and thus further increasing carer burden and reducing mental well-being in many. CONCLUSIONS The needs of unpaid dementia carers appear to have increased during the pandemic, without adequate support provided. Policy initiatives need to enable better mental health support and formal care provision for unpaid carers and their relatives with dementia, whilst future research needs to explore the long-term implications of carer needs in light of care home restrictions and care delivery.
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Affiliation(s)
- Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
| | | | - Emily Wharton
- NIHR ARC NWC, Liverpool, UK
- School for Sport and Exercise Science, Liverpool John Moore's University, Liverpool, UK
| | - Klara Lorenz-Dant
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | | | - Hilary Tetlow
- NIHR ARC NWC, Liverpool, UK
- SURF Liverpool, Liverpool, UK
| | - Katarzyna M Lion
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jochen René Thyrian
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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15
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Giebel C, Lion KM, Lorenz-Dant K, Suárez-González A, Talbot C, Wharton E, Cannon J, Tetlow H, Thyrian JR. The early impacts of COVID-19 on people living with dementia: part I of a mixed-methods systematic review. Aging Ment Health 2023; 27:533-546. [PMID: 35763444 DOI: 10.1080/13607863.2022.2084509] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/14/2022] [Indexed: 11/01/2022]
Abstract
Objectives: The aim of this Part I systematic review was to understand the impact of the COVID-19 pandemic on the lives of people with dementia living in the community or in residential care. Part II focused on unpaid carers.Methods: This review was registered on PROSPERO [CRD42021248050]. Five data bases (PubMed, CINAHL, Embase, Scopus, Web of Science) were searched in July 2021. Studies were included if they reported on the impacts of the pandemic on people living with dementia, either in the community or residential settings, and published in English, German, Polish, or Spanish. Risk of bias was assessed using the Standard Quality Assessment QualSyst.Results: Forty papers from 33 studies reported on the effects of COVID-19 on people with dementia. Included studies were conducted across 15 countries, focusing on single-country evaluations except in one study. Three studies focused on care homes, whilst the remainder reported on the community. Studies were categorised into five impacts: Cognition; Independence and physical functioning; Behavioural symptoms; Well-being; and Access to care. All studies evidenced the negative pandemic impacts, including faster cognitive, physical, and behavioural deterioration, limited access to care, and poorer mental and social health.Conclusions: Future restrictions need to consider the need for people with dementia to stay cognitively, physically, and socially stimulated to live well, and this review provides a call for a future pandemic strategy for dementia. Longitudinal research is required on the long-term impacts of the pandemic on the lives of people with dementia, including time to care home entry.
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Affiliation(s)
- Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
| | - Katarzyna M Lion
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Klara Lorenz-Dant
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Catherine Talbot
- Faculty of Science & Technology, Bournemouth University, Poole, UK
| | - Emily Wharton
- NIHR ARC NWC, Liverpool, UK
- School of Sport and Exercise Sciences, Liverpool John Moore's University, Liverpool, UK
| | - Jacqueline Cannon
- School of Sport and Exercise Sciences, Liverpool John Moore's University, Liverpool, UK
| | - Hilary Tetlow
- NIHR ARC NWC, Liverpool, UK
- Lewy Body Society, Wigan, UK
| | - Jochen René Thyrian
- Lewy Body Society, Wigan, UK
- SURF Liverpool, Liverpool, UK
- German Centre for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
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16
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Atef RZ, Michalowsky B, Raedke A, Platen M, Mohr W, Mühlichen F, Thyrian JR, Hoffmann W. Impact of Hearing Aids on Progression of Cognitive Decline, Depression, and Quality of Life Among People with Cognitive Impairment and Dementia. J Alzheimers Dis 2023; 92:629-638. [PMID: 36776058 DOI: 10.3233/jad-220938] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Hearing loss is common in people with dementia (PwD) and a modifiable risk factor for cognitive decline. Recent studies revealed that hearing loss could cause social isolation and depression, which is associated with health-related quality of life (HRQoL). However, there is a lack of knowledge about the impact of the utilization of hearing aids on these outcomes. OBJECTIVE To assess whether hearing aids use might be positively associated with the progression of cognitive function, depression, and HRQoL among PwD. METHODS We analyzed two-year follow-up data from 258 PwD (≥70 years, living at home). Cognitive decline was measured with Mini-Mental Status Examination (MMSE), depression using Geriatric Depression Scale (GDS), and HRQoL with Quality of Life in Alzheimer's Disease Scale (QoL-AD). The impact of hearing aid utilization on the progression of outcomes was assessed using multivariate regression models. RESULTS 123 patients had hearing loss (47.7%), from which n = 54 (43.9%) used hearing aids. Patients with hearing loss were older and had a lower HRQoL than those without hearing loss. Use of hearing aids in patients with hearing loss was associated with a lower increase in symptoms (b = -0.74, CI95 -1.46 --0.01, p = 0.047) over time as compared to those not using hearing aids. There was no effect on PwD's cognition, and the association with higher HRQoL was significant after one, but not consistently over two years. CONCLUSION Early detection and intervention of presbycusis using hearing aids might improve mental health and HRQoL in dementia.
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Affiliation(s)
- Roaa Zayed Atef
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Anika Raedke
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Moritz Platen
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Wiebke Mohr
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Franka Mühlichen
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
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17
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Gerhards SK, Luppa M, Röhr S, Pabst A, Bauer A, Frankhänel T, Döhring J, Escales C, Zöllinger IR, Oey A, Brettschneider C, Wiese B, Hoffmann W, Gensichen J, König HH, Frese T, Thyrian JR, Kaduszkiewicz H, Riedel-Heller SG. Depression and Anxiety in Old Age during the COVID-19 Pandemic: A Comparative Study of Individuals at Cardiovascular Risk and the General Population. Int J Environ Res Public Health 2023; 20:2975. [PMID: 36833671 PMCID: PMC9957242 DOI: 10.3390/ijerph20042975] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 05/22/2023]
Abstract
Our study aims to examine the associations of sociodemographic factors, social support, resilience, and perceptions of the COVID-19 pandemic with late-life depression and anxiety symptoms in a cardiovascular risk group and a matched sample from the German general population during the beginning of the pandemic and draw a comparison regarding psychosocial characteristics. Data of n = 1236 participants (aged 64-81 years) were analyzed, with n = 618 participants showing a cardiovascular risk profile, and n = 618 participants from the general population. The cardiovascular risk sample had slightly higher levels of depressive symptoms and felt more threatened by the virus due to pre-existing conditions. In the cardiovascular risk group, social support was associated with less depressive and anxiety symptoms. In the general population, high social support was associated with less depressive symptoms. Experiencing high levels of worries due to COVID-19 was associated with more anxiety in the general population. Resilience was associated with less depressive and anxiety symptoms in both groups. Compared to the general population, the cardiovascular risk group showed slightly higher levels of depressive symptomatology even at the beginning of the pandemic and may be supported by addressing perceived social support and resilience in prevention programs targeting mental health.
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Affiliation(s)
- Sina K. Gerhards
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, 04103 Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, 04103 Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, 04103 Leipzig, Germany
- Health and Ageing Research Team (HART), School of Psychology, Massey University, Palmerston North 4474, New Zealand
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, 04103 Leipzig, Germany
| | - Alexander Bauer
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Thomas Frankhänel
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany
| | - Catharina Escales
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany
| | - Isabel Renate Zöllinger
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany
| | - Anke Oey
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, 30625 Hannover, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Birgitt Wiese
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, 30625 Hannover, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Jochen René Thyrian
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | | | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, 04103 Leipzig, Germany
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18
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Ketchum FB, Monsees J, Kim AJ, Schmachtenberg T, Kind A, Shah M, Hoffmann W, Thyrian JR, Gilmore-Bykovskyi A. Pathways of care: a qualitative study of barriers and facilitators to engaging dementia care among underserved and minority populations in the US and Germany. Aging Ment Health 2023; 27:389-398. [PMID: 35138213 PMCID: PMC9360197 DOI: 10.1080/13607863.2022.2033695] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/17/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To identify barriers and facilitators to the use of formal dementia services among underserved and minority groups (UMG) in the United States and Germany. METHOD Semi-structured qualitative interviews with caregivers (N = 18) of persons with dementia in the United States and Germany. Data were analyzed using thematic analysis. RESULTS Caregivers described their experiences in three stages of seeking, initiating, and utilizing care, and different factors served to hinder or enable the use of care services in each stage. The most important factors included limited knowledge about dementia, challenges interacting with healthcare systems, and how closely formal services met the expectations and needs of caregivers, particularly with regard to accommodating cultural or ethnic/racial identity. Caregivers preferred interacting with service care providers who shared a similar identity to receive information or services. CONCLUSION Barriers and facilitators to using dementia care services vary by stage of engaging services and may be shared across different healthcare contexts. Targeting specific barriers and strengthening facilitators could help reduce disparities in dementia care among UMG.
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Affiliation(s)
- Fred B Ketchum
- Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Alice J Kim
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Tim Schmachtenberg
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Amy Kind
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
- Center for Health Disparities Research, University of Wisconsin, Madison, Wisconsin, USA
| | - Manish Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Andrea Gilmore-Bykovskyi
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
- Center for Health Disparities Research, University of Wisconsin, Madison, Wisconsin, USA
- Madison School of Nursing, University of Wisconsin, Madison, Wisconsin, USA
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19
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Kilimann I, Klein OA, Thyrian JR, Boekholt M, Teipel S, Hoffmann W. Effectiveness of a digitally supported care management program for family and other informal dementia caregivers: baseline data from the GAIN randomized controlled trial. Alzheimers Dement 2022. [DOI: 10.1002/alz.061719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ingo Kilimann
- German Center for Neurodegenerative Diseases Rostock Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center Rostock Germany
| | - Olga A. Klein
- Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE) Rostock/Greifswald Rostock Germany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) Rostock/Greifswald Greifswald Germany
| | - Melanie Boekholt
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) Rostock/Greifswald Greifswald Germany
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE) Rostock/Greifswald Rostock Germany
- Rostock University Medical Centre Rostock Germany
| | - Wolfgang Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) Rostock/Greifswald Greifswald Germany
- Institute for Community Medicine / University of Greifswald Greifswald Germany
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20
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Mühlichen F, Michalowsky B, Raedke A, Platen M, Mohr W, Thyrian JR, Hoffmann W. Tasks and activities of an effective collaborative Dementia Care Management program in German Primary Care. Alzheimers Dement 2022; 18 Suppl 9:e063085. [DOI: 10.1002/alz.063085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Franka Mühlichen
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald Greifswald Germany
| | - Bernhard Michalowsky
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) Rostock/Greifswald Germany
| | - Anika Raedke
- German Center for Neurodegenerative Diseases (DZNE) Rostock/ Greifswald Germany
| | - Moritz Platen
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald Greifswald Germany
| | - Wiebke Mohr
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald Greifswald Germany
| | | | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald Greifswald Germany
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21
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Schmachtenberg T, Monsees J, Thyrian JR. Structures for the care of people with dementia: a European comparison. BMC Health Serv Res 2022; 22:1372. [PMCID: PMC9673874 DOI: 10.1186/s12913-022-08715-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Dementia is a disease that impacts people with dementia, their families, and the healthcare system. In 2018, the number of people with dementia in the EU, the European Free Trade Association (EFTA), and the UK was estimated to be 9.1 million. National dementia strategies and publications by organisations such as Alzheimer Europe outline how dementia-specific care should be designed. This study aims to provide insights into existing formal care structures, models of good practise, and gaps in dementia-specific care for people with dementia in 17 European countries.
Methods
The research is based on guided interviews with
country-specific care experts. A mixed-methods approach with a combination of
open and closed questions was used. All interviews were
recorded and transcribed verbatim based on the transcription rules of Kuckarts
(2010). For data evaluation, the qualitative content analysis model of Mayring
(2014) was used.
Results
In all 17 countries, efforts for
dementia-friendly care and models of good care practise exist. However, there
are large differences between European countries regarding the spread of
dementia-specific services. In nine countries (Bulgaria, Finland, Italy,
Liechtenstein, Luxembourg, the Netherlands, Norway, Sweden, the UK), there are
already nationwide structures, while in five countries (Belgium, Greece,
Ireland, Portugal, Romania), services are only available in certain regions. In
three countries (Austria, Denmark, Germany) dementia-specific outpatient
services are widespread nationwide, whereas inpatient services are not.
Simultaneously, in all countries, areas with major care gaps exist. Several
European states have an urgent need for action concerning the expansion of the
provision of dementia-specific services, the reduction of regional differences
regarding the provision of care, the elimination of barriers to access to care,
the dementia-friendliness of services, and the participation of people with dementia
and their relatives in care and research.
Conclusions
To reduce the existing structural inequalities
in care between and within European countries, and to establish quality-related
minimum standards in the care of people with dementia, transnational concepts
are needed. The EU, in cooperation with care planners, research institutions,
care providers, and patient organisations, should develop European care
guidelines or dementia plans that contain concrete measures, schedules, and
budgets.
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22
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Boccardi M, Handels R, Gold M, Grazia A, Lutz MW, Martin M, Nosheny R, Robillard JM, Weidner W, Alexandersson J, Thyrian JR, Winblad B, Barbarino P, Khachaturian AS, Teipel S. Clinical research in dementia: A perspective on implementing innovation. Alzheimers Dement 2022; 18:2352-2367. [PMID: 35325508 DOI: 10.1002/alz.12622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 01/31/2023]
Abstract
The increasing global prevalence of dementia demands concrete actions that are aimed strategically at optimizing processes that drive clinical innovation. The first step in this direction requires outlining hurdles in the transition from research to practice. The different parties needed to support translational processes have communication mismatches; methodological gaps hamper evidence-based decision-making; and data are insufficient to provide reliable estimates of long-term health benefits and costs in decisional models. Pilot projects are tackling some of these gaps, but appropriate methods often still need to be devised or adapted to the dementia field. A consistent implementation perspective along the whole translational continuum, explicitly defined and shared among the relevant stakeholders, should overcome the "research-versus-adoption" dichotomy, and tackle the implementation cliff early on. Concrete next steps may consist of providing tools that support the effective participation of heterogeneous stakeholders and agreeing on a definition of clinical significance that facilitates the selection of proper outcome measures.
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Affiliation(s)
- Marina Boccardi
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany
| | - Ron Handels
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Division of Neurogeriatrics, Dept for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Alice Grazia
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany.,Department of Psychosomatic Medicine, Rostock Universitätsmedizin, Rostock, Germany
| | - Michael W Lutz
- Department of Neurology Duke University School of Medicine, Durham, North Carolina, USA
| | - Mike Martin
- Gerontology Center, University of Zurich, Zürich, Switzerland
| | - Rachel Nosheny
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.,San Francisco Veteran's Administration Medical Center, San Francisco, California, USA
| | - Julie M Robillard
- The University of British Columbia; BC Children's & Women's Hospitals, Vancouver, Canada
| | | | | | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Healthcare, University Medicine of Greifswald, Greifswald, Germany
| | - Bengt Winblad
- Division of Neurogeriatrics, Dept for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Ara S Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's Association, Rockville, Maryland, USA.,Campaign to Prevent Alzheimer's Disease, Rockville, Maryland, USA
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany.,Department of Psychosomatic Medicine, Rostock Universitätsmedizin, Rostock, Germany
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23
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Wendel F, Bauer A, Blotenberg I, Brettschneider C, Buchholz M, Czock D, Döhring J, Escales C, Frese T, Hoffmann W, Kaduszkiewicz H, König HH, Löbner M, Luppa M, Schwenker R, Thyrian JR, Weißenborn M, Wiese B, Zöllinger I, Riedel-Heller SG, Gensichen J. Social Network and Participation in Elderly Primary Care Patients in Germany and Associations with Depressive Symptoms-A Cross-Sectional Analysis from the AgeWell.de Study. J Clin Med 2022; 11:jcm11195940. [PMID: 36233810 PMCID: PMC9572848 DOI: 10.3390/jcm11195940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to describe social network and social participation and to assess associations with depressive symptoms in older persons with increased risk for dementia in Germany. We conducted a cross-sectional observational study in primary care patients (aged 60−77) as part of a multicenter cluster-randomized controlled trial (AgeWell.de). We present descriptive and multivariate analyses for social networks (Lubben Social Network Scale and subscales) and social participation (item list of social activities) and analyze associations of these variables with depressive symptoms (Geriatric Depression Scale). Of 1030 included patients, 17.2% were at risk for social isolation (Lubben Social Network Scale < 12). Looking at the subscales, a reduced non-family network was found almost twice as often as a reduced family network. Patients with depressive symptoms had significantly smaller social networks than patients without depression (p < 0.001). They rather engaged in social activities of low involvement level or no weekly social activity at all (p < 0.001). The study shows associations of depressive symptoms with a decreased social network and less social participation in elderly participants. Sufficient non-family contacts and weekly social activities seem to play an important role in mental health and should be encouraged in elderly primary care patients.
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Affiliation(s)
- Flora Wendel
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany
- Correspondence:
| | - Alexander Bauer
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Maresa Buchholz
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany
| | - Catharina Escales
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, 17487 Greifswald, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Rosemarie Schwenker
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - Marina Weißenborn
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Birgitt Wiese
- MHH Information Technology, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Isabel Zöllinger
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany
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24
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Dreyer J, Bergmann JM, Köhler K, Hochgraeber I, Pinkert C, Roes M, Thyrian JR, Wiegelmann H, Holle B. Differences and commonalities of home-based care arrangements for persons living with dementia in Germany - a theory-driven development of types using multiple correspondence analysis and hierarchical cluster analysis. BMC Geriatr 2022; 22:723. [PMID: 36050645 PMCID: PMC9438141 DOI: 10.1186/s12877-022-03310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most persons with dementia live at home and want to stay there as long as possible. In most cases, informal carers such as spouses or children care for them. Together with other family members and professional carers, they form care arrangements to address the complex needs of persons with dementia. One major aim of informal carers is to keep the care arrangement stable. The middle-range theory of 'stability of home-based care arrangements for people living with dementia' (SoCA-Dem theory) offers a theory to understand what constitutes and influences the stability of home-based care arrangements. Based on this theory, the aim of this study was to (1) uncover the underlying structures of differences and commonalities of home-based care arrangements for persons living with dementia, (2) construct types of these care arrangements, and (3) compare these types with regard to their stability. METHOD This is a secondary analysis of data from a convenience sample of n = 320 care arrangements for persons with dementia obtained in the observational DemNet-D study. Data were analysed using multiple correspondence analysis and hierarchical cluster analysis. Sociodemographic data and variables related to the structure of the care arrangement (D-IVA), burden of the informal carer (BICS-D), dementia severity (FAST), and quality of life of the person with dementia (QOL-AD) were included. RESULTS The multiple correspondence analysis identified 27 axes that explained the entire variance between all care arrangements. The two axes 'dementia and care trajectory' and 'structure of the dyadic relationship' best distinguished care arrangements from each other and together explained 27.10% of the variance. The subsequent cluster analysis identified four types of care arrangements. Two types included spouse-centred care arrangements, and two types included child-centred care arrangements at different phases of the dementia and care trajectory. The types differ with regard to their stability. CONCLUSION The results highlight the heterogeneity and commonality of care arrangements for persons living with dementia. They contribute to a better understanding of informal dementia home care. Furthermore, the results can guide the development of tailored support for persons living with dementia and their caring families.
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Affiliation(s)
- Jan Dreyer
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany.
| | | | - Kerstin Köhler
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Iris Hochgraeber
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Christiane Pinkert
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Henrik Wiegelmann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
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25
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Wittmann F, Czock D, Frese T, Gensichen J, Haefeli W, Hoffmann W, Kaduszkiewicz H, König HH, Thyrian JR, Wiese B, Luppa M, Riedel-Heller SG. COVID-19 measures and their impact on mental health of older people
and the effect of perceived stress and resilience. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- F Wittmann
- Universität Leipzig, Institut für Sozialmedizin,
Arbeitsmedizin und Public Health (ISAP), Leipzig, Deutschland
| | - D Czock
- Universitätsklinikum Heidelberg, Department of Clinical
Pharmacology and Pharmacoepidemiology, Heidelberg, Deutschland
| | - T Frese
- Martin-Luther Universität Halle-Wittenberg, Institute of
General Practice and Family Medicine, Halle, Deutschland
| | - J Gensichen
- Universität München, Institute of General Practice and
Family Medicine, München, Deutschland
| | - W Haefeli
- Martin-Luther Universität Halle-Wittenberg, Institute of
General Practice and Family Medicine, Halle, Deutschland
| | - W Hoffmann
- Universität Rostock, Deutsches Zentrum für
Neurodegenerative Erkrankungen, Greifswald, Deutschland
- Universität Greifswald, Institute for Community Medicine,
Greifswald, Deutschland
| | - H Kaduszkiewicz
- Universität Kiel, Institute of General Practice, Kiel,
Deutschland
| | - H-H König
- Universität Hamburg, Department of Health Economics and Health
Service Research, Hamburg, Deutschland
| | - JR Thyrian
- Universität Rostock, Deutsches Zentrum für
Neurodegenerative Erkrankungen, Greifswald, Deutschland
| | - B Wiese
- Medizinische Hochschule Hannover, Institute for General Practice,
Hannover, Deutschland
| | - M Luppa
- Universität Leipzig, Institut für Sozialmedizin,
Arbeitsmedizin und Public Health (ISAP), Leipzig, Deutschland
| | - SG Riedel-Heller
- Universität Leipzig, Institut für Sozialmedizin,
Arbeitsmedizin und Public Health (ISAP), Leipzig, Deutschland
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Claus M, Luppa M, Czock D, Frese T, Gensichen J, Haefeli W, Hoffmann W, Kaduszkiewicz H, König HH, Wiese B, Thyrian JR, Riedel-Heller SG. Association of modifiable lifestyle factors with cognitive function
in the AgeWell.de-trial. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- M Claus
- Medical Faculty, University of Leipzig, Institute of Social Medicine,
Occupational Health and Public Health (ISAP), Leipzig, Deutschland
| | - M Luppa
- Medical Faculty, University of Leipzig, Institute of Social Medicine,
Occupational Health and Public Health (ISAP), Leipzig, Deutschland
| | - D Czock
- University Hospital Heidelberg, Department of Clinical Pharmacology and
Pharmacoepidemiology, Heidelberg, Deutschland
| | - T Frese
- Martin-Luther-University Halle-Wittenberg, Institute of General
Practice and Family Medicine, Halle (Saale), Deutschland
| | - J Gensichen
- University of LMU Munich, Institute of General Practice and Family
Medicine, Munich, Deutschland
| | - W Haefeli
- University Hospital Heidelberg, Department of Clinical Pharmacology and
Pharmacoepidemiology, Heidelberg, Deutschland
| | - W Hoffmann
- University Medicine Greifswald, Institute for Community Medicine,
Greifswald, Deutschland
- German Center for Neurodegenerative Diseases (DZNE), Site
Rostock/Greifswald, Greifswald, Deutschland
| | - H Kaduszkiewicz
- University of Kiel, Institute of General Practice, Kiel,
Deutschland
| | - H-H König
- University Medical Center Hamburg-Eppendorf, Department of Health
Economics and Health Services Research, Hamburg, Deutschland
| | - B Wiese
- Hannover Medical School, Institute for General Practice, Work Group
Medical Statistics and IT-Infrastructure, Hannover, Deutschland
| | - JR Thyrian
- University Medicine Greifswald, Institute for Community Medicine,
Greifswald, Deutschland
- German Center for Neurodegenerative Diseases (DZNE), Site
Rostock/Greifswald, Greifswald, Deutschland
| | - SG Riedel-Heller
- Medical Faculty, University of Leipzig, Institute of Social Medicine,
Occupational Health and Public Health (ISAP), Leipzig, Deutschland
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Thyrian JR. [Dementia and migration]. Z Gerontol Geriatr 2022; 55:267-268. [PMID: 35729432 PMCID: PMC9213363 DOI: 10.1007/s00391-022-02078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Jochen René Thyrian
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Ellernholzstr. 1-2, 17489, Greifswald, Deutschland.
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Monsees J, Schmachtenberg T, René Thyrian J. Intercultural care for people of migrant origin with dementia - A literature analysis. Dementia (London) 2022; 21:1753-1770. [PMID: 35506672 DOI: 10.1177/14713012221086702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Close to 12 million people of migrant origin who are 65 years or older live in different European countries. In the European Union (EU) and the European Free Trade Association (EFTA) countries, approximately half a million are estimated to have dementia. This rate is expected to increase in the coming decades. People of migrant origin who develop dementia and their families face challenges people without migration backgrounds do, but due to cultural differences, additional challenges may arise. There is an increasing need for interculturally sensitive care. There is research on certain aspects of intercultural care and this study will be a comprehensive summary of current topics in intercultural care. RESEARCH QUESTION What factors of intercultural care for people of migrant origin with dementia can be identified? What requirements and aspects are necessary to ensure intercultural care? METHOD A systematic literature analysis in the databases PubMed, PsycInfo and Psychology and Behavioural Sciences Collection was conducted. FINDINGS Thirty-nine articles were eligible for analysis. Enhancement in the areas diagnostics, education and information, healthcare services and healthcare professionals to ensure intercultural care is needed. DISCUSSION Current evidence supports the need for (a) thorough education of people of migrant origin with dementia, their families and healthcare professionals, (b) collaborations among everyone involved, (c) embracing different cultures in healthcare services, (d) the implementation of a care navigator functioning as a contact person and connecting all relevant parties with one another and (e) dementia testing suitable to the target group to ensure culturally sensitive and appropriate care for people of migrant origin with dementia and their families.
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Affiliation(s)
- Jessica Monsees
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Greifswald, Germany
| | - Tim Schmachtenberg
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Greifswald, Germany; and Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Seidel K, Quasdorf T, Haberstroh J, Thyrian JR. Adapting a Dementia Care Management Intervention for Regional Implementation: A Theory-Based Participatory Barrier Analysis. IJERPH 2022; 19:ijerph19095478. [PMID: 35564877 PMCID: PMC9101206 DOI: 10.3390/ijerph19095478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022]
Abstract
Dementia is a leading cause of disability and dependency in older people worldwide. As the number of people affected increases, so does the need for innovative care models. Dementia care management (DCM) is an empirically validated approach for improving the care and quality of life for people with dementia (PwD) and caregivers. The aim of this study is to investigate the influencing factors and critical pathways for the implementation of a regionally adapted DCM standard in the existing primary care structures in the German region of Siegen-Wittgenstein (SW). Utilizing participatory research methods, five local health care experts as co-researchers conducted N = 13 semi-structured interviews with 22 local professionals and one caregiver as peer reviewers. Data collection and analysis were based on the Consolidated Framework for Implementation Research (CFIR). Our results show that among the most mentioned influencing factors, three CFIR constructs can be identified as both barriers and facilitators: Patients’ needs and resources, Relative advantage, and Cosmopolitanism. The insufficient involvement of relevant stakeholders is the major barrier and the comprehensive consideration of patient needs through dementia care managers is the strongest facilitating factor. The study underlines the vital role of barrier analysis in site-specific DCM implementation.
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Affiliation(s)
- Katja Seidel
- Psychological Ageing Research, Department of Psychology, Faculty V: School of Life Sciences, University of Siegen, Adolf-Reichwein-Str. 2a, 57068 Siegen, Germany;
- Correspondence: ; Tel.: +49-271-740-4053
| | - Tina Quasdorf
- German Center for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453 Witten, Germany;
- Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany
| | - Julia Haberstroh
- Psychological Ageing Research, Department of Psychology, Faculty V: School of Life Sciences, University of Siegen, Adolf-Reichwein-Str. 2a, 57068 Siegen, Germany;
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Ellernholzstr. 1/2, 17489 Greifswald, Germany;
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
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Mühlichen F, Michalowsky B, Rädke A, Platen M, Mohr W, Thyrian JR, Hoffmann W. Tasks and Activities of an Effective Collaborative Dementia Care Management Program in German Primary Care. J Alzheimers Dis 2022; 87:1615-1625. [PMID: 35491783 PMCID: PMC9277686 DOI: 10.3233/jad-215656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Recent studies have demonstrated the efficiency of collaborative dementia care, which aims to improve post-diagnostic support. However, tasks carried out of such models are currently unknown, hindering its implementation. Objective: To describe tasks of a collaborative model of dementia care, analyze the association between specific task subgroups and number of tasks with patients’ and caregivers’ characteristics and the impact of specific tasks on health-related quality of life (HRQoL). Methods: The analysis was based on 183 persons with dementia (PwD) who received dementia care management conducted by dementia-specific qualified nurses. A standardized, computer-assisted assessment was used to identify patients’ and caregivers’ unmet needs. Tasks carried out to address unmet needs were documented, categorized, and descriptively analyzed. We used multivariate regression models to identify socio-demographic and clinical factors associated with a specific subgroup of tasks or a higher number of tasks. Results: On average, 20.5 tasks were carried out per dyad (PwD and caregiver). 41% of tasks were categorized to cooperation with other healthcare providers, 39% to nursing care, and 19% to social support. Lower HRQoL and higher age, cognitive impairment, deficits in daily living activities, and depressive symptoms were significantly associated with a higher number of tasks. A higher number of cooperation tasks were associated with a higher gain in HRQoL. Conclusion: Patients’ characteristics and HRQoL significantly determine the intensity of collaborative care interventions. Variability of the intensity should be considered in developing future studies and in the implementation into routine care. ClinicalTrials.gov Identifier: NCT01401582
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Affiliation(s)
- Franka Mühlichen
- German Center for Neurodegenerative Diseases (DZNE) Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE) Greifswald, Greifswald, Germany
| | - Anika Rädke
- German Center for Neurodegenerative Diseases (DZNE) Greifswald, Greifswald, Germany
| | - Moritz Platen
- German Center for Neurodegenerative Diseases (DZNE) Greifswald, Greifswald, Germany
| | - Wiebke Mohr
- German Center for Neurodegenerative Diseases (DZNE) Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE) Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine, University of Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE) Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine, University of Greifswald, Greifswald, Germany
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Zülke AE, Luppa M, Röhr S, Weißenborn M, Bauer A, Samos FAZ, Kühne F, Zöllinger I, Döhring J, Brettschneider C, Oey A, Czock D, Frese T, Gensichen J, Haefeli WE, Hoffmann W, Kaduszkiewicz H, König HH, Thyrian JR, Wiese B, Riedel-Heller SG. Association of mental demands in the workplace with cognitive function in older adults at increased risk for dementia. BMC Geriatr 2021; 21:688. [PMID: 34893023 PMCID: PMC8665567 DOI: 10.1186/s12877-021-02653-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Growing evidence suggests a protective effect of high mental demands at work on cognitive function in later life. However, evidence on corresponding associations in older adults at increased risk for dementia is currently lacking. This study investigates the association between mental demands at work and cognitive functioning in the population of the AgeWell.de-trial. Methods Cross-sectional investigation of the association between global cognitive functioning (Montreal Cognitive Assessment) and mental demands at work in older individuals at increased risk for dementia (Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE)score ≥ 9; n = 941, age: 60–77 years). Occupational information was matched to Occupational Information Network (O*NET)-descriptors. Associations between cognitive function and O*NET-indices executive, verbal and novelty were investigated using generalized linear models. Results Higher values of index verbal (b = .69, p = .002) were associated with better cognitive function when adjusting for covariates. No association was observed for indices executive (b = .37, p = .062) and novelty (b = .45, p = .119). Higher education, younger age, and employment were linked to better cognitive function, while preexisting medical conditions did not change the associations. Higher levels of depressive symptomatology were associated with worse cognitive function. Conclusions Higher levels of verbal demands at work were associated with better cognitive function for older adults with increased dementia risk. This suggests an advantage for older persons in jobs with high mental demands even after retirement and despite prevalent risk factors. Longitudinal studies are warranted to confirm these results and evaluate the potential of workplaces to prevent cognitive decline through increased mental demands.
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Affiliation(s)
- Andrea E Zülke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103, Leipzig, Germany.
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103, Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103, Leipzig, Germany.,Global Brain Health Institute (GBHI), Trinity College Dublin, D02 PN40, Dublin, Ireland
| | - Marina Weißenborn
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Alexander Bauer
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112, Halle (Saale), Germany
| | - Franziska-Antonia Zora Samos
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112, Halle (Saale), Germany
| | - Flora Kühne
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336, Munich, Germany
| | - Isabel Zöllinger
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336, Munich, Germany
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, 24105, Kiel, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Service Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Anke Oey
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, 30625, Hannover, Germany
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112, Halle (Saale), Germany
| | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336, Munich, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Wolfgang Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Rostock/ Greifswald, 17489, Greifswald, Germany.,Institute of Community Medicine, Dept. of Epidemiology of Health Care and Community Health, University Medicine Greifswald, 17487, Greifswald, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Service Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Rostock/ Greifswald, 17489, Greifswald, Germany.,Institute of Community Medicine, Dept. of Epidemiology of Health Care and Community Health, University Medicine Greifswald, 17487, Greifswald, Germany
| | - Birgitt Wiese
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, 30625, Hannover, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103, Leipzig, Germany
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Boekholt M, Nowossadeck S, Michalowsky B, Hoffmann W, Thyrian JR. Studying the relation between cognition and frailty: How can frailty be assessed using existing data? Alzheimers Dement 2021. [DOI: 10.1002/alz.051259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Melanie Boekholt
- German Center for Neurodegenerative Diseases (DZNE) Greifswald Germany
| | | | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald Greifswald Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald Greifswald Germany
- German Center for Neurodegenerative Disease (DZNE) Greifswald Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald Greifswald Germany
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Monsees J, Schmachtenberg T, Thyrian JR. Prevalence of dementia in people with migration background in Europe. Alzheimers Dement 2021. [DOI: 10.1002/alz.053618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
| | - Tim Schmachtenberg
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
- Institute for Community Medicine/University of Greifswald Greifswald Germany
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Gove D, Nielsen TR, Smits C, Plejert C, Rauf MA, Parveen S, Jaakson S, Golan‐Shemesh D, Lahav D, Kaur R, Herz MK, Monsees J, Thyrian JR, Georges J. The challenges of achieving timely diagnosis and culturally appropriate care of people with dementia from minority ethnic groups in Europe. Int J Geriatr Psychiatry 2021; 36:1823-1828. [PMID: 34378237 PMCID: PMC9291493 DOI: 10.1002/gps.5614] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a just society, everyone should have equal access to healthcare in terms of prevention, assessment, diagnosis, treatment and care. Europe is a multicultural society made up of people who identify with a wide range of ethnic groups. Many older people from minority ethnic groups also have a direct migration background. Several studies have shown that there is a lack of equity in relation to dementia diagnoses and care because equal opportunities do not necessarily translate into equal outcomes. An expert ethics working group led by Alzheimer Europe has produced an extensive report on this issue, a policy brief and a guide for health and social care workers. In this brief summary, the authors/members of the expert working group present some of the key challenges and recommendations for healthcare clinicians striving to provide timely diagnosis and good quality care and treatment to people with dementia from all ethnic groups.
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Affiliation(s)
| | - Thomas Rune Nielsen
- Department of NeurologyDanish Dementia Research CentreCopenhagen University HospitalKobenhavnDenmark
| | - Carolien Smits
- Pharos Dutch Centre of Expertise on Health DisparitiesUtrechtthe Netherlands
| | - Charlotta Plejert
- Department of Biomedical and Clinical SciencesDivision of Sensory Organs and CommunicationLinköping UniversityLinköpingSweden
| | | | - Sahdia Parveen
- Centre for Applied Dementia StudiesUniversity of BradfordBradfordUK
| | - Siiri Jaakson
- Multicultural Memory Centre ‐ the Finnish Society for Memory WorkVantaaFinland
| | | | - Debi Lahav
- Emda Alzheimer's AssociationKefar SabaIsrael
| | | | | | - Jessica Monsees
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)GreifswaldGermany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)GreifswaldGermany
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Platen M, Raedke A, Wucherer D, Thyrian JR, Mohr W, Scharf A, Mühlichen F, Hoffmann W, Michalowsky B. Associations between low‐value care treatments and patient‐centered outcomes of people with dementia: A cross‐sectional analysis. Alzheimers Dement 2021. [DOI: 10.1002/alz.052243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Moritz Platen
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
| | - Anika Raedke
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
- Institute for Community Medicine / University of Greifswald Greifswald Germany
| | - Wiebke Mohr
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
| | - Annelie Scharf
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
| | - Franka Mühlichen
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
- Institute for Community Medicine / University of Greifswald Greifswald Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
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Schmachtenberg T, Monsees J, Thyrian JR. What elements are important in current treatment and care guidelines to provide culturally sensitive care for people with a migration background with dementia? A systematic analysis. Alzheimers Dement 2021. [DOI: 10.1002/alz.053578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tim Schmachtenberg
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald Greifswald Germany
- Institute for Community Medicine/University of Greifswald Greifswald Germany
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Schumacher-Schönert F, Wucherer D, Nikelski A, Kreisel S, Vollmar HC, Hoffmann W, Thyrian JR. [Discharge management in German hospitals for cognitively impaired, older people-a scoping review]. Z Gerontol Geriatr 2021; 54:695-703. [PMID: 32383064 PMCID: PMC8551109 DOI: 10.1007/s00391-020-01732-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In German hospitals approximately 40% of all patients over the age of 65 years are cognitively impaired (MmkB). After discharge from hospital it is particularly important for MmkB that the transition to domestic life is organized as seamlessly and as well-coordinated as possible. OBJECTIVE The aim of the study was to determine the existing evidence on discharge management (EM) in MmkB and people with dementia (MmD). Furthermore, the study examined the necessity of an intersectoral concept for MmkB. MATERIAL AND METHODS Based on a scoping review a total of 102 publications were identified, of which 6 articles were finally used for the evaluation. RESULTS The article provides an overview of the current care of MmkB in acute care hospitals in Germany. General information on EM in hospitals was given in three of the six publications included. Information on special discharge and care management for MmkB and MmD was contained in five out of six papers. DISCUSSION The article illustrates significant gaps in the hospital care for older MmkB, in particular at the interface of discharge management and demonstrates the need for new care models. To what extent these new care models can be structurally, procedurally and systemically embedded in the standard care and financed, is an open and unexplored question.
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Affiliation(s)
- F Schumacher-Schönert
- AG Interventionelle Versorgungsforschung, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE) Standort Rostock/Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Deutschland.
| | - D Wucherer
- AG Interventionelle Versorgungsforschung, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE) Standort Rostock/Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - A Nikelski
- Evangelisches Klinikum Bethel gGmbH, Akademisches Lehrkrankenhaus, Universität Münster, Münster, Deutschland
| | - S Kreisel
- Evangelisches Klinikum Bethel gGmbH, Akademisches Lehrkrankenhaus, Universität Münster, Münster, Deutschland
| | - H C Vollmar
- Abteilung für Allgemeinmedizin, Ruhr-Universität Bochum, Bochum, Deutschland
| | - W Hoffmann
- AG Interventionelle Versorgungsforschung, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE) Standort Rostock/Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - J R Thyrian
- AG Interventionelle Versorgungsforschung, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE) Standort Rostock/Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Greifswald, Deutschland
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Cotton QD, Kind AJH, Kim AJ, Block LM, Thyrian JR, Monsees J, Shah MN, Gilmore-Bykovskyi A. Dementia Caregivers' Experiences Engaging Supportive Services While Residing in Under-Resourced Areas. J Alzheimers Dis 2021; 84:169-177. [PMID: 34487046 DOI: 10.3233/jad-210609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family caregivers of people living with dementia benefit from supportive service use to address care needs associated with caregiving. Yet, research consistently demonstrates low rates of service use. Existing research has focused on barriers and facilitators to service use, with few studies examining the influence of caregivers' environmental context which often patterns social advantage and health services accessibility. OBJECTIVE To describe the perspectives of caregivers residing in socially disadvantaged areas have in regards to utilizing supportive services. METHODS Ten informal caregivers residing in socially disadvantaged areas participated in in-depth interviews that were analyzed using thematic analysis. RESULTS Across all interviews, caregivers spontaneously described common precedents of service use (crisis or accumulation of unmet needs) and a distinct sequence of stages (seeking, initiating, and utilizing) surrounding service engagement. Major themes characterizing caregivers' experiences throughout service engagement highlight the varied influence of personal, familial, health, and social system-related factors. Findings demonstrate that caregivers may have different service needs as dementia progresses and that gerontological social work practice can facilitate service use. CONCLUSION While preliminary, these findings provide important insights into new domains that can be further examined in future research and intervention efforts to improve supportive service use in socially disadvantaged and underserved communities.
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Affiliation(s)
- Quinton D Cotton
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA.,University of Wisconsin-Madison Institute for Clinical and Translational Research, Madison, WI, USA
| | - Amy J H Kind
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA.,William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, WI, USA
| | - Alice J Kim
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA.,Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Laura M Block
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany.,Institute of Community Medicine, University Medicine-Greifswald, Greifswald, Germany
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Manish N Shah
- University of Wisconsin-Madison Institute for Clinical and Translational Research, Madison, WI, USA.,Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrea Gilmore-Bykovskyi
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA.,University of Wisconsin-Madison School of Nursing, Madison, WI, USA
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Platen M, Fleßa S, Rädke A, Wucherer D, Thyrian JR, Mohr W, Scharf A, Mühlichen F, Hoffmann W, Michalowsky B. Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia. J Alzheimers Dis 2021; 83:1775-1787. [PMID: 34459396 PMCID: PMC8609693 DOI: 10.3233/jad-210439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Low-value care (LvC) is defined as care unlikely to provide a benefit to the patient regarding the patient’s preferences, potential harms, costs, or available alternatives. Avoiding LvC and promoting recommended evidence-based treatments, referred to as high-value care (HvC), could improve patient-reported outcomes for people living with dementia (PwD). Objective: This study aims to determine the prevalence of LvC and HvC in dementia and the associations of LvC and HvC with patients’ quality of life and hospitalization. Methods: The analysis was based on data of the DelpHi trial and included 516 PwD. Dementia-specific guidelines, the “Choosing Wisely” campaign and the PRISCUS list were used to indicate LvC and HvC treatments, resulting in 347 LvC and HvC related recommendations. Of these, 77 recommendations (51 for LvC, 26 for HvC) were measured within the DelpHi-trial and finally used for this analysis. The association of LvC and HvC treatments with PwD health-related quality of life (HRQoL) and hospitalization was assessed using multiple regression models. Results: LvC was highly prevalent in PwD (31%). PwD receiving LvC had a significantly lower quality of life (b = –0.07; 95% CI –0.14 – –0.01) and were significantly more likely to be hospitalized (OR = 2.06; 95% CI 1.26–3.39). Different HvC treatments were associated with both positive and negative changes in HRQoL. Conclusion: LvC could cause adverse outcomes and should be identified as early as possible and tried to be replaced. Future research should examine innovative models of care or treatment pathways supporting the identification and replacement of LvC in dementia.
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Affiliation(s)
- Moritz Platen
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Steffen Fleßa
- Department of General Business Administration and Health Care Management, University of Greifswald, Greifswald, Germany
| | - Anika Rädke
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald (UMG), Greifswald, Germany
| | - Wiebke Mohr
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Annelie Scharf
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Franka Mühlichen
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald (UMG), Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
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Cardona MI, Afi A, Lakicevic N, Thyrian JR. Physical Activity Interventions and Their Effects on Cognitive Function in People with Dementia: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2021; 18:ijerph18168753. [PMID: 34444501 PMCID: PMC8394441 DOI: 10.3390/ijerph18168753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Physical activity (PA) has emerged as an alternative nonpharmacological approach to effectively address the effects of dementia. The primary aim was to identify and summarize PA interventions and their effects on cognitive function among persons with dementia (PwD). METHODS A systematic review was conducted with a meta-analysis using different electronic databases, such as PubMed, Embase, APA PsycNET, and the Web of Science. The identified and selected studies were randomized controlled trials (RCTs) that were written in English, published between 2000 and 2020, and implemented among PwD who received a PA intervention and whose cognitive function was measured at baseline and during a follow-up. RESULTS Twenty-two PA intervention studies met the eligibility criteria and showed a medium-size effect on the cognitive function of PwD, 0.4803 (95% CI = 0.1901-0.7704), with a high percentage of heterogeneity (I2 = 86%, p ≤ 0.0001). Moreover, this review complements other reviews by including eight studies that have not previously been considered. Overall, studies have methodological limitations. However, six studies implemented in the past five years have shown more robust methodological designs, including larger sample sizes and more comprehensive measurement tools. CONCLUSION It is not yet possible to draw a conclusion on the ideal PA intervention for this population due to the high proportion of heterogeneity within the included studies. More emphasis is needed on the intensity of PA monitoring and adherence to such programs.
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Affiliation(s)
- Maria Isabel Cardona
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Rostock/Greifswald, Ellernholzstr. 1–2, 17489 Greifswald, Germany; (A.A.); (J.R.T.)
- Correspondence: ; Tel.: +49-383-486-7593; Fax: +49-383-4861-9551
| | - Adel Afi
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Rostock/Greifswald, Ellernholzstr. 1–2, 17489 Greifswald, Germany; (A.A.); (J.R.T.)
| | - Nemanja Lakicevic
- Sport and Exercise Sciences Research Unit, University of Palermo, 90133 Palermo, Italy;
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Rostock/Greifswald, Ellernholzstr. 1–2, 17489 Greifswald, Germany; (A.A.); (J.R.T.)
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstraße 1–2, 17489 Greifswald, Germany
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Kracht F, Boekholt M, Schumacher-Schönert F, Nikelski A, Chikhradze N, Lücker P, Vollmar HC, Hoffmann W, Kreisel SH, Thyrian JR. Describing people with cognitive impairment and their complex treatment needs during routine care in the hospital - cross-sectional results of the intersec-CM study. BMC Geriatr 2021; 21:425. [PMID: 34253180 PMCID: PMC8276375 DOI: 10.1186/s12877-021-02298-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cognitive impairment is an important determinant in health care. In the acute hospital setting cognition has a strong impact on treatment and care. Cognitive impairment can negatively affect diagnostics and treatment success. However, little is known about the individual situation and specific risks of people with cognitive impairments during hospital stays. The aim of the present research is to describe and analyze the treatment needs of people with cognitive impairments in acute hospital care. METHODS The analyses use baseline data of the ongoing multisite, longitudinal, randomized controlled intervention trial intersec-CM (Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management), which recruited 402 participants at baseline. We assessed sociodemographic aspects, cognitive status, functional status, frailty, comorbidities, level of impairment, formal diagnosis of dementia, geriatric diagnoses, delirium, depression, pharmacological treatment, utilization of health care services and health care related needs. RESULTS The sample under examination had been on average mildly cognitively impaired (MMSE M = 22.3) and had a mild to moderate functional impairment (Barthel Index M = 50.4; HABAM M = 19.1). The Edmonton Frail Scale showed a mean of 7.4 and half of the patients (52.3%) had been assigned a care level. About 46.9% had a geriatric diagnosis, 3.0% had a diagnosis of dementia. According to DSM-V 19.2% of the patients had at least one main symptom of depression. The mean number of regularly taken drugs per patient was 8.2. Utilization of health care services prior to the hospital stay was rather low. On average, the sample showed 4.38 care related needs in general, of which 0.60 needs were unaddressed at the time of assessment. CONCLUSIONS Descriptive analyses highlight an in-depth insight into impairments and different care needs of people with cognitive impairments. The results emphasize the need for gender-specific analyses as well as an increased attention to the heterogeneity of needs of people with cognitive impairments related to specific wards, settings and regions where they are admitted. Our results indicate also that people with cognitive impairments represent a high proportion of older patients in acute hospital care. TRIAL REGISTRATION The intersec-CM trial is registered at ClinicalTrials.gov ( NCT03359408 ).
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Affiliation(s)
- F Kracht
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany.
| | - M Boekholt
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany.
| | - F Schumacher-Schönert
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany
| | - A Nikelski
- Evangelisches Klinikum Bethel, Campus Bielefeld-Bethel, Division of Geriatric Psychiatry, Universitätsklinikum OWL der Universität Bielefeld, Bielefeld, Germany
| | - N Chikhradze
- Institute of General Practice and Family Medicine (AM RUB), Faculty of Medicine, Ruhr University Bochum (RUB), Bochum, Germany
| | - P Lücker
- Institute for Community Medicine, Section of Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - H C Vollmar
- Institute of General Practice and Family Medicine (AM RUB), Faculty of Medicine, Ruhr University Bochum (RUB), Bochum, Germany
| | - W Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany
- Institute for Community Medicine, Section of Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - S H Kreisel
- Evangelisches Klinikum Bethel, Campus Bielefeld-Bethel, Division of Geriatric Psychiatry, Universitätsklinikum OWL der Universität Bielefeld, Bielefeld, Germany
| | - J R Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany.
- Institute for Community Medicine, Section of Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany.
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Klein OA, Boekholt M, Afrin D, Dornquast C, Dreier-Wolfgramm A, Keller A, Michalowsky B, Zwingmann I, Teipel S, Thyrian JR, Kilimann I, Hoffmann W. Correction to: Effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia: study protocol for a cluster randomised controlled trial (GAIN). Trials 2021; 22:432. [PMID: 34229746 PMCID: PMC8259009 DOI: 10.1186/s13063-021-05395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Olga A Klein
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.
| | - Melanie Boekholt
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Dilshad Afrin
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Christina Dornquast
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier-Wolfgramm
- Hamburg University of Applied Sciences (HAW), Faculty of Business and Social Sciences, Department of Nursing and Management, Hamburg, Germany
| | - Armin Keller
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, University of Rostock, Rostock, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Ina Zwingmann
- European University of Applied Sciences (EU FH), Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.,Department for Psychosomatic and Psychotherapeutical Medicine, University Hospital Rostock, Rostock, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.,Department for Psychosomatic and Psychotherapeutical Medicine, University Hospital Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
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Klein OA, Boekholt M, Afrin D, Dornquast C, Dreier-Wolfgramm A, Keller A, Michalowsky B, Zwingmann I, Teipel S, Thyrian JR, Kilimann I, Hoffmann W. Effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia: study protocol for a cluster randomised controlled trial (GAIN). Trials 2021; 22:401. [PMID: 34134744 PMCID: PMC8206900 DOI: 10.1186/s13063-021-05290-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background Up to two-thirds of dementia care is provided by family caregivers who often experience high burden, little support and adverse health outcomes. Enabling and supporting family caregivers to provide care at home prevents early institutionalisation of the person with dementia and alleviates the economic burden of dementia in the long term. General practitioners (GPs), as the first point of contact, have a key role in identifying and managing burden and care needs of family caregivers. However, in routine care, this opportunity is often limited by time constraints and even if caregiver needs are recognised, detailed information about regionally available support and advice on healthcare services is often lacking. Methods This is a cluster randomised, controlled trial investigating the clinical use and cost-effectiveness of a digitally supported care management programme for caregivers of people with dementia (PwD). Five hundred family caregivers will be randomised at GP offices, specialist practices and memory clinics, with about n=250 participants per arm. Participants are eligible if they are the primary family caregiver of a PwD, are at least 18 years of age and provide informed consent. Participants in the intervention group will receive an individualised care management plan, which will be carried out by qualified study nurses in collaboration with the treating GP. All participants will receive a baseline assessment and a 6-months follow-up assessment. Participants in the wait-list control group will receive usual care. Starting at the 6 months’ follow-up, the former controls will also receive an individualised management plan. Primary outcomes are the number of unmet needs (incl. the Camberwell Assessment of Need for the Elderly, CANE) and health-related quality of life (EQ-5D-5L) at 6 months. Secondary outcomes include caregiver burden (Zarit Burden Interview, ZBI), social support (Lubben Social Network Scale, LSNS), the use of medical and non-medical services (Questionnaire for the Use of Medical and Non-Medical Services, FIMA) and resource utilisation (Resource Utilisation in Dementia, RUD). The primary analysis will be based on intention-to-treat. Between- and within-group analyses and a cost-effectiveness analysis will be conducted to estimate the effect of the tablet PC-based care management programme. This trial is funded by the German Federal Joint Committee (G-BA) Innovation Fund. Discussion The findings of this trial will be useful in informing and improving current healthcare system structures and processes to support family dementia caregivers within routine care practices. Trial registration ClinicalTrials.gov NCT04037501. Registered on 30 July 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05290-w.
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Affiliation(s)
- Olga A Klein
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.
| | - Melanie Boekholt
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Dilshad Afrin
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Christina Dornquast
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier-Wolfgramm
- Hamburg University of Applied Sciences (HAW), Faculty of Business and Social Sciences, Department of Nursing and Management, Hamburg, Germany
| | - Armin Keller
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, University of Rostock, Rostock, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Ina Zwingmann
- European University of Applied Sciences (EU FH), Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.,Department for Psychosomatic and Psychotherapeutical Medicine, University Hospital Rostock, Rostock, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.,Department for Psychosomatic and Psychotherapeutical Medicine, University Hospital Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
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Schmachtenberg T, Monsees J, Thyrian JR. What elements are important in current treatment and care guidelines to provide culturally sensitive care for people with a migration background and dementia? A systematic analysis. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01531-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Müller B, Kropp P, Cardona MI, Michalowsky B, van den Berg N, Teipel S, Hoffmann W, Thyrian JR. Types of leisure time physical activities (LTPA) of community-dwelling persons who have been screened positive for dementia. BMC Geriatr 2021; 21:270. [PMID: 33892624 PMCID: PMC8063325 DOI: 10.1186/s12877-021-02201-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background To (a) describe the pattern of leisure time physical activities (LTPA) in community-dwelling persons who have been screened positive for dementia and (b) determine the health-related and sociodemographic factors associated with LTPA. Methods Data of the general practitioner-based, randomized, controlled intervention trial, DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) were used. Patients aged 70 years or older, who lived at home and had a DemTect< 9 were informed about the study by their General practitioners and invited to participate. Data from 436 participants with complete baseline data were used. Standardized, computer-assisted assessments were made during face-to-face interviews at the participants’ homes. Results Two hundred thirty-eight patients (54.6%) carried out LTPA (men 58.4%, women 51.8%). Physically active patients mentioned one to two different activities; diversity of LTPA was higher for men than for women. The most-frequently mentioned types of activity were gardening (35.3%), cycling (24.1%) and mobility training (12.4%); there was only a statistically significant difference between men and women in cycling, χ2(1) = 21.47, p < .001. The odds of LTPA increased with increasing quality of life (OR = 2.41), lower impairments in activities of daily living (OR = 0.85), and living in a rural environment (OR = 2.02). Conclusions Our findings suggest that people who have been screened positive for dementia living in a rural area are more likely to be active than people living in an urban area. Following studies should investigate whether this difference has an effect on the progression of dementia. Trial registration ClinicalTrial.gov Identifier NCT01401582. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02201-1.
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Affiliation(s)
- Britta Müller
- Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Gehlsheimer Str. 20 Rostock, 18147, Rostock, Germany.
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Gehlsheimer Str. 20 Rostock, 18147, Rostock, Germany
| | | | | | - Nanja van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Psychosomatic and Psychotherapeutic Medicine, University Medicine Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Röhr S, Zülke A, Luppa M, Brettschneider C, Weißenborn M, Kühne F, Zöllinger I, Samos FAZ, Bauer A, Döhring J, Krebs-Hein K, Oey A, Czock D, Frese T, Gensichen J, Haefeli WE, Hoffmann W, Kaduszkiewicz H, König HH, Thyrian JR, Wiese B, Riedel-Heller SG. Recruitment and Baseline Characteristics of Participants in the AgeWell.de Study-A Pragmatic Cluster-Randomized Controlled Lifestyle Trial against Cognitive Decline. Int J Environ Res Public Health 2021; 18:ijerph18020408. [PMID: 33430189 PMCID: PMC7825589 DOI: 10.3390/ijerph18020408] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 11/16/2022]
Abstract
Targeting dementia prevention, first trials addressing multiple modifiable risk factors showed promising results in at-risk populations. In Germany, AgeWell.de is the first large-scale initiative investigating the effectiveness of a multi-component lifestyle intervention against cognitive decline. We aimed to investigate the recruitment process and baseline characteristics of the AgeWell.de participants to gain an understanding of the at-risk population and who engages in the intervention. General practitioners across five study sites recruited participants (aged 60–77 years, Cardiovascular Risk Factors, Aging, and Incidence of Dementia/CAIDE dementia risk score ≥ 9). Structured face-to-face interviews were conducted with eligible participants, including neuropsychological assessments. We analyzed group differences between (1) eligible vs. non-eligible participants, (2) participants vs. non-participants, and (3) between intervention groups. Of 1176 eligible participants, 146 (12.5%) dropped out before baseline; the study population was thus 1030 individuals. Non-participants did not differ from participants in key sociodemographic factors and dementia risk. Study participants were M = 69.0 (SD = 4.9) years old, and 52.1% were women. The average Montreal Cognitive Assessment/MoCA score was 24.5 (SD = 3.1), indicating a rather mildly cognitively impaired study population; however, 39.4% scored ≥ 26, thus being cognitively unimpaired. The bandwidth of cognitive states bears the interesting potential for differential trial outcome analyses. However, trial conduction is impacted by the COVID-19 pandemic, requiring adjustments to the study protocol with yet unclear methodological consequences.
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Affiliation(s)
- Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (A.Z.); (M.L.); (S.G.R.-H.)
- Global Brain Health Institute (GBHI), Trinity College Dublin, D02 PN40 Dublin, Ireland
- Correspondence: ; Tel.: +49-341-9724568; Fax: +49-341-9724569
| | - Andrea Zülke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (A.Z.); (M.L.); (S.G.R.-H.)
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (A.Z.); (M.L.); (S.G.R.-H.)
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (C.B.); (H.-H.K.)
| | - Marina Weißenborn
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.W.); (D.C.); (W.E.H.)
| | - Flora Kühne
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (F.K.); (I.Z.); (J.G.)
| | - Isabel Zöllinger
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (F.K.); (I.Z.); (J.G.)
| | - Franziska-Antonia Zora Samos
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany; (F.-A.Z.S.); (A.B.); (T.F.)
| | - Alexander Bauer
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany; (F.-A.Z.S.); (A.B.); (T.F.)
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (K.K.-H.); (H.K.)
| | - Kerstin Krebs-Hein
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (K.K.-H.); (H.K.)
| | - Anke Oey
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (B.W.)
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.W.); (D.C.); (W.E.H.)
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany; (F.-A.Z.S.); (A.B.); (T.F.)
| | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (F.K.); (I.Z.); (J.G.)
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.W.); (D.C.); (W.E.H.)
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany; (W.H.); (J.R.T.)
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (K.K.-H.); (H.K.)
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (C.B.); (H.-H.K.)
| | - Jochen René Thyrian
- Institute for Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany; (W.H.); (J.R.T.)
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - Birgitt Wiese
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (B.W.)
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (A.Z.); (M.L.); (S.G.R.-H.)
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Thyrian JR, Kracht F, Nikelski A, Boekholt M, Schumacher-Schönert F, Rädke A, Michalowsky B, Vollmar HC, Hoffmann W, Rodriguez FS, Kreisel SH. The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany. BMC Geriatr 2020; 20:540. [PMID: 33375944 PMCID: PMC7770747 DOI: 10.1186/s12877-020-01957-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and living at home in Germany. METHODS This analysis is based on data of a telephone-based assessment in a convenience sample of n = 141 people with known cognitive impairment in the primary care setting. Data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, change in the frequency of social activities due to the pandemic and perceived impact of the pandemic on health care related services were assessed during the time of lockdown. RESULTS The vast majority of participants are sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-5. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low symptoms of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or visiting birthdays have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies have been reported to have worsened due to the pandemic. Visits to general practitioners decreased. CONCLUSIONS The study shows a small impact of the pandemic on psychological variables like depression, anxiety and loneliness in the short-term in Germany. There is a decrease in social activities as expected. The impact on health care provision is prominent. There is a need for qualitative, in-depth studies to further interpret the results.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany.
- Institute for Community Medicine, Department of Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany.
| | - Friederike Kracht
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Angela Nikelski
- Division of Geriatric Psychiatry, Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University Hospital OWL - Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Melanie Boekholt
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Fanny Schumacher-Schönert
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Anika Rädke
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr-University Bochum (RUB), Bochum, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
- Institute for Community Medicine, Department of Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Francisca S Rodriguez
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Stefan H Kreisel
- Division of Geriatric Psychiatry, Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University Hospital OWL - Campus Bielefeld-Bethel, Bielefeld, Germany
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48
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Klein OA, Thyrian JR, Boekholt M, Teipel SJ, Hoffmann W, Kilimann I. Development of a digital system to assess and manage unmet needs of family dementia caregivers in clinical practice. Alzheimers Dement 2020. [DOI: 10.1002/alz.043142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Olga A Klein
- German Center for Neurodegenerative Diseases (DZNE) Rostock Germany
| | | | - Melanie Boekholt
- German Center for Neurodegenerative Diseases (DZNE) Greifswald Germany
| | - Stefan J Teipel
- German Center for Neurodegenerative Diseases (DZNE) Rostock Germany
- Clinic for Psychosomatics and Psychotherapeutic Medicine Rostock Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE) Greifswald Germany
- Institute for Community Medicine / University of Greifswald Greifswald Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE) Rostock Germany
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49
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Klein OA, Kilimann I, Thyrian JR, Teipel SJ, Keller A, Boekholt M, Michalowsky B, Zwingmann I, Dreier‐Wolfgramm A, Hoffmann W. Protocol of a cluster randomised controlled trial to assess the effectiveness of a care management programme for caregivers of people with dementia (GAP study). Alzheimers Dement 2020. [DOI: 10.1002/alz.043879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Olga A Klein
- German Center for Neurodegenerative Diseases (DZNE) Rostock Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE) Rostock Germany
| | | | - Stefan J Teipel
- German Center for Neurodegenerative Diseases (DZNE) Rostock Germany
- Clinic for Psychosomatics and Psychotherapeutic Medicine Rostock Germany
| | - Armin Keller
- German Center for Neurodegenerative Diseases (DZNE) Rostock Germany
| | - Melanie Boekholt
- German Center for Neurodegenerative Diseases (DZNE) Greifswald Germany
| | | | - Ina Zwingmann
- European University of Applied Sciences (EU FH) Rostock Germany
| | | | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE) Greifswald Germany
- Institute for Community Medicine / University of Greifswald Greifswald Germany
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50
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Roehr S, Hoffmann W, Thyrian JR, Kaduszkiewicz H, Frese T, Gensichen J, Haefeli WE, Czock D, König H, Wiese B, Riedel‐Heller SG. AgeWell.de (Germany). Alzheimers Dement 2020. [DOI: 10.1002/alz.046950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Susanne Roehr
- Institute of Social Medicine, Occupational Medicine and Public Health (ISAP), Medical Faculty University of Leipzig Leipzig Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald Greifswald Germany
| | | | | | - Thomas Frese
- University Medical Center Halle (Saale) Halle Germany
| | - Jochen Gensichen
- Klinikum der Ludwig‐Maximilians‐Universität München München Germany
| | | | | | | | - Birgitt Wiese
- Institute for General Practice, Hannover Medical School Hannover Germany
| | - Steffi G. Riedel‐Heller
- Institute of Social Medicine, Occupational Medicine and Public Health (ISAP), Medical Faculty University of Leipzig Leipzig Germany
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