Zeitschrift Fur Gerontologie Und Geriatrie最新文献

Background: Maintaining the autonomy, independence and social participation of older adults is a cornerstone of geriatric care. Against the background of demographic change and the stagnating expansion of inpatient rehabilitation capacities, new care models are of increasing interest. Telerehabilitation could be a promising supplementation to existing structures.

Objective: This article analyzes the potential, challenges and evidence for telerehabilitation in the home environment of older adults.

Methods: A comprehensive literature review is used to present applications and evidence of the effectiveness of telerehabilitation in older adults. In addition, factors that promote or hinder its implementation and utilization are identified.

Results: Telemedical services enable an extension of the rehabilitative range. To date, various communication media and rehabilitation contents have been applied. Telerehabilitation options for older people demonstrate functional and psychosocial benefits; however, only a few studies have investigated a multiprofessional program which would be transferable to the care structures of geriatrics in Germany.

Discussion: Adapted concepts are required for the nationwide integration of telerehabilitation into geriatric care. The feasibility and effectiveness must be studied within the context of the German care structures. In addition, legal and structural framework conditions need to be further developed.

Background: Despite there is evidence for the need for advance care planning for older people living alone (OPLA), especially if they want to stay at home until the end, utilization of measures for ACP remains rather scarce. The causes for this discrepancy have not yet been researched in this target group.

Objectives: Aim of this study was to get insight into the perspectives of OPLA in the community on planning ahead for the end of life.

Materials and methods: (Secondary) Analysis of 26 qualitative interviews. 17 were from the Austrian Survey on the very old (ÖIHS), and 9 additional interviews were conducted with a specific focus on advance care planning to enrich the data base. Verbatim transcripts were analysed by applying coding procedures.

Results: Not all people had specific concerns or a desire to deal with the end of life. In contrast to others, concerns about avoiding (unnecessary) life-prolonging measures resulted in a formal regulation, usually a living will. Staying at home or issues regarding burial and inheritance were often equally important concerns for OPLA. Numerous obstacles to formal arrangements were identified.

Conclusion: The heterogeneity of OPLA with regard to their willingness and form of planning ahead for staying at home shows the limits of standardized procedures. Comprehensive approaches to advance care planning that go beyond health issues are needed to meet the concerns of OPLA in the community.

Background: Family caregivers (FC) rarely utilize formal and informal help, which affects their burden and quality of life. Factors that result in rejection are often psychosocial (shame, guilt, heteronomy and social expectations). Previous studies on psychosocial reasons neglected the spiritual dimension. This study aims to identify the psychosociospiritual reasons for the (non)utílization of help from the perspective of FCs.

Methods: This qualitative study conducted semi-structured interviews with 24 FCs between August 2022 and July 2023 and analyzed according to Mayring.

Results: The FCs request formal and informal help to find a balance between their needs and those of the persons in need of care and to develop and maintain interpersonal boundaries. Help is rejected due to negative experiences with help offers as well as personal, familiar, and social role expectations. As long as nursing care is seen as the only meaning in life, help from outside can be perceived as a threat.

Conclusion: When utilizing help, it is not only about the quality of the offered help but also about its compatibility with one's own values and aims. Psychosociospiritual counselling should be provided before counselling for benefits.

Background: The Barthel Index is the most commonly used instrument for assessing basic self-care ability; however, it only records impairments first at the stage of needing personal support.

Objective: Based on the long version of the Hamburg Classification Manual (HEMB-L), the Barthel plus (Bplus) was developed in consultation with specialist nursing personnel as an operationalization that also depicts compensated impairments via point-neutral subscaling. The article presents the instrument and its quality characteristics.

Material and methods: For patients in acute geriatric care the Bplus was employed twice at an interval of more than 1 week and audio recordings were made. The Bplus was assessed by telephone 1, 12, 24 and 36 months after discharge. The effect size (Cohen's d) was calculated for the sensitivity to change during the inpatient course. The interrater reliability and agreement with the HEMB‑L were determined taking the evaluation of the audio files by blinded examiners into account.

Results: Between 29 April 2019 and 25 June 2021 a total of 124 patients were included in the study. The Barthel Index scores obtained using the Bplus and HEMB‑L did not show a significant difference. The interrater reliability, internal consistency and change sensitivity of the Bplus were high, each at > 0.9. For activities performed independently but with impairment, there was an increased risk of care dependency occurring over the course of the study.

Conclusion: While maintaining the same sum score as the HEMB‑L, the Bplus can highlight abilities prone to a high risk for loss of independence and thus facilitate the prevention of progressive care dependency.

Background: In Germany around 1.8 million people live with dementia, with the numbers rising. Dementia is underdiagnosed. Although family practitioners (FP) are often the first point of contact for cognitive problems, the diagnosis is frequently delayed and mostly made in specialized centers. The "iCreate" project examined an optimized tablet-based case-finding approach to testing cognition. Patients with conspicuous results were referred to a memory clinic (MC) for differential diagnostics. Despite positive feedback regarding practical feasibility, various barriers in the care pathway of the project were identified. These are critically examined and possible solutions for improving a structured early detection process for dementia in the FP care are presented.

Method: Secondary analysis of 21 qualitative interviews and 56 project protocols (telephone notes, email correspondences, team meeting protocols) from the "iCreate" project using framework analysis according to Spencer et al. [16].

Results: Key barriers identified along the care pathway included: a) patient selection and approach were frequently restrained due to fear of stigmatization, b) lack of time and resources in FP practices and the MC, c) non-standardized procedures and organizational deficiencies in the care pathway (e.g., poor communication, difficult appointment scheduling) and d) high "no-show" rate of ca. 28% of the referred patients for diagnostic appointments in the MC.

Conclusion: The identified barriers highlight the need for action toward a structured and patient-centered dementia diagnostic process. Standardized procedures, interdisciplinary collaboration and training on sensitive communication are necessary.

Background: Falls in older adults pose a significant health risk and reliable predictive models for assessing the risk of falling would be highly beneficial and clinically relevant. This study evaluates the performance of various supervised machine learning (ML) algorithms in predicting the risk of falling (≥ 1 self-reported fall in the past year) using balance and functional ability measures.

Methods: Data from 94 older adults were analyzed incorporating comprehensive assessments of physical function and balance, including the five-repetition sit-to-stand test (5XSTS), 30-second chair stand test (30CST), Berg balance scale (BBS), hip abduction strength, 6‑minute walk test (6 MWT) and 10-meter walk test (10 MWT). We implemented and compared four ML models: partial least squares discriminant analysis (PLS-DA), linear discriminant analysis (LDA), support vector machines (SVM) and k‑nearest neighbors (k-NN). Model performance was evaluated using cross-validation, with sensitivity, specificity, precision and accuracy. To provide a clinically interpretable benchmark, stepwise logistic regression with cross-validation was also applied.

Results: All ML models demonstrated strong discriminatory power. The PLS-DA achieved the highest sensitivity (0.96), specificity (0.96), precision (0.96), accuracy (0.96) and area under the receiver operating characteristic curve (AUC, 0.97). The LDA and k‑NN exhibited balanced overall AUCs (0.94 and 0.96, respectively). The regression benchmark consistently retained a small subset of predictors, most often the 6 MWT, 30CST and BBS. These models achieved mean accuracy of 0.84, sensitivity of 0.82, specificity of 0.85 of and AUC of 0.94.

Conclusion: Supervised ML models effectively predict the risk of falling in older adults, with PLS-DA emerging as the most robust classifier. While SVM showed strong predictive power, other models provided better clinical interpretability. Regression benchmarks highlight that a few functional measures already perform strongly but ML further improves classification by integrating multidimensional patterns. Importantly, as our design is retrospective, these findings represent a classification of the fall history rather than definitive prediction of future falls.

Background: People in need of care and their relatives have a high need for information, especially at the beginning of a need for care. The aim of this qualitative study was to explore the use of digital information and support services by informal caregivers from the perspective of medical assessors at the Bavarian Medical Service (MD Bayern), who conduct numerous home visits.

Method: From June to July 2024, four guided online-based focus group interviews were conducted with 29 medical assessors from MD Bayern. The data were transcribed, pseudonymized, and evaluated using qualitative content analysis.

Results: The medical assessors' experience show that digital care-related services are only used to a limited extent by people in need of care, despite the existing need. Use is more widespread among relatives, especially the so-called "care degree calculator". The experts believe that the main reasons for the low use are older age, lack of digital skills, and limited infrastructure in rural areas. Experts assessed an information flyer as a suitable means of informing caregiving households specifically about digital services.

Conclusion: In order to increase the use of digital services in the context of home care, targeted information campaigns and measures to promote digital literacy are essential. In addition, these services need to be more closely aligned with the heterogeneous needs of the target group.

Background: International associations advocate the care model of person-centered care (PCC) that focuses on people with chronic illnesses rather than on disease patterns.

Objective: To present the concept and its legitimacy concerning the care of people with chronic wounds.

Material and method: A narrative review, identification and analysis of review articles as well as conceptual foundations, practical examples and discussion of implementation.

Results: The PCC is based on the health needs, expectations, values and commitments of persons and not on diseases, symptoms and clinical data. Key components include providing the affected individuals with the support and education needed to make decisions and participate in their own care. Evaluations of PCC implementation primarily measure components, such as communication or shared decision making and use patient-reported outcome measures (PROM) and patient-reported experience measures (PREM). The largest barriers to implementing the concept are a healthcare system focused on acute care, a lack of patient involvement in decision making, inadequate communication skills and disease-oriented attitudes. A successful implementation requires cultural, structural and organizational measures.

Conclusion: Implementing PCC into the clinical practice requires commitment and perseverance. Organizations must be willing to engage in this approach. The German-Austrian-Swiss Wound Healing Organization (WundD.A.CH) has identified the promotion of its implementation as a key priority.

Background: Due to demographic ageing, the number of care receivers has been rising, while the number of caregivers is decreasing in many countries. Informal caregiving often begins while still in active employment often leading to role conflicts. The dual burden can negatively affect job performance and lead to changes in occupational self-efficacy.

Objective: Despite being of high relevance for individuals, organizations and society, there is a research gap concerning occupational self-efficacy, which may serve as a mechanism for reduced working hours or exit from the labor market after taking on care responsibilities. Thus, this article analyzes the impact of transitioning into informal caregiving on occupational self-efficacy longitudinally.

Material and methods: This study included the 2017, 2019 and 2021 waves of the Federal Institute for Occupational Safety and Health (BAuA) Working Time Survey, which is a representative panel study of employees in Germany. For each respondent, two waves were used (n ≥ 3052). Difference-in-differences (DiD) models with the transition into informal care with distinctions of different care frequencies as the treatment variables were calculated. To control for selection bias, propensity score matching (PSM) was applied.

Results: Based on the DID models, transitioning into at least occasionally caregiving had a negative effect on occupational self-efficacy, leading to a significant deterioration in composure in the face of occupational difficulties, ideas for solving problems at work and the ability to cope with most occupational demands. The results based on PSM supported these findings.

Conclusion: With respect to, e.g., skilled labor shortages and challenges for welfare systems, sustaining employees' working ability including occupational self-efficacy is of utmost relevance in ageing societies.

Background: Geriatric patients after hospitalization often utilize subacute inpatient care (SC); however, little is known about their care and further health status.

Objective: To identify persons in SC with rehabilitation needs and improvement potential after hospitalization and to describe the care, relevant parameters of the health status as well as use of medical/nursing services in and after SC.

Methods: After positive screening for previous hospitalization and need of rehabilitation with improvement potential in 13 nursing homes, the length of stay, therapeutic treatments and physician contacts in SC as well as functional parameters, pain, quality of life and the utilization of services according to the Social Security Code V (SGB V) and SGB XI were assessed at baseline, at the end and 3 months after SC.

Results: A total of 108 (44%) out of 243 screened persons with previous hospitalization had a need of rehabilitation with improvement potential, of whom 57 participated in the study. In SC (median = 26 days) 35% received no therapeutic treatments and 28% had no physician contact. After SC 40% were transferred to rehabilitation. Participants with rehabilitation transition more frequently received therapeutic treatments in SC (p = 0.021) and were less frequently in long-term care 3 months after SC (p = 0.015).

Conclusion: This study suggests that a high proportion of persons in SC after hospitalization are in need of rehabilitation with improvement potential, which is not sufficiently treated. Regular therapeutic treatments in SC could improve the transition rate to rehabilitation and subsequent home environment.