Cognitive, physical and emotional determinants of activities of daily living in nursing home residents-a cross-sectional study within the PROCARE-project.

BACKGROUND: Interdependencies of health, fitness, cognition, and emotion can promote or inhibit mobility. This study aimed to analyse pathways and interactions between individual subjective and objective physical performance, cognition, and emotions with activities of daily living (ADLs) as mobility indicators in multimorbid nursing home residents. METHODS: The study included n = 448 (77.1% females, age = 84.1 ± 7.8 years) nursing home residents. To describe the participant's demographics, frailty, number of falls, and participating institutions' socioeconomic status (SES) were assessed. ADLs were measured with the Barthel Index (BI; dependent variable). Independent variables included objective physical performance, subjective physical performance, cognition, and emotions. A structural equation model (SEM) with maximum likelihood estimation was conducted with AMOS. Direct and indirect effects were estimated using standardized coefficients (significance level of 0.05). RESULTS: Indices showed (Chi2(148) = 217, PCMIN/DF = 1.47; p < .001; Comparative Fit Index = .940; Tucker Lewes Index = .902, RMSEA = .033) that the model fitted the data adequately. While there was no direct association between emotions, subjective physical performance, and ADLs, objective physical performance and cognition predicted higher ADLs (p < .01). Emotions had a strong relationship with subjective physical performance, and cognition had a moderate relationship with objective physical performance. DISCUSSION AND CONCLUSION: Objective performance and cognition predicted higher functional status, as expressed by higher BI scores. ADLs, such as mobility, dressing, or handling tasks, require motor and cognitive performance. Subjective performance is an important predictor of ADLs and is only partly explained by objective performance, but to a large extent also by emotions. Therefore, future interventions for nursing home residents should take a holistic approach that focuses not only on promoting objective physical and cognitive performance but also on emotions and perceived physical performance. TRIAL REGISTRATION: Trial registration number: DRKS00014957.

[Personal Resources of Geriatric Nursing Staff - Results of a Cross-Sectional Study]. / Gesundheitsressourcen von Altenpflegepersonal ­ Ergebnisse einer Querschnittsstudie.

OBJECTIVES: Geriatric nursing staff are exposed to high workloads, which often lead to stress, incapacity to work and early retirement. Personal resources can help deal with work demands and can have a positive effect on health. To design tailored interventions, this study aims to identify personal resources of staff and its impact on stress levels. MEASURES: Data on 195 geriatric nurses (87.4% female, 40.1±12.2 years) were collected using a set of validated questionnaires consisting of Slesina questionnaire, Nordic Questionnaire, SF-12, personal resources (according to WHO criteria), AVEM questionnaire and the SSCS scale of the TICS questionnaire. According to the SSCS scale, nursing staff were divided into stressed and non-stressed. To further investigate potential factors influencing the development of stress, a four-step regression analysis was carried out. RESULTS: Non-stressed geriatric nursing staff felt less burdened by work-related stress factors, had fewer physical complaints, had higher physical (p<0.001) and mental well-being (p <0.001), better personal resources and healthier work-related behavior and experience. The regression analysis showed that personal resources such as satisfaction with health status, nutritional behavior, frequency of being calm and relaxed, frequency of being full of energy as well as the stress level can improve physical and mental well-being, but cannot decrease the emergence of stress in case of unhealthy work coping behavior (R²=0.760). CONCLUSION: When developing stress prevention interventions, the focus should be on strengthening personal resources. In addition, individual work-related behavior and experience patterns should be taken into account.

App-Tailoring Requirements to Increase Stress Management Competencies Within Families: Cross-sectional Survey Study.

BACKGROUND: Families experiencing high levels of psychological distress are considered a particularly vulnerable population for adverse effects on mental and physical health. Moreover, highly stressed individuals engage less in mental health promoting activities and show low stress management competencies. App-based stress interventions seem promising for the treatment and prevention of stress outcomes and might be a low-threshold solution. OBJECTIVE: The aim of this study was to identify the requirements for a tailored app to reduce stress in a cohort of highly stressed families that have low stress management skills. METHODS: Parents (n=1008; age: mean 47.7 years, SD 6.1; female: 599/1008, 59.7%) completed an extensive web-based survey and were subdivided into a target (stressed individuals with low stress competency) and nontarget group according to their reported stress level and stress management competencies. Group differences were analyzed using analysis of variance. In principal component analysis with Kaiser varimax rotation, personally defined stress management goals were grouped into components. Linear regression models were also calculated. RESULTS: A 3-factor solution cumulatively explained 56% of the variance in personally defined goals of interest for stress management with (1) active strategies (25.61% explained variance), (2) general competency (17.95% explained variance) and (3) passive strategies (12.45% explained variance). The groups differed in age (F1,978=27.67, P<.001), health index (F1,958=246.14, P<.001), personally defined general-competency goal (F1,958=94.16 P<.001), as well as "information acquisition" (F1,971=14.75, P<.001) and "need for stimulation" (F1,981=54.49, P<.001) personality traits. A regression model showed that for the active strategies goals of interest, only app feature information or instructional videos had a significant effect (P=.02). The general competency factor showed none, and the passive strategies factor showed significant effects for 2 app features-suggestions for planning possible activities with the family (P=.01) and diaries for documentation and development of strategies (P=.03). CONCLUSIONS: The results of this survey study highlight the need to develop an app to increase stress management competencies that takes into consideration perceived stress level, stress management skills, personality, and personally defined goals of the user. The content of the app should be tailored to previously detected personality traits, especially selective information acquisition and low need for stimulation. Furthermore, personally defined stress management goals seem to affect interest in some features.

[Motivation of Men to Participate in Physical Activity Programs for Health Promotion]. / Teilnahmemotivation von Männern an bewegungsorientierten Präventionsangeboten.

STUDY AIM: The rate of men participating in health promotion programs is lower than that of women. The reasons and barriers for the different motivation of men as well as wishes and perception for prevention are not yet sufficiently analyzed. This quantitative survey examines motives and barriers of men for participation in primary prevention. Thus, the sample was subdivided into 2 groups, namely motivated vs. non-motivated regarding being active for health promotion. Differences between the 2 groups concerning current health status, health beliefs and health behavior were analyzed to plan more suitable programs in the future. METHODS: A sample of N=243 men (motivated n=147, non-motivated n=96) participated in the standardized online-survey. The quantitative data analysis integrated the BMZI, KKG, SF-12, TICS and the MGV-39. The examination of the differences between the sub-groups was done with Chi²-Tests and analysis of variance (one-way ANOVA) with IBM SPSS 22 (Armonk, NY: IBM Corp). RESULTS: The group of motivated men reported worse health status, especially in psychological well being compared to the non-motivated group (SF-12: F=6.3, p=0.013, eta²=0.025). Both groups named refusal to use harmful substances (e.g. drugs, alcohol), good nutrition and active life-style as important factors for health. Non-motivated men showed a higher score for the fatalistic externality of health (KKG: F=7.609, p=0.006, eta²=0.031) and rated health promotion as paternalism (Chi²=17.693, p≤0.001, C=0.261). CONCLUSION: The men of this study who were motivated to join health promotion programs had a worse health status that might explain their compliance. For the non-motivated men, there was a discrepancy between their own beliefs in health behavior and their real daily activities (e.g. physical activity). In order to reach this target group of men before their health status worsens, prevention programs should integrate incentive systems that integrate features for overcoming dysfunctional daily behavior.