Frequency and gender differences in the use of professional home care in late life. Findings from three German old-age cohorts.

Aim: The aim of this study was to investigate the frequency of and the gender differences in the use of professional home care in Germany. Methods: We used harmonized data from three large cohort studies from Germany ("Healthy Aging: Gender-specific trajectories into the latest life"; AgeDifferent.de Platform). Data were available for 5,393 older individuals (75 years and older). Mean age was 80.2 years (SD: 4.1 years), 66.6% were female. Professional homecare outcome variables were use of outpatient nursing care, paid household assistance, and meals on wheels' services. Logistic regression models were used, adjusting for important sociodemographic variables. Results: Altogether 5.2% of older individuals used outpatient nursing care (6.2% women and 3.2% men; p < 0.001), 24.2% used paid household assistance (26.1% women and 20.5% men; p < 0.001) and 4.4% used meals on wheels' services (4.5% women and 4.0% men; p = 0.49). Regression analysis revealed that women had higher odds of using paid household assistance than men (OR = 1.48, 95% CI: [1.24-1.76]; p < 0.001), whereas they had lower odds of using meals on wheels' services (OR = 0.64, 95% CI: [0.42-0.97]; p < 0.05). No statistically significant differences in using outpatient nursing care between women and men were found (OR = 1.26, 95% CI: [0.87-1.81]; p = 0.225). Further, the use of home care was mainly associated with health-related variables (e.g., stroke, Parkinson's disease) and walking impairments. Conclusions: Our study showed that gender differences exist in using paid household assistance and in culinary dependency. For example, meals on wheels' services are of great importance (e.g., for individuals living alone or for individuals with low social support). Gender differences were not identified regarding outpatient nursing care. Use of professional home care services may contribute to maintaining autonomy and independence in old age.

Gender Specifics of Healthy Ageing in Older Age as Seen by Women and Men (70+): A Focus Group Study.

(1) The rising proportion of older adults in the population represents a challenge for the healthcare system. Women and men age differently. This study aims to examine gender-specific characteristics of health in old age from male and female perspectives. (2) Two focus groups were formed in this qualitative study of older (70+) women (n = 10) and men (n = 8) in accordance with the theoretical framework of the World Health Organization (WHO) on healthy ageing determinants. The data were audio recorded and fully transcribed. Qualitative content analysis was performed using MAXQDA. (3) In both focus groups (average age: women 77.1 years, men 74.9 years), gender-specific characteristics regarding healthy ageing were discussed. Women focused on healthy eating, while men focused on an active lifestyle and meaningful activities. Physical and social activities were considered as important for healthy ageing in both groups. (4) Important gender-specific characteristics of health in old age were identified and recommendations for gender-unspecific and gender-specific recommendations were derived. The results provide important information for promoting and maintaining health in old age. Women and men show both similarities and differences in terms of health-related needs and individual experiences. We suggest gender-specific features in nutrition and health programs for older adults.

The Role of Social Isolation and the Development of Depression. A Comparison of the Widowed and Married Oldest Old in Germany.

Widowhood is common in old age, can be accompanied by serious health consequences and is often linked to substantial changes in social network. Little is known about the impact of social isolation on the development of depressive symptoms over time taking widowhood into account. We provide results from the follow-up 5 to follow-up 9 from the longitudinal study AgeCoDe and its follow-up study AgeQualiDe. Depression was measured with GDS-15 and social isolation was assessed using the Lubben Social Network Scale (LSNS-6). The group was aligned of married and widowed people in old age and education through entropy balancing. Linear mixed models were used to examine the frequency of occurrence of depressive symptoms for widowed and married elderly people depending on the risk of social isolation. Our study shows that widowhood alone does not lead to an increased occurrence of depressive symptoms. However, "widowed oldest old", who are also at risk of social isolation, have significantly more depressive symptoms than those without risk. In the group of "married oldest old", women have significantly more depressive symptoms than men, but isolated and non-isolated do not differ. Especially for people who have lost a spouse, the social network changes significantly and increases the risk for social isolation. This represents a risk factor for the occurrence of depressive symptoms.

[Health-related consequences of social isolation: a qualitative study on psychosocial stress and resources among older adults in the COVID-19 pandemic]. / Gesundheitliche Folgen sozialer Isolation: Qualitative Studie zu psychosozialen Belastungen und Ressourcen älterer Menschen im Zusammenhang mit der COVID-19-Pandemie.

BACKGROUND: The SARS-CoV-2 pandemic led to a general uncertainty about risk and consequences of the disease. Older adults are specifically vulnerable with regard to severe courses of the disease and have been particularly encouraged to self-isolate during the pandemic. Subsequently, expressions of concern have been raised regarding the negative impact of disease risk and quarantine on the mental health of older people. OBJECTIVES: Assessment of psychosocial stress, coping strategies, need for support, and sense of coherence of older people during the COVID-19 pandemic. MATERIALS AND METHODS: The study follows a qualitative research design. Between May and June 2020 N = 11 guided telephone interviews were conducted with older adults (70+ years). Telephone interviews were recorded by audio tape and fully transcribed. A qualitative content analysis was performed according to Mayring and Fenzl (2019) using MAXQDA. RESULTS: Participants were 74.8 years old on average. Participants showed predominantly good psychosocial health and functional coping strategies. Life experience, an optimistic attitude, understanding of the necessity of restrictions, and previous crises that have been mastered were the most important resources during the COVID-19 pandemic for older adults. Offers of support were rarely used. Participants were critical of the closing of centers or meeting points for older people. CONCLUSION: Older adults appear to be able to preserve their mental wellbeing during the COVID-19 pandemic. The relevance of mental resources of older adults for supporting younger generations seems to be unrecognized.

[Grief and loss in elderly people: A qualitative study regarding the user acceptance of an internet-based self-help program from user and expert perspective]. / Trauer und Verlust bei älteren Menschen: Eine qualitative Studie zur Nutzungsakzeptanz eines internetbasierten Selbsthilfeprogramms aus Betroffenen - und Expertenperspektive.

INTRODUCTION: The loss of a significant other is a stressful life event, especially for older people. The aim of this study was to investigate user acceptance of an internet-based self-help program for mourners aged 60 years and above. Potential access paths as well as barriers of use were to be identified from both users' and experts' perspectives. METHODS: This study is following a qualitative design. Two focus groups were formed consisting of elderly people (60+) with loss experience (N=12) and of experts from the medical care system (N=8). The focus groups were conducted using a discussion guide related to the model of the Unified Theory of Acceptance and Use of Technology (UTAUT). Focus group data were recorded by audio tape and fully transcribed. Qualitative content analysis according to Mayring (2015) was applied using MAXQDA. RESULTS: The mean age of elderly participants with loss experience was 64.5 years, 50 % were women. From the user's perspective, an internet-based self-help program should comprise information regarding grieving, suggestions and motivation for behavioral activation, strengthening self-esteem, and suggestions for dealing with other feelings related to grief (such as guilt). Directions for relatives of mourners as well as faith and spirituality were important topics for users. Elderly participants felt confident to be able to use an internet-based self-help program. Processing time and topic selection should be flexible for the user. Potential access paths included general practitioners and specialists, mourning cafés, or local media. A potential barrier was seen for people who prefer a personal relationship. The average age of participants in the expert focus group was 40.1 years, 87.5 % were female. There was a high user acceptance from the perspective of health care experts with regard to the target group of elderly people (60+). Access paths were seen across all specialist groups working with elderly people (e.g., physicians, occupational therapists, nursing facilities). Lack of guidance was discussed as a potential barrier. DISCUSSION: A key aspect and prerequisite for the use and effectiveness of an internet-based self-help intervention for mourners is user acceptance. Judgments from potential users and experts showed a high user acceptance, but also the need to address age group-specific topics for coping with grief. CONCLUSION: Internet-based self-help interventions can be a promising add-on treatment option for elderly bereaved people. The implementation of such programs should take the access paths mentioned into account in order to inform users and experts about the intervention.

[User Acceptance of an Online-Intervention for Improving Depressive Symptoms in Adults with Obesity - Results of a Pilot Study]. / Nutzungsakzeptanz einer Online-Intervention zur Verbesserung depressiver Symptome bei Menschen mit Adipositas.

OBJECTIVES: Investigating the user acceptance and associated factors regarding the use of an unguided online-intervention in people with obesity and comorbid depressive symptoms. METHODS: Quantitative longitudinal pilot study with regard to user acceptance (Baseline before access to online-intervention; Follow-up after 3 months) with n = 46 subjects. RESULTS: Moderate (usefulness, ease of use, satisfaction) to high (ease of learning) user acceptance was reported with regard to the online-intervention. Uptake-rates were 76.1 %, completion-rates were 22.9 %. Positive associations were found e. g. for people receiving invalidity pension and personality traits. CONCLUSIONS: Online-interventions for people with obesity and comorbid depressive symptoms represent a complementary treating component. Associated factors of user acceptance should be taken into account when implementing online-interventions to support high fitting accuracy and to increase the benefit for program users.

Are older men more vulnerable to depression than women after losing their spouse? Evidence from three German old-age cohorts (AgeDifferent.de platform).

BACKGROUND: Old age is accompanied by a higher risk of losing a spouse. This study aims to longitudinally investigate the effect of widowhood on depression severity with a special focus on sex differences. We examine depression before and after widowhood in men and women separately to investigate which sex is at greater risk after losing a spouse. METHODS: Data came from the AgeDifferent.de platform, which includes three pooled old age cohort studies. In order to examine factors associated with depression over time, we applied a linear hybrid mixed-effects regression model for the overall sample and analysed additional separate models for men and women. RESULTS: Of 2470 respondents (mean age at baseline 79.2 (SD 3.64) years), 1256 were men. In total, 209 men and 332 women experienced spousal bereavement after baseline. In general, both sexes showed higher depression severity after widowhood. However, there were significant sex differences. Widowed men were more prone to subsequent depression than widowed women. In terms of depression severity, widowed men differed significantly compared to non-widowed men; however, this was not the case for women. LIMITATION: We harmonized three cohort studies which used different measurement scales for depression and different recruitment procedures. CONCLUSION: Our study showed that although both genders suffer from losing a spouse, men are more prone to subsequently develop depressive symptoms. Raising the awareness among practitioners for sex-specific differences as well as developing tailored interventions for both widowed men and women should be considered.

Loss experiences in old age and their impact on the social network and depression- results of the Leipzig Longitudinal Study of the Aged (LEILA 75+).

BACKGROUND: Loss experiences and bereavement are common among the oldest old. This study aims to investigate the effects of loss experiences and the social network type on depression in old age. METHODS: As part of the Leipzig Longitudinal Study of the Aged (LEILA 75+), a representative population-based cohort study, 783 persons aged 75+ years were assessed via standardized interviews including the Practitioner Assessment of Network Type Instrument (PANT) and the Center for Epidemiologic Studies-Depression Scale (CES-D). Effects of loss experiences and network type on depression were analysed cross-sectionally (baseline survey) using logistic regressions. Effects over time were analysed longitudinally (follow-up1 and follow-up2) using hybrid techniques. RESULTS: More than half of the elderly (57%) continuously lived in a restricted network. Only 12.1% lived in an integrated network. Although 30.9% had a change in their network, no significant association with loss experiences was found. Nevertheless, loss experiences (OR 7.56 (1.60-35.72)) and a restricted social network (OR 4.08 (1.52-10.95)) appeared to be the significant predictors of depression. LIMITATIONS: Our study captures only a selected time window of the individual life and loss experience was only assessed at the time of the baseline survey. CONCLUSION: Our findings revealed that elderly individuals, who experienced social loss or lived in restricted social networks, were more likely to develop depression compared to individuals who lived in integrated social networks or without loss experiences. The social integration of elderly individuals is an urgent issue that should be addressed in order to reduce depression in old age.

[Implementation of the Internet-Based Self-Management Program "moodgym" in Patients with Depressive Disorders in Inpatient Clinical Settings - Patient and Expert Perspectives]. / Der komplementäre Einsatz des internetbasierten Selbstmanagementprogramms "moodgym" bei Menschen mit depressiven Erkrankungen in der stationären Versorgung ­ die Perspektive von Patienten und Behandlern.

OBJECTIVE: The study aims to assess the acceptance, chances and barriers of an online self-management program (moodgym) for depression from the perspective of experts and patients in inpatient psychiatric settings. METHODS: Paper-pencil interviews were conducted with n = 181 depressed inpatients (n = 181, pre-post-assessment after 8 weeks) and n = 31 medical experts. Two regression models were carried out to investigate factors associated with the uptake and the user acceptance of moodgym. Chances and barriers were analysed qualitatively. RESULTS: Experts and patients reported moderate to high user acceptance. 59 % (n = 107) of the patients logged in to moodgym. Factors associated with the uptake were the educational level and treatment preferences. The user acceptance was influenced by the patients' self-rated health and the frequency of using moodgym. Relevant barriers anticipated by experts were limited computer skills, difficulties in concentration and a severe course of depression. Patients highlighted the ease of use, the moodgym characters and the flexible availability. CONCLUSIONS: moodgym may represent a complementary treatment option for depressive disorders in an inpatient setting.

[Innovative E-Health Approaches for Comorbid Depression in Patients with Obesity: Patient and Expert Perspectives on User Acceptance]. / Innovative E-Health-Ansätze für komorbide Depressionen bei Patienten mit Adipositas: Nutzungsakzeptanz aus Patienten- und Expertenperspektive.

Objective Patients with chronic somatic diseases such as obesity often suffer from comorbid depressive disorders and present a great challenge for the medical health care system. The study aims to investigate the user acceptance of an internet-based self-management program regarding depression (using the example of MoodGYM) from two different perspectives: (A) the perspective of patients as well as (B) the perspective of experts based on Rogers' 5 stages model of the innovation-decision process (2003). Methods This study is following a qualitative design including qualitative patient interviews (N = 7) and a focus group with medical experts (N = 12). Results Internet-based self-management programs represent a complementary treatment approach for patients and experts. Both groups see the need for combining the topics overweight, activity, depression and social interchange. Conclusion Patient and expert judgement showed a high degree of user acceptance for internet-based self-management programs regarding depression. The implementation of such programs within the medical care system of patients with obesity should take physical and social aspects of the illness into account.

Improving the in vitro ethoxyresorufin-O-deethylase (EROD) assay with RTL-W1 by metabolic normalization and use of ß-naphthoflavone as the reference substance.

The ethoxyresorufin-O-deethylase (EROD) assay is a widely applied method for the evaluation of the dioxin-like activity of single substances and environmental samples. As for most enzyme assays, the specific activity is normally related to total protein contents, the determination of which has clear limitations in high-throughput assays. EROD induction potentials are usually expressed as 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) equivalents, a substance highly toxic to humans. In order to compensate for these shortcomings, two modifications of the EROD protocol are proposed: (1) EROD activity is normalized to the metabolic activity of the cells as determined by a modified thiazolyl blue tetrazolium (MTT) assay and expressed as metabolic cell equivalents (MCE) based on MTT data rather than to protein contents. Via MCE data, cytotoxicity information can always be reported in parallel to EROD data; with the protocol presented here, MTT and EROD data are collected simultaneously. (2) Among several reference substances tested (2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), ß-naphthoflavone and benzo[a]pyrene), ß-naphthoflavone proved to be the most suitable reference for the routine in vitro EROD assay, although TCDD has generally been preferred for purely scientific reasons.