[Travel time to memory clinics in Bavaria: A geographical analyses within the framework of digiDEM Bayern]. / Räumliche Erreichbarkeit von Gedächtnisambulanzen ­ Eine geographische Analyse im Rahmen von digiDEM Bayern.

BACKGROUND: Memory clinics can contribute significantly to a qualified diagnosis of dementia. Since the accessibility of medical facilities is an important predictor for their utilisation, the aim of this study was to determine the accessibility of memory clinics for persons with dementia in Bavaria. METHODS: We used a Geographic Information System (GIS) to determine travel times to the nearest memory clinic for all Bavarian municipalities based on OpenStreetMap road network data. RESULTS: The majority of the modelled persons with dementia in Bavaria (40%; n = 93,950) live in communities with an average travel time of 20 to 40 minutes to the nearest memory clinic. Almost 7,000 (3%) require more than one hour. Especially persons from rural communities have to travel significantly longer distances than people from urban areas. CONCLUSION: In view of demographic developments, there is an urgent need for memory clinics to be accessible throughout the country for all persons with dementia, regardless of where they live. The systematic development of memory clinics in areas with long travel times or the establishment of mobile diagnostic services could help to improve dementia care.

[Desire and Reality: Discrepancy Between the Actual Usage and the Need to Use Ambulant Support Services - Cross Sectional Study of Elderly People Living at Home in Chronic Need of Care]. / Wunsch und Wirklichkeit: Diskrepanz zwischen tatsächlicher und beabsichtigter Nutzung von ambulanten Entlastungsangeboten.

AIM: In Germany, people in need of care are mainly cared for by their relatives who make use of various outpatient relief and support services. The aim of this study was to determine the frequency of actual use as well as the desired use of outpatient relief and support services. Dementia and non-dementia as causes behind need for care are distinguished. METHODS: A representative sample of informal caregivers of statutorily insured care recipients assessed by the MD Bayern during application for a care level classification (n=958) was analyzed. The use of the following outpatient relief and support services was investigated: outpatient care service; domestic help; day care centre; meals on wheels; driving service; care service; 24-hour care; and care group. Characteristics of the care receiver, the informal caregiver and the care situation were recorded. Difference analyses were carried out using Chi² tests and t-tests. RESULTS: The use of outpatient support services was low despite the high care burden on informal caregivers ranging from 1,7% for the care group to 38,4% for the outpatient care service. More than 40% of respondents did not use any of the eight services. However, from this non-user group, 72% had a desire to use at least one of the eight services in the future. Domestic help and outpatient care services were the most frequently requested services by non-users. Actual and desired use was more common for dementia than for other causes of need for care, especially for day care, care group and care service. CONCLUSION: The desire for utilization is significantly higher than the reality of utilization. In general, the use of outpatient relief and support services is low. The causes of this discrepancy need to be explored. Therefore, effective strategies need to be developed to advise informal caregivers which ensure suitable respite services will be used to strengthen the home care situation.

[Reconciling Employment and Informal Caregiving for an Elderly Person at Home: Factors Influencing a Reduction in Employment due to Caregiving and Work-Related Wishes of Informal Caregivers]. / Vereinbarkeit von Erwerbstätigkeit und häuslicher Pflege: Einflussfaktoren auf eine pflegebedingte Erwerbstätigkeitsreduktion und arbeitsbezogene Wünsche pflegender Angehöriger.

OBJECTIVE: Reconciling informal caregiving and gainful employment is a challenge for many informal caregivers. The goals of this paper are to identify factors influencing care-related employment reduction, and to record work-related wishes for improving the compatibility of informal caregiving and being employed. METHODS: Analyses were based on the cross-sectional Benefits of Being a Caregiver Study of 426 employed caregivers of an older person in need of care. Data were collected on characteristics of the care receivers and caregivers, and aspects of the caregiving and employment situation. Potential influencing factors of care-related employment reduction (n=426) were analyzed using binary logistic regression. The wishes regarding the compatibility of informal care at home and employment were examined descriptively using structured content analysis according to Mayring. RESULTS: One quarter of the employed informal caregivers (n=108) reduced their hours of employment due to the demands of caregiving. The profile of influencing factors of a care-related employment reduction was composed of a higher number of working hours, higher effort for activities of daily living, and co-residence with the care receiver. Employed caregivers primarily expressed a desire for flexibility in working hours, a reduction in working hours, and some concessions with regard to absenteeism. CONCLUSIONS: Relieving the burden on caregivers in the activities of daily living in form of formal and informal support services can probably reduce the likelihood of a care-related reduction in gainful employment.

[Need for Care in Old Age: Characterization of Informal Caregivers and the Care Situation with Regard to Care Levels in Home Care]. / Pflegebedürftigkeit im Alter: Angehörigen- und Versorgungssituation im Zusammenhang mit den Pflegegraden bei häuslicher Pflege.

OBJECTIVE: In Germany, people in need of care can be supported by benefits from care insurance. Prerequisite is an official assessment of the need for care, which is carried out by assigning care levels (1 to 5) according to the Second Care Strengthening Act. One of the reasons for introducing care levels was to pay more attention to the needs of people with dementia. In this article, characterization of care levels were based on characteristics of care recipients, their relatives, and the care situation. The aim was to map the current state of health care and providing practical suggestions to improve health care. METHODS: Data was collected as part of the cross-sectional study "Benefits of being a caregiver" by a written survey of informal caregivers throughout Bavaria on aspects of the caregiving situation as well as on current and desired future use of 15 care services. To compare care levels, group differences were analyzed using χ2-tests and one-factor analysis of variance. The effect size measures odds ratio and Cohen's d were reported for significant group differences comparing care levels 1 and 4. The sample consisted of 958 cases of people in need of care aged 65 and above. RESULTS: The proportion of people with dementia increased significantly with care level. For informal caregivers, subjective burden, functional coping strategies, and the caregiving motive of not wanting to place the care recipient in a nursing home increased with care level. Informal caregivers of those with higher care levels spent significantly more time on supporting activities of daily living and supervision; they received more informal help, and more often lived together with the care recipient in a household. For 9 of the 15 care services surveyed (e. g. 24-h care), current use increased significantly with increasing care level. However, we recorded a low overall utilization rate of care services across all care levels (M=2.20; SD=1.90). CONCLUSIONS: As a result of the Second Care Strengthening Act, people with dementia get good access to care insurance benefits. The increasing amount of time required for assisting in activities of daily living and supervision is reflected by care levels. Despite the increasing caregiving burden, care services are rarely used. Therefore, we recommend that measures to increase the use of support and counselling services be expanded.

[Outpatient Care Service: Predictors Of Current And Future Use Of Outpatient Care Service By Family Members Providing Informal Care To Elderly Persons In Long-Term Home Care]. / Ambulanter Pflegedienst: Wer nutzt ihn und wer möchte ihn nutzen? Prädiktoren der aktuellen und künftigen Inanspruchnahme.

OBJECTIVE: In Germany, people in need of care are usually cared for at home by their informal caregivers. The outpatient care service represents a central pillar in the home care of people in need of care. The aim of this article was to analyse the factors influencing the current as well the future use of outpatient care service. METHODS: With the cross-sectional study Benefits of Being a Caregiver (October 2019 - March 2020) overall 958 family caregivers of elderly people in need of care from Bavaria were interviewed. In addition to the characteristics of the caregivers and those in need of care, information on the care situation as well as the current and desired future use of outpatient care service were collected. Two binary logistic regression analyses were carried out to determine the predictors of the use. RESULTS: The outpatient care service was used by 368 (38%) care giving relatives or those in need of care currently or recently. 236 family caregivers (40% of current non-users) stated that they would like to use an outpatient care service in the future. As predictors for the current use, the relationship non-partner, a higher care level of the persons in need of care and the perception of caregivers of not being able to manage care-giving were determined. Predisposing factors for the desired future use were the desire for current informal help and a lower care level. CONCLUSION: Family caregivers using the outpatient care service state that they are less able to cope with home care. Therefore, this service should focus its counselling on the empowerment of the caregivers. Moreover, the users are predominantly employed daughters or daughters-in-law who live in separate households. Therefore, the reliability of the offer is a basic condition for being able to maintain home care. In the future, a considerable increase in the number of informal care givers wishing to use outpatient care services is to be expected. Efforts should therefore be made to enlarge the range of services.

[Care-related Termination of Employment among Informal Caregivers of Elderly Persons: Identification of a Risk Profile]. / Pflegebedingte Beendigung der Erwerbstätigkeit pflegender Angehöriger: Identifikation eines Risikoprofils.

OBJECTIVE: Employed informal caregivers often experience role conflicts between caring for an elderly person in need of care at home and their employment. The goal of this paper was to identify a risk profile of care-related termination of employment. METHODS: Analyses are based on the cross-sectional Benefits of Being a Caregiver Study (October 2019 - March 2020) with data from 481 informal caregivers of elderly persons in need of care. The data collected relate to characteristics of the care recipient, the informal caregiver, and the caregiving situation, as well as aspects of the employment situation. The risk profile of care-related cessation of employment is based on a binary logistic regression. RESULTS: Approximately one in nine in the present sample (n=55) terminated employment because of having to offer informal care to an elderly person at home. Factors characterizing the risk profile of a care-related termination of employment were female gender of the caregivers, younger age of the care receiver, co-residence with the care receiver, and a higher care level of the care receiver. CONCLUSIONS: In order to reduce care-related cessation of employment, support and relief services need to be adapted to the factors of the identified risk profile. In particular, the form and content of informal caregiver counselling should be modified in order to reach informal caregivers at an early stage. Adapted support programs should focus on and reach in particular female employed caregivers.

[Adult Day Care Service: Who Uses it and Who Wants to Use it? Multivariable Analysis of Current and Future Use of Adult Day Care Service by Elderly Persons in Long-Term Care]. / Tagespflege: Wer nutzt sie und wer möchte sie nutzen? Multivariable Analyse der aktuellen und zukünftigen Inanspruchnahme der Tagespflege bei der häuslichen Pflege.

Background Adult day care serves to ease the burden on informal caregivers and to provide adequate care and support for care recipients. Across Bavaria and Germany, adult day care is attended by 4% of all care recipients. The aim of the secondary analysis was to identify variables linked to the current or desired future use of adult day care services. Methodology For the cross-sectional study Benefits of Being a Caregiver ("Zugewinne durch die Pflege"), informal caregivers of geriatric care receiver were surveyed in Bavaria from October 2019 to March 2020 (age>65; n=958). Data regarding caregiving situation, characteristics of informal caregivers and care recipients, and sociodemographic information were collected. Two binary logistic regression analyses were conducted to identify predictors of current or desired adult day care service use. Results Adult day care was used by 7.3% (n=70) of informal caregivers. Utilization was associated with dementia and high care degree requirements of the care recipient(Nagelkerke's R2 = 0.200). Of the 888 informal caregivers not using adult day care services, 223 (25.1%) expressed a desire to use them. This was associated with care recipients suffering from dementia, a poor previous relationship, and a high subjective burden on the informal caregiver (Nagelkerke's R²=0.083). Conclusion The utilization rate of adult day care was found to be higher than reported in Bavarian or German care statistics. Dementia and an increased need for care of the care recipient were associated with utilization, but contrary to reports in literature, no association with everyday limitations, sex, education, or duration of care was found. More than two-thirds of Bavarian informal caregivers do not want to use adult day care services either now or in the future.

[Sometimes, I Also Drink Water - Alcohol Consumption of People With Mild Cognitive Impairment]. / Manchmal trink ich auch Wasser ­ Alkoholkonsum von Menschen mit leichter kognitiver Beeinträchtigung.

AIM: Risky alcohol consumption increases the risk of dementia for people with mild cognitive impairment (MCI). The aim of this study is to assess alcohol consumption in people with MCI. METHODS: Socio-demographics, 12-month prevalence, 30-d prevalence, prevalence of risky consumption (>10 g/20 g/d pure alcohol for women/men) and binge drinking (≥50 g pure alcohol on one occasion) were recorded in 270 people (≥60 years) with MCI from the German RCT "Brainfit-Nutrition" in 2022. RESULTS: Approximately half of the people with MCI (50.8%) drink at least once a week. About one fifth (17.0%) of participants met the criterion for binge drinking; every third woman (34.8%) and every fifth man (18.6%) crossed the line to risky consumption in the last 30 d. DISCUSSION: Generally, people with MCI show similar consumption prevalence as the 65+German general population. However, the prevalence of risky consumption in women with MCI is significantly higher.

Under What Conditions Can People With Severe Dementia in Nursing Homes Benefit From a Multicomponent Psychosocial Intervention? / Unter welchen Bedingungen können Menschen mit schwerer Demenz im Pflegeheim von einer psychosozialen Mehrkomponenten-Intervention profitieren?

BACKGROUND: The majority of psychosocial interventions are considered effective in the treatment of dementia symptoms. However, there are hardly any evaluated concepts for people with severe dementia. An RCT study of patients with severe dementia in nursing homes during the Covid-19 pandemic found no effect of the newly developed multi-component intervention MAKS-s (motor, activities of daily living, cognitive, social version for persons with severe dementia) on patients' quality of life, behavioural and psychological symptoms. MATERIAL AND METHODS: At the end of the controlled phase, 6 months after beginning of the study, the nursing staff of the control groups were also trained in MAKS-s. They were then free to decide whether and how often they wanted to use MAKS-s (open phase). By means of a written follow-up survey, conducted with trained therapists, after another 6 months, predictors for positive effects of the intervention on people with severe dementia were to be identified. The survey also aimed to identify predictors of therapy fidelity. Data acquisition based on a self-developed questionnaire, assessing the therapists' subjective ratings of the three areas of structure, process and outcome quality of the MAKS-s intervention. Apart from descriptive evaluations, the predictors of benefit for people with severe dementia were analysed using a linear regression model and the predictors of therapy fidelity by using a binary logistic regression model. RESULTS: The more pronounced the normative restrictions due to the Covid-19 pandemic were, the more frequently manual deviations were observed. Fewer deviations from the manual were significantly associated with positive effects on people with severe dementia. CONCLUSION: The results indicate the importance of therapy fidelity for the success of MAKS-s intervention. Therapy fidelity is decisive for the extent of the positive effects of MAKS-s, experienced by the therapists. Furthermore, the survey results show that activity-restricting pandemic policies in nursing homes negatively influenced the perceived effectiveness.

[The controversy over early diagnosis of Alzheimer's disease: A literature review of the advantages and disadvantages]. / Kontroverse um die Alzheimer-Frühdiagnostik ­ eine literaturbasierte Übersicht über die Vor- und Nachteile.

BACKGROUND: The continuum of Alzheimer's disease (AD) comprises three stages: the pre-clinical stage (with few to no subjective symptoms), the prodromal stage (measurable mild cognitive impairment) and the final stage of clinically manifest (AD) dementia. Neuropathological correlates in accordance with these stages have been found with varying frequency. The aim of early AD diagnosis is to determine such correlates in these preclinical and prodromal stages and to determine the probability of the manifestation of a later AD dementia. In this regard, the prognostic validity is of vital importance. From the perspective of those affected, the issue of early diagnosis cannot be reduced to AD, although Alzheimer's dementia is by far the most common form of dementia. The aim of this review is to provide a literature-based overview of the advantages and disadvantages of early AD diagnosis in contrast to other types of dementia. Based on this, recommendations will be formulated for the prioritisation of early diagnostic advantages and disadvantages in the patient counselling situation in clinical practice. METHODS: Three databases were searched for current reviews addressing the advantages, disadvantages and ethical aspects of early AD diagnosis. The search was limited to current German or English reviews published between January 1, 2018 and November 30, 2022. The systematic search strategy was based on the PICO model and included both a Boolean and a focus-expanding keyword search using previously defined search terms. In addition, snowballing was used as a search strategy. Qualitative synoptic content analysis in accordance with Mayring was used to analyse both advantages and disadvantages. Similar arguments were combined into single statements. The resulting statements were categorized into three main groups: social, individual or clinical aspects. To emphasize the aforementioned aims, arguments were additionally distinguished into "only valid for early AD diagnosis" and "valid for early diagnosis of all types of dementia". RESULTS: Overall, seven reviews with suitable content were included. Social aspects of early AD diagnosis comprise the protection of the affected person and the society as well as potential stigmatisation of the affected and their family members. Individual arguments range from the right to a "rational suicide", including the avoidance of financial and caregiving burdens on family members, to the right not to know the diagnosis. Clinical arguments include, for example, the scientific research context (facilitating the identification of suitable clinical trial participants) and various negative effects of a false positive or false negative early diagnosis. CONCLUSION: Early diagnosis of AD as well as of other forms of dementia is characterised by numerous advantages and disadvantages of a social, individual and clinical nature. The decision for or against early diagnosis should always be made by weighing the current advantages against the disadvantages in a specific case. In particular, the desires of the person affected, the validity of the diagnostic procedures available and, above all, the availability of effective preventive or therapeutic measures must be taken into account.

[Staying Healthy While Caregiving at Home? Risk and Protective Factors for Dysfunctional Coping in Family Caregivers]. / Zuhause-Pflegen und trotzdem gesund bleiben? Risiko- und Schutzfaktoren für dysfunktionales Coping bei pflegenden Angehörigen.

OBJECTIVE: In Germany, 3.3 million people in need of care are cared for at home. More than half (54%) of informal caregivers estimate their own stress as high or very high [1]. Coping strategies, including dysfunctional ones, are used to cope with stress. These bear the risk of negative health consequences. The aim of this study is to assess the frequency of dysfunctional coping strategies among informal caregivers and to identify protective and risk factors for these unfavorable coping mechanisms. METHODS: A cross-sectional study with N=961 interviewed informal caregivers in Bavaria was conducted in 2020. Dysfunctional coping strategies (substance use and abandonment/avoidance) were assessed. Additionally, subjective stress, positive aspects of caregiving, caregiving motives, characteristics of the caregiving situation as well as caregivers' cognitive evaluation of the care situation and their subjective assessment of available resources (based on the Transactional Stress Model) were recorded. Descriptive statistics were used to explore the frequency of dysfunctional coping behavior. Linear regressions were run, after statistical precondition testing, to investigate which predictors can be identified for dysfunctional coping. RESULTS: 14.7% of respondents reported using alcohol or other substances at least some of the time in difficult situations, and 47.4% of respondents had given up dealing with the care situation. Subjective caregiver burden (p<0.001), the motive to care out of obligation (p=0.035), and resources for manageability of the caregiving situation rated as insufficient (p=0.029) were identified as risk factors for dysfunctional coping in a significant overall model with medium fit (F (10)=16.776; p<0.001). DISCUSSION AND CONCLUSION: Dysfunctional coping concerning the stress related to the caregiving situation is not uncommon. The most promising target for intervention is subjective caregiver burden. This is known to be reduced by the use of formal and informal help [2, 3]. However, this requires overcoming the problem of low rates of use of counseling and other support services [4]. Newer digital promising approaches to this are being developed [5, 6].

Predictors of expressed, felt, and normative needs for informal caregiver counseling : Domestic care for people aged 65+ years.

BACKGROUND: Informal caregivers (CGs) often fail to recognize or express a need for informal caregiver counseling (ICC) but ICC is an essential but relatively rarely used support service for CGs. OBJECTIVE: Our aim is to identify predictors of CGs' need for ICC. Stirling et al.'s need model, which includes three needs (expressed, felt, and normative), serves as a theoretical basis. MATERIAL AND METHODS: Analyses are based on cross-sectional data (n = 958) from the "Benefits of being a caregiver" study. Predictors of the need to use ICC were analyzed with binary logistic regression. A sensitivity analysis using multiple linear regression was performed for the metric value of normative needs. RESULTS: We found that 6.8% of CGs currently or have recently used ICC. This expressed need was related to higher education and higher effort in instrumental activities; 24.1% of CGs reported an intention to use ICC in the future. This felt need was related to male gender, lower care level, more problem-focused coping, and a desire for more informal help. Objective need for ICC (normative need), which was related to a higher burden of care, less experienced benefits, and negative relationship quality, was reported by 21.4% of CGs. According to a sensitivity analysis, higher education, a desire for informal help, and living in separate households also predicted a normative need for counseling. DISCUSSION: Current utilization is significantly lower than the subjectively perceived and objectively existing need for ICC. The identified predictors provide initial strategies for motivating more CGs to use ICC.

[Predictors of intensity of use of adult day care centers in people with cognitive impairment]. / Prädiktoren für die Nutzungsintensität von Tagespflegen bei Menschen mit kognitiven Einschränkungen.

BACKGROUND: Adult day care is an established concept in Germany for people with cognitive impairment; however, only a small fraction of people in need for care actually use adult day care. Studies so far highlighted some predictors for the use of adult day care; however, it remains unclear which factors are associated with the intensity of use. OBJECTIVE: To identify relevant predictors for the intensity of use of adult day care using the Andersen healthcare utilization model. MATERIAL AND METHODS: Data used were obtained within the project dementia in day care with psychosocial MAKS interventions (DeTaMAKS), which studied adult day care users with cognitive impairments and their family caregivers. A logistic regression was performed to predict frequent or low use of adult day care. RESULTS: The following factors were significantly associated with higher intensity of use: civil status of adult care user being widowed or single, higher educational level of caregiver, higher care level, longer duration of adult day care use and more mental and behavioral symptoms of the adult day care user. The sensitivity analysis for cohabiting dyads additionally showed a higher intensity of use with a lower age of the caregiver and shorter distance between place of residence and adult day care but not with respect to educational level of the caregiver and mental and behavioral symptoms of the user. CONCLUSION: The results show a need for adult day care, which increases with caregivers being employed and users living outside of permanent relationships. A short distance to the adult care center as well as flexible care options may increase the frequency of use.

[Implementation and Effect of the Multimodal Psychosocial MAKS Intervention in Day Care Centers for People with Cognitive Impairment: Follow-up Results After the End of the RCT]. / Implementierung und Wirkung der multimodalen psychosozialen MAKS-Intervention in der Tagespflege bei Menschen mit kognitiven Beeinträchtigungen: Ergebnisse in der offenen Phase nach Beendigung des RCT.

AIM OF THE STUDY: Study of the long-term effects of a psychosocial intervention in dementia including its implementation under real world conditions in day care centers. In the present study this was investigated for the MAKS intervention - Motor, Activities of daily living, (K)Cognitive and Social-communicative component. METHODS: At the end of a 6-month, cluster-randomised, controlled study, professional caregivers in all 32 day care centers (DCC) were trained in MAKS. From then on, all centers were free to carry out the intervention or not (open phase). In the 18-month follow-up phase, after 6 and 18 months the heads of the DCC were asked whether MAKS was carried out regularly in the trained form. After 6 months in the open phase, the cognitive abilities of the study participants with mild cognitive impairment, mild to moderate dementia were again assessed using Mini-Mental Status Examination (MMSE). Multiple linear regression analysis was used to investigate whether the MMSE score was predicted by carrying out MAKS or not. Other adjustment variables were MMST score at t6, age, sex, frequency of visits to TP, antidementia medication use, and depressiveness. RESULTS: In the first 6 months of the open phase, 22 DCC (69%) stated that they performed MAKS. In months 7 to 18, this proportion increased up to 81%. For the 287 study participants in the 32 DCC, the fact whether they were guests in a DCC with or without MAKS was a significant predictor of the course of cognitive abilities (p=0.019). The average MMSE score in DCC without MAKS decreased; in DCC with MAKS it stayed approximately the same. Other significant predictors were baseline score and use of antidementia medications (individuals on antidementia medications scored worse). CONCLUSION: The multimodal, psychosocial MAKS intervention for people with cognitive impairment that has been trained in a structured way can be implemented in day care centers on a long-term basis. MAKS has a positive effect on cognitive abilities also in a real world scenario.

Usability Evaluation of an Offline Electronic Data Capture App in a Prospective Multicenter Dementia Registry (digiDEM Bayern): Mixed Method Study.

BACKGROUND: Digital registries have been shown to provide an efficient way of gaining a better understanding of the clinical complexity and long-term progression of diseases. The paperless method of electronic data capture (EDC) during a patient interview saves both time and resources. In the prospective multicenter project "Digital Dementia Registry Bavaria (digiDEM Bayern)," interviews are also performed on site in rural areas with unreliable internet connectivity. It must be ensured that EDC can still be performed in such a context and that there is no need to fall back on paper-based questionnaires. In addition to a web-based data collection solution, the EDC system REDCap (Research Electronic Data Capture) offers the option to collect data offline via an app and to synchronize it afterward. OBJECTIVE: The aim of this study was to evaluate the usability of the REDCap app as an offline EDC option for a lay user group and to examine the necessary technology acceptance of using mobile devices for data collection. The feasibility of the app-based offline data collection in the digiDEM Bayern dementia registry project was then evaluated before going live. METHODS: An exploratory mixed method design was employed in the form of an on-site usability test with the "Thinking Aloud" method combined with an online questionnaire including the System Usability Scale (SUS). The acceptance of mobile devices for data collection was surveyed based on five categories of the technology acceptance model. RESULTS: Using the "Thinking Aloud" method, usability issues were identified and solutions were accordingly derived. Evaluation of the REDCap app resulted in a SUS score of 74, which represents "good" usability. After evaluating the technology acceptance questionnaire, it can be concluded that the lay user group is open to mobile devices as interview tools. CONCLUSIONS: The usability evaluation results show that a lay user group generally agree that data collecting partners in the digiDEM project can handle the REDCap app well. The usability evaluation provided statements about positive aspects and could also identify usability issues relating to the REDCap app. In addition, the current technology acceptance in the sample showed that heterogeneous groups of different ages with diverse experiences in handling mobile devices are also ready for the use of app-based EDC systems. Based on these results, it can be assumed that the offline use of an app-based EDC system on mobile devices is a viable solution for collecting data in a decentralized registry-based research project.

[Impact of Sedating Drugs on Falls Resulting Injuries Among People with Dementia in a Nursing Home Setting]. / Einfluss zentralnervös dämpfender Arzneimittel auf Stürze mit Verletzungsfolgen bei Menschen mit Demenz in Pflegeheimen.

AIM: The aims of this study were to create a scale for measuring the sedating and activating effects of drugs and to analyse if the total value of this scale correlates significantly with falls requiring medical treatment in dementia patients. Furthermore, prescription of drugs in nursing homes included in the PRISCUS-List, Anticholinergic Cognitive Burden List (ACB-List) and usage of psychotropic drugs were investigated. METHOD: This is a data analysis of a randomized controlled trial which tested the effects of a non-pharmacological multimodal activation therapy (MAKS®) in 139 patients with degenerative dementia in 5 nursing homes. At the beginning of the study, all prescribed drugs were rated on a five-tier scale by 2 pharmacologists based on the drugs' sedating or activating effects. The scale ranged from severely activating (+2) to severely sedating (- 2). The "central nervous system (CNS) depressant score" of each patient was calculated by summing up the scale value of all the medications they were taking. The correlation between CNS-depressant score and falls resulting in injuries within an observation period of 12 months was investigated by binary logistic regression analysis. RESULTS: Nearly 30% of the nursing home residents received drugs listed in the PRISCUS-list, 50% received drugs on the ACB-List, 55% took psychotropic drugs and 66% received at least 5 drugs. Sedating drugs were prescribed to 62% of patients. During the observation period, 36 out of 139 nursing home residents suffered falls and medical treatment was necessary. In multivariate analysis, the CNS-depressant score was associated significantly (p=0.045) with falls with resulting injuries. Increased sedation resulted in a higher number of fall incidents. CONCLUSIONS: The CNS-depressant score is a useful tool to describe the degree of sedation. Due to the significant association between sedation and falls resulting in injuries, the sedating medication of people suffering from dementia should be minimised as much as possible to reduce the risk of undesirable side effects.

Access to Pain Management Programs: A Multifactorial Analysis of the Pathways of Care for Chronic Pain Patients in the University Clinic Erlangen.

BACKGROUND: Different treatment options are offered for patients suffering from chronic pain, which differ in intensity and costs: 1) monodisciplinary treatment, mostly in outpatient care and 2) interdisciplinary treatment with the option of participating in pain management programs as outpatients or inpatients. The present work investigates how patients at the University Clinic Erlangen receiving monodisciplinary treatment differ from those receiving interdisciplinary treatment (research question I) as well as how patients participating in a pain management program differ from those who do not (research question II). The aim is to generate insights into whether the differences between the patient groups under various treatment modalities reflect the officially defined criteria for the indication of chronic pain management programs. METHODS: Routine data of 1,833 patients treated from January 2008 to March 2013 at the University Clinic Erlangen were analyzed. After univariate preanalyses and checks for multicollinearity, the remaining variables were used for the final multivariate model (multiple binary logistic regression) for research question I and II. RESULTS: Research question I: Patients getting interdisciplinary treatment were more often employed, had higher affective experience of pain, more often regarded their pain as treatable, had more often participated in at least one pain-associated rehabilitation treatment in the past, were younger and rarely had application for retirement in consideration. Research question II: Patients who participated in a pain management program were more often female, more often employed, described their pain as mainly located at the upper part of the body, had more concomitant symptoms, were more often diagnosed with musculoskeletal pain and rarely had a retirement request pending. CONCLUSIONS: It could be shown that patients in the analyzed pathways of care mainly differed in demographic variables, and regarding pain management programs, also in the type of pain. Differences between patients in different treatment paths reflecting the officially defined indication criteria for chronic pain management programs were detectable only to a minor extent. Clearer and operational practical guidance should help support the clinical decision to assign patients to different treatment options and close the gap between theory and practice.

[Predictors of Caregiver Burden in Dementia: Results of the Bavarian Dementia Survey (BayDem)]. / Einflussfaktoren auf die Pflegebelastung der Angehörigen von Menschen mit Demenz: der Bayerische Demenz Survey (BayDem).

BACKGROUND: Dementia is an age-specific disease with increasing care needs over the course of the disease. Care is predominantly conducted by caregivers. Caregiver burden is a core criterion for the evaluation of the care situation. The aims of this examination are to identify predictors of caregiver burden and to analyze the course of the caregiver burden over a 12 months period. METHODS: The Bavarian Dementia Survey (BayDem) is a supra-regional, longitudinal study carried out at 3 different sites in Bavaria, Germany. Participants were people with dementia (pwd) as defined by ICD-10 and their informal caregivers. Data was collected by standardized face-to-face interviews in cooperation with local actors. For statistical analysis, a multiple regression as well as a mixed ANOVA (Analysis of Variance) and repeated measures ANOVAs were used. RESULTS: In this analysis, 295 pwd and 276 caregivers were studied. Key factors influencing caregiver burden were gender of the pwd, behavioral and psychological symptoms and a decline of everyday functioning of the pwd as well as gender of the informal caregivers, their relation to the pwd and if they live at the same household as the pwd. Analysis showed a significant main effect of time over the course of the caregiver burden. CONCLUSION: A permanent high caregiver burden can cause health problems for the caregivers. However, caregivers can be supported according to the specific factors of the caregiver burden. One approach in order to support caregivers could be a combination of pharmacological and non-pharmacological interventions for the treatment of disease-specific symptoms and an empowerment as well as the provision of support services for the caregivers. Furthermore, tailored services for specific target groups can be meaningful.