[Disease sequelae on function in persons 70 years and older and the acceptance of a new supporting network, the NetzWerk GesundAktiv (NWGA)]. / Funktionale Krankheitsfolgen von Menschen im Alter ab 70 Jahren und die Akzeptanz eines neuen Unterstützungs-Netzwerkes, das NetzWerk GesundAktiv (NWGA).

BACKGROUND: The growing need of nursing care as life expectancy increases is a problem. The Netzwerk AktivGesund (NWGA) tries to change this development in a positive way. In a pilot region of the city of Hamburg, persons 70 years and older were invited by their health insurance companies to participate in the NWGA supportive network. Results of the acceptance analysis are described here. METHODS: In order to focus on persons at risk of need for help functional competence was assessed by using the LUCAS functional ability index (selfreport questionnaire). In an explorative way, participants, refusers, persons interested (excluded due to high functional competence), and non-responders were compared in a retrospective observational study. Sociodemographic and routine data were used as ICD diagnoses from hospitalisations, number of contacts to physicians and level of need of nursing care during the 12 months before recruitment. RESULTS: There were 962 participants (7.4 %), 948 refusers (7.2 %), 2437 persons with interest (18.6 %) and 8753 non-responders (66.8 %) from the 13 100 persons contacted by mail. The sociodemographic factors differed between these groups. ICDs typical of older patients and ICD codes of functional impairment from the 5422 hospital stays showed different frequencies. Persons with interest had nearly no need of nursing care and the lowest level of morbidity. CONCLUSIONS: The results show that impairments of motoric and cognitive functions, in particular, and sociodemographic factors have impact on the acceptance of the NWGA. The recruitment for participation should be improved using approaches that are differentiated, respectively. Awareness of functional impairment as disease sequelae and pacemaker of need of nursing care, in general, might facilitate health promotion and prevention in older persons. An interest in preventative activities was remarkably frequent among the persons 70 years and older.

Effectiveness of a multi-component community-based care approach for older people at risk of care dependency - results of a prospective quasi-experimental study.

BACKGROUND: Due to demographic changes, the elderly population in western countries is constantly growing. As the risk of functional decline and multimorbidity increases with age, health care systems need to face the challenge of high demand for health care services and related costs. Therefore, innovative health care approaches and geriatric screenings are needed to provide individualised care. This study aims to expand the state of research by investigating the effectiveness of a multi-component care approach for the elderly in a German community setting. METHODS: A prospective, quasi-experimental study was initiated by statutory health insurance (SHI) companies. The innovative care approach includes a geriatric assessment, a case and network management as well as digital supporting tools and was implemented at the Center for Geriatrics and Gerontology (Albertinen Haus, Hamburg-Eimsbuettel). Participants of the intervention were compared to matched controls recruited in comparable urban areas. The primary outcome measure was the progression in long-term care grade during the period of observation (21 months), which was analysed on the basis of SHI claims data. Secondary endpoints were morbidity, mortality and self-reported health-related quality of life (HRQoL) measured by SF-36. RESULTS: Overall, 2,670 patients (intervention group (IG) n=873; control group (CG) n=1,797) were analysed. Logistic regression analysis showed no statistically significant difference in progression of long-term care grade between IG and CG (Odds Ratio (OR)=1.054; 95% confidence interval (CI) 0.856-1.296; p-value=0.616). Differentiated analyses indicated an initial effect, which might be attributable to the geriatric assessment. However, an adapted regression model resulted in a reversed but even non-significant effect (OR=0.945; 95% CI 0.757-1.177; p-value=0.619). While secondary analyses of long-term care grade, mortality and HRQoL did not show intervention effects, a statistically significant relative change of 0.865 (95% CI 0.780, 0.960; p-value=0.006) in morbidity indicated a potential benefit for the IG. CONCLUSIONS: The analyses did not reveal a significant effect of the community-based intervention on the primary outcome and thus we are not able to recommend a transfer into SHI standard care. Tendencies in secondary analyses need to be proved in further research. TRIAL REGISTRATION: German Clinical Trials Register, retrospective registration on February 01, 2022 ( DRKS00027866 ).

Comparison of FORTA, PRISCUS and EU(7)-PIM lists on identifying potentially inappropriate medication and its impact on cognitive function in multimorbid elderly German people in primary care: a multicentre observational study.

OBJECTIVES: Our study aimed to assess the frequency of potentially inappropriate medication (PIM) use (according to three PIM lists) and to examine the association between PIM use and cognitive function among participants in the MultiCare cohort. DESIGN: MultiCare is conducted as a longitudinal, multicentre, observational cohort study. SETTING: The MultiCare study is located in eight different study centres in Germany. PARTICIPANTS: 3189 patients (59.3% female). PRIMARY AND SECONDARY OUTCOME MEASURES: The study had a cross-sectional design using baseline data from the German MultiCare study. Prescribed and over-the-counter drugs were classified using FORTA (Fit fOR The Aged), PRISCUS (Latin for 'time-honoured') and EU(7)-PIM lists. A mixed-effect multivariate linear regression was performed to calculate the association between PIM use patients' cognitive function (measured with (LDST)). RESULTS: Patients (3189) used 2152 FORTA PIM (mean 0.9±1.03 per patient), 936 PRISCUS PIM (0.3±0.58) and 4311 EU(7)-PIM (1.4±1.29). The most common FORTA PIM was phenprocoumon (13.8%); the most prevalent PRISCUS PIM was amitriptyline (2.8%); the most common EU(7)-PIM was omeprazole (14.0%). The lists rate PIM differently, with an overall overlap of 6.6%. Increasing use of PIM is significantly associated with reduced cognitive function that was detected with a correlation coefficient of -0.60 for FORTA PIM (p=0.002), -0.72 for PRISCUS PIM (p=0.025) and -0.44 for EU(7)-PIM (p=0.005). CONCLUSION: We identified PIM using FORTA, PRISCUS and EU(7)-PIM lists differently and found that PIM use is associated with cognitive impairment according to LDST, whereby the FORTA list best explained cognitive decline for the German population. These findings are consistent with a negative impact of PIM use on multimorbid elderly patient outcomes. TRIAL REGISTRATION NUMBER: ISRCTN89818205.

Non-random relations in drug use expressed as patterns comprising prescription and over-the-counter drugs in multimorbid elderly patients in primary care: Data of the exploratory analysis of the multicentre, observational cohort study MultiCare.

BACKGROUND: The elderly population deals with multimorbidity (three chronic conditions) and increasinged drug use with age. A comprehensive characterisation of the medication - including prescription and over-the-counter (OTC) drugs - of elderly patients in primary care is still insufficient. OBJECTIVES: This study aims to characterise the medication (prescription and OTC) of multimorbid elderly patients in primary care and living at home by identifying drug patterns to evaluate the relationship between drugs and drug groups and reveal associations with recently published multimorbidity clusters of the same cohort. METHODS: MultiCare was a multicentre, prospective, observational cohort study of 3189 multimorbid patients aged 65 to 85 years in primary care in Germany. Patients and general practitioners were interviewed between 2008 and 2009. Drug patterns were identified using exploratory factor analysis. The relations between the drug patterns with the three multimorbidity clusters were analysed with Spearman-Rank-Correlation. RESULTS: Patients (59.3% female) used in mean 7.7 drugs; in total 24,535 drugs (23.7% OTC) were detected. Five drug patterns for men (drugs for obstructive pulmonary diseases (D-OPD), drugs for coronary heart diseases and hypertension (D-CHD), drugs for osteoporosis (D-Osteo), drugs for heart failure and drugs for pain) and four drug patterns for women (D-Osteo, D-CHD, D-OPD and drugs for diuretics and gout) were detected. Significant associations between multimorbidity clusters and drug patterns were detectable (D-CHD and CMD: male: ρ = 0.376, CI 0.322-0.430; female: ρ = 0.301, CI 0.624-0.340). CONCLUSION: The drug patterns demonstrate non-random relations in drug use in multimorbid elderly patients and systematic associations between drug patterns and multimorbidity clusters were found in primary care.

[The "Hamburg home visit for older citizens" : Development, execution and acceptance in 4716 older people in 15 months]. / Der "Hamburger Hausbesuch für Seniorinnen und Senioren" : Entwicklung, Durchführung und Akzeptanz bei 4716 älteren Menschen in 15 Monaten.

BACKGROUND: Preventive home visits are part of communal programs for older citizens. The city of Hamburg promoted the pilot project "The Hamburg home visit for older citizens" in two city districts. The voluntary program is offered to persons on their 80th birthday, without comprehensive assessment and is performed by visitors with a background in healthcare or social work. The aim is to provide information, to identify need of help and to initiate contact with officials for support if wanted. METHODS: The structural and administrative prerequisites were defined together with officials of the city of Hamburg and the two city districts. The data safety concept, provision of addresses, birthday letter, information to be provided, recruitment, qualification and training of the visitors, timing and performance of visits, guiding how to communicate during the home visit, documentation and quarterly reports are described in detail. RESULTS: From September 2018 to December 2019, 1636 (35%) out of 4716 persons contacted were visited by 59 visitors. The most frequent reasons for refusal were no need because of good health (40%) or satisfaction with existing support (14%). Most issues addressed were health situation (51%), mobility (43%), housing conditions (42%) and social contacts (41%). There was need of support as documented in 399 out of 1636 home visits, and contacts for support were initiated as required by 55 persons. CONCLUSION: The acceptance of this new approach was 10% higher than 25% per month that had been expected in both the concentrated urban as well as the more rural city districts. Home visits on the 80th birthday appear to be feasible provided that structural and operational prerequisites are considered. In 2020, they were offered to all districts of the city, i.e. to about 15,000 persons per year.

Anticholinergic drug burden according to the anticholinergic drug scale and the German anticholinergic burden and their impact on cognitive function in multimorbid elderly German people: a multicentre observational study.

OBJECTIVES: The aims of our study were to examine the anticholinergic drug use and to assess the association between anticholinergic burden and cognitive function in the multimorbid elderly patients of the MultiCare cohort. SETTING: MultiCare was conducted as a longitudinal cohort study in primary care, located in eight different study centres in Germany. PARTICIPANTS: 3189 patients (59.3% female). PRIMARY AND SECONDARY OUTCOME MEASURES: Baseline data were used for the following analyses. Drugs were classified according to the well-established anticholinergic drug scale (ADS) and the recently published German anticholinergic burden (German ACB). Cognitive function was measured using a letter digit substitution test (LDST) and a mixed-effect multivariate linear regression was performed to calculate the influence of anticholinergic burden on the cognitive function. RESULTS: Patients used 1764 anticholinergic drugs according to ADS and 2750 anticholinergics according to the German ACB score (prevalence 38.4% and 53.7%, respectively). The mean ADS score was 0.8 (±1.3), and the mean German ACB score was 1.2 (±1.6) per patient. The most common ADS anticholinergic was furosemide (5.8%) and the most common ACB anticholinergic was metformin (13.7%). The majority of the identified anticholinergics were drugs with low anticholinergic potential: 80.2% (ADS) and 73.4% (ACB), respectively. An increasing ADS and German ACB score was associated with reduced cognitive function according to the LDST (-0.26; p=0.008 and -0.24; p=0.003, respectively). CONCLUSION: Multimorbid elderly patients are in a high risk for using anticholinergic drugs according to ADS and German ACB score. We especially need to gain greater awareness for the contribution of drugs with low anticholinergic potential from the cardiovascular system. As anticholinergic drug use is associated with reduced cognitive function in multimorbid elderly patients, the importance of rational prescribing and also deprescribing needs to be further evaluated. TRIAL REGISTRATION NUMBER: ISRCTN89818205.

The inter-relationship between depressed mood, functional decline and disability over a 10-year observational period within the Longitudinal Urban Cohort Ageing Study (LUCAS).

BACKGROUND: The WHO defines 'healthy ageing' as 'the process of developing and maintaining the functional ability'. Late-life depression and frailty compromise well-being and independence of older people. To date, there exists little research on the interaction of the dynamic processes of frailty and depression and only a few studies were longitudinal. Conclusions about the direction of effects remained uncertain. METHODS: Data were obtained from each of the last six biyearly waves (2007-2017) of the Longitudinal Urban Cohort Ageing Study (LUCAS) in Hamburg, Germany, a prospective observational cohort study of manifold aspects of ageing. Screening of predictor and event variables: depressed mood: one question from the 5-item Mental Health Inventory Screening Test; frailty: LUCAS Functional Ability Index, status 'frail'; disability: one question on need for human help with basic activities of daily living. Kaplan-Meier curves and Cox's proportional hazards regression were used for time-to-event analyses with shifting baseline. RESULTS: Sample size in 2007 was 2012, average age 76.2 years; ±6.5. Main results were as follows: (1) depression significantly increased the hazard of subsequent frailty (HR=1.581; 95% CI 1.257 to 1.988; p<0.001); (2) frailty significantly increased the hazard of subsequent depression (HR=2.324; 95% CI 1.703 to 3.172; p<0.001); (3) depression significantly increased the hazard of subsequent disability (HR=2.589; 95% CI 1.885 to 3.557; p<0.001) and (4) disability did not significantly increase the hazard of subsequent depression (HR=1.540; 95% CI 0.917 to 2.579; p=0.102). CONCLUSION: Our results suggest an interdependence of the processes of depression and frailty/disability rather than unidirectional dependencies. These observable processes may be representative of underlying unobservable profound life changes. Obviously, there is a need for early screening to initiate appropriate interventions.

[Effectiveness of "Active health promotion in old age" : Results regarding compression of morbidity by target groups in 13.8 years of observation in LUCAS]. / Wirksamkeit der "Aktiven Gesundheitsförderung im Alter" : Zielgruppenspezifische Ergebnisse bezüglich einer Kompression von Morbidität über 13,8 Jahre LUCAS Verlauf.

BACKGROUND AND OBJECTIVE: Healthy ageing as defined by the World Health Organization (WHO) is the development and maintenance of functional competence. Unfavourable ageing is described by the term frailty and is characterised by a decline in functional reserves. The frailty process can be influenced in a positive way. Previous interventions concerned mostly hospital patients and residents of nursing homes. In this study we examined the maintenance of functional competence in an urban community setting. MATERIAL AND METHODS: The programme "Active health promotion in old age" was carried out by a health advisory team with geriatric expertise for independent persons 60 years and older without disabilities. Its effectiveness was evaluated in the Longitudinal Urban Cohort Ageing Study (LUCAS) over a period of 13.8 years. Survival and disability-free survival were calculated separately for persons with a high level of functional competence (many reserves) and persons with few functional reserves, using Kaplan-Meier curves. Adjustments were made for unequal distribution of age, gender, educational level, chronic diseases and functional status using multivariate Cox regressions. This methodology facilitates the study of interrelationships between mortality and morbidity (compression of morbidity) including an impact from life style interventions. RESULTS: Participants with a high level of functional competence had longer disability-free lifes (p < 0.001), and their average proportion of life time with disability was shorter than either for non-participants, or those with low functional competence. CONCLUSION: There is evidence from these analyses on compression of morbidity that the health promotion programme had its strongest effects in persons with high functional competence, exactly those people for whom it has been developed.

[Comparability of studies of epidemiological research on aging : Results from the Longitudinal Urban Cohort Ageing Study (LUCAS) and three representative Hamburg cross-sectional studies of healthy aging]. / Vergleichbarkeit von Studien epidemiologischer Alternsforschung : Ergebnisse aus der Longitudinalen Urbanen Cohorten-Alters-Studie (LUCAS) und drei repräsentativen Hamburger Querschnitt-Studien zur Gesundheit im Alter.

BACKGROUND: Participants of the Longitudinal Urban Cohort Ageing Study (LUCAS) were recruited from patients 60 years and older from general practitioner's offices in Hamburg. This is different from the usual methods of drawing representative samples. OBJECTIVES: The research question addressed the comparability of LUCAS results with those from cross-sectional surveys with participants randomly chosen from a population list. Therefore, the LUCAS data collected in four waves during the first 12 years were compared with data (age, gender) from the Hamburg Statistics Office (HSO), and selected characteristics (socio-demography, health, mobility) from three representative cross-sectional surveys in older Hamburg citizens. METHODS: First, HSO data compiled in population pyramids for older men and women were compared with equivalent pyramids based on the LUCAS data at recruitment (2000/01) and in waves 2 to 4. Second, characteristics worded identically in the cross-sectional surveys and the simultaneous LUCAS waves were compared. RESULTS: The LUCAS population pyramids were in good accordance at all time points with those of the general older population in Hamburg (except ages 60-64 in men in 2000). Good comparability was also found for health related characteristics from the three representative studies and simultaneous LUCAS waves (e. g. need of nursing care in 2012: LUCAS 7.1 %; Hamburg 7.4 %). CONCLUSIONS: Information on health in old age generated periodically in the LUCAS cohort was largely comparable with that from representative cross-sectional studies and statistics registries. Older people are frequently under-represented in epidemiological studies. Therefore, the LUCAS data may provide useful information for Hamburg and similar metropolitan areas in Germany.

[Frailty in Germany: status and perspectives : Results from a workshop of the German Society for Epidemiology]. / Frailty in Deutschland: Stand und Perspektiven : Ergebnisse eines Workshops der Deutschen Gesellschaft für Epidemiologie.

BACKGROUND: A standardized, valid and comparable operationalization and assessment of frailty in population-based studies is essential in order to describe the prevalence and determinants of frailty in the population. AIM: After an introduction to the subject the main goal of a workshop at the 9th annual meeting of the German Society for Epidemiology (DGEpi) was to present approaches and results from four different studies in Germany. MATERIAL AND METHODS: The following four population-based studies were used to describe frailty in Germany: the German health interview and examination survey for adults (DEGS1), the epidemiological study on the chances of prevention, early recognition and optimized treatment of chronic diseases in the older population (ESTHER), the cooperative health research in the region Augsburg (KORA Age) study and the longitudinal urban cohort ageing study (LUCAS) in Hamburg. RESULTS: The four studies consistently showed that frailty is widespread in older and oldest-old persons in Germany. It is obvious that frailty represents a relevant concept in Germany even if there is currently no uniform basis for operationalization. CONCLUSION: Concepts and instruments for the collation of frailty should be included in future population-based studies in order to make a better assessment of older people's health situation and to describe the unused potential for prevention in an aging society.

[Home and dwelling arrangements in old age]. / Altern und Wohngestaltung.

The increase of life expectancy provides the unique opportunity to participate actively in social life many years after retirement and upbringing of children. In Germany, over 80 % of the population 60 years and older are living independently in the community, and approximately 95 % stay in their own homes. On the other hand, the probability to suffer from diseases, frailty and impaired activities of daily life activities also rises with higher age. However, only on rare occasions older people in need of nursing care do like to give up their home voluntarily. Next to innovative forms of dwelling, home replacement, technical aids and us of information and communication technology (ICT), efforts to strengthen the older persons' independence of maintaining mobility in their home environment (life space) is emphasised in this article. The particular focus is on the use of preventative strategies and to support geriatric network facilities.

Spinocerebellar ataxia type 6 protein aggregates cause deficits in motor learning and cerebellar plasticity.

Spinocerebellar ataxia type 6 (SCA6) is linked to poly-glutamine (polyQ) within the C terminus (CT) of the pore-forming subunits of P/Q-type Ca(2+) channels (Cav2.1) and is characterized by CT protein aggregates found in cerebellar Purkinje cells (PCs). One hypothesis regarding SCA6 disease is that a CT fragment of the Cav2.1 channel, which is detected specifically in cytosolic and nuclear fractions in SCA6 patients, is associated with the SCA6 pathogenesis. To test this hypothesis, we expressed P/Q-type channel protein fragments from two different human CT splice variants, as predicted from SCA6 patients, in PCs of mice using viral and transgenic approaches. These splice variants represent a short (CT-short without polyQs) and a long (CT-long with 27 polyQs) CT fragment. Our results show that the different splice variants of the CTs differentially distribute within PCs, i.e., the short CTs reveal predominantly nuclear inclusions, whereas the long CTs prominently reveal both nuclear and cytoplasmic aggregates. Postnatal expression of CTs in PCs in mice reveals that only CT-long causes SCA6-like symptoms, i.e., deficits in eyeblink conditioning (EBC), ataxia, and PC degeneration. The physiological phenotypes associated specifically with the long CT fragment can be explained by an impairment of LTD and LTP at the parallel fiber-to-PC synapse and alteration in spontaneous PC activity. Thus, our results suggest that the polyQ carrying the CT fragment of the P/Q-type channel is sufficient to cause SCA6 pathogenesis in mice and identifies EBC as a new diagnostic strategy to evaluate Ca(2+) channel-mediated human diseases.

Dysphagia in Dementia: Influence of Dementia Severity and Food Texture on the Prevalence of Aspiration and Latency to Swallow in Hospitalized Geriatric Patients.

OBJECTIVES: To evaluate influences of disease severity and food texture on prevalence and type of dysphagia in hospitalized geriatric patients. DESIGN: We screened for dysphagia in 161 geriatric inpatients with different forms of dementia and 30 control patients. MEASUREMENTS: Signs of aspiration were registered with 3 different food consistencies (water, apple puree, and slice of an apple) and the latency until the first swallow was documented. SETTING: Geriatric department of an academic teaching hospital in Hamburg, Germany. RESULTS: Compared with the controls, patients with dementia more often showed signs of aspiration. In the patients with dementia, signs of aspiration occurred more frequently with water (35.6%) than with a slice of an apple (15.1%) or apple puree (6.3%). We observed an inverse relationship between Mini-Mental State Examination score level and the suspected rate of aspiration, as well as with the length of latency until the first swallow of puree. CONCLUSIONS: The prevalence of dysphagia is high in patients with dementia, especially in patients with moderate to severe cognitive impairment. The relationships observed in this study encourage screening for dysphagia and adapting meal consistencies to prevent aspiration in patients with dementia.

Geriatric patients with cognitive impairment.

BACKGROUND: Hospitals are now faced with increasing numbers of cognitively impaired patients aged 80 and older who are at increased risk of treatment complications. This study concerns the outcomes when such patients are treated in a specialized ward for cognitive geriatric medicine. METHODS: Observation of a cohort of 2084 patients from 2009 to 2014, supplemented by a sample of 380 patients from the hospital cohort of the Longitudinal Urban Cohort Ageing Study (LUCAS) for the years 2010 and 2011. RESULTS: Geriatric inpatients with cognitive impairment tend to be multimorbid. Half of the patients studied (1031 of 2084 patients) were admitted to the hospital on an emergency basis. Complications arising on the ward that necessitated transfer elsewhere arose in 2.6% (51 of 2084 patients). Moreover, analysis of the sample of 380 patients from the LUCAS cohort revealed that the treatments they underwent during hospitalization were associated with an improvement of their functional state: their mean overall score on the Barthel index rose from 39.8 ± 24.3 (median, 35) on admission to 52.7 ± 27.0 (median, 55) on discharge. The percentage of patients being treated with 5 or more drugs fell from 98.2% (373/380) on admission to 79.3% (314/362) on discharge. The percentage receiving potentially inappropriate medications (PIM), as defined by the PRISCUS list, fell from 45% to 13.3%, while the percentage of drug orders and prescriptions involving PIM fell from 7.8 % (327/4181) to 2.0% (53/2600). 70% of the patients were discharged to the same living situation where they had been before admission. CONCLUSION: In this study, structured geriatric treatment in a cohort of older acutely ill patients with cognitive impairment was associated with improvement of functions that are relevant to everyday life, as well as with a reduction of polypharmacy. Controlled studies are needed to confirm the observed benefit.

Long-term prediction of changes in health status, frailty, nursing care and mortality in community-dwelling senior citizens­results from the Longitudinal Urban Cohort Ageing Study (LUCAS).

BACKGROUND: The detection of incipient functional decline in elderly persons is not an easy task. Here, we propose the self-reporting Functional Ability Index (FA index) suitable to screen functional competence in senior citizens in the community setting. Its prognostic validity was investigated in the Longitudinal Urban Cohort Ageing Study (LUCAS). METHODS: This index is based equally on both, resources and risks/functional restrictions which precede ADL limitations. Since 2001, the FA index was tested in the LUCAS cohort without any ADL restrictions at baseline (n = 1,679), and followed up by repeated questionnaires in Hamburg, Germany. RESULTS: Applying the index, 1,022 LUCAS participants were initially classified as Robust (60.9%), 220 as postRobust (13.1%), 172 as preFrail (10.2%) and 265 as Frail (15.8%). This classification correlated with self-reported health, chronic pain and depressive mood (rank correlations 0.42, 0.26, 0.21; all p < .0001). Survival analyses showed significant differences between these classes as determined by the FA index: the initially Robust survived longest, the Frail shortest (p < .0001). Analyses of the time to need of nursing care revealed similar results. Significant differences persisted after adjustment for age, sex and self-reported health. CONCLUSIONS: Disability free lifetime and its development over time are important topics in public health. In this context, the FA index presented here provides answers to two questions. First, how to screen the heterogeneous population of community-dwelling senior citizens, i.e. for their functional ability/competence, and second, how far away they are from disability/dependency. Furthermore, the index provides a tool to address the urgent question whether incipient functional decline/incipient frailty can be recognized early to be influenced positively. The FA index predicted change in functional status, future need of nursing care, and mortality in an unselected population of community-dwelling seniors. It implies an operational specification of the classification into Robust, postRobust, preFrail and Frail. Based on a self-administered questionnaire, the FA index allows easy screening of elderly persons for declining functional competence. Thereby, incipient functional decline is recognized, e.g. in GPs' practices and senior community health centers, to initiate early appropriate preventive action.

Optogenetic modulation and multi-electrode analysis of cerebellar networks in vivo.

The firing patterns of cerebellar Purkinje cells (PCs), as the sole output of the cerebellar cortex, determine and tune motor behavior. PC firing is modulated by various inputs from different brain regions and by cell-types including granule cells (GCs), climbing fibers and inhibitory interneurons. To understand how signal integration in PCs occurs and how subtle changes in the modulation of PC firing lead to adjustment of motor behaviors, it is important to precisely record PC firing in vivo and to control modulatory pathways in a spatio-temporal manner. Combining optogenetic and multi-electrode approaches, we established a new method to integrate light-guides into a multi-electrode system. With this method we are able to variably position the light-guide in defined regions relative to the recording electrode with micrometer precision. We show that PC firing can be precisely monitored and modulated by light-activation of channelrhodopsin-2 (ChR2) expressed in PCs, GCs and interneurons. Thus, this method is ideally suited to investigate the spatio/temporal modulation of PCs in anesthetized and in behaving mice.