[Efficacy of an intervention programme on burnout symptoms of partners of depressed patients]. / Wirksamkeit eines Interventionsprogramms auf die Burnout-Belastung von Lebenspartnern depressiv Erkrankter.

AIM OF THE STUDY: A newly developed group intervention programme was evaluated with regard to its effectiveness to decrease the burnout symptoms of the partners of depressed patients. METHODS: Within a period of six months, a group of 66 persons has taken part in the intervention for a total of twelve group sessions. A control group consisted of 50 persons without any intervention. Burnout was assessed using the German version of the Maslach Burnout Inventory (MBI). To evaluate the time effect, the burnout dimensions were used as independent variables in random effects models. RESULTS: Over the analyzed period of time no significant positive effect was measured on any of the assessed burnout dimensions. CONCLUSIONS: An increased inclusion of depressed patients in the intervention as well as an increased intensity and a lowering of the admission threshold for the heavily burdened relatives could increase the effectiveness of the program.

[A programme to assist close relatives and lifelong partners in caring for persons suffering from depressions or schizophrenic disorders]. / Ein Unterstützungsprogramm für Lebenspartner von Menschen mit depressiven oder schizophrenen Störungen.

OBJECTIVE: Lifelong partners or close relatives of persons suffering from mental disorders will naturally step in to help by assuming a great variety of tasks. By witnessing their relative's illness on a daily basis, they are exposed to many burdens with a negative impact on their own well-being. Hence, supporting the relatives of persons with mental disorders appears imperative. While there are various approaches to working with relatives, there are hardly any specific programmes for working with certain groups of relatives such as spouses, children or siblings. METHODS: Basing on a discussion of the various approaches to looking after relatives, development of a programme is described aimed at specifically supporting spouses of persons suffering from depression or schizophrenia. RESULTS: The concept of our programme is presented and results of its evaluation by participants are reported. CONCLUSION: The initial experiences with the support programme are quite promising. An evaluation of its effects, based on a case-control-design, is currently under way.

[Need for help and nursing care in the elderly of the new German territories: results of a Leipzig long-term study of the elderly population (LEILA75+)]. / Hilfe- und Pflegebedürftigkeit im Alter in den neuen Bundesländern: Ergebnisse aus der Leipziger Langzeitstudie in der Altenbevölkerung (LEILA75+).

In a representative sample of the Leipzig population age 75 and older 61.8% of the participants showed relevant deficits in their capacity of independent living as assessed by a combined ADL/IADL scale. According to a staging model of care as promoted by Schneekloth and coworkers, 17% of the sample was in need of care. Especially, mobility-related instrumental activities of daily living (IADL) such as shopping, cleaning and visiting are affected, but also basic activities (ADL) such as climbing stairs, walking or taking a shower/bath. Each of these activities created problems for more than 45% of the participants. Between 18 and 33% of the sample even regarded it as impossible to carry out these activities. Expectedly, the percentages of assistance needed with ADLs/IADLs appeared to be strongly age-related with exponential increases beyond the age of 85. Beyond effects of sampling and life expectancy, significantly more women suffered from decreases in their capacity of independent living. Community-dwelling elderly on average had a 10% higher rate of problems with ADLs/IADLs as compared to German reference data from the studies on "Chances and Limits of Independent Living in Old Age"; the rate of institutionalized participants, who regarded it impossible to carry out these activities, was even higher by about 30%. As discussed by Schneekloth et al., data from the LEILA study support the hypothesized pattern that ecological disadvantages under both community-dwelling as well as insitutionalized living conditions lead to higher percentages of elderly in the former East German states who are in need of care. As a consequence and although more disabled, elderly seem to stay longer under community-dwelling living conditions and move even more disabled into an institutionalized form of living.

The Alzheimer's disease activities of daily living international scale (ADL-IS).

BACKGROUND: Activities of daily living (ADL) deficits are integral components of dementia disorders, and ADL measures are among the most robust markers of the course of Alzheimer's disease (AD). Despite this acknowledged importance, no clearly useful ADL instrument for cross-cultural application in pharmacologic trials in the early stages of AD had been available. METHOD: An international effort was launched to develop an ADL scale for pharmacologic trials in early AD. Steps taken from 1990 to the present included: (1) international scientific working group meetings and reviews, (2) reviews of existing measures, (3) collating of existent, nonredundant items, (4) querying experts for new items, (5) interviews with informants and subjects in the USA, France, and Germany, toward the identification of potential new items, (6) identification of an item pool based upon these procedures, (7) creation of a trial instrument, (8) piloting of this instrument, and (9) refinement of the scale based upon statistical analysis of the pilot data. Final item selection was based upon: (1) relevance for > or = 80% of subjects in severity-stratified USA and German samples; (2) absence of gender and national biases; (3) significant (p <.05) discrimination between (a) normal versus mildly impaired and (b) mildly impaired versus moderately to moderately severely impaired subjects; and (4) Global Deterioration Scale (GDS) scores accounting for > or = 12% of variance in the item after controlling for age and gender. RESULTS: An ADL scale consisting of 40 items that correlate with the global and cognitive progress of AD is developed for international usage in pharmacologic trials in incipient, mild, moderate, and moderately severe AD. The scale contains 40 items falling within 13 ADL categories. The 40-item scale is shown to have .81 correlation with GDS staging, .81 with mental status assessment (Mini-Mental State Examination), and .81 with a psychometric test (the SKT) (p values < .001). CONCLUSION: This scale can be used to measure therapeutic response in AD.

Limitations in activities of daily living: towards a better understanding of subthreshold mental disorders in old age.

Based on a representative sample of elderly subjects, a description of the limitations in activities of daily living (ADL) and instrumental ADL (IADL) at subthreshold levels of dementia and depression is presented and compared against a sample of psychiatric non-cases and samples with specified levels of the respective illnesses. Additionally, it was analyzed whether these limitations are useful diagnostic markers with regard to subdiagnostic psychiatric disorders. Even at subthreshold levels of depression and dementia, elderly people suffer quite extensively from ADL and IADL limitations. However, multifactorial analyses indicate little evidence that these limitations are specific for psychiatric morbidity, be it at subdiagnostic or specified levels. By and large, ADL and IADL limitations in an elderly sample have to be considered instead as consequences of physical health-related comorbidity. Thus, issues regarding the treatment of ADL and IADL limitations at subdiagnostic as well as specified levels of psychiatric morbidity may not be solved from a psychiatric point of view alone, and a multifactorial, i.e., multiprofessional, perspective is strongly recommended.

Daily life in very old age: everyday activities as expression of successful living.

The goals of this article are (a) to describe the daily life of the very old in terms of frequency, duration, variety, and social and physical contexts of activities, and (b) to examine the effects of background variables (e.g., age, sex, residential and marital status, income, and education) on late life activity engagement. A representative sample of 516 adults aged 70-105 was interviewed about their activities using the Yesterday Interview. In contrast to most research on activity engagement, this measurement approach allows for assessment of both the type and context of activities engaged in during the day preceding the interview. The results indicated high frequencies of obligatory activities but also showed substantial time spent in discretionary activities, with television viewing occupying most of the participants' leisure time. Most activities were done alone and at home. In bivariate and multiple regression analyses, age and residential status had the strongest association with activity frequency, duration, and variety; the oldest-old and those residing in long-term care facilities had lower levels of activity engagement. Results are discussed in terms of their relevance for successful aging.

[Dementias and daily competence: effects beyond ADL and IADL]. / Demenzerkrankungen und Alltagskompetenz: Effekte auch jenseits von ADL und IADL.

Using a time-budget method in a 3 year longitudinal study with a control group design, substantial reductions in the engagement of nonobligatory instrumental, social, and leisure activities could be found in a group of mildly to moderately demented patients. Controlling these changes for differences in baseline parameters, the dementia-specific reduction was about 1 1/2 hours compared to a non-psychiatric control group. These clinically relevant changes in activity levels underscore the importance of these activity domains with regard to the development of diagnostically useful indicators at the early stages of dementia. Time-budget methods seem to be particularly useful to close the diagnostic gap with regard to the assessment of everyday competence indicators especially at early stages of the dementia illness.

[Schizophrenic patients in ambulatory treatment of a psychiatric hospital and in general practice of established psychiatrists]. / Schizophrene Patienten in ambulanter Behandlung eines psychiatrischen Krankenhauses und in Praxen niedergelassener Nervenärzte.

Two large samples of schizophrenic patients treated in a psychiatric hospital outpatient clinic (n = 108) and by psychiatrists in office practice (n = 265) are compared in regard to socio-demographic and illness characteristics, pharmacological treatment, tardive dyskinesia rate and psychopathological status--also with respect to results on an outcome-scale. For the outpatient clinic patients changes in hospitalization rates and duration of stay, together with predictors of psychosocial outcome dimensions are reported. The strongest differences between the samples are found in a more complicated course of illness for the outpatient clinic patients, which is interpreted as indication for a higher vulnerability. Against expectation, socio-demographic variables showed no significant differences.

[Definition, significance and measurement of disease concepts of patients. The Disease Concept Scale for schizophrenic patients]. / Zur Definition, Bedeutung und Messung der Krankheitskonzepte von Patienten. Die Krankheitskonzeptskala (KK-Skala) für schizophrene Patienten.

Illness concepts represent cognitive interpretations, explanations and predictions of health status. Illness concepts are a consequence and an expression of the patient's cultural background, view of the world, value system, way of living, and personal life experiences. Illness concepts are significant in that they influence patient's informed consent and compliance behavior. Illness concepts have been formulated in phenomenological-descriptive, formal-structural and psychological approaches. Based on these alternative conceptualizations, a scale was developed to measure seven dimensions of illness concepts. including trust in medication, trust in the treating physician, negative treatment expectations, guilt, chance control, susceptibility, and idiosyncratic assumptions. The reliability and validity of the scale (KK-scale) was tested in a group of schizophrenic patients in different treatment settings. The psychometric properties of the scale were found to be satisfactory. Support for the discriminant validity of the scale was found in relation to patient's age, education, sex, and compliance treatment institution.