[Subjective health of older people in view of the SF-36: Values from a large community-based sample]. / Die subjektive Gesundheit älterer Menschen im Spiegel des SF-36: Normwerte aus einer bevölkerungsrepräsentativen Erhebung.

This paper presents data regarding the German version of the SF-36 (Short Form 36 Questionnaire; Bullinger and Kirchberger, 1998) that were obtained from a large community based sample of the German population. Results are reported for the elderly at the age of 60 and older from the German general population (N = 690; 57% female). Presented are the internal consistencies of the scales (Cronbach's Alpha), the intercorrelations of the scales, mean values of the scales separated by sex, age group (60-64 years, 65-69 years, 70-74 years, 75-79 years, 80 years and older) and residence (Eastern and Western Germany) as well as percentile ranks for the whole sample.

[The emotional sensitivity of elderly people--validation of the Profile of Mood States for people over 60 years]. / Die emotionale Befindlichkeit älterer Menschen -- Normierung des Profile of Mood States für über 60-Jährige.

The German short version of the "Profile of Mood States (POMS)" with 35 items (seven-point response scale; rating related to the past 24 hours) was psychometrically tested in a sample of elderly people of 60 years of age and older (n=690; 57% female). The internal structure of the POMS with four factors (dejection, fatigue, displeasure, vigour) could largely be replicated, even though the first three factors are intercorrelated. Reliability of the scales appears to be very good. The convergent validity of the POMS scales could be proved by correlations with the Beck Depression Inventory and the SF-36. Specific norms are presented for four age groups, men and women and elderly living in Eastern and Western Germany. So it seems appropriate to use the German short version of the POMS as a valid and economic instrument for gerontological studies.

[Attitudes towards eroticism and sexuality in the elderly over 60 years of age]. / Einstellungen zu Erotik und sexueller Aktivität bei über 60-Jährigen.

BACKGROUND: Sexual activities in the elderly were considered as a taboo for a long time. Therefore only few empirical results exist regarding sexuality in higher age. This paper presents results of interviews with persons at the age of 60 years or older regarding their sexual activities and aspects of eroticism. PARTICIPANTS AND METHODS: N = 728 persons at the age of 60 years or older were interviewed by means of structured interviews and questionnaires. RESULTS: Relationship-oriented aspects like confidence, love, faith and communication with the partner were more important than aspects like passion, change or physical attraction. Compared with people younger than 60 years, sexual activity is regarded as less important. This is mainly explained by the elderly with body complaints. Men wish more sexual activity than women, but experience more body complaints than women. Women more often than men have no partner for sexual activity. CONCLUSIONS: Sexuality in the elderly is not only influenced by body functions. Important factors are also relationship-oriented aspects, subjective attitudes regarding one's own body, subjects health and attitudes regarding sexuality.

[Somatoform complaints in elderly of Germany]. / Somatoforme Beschwerden bei über 60-Jährigen in Deutschland.

The aim of this paper is to report on the prevalence of somatoform disorders in older age. A total of 630 representatively selected persons older than 60 years were asked to complete the questionnaire SOMS 2 (Screening for somatoform disorders, Rief et al., 1997). The results show that somatoform pain is very common in old age. Of the people, 71.8% report at least one symptom, 50.5% on at least four symptoms and 23.4% suffer from at least eight symptoms. The frequency of somatoform symptoms is much higher in people over 60 years old than in persons who are younger than 60 years old. Pain is very often localized in several body regions. In contrast to findings from younger age groups, older women do not report more somatoform pain than older men. When looking at the differences between "young olds" and "old olds" somatoform pain increases with increasing age. The high frequency of somatoform pain in older people is in clear contrast to the low prevalences of somatoform disorders defined according to DSM-IV or ICD-10 (0%-0.3%). The results show that the real prevalence of somatoform disorders is extremely underestimated because of the restrictive criteria of the diagnosis systems.

[The influence of socio-demographic factors on personality dimensions in the elderly]. / Persönlichkeitsmerkmale über 60-Jähriger im Kontext sozio-demographischer Faktoren.

The personality factors neuroticism, extraversion, openness for experiences, agreeableness and conscientiousness were investigated in a random population sample of n=497 people over 60 years old with the help of a German version of the NEO Five-Factor Inventory - NEO-FFI (2, 6). The results were compared with those from n=497 people between 18 and 30 years old and with those from n=1051 people between 31 and 60 years old. The elderly described themselves as being less extroverted, less open, more agreeable and more conscientious than the people under 60 years old. Means of the personality factors were not associated with age in the over 60 years old. The average level of neuroticism and conscientiousness was significantly higher in women over 60 years old than in men. People living in the former Eastern Germany were more open and conscientiousness than those living in former Western Germany. A higher level of openness was found in people with a higher educational level. There was a higher level of neuroticism in people living without a partner than in those living with a partner.

[The prevalence of pain in the elderly German population: results of population-based studies with the Giessen Subjective Complaints List (Giessener Beschwerdebogen GBB)]. / Prävalenz von Schmerzen im Alter: Ergebnisse repräsentativer Befragungen der deutschen Altenbevälkerung mit dem Giessener Beschwerdebogen.

METHODS: In a separate population-based cross-sectional study (n = 593; 53,62% female) using the short form of the Giessen Subjective Complaints List (Giessener Beschwerdebogen GBB-24), data was collected on current pain in various parts of the body (limbs, back, neck, head, stomach). RESULTS: Rheumatic pain is most frequent in the elderly. At the age of 76 years or older more than 90% are affected from this form of pain. Even if the frequency of pain in the highest grading is lightly higher for women than for men, there are only few significant sex-related effects. Furthermore, there are only few age-related effects beyond the age of 60. CONCLUSIONS: The results show that pain is a common problem in the elderly.

[Normal values of the Giessen Test for over 60-year-old probands]. / Normierung des Giessen-Tests für über 60-Jährige.

A representative sample of N = 507 elderly over 60 years of age (mean age: 69.46 years; 42.6% male; 57.4% female) was assessed in 1999 by means of the Giessen test (GT) in 1999. Means and standard deviations are given for sub-groups according to gender, age and place of residence (East vs. West Germany) for items and scales, and percentile ranks are given for the GT scales. Furthermore, reliability of the GT scales for the elderly is reported (Cronbach's alpha; split-half-reliability). Reliability is satisfactory except for the scales "Control" and "Dominance". Further, the correlations between the GT scales and the scales of the NEO-FFI are given. The correlations of the GT scales "Social response", "Openness", and "Social potency" with the scale "Extraversion" of the NEO-FFI indicate a clear interpersonal component of the GT. A depressive mood as measured by the Giessen test corresponds positively with neuroticism as measured by the NEO-FFI.

[Anxiety and depression in the general population over 60 years old]. / Angst und Depressivität in der über 60-jährigen Allgemeinbevölkerung.

BACKGROUND: Anxiety and depression lead to extensive utilization of the health service. Frequency and extent of symptoms of anxiety and depression were assessed in the elderly general population. PARTICIPANTS AND METHOD: In a random community sample of 622 elderly persons aged above 60 years (mean age 69.55 years; 56.1% women), the frequency of anxiety and depression was assessed by means of the Hospital Anxiety and Depression Scale. RESULTS: Probable anxiety was found in 7.6% of the elderly, probable depression in 27.5%. Negative affectivity (based on the total scale) was found in 31.7% of the elderly. Self-reported anxiety and depression symptoms correlated to a considerable extent (r = 0.69). There were higher rates of probable anxiety and depression in women than in men. However, a significant effect of the sex on anxiety and depression scores was not found. There was a significant effect of age, with higher depression rates with increasing age. Anxiety and depression correlate significantly positively with the fatigue syndrome and with subjective bodily complaints and significantly negatively with different aspects of quality of life. CONCLUSIONS: Physical complaints in the elderly cannot be directly traced back to age-correlated multimorbidity. Rather, elderly persons with nonspecific bodily complaints and fatigue should also be screened for anxiety and depression.

[Utilization of medical services and medication intake of patients over 60 in Germany--health related, social structure related, socio-demographic and subjective factors]. / Inanspruchnahme medizinischer Leistungen und Medikamenteneinnahme bei über 60jährigen in Deutschland--gesundheitliche, sozialstrukturelle, sozio-demographische und subjektive Faktoren.

In a community sample of 394 elderly aged 61 years and older from East and West Germany, diseases, contacts with general practitioners and specialists, the use of medicine, attitudes regarding health and illness, the subjective health, psychic problems, social support, social integration, social burden, and socio-demographic variables were assessed. Based on these data the determinants for the contact of physicians and the use of medicine were analyzed. The results confirmed the frequency of multimorbidity in the elderly; on average we found three different diseases at the same time for each person. In nearly 10% of the sample we found seven diagnoses existing at the same time. 88% had contact with a general practitioner at least once a year, 97% had contact either with a general practitioner or with a specialist once a year. 55.8% took at least one medicine each day. The number of diseases existing at the same time was the most determining variable for the contact of physicians and the use of medicine. Furthermore, the elderly had more contact with physicians and took more medicine if they thought they were susceptible to diseases in a high degree, and if they rated their own health as poor. Fewer contacts with physicians and a lower use of medicine were found in those elderly that rated health behavior as little useful, that had low control beliefs regarding their own health, and that experienced only a low degree of health-related limitations in their everyday life. Furthermore, we found a higher use of medicine if there was little social support. There were no significant age-related or sex-related differences regarding the contact of practitioners or the use of medicine.

[The Antonovsky Sense of Coherence Scale. Test statistical evaluation of a representative population sample and construction of a brief scale]. / Die Sense of Coherence Scale von Antonovsky. Teststatistische Uberprüfung in einer repräsentativen Bevölkerungsstichprobe und Konstruktion einer Kurzskala.

In this article we will describe the evaluation of Antonovsky's 29-items Sense of Coherence Scale (SOC-29) in a large community sample (n = 2.005) of the German population and the development of the Leipzig Short Scale (SOC-L9), which consists of only 9 items. The SOC-29 has a high internal consistency (alpha = 0.92), however, the SOC-subscales (comprehensibility, manageability, meaningfulness) were correlated with each other. A principal component factor analysis did not identify the 3-factor structure of the SOC-Scale. It appears that the best solution consists of one global factor. The newly developed SOC-L9, conceptualized as an unidimensional scale, is a reliable and valid instrument, which allows to assess the SOC economically. In our study the Sense of Coherence depended on age and gender. Women and older people reported a lower SOC. Furthermore we found significant associations between SOC and different subjective health measures. A high SOC was associated with both a lower extent of subjective body complaints and somatoform symptoms and with minor health-related problems in daily living.

[Coping with disease in the elderly - the effect of perceived control, subjective morbidity, social support and socio-demographic variables]. / Formen der Krankheitsbewältigung bei älteren Menschen - differentielle Effekte von Kontrollerleben, subjektiver Morbidität, sozialer Unterstützung und sozio-demographischen Variablen.

In a community sample of 165 elderly aged 61 to 96 years (mean 69.65 years) from East and West Germany, present diseases, subjective health, impairments, health-related control-beliefs, social support (F-SOZU; Sommer & Fydrich, 1989), and health related coping-styles ("Bern Coping Styles Questionnaire" BEFO; Heim et al., 1991) were assessed. By means of a stepwise multiple regression analysis, the differential impact of control beliefs, subjective morbidity, subjective health, social support, social integration, social burden, and socio-demographic variables (age, sex, educational level) was analyzed. Elderly with little health related impairments, emotional support, and a relatively high educational level tried to cope with diseases by lowering the affective burden by cognitive and behavioral strategies. A growing number of diseases, a high level of practical help by others, but also a high degree of social burden were the best predictors for a health related coping strategy that is characterized by avoiding the preoccupation with the disease and by searching for emotional support. A health related coping style that is characterized by lamentation, brooding, and resignation was predicted best by poor subjective health, a high degree of social burden, and a low educational level.

[Effects of chronic stress on physical or psychological health - an analysis of family caregivers of dementia patients]. / Auswirkungen chronischer Belastungen auf die physische und psychische Befindlichkeit - eine Prozessanalyse bei Pflegenden Angehörigen von Demenzkranken.

The effects of chronical strains on physical or psychological health are subject of this paper. Stress-related symptoms of family caregivers of dementia patients have been proven in various studies. For this group of people an analysis of the health risk factors is regarded as to be especially important. Diary investigations allow to identify the individual assessment (by the caring person) of factors related to the care situation and to recognize the health and quality of sleep have been used as indicators regarding the state of health. In this study strong differences in the individual view of stress factors and their effects on psychological an physical state of the caring person are shown.

["I never feel free"--women care for the demented husband, father or mother]. / "Frei fühle ich mich nie"--Frauen pflegen ihren an Demenz erkrankten Ehemann, Vater oder Mutter.

The care of elderly relatives with dementia is not any longer a job exclusively done by women nevertheless the care for three quarters of patients is mainly provided by women. This study comprises 70 persons consulting the "Alzheimer Advice Centre" in Leipzig. The aim was to examine the difference between nursing men and women with regard to the way they experience their situation. Independent of sex nursing persons experience their job as a strain. Especially spouses suffer from depressive disorders, states of exhaustion and pain in arms and legs. Nursing spouses differ in their ways of coping with regard to their sex. Wives experience the symptoms of dementia and the limitation of personal freedom as stressing whereas husbands pick out as a central theme the worries about their wives. Men use instrumental support in the nursing situation more often than wives. Altogether mainly women provide care. Sometimes they even take care of several persons. Therefore the resulting strains and limitations are to be regarded as special problems of women.

The SIMA-project: effects of 1 year cognitive and psychomotor training on cognitive abilities of the elderly.

In an interdisciplinary project on maintaining and supporting independent living in old age, (a) competence training, (b) memory training and (c) psychomotor training as well as (d) combined competence and psychomotor training and (e) combined memory and psychomotor training was performed with n = 309 elderly of 75 to 89 years of age for 9 months. Regardless of treatment conditions, an age-related decline of health and subjective well-being was found 1 year after the end of the training. The specific training measures each led to highly significant specific improvements of the trained functions. A favorable influence of competence training on everyday coping and hence on active strategies for staying independent as well as of memory training on all cognitive functions and especially on memory performance was found. While global psychomotor performance was not significantly improved, effects of psychomotor training on specific functions were detected. In addition, the combined psychomotor and memory training led to an improvement of psychomotor performance and to a reduction of symptoms of dementia, even though neither psychomotor training alone nor memory training alone resulted in such effects. Neurophysiological changes leading to a provision of reserve-capacity of CNS-performance are among other effects assumed as an explanation.

[Physical complaints in old age: standardization of the Giessen Complaint Questionnaire GBB-24 in over 60-year-old patients]. / Körperbeschwerden im Alter: Standardisierung des Giessener Beschwerdebogens GBB-24 bei über 60jährigen.

Psychosomatic and functional body complaints in the elderly became more significant in psychosomatic research and therapy during recent years. On the other hand, there is a lack of epidemiological studies on this topic. The present paper presents results of a study with a community sample of 764 elderly older than 60 years. Body complaints were self-rated by the Giessener Beschwerdebogen (The Giessen Subjective Complaints List) GBB (Brähler and Scheer, 1995). This study presents age-specific and sex-specific norms for the GBB. Compared to representative samples of younger people (< 30 years of age, 30-60 years of age) we found a significantly higher amount of body complaints in the elderly (exhaustion, stomach trouble, rheumatic pains, heart trouble, and the sum score of body complaints). Within the age group over 60 years, there is an increasing amount of body complaints with higher age. The amount of body complaints is higher for women than for men. Besides analyzing age-specific and sex-specific body complaints, the correlation with personality characteristics and with life satisfaction and the influence of health-related beliefs were analyzed. There were greater body complaints in elderly with depressive mood and with low internal control beliefs regarding health. The elderly that consider the psychological influence on health significant experience a greater amount of body complaints than the other.

[Perception of stress by caregiving relatives of dementia patients]. / Belastungserleben pflegender Angehöriger von Demenzpatienten.

The increasing interest in research on burden and health risks of family caregivers was furthered by the increasing prevalence rate of dementias in the elderly and by the fact that 80-90% of the demented are cared for by near family members. The present paper presents some results of a study investigating stress-related symptoms of family caregivers. From a clinical perspective these results point to needed interventions for supporting the caregivers. Specific burden components, depression, and body complaints were assessed in n = 70 family caregivers of dementia patients. A substantial degree of social isolation, depressive disorders, and physical complaints could be found. The level of burden experienced was not directly related to severity of dementia and to impairment of the demented or to structural conditions of the care (degree and length of care). Differences were observed between spouse caregivers and other relatives; spouses suffer more psychosomatic complaints and depression.

Functional rating scales and psychometric assessment in Alzheimer's disease: applications in pharmacological trials.

New findings on cognitive aging show that decline in brain functions is not part of a general decline of functioning in old age. We know now that with increasing age there is a differentiation of cognitive functions into two independent dimensions (fluid and crystallized functions). This two-dimensional model allows a more precise description of the cognitive aging process and of pathological changes. While crystallized cognitive abilities can be improved by training till late in life, fluid cognitive functions are subject to a progressive decrease starting as early as age 30, becoming most evident in cases of organic mental disorders. Thus, pathological aging is not necessarily accompanied by global loss of functions. Different abilities undergo changes in different ways, a fact taken into consideration by modern methods of psychometric evaluation. Beyond the aging processes mentioned previously, cognitive and behavioral changes in the elderly may be considered to be early indicators of organic mental disorders. The Nuremberg Self-Evaluation List seems to be a promising approach to diagnosis.