Correction to: Dimensions within 24 weight history indices and their association with inpatient treatment outcome in adults with anorexia nervosa: analysis of routine data.

[This corrects the article DOI: 10.1186/s40337-019-0249-z.].

Care challenges in older general hospital patients : Impact of cognitive impairment and other patient-related factors.

BACKGROUND: Older general hospital patients, particularly those with cognitive impairment, frequently experience adverse events and other care complications during their stay. As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment). METHODS: A cross-sectional representative study comprising 1469 patients aged ≥65 years from 33 randomly selected general hospitals in southern Germany (GHoSt). Data collection included the use of different data sources, e.g. structured interviews with responsible nursing staff concerning care challenges and procedures for determining the patients' cognitive status. RESULTS: Care challenges were statistically significantly (p < 0.001) more often reported for patients with dementia and/or delirium (87.5%) and mild cognitive impairment (47.9%) compared to cognitively unimpaired patients (24.6%). Adjusted odds ratios suggested cognitive impairment, impaired activities of daily living, receiving long-term care and unplanned admission as significant patient-related risk factors for care challenges. Furthermore, the occurrence of such issues was associated with the application of physical restraints, support from relatives, prescription of psycholeptics and specialist consultations. CONCLUSION: The findings suggest a strong impact of different degrees of cognitive impairment on challenges in care. The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations.

[Pathways to Care and Duration of Untreated Illness of Inpatients with Anorexia and Bulimia nervosa]. / Wege in die Versorgung und Behandlungslatenzen bei stationären Patienten mit Anorexia und Bulimia nervosa.

OBJECTIVE: The study aimed to investigate pathways to care and duration of untreated illness of inpatients with eating disorders. METHODS: 206 patients were assessed using a self-developed questionnaire. RESULTS: On average, the delay between the onset of the eating disorder and treatment initiation was up to five years. The diagnosis of bulimia nervosa, a higher age and lack of problem perception predicted a higher duration of untreated illness. CONCLUSION: Duration of untreated illness should be reduced by adequate interventions in order to prevent chronification.

Dimensions within 24 weight history indices and their association with inpatient treatment outcome in adults with anorexia nervosa: analysis of routine data.

OBJECTIVE: Next to weight suppression (WS), there are a range of less often examined weight history indices, and improvements to the WS construct have been proposed. We aimed to examine redundancy and overlap between 24 weight history indices in order to identify suitable constructs for further investigation. METHOD: Analysis of routine data of 770 female adult inpatients treated for AN. Twenty-four indices based on highest, lowest, and current weight, as well as developmental aspects were calculated and employed in correlational and factor analyses. The indices' ability to predict core outcomes of inpatient treatment was investigated with regression analyses. RESULTS: Five factors emerged: "WS and highest weight", "weight elevation (i.e., difference between current and lowest weight since puberty)", "lowest weight", "age at past highest or lowest weight", and "years since past highest or lowest weight". The constructs within these factors showed high correlations. Most indices related to change in weight, ED psychopathology, as well as behavioral aspect of AN. While measures of WE related more to weight gain and general ED Psychopathology, indices including lowest weight were stronger predictors of changes in slimness ideal and inappropriate compensatory behaviors. CONCLUSION: Many proposed weight history indices are closely related and the amount of additional information in complex indices appears questionable. While highest weight seems to dominate indices of WS, WE may rely on current weight. These findings highlight that different aspects of weight history may relate to different aspects of current ED symptoms and their amenability to change under specialized treatment.

Predicting Cognitive Decline and Dementia with the Newly Normed SKT Short Cognitive Performance Test.

OBJECTIVE: The aim of this article was to determine the criterion-related validity of the newly normed SKT (Syndrom-Kurztest) Short Cognitive Performance Test with the onset of dementia as the predicted criterion. METHODS: The cognitive ability was tested with the SKT in a sample of 546 cognitively healthy adults aged 65-85 years. New cases of mild cognitive impairment (MCI) or dementia were determined in 3 follow-up investigations at 1-year intervals. Each participant's cognitive status was rated on the Clinical Dementia Rating Scale. The cognitive status according to the SKT is presented in terms of a traffic light system. RESULTS: Based on Kaplan-Meier estimators, the trajectories of the different SKT traffic light labels were investigated over 3 years. The trajectories were significantly different, representing differential risks for dementia onset. In comparison to the green group, the hazard ratio (HR) for the development of dementia and MCI amounted to HR 6.63 (95% CI 2.75-15.96) and HR 2.34 (95% CI 1.37-3.99), respectively, in the yellow group, and to HR 25.40 (95% CI 10.73-60.14) and HR 3.83 (95% CI 1.86-7.86), respectively, in the red group. CONCLUSIONS: The newly normed SKT showed a high predictive validity for the onset of dementia.

Impact of comorbid borderline personality disorder on inpatient treatment for bulimia nervosa: analysis of routine data.

BACKGROUND: A substantial rate of patients with bulimia nervosa (BN) also suffer from Borderline personality disorder (BN + BPD). It is widely unknown how these comorbid patients with BN + BPD present and respond to inpatient treatment. Aims of the study were to examine (1) specific characteristics of patients with BN + BPD at admission, discharge, and during treatment, and (2) differential effects of inpatient treatment for BN vs. BN + BPD. METHOD: We analyzed routine data of inpatients admitted for the treatment of BN between 2013 and 2017 in a specialized hospital for eating disorders. (1) Cross-sectional differences were examined with independent t-tests and χ2-tests; and (2) treatment effects pertaining to eating disorders symptoms, depression, psychosocial functioning and general psychopathology with repeated measures analysis of variance. RESULTS: Of 1298 inpatients (96% female), 13.2% also had a diagnosis of BPD. (1) Patients with BN + BPD had more previous inpatient treatments (p = 0.001), had a longer length of stay (p = 0.003), gained more weight during treatment (p = 0.006), and were more often irregularly discharged (p = 0.018) as well as rated as unfit to work at discharge (p = 0.003). (2) Both groups improved in all examined variables (all main effects treatment p <  0.001). Patients with BN + BPD showed worse symptoms aggregated across admission and discharge (all main effects diagnosis p <  0.05). Patients with BN + BPD showed smaller improvements (interaction treatment×discharge) in depressive symptoms (p = 0.018), perfectionism (p = 0.009), and asceticism (p = 0.035) and discharge scores mostly lay in the range of the admission scores of the BN-only group. CONCLUSION: Patients with BN + BPD improve during intense and specialized inpatient treatment, yet, retain pronounced impairment at discharge despite longer treatment. Treatment needs to be improved and should focus on transdiagnostic symptoms of BN and BPD.

Applying Psycholinguistic Evidence to the Construction of a New Test of Verbal Memory in Late-Life Cognitive Decline: The Auditory Wordlist Learning Test.

The construction of the German Auditory Wordlist Learning Test (AWLT) for the assessment of verbal memory in late-life cognitive decline was guided by psycholinguistic evidence, which indicates that a word's linguistic characteristics influence its probability of being learned and recalled. The AWLT includes four trials of learning, short and long delayed free recall, and a recognition task. Its words were selected with taking into account their semantic content, orthographic length, frequency in the language, and orthographic neighborhood size (the number of words derived by adding, subtracting, or replacing a single letter at a time). Through this method, it was possible to better control item and test difficulty, improve the similarity between parallel forms, and reduce bias through recall advantages for certain words due to their linguistic characteristics. In two pilot studies with cognitively healthy subjects, the AWLT showed good internal consistency, split-half reliability, and parallel forms reliability and proved able to assess learning, retention, and recognition. Overall, linguistic recall effects were mitigated; however, an advantage for high-frequency words was observed.

Are there differences between men and women in outcome of intensive inpatient treatment for anorexia nervosa? An analysis of routine data.

OBJECTIVE: Anorexia nervosa (AN) in men is rare and understudied. We compared admission characteristics and response to specialized inpatient treatment between men and women with AN. METHOD: One hundred sixteen consecutive male patients with AN were matched to 116 female patients. Patients completed the self-rating Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-S) at admission and discharge. Differences at admission and in treatment response were examined with independent samples t-tests and ANOVA for repeated measures, respectively. RESULTS: Men had lower body mass index (BMI)-percentiles (Cohen's d = -0.55), higher levels of weight suppression (d = 0.65), and higher scores in the SIAB-S general psychopathology and social integration scale (d = 0.47) at admission. There were no differences in response to treatment except for changes in BMI-percentile (F = 4.49, p = 0.035). CONCLUSIONS: There were more similarities than differences between genders in AN. Because this similarity might be confounded with traditionally "feminine" conceptualizations of AN, further studies of male AN are needed.

The Prevalence of Dementia and Cognitive Impairment in Hospitals.

BACKGROUND: The care of elderly patients with comorbid dementia poses an increasing challenge in the acute inpatient setting, yet there remains a lack of representative studies on the prevalence and distribution of dementia in general hospitals. METHODS: We conducted a cross-sectional study of patients aged 65 and older in randomly selected general hospitals in southern Germany. Patients were excluded if they were in an intensive care unit or isolation unit or if they were on specialized wards for psychiatry, neurology, or geriatric medicine. The findings are derived from patient interviews, neuropsychological testing, standardized rating scales, questioning of nursing staff, and the patients' medical records. RESULTS: 1469 patients on 172 inpatient wards of 33 hospitals were studied. 40.0% of them (95% confidence interval, [36.2; 43.7]) had at least mild cognitive impairment. The point-prevalence of dementing illnesses was 18.4% [16.3; 20.7]. Delirium, most often on the basis of dementia, was present in 5.1% [3.9; 6.7]. 60.0% had no cognitive impairment. Dementia was more common among patients of very advanced age, those who were dependent on nursing care, those who lived in old-age or nursing homes, and those with a low level of education. Among patients with dementia, only 36.7% had a documented diagnosis of dementia in the medical record. Patients with dementia were treated more often for dehydration, electrolyte disturbances, urinary tract infections, contusions, and bone fractures, as well as for symptoms and findings of an unknown nature, and much less often for cancer or musculoskeletal diseases. CONCLUSION: Two out of five elderly patients in general hospitals suffer from a cognitive disturbance. Patients with severe impairments such as dementia or delirium often need special care. Guidelines and model projects offer approaches by which the inpatient care of patients with comorbid dementia can be improved.

Usability and Naturalness of Videoconference-Based Exposure and Response Prevention for Obsessive-Compulsive Disorder at the Patients' Homes: A Pilot Study.

The treatment of choice for obsessive-compulsive disorders is cognitive behavioral therapy, including exposure and response prevention (ERP). Therapist-supervised ERP is more effective than self-controlled ERP, and exposure should take place at the patient's home. This standard might be achieved with ERPs at home via videoconference supervision from the therapist. The aim of this study was to (a) assess the usability and naturalness of videoconference exposure and (b) to compare it with face-to-face exposure at an inpatient clinic and exposure at home alone regarding therapeutic alliance, patients' expectancies, and credibility of the treatment and an overall rating of the exposure session. Mean differences and effect sizes suggested a slight general advantage of videoconference-based ERP and the interaction with the therapist felt natural to the participants. The technical system was rated as medium usable, suggesting a need for better training.

Weight Suppression But Not Symptom Improvement Predicts Weight Gain During Inpatient Treatment for Bulimia Nervosa.

OBJECTIVE: Fear of gaining weight is a common obstacle to seeking treatment for bulimia nervosa (BN). We investigated changes in body mass index (BMI) during inpatient treatment for BN in relation to treatment outcome and weight suppression (WS). METHODS: Female inpatients of a specialized eating disorders clinic were grouped as deteriorated/unchanged, reliably improved, and clinically significantly improved based on Eating Disorder Inventory-2 scores. Repeated measures ANOVA was employed to examine changes in BMI between admission and discharge depending on treatment outcome and WS. RESULTS: One-hundred seventy-nine patients were included. Overall, the average BMI significantly increased by 0.54 kg/m2 (SD = 1.24). Repeated measures ANOVA revealed no association of change in BMI with treatment outcome [F(df) = 1.13 (2166), p = 0.327] but with WS [F(df) = 2.76 (3166), p < 0.044]. DISCUSSION: Bulimia nervosa can be successfully treated without causing excessive weight gain. Patients with higher WS might expect somewhat more weight gain. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

[Dementia friendly care services in general hospitals : Representative results of the general hospital study (GHoSt)]. / Demenzsensible Versorgungsangebote im Allgemeinkrankenhaus : Repräsentative Ergebnisse aus der General Hospital Study (GHoSt).

BACKGROUND: Mostly model projects report on special care services and procedures for general hospital patients with cognitive impairment. The objective of this study was to determine the frequency of special care services and procedures in general hospitals on the basis of a representative cross-sectional study. METHODS: From a list of all general hospitals in southern Germany we randomly selected a specified number of hospitals und somatic wards. The hospitals were visited and all older patients on the selected wards on that day were included in the study. Information about care services and their utilization was collected with standardized instruments. RESULTS: A total of 33 general hospitals and 172 wards participated in the study. The patient sample included 1469 persons over 65 (mean age 78.6 years) and 40% of the patients showed cognitive impairments. The staff reported that the most frequent measures for patients with cognitive impairments concerned patients with wandering behavior (63.1%), efforts to involve the patients' relatives to help with their daily care (60.1%), conducting nonintrusive interviews to identify cognitive impairments (59.9%), allocation to other rooms (58%) and visual aids for place orientation of patients (50.6%). In accordance with earlier studies our results show that other dementia friendly services implemented in pilot projects were rare. The existing special services for patients with cognitive impairment were rarely used by the patients or their relatives. DISCUSSION: The results demonstrate the urgent need to improve special care services and routines for identification of elderly patients with cognitive impairment and risk of delirium in general hospitals.

The 6-Item Cognitive Impairment Test as a bedside screening for dementia in general hospital patients: results of the General Hospital Study (GHoSt).

OBJECTIVE: The objective of this study was to examine the psychometric quality of the 6-Item Cognitive Impairment Test (6CIT) as a bedside screening for the detection of dementia in general hospital patients. METHOD: Participants (N = 1,440) were inpatients aged ≥65 of 33 randomly selected general hospitals in Southern Germany. The 6CIT was conducted at bedside, and dementia was diagnosed according to DSM-IV. Nursing staff was asked to rate the patients' cognitive status, and previous diagnoses of dementia were extracted from medical records. Completion rates and validity statistics were calculated. RESULTS: Two-hundred seventy patients had dementia. Cases with delirium but no dementia were excluded. Feasibility was 97.9% and 83.3% for patients without and with dementia, respectively, and decreased from moderate (93.8%) to severe dementia (53%). The area under the curve of the 6CIT was 0.98. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated for the cutoffs 7/8 (0.96, 0.82, 0.85, 0.52, 0.99) and 10/11 (0.88, 0.95, 0.94, 0.76, 0.98). The nurse ratings and medical records information had lower validity statistics. Logistic regression analyses revealed that the 6CIT statistically significantly provided information above nurse ratings and medical records. Twenty-five and 37 additional patients were correctly classified by the 7/8 and 10/11 cutoffs, respectively. CONCLUSION: The 6CIT is a feasible and valid screening tool for the detection of dementia in older general hospital patients. The 6CIT outperformed the nurse ratings of cognitive status and dementia diagnoses from medical records, suggesting that standardized screening may have benefits with regard to case finding. Copyright © 2016 John Wiley & Sons, Ltd.

Predicting dementia in primary care patients with a cardiovascular health metric: a prospective population-based study.

BACKGROUND: Improving cardiovascular health possibly decreases the risk of dementia. Primary care practices offer a suitable setting for monitoring and controlling cardiovascular risk factors in the older population. The purpose of the study is to examine the association of a cardiovascular health metric including six behaviors and blood parameters with the risk of dementia in primary care patients. METHODS: Participants (N = 3547) were insurants aged ≥55 of the largest German statutory health insurance company, who were enrolled in a six-year prospective population-based study. Smoking, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose were assessed by general practitioners at routine examinations. Using recommended cut-offs for each factor, the patients' cardiovascular health was classified as ideal, moderate, or poor. Behaviors and blood parameters sub-scores, as well as a total score, were calculated. Dementia diagnoses were retrieved from health insurance claims data. Results are presented as hazard ratios (HRs) and 95% confidence intervals (95% CIs). RESULTS: Over the course of the study 296 new cases of dementia occurred. Adjusted for age, sex, and education, current smoking (HR = 1.77, 95% CI 1.09-2.85), moderate (1.38, 1.05-1.81) or poor (1.81, 1.32-2.47) levels of physical activity, and poor fasting glucose levels (1.43, 1.02-2.02) were associated with an increased risk of dementia. Body mass index, blood pressure, and cholesterol were not associated with dementia. Separate summary scores for behaviors and blood values, as well as a total score showed no association with dementia. Sensitivity analyses with differently defined endpoints led to similar results. CONCLUSIONS: Due to complex relationships of body-mass index and blood pressure with dementia individual components cancelled each other out and rendered the sum-scores meaningless for the prediction of dementia.

Differential Linguistic Recall Effects in the California Verbal Learning Test in Healthy Aging and Alzheimer's Dementia: Analysis of Routine Diagnostic Data.

OBJECTIVE: Psycholinguistic evidence suggests that certain word characteristics might influence recall rates in word-list learning tests. These effects were investigated in the German California Verbal Learning Test (CVLT-G) in a clinical setting. METHOD: Subjects were memory clinic patients without cognitive diagnosis (N = 45) and with dementia of the Alzheimer type (DAT) (N = 48) matched for age, sex, depressive symptoms, and education. The CVLT-G's words were analyzed with regard to length, frequency, and neighborhood size and dichotomized into low and high value groups. For each linguistic variable, a 2 (diagnosis: control vs. DAT) × 3 (time: Trial 1 vs. Trial 5 vs. Long Delay Free Recall) × 2 (linguistic: low vs. high) repeated measures analysis of variance (RM-ANOVA) was conducted. RESULTS: RM-ANOVAs revealed a main effect for frequency, F(1,91) = 21.03, p < 0.001, and interactions between time and frequency, F(1.97,179.09) = 5.18, p = 0.007, and diagnosis and neighborhood, F(1.77,161.23) = 13.60, p < 0.001. High-frequency words were better recalled at Trial 5 (Cohen's d = 0.37) and long delayed free recall (d = 0.16) and learning from Trials 1 to 5 was better for high-frequency words (d = 0.39). Controls recalled large neighborhood words better whereas the opposite was true for persons with DAT (d = 0.76). CONCLUSION: Frequency and neighborhood size seem to influence learning and retention in the CVLT-G with neighborhood size producing opposed effects for persons with and without DAT. These results are in line with international experimental studies and likely not specific to the German language. Potential diagnostic implications and possibilities for test construction and interpretation are discussed.

Smoking increases the risk of delirium for older inpatients: a prospective population-based study.

OBJECTIVES: To investigate the association between smoking in the older population and the risk of inpatient delirium, which is common and has adverse consequences. METHOD: Participants (N=3754) were insurants aged ≥55years of the largest German statutory health insurance company, who enrolled in a 6-year prospective population-based study. Baseline smoking, adjusted for age, sex, depressive symptoms, cognitive impairment and alcohol consumption, was analyzed as risk factor of inpatient delirium. Results are presented as hazard ratios (HRs) and 95% confidence intervals (95% CIs). RESULTS: Three-hundred seventy-three (10.0%) participants were smokers at baseline, 865 (23.0%) were quitters and 2516 (67.0%) were lifelong abstainers. Mean pack-years of smokers and quitters were 23.8 (S.D.=22.4). Sixty-one (1.6%) received a diagnosis of inpatient delirium. Smokers had an increased risk of delirium compared to abstainers in the fully adjusted model (HR=2.87, 95% CI 1.24-6.66). Quitters and abstainers did not differ (HR=0.79, 95% CI 0.37-1.72). Comparing smokers and quitters, current smoking status (HR=3.22, 95% CI 1.20-8.62) but not pack-years [residual χ(2)(1)=0.25, P=.874] were associated with inpatient delirium. CONCLUSION: Only current smoking but not being a quitter and the lifetime amount smoked were associated with inpatient delirium, indicating that acute nicotine withdrawal may represent a relevant pathogenic mechanism.