Cognition in People Aged 80 Years and Older: Determinants and Predictors of Change from a Population-Based Representative Study in Germany.

BACKGROUND: The number of people aged 80 years and older (80+) will increase drastically in the upcoming decades. The preservation of cognitive functions will contribute to their quality of life and independence. OBJECTIVES: To identify determinants of cognition and predictors of change in cognitive performance in the population 80+. DESIGN: Cross-sectional and longitudinal population-based on the representative NRW80+ survey. SETTING: Randomly drawn cases of people aged 80+ from the municipal registration offices, including people living in private homes and institutional settings. PARTICIPANTS: The participants in the cross-sectional sample (N=1503, 65.5%female) were 84.7 years old (95%CI[84.5,85.0]) and had 12.3 years of education (95%CI[12.1,12.4]). The participants in the longitudinal sample (N=840, 62.5%female) were 84.9 years old (95%CI[84.6,85.2]) and had 12.3 years of education (95%CI[12.0,12.5]). MEASUREMENTS: The cognitive screening DemTect, age, sex, education, and social, physical, and cognitive lifestyle activities, as well as subjective general health status and depressive symptoms, were assessed at baseline and 24-month follow-up. RESULTS: Younger age, more years of education, and more cognitive lifestyle activities were identified as the most consistent determinants of both better cognitive performance and preservation of cognitive performance for both global cognition as well as the DemTect subtests on memory and executive functions. CONCLUSIONS: Our findings reveal that commonly investigated determinants of, and change in, cognitive performance are valid for the people 80+ and highlight the importance of cognitive lifestyle activities for cognitive health. The maintenance of cognitive functions is a key aspect of healthy aging in terms of preserving independence in people 80+.

Compreendendo a relação entre saúde do ambiente e saúde humana em comunidades Quilombolas de Santa Catarina / The forest gives us health: relationships between environmental health and human health in Maroon communities of Santa Catarina

RESUMO Neste artigo investigamos a relação entre a saúde humana e saúde do ambiente em comunidades quilombolas do litoral de Santa Catarina, analisando a situação de saúde destas comunidades, as percepções sobre elementos que influenciam a saúde humana, as plantas medicinais conhecidas e o mapeamento de ambientes que trazem benefícios para a saúde. Foi realizado entrevistas e listagem-livre de plantas medicinais com 184 adultos (63 no Morro do Fortunato, 56 na Santa Cruz e 65 na Aldeia), e uma reunião comunitária para a realização do mapeamento participativo em cada comunidade. As comunidades quilombolas percebem diversas influências na saúde, sendo que os elementos de cuidado com o corpo foram os mais citados. A qualidade da água/ar e recreação/lazer foram os benefícios mais reconhecidos das áreas florestais para a saúde humana. Foram identificadas 152 espécies de plantas medicinais, sendo que as espécies mais citadas são plantas cultivadas e/ou que ocorrem espontaneamente próximo às moradias. O mapeamento de serviços ambientais revela áreas prioritárias para a saúde, que estão localizadas em florestas e próximo aos corpos d’água, ressaltando a importância de conservar estes locais e de construir estratégias para garantir o acesso a eles pelas comunidades.

ABSTRACT In this article we investigate the relationship between human health and environmental health in maroon communities of Santa Catarina, analyzing the health situation of these communities, the perceptions of elements that influence human health, medicinal plants known and mapping environments that bring health benefits. We conducted interviews and free-listing of medicinal plants with 184 adults (63 in Morro do Fortunato, 65 em Santa Cruz and 56 in Aldeia), and a community meeting for the realization of participatory mapping in each community. Maroon communities realize diverse influences on health, and the elements of care with the body were the most cited. The quality of the water/air and recreation/leisure were the most recognized benefits of forests to human health. 152 species of medicinal plants have been identified, and the most cited species are cultivated plants and/or occurring spontaneously near the houses. The mapping of environmental services reveals priority areas for health, which are located in forests and near the water bodies, emphasizing the importance of conserving these places and build strategies to ensure access to them by communities.

Effects of inpatient geriatric interventions in a German geriatric hospital: Impact on ADL, mobility and cognitive status.

BACKGROUND: Given the demographic changes, the need for effective geriatric intervention is obvious. Geriatric care aims to maintain the highest possible level of independence and quality of life and to reduce the risk of need for care. OBJECTIVES: This study investigated the benefits of geriatric care on functional performance, mobility and cognition. MATERIAL AND METHODS: This study involved a retrospective analysis of clinical data from 646 patients. At hospital admission and discharge functional status was assessed using the Barthel index. Mobility was evaluated by means of the Tinetti test and cognition by the mini-mental state examination (MMSE). A follow-up was conducted on 112 patients 2-5 months after hospital discharge. Statistical analysis included t-tests including Cohen's d for effect size and multivariate regression analysis. RESULTS: The mean age of the study population was 81.1 ± 7.1 years including 439 women (68%) and 207 men (32%). There were significant average improvements for activities of daily living (ADL), mobility and cognition comparing discharge and admission scores. For functional and mobility status, effect sizes were medium to high. Regression analyses showed that ADL improvement was predicted by functional, mobile and cognitive status at admission. Follow-up analyses revealed a high percentage of former patients still living at home and an overall maintenance of ADL levels. CONCLUSION: Geriatric patients seem to experience long-term improvements during geriatric treatment, which appears to fulfill its aim of recovering independence. For a better understanding of relevant factors for the recreation of geriatric patients, further research is needed, e.g. with respect to the impact of the nutritional status.

[World War II and current care provision: impact of war-related trauma on present professional care situations]. / Zweiter Weltkrieg und pflegerische Versorgung heute : Einfluss von Kriegstraumatisierungen auf professionelle Pflegesituationen.

BACKGROUND: This study represents the first empirical research into the impact of war-related trauma on present professional care situations in Germany. METHODS: A total of 105 professional caregivers from North Rhine-Westphalia were questioned in a standardized form about the impact of war-related trauma on the daily work. RESULTS: Of the professional caregivers questioned 82%reported that they were already caring for a person suffering from post-war trauma and 77% stated that war-related trauma had an impact on the daily work. Altogether 63% reported that war-related trauma is highly significant for the daily work. The professional caregivers reported that there was often a lack of knowledge and awareness of the topic among colleagues. CONCLUSIONS: The study showed that there is a need for increasing awareness and providing further staff education and training regarding the treatment of people suffering from (war-related) trauma in order to ensure adequate care for those concerned.

[Early detection and prevention of elder abuse and neglect in family care giving: development of the PURFAM assessment]. / Früherkennung und Prävention von Misshandlung und Vernachlässigung in der familialen Pflege: Die Entwicklung des PURFAM-Assessments.

The purpose of the PURFAM ("potentials and risk factors of family caregiving for older people") project is to support staff members of home care services in preventing elder abuse by facilitating an assessment instrument for early recognition and a standard for action. During a pilot phase of the project nursing staff of home services were presented with training sessions in which the use of the PURFAM assessment was introduced using concrete examples from routine daily work. The article describes the development of the PURFAM assessment and its first evaluation by staff members of nursing home services. The preliminary results indicate a high practicability und acceptance of the instrument by staff members. The sustainability of PURFAM is yet to be tested using the data of the still ongoing main part of the evaluation.

[Development of a new screening instrument for geriatric depression. The depression in old age scale (DIA-S)]. / Entwicklung eines neuen Depressionsscreenings für den Einsatz in der Geriatrie. Die "Depression-im-Alter-Skala" (DIA-S).

PURPOSE: The purpose of the study was to develop and validate the depression in old age scale (DIA-S). The DIA-S is a new screening scale for depression, which is comparable to the GDS-15 in terms of practicality but which is more appropriate for the use in geriatric patients. METHODS: The DIA-S and the GDS-15 were validated among a sample of n=331 geriatric inpatients (n=151 depressed subjects and n=180 not depressed subjects), using the Montgomery and Asperg Depression Rating Scale as gold standard criterion for depression. For the comparison of the two scales, item analysis (missing values, difficulty, discriminatory power) was considered as well as test performance (internal consistency, correlation with the MADRS, ROC curves, sensitivity, specificity). RESULTS: All outcomes indicate a good psychometrical quality of the DIA-S. The new instrument showed a considerably higher discriminatory power for the items internal consistency and test specificity than the GDS-15.

[Predictors of personal growth among caregivers of dementia patients]. / Prädiktoren von Persönlichkeitswachstum bei pflegenden Angehörigen demenziell Erkrankter.

Much of the research on caregiving has focussed on burden, stress, and coping, but there may also be positive outcomes associated with the process of care. Relatives caring for dementia patients report that they have grown more mature personally and gain a better idea of what is important in life. The purpose of this study is to look at predictors of personal growth. A total of 888 relatives of patients with dementia were examined. We found, using ordinary least squares regression, that personal growth was correlated with stressors and context variables like duration of caregiving, lack of social recognition, and the need for help with Activities of Daily Living (ADL) in the person with dementia. Personal growth through caregiving was predicted by duration of caregiving during the first years of caregiving. These findings underscore the importance of the negative aspects (stress, burden, long duration) that contribute to the development of personal growth through care.

[Domestic abuse of dementia patients: data collection in a difficult research area]. / Gewalt gegen demenziell Erkrankte in der Familie: Datenerhebung in einem schwer zugänglichen Forschungsgebiet.

In the context of a longitudinal dementia caregiver stress study, a short questionnaire was developed in order to assess domestic abuse of dementia patients. By embedding the sensitive topic of domestic violence in a different research context, good compliance in the sample could be achieved which results in high prevalence rates.

Family and professional caregivers' ratings of dementia symptoms and activities of daily living of day care patients: do differences change over time?

The purpose of this study was to compare ratings of patients' carried out by professional and family caregivers. These patients were attending rehabilitative geriatric and gerontopsychiatric day care centres, they were about 77 years old, 93% had dementia, and each had an average of 4.7 diseases. Eighty percent of the family caregivers were female, and 60% were children of the patients. Staff raters of the day care units were trained professionals. Data were collected at two measurement times: T1 took place during the first ten days of service use; T2 was conducted six months later. Activities of daily living (ADL) and Memory and Behaviour Problems (MBPC) were investigated. Family caregivers noted significantly more deficits on the ADL scale, and significantly more problems on the MBPC scale. These differences increased when subjective burden of the family caregiver was high. The longitudinal results showed that these differences in ADL and MBPC ratings remained remarkably stable, although there was an increase in deficit ratings in both groups.

[Family care of patients with dementia: differential significance of specific stress dimensions for the well-being of caregivers and the stability of the home nursing situation]. / Zur familiären Pflege demenzkranker Menschen: Die differentielle Bedeutung spezifischer Belastungsdimensionen für das Wohlbefinden der Pflegenden und die Stabilität der häuslichen Pflegesituation.

In Germany more than 60% of those elderly who suffer from dementia are being cared for by family members within the community. The objective conditions are perceived as extremely burdensome by many caregivers and can seriously affect their psychological and physical well-being. The aim of this study was to discrimininatively analyze the meaning of various dimensions of burden for the carers' well-being and the stability of the caregiving situation. Thus, an explicit distinction is made between caregiver burden which directly refers to the situation and the more general concept of well-being which is potentially, but not necessarily, affected by the caregiving situation. Caregivers' life satisfaction, self-esteem, and their subjective perception of the stability of the caregiving situation (subjective probability of patient's institutionalization within the next 12 months) were regarded as indicators for potential outcomes of caregiving. Regression analysis revealed that to the caregiver's life satisfaction perceived role conflicts are most significant. For the caregiver's self-esteem patient's objective cognitive impairment is decisive. Here the direction of the relation is remarkable: The more severe the patient's impairment, the higher the caregiver's self-esteem. Regarding the stability of the caregiving situation the perceived inadequacy of caregiving resources proves to be of prime importance. Results suggest that a differentiated examination of the complex relations between specific dimensions of burden and potential caregiving outcomes is an adaquate approach to a deeper understanding of the consequences of family caregiving.

Maintenance and rehabilitation of independence in old age: an intervention program for staff.

Research has attested to the prevalence of a "dependency-support" and "independence-ignore" script characterizing the interactions between staff and elderly residents in long-term care institutions. To examine whether the scripts could be modified, a staff training program (focusing on communication skills, knowledge about aging, and basic behavior principles) was implemented in 3 different institutions. Observational data on staff-resident interactions in the context of self-care were collected pre- and postintervention. Findings revealed significant changes for the experimental group. Specifically, a decrease in dependence-supportive behavior of staff and an increase in their independence-supportive behavior, an increase in independent behavior of residents, and an increase in independence-related interaction patterns were demonstrated.