Limitations in activities of daily living and support needs – Analysis of GEDA 2019/2020-EHIS

Being able to perform activities of daily living is an important component of a person's ability to function. If these activities are impaired, support is needed. Using data from GEDA 2019/2020-EHIS, we present how many people aged 55 and older living in private households in Germany experience limitations in activities of daily living. Severe limitations in basic (fundamental) activities (e.g. food intake) are reported by 5.8% of women and 3.7% of men. The proportion increases with age as 13.4% of women and 9.0% of men aged 80 and older experience limitations. Severe limitations of instrumental activities of daily living (e.g. grocery shopping) are rather rare in participants less than 80 years of age. But at age 80 and older the proportion rises to 35.9% of women and 21.0% of men. A total of 68.1% of afflicted women and 57.5% of men receive help and support related to limitations of basic activities. Women are also more likely to report a lack of support (48.8% vs. 43.2%). The situation is slightly better with regard to instrumental activities. The results of GEDA 2019/2020-EHIS show in which areas of daily life older and very old people are impaired, give an impression of who is affected particularly strongly and indicate where support services are insufficient. As such, these results provide clues as to where support can be provided to enable older people to keep living in their own homes for a long time

‘We can do only what we have the means for’ general practitioners’ views of primary care for older people with complex health problems

Background: Due to demographic change, general practitioners (GPs) are increasingly required to care for older people with complex health problems. Little is known about the subjective appraisals of GPs concerning the demanded changes. Our objective is to explore how general practitioners view their professional mandates and capacities to provide comprehensive care for older people with complex health problems. Do geriatric training or experience influence viewpoints? Can barriers for the implementation of changes in primary care for older people with complex health problems be detected? Methods: Preceding a controlled intervention study on case management for older patients in the primary care setting (OMAHA II), this qualitative study included 10 GPs with differing degrees of geriatric qualification. Semi structured interviews were conducted and audio-taped. Full interview transcripts were analyzed starting with open coding on a case basis and case descriptions. The emerging thematic structure was enriched with comparative dimensions through reiterated inter-case comparison and developed into a multidimensional typology of views. Results: Based on the themes emerging from the data and their presentation by the interviewed general practitioners we could identify three different types of views on primary care for older people with complex health problems: ‘maneuvering along competence limits’, ‘Herculean task’, and ‘cooperation and networking’. The types of views differ in regard to role-perception, perception of their own professional domain, and action patterns in regard to cooperation. One type shows strong correspondence with a geriatrician. Across all groups, there is a shared concern with the availability of sufficient resources to meet the challenges of primary care for older people with complex health problems. Conclusions: Limited financial resources, lack of cooperational networks, and attitudes appear to be barriers to assuring better primary care for older people with complex health problems. To overcome these barriers, geriatric training is likely to have a positive impact but needs to be supplemented by regulations regarding reimbursement. Most of all, general practitioners’ care for older people with complex health problems needs a conceptual framework that provides guidance regarding their specific role and contribution and assisting networks. For example, it is essential that general practice guidelines become more explicit with respect to managing older people with complex health problems

Einschränkungen bei Alltagsaktivitäten und Unterstützungsbedarfe – Auswertungen der Studie GEDA 2019/2020-EHIS

Die Ausübung von Aktivitäten des täglichen Lebens ist ein wichtiger Bestandteil der Funktionsfähigkeit eines Menschen. Falls Einschränkungen vorliegen, ist Unterstützung bei diesen Tätigkeiten erforderlich. Anhand von Daten der Studie GEDA 2019/2020-EHIS wird dargestellt, wie viele der in Privathaushalten lebenden Personen ab 55 Jahren in Deutschland Einschränkungen in Alltagsaktivitäten aufweisen. Schwere Einschränkungen in den basalen (grundlegenden) Aktivitäten (z. B. der Nahrungsaufnahme) geben 5,8 % der Frauen und 3,7 % der Männer an. Der Anteil nimmt mit dem Alter zu, von den ab 80-Jährigen sind 13,4 % der Frauen und 9,0 % der Männer betroffen. Schwere Einschränkungen bei den instrumentellen Aktivitäten des täglichen Lebens (z. B. Einkäufe erledigen) sind bei Personen unter 80 Jahren eher selten. Der Anteil bei den ab 80-Jährigen liegt bei den Frauen bei 35,9 % und bei den Männern bei 21,0 %. Bei Einschränkungen der basalen Aktivitäten erhalten 68,1 % der betroffenen Frauen und 57,5 % der Männer Hilfe und Unterstützung. Frauen berichten zudem häufiger über fehlende Unterstützung (48,8 % vs. 43,2 %). Bei den instrumentellen Aktivitäten ist die Lage etwas besser. Die Ergebnisse aus der Studie GEDA 2019/2020-EHIS zeigen, in welchen Bereichen des täglichen Lebens ältere und hochaltrige Menschen eingeschränkt sind, geben einen Eindruck, wer besonders betroffen ist und wo Unterstützungsleistungen nicht ausreichend sind. Sie liefern damit Anhaltspunkte, wo unterstützend angesetzt werden kann, um älteren Menschen einen langen Verbleib in der eigenen Häuslichkeit zu ermöglichen

Prevalence and correlates of frailty among older adults: findings from the German health interview and examination survey

Background: Despite having the third highest proportion of people aged 60 years and older in the world, Germany has been recently reported as having the lowest prevalence of frailty of 15 European countries. The objective of the study is to describe the prevalence of frailty in a large nationwide population-based sample and examine associations with sociodemographic, social support and health characteristics. Methods: We performed a cross-sectional analysis of the first wave of the German Health Interview and Examination Survey for Adults (DEGS1) conducted 2008–2011. Participants were 1843 community-dwelling people aged 65–79 years. Frailty and pre-frailty were defined, according to modified Fried criteria, as 3 and more or 1–2 respectively, of the following: exhaustion, low weight, low physical activity, low walking speed and low grip strength. The Oslo-3 item Social Support Scale (OSS-3) was used. Patient Health Questionnaire (PHQ-9) measured depressive symptoms and the Digit Symbol Substitution Test (DSST) measured cognition. Associations between participants’ characteristics and frailty status were examined using unadjusted and adjusted multinomial logistic regression models estimating relative risk ratios (RRR) of frailty and pre-frailty. Results: The prevalence of frailty among women was 2.8% (CI 1.8-4.3) and pre-frailty 40.4% (CI 36.3-44.7) and among men was 2.3% (CI 1.3-4.1) and 36.9% (CI 32.7-41.3) respectively. Independent determinants of frailty, from unadjusted models, included older age, low socioeconomic status, poor social support, lower cognitive function and a history of falls. In adjusted models current depressive symptoms (RRR 12.86, CI 4.47-37.03), polypharmacy (RRR 7.78, CI 2.92-20.72) and poor hearing (RRR 5.38, CI 2.17-13.35) were statistically significantly associated with frailty. Conclusions: Frailty prevalence is relatively low among community-dwelling older adults in Germany. Modifiable characteristics like low physical activity provide relevant targets for individual and population-level frailty detection and intervention strategies

who is missed and why?

Background Public health monitoring depends on valid health and disability estimates in the population 65+ years. This is hampered by high non- participation rates in this age group. There is limited insight into size and direction of potential baseline selection bias. Methods We analyzed baseline non-participation in a register-based random sample of 1481 inner-city residents 65+ years, invited to a health examination survey according to demographics available for the entire sample, self-report information as available and reasons for non-participation. One year after recruitment, non- responders were revisited to assess their reasons. Results Five groups defined by participation status were differentiated: participants (N = 299), persons who had died or moved (N = 173), those who declined participation, but answered a short questionnaire (N = 384), those who declined participation and the short questionnaire (N = 324), and non-responders (N = 301). The results confirm substantial baseline selection bias with significant underrepresentation of persons 85+ years, persons in residential care or from disadvantaged neighborhoods, with lower education, foreign citizenship, or lower health-related quality of life. Finally, reasons for non-participation could be identified for 78 % of all non-participants, including 183 non- responders. Conclusion A diversity in health problems and barriers to participation exists among non-participants. Innovative study designs are needed for public health monitoring in aging populations

Gesundheitliche Lage älterer und hochaltriger Menschen in Deutschland: Ergebnisse der Studie Gesundheit 65+

Hintergrund: Aufgrund des demografischen Wandels ist eine umfassende Gesundheitsberichterstattung zur Gesundheit im höheren Alter wichtig. Methode: Gesundheit 65+ ist eine epidemiologische Längsschnittstudie zur gesundheitlichen Lage der Personen ab 65 Jahren in Deutschland. Auf Grundlage einer zweistufigen, geschichteten Zufallsstichprobe aus 128 Einwohnermeldeämtern nahmen zwischen Juni 2021 und April 2022 3.694 Personen an der Basisbefragung teil (47,9 % Frauen, Durchschnittsalter 78,8 Jahre). Es werden gewichtete Prävalenzen für 19 Indikatoren der Basisbefragung insgesamt und nach Alter, Geschlecht, Bildung sowie Wohnregion dargestellt. Ergebnisse: Insgesamt berichteten 52,0 % aller Teilnehmenden der Basisbefragung über eine gute oder sehr gute Gesundheit und 78,5 % über eine hohe oder sehr hohe Lebenszufriedenheit. Demgegenüber standen eine Vielzahl von gesundheitlichen/funktionellen Einschränkungen mit Prävalenzen von 5,3 % bei schwerwiegenden Seheinschränkungen bis 69,2 % bei Multimorbidität. Die gesundheitliche Lage der Frauen war deutlich schlechter als die der Männer, die der Personen ab 80 Jahren schlechter als zwischen 65 und 79 Jahren. Es zeigte sich ein deutlicher Bildungsgradient der gesundheitlichen Lage, jedoch keine Unterschiede zwischen West- und Ostdeutschland. Schlussfolgerungen: Die Studie Gesundheit 65+ liefert eine umfangreiche Datenbasis zur Beschreibung der gesundheitlichen Lage älterer und hochaltriger Personen in Deutschland, auf deren Grundlage Handlungsempfehlungen für Politik und Praxis abgeleitet werden können

Changes in physical functioning among men and women aged 50–79 years in Germany: an analysis of National Health Interview and Examination Surveys, 1997–1999 and 2008–2011

Background: This study examines changes in physical functioning among adults aged 50-79 years in Germany based on data from two German National Health Interview and Examination Surveys conducted in 1997–1999 (GNHIES98) and 2008–2011 (DEGS1). Methods Using cross-sectional data from the two surveys (GNHIES98, n = 2884 and DEGS1, n = 3732), we examined changes in self-reported physical functioning scores (Short Form-36 physical functioning subscale (SF-36 PF)) by sex and age groups (50–64 and 65–79 years). Covariables included educational level, living alone, nine chronic diseases, polypharmacy (≥5 prescribed medicines), body mass index, sports activity, smoking and alcohol consumption. Multimorbidity was defined as ≥2 chronic diseases. Multivariable models were fitted to examine consistency of changes in physical functioning among certain subgroups and to assess changes in mean SF-36 PF scores, adjusting for changes in covariables between surveys. Results: Mean physical functioning increased among adults aged 50–79 years between surveys in unadjusted analyses, but this change was not as marked among men aged 65–79 years who experienced rising obesity (20.6 to 31.5%, p = 0.004) and diabetes (13.0 to 20.0%, p = 0.014). Prevalence of multimorbidity and polypharmacy use increased among men and women aged 65–79 years. In sex and age specific multivariable analyses, changes in physical functioning over time were consistent across subgroups. Gains in physical functioning were explained by improved education, lower body mass index and improved health-related behaviours (smoking, alcohol consumption, sports activity) in women, but less so among men. Conclusions: Physical functioning improved in Germany among adults aged 50–79 years. Improvements in the population 65–79 years were less evident among men than women, despite increases in multimorbidity prevalence among both sexes. Changes in health behaviours over time differed between sexes and help explain variations in physical functioning. Targeted health behaviour interventions are indicated from this study

The Role of Tobacco Smoking in the Efficacy of Brief Alcohol Intervention: Results from a Randomized Controlled Trial

This study investigated whether tobacco smoking affected outcomes of brief alcohol interventions (BAIs) in at-risk alcohol-drinking general hospital patients. Between 2011 and 2012 among patients aged 18–64 years, 961 patients were allocated to in-person counseling (PE), computer-based BAI containing computer-generated individual feedback letters (CO), and assessment only. PE and CO included contacts at baseline, 1, and 3 months. After 6, 12, 18, and 24 months, self-reported reduction of alcohol use per day was assessed as an outcome. By using latent growth curve models, self-reported smoking status, and number of cigarettes per day were tested as moderators. In PE and CO, alcohol use was reduced independently of smoking status (IRRs ≤ 0.61, ps 0.05) and CO (IRR = 0.85, ps > 0.05). Up to month 12, among persons smoking ≤ 19 cigarettes per day, the efficacy of CO increased with an increasing number of cigarettes (ps < 0.05). After 24 months, the efficacy of PE and CO that have been shown to reduce drinking did not differ by smoking status or number of cigarettes per day. Findings indicate that efficacy may differ by the number of cigarettes in the short term.Peer Reviewe

Behavioral Health Risk Factors and Motivation to Change among Cardiovascular General Hospital Patients Aged 50 to 79 Years

Little is known about the (co-)occurrence of smoking, alcohol at-risk drinking, physical inactivity and overweight, and the motivation to change these behavioral health risk factors (HRFs) in older general hospital patients with cardiovascular disease. Between October and December 2016, all consecutively admitted patients aged 50 to 79 years were proactively recruited on 3 cardiology wards and asked to participate in a survey on HRFs and behavior change motivation. Of the eligible patients, 80.4% participated in the survey (n = 328). The mean age was 66.5 years (standard deviation 9.0), and 65.5% were male. At least 1 HRF was present in 91.8% (n = 280), at least 2 HRFs in 54.4% (n = 166), and 3 or 4 HRFs in 12.1% (n = 37) of participants. The proportion of older adults who contemplated or were changing or planning to change their behavior to meet health behavior recommendations ranged between 66.0% (smoking) and 93.2% (alcohol consumption). The results indicate a notable co-occurrence of behavioral HRFs in older patients with cardiovascular disease. The majority of older adults were at least considering changing the respective behavior. To prevent and treat diseases efficiently, hospitalization may be a suitable moment for systematic multiple HRF screening and intervention.Peer Reviewe

Health situation in Germany during the COVID-19 pandemic. Developments over time for selected indicators of GEDA 2019/2020 – An update

The spread of the coronavirus SARS-CoV-2 in 2020 and the containment measures associated therewith have changed many aspects of daily life. An impact on health even beyond infections itself is assumed as well. The health situation of the population in the first phase of the pandemic was thus analysed using data from the German Health Update (GEDA 2019/2020-EHIS). By continuing the survey, the analyses for 2020 are completed (n=26,507 participants), whereby the focus is now on the third phase of the pandemic (second wave of infection, gradual reintroduction of containment measures). The health indicators are presented on a monthly basis. As in the first phase of the pandemic, no pandemic-related changes were observed for tobacco smoking/ second-hand smoke exposure and for received/lack of/provided support. In contrast to the first phase of the pandemic, declines in utilisation of medical services and depressive symptoms are not observed in the third phase. The increase in body weight/body mass index after the first phase of the pandemic did not continue. The survey period allows for a comparison of the periods before and as of the pandemic situation. A decrease in the medical services utilisation and depressive symptoms as well as an increase in the body weight/body mass index is observed in the period from March 2020 to January 2021 compared to the pre-pandemic period from April 2019 to March 2020