A randomized trial of effects of health risk appraisal combined with group sessions or home visits on preventive behaviors in older adults

Background. To explore effects of a health risk appraisal for older people (HRA-O) program with reinforcement, we conducted a randomized controlled trial in 21 general practices in Hamburg, Germany. Methods. Overall, 2,580 older patients of 14 general practitioners trained in reinforcing recommendations related to HRA-O-identified risk factors were randomized into intervention (n = 878) and control (n = 1,702) groups. Patients (n = 746) of seven additional matched general practitioners who did not receive this training served as a comparison group. Patients allocated to the intervention group, and their general practitioners, received computer-tailored written recommendations, and patients were offered the choice between interdisciplinary group sessions (geriatrician, physiotherapist, social worker, and nutritionist) and home visits (nurse). Results. Among the intervention group, 580 (66%) persons made use of personal reinforcement (group sessions: 503 [87%], home visits: 77 [13%]). At 1-year follow-up, persons in the intervention group had higher use of preventive services (eg, influenza vaccinations, adjusted odds ratio 1.7; 95% confidence interval 1.4-2.1) and more favorable health behavior (eg, high fruit/fiber intake, odds ratio 2.0; 95% confidence interval 1.6-2.6), as compared with controls. Comparisons between intervention and comparison group data revealed similar effects, suggesting that physician training alone had no effect. Subgroup analyses indicated favorable effects for HRA-O with personal reinforcement, but not for HRA-O without reinforcement. Conclusions. HRA-O combined with physician training and personal reinforcement had favorable effects on preventive care use and health behavio

MATERIALISM: THE SEARCH FOR SOMETHING MORE

“Part of our troubles results from the tendency to ascribe to architects – or, for that matter, to all specialists – exceptional insight into problems of living when, in truth, most of them are concerned with problems of business and prestige. Besides, the art of living is neither taught nor encouraged in this country. We look at it as a form of debauch. Little aware that its tenets are frugality, cleanliness, and a general respect for creation, not to mention Creation.” – Bernard Rudofsky (Rudofsky, 1964) – Life is complicated – because of this, specialists derive narratives as readings for the living. Too often, these narratives are simplified to guide erroneous expectations of conformity within the collective. Ironically, those who adopt these influenced experiences put the very collective they are a part of at risk. They devalue the well-being of community by privileging a singular expression of reality. Materialism is one of those readings. The product of an enterprise culture, materialism as a narrative for living ignores the complexities entailed by reality. In spite of the infinite number of readings that exist, simplified narratives attempt to claim that life is simple – they try to be maps for living. And like most maps, they inevitably become unreliable for their original purpose. Living is not a matter of business and prestige. Materialism is a matter of business and prestige. The modern states’ preference for simplified narratives endangers the individual’s sense of self. By diverting attention from the art of living, the modern state has over-used materialism as a form of governance. This thesis intends to discover if a new reading of materialism can be found as a form of liberation. The work found within this document is the culmination put forth over the last three years. Consisting of three major sections, the first section is critical as it grounds the entire discussion by defining materialism through the review of literature. Adviser: Betsy Gab

Ressourcen und Risiken im Alter. Die LUCAS-I Marker zur Klassifizierung älterer Menschen als FIT, pre-FRAIL und FRAIL. Validierung und erste Ergebnisse aus der Longitudinalen Urbanen Cohorten-Alters-Studie (LUCAS)

BACKGROUND: There is a need for a simple self-administered instrument to assess frailty in community-dwelling seniors. METHODS: We present a new marker set to assess the functional state of seniors. Contrary to current literature, we focus not only on risks, but also include resources. The questions relate to facts (ways to do things), rather than on subjective information (e.g. exhaustion). It was developed in the context of the Longitudinal Urban Cohort Ageing Study (LUCAS) in Hamburg, Germany. RESULTS: The classification based on these questions proposes operational definitions of the terms fit, pre-frail and frail and is predictive for need for nursing care as well as mortality. A wealth of results establishes the validity of the categorisation compared to other health questions. One of the classification questions concerns cycling. For areas where cycling is not suitable, we propose to replace this question with one about independently walking 500 m. However, the cycling question appears to indicate frailty earlier. CONCLUSION: The self-administered questionnaire provides a simple, cost-effective way to screen seniors for early signs of declining function in order to start preventive action

Grauzonen von Gesundheit und Handlungsfähigkeit. Erfassung und Aufschlüsselung durch Assessments in der Longitudinalen Urbanen Cohorten-Alters-Studie (LUCAS)

PURPOSE: The goal of this work was to characterise and distinguish persons without (fit), with earliest signs (pre-frail) or accelerated functional decline (frail) during self-referral (geriatric centre) or preventive home visits. METHODS: After screening independently living older people in an urban longitudinal cohort (n = 1,995) using a self-administered questionnaire, they were functionally classified as fit, pre-frail or frail. In 10% randomly selected samples of these cohort parts a comprehensive extended gerontological-geriatric assessment (EGGA) was administered. RESULTS: Fit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition. The best indicator to discriminate fit versus frail was exhaustion (mobility tiredness). CONCLUSION: Competence is essential regarding health in old age. Identification of resources and risks by comprehensive assessment is useful before planning interventions to prevent frailty or its progression