Physical activity patterns in older men and women in Germany: a cross-sectional study

Data on physical activity in older adults in Germany is scarce. The aim of this study was to analyze physical activity patterns and to explore factors associated with physical activity in different domains, i.e. sporting activities (SA) and domestic activities (DA), in older men and women.; As part of the 7-year follow-up telephone interviews of the getABI cohort (community-dwelling older adults in Germany), the PRISCUS-PAQ was used to survey participants about their everyday physical activity patterns. Time per week (hh:mm) spent in SA and DA (heavy housework, gardening) was analyzed for men and women. Multivariate logistic regression analyses were performed in order to assess the odds of participating in SA and DA for at least 2.5 hours/week in association with sociodemographic factors, a broad range of physical health-related factors and interview date (season of the year).; A total of 1,610 primary health care patients (51.6% women) with a median age of 77 (range 72-93) years were included in the analyses. Men engaged in SA more often than women (01:45 vs. 01:10), whereas women did more DA per week than men (04:00 vs. 03:00).Being interviewed in spring or summer was associated with increased performance of DA in both sexes. Participation in these activities was reduced in more highly educated men and women. Living alone increased the odds of sports participation in women, but not in men. Most physical health-related factors were only selectively associated with either SA or DA, in men or women, respectively. The need for a walking aid was the only factor that consistently lowered the odds of being active in both activity domains and sexes.; This exploratory study delivers reliable and relevant data on the participation in and correlates of sporting and domestic activities of community-dwelling older adults for whom there had previously been only limited information at a population level in Germany. Findings are discussed and implications for epidemiological research and health promotion practice are provided

Correlates of sport participation among community-dwelling elderly people in Germany: a cross-sectional study

The aims of this study were (1) to analyze the sport participation in a cohort of community-dwelling elderly people in Germany and (2) to evaluate associations between sport participation, sociodemographic factors, cardiovascular risk factors, and health status. In a monitored prospective cohort study (getABI), 6,880 unselected patients ≥65 years have been followed up by 344 general practitioners beginning in 2001. As part of the 5-year follow-up telephone interview, a sample of 1,376 participants was interviewed on sport participation. The association between participation in at least one sporting activity (“sporty” yes/no) during the past week (cycling) or month (other sports) and the following parameters was analyzed by logistic regression: age, sex, immigration background, education, waist circumference, smoking, self-reported health, history of vascular events, diabetes mellitus, lipometabolic disorder, and arterial hypertension. Analysis of activities (n = 1,304; median age 76 (70–94) years; 55.1% women) showed that 27.6% of participants rode a bicycle during the previous week. During the previous month, 24.9% of participants did gymnastics or strength training, and 16.5% swam. Of all participants, 53.8% were sporty. Multivariate analysis revealed several independent factors to be associated with being sporty (p < 0.05): younger age, male sex, higher education, nonsmoking, better self-reported health, and not being diagnosed with diabetes. Immigration background, waist circumference, history of vascular events, lipometabolic disorder, and hypertension did not show a statistically significant association (p ≥ 0.05) with sport participation. Summing up, the most frequently performed sporting activities were cycling, gymnastics or strength training, and swimming. Sport participation was associated with, for example, age and sex

Effects of three different methods defining onset of peripheral artery disease on the assessments of incidence and important predictors

$\bf Purpose:$ The common definition of asymptomatic peripheral artery disease (PAD) by a single determination of the ankle brachial index (ABI) has some uncertainty due to measurement errors. This may impact estimates of PAD incidence and assessment of PAD risk factors. To investigate this issue, we used three methods to define asymptomatic PAD and made use of data from the German Epidemiological Trial on Ankle Brachial Index (getABI). $\textbf {Patients and Methods:}$ A total of 6,880 unselected subjects aged ≥ 65 years, enrolled by 344 trained general practitioners, had ABI assessments at baseline and four visits during follow-up. The first approach defined asymptomatic PAD onset as soon as a single ABI value was below 0.9 (single ABI). The second approach employed a regression method using all available ABI values (regression A), while for the third approach (regression B), an extended regression beyond the last valid ABI value for the observation time of the study was allowed. For each approach, we calculated PAD incidence rates and assessed the effect of important PAD predictors using multivariable Cox proportional hazards regression. $\bf Results:$ The regression method A showed the lowest (25.0 events per 1,000 person years) and the single ABI method the highest incidence rate (41.2). The regression methods assigned greater impact to several risk factors of incident PAD. Using regression A, the hazard ratios (HR) of active smoking (2.36; 95% CI 1.92 to 2.90) and of diabetes (1.33; 95% CI 1.13 to 1.56), using regression B the HR of older age (1.72; 95% CI 1.50 to 1.97) were about twice as high as the corresponding HR of the single ABI approach. $\bf Conclusion:$ Use of the single ABI method leads to higher PAD incidence rates and to lower impact of important PAD predictors compared to regression methods. For an alert risk factor management, multiple ABI determination may be useful

Reduction of Potentially Inappropriate Medication in the Elderly

Rudolf H, Thiem U, Aust K, et al. Reduction of Potentially Inappropriate Medication in the Elderly. Deutsches Ärzteblatt international . 2021;118(51-52):875-882.BACKGROUND: Medications with an unfavorable risk-benefit profile in the elderly, and for which there are safer alternatives, are designated as potentially inappropriate medications (PIM). The RIME trial (Reduction of Potentially Inappropriate Medication in the Elderly) was based on PRISCUS, a list of PIM that was developed in 2010 for the German pharmaceuticals market. In this trial, it was studied whether special training and the PRISCUS card could lessen PIM and undesired drug-drug interactions (DDI) among elderly patients in primary care.; METHODS: A three-armed, cluster-randomized, controlled trial was carried out in two regions of Germany. 137 primary care practices were randomized in equal numbers to one of two intervention groups-in which either the primary care physicians alone or the entire practice team received special training-or to a control group with general instructions about medication. The primary endpoint was the percentage of patients with at least one PIM or DDI (PIM/DDI) per practice. The primary hypothesis was that at 1 year this endpoint would be more effectively lowered in the intervention groups compared to the control group.; RESULTS: Among 1138 patients regularly taking more than five drugs, 453 (39.8%) had at least one PIM/DDI at the beginning of the trial. The percent - ages of PIM/DDI at the beginning of the trial and 1 year later were 43.0% and 41.3% in the intervention groups and 37.0% and 37.6% in the control group. The estimated intervention effect of any intervention (69 practices) versus control (68 practices) was 2.3% (p = 0.36), while that of team training (35 practices) versus physician training (34 practices) was 4.3% (p = 0.22).; CONCLUSION: The interventions in the RIME trial did not significantly lower the percentage of patients with PIM or DDI

Polypharmacy in chronic diseases–Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support (PRIMA-eDS): study protocol for a randomized controlled trial

Background: Multimorbidity is increasing in aging populations with a corresponding increase in polypharmacy as well as inappropriate prescribing. Depending on definitions, 25-50 % of patients aged 75 years or older are exposed to at least five drugs. Evidence is increasing that polypharmacy, even when guidelines advise the prescribing of each drug individually, can potentially cause more harm than benefit to older patients, due to factors such as drug-drug and drug-disease interactions. Several approaches reducing polypharmacy and inappropriate prescribing have been proposed, but evidence showing a benefit of these measures regarding clinically relevant endpoints is scarce. There is an urgent need to implement more effective strategies. We therefore set out to develop an evidence-based electronic decision support (eDS) tool to aid physicians in reducing inappropriate prescribing and test its effectiveness in a large-scale cluster-randomized controlled trial.Methods: The “Polypharmacy in chronic diseases–Reduction of Inappropriate Medication and Adverse drug events in older populations” (PRIMA)-eDS tool is a tool comprising an indication check and recommendations for the reduction of polypharmacy and inappropriate prescribing based on systematic reviews and guidelines, the European list of inappropriate medications for older people, the SFINX-database of interactions, the PHARAO-database on adverse effects, and the RENBASE-database on renal dosing. The tool will be evaluated in a cluster-randomized controlled trial involving 325 general practitioners (GPs) and around 3500 patients across five study centres in the United Kingdom, Germany, Austria and Italy. GP practices will be asked to recruit 11 patients aged 75 years or older who are taking at least eight medications and will be cluster-randomized after completion of patient recruitment. Intervention GPs will have access to the PRIMA-eDS tool, while control GPs will treat their patients according to current guidelines (usual care) without access to the PRIMA-eDS tool. After an observation time of 2 years, intervention and control groups will be compared regarding the primary composite endpoint of first non-elective hospitalization or death.Discussion: The principal hypothesis is that reduction of polypharmacy and inappropriate prescribing can improve the clinical composite outcome of hospitalization or death. A positive result of the trial will contribute substantially to the improvement of care in multimorbidity. The trial is necessary to investigate not only whether the reduction of polypharmacy improves outcome, but also whether GPs and patients are willing to follow the recommendations of the PRIMA-eDS tool.Trial registration: This trial has been registered with Current Controlled Trials Ltd. on 31 July 2014 ( ISRCTN10137559 )

Additional file 1: Figure S1. of Polypharmacy in chronic diseases–Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support (PRIMA-eDS): study protocol for a randomized controlled trial

Recruitment of 325 practices and 3575 patients for the PRIMA-eDS* trial. Figure describing the flow of recruitment for the PRIMA-eDS trial. (JPG 117 kb