Social support for older adults in Germany, using the example of senior citizens’ cooperatives

In 2016 the interdisciplinary research team Tech4Age started its long-term survey to evaluate the use of information and communication technology (ICT) by older adults (60+) in Germany. This study focuses on the use of ICT devices and applications, the evaluation how these devices are operated in terms of ergonomic hand positions, the investigation of health information usage as well as technology affinity, health literacy and computer literacy. The first run of the Tech4Age long-term study was done by sending a paper-based questionnaire to 5,000 individuals older than 60 years randomly selected from the total German population and equally locally distributed within Germany. Responses were collected from N = 551 participants with a mean age of 69.17 years (SD = 5.787). The gender ratio of the sample is balanced, including 51.3% male and 48.7% female. Results provide descriptive insights into technology usage and knowledge about influencing factors. Older adults already use modern ICT on a large scale, for example to do online banking or for mobility reasons (navigation, booking tickets, etc.), but health-related ICT products and applications have been used less, mainly due to mistrust. Investigation of health information usage showed that doctors and pharmacists are the main sources older adults rely on. Two thirds of all participants were satisfied with general information they got about health. The evaluation of the ergonomic use of ICT devices revealed a common way of use, namely that a majority of older adults prefer to use their ICT devices in the case of a small display in portrait mode and in the case of larger displays in portrait as well as landscape mode. Touch input is always performed with a finger or the second hand, the one not holding the device. The article will present and discuss the results in detail.

In this study, we developed and validated the Internalized Caregiver Stigma Scale (ICSS) to measure internalized stigma targeting informal care for older adults (≥60 years) in Germany. The ICSS scale was developed in the Attitudes Towards Informal Caregivers project based on stigma theories and (cognitive) pretesting with informal caregivers. Informal long-term caregivers (aged ≥40 years; n = 433) of older relatives (aged ≥60 years) were quota-sampled from the online panel GapFish in December 2023 (twice as many female and middle-aged [aged 40-64 years] caregivers than male and younger [18-39 years] or older adults [65+ years] were included in the sample). Caregiver identification and the Social Impact Scale were used for validation of the newly developed measure. Factor structure, reliability, and concurrent validity were tested. A correlated 2-factor model with excellent goodness-of-fit criteria and good to excellent internal consistency of the factors and the total scale was confirmed for the ICSS. The negative ICSS subscale correlated highly, and the positive ICSS subscale correlated weakly, with the care-specific Social Impact Scale. Both ICSS subscales were weakly correlated with caregiver identification. Both aspects of self-stigma showed significant associations with sociodemographic and care-specific factors in the regression models. The ICSS is the first scale measuring internalized stigma targeting informal care for older adults directly and shows excellent psychometric criteria. It provides the necessary tool for a new approach to analyze the complex psychosocial mechanisms in this highly relevant care context.

BackgroundTo increase effective communication in primary care consultations among older adults in Germany, the photo story is considered to be a useful tool based on Bandura’s social cognitive theory. With information technology helping to increase effective communication, the use of tablets is gaining attention in health care settings, especially with older adults. However, the effectiveness of tablet technology and photo stories has rarely been tested.ObjectiveThe aim is to compare the effectiveness of a photo story intervention to a traditional brochure. Both were delivered either in paper or tablet format.MethodsA trial was conducted with 126 older adults, aged 50 years and older, who were approached and recruited by researchers and administrative staff from senior day care, doctors in rehabilitation centers, and trainers in sports clubs in Germany. Open and face-to-face assessment methodologies were used. Participants were randomly assigned to one of four intervention conditions: traditional brochure in paper format (condition 1) and tablet format (condition 2), and photo story in paper format (condition 3) and tablet format (condition 4). Each participant received a questionnaire and either the traditional brochure or photo story in a paper or tablet version. To evaluate the effectiveness of each intervention, participants completed evaluation questionnaires before and after each intervention. The second part of the questionnaire measured different indicators of health literacy, communication skills, health measurements, and possible underlying mechanisms.ResultsCompared to the traditional brochure, participants considered the photo story easier to understand (t124=2.62, P=.01) and more informative (t124=–2.17, P=.03). Participants preferred the paper format because they found it less monotonous (t124=–3.05, P=.003), less boring (t124=–2.65, P=.009), and not too long (t124=–2.26, P=.03) compared to the tablet format. Among all conditions, the traditional brochure with a tablet (condition 2) was also perceived as more monotonous (mean 3.07, SD 1.08), boring (mean 2.77, SD 1.19), and too long to read (mean 2.50, SD 1.33) in comparison to the traditional brochure in paper format (condition 1). Moreover, the participants scored significantly higher on self-referencing on the traditional brochure in paper format (condition 1) than tablet format for both types of the brochure (conditions 2 and 4).ConclusionsTraditional brochures on a tablet seem to be the least effective communication option in primary care consultations among all conditions for older adults. The findings might be specific for the current generation of older adults in Germany and need to be replicated in other countries with larger sample sizes. Although information technology brings advantages, such as effective interventions in different fields and settings, it may also come with several disadvantages, such as technical requirements of the users and devices. These should be considered when integrating information technology into wider situations and populations.Trial RegistrationClinicalTrials.gov NCT02502292; https://clinicaltrials.gov/ct2/show/NCT02502292 (Archived by Webcite at http://www.webcitation.org/747jdJ8pU)

ObjectivesTo investigate individual, interpersonal and environmental baseline factors predicting regular aerobic physical activity (PA) participation among older adults in Germany at follow-up 12 years later.DesignPopulation-based cohort study.SettingCluster-randomised general population sample...

Introduction Among older adults, lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) is common. We evaluated the cost-effectiveness of bivalent RSV prefusion F protein-based vaccine (RSVpreF) for prevention of RSV-LRTI among older adults in Germany. Research design and methods A static cohort model was developed to estimate lifetime health and economic outcomes of RSV-LRTI among adults aged 60–99 years in Germany, with (vs. without) use of RSVpreF. Vaccine uptake ranged from 27% to 54%. Vaccine effectiveness was derived from trial data and was assumed to last over 3 years, with some waning, following vaccination. Base case analyses were conducted from the societal perspective (costs/benefits discounted 3% annually); sensitivity analyses also were conducted. Results Among adults aged 60–99 years (N = 25.3 M), RSVpreF prevented 117,360 cases of hospitalized RSV-LRTI, 100,433 cases of ambulatory RSV-LRTI, and 9,298 RSV-LRTI-related deaths over a lifetime horizon. With total overall costs higher by 1.8 € billion and 49,576 quality-adjusted life-years (QALYs) gained, cost-effectiveness of RSVpreF was 36,064 €/QALY. In probabilistic sensitivity analyses, the mean cost-effectiveness ratio was 36,518 €/QALY; 925 of 1,000 replications yielded ratios <50,000 €/QALY. Conclusions RSVpreF has the potential to greatly reduce the public health and economic burden of RSV among older adults in Germany.

BackgroundManagement of hypertension is a public health concern due to its strong association with cardiovascular events. Recently, after decades of progress, hypertension treatment and control in high income countries has been observed to plateau. Trends of hypertension management in the growing ageing population are of special interest, but data are scare. We compare a German representative population-based examination survey 15 years ago with current data.MethodsBlood pressure (BP) measurements, medication intake, and self-reported diagnoses in 66- to 79-year-olds are available from the German Health and Examination Survey for Adults (DEGS1) 2008-2011 and the study Gesundheit 65+ 2022-2023. A calibration formula accounted for the change in BP device (DEGS1: Datascope Accutorr Plus; Gesundheit 65+: Mobil-O-Graph). Definitions were: HYPERTENSIVE BP: ⩾140/90 mmHg; TREATMENT: use of antihypertensives among participants with hypertension diagnosis; HYPERTENSION: hypertensive BP or treatment; CONTROL: BP < 140/90 mmHg in treated participants. We report weighted statistics.ResultsOf 1,730 DEGS1 and 664 Gesundheit 65+ participants, 60% (n = 1,041) and 52% (n = 343), respectively, had hypertension and were under treatment. In 2008-2011, diuretics (55%) alongside beta-blockers (54%) were the most commonly used antihypertensives among treated participants with hypertension. 15 years later, the use of diuretics significantly declined to 42%. The most frequently used antihypertensives in Gesundheit 65+ were angiotensin receptor blockers (49%) and beta-blockers (49%). From 2008-2011 to 2022-2023, control of BP did not change significantly (69% to 64%), also not within medication classes.ConclusionsOur trend analysis of hypertension management and control among older people in Germany shows changes in classes of medication intake, but not BP control. These results confirm the recent plateau in control of BP also for older adults, contrasting the earlier trend.Key messages• Two of three older adults in Germany with treated hypertension achieve BP control.• In the last 15 years, control of BP in older adults in Germany with treated hypertension remained unchanged.

BackgroundData on barriers to physical activity in older adults in Germany are scarce. The aim of this study was to analyse barriers to physical activity in a cohort of older adults, allowing comparisons between men and women, and age groups.Methods1,937 older adults with a median age of 77 (range 72-93) years (53.3% female) took part in the 7-year follow-up telephone interviews of the getABI cohort. Participants who stated that they did not get enough physical activity were surveyed with respect to barriers to physical activity. Barriers were analysed for all respondents, as well as by sex and age group for cases with complete data. Multivariate logistic regression analysis was performed to evaluate differences between sexes and age groups. The level of significance (alpha < 0.05) was adjusted for multiple testing according to Bonferroni (p < .004).Results1,607 (83.0%) participants stated that they were sufficiently physically active. 286 participants rated their physical activity as insufficient and responded to questions on barriers to physical activity completely. The three most frequently cited barriers were poor health (57.7%), lack of company (43.0%), and lack of interest (36.7%). Lack of opportunities for sports or leisure activities (30.3% vs. 15.6%), and lack of transport (29.0% vs. 7.1%) were more frequently stated by female respondents than male respondents. These differences between men and women were significant (p = .003; p < .001) after adjustment for respondents' age. Analyses by age groups revealed that poor health was more frequently considered a barrier to physical activity by participants aged 80+ years compared to the younger age group (71.1% vs. 51.5%). This age-dependent difference was significant (p = .002) irrespective of the participants' sex.ConclusionsThe present study provides relevant data on barriers to physical activity in older adults. By revealing appreciable differences between men and women, and age groups, this study has implications for efforts to increase older adults' physical activity. Promotion and intervention strategies should consider the barriers and tailor measures to the specific needs of older adults in order to reduce their constraints to physical activity.

Purpose: As the proportion of older adults in Germany continues to grow, so does the need for physical activity as a strategy for health promotion. The purpose of this study is to gain insights into the belief system underlying older adults’ physical activity and its interplay with motivation by integrating Theory of Planned Behaviour and Self-Determination Theory. Methods: We conducted 20 semi-structured interviews with residents of Germany who were 65 years of age or older. Transcripts of interviews were analysed with a coding frame of deductive main categories and inductive subcategories. Results: Part of our results is a typology that divides our sample into four groups based on the intensity and perceived sufficiency of their physical activity. These groups mainly differ in their intrinsic vs. extrinsic motivation and how they deal with barriers to physical activity, i.e., control beliefs. Conclusion: Messages to promote physical activity should be tailored regarding older adults’ varying beliefs and motivation. To overcome barriers, intrinsic motivation plays a crucial role. Intrinsic motivation is closely linked to activities that are joyful and satisfy basic psychological needs. Moreover, it is important for older adults to be able to adjust their activities to age-related physical limitations and chronic diseases.

<b>Objectives:</b> In Germany, PPSV23 is recommended for the prevention of pneumococcal diseases (PD) in older adults. In 2016, a German modelling study showed that PCV13 was less effective and sequential vaccination (PCV13 + PPSV23; SEQ) not efficient due to major declines in PCV13-type PD. This study reevaluates the performance of pneumococcal vaccination strategies in older adults in Germany based on new available data. <b>Methods:</b> A dynamic transmission model of pneumococcal carriage was developed to predict the epidemiological impact of childhood PCV13-vaccination (indirect herd effects and serotype replacement) on the incidence and the serotype mix in PD among older adults. Vaccination strategies in older adults were evaluated in 48 scenarios. <b>Results:</b> Compared with pre-PCV levels, the model predicted reductions of 84% and 69% in PCV13-type invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP). Non-PCV13-type PD incidence increased by 170% in IPD and 190% in NBPP. Depending on the scenario, a SEQ vaccination campaign in pneumococcal seasons 2020/2021-2029/2030 would gain 249-65,131 QALYs compared with PPSV23 and 3,958-17,152 compared with PCV13. At a threshold of 50,000 Euro per QALY gained, PPSV23 was the most cost-effective vaccination strategy in 25 scenarios, SEQ in 20 scenarios and PCV13 in 3 scenarios. At a threshold of 100,000 Euro per QALY gained, SEQ was economically preferable in 32 scenarios and PPSV23 in 16 scenarios. <b>Conclusions:</b> Vaccination of older adults against PD is highly effective and very likely to be cost-effective in Germany. From an economic perspective, PPSV23 or SEQ would be preferred to PCV13 only.

BackgroundHealth apps are increasingly becoming an integral part of health care. Especially in older adults, the self-management of chronic diseases by health apps might become an integral part of health care services.ObjectiveThe aim of this explorative study was to investigate the prevalence of health app use and related demographic factors, as well as health status among older adults in Germany.MethodsA nationwide postal survey was conducted. Of the 5000 individuals contacted, a total of 576 participants completed this survey. On the basis of their self-indicated assignment to one of the three predefined user groups (health app users, general app users, and nonusers of apps), participants answered various questions regarding app and health app use, including frequency of use and number of installed apps, demographic factors, and health status.ResultsIn total, 16.5% (95/576) used health apps, whereas 37.5% (216/576) indicated only using general apps, and 46.0% (265/576) reported using no apps at all. The number of installed health apps was most frequently reported as between 1 and 5 apps per participant, which were usually used on a weekly basis. The most frequently cited type of health apps were exercise-related ones. Individuals using health apps were found to be younger (MeanmHealth 66.6, SD 4.7) and to have a higher level of technical readiness compared with general app users and nonusers of apps (adjusted odds ratio, AOR=4.02 [95% CI 2.23-7.25] for technical readiness, and AOR=0.905 [95% CI 0.85-0.97] for age). The most frequently mentioned sources of information about apps within the group of health and general app users were family and friends. Identified barriers against the use of health apps were a lack of trust, data privacy concerns, and fear of misdiagnosis.ConclusionsHealth apps are already used by older adults in Germany. The main type of apps used are exercise-related ones. Barriers to and incentives for the use of health apps and associations with health status and users’ demographics were revealed.

The relationship between social support and sleep quality in older adults: A review of the evidence

To estimate the extent of off-label prescribing of antidepressants in older adults and to characterize patients with off-label vs on-label prescriptions of antidepressants using a large German health claims database. Using data from the German Pharmacoepidemiological Research Database (GePaRD), we conducted a cross-sectional study in adults aged 65 years or older with a dispensation of an antidepressant between 1 January 2009 and 31 December 2015 after a period of 365 days without such a dispensation. We assessed the overall and annual proportion of off-label prescriptions of antidepressants by class and individual substance. Among 263 276 incident users of antidepressants, the proportion of off-label prescribing was 43.6% (95% CI 43.4-43.8%) with little variation between 2009 and 2015 (42.2-44.4%). The proportion of off-label use was higher in men (49%) than women (41%). While the proportion of off-label prescriptions was highest for tri- and tetracyclic antidepressants with 56.2% (amitriptyline 54.6%, maximum 65.9% for trimipramine), it amounted to 41.8% for selective serotonin reuptake inhibitors (citalopram 41.6%, maximum 46.0% for escitalopram) and was 51.2% for mirtazapine. Indicators of overall morbidity were similar in both groups, eg, pain was coded in 72% of off-label users vs 77% of on-label users (insomnia 20% vs 24%). Our study suggests a high prevalence of off-label antidepressant use among older adults in Germany, which was not restricted to certain classes of antidepressants or individual antidepressants. Given the unclear risk-benefit ratio, studies investigating the safety of off-label use among older adults for individual antidepressants are urgently needed.

Objective To examine the association between voluntary work, loneliness and perceived social isolation amongst middle aged and older adults in Germany. Methods Data were taken from Wave 5 (Year 2014; n = 7,164 in the analytical sample) of the German Ageing Survey – a nationally representative survey of middle-age and older adults. Voluntary work was quantified using a qualitative scale. The De Jong Gierveld tool was used to assess loneliness. The Bude and Lantermann tool was used to assess perceived social isolation. It was adjusted for several covariates in regression analysis. Results Multiple linear regression analyses, that adjusted for several covariates, revealed a negative association between voluntary work and loneliness as well as perceived social isolation. Similar associations between volunteering and social isolation in people 40–64 years old and older, as well as volunteering and loneliness in those 40–64 years old, were discovered in age-stratified regression analyses. Volunteering, however, was not significantly linked to loneliness in people 65 and older. Conclusion Study findings showed a negative association between voluntary work and loneliness as well as perceived social isolation. Since protecting against loneliness and perceived social isolation can contribute to successful ageing, this is of great importance.

BackgroundUse of psychotropic drugs is common among older adults. Population-based studies on the associations of psychotropic drug use with mortality are sparse.ObjectivesTo investigate the associations between the use of specific psychotropic drug groups (opioids, antipsychotics, antidepressants and benzodiazepines) and all-cause mortality among community-dwelling older adults in Germany.MethodsParticipants of the German National Health Interview and Examination Survey 1998 were followed up for mortality from 1997 to 2011. Persons aged 60–79 years with complete data on psychotropic drug use at baseline and on mortality follow-up were considered as study population (N = 1,563). Associations between the use of opioids, antipsychotics, antidepressants and benzodiazepines and all-cause mortality were examined by Cox proportional hazards models adjusted for sociodemographics (sex, age, community size, region, socioeconomic status), life style (smoking, sports, risky alcohol drinking) and health conditions (obesity, disability, history of cardiovascular diseases, diabetes, hyperlipidemia, hypertension, any cancers, any mental disorders) at baseline.ResultsAfter a median follow-up of 11.4 years, 21, 18, 23 and 26 deaths were documented among those who used at baseline opioids (n = 39), antipsychotics (n = 30), antidepressants (n = 53) and benzodiazepines (n = 54) with an unadjusted mortality rate (MR) of 57.7, 59.1, 44.6 and 53.7 per 1000 person-years, respectively. Meanwhile, 400 deaths were documented among 1,406 nonusers of any of the above mentioned psychotropic drugs with a MR of 26.7 per 1000 person-years. The age and sex adjusted mortality rate ratios in comparison with nonusers were 2.20 (95% confidence intervals 1.42–3.41), 1.66(1.03–2.70), 1.56(1.06–2.28), and 1.57(1.07–2.31) for the use of opioids, antipsychotics, antidepressants and benzodiazepines, respectively. In the fully adjusted Cox models, use of opioids (hazardous ratio 2.04, 95% confidence intervals 1.07–3.89), antipsychotics (2.15, 1.11–4.15) and benzodiazepines (1.76, 1.09–2.82), but not antidepressants, were significantly associated with an increased risk of mortality.ConclusionsUse of opioids, antipsychotics, benzodiazepines is significantly associated with an increased risk of all-cause mortality among community-dwelling older adults in Germany. Clinicians should be careful in prescribing these psychotropic drugs to older adults while patients already under psychotropic therapy should well balance the risks and benefits of drug use. Further studies with a larger sample size and information on specific indications for psychotropic drug use and mental comorbidities are required to confirm the findings of the present study.

BackgroundHealthy ageing is an important concern for many societies facing the challenge of an ageing population. Physical activity (PA) is a major contributor to healthy ageing; however insufficient PA levels are prevalent in old age in Germany. Community capacity building and community involvement are often recommended as key strategies to improve equitable access to prevention and health promotion. However, evidence for the effectiveness of these strategies is scarce. This study aims to assess the community readiness for PA promotion in local environments and to analyse the utility of strategies to increase community readiness for reaching vulnerable groups.Methods/DesignWe designed a mixed method intervention trial comprising three study modules. The first module includes an assessment of community readiness for PA interventions in older adults. The assessment is carried out in a sample of 24 municipalities in the Northwest of Germany using structured key informant interviews. In the second module, eight municipalities with the low community readiness are selected from the sample and randomly assigned to one of two study groups: active enhancement of community readiness (intervention) versus no enhancement (control). After enhancing community readiness in the active enhancement group, older adults in both study groups will be recruited for participation in a PA intervention. Participation rates are compared between the study groups to evaluate the effects of the intervention. In addition, a cost-effectiveness analysis is carried out calculating recruitment costs per person reached in the two study groups. In the third module, qualitative interviews are conducted with participants and non-participants of the PA intervention exploring reasons for participation or non-participation.DiscussionThis study offers the potential to contribute to the evidence base of reaching vulnerable older adults for PA interventions and provide ideas on how to reduce participation barriers. Its findings will inform governmental authorities, professionals, academics, and NGOs with an estimate of resources necessary to achieve equitable access to physical activity programs for vulnerable older adults.Trial registrationGerman Clinical Trials Register DRKS00009564 (Date of registration 03-11-2015)