Older Adults In Germany Research Articles

Prevalence of dementia in nursing home and community-dwelling older adults in Germany

We compared the prevalence of dementia in nursing home residents and community-dwelling older adults . Using health insurance claims data for the year 2009, we estimated the prevalence of at least three of four quarters with a diagnosis of dementia in persons aged ≥65years. Of 213,694 persons aged 65+ years, 4,584 (2.2%) lived in nursing homes. The prevalence of dementia was 51.8% (95% CI 50.4-53.3) in nursing home residents and 2.7% (95% CI 2.6-2.8) in community-dwelling elderly. Increasing prevalences with age were found in both sexes in community-dwelling elderly. These trends were not seen in nursing home residents where prevalences were already high for the age group 65-69years (35.7% in males and 40.9% in females, respectively). More than half of nursing home residents suffer from dementia, which is about 19-fold higher than the prevalence in insured living in the community.

Self- or Physician-reported Diabetes, Glycemia Markers, and Cognitive Functioning in Older Adults in Germany

To assess the association of different diabetes-related variables, including self- and physician-reported information, as well as biomarkers, with cognitive functioning in the elderly general population in Germany. Cross-sectional observational study. A total of 1,697 subjects with a mean ± standard deviation age of 74 ± 2.8 years were included. These were recruited from among the participants of an ongoing epidemiological study of the elderly general population in Saarland state and had been recruited 5 years earlier on the occasion of a health screening exam by their general practitioners. Cognitive functioning across six subdomains was assessed using the Cognitive Telephone Screening Instrument. Data on prevalent diabetes at baseline were obtained from the study participants and their general practitioners. Baseline fasting glucose was assessed as part of the screening exam, and baseline HbA1c was determined centrally by standardized methods. The association of cognitive functioning with self-reported diabetes (N= 189) was more pronounced than with physician-reported diabetes (N= 280). HbA1c showed a nonlinear association with cognitive functioning, with a peak of cognitive performance in the central quintile of HbA1c. In the case of fasting glucose, lower cognitive functioning was only observed in the highest quintile. The estimates were robust in confounder-adjusted models, but attentuated when excluding subjects with baseline prevalent or follow-up incident diabetes. Future studies of diabetes-related biomarkers and cognition should take possible nonlinearity of the relationships into account, as the strength of the associations otherwise might be underestimated.

Prävalenz ausgewählter muskuloskelettaler Erkrankungen

The term musculoskeletal condition (MSKC) comprises inflammatory and degenerative diseases of joints and bones. They are among the most common conditions in older age and cause of severe long-term pain, physical disability, and decrease in quality of life. Data from the German Health Interview and Examination Survey for Adults (DEGS1) were used to estimate the life-time prevalence of osteoarthritis, rheumatoid arthritis (RA) and osteoporosis in Germany. A total of 7,988 persons aged 18-79 years (osteoporosis 50-79 years) were asked to report doctor-diagnosed MSKC in face-to-face interviews. Women were more likely to report all MSKC and all prevalences increase with age. Osteoarthritis is reported by 22.3 % of women and 18.1 % of men, RA by 3.2 % of women and 1.9 % of men, and osteoporosis by 13.1 % of women and 3.2 % of men. MSKC are of great relevance for older adults in Germany. Data from DEGS1 provide a lot of information along to MSKC and hereby allow a closer description of the health situation of older adults. An English full-text version of this article is available at SpringerLink as supplemental.

Differences in late-life loneliness: a comparison between Turkish and native-born older adults in Germany.

The aim of this study was (1) to examine whether Turkish older migrants are indeed-as is often claimed without solid scientific evidence-lonelier than their peers with no migration background and (2) to determine the factors that account for the differences in loneliness between them. We analysed data of adults aged 50-79 from the first wave of the German Generations and Gender Survey and a supplementary survey of Turkish nationals in Germany (N=3,248 born in Germany and N=494 born in Turkey). Differences in degree of loneliness between Turkish and native-born older adults were determined by the six-item Loneliness Scale of de Jong Gierveld. To identify the specific factors contributing to these loneliness differences, a series of multivariate regression analyses were conducted, examining the impact of two groups of risk factors (poor health and low socioeconomic status) and two groups of protective factors (social embeddedness in the family and informal support exchanges) on loneliness. Results showed that feelings of loneliness are indeed more prevalent among older adults of Turkish origin than their German counterparts, which is entirely attributable to their lower socioeconomic status and poorer health. Living with a partner or children, frequent contacts with non-coresident children, emotional support exchange and looking after grandchildren-though important factors to prevent loneliness at the individual level-did not specifically protect Turkish older adults from loneliness, or did so rarely. These findings not only indicate new and challenging directions for further research but also raise questions about the effectiveness of the most common loneliness interventions, which focus on improving number and quality of social relationships.

Prevalence and comorbidity of diabetes mellitus among non-institutionalized older adults in Germany - results of the national telephone health interview survey ‘German Health Update (GEDA)’ 2009

BackgroundDespite the major public health impact of diabetes, recent population-based data regarding its prevalence and comorbidity are sparse.MethodsThe prevalence and comorbidity of diabetes mellitus were analyzed in a nationally representative sample (N = 9133) of the non-institutionalized German adult population aged 50 years and older. Information on physician-diagnosed diabetes and 20 other chronic health conditions was collected as part of the national telephone health interview survey ‘German Health Update (GEDA)’ 2009. Overall, 51.2% of contacted persons participated. Among persons with diabetes, diabetes severity was defined according to the type and number of diabetes-concordant conditions: no diabetes-concordant condition (grade 1); hypertension and/or hyperlipidemia only (grade 2); one comorbidity likely to represent diabetes-related micro- or macrovascular end-organ damage (grade 3); several such comorbidities (grade 4). Determinants of diabetes severity were analyzed by multivariable ordinal regression.ResultsThe 12-month prevalence of diabetes was 13.6% with no significant difference between men and women. Persons with diabetes had a significantly higher prevalence and average number of diabetes-concordant as well as diabetes-discordant comorbidities than persons without diabetes. Among persons with diabetes, 10.2%, 46.8%, 35.6% and 7.4% were classified as having severity grade 1–4, respectively. Determinants of diabetes severity included age (cumulative odds ratio 1.05, 95% confidence interval 1.03-1.07, per year) and number of discordant comorbidities (1.40, 1.25-1.55). With respect to specific discordant comorbidities, diabetes severity was correlated to depression (2.15, 1.29-3.56), respiratory disease (2.75, 1.72-4.41), musculoskeletal disease (1.53, 1.06-2.21), and severe hearing impairment (3.00, 1.21-7.41).ConclusionsDiabetes is highly prevalent in the non-institutionalized German adult population 50 years and older. Diabetes comorbidities including diabetes-concordant and diabetes-discordant conditions need to be considered in epidemiological studies, in order to monitor disease burden and quality of diabetes care. Definitional standards of diabetes severity need to be refined and consented.

Physical activity and other health-related factors predict health care utilisation in older adults

Health care utilisation (HCU) can be a useful outcome for estimating costs and patient needs. It can also be used as a surrogate parameter for healthy ageing. The aim of this study was to analyse the associations of formerly described and potentially new parameters influencing health care utilisation in older adults in Germany. The ActiFE Ulm (Activity and Function in the Elderly in Ulm) study is a population-based study in 1,506 community dwelling older adults aged 65-90 years in Ulm and surrounding areas in southwestern Germany. Between March 2009 and April 2010 a full geriatric assessment was performed including accelerometer-based average daily walking duration, comorbidity, medication, physical and psychological functioning, health care utilisation, sociodemographic factors etc. The association between above named measures and health care utilisation, represented by the number of drugs, the days in hospital and the number of physician contacts over one year was calculated in multiple regression models. Analysis was conducted among subjects with complete information (n = 1,059, mean age 76 years, 55% male). The average number of drugs was 4.5 and over 95% of participants visited a physician at least once a year while still more than 65% contacted their physician more than twice a year. Reduced physical activity, BMI, self-rated health and/or comorbidity and male sex were the best predictors of health care utilisation in community dwelling older adults when looking at both the number of drugs and the number of physician contacts over 12 months together. With regard to single diseases entities the best predictors of both the number of drugs and the number of physician contacts were asthma, chronic obstructive pulmonary disease (COPD)/chronic bronchitis and chronic neurological diseases (mostly Parkinson's disease). The number of drugs was most strongly associated with coronary heart disease, diabetes, and high blood pressure. Reduced walking activity, self-rated health and/or comorbidity and male sex are the best predictors of health care utilisation as measured by the number of drugs and number of physician contacts over 12 months. Walking activity could be regarded as the most promising modifiable predictor of HCU in older adults.

Relationship between multimorbidity and direct healthcare costs in an advanced elderly population

The goal of this work was to analyze the impact of the extent of multimorbidity on health service resource utilization and, thus, direct healthcare costs of advanced elderly in the German population. Based on a cross-sectional sample aged 72 or above in Germany (n = 1,937), a bottom-up study assessing resource utilization and corresponding costs was performed. Main data sources were patient-reported information concerning morbidity and health service resource utilization administered via telephone interviews within the framework of the PRISCUS trial. To value resource utilization, unit costs were determined for all services under consideration. In order to estimate the impact of multimorbidity on mean annual direct costs, a cumulative multimorbidity index was constructed. Influencing factors on annual average costs were identified via multivariate linear regression models. Mean annual direct costs of 3,315EUR (95%confidence interval (CI) 3,118; 3,512) at 2010 prices were caused by the involved patients: 25% of mean annual costs were due to inpatient care, 20% to outpatient physician services, 20% to pharmaceuticals, 12% to assisted living and transportation, 8% to healthcare products and dentures, 7% to rehabilitation services, 5% to outpatient nonphysician providers, and 3% to spending from compulsory long-term care insurance. Each additional comorbidity was accompanied by a cost increase of 563EUR (95%CI 488; 638). Participants with no diseases mentioned in the multimorbidity index caused average annual costs of 1,250EUR. In contrast, respondents with 10 + diseases caused the highest mean annual costs of 6,862EUR. Longer life expectancy has become commonplace and is often associated with the simultaneous occurrence of several diseases. A clear understanding of the impact of multimorbidity on costs is highly relevant for health policy decision makers. The present study provides a well-founded basis to analyze the relationship between multiple morbidity and associated costs due to healthcare resource consumption of older adults in Germany.

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

BackgroundData 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.MethodsAs 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).ResultsA 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.ConclusionsThis 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.

Barriers to physical activity in older adults in Germany: a cross-sectional study.

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.

Wellbeing depends on social relationship characteristics: comparing different types and providers of support to older adults

ABSTRACTThis paper examines the associations between different forms of support, who provides the support and the wellbeing of older adults in Germany. Particular attention is paid to the wellbeing differences associated with kin and non-kin providers and with emotional support and instrumental support. In addition, the quality of relationships with kin and non-kin is examined as a moderator of the association between social support and wellbeing. Data for 1,146 respondents to the German Ageing Survey in 2002 were analysed to determine the combinations of emotional or instrumental support, kin or non-kin providers and relationship quality that best predicted wellbeing. Emotional support from kin and instrumental support from non-kin were both found to associate positively with wellbeing. Emotional support from non-kin providers did not associate with wellbeing, whereas instrumental support from kin providers had a negative association with one aspect of wellbeing. Higher relationship quality, whether with kin or non-kin, positively related to wellbeing. Interestingly, the negative impact of instrumental kin support was qualified by relationship quality. In other words, for people with high-quality relationships, receiving instrumental support from kin did not decrease wellbeing. When the relationship with a family carer or supporter is characterised by high quality, the challenges of frailties in old age, such as decreasing capacities and an increasing need for social support, can be met without compromising wellbeing.

Ulcers and gastritis

Chronic atrophic gastritis (CAG) plays a crucial role in the development of intestinal-type gastric carcinoma. Helicobacter pylori infection seems to be the main cause of CAG. Diagnosis of CAG is based mostly on gastroscopy and histological findings following gastric biopsy, which is difficult to apply in large-scale population-based studies. An approach more suitable for such studies is to obtain information on the gastric mucosal status by measuring pepsinogen (PG) concentrations in the blood, as has been developed by Miki et al. [2] and Samloff et al. [3]. The objectives of this study by Weck et al. were to estimate prevalence of CAG by using two diagnostic criteria and to examine the association between CAG and potential risk factors and clinical consequences in a large population-based study among elderly individuals in Germany. From the variety of cut-off points used to define CAG in previous epidemiological studies, the following two were chosen: (i) PG I < 25 ng/mL, which was used in the EUROGAST study by Webb et al. [4], the only large international comparative study to delineate severe forms of CAG; and (ii) PG I < 70 ng/mL and PG I/PG II < 3, as used in several studies from Japan to define any form of CAG. With the definition used in the EUROGAST study (PG I < 25 ng/mL), prevalence of CAG increased from 4.8 % in the age group 50 – 54 years to 8.7 % in the age group 70 – 74 years. The alternative definition of CAG (PG I < 70 ng/mL and PG I/PG II < 3) used in the Japanese studies, revealed a greater increase with age (from 2.7 % to 9.1 %) and a strong association with H. pylori infection. Prevalence of CAG was found to be at a low level in this large study of older adults in Germany, and strongly increased with age but was unrelated to sex, smoking, and alcohol consumption. A strong association with H. pylori infection emerged only when CAG was defined by both PG I and the PG I/PG II ratio. Therefore, the role of H. pylori infection may be underestimated in studies where CAG is defined only by PG I levels, supporting the use of the PG I/PG II ratio for the definition of CAG in epidemiological studies.

Epidemiology of chronic kidney disease: Results from a population of older adults in Germany

Objective To determine prevalences and stages of chronic kidney disease (CKD), and evaluate association of CKD with related covariables in a large population of older adults. Methods This cross-sectional analysis included 9806 participants of a general health check-up aged 50–74 years in Germany. We performed multivariate analysis to identify association of CKD with related covariables. Partial spearman correlations of eGFR with related biomarkers were calculated. Results Overall, 17.4% of subjects had CKD. Prevalences of stages 1, 2, 3, 4/5 CKD were 4.6%, 4.7%, 17.0% and 0.4%, respectively. Prevalence of CKD increased with age and peaked in age 70–74 years with 23.9%. In multivariable analysis of older age, female, self-reported history of cardiovascular diseases, diabetes and statin usage were independently associated with increased risk for CKD. Significant correlations were found between eGFR and serum cystatin C (− 0.28), C-reactive protein (− 0.04), fasting glucose (0.12), HbA 1c (− 0.06), total cholesterol (− 0.32), and triglycerides (− 0.07) after adjustment for covariates. Conclusions This study shows a high prevalence of CKD among older adults. It highlights the association of eGFR with history of cardiovascular diseases, glycemic markers, and cardiovascular risk factors and may point to further possible targets in early prevention of CKD.

Reproducibility of a telephone interview assessing cognitive function and depressive symptoms in older adults in Germany

Reproducibility of a telephone interview assessing cognitive function and depressive symptoms in older adults in Germany

Changes of cardiovascular risk factors and their implications in subsequent birth cohorts of older adults in Germany: a life course approach

To examine lifetime patterns of cardiovascular risk factors and their implications in subsequent birth cohorts of older adults in Germany, who experienced very different political and socioeconomic conditions at various phases of their lives. Participants of the ESTHER study, a statewide cohort study conducted in Saarland, Germany, were categorized into four birth cohorts: 1925-1934, 1935-1939, 1940-1944, 1945-1952. At baseline, lifetime history of body weight, physical activity, smoking and drinking habits, and of physician-diagnosed diabetes mellitus were documented. The average BMI, the average number of hours of physical activity, prevalence of smoking and alcohol consumption between ages 20 and 50 years were assessed. The relative risks of a first diagnosis of diabetes mellitus before or at the age of 50 years by birth cohorts were assessed by multiple logistic regressions controlling for education and BMI at the age of 20. For both men and women, later birth cohorts had considerably worse lifestyle profiles. The frequency of diabetes mellitus up to the age of 50 years was much higher in the later than in the earlier cohorts. The increase was more pronounced among men than among women. Women and men reaching old age in the forthcoming years have more unfavourable lifetime risk factor profiles than earlier birth cohorts. These patterns might have substantial implications for the future burden of chronic disease.

Epidemiology of chronic atrophic gastritis: population‐based study among 9444 older adults from Germany

Epidemiological data on chronic atrophic gastritis from general population samples are sparse in Germany. To assess prevalence of chronic atrophic gastritis according to potential risk factors and clinical outcomes in a large-scale population-based study. In the baseline examination of ESTHER, a population-based cohort study conducted in Germany, serological measurements of pepsinogen (PG) I and II and Helicobacter pylori antibodies were taken in 9444 women and men aged 50-74 years. Information on potential risk factors and medical history were obtained by questionnaire. With the definition used in the EUROGAST study (PG I < 25 ng/mL), prevalence of chronic atrophic gastritis increased from 4.8% in age group 50-54 to 8.7% in age group 70-74. An alternative definition of chronic atrophic gastritis (PG I < 70 ng/mL and PG I/PG II < 3), used in multiple studies from Japan, revealed a greater increase with age (from 2.7% to 9.1%) and a strong association with H. pylori infection (adjusted odds ratio: 2.9, 95% confidence interval: 2.4-3.7). With both definitions, a strong inverse association with heartburn was observed. Overall chronic atrophic gastritis prevalence is low among older adults in Germany, but it strongly increases with age and H. pylori infection.