Depressive symptoms among individuals identifying as asexual: a cross-sectional study.

Although asexuality became a growing research subject over the last decade, data on the mental health of individuals identifying as asexual is still rare. The key objective of the present study was to examine depressive symptoms among individuals identifying as asexual. Data of LGBTQIA+ (Lesbian, Gay, Bi-sexual, Trans*, Queer, Inter*, Asexual and/or + indicating others within the community) and cisgender heterosexual individuals was collected through an online survey during the COVID-19 lockdowns in Germany. The survey included questions about sexual and gender identity, depressive symptoms, and asexual identity. An analysis of N = 6601 participants was conducted. A total of n = 445 individuals identified as asexual. Regression results indicated identifying as asexual being significantly associated with higher depressive symptoms. Results suggest that individuals identifying as asexual represent a vulnerable group within the group of sexual minorities, one that fundamentally requires special psychosocial support, especially in times of pandemics.

Sex and Age Characteristics in Acute or Chronic Myocarditis A Descriptive, Multicenter Cohort Study.

BACKGROUND: Understanding the clinical features of myocarditis in various age groups is required to identify age-specific disease patterns. OBJECTIVES: The objective of this study was to examine differences in sex distribution and clinical outcomes in patients with myocarditis of various ages. METHODS: Patients with acute or chronic myocarditis in 3 centers in Berlin, Germany from 2005 to 2021 and in the United States (National Inpatient Sample) from 2010 to 2019 were included. Age groups examined included "prepubescent" (below 11 years for females and below 13 years for males), adolescents (11 [female] or 13 [male] to 18 years), young adults (18-35 years), "middle-aged adults" (35-54 years), and older adults (age >54 years). In patients admitted to the hospital, hospital mortality, length of stay, and medical complication rates were examined. RESULTS: Overall, 6,023 cases in Berlin and 9,079 cases in the U.S. cohort were included. In both cohorts, there were differences in sex distribution among the 5 age categories, and differences in the distribution were most notable in adolescents (69.3% males vs 30.7% females) and in young adults (73.8% males vs 26.3% females). Prepubescent and older adults had the highest rates of in-hospital mortality, hospital length of stay, and medical complications. In the Berlin cohort, prepubescent patients had higher levels of leukocytes (P < 0.001), antistreptolysin antibody (P < 0.001), and NT-proBNP (P < 0.001) when compared to young adults. CONCLUSIONS: In this study, we found that sex differences in myocarditis and clinical features of myocarditis were age-dependent.

Effectiveness of Psychotherapy for Community-Dwelling Vulnerable Older Adults with Depression and Care Needs: Findings from the PSY-CARE Trial.

BACKGROUND: For older adults with care needs, evidence for the effectiveness of psychotherapy on depression is scarce. METHODS: In PSY-CARE, a pragmatic randomized controlled trial, N = 197 home-living older adults with depression and care needs were randomized into outpatient psychotherapy or an active control condition. Residential psychotherapists offered age-sensitive cognitive-behavioral psychotherapy (at-home if needed). Control group participants received telephone counseling and a self-help guide. Outcomes were assessed at baseline (T1), after (T2), 3 months after (T3), and 12 months after the intervention (T4). RESULTS: There was a significant decrease in depressive symptoms across both arms with Cohen's d T4-T1 = .52 in the psychotherapy and .55 in the control group. Mixed models revealed no statistically significant difference in primary and secondary outcomes between interventions. Posthoc, we found control group participants with greater ADL limitations experienced significantly increased depressive symptoms compared to those reporting lower limitations. CONCLUSIONS: Interventions were successful in reducing depressive symptoms, even though treatment fidelity was decreased due to the COVID-19 pandemic. We could not demonstrate superior effectiveness of psychotherapy for older adults with care needs. CLINICAL IMPLICATIONS: Findings suggest that psychotherapy may be an important and superior treatment to circumvent aggravation of depression in older patients with high functional limitations. TRIAL REGISTRATION: The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN55646265, February 15, 2019).

Statin Use and All-Cause Mortality in Nursing Home Residents With and Without Dementia: A Retrospective Cohort Study Using Claims Data.

BACKGROUND AND OBJECTIVES: Little is known about the benefits of statin therapy in older adults with dementia. We aimed to evaluate the role of statin use for all-cause mortality in nursing home residents with and without dementia. METHODS: This retrospective cohort study used claims data collected between January 2015 and December 2019 from a German health and long-term care insurance provider. Propensity score-based Cox proportional hazards models were used to evaluate the association of statin use with all-cause mortality and adjusted for potential confounders in nursing home residents. Subgroup analyses were performed based on the presence or absence of atherosclerotic cardiovascular disease (ASCVD), statin intensity (low, moderate, high), dementia type, age, sex, and level of care required. RESULTS: A total of 282,693 participants were included in the study, of which 96,162 were matched. In total, 68.9% were women, and the mean age was 82.91 years (SD ±7.97). The average observation period was 2.25 years (SD ±1.35), and 54,269 deaths were recorded. Statin use in individuals with dementia resulted in lower all-cause mortality (hazard ratio [HR] 0.80, 95% CI 0.78-0.82, p < 0.001) compared with statin nonusers. Similarly, in individuals without dementia, statin use was associated with lower all-cause mortality (HR 0.73, 95% CI 0.71-0.76, p < 0.001) compared with statin nonusers. Similar findings were observed in subanalyses excluding participants with a history of ASCVD and across subgroups stratified by age, sex, care level required, and dementia type. Statin benefits were consistent among individuals with and without dementia. DISCUSSION: Statin benefits were consistent among individuals with and without dementia. Statin therapy may be continued in nursing home residents with dementia to mitigate the risk of all-cause mortality. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that nursing home patients receiving statins have a lower mortality rate, whether they have a dementia diagnosis or not.

Effectiveness of a tablet-based intervention for people living with dementia in primary care-A cluster randomized controlled trial.

BACKGROUND: Primary care physicians (PCP) play a key role in the care of people living with dementia. However, the implementation and practicability of the German S3 Dementia Guideline in primary care remain unclear. The main objective of the present study was to evaluate an intervention for improving guideline-based dementia care in primary care. DESIGN: A two-arm, 9-month follow-up cluster-randomized controlled trial with two parallel groups. SETTING: 28 primary care practices in Berlin and the surrounding area in Germany. PARTICIPANTS: A total of N = 28 PCP, N = 91 people living with dementia, and N = 88 informal caregivers participated in the trial. INTERVENTION: A tablet-based intervention to improve adherence to the German S3 Dementia Guideline in primary care was compared to a control group (care as usual plus a handbook on dementia). MeasurementsAdherence to dementia guideline (primary outcome) was measured on PCP' (23 items) and informal caregivers' level (19 items) with a self-developed checklist. Secondary outcomes (quality of life, neuropsychiatric symptoms, activities of daily living, general health status, depression, and caregiver burden) were measured with standardized assessments. Also, post-hoc per-protocol analyses were conducted. RESULTS: No differences in guideline adherence between the intervention and the control group were observed. Further, no significant impact of the intervention on secondary outcomes was detected. CONCLUSION: The DemTab Study did not improve self-reported guideline adherence in PCP. However, important implementation barriers such as lack of interoperability and low applicability of existing German S3 Dementia Guideline in the primary care setting were identified and are being discussed. TRIAL REGISTRATION: The DemTab trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019, https://doi.org/10.1186/ISRCTN15854413.

Safety and Healthcare Resource Utilization in Patients Undergoing Left Atrial Appendage Closure-A Nationwide Analysis.

Percutaneous left atrial appendage closure (LAAC) has emerged as a non-pharmacological alternative for stroke prevention in patients with atrial fibrillation (AF) not suitable for anticoagulation therapy. Real-world data on peri-procedural outcomes are limited. The aim of this study was to analyze outcomes of peri-procedural safety and healthcare resource utilization in 11,240 adult patients undergoing LAAC in the United States between 2016 and 2019. Primary outcomes (safety) were in-hospital ischemic stroke or systemic embolism (SE), pericardial effusion (PE), major bleeding, device embolization and mortality. Secondary outcomes (resource utilization) were adverse discharge disposition, hospital length of stay (LOS) and costs. Logistic and Poisson regression models were used to analyze outcomes by adjusting for 10 confounders. SE decreased by 97% between 2016 and 2019 [95% Confidence Interval (CI) 0-0.24] (p = 0.003), while a trend to lower numbers of other peri-procedural complications was determined. In-hospital mortality (0.14%) remained stable. Hospital LOS decreased by 17% (0.78-0.87, p < 0.001) and adverse discharge rate by 41% (95% CI 0.41-0.86, p = 0.005) between 2016 and 2019, while hospital costs did not significantly change (p = 0.2). Female patients had a higher risk of PE (OR 2.86 [95% CI 2.41-6.39]) and SE (OR 5.0 [95% CI 1.28-43.6]) while multi-morbid patients had higher risks of major bleeding (p < 0.001) and mortality (p = 0.031), longer hospital LOS (p < 0.001) and increased treatment costs (p = 0.073). Significant differences in all outcomes were observed between male and female patients across US regions. In conclusion, LAAC has become a safer and more efficient procedure. Significant sex differences existed across US regions. Careful considerations should be taken when performing LAAC in female and comorbid patients.

Homelessness and associated factors over a 13-year period among psychiatric in-patients in Berlin, Germany: routine data analysis.

BACKGROUND: Homeless patients in psychiatric hospitals are a scarcely studied and there is lack of knowledge about factors associated with homelessness and in-patient treatment. AIMS: To determine the change over time in the number of homeless psychiatric in-patients and to examine factors associated with homelessness. METHOD: Retrospective data analysis of 1205 selected electronic patient files on psychiatric in-patient treatment in a university psychiatric hospital in Berlin, Germany. The rate of patients experiencing homelessness over a 13-year period (2008-2021) and the sociodemographic and clinical factors associated with homelessness are analysed over time. RESULTS: Our study revealed a 15.1% increase in the rate of homeless psychiatric in-patients over the 13-year period. Of the whole sample, 69.3% people lived in secure private housing, 15.5% were homeless and 15.1.% were housed in sociotherapeutic facilities. Homelessness was significantly associated with being male (OR = 1.76 (95% CI 1.12-2.76), born outside of Germany (OR = 2.22, 95% CI 1.47-3.34), lack of out-patient treatment (OR = 5.19, 95% CI 3.35-7.63), psychotic disorders (OR = 2.46, 95% CI 1.16-5.18), reaction to severe stress (OR = 4.19, 95% CI 1.71-10.24), personality disorders (OR = 4.98, 95% CI 1.92-12.91), drug dependency (OR = 3.47, 95% CI 1.5-8.0) and alcohol dependency (OR = 3.57, 95% CI 1.67-7.62). CONCLUSIONS: The psychiatric care system is facing an increasing number of patients in precarious social situations. This should be considered in resource allocation planning in healthcare. Individual solutions for aftercare, along with supported housing, could counteract this trend.

Urban-rural differences in health literacy in the metropolitan area of Berlin, Germany, and its surroundings.

BACKGROUND: Health literacy is gaining importance as it concerns the ability of individuals to encounter the complex demands of health in modern societies. Little is known about the environmental associations of health literacy in high-income countries. This study aims to (i) analyse urban-rural differences in health literacy and further (ii) investigate the interrelations of associated factors. METHODS: Based on secondary analyses using a population-based survey of individuals aged 35 years and older from Berlin, Germany, and the surrounding rural area. Health literacy, sociodemographic factors (gender, age, educational level, marital status, income), environmental factors (urban/rural) and health behaviour (physical activity) were assessed with questionnaires. T-tests, Analyses of Variance and multiple regression with interaction terms have been applied. RESULTS: In total, 1822 participants (51.2% female and 56.8% living in an urban region) took part in this study. Health literacy was significantly higher in rural regions (mean = 35.73, SD = 7.56) than in urban regions (mean = 34.10, SD = 8.07). Multiple multivariate regressions showed that living in urban regions, being older, having vocational or basic education, having mid or low income, being widowed, having moderate or low levels of physical activity were significantly negatively associated with health literacy. Incorporating interaction terms showed significance that being older is positively associated with urban regions. CONCLUSION: We found higher levels of health literacy in rural regions and also demonstrated that multiple associated factors of health literacy work congruously. Thus, the environment, associated factors and their interplay must be considered in future urban-rural health literacy research.

[Changes in the provision of primary care and psychotherapy in Germany during the first two lockdowns in 2020 and 2021: A two-wave survey giving consideration to gender identity and sexual orientation]. / Veränderung hausärztlicher und psychotherapeutischer Versorgung in Deutschland während der ersten beiden COVID-19-Lockdowns 2020 und 2021: Zwei Befragungswellen unter Berücksichtigung von Geschlechtsidentität und sexueller Orientierung.

INTRODUCTION: Measures against the COVID-19 pandemic led to restrictions in ambulatory health care in Germany. While the restrictions have been described from claims data, the patients' perspective has been missing. Lesbian, gay, bisexual, trans-, inter- and asexual persons (LGBTIA) might have been particularly affected by these restrictions because of their vulnerability. Thus, our research questions were: 1) How did the restrictions during the pandemic influence primary care and psychotherapy in Germany from the patients' perspective? 2) Are there differences between LGBTIA and cis-heterosexual persons regarding these restrictions? METHODS: We conducted an online survey with two survey waves in March/April 2020 and January/February 2021. Sampling was conducted via multiplicators and via snowball sampling. Amongst others, the survey contained open-ended questions regarding primary care and psychotherapy. From the answers of the first survey wave we constructed quantitative items for the second survey wave. Descriptive and inferential statistical analysis was conducted, including linear regression with R. RESULTS: 6,784 participants took part in the survey (2,641 in the first survey wave), 5,442 of whom identified as LGBTIA. Categories of changes in primary care were: no health care utilization, no changes in primary care, insecurity regarding primary care, and changes in primary care which could be less frequent utilization, differing procedures or changes in ways of communication. In the second wave, LGBTIA participants rated the worsening of primary care during the pandemic as being more pronounced. Regarding psychotherapy, the change can be described as no change in care, changes in the form of therapy, treatment in emergencies only and a longer break from psychotherapy. There was no different rating by LGBTIA persons compared to cis-heterosexual persons in the second survey wave. Telephone and video consultations were more common in psychotherapy than in primary care. DISCUSSION: LGBTIA persons were oversampled, so the sample included more people from urban areas than the German population. Due to the online survey form, older people were underrepresented relative to their numbers in the general German population. CONCLUSION: With respect to future pandemics general practitioners in primary care must be prepared that psychotherapy might be paused and delayed for some time. Video and telephone consultations should be offered to overcome pandemic-related restrictions in the future. General practitioners should know the gender identity and sexual orientation of their patients in order to proactively address health care barriers.

Use of digital technologies by users of psychiatric inpatient services in Berlin, Germany: a cross-sectional patient survey.

Few studies and almost exclusively from the USA have recently investigated mobile phone and computer use among users of psychiatric services, which is of high relevance regarding the increasing development of digital health applications and services. OBJECTIVE, DESIGN AND SETTING: In a cross-sectional patient survey, we examined (a) rates and purposes of mobile phone, computer, internet and social media use, and (b) the role of social and clinical predictors on rates of utilisation among psychiatric inpatients in Berlin, Germany. PARTICIPANTS AND RESULTS: Descriptive analyses showed that among 496 participants, 84.9% owned a mobile phone and 59.3% a smartphone. Among 493 participants, 68.4% used a computer regularly. Multivariate logistic regression models revealed being homeless, diagnosis of a psychotic illness, being of older age and a lower level of education to be significant predictors for not owning a mobile phone, not using a computer regularly or having a social media account, respectively. CONCLUSIONS: Users of psychiatric services may have access to mobile phones and computers, although rates are lower than in the general population. However, key barriers that need to be addressed regarding the development of and engagement with digital health interventions are factors of social exclusion like marginalised housing as well as clinical aspects like psychotic illness.

The psychological burden of COVID-19 on the desire for parenthood in minoritized sexual identities: a study on depressive symptoms and family planning in Germany.

BACKGROUND: The COVID-19 pandemic continues to spread across the globe and is associated with significant clinical and humanitarian burden. The desire for parenthood has been described to be positively correlated with psychological well-being: An unfulfilled wish for parenthood is associated with impaired mental health, and the wish for parenthood is a predictor for the development of depressive symptoms. While higher rates of anxiety and depression have been reported in individuals with minoritized sexual identities (compared to heterosexual individuals) during the COVID-19 pandemic, the specific impact of the pandemic and its social restriction measures on this population is poorly understood. METHODS: From April to July 2020, we conducted an anonymous cross-sectional survey online among N = 2463 adults living in Germany. We screened for depressive symptoms (Patient Health Questionnaire-4; PHQ-4) and assessed individuals' desire for parenthood during the pandemic, and motives for or against the desire for parenthood (Leipzig questionnaire on motives for having a child, Version 20; LKM-20), with the aim of identifying differences between individuals with minoritized sexual identities and heterosexual individuals. RESULTS: Compared to heterosexual individuals (n = 1304), individuals with minoritized sexual identities (n = 831) indicated higher levels of depressive symptoms. In our study sample the majority of all participants (81.9%) reported no change in the desire for parenthood since the COVID-19 pandemic. CONCLUSION: The findings underline the unmet need for social, psychological and medical support in regard to family-planning and the desire for parenthood during a pandemic. Furthermore, future research should explore COVID-19-related psychological consequences on individuals' desire for parenthood and building a family.

Life-space mobility among home-living older adults with care needs and clinical depression-A cross-sectional analysis.

OBJECTIVES: While life-space mobility is key for wellbeing, social participation and access to health care, vulnerable older adults face physical and mental barriers that may restrict mobility. The present exploratory study examined associations between physical functional limitations, depressive symptoms, life-space mobility and outpatient health care utilization. METHODS: Cross-sectional data from 197 community-dwelling older adults with care needs and clinical depression was collected. Life-space assessment composite score (LS-C), instrumental activities of daily living scale (iADL), Geriatric Depression Scale (GDS-12) and outpatient health care utilization have been assessed. Multiple regression analyses were conducted. RESULTS: Mean LS-C score was 31.8 (SD = 17.7, range: 0-92), indicating low mobility levels. Depressive symptoms (ß = -0.21, p = 0.001) and iADL (ß = 0.54, p < 0.001) were significantly related with life-space mobility, over and above age and living alone. An interaction effect between depressive symptoms and iADL was not significant (ß = -0.07, 0.17, p = 0.26). Moreover, life-space mobility was positively associated with primary care (ß = 0.19, p = 0.02) and mental health care utilization (ß = 0.33, p < 0.001). CONCLUSIONS: Life-space mobility appears to be largely restricted in home-living vulnerable older adults with clinically significant depression; and factors associated with these restrictions appear to be physical and mental. The interplay of depression, mobility and health care utilization and its potential for interventional approaches need further investigations. Present findings underline an urgent need for new health care services that allow mobility-impaired older patients to receive mental health outpatient treatment in their own home. CLINICAL TRIAL REGISTRATION: The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN55646265, registered February 15, 2019).

Loneliness and depressive symptoms differ by sexual orientation and gender identity during physical distancing measures in response to COVID-19 pandemic in Germany.

During the COVID-19 pandemic, physical distancing measures to prevent transmission of the virus have been implemented. The effect of physical distancing measures on loneliness especially for vulnerable groups remained unclear. Thus, we aimed to investigate loneliness in relation with depressive symptoms among lesbian, gay, bisexual, trans, inter, asexual, and queer (LGBT) persons compared with cis-heterosexual persons during the pandemic. We conducted an online survey during the first two waves of the COVID-19 pandemic in Germany. The survey contained self-categorizations regarding sexual orientation and gender identity, questions on loneliness, social contacts, depressive symptoms, and healthcare. Descriptive and regression analysis and propensity score matching across cohorts was conducted using R; 2641 participants took part in first wave of the survey and 4143 participants in the second wave. The proportion of lonely people was higher in the second wave compared with the first wave. LGBT persons were more lonely than cis-heterosexual persons. In both waves, being LGBT was associated with depressive symptoms, but loneliness mediated the effect, even when adjusting for social contacts. Psychologists and other practitioners should be aware that LGBT clients might have an increased risk for loneliness and depressive symptoms and of the potential burden of the pandemic measures.

Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany.

BACKGROUND: Depression is the most common mental health burden worldwide. Primary care physicians (PCPs) play a key role in the care provision for people with depression. The first objective of the present study was to examine the health care situation of depression in primary care, focusing on the cooperation between PCPs and mental health specialists. Secondly, we aimed at examining the role of the German S3 Guideline for Unipolar Depression in the primary care provision. METHODS: Data of N = 75 PCPs were analysed from a cross-sectional online survey. Analysis of descriptive information on the current status of primary health care and depression was conducted. Further, to examine factors that are related to the usage of guidelines, multiple regression was performed. RESULTS: Only 22.1% of PCPs described the quality of cooperation with ambulatory mental health specialist as good. The most frequent problems in the cooperation were of structural nature (49.3%, long waiting list, few therapy units, as well as barriers in the communication and the information exchange). With regard to the role of the guideline, 65% of PCPs reported never or seldom using the guideline and 31.7% of PCPs perceived the guideline as not useful at all. In addition, perceived usefulness of the S3 guideline was positively associated with the usage of the guideline. Results of the logistic regression revealed a significant association between the usage of the German S3 Guideline for Unipolar Depression and rating of perceived usefulness of the guideline (OR: 4.771; 95% CI: 2.15-10.59; p < 0.001). CONCLUSION: This study highlights the central role of PCPs and demonstrates major barriers in the outpatient health care provision of depression. Present findings suggest a strong need for collaborative health care models to resolve obstacles resulting from fragmented mental health care systems. Finally, reported perceived barriers in the implementation of the German S3 Guideline for Unipolar Depression indicate the urge to involve PCPs in the development of evidence-based guidelines, in order to ensure a successful implementation and usage of guidelines in clinical practice.

Concordance of self- and informant-rated depressive symptoms in nursing home residents with Dementia: cross-sectional findings.

BACKGROUND: Depression is highly prevalent in nursing home residents living with moderate to severe dementia. However, assessing depressive symptoms in residents with dementia can be challenging and may vary by rater perspective. We aimed to investigate the concordance of, and factors associated with self- and informant-rated depressive symptoms in nursing home residents with dementia. METHODS: Cross-sectional data was collected from N = 162 nursing home residents with dementia (age: 53-100; 74% women). Self-ratings were assessed with the Geriatric Depression Scale, while the depression and anxiety items of the Neuropsychiatric Inventory were used for informant-ratings. Cohen's Kappa was calculated to determine the concordance of both measures and of each with antidepressant medication. Multivariate associations with sociodemographic variables, self- and informant-rated quality of life, dementia stage, neuropsychiatric symptoms, functional status and antidepressant medication were analysed with linear mixed models and generalized estimating equations. RESULTS: Concordance between self- and single item informant-rated depressive symptoms was minimal (Cohen's Kappa = .22, p = .02). No concordance was found for self-reported depressive symptoms and the combined informant-rated depression-anxiety score. Self-reported depression was negatively associated with self-rated quality of life (ß = -.32; 95%CI: -.45 to -.19, p < .001), informant-rated quality of life (ß = -.25; 95%CI: -.43 to -.07, p = .005) and functional status (ß = -.16; 95%CI: -.32 to -.01, p = .04), whilst single item informant-rated depression revealed negative associations with informant-rated quality of life (ß = -.32; 95%CI: -.52 to -.13, p = .001) and dementia stage (ß = -.31; 95%CI: -.52 to -.10, p = .004). The combined informant-rated depression-anxiety score showed negative associations with self-rated quality of life (ß = -.12; 95%CI: -.22 to -.03, p = .01) and dementia stage (ß = -.37; 95%CI: -.67 to -.07, p = .02) and a positive association with neuropsychiatric symptoms (ß = .30; 95%CI: .10 to .51, p = .004). No concordance was found with antidepressant medication. CONCLUSIONS: In line with our expectations, low agreement and unique association patterns were found for both measures. These findings indicate that both instruments address different aspects of depression und underline the need for comprehensive approaches when it comes to detecting signs of clinically relevant depressive symptoms in dementia. TRIAL REGISTRATION: The trial was registered with the ISRCTN registry (Trial registration number: ISRCTN98947160 ).

A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial.

OBJECTIVES: To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. DESIGN: Cluster-randomized controlled trial. SETTING: Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). PARTICIPANTS: N = 162 residents with dementia. INTERVENTION: Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. MEASUREMENTS: Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer's Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. RESULTS: Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI -3.54, 2.33 for TBI and .36 points, 95% CI -3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (ß = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen's d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. CONCLUSIONS: Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

Dementia care and the role of guideline adherence in primary care: cross-sectional findings from the DemTab study.

BACKGROUND: General practitioners (GPs) play a key role in the care of people with dementia (PwD). However, the role of the German Dementia Guideline in primary care remains unclear. The main objective of the present study was to examine the role of guideline-based dementia care in general practices. METHODS: A cross-sectional analysis of data obtained from the DemTab study was conducted. Descriptive analyses of sociodemographic and clinical characteristics for GPs (N = 28) and PwD (N = 91) were conducted. Adherence to the German Dementia Guideline of GPs was measured at the level of PwD. Linear Mixed Models were used to analyze the associations between adherence to the German Dementia Guideline and GP factors at individual (age, years of experience as a GP, frequency of utilization of guideline, perceived usefulness of guideline) and structural (type of practice, total number of patients seen by a participating GP, and total number of PwD seen by a participating GP) levels as well as between adherence to the German Dementia Guideline and PwD's quality of life. RESULTS: Self-reported overall adherence of GPs was on average 71% (SD = 19.4, range: 25-100). Adherence to specific recommendations varied widely (from 19.2 to 95.3%) and the majority of GPs (79.1%) reported the guideline as only partially or somewhat helpful. Further, we found lower adherence to be significantly associated with higher numbers of patients (γ10 = - 5.58, CI = - 10.97, - 0.19, p = .04). No association between adherence to the guideline and PwD's quality of life was found (γ10 = -.86, CI = - 4.18, 2.47, p = .61). CONCLUSION: The present study examined the role of adherence to the German Dementia Guideline recommendations in primary care. Overall, GPs reported high levels of adherence. However, major differences across guideline recommendations were found. Findings highlight the importance of guidelines for the provision of care. Dementia guidelines for GPs need to be better tailored and addressed. Further, structural changes such as more time for PwD may contribute to a sustainable change of dementia care in primary care. TRIAL REGISTRATION: The DemTab trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413 ). Registered 01 April 2019.