Climate change distress and impairment in Germany.

Introduction: Climate change has been widely recognized as one of the most challenging problems facing humanity and it imposes serious mental health threats. It is important, however, to differentiate between the affective experience of distress over climate change and the functional impairments associated with climate change. Such a distinction is crucial because not all negative affective states are pathological, and they might even motivate pro-environmental behavior. Functional impairments, like not being able to work or maintaining social relationships, however, might require immediate treatment. This study assesses climate change distress and climate change impairment within the population of Germany using a population-representative sample. The results identify vulnerable subgroups and thereby can help to facilitate the development of target group specific intervention programs. Furthermore, this study explores whether climate change distress and climate change impairment are associated with general health, physical health, mental health, and diverse health behaviors. Methods: Study participants were drawn from a panel which is representative of the German-speaking population in Germany with Internet access. Participants answered a series of questionnaires regarding their climate change distress, climate change impairment, general health, physical health, mental health, and diverse health behaviors. To evaluate differences between subgroups, Bayesian independent samples t-tests were calculated. To evaluate associations between constructs, Bayesian correlations were calculated. Results: Especially women, younger people, people from West Germany, and people with a high level of formal education seem to experience higher levels of climate change distress. Regarding climate change impairment, the results suggest that especially women, older people, people from West Germany, people with a low level of formal education, people with a low or middle social status, and people with an inadequate/problematic health literacy seem to experience higher levels of climate change impairment. Furthermore, climate change distress and climate change impairment were weakly and differently associated with general health, physical health, mental health, and diverse health behaviors. Discussion: Climate change distress and impairment are not evenly distributed within German society. The results of this study provide a starting point for the development of target group specific intervention programs.

Eating disorders and health literacy in Germany: results from two representative samples of adolescents and adults.

Introduction: Eating disorders are associated with substantial burden for the affected individuals including negative health outcomes and increased mortality. So far, prevention programs for eating disorders have yielded mixed results concerning their efficacy. Therefore, more targeted prevention programs need to be developed. Health literacy has been identified as a potential influencing factor of eating disorders. This study aimed at exploring the relationship between likely cases of eating disorders and health literacy, alongside additional sociodemographic factors. Materials and methods: Two large samples of adults (N = 3,011) and adolescents (N = 1,021) representative of the German-speaking population in Germany were recruited. Likely cases of eating disorders were identified using the SCOFF questionnaire. Health literacy was assessed with the HLS-EU-Q16 questionnaire. Sociodemographic information, including age, gender, social status and level of education, and subjective body image were obtained. χ2-tests of independence were calculated to determine the association between the investigated constructs. Results: Suspected eating disorders were more likely in female than male adolescents but were not related to gender in adults. Rates of suspected eating disorders increased with increasing age in adolescents and decreased with increasing age in adults. While levels of education were unrelated to suspected eating disorders, low social status was associated with higher rates of suspected eating disorders in adults but not adolescents. Inadequate or problematic health literacy and negative body image were associated with higher rates of suspected eating disorders compared to adequate health literacy and more positive body image. Discussion: Likely cases of eating disorders are related to health literacy and body image as well as sociodemographic factors. These constructs should therefore be addressed in future research to improve prevention programs.

Digital Health Literacy of the Population in Germany and Its Association With Physical Health, Mental Health, Life Satisfaction, and Health Behaviors: Nationally Representative Survey Study.

BACKGROUND: Digital health literacy, also known as eHealth literacy, describes the ability to seek, find, understand, and apply health information from the internet to address health problems. The World Health Organization calls for actions to improve digital health literacy. To develop target group-specific digital health literacy interventions, it is necessary to know the digital health literacy of the general population and relevant subgroups. OBJECTIVE: This study aims to representatively assess the digital health literacy of the population in Germany and relevant subgroups. The results are meant to facilitate the development of target group-specific digital health literacy interventions. Additionally, this study further explores the associations between digital health literacy and physical health, mental health, life satisfaction, and diverse health behaviors. METHODS: Study participants were drawn from a representative panel of the German-speaking population with internet access. To further increase the representativeness of the sample, survey weights were calculated using an iterative proportional fitting procedure. Participants answered a series of questionnaires regarding their digital health literacy, physical health, mental health, life satisfaction, and diverse health behaviors. Two-sided independent sample t tests were conducted to determine the significant differences between societal subgroups. Pearson correlation coefficients were calculated to explore the correlates of digital health literacy. RESULTS: Digital health literacy is unevenly distributed within German society. The results of this study suggest that people with a low level of formal education and people with a low social status would benefit from digital health literacy interventions that address their competencies in the domains of information seeking and information appraisal. Furthermore, the results suggest that older people would likely benefit from digital health literacy interventions that address their competencies in the domains of information seeking and also information appraisal. Regarding sex, this study suggests that men might benefit from digital health literacy interventions that specifically address their competencies in the domain of information seeking. Furthermore, digital health literacy is weakly positively correlated with physical health, mental health, life satisfaction, exercise routines, fruit consumption, and vegetable consumption. CONCLUSIONS: Overall, the results of this study demonstrate that digital health literacy is associated with diverse health outcomes and behaviors. Furthermore, the results provide a starting point for the development of target group-specific digital health literacy interventions.

The Effectiveness of Publicly Available Web-Based Interventions in Promoting Health App Use, Digital Health Literacy, and Media Literacy: Pre-Post Evaluation Study.

BACKGROUND: According to the World Health Organization, implementing mobile health (mHealth) technologies can increase access to quality health services worldwide. mHealth apps for smartphones, also known as health apps, are a central component of mHealth, and they are already used in diverse medical contexts. To benefit from health apps, potential users need specific skills that enable them to use such apps in a responsible and constructive manner. OBJECTIVE: This study aimed to evaluate the effectiveness of the free and widely used web-based intervention, The APPocalypse?. Besides providing knowledge about health apps, the web-based intervention was designed to promote digital health and media literacy by teaching skills that enable users to distinguish between trustworthy and less trustworthy health apps. It was hypothesized that after completing the web-based intervention, participants' knowledge in the domain of health apps, their digital health literacy, and their media literacy would be higher than it was before completing the web-based intervention. METHODS: The study was divided into 3 parts. During part 1, participants (n=365; 181 female, 181 male, and 3 diverse; mean age 17.74, SD 1.391 years) provided demographic information and answered the pre- and postmeasurements. The measurements included questionnaires about participants' knowledge in the domain of health apps, digital health literacy, and media literacy. During part 2, participants had 1 week to complete the web-based intervention. During part 3, participants answered the pre- and postmeasurements again. Furthermore, they answered educational quality and user experience questionnaires. Bayesian paired samples 2-tailed t tests were conducted to test the hypotheses. RESULTS: Overall, the results support the hypotheses. After completing the web-based intervention, participants demonstrated more elaborate knowledge in the domain of health apps. Specifically, they displayed higher competencies in the domains of subjective (Bayes factor10 [BF10]=1.475×1079; effect size δ=-1.327) and objective health app knowledge (BF10=8.162×1080; effect size δ=-1.350). Furthermore, participants demonstrated higher digital health literacy. Specifically, they displayed higher competencies in the domains of information appraisal (BF10=3.413×1043; effect size δ=-0.870), information searching (BF10=3.324×1023; effect size δ=-0.604), evaluating reliability (BF10=3.081×1035; effect size δ=-0.766), and determining relevance (BF10=3.451×1024; effect size δ=-0.618). Regarding media literacy, the results were mixed. Participants displayed higher competencies in the domain of technology literacy beliefs (BF10=1.533×1021; effect size δ=-0.570). In the domain of technology control beliefs, their competencies did not seem to improve (BF10=0.109; effect size δ=-0.058). In comparison to relevant benchmarks, the web-based intervention offers exceptional educational quality and a superior user experience. CONCLUSIONS: The free web-based intervention The APPocalypse? might promote the constructive use of health apps, digital health literacy, and media literacy. Therefore, it may contribute to achieving the health-related United Nations Sustainable Development Goals.

Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study.

BACKGROUND: Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one's state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm. OBJECTIVE: This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users' perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions. METHODS: Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions. RESULTS: Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one's state of health, and preventing health problems. In total, 66.62% (1333/2001) of internet users engaged in this behavior. Health care-related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition). CONCLUSIONS: Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key.

Interventions to enhance safety culture for nursing professionals in long-term care: A systematic review.

Background: Recognizing safety risks and promoting safe care is essential for care dependent people and should be an integral part of the overall preventive endeavors while providing care. The term 'safety culture' describes efforts regarding the acknowledgement and reduction of safety risks. Enhanced safety culture in health care organizations can be associated with a lower incidence of missed nursing care and adverse events. Objective: Identify strategies to enhance safety culture in long-term care settings and describe factors facilitating or inhibiting the process from the available evidence. Design: This systematic review is a narrative description of intervention studies. Methods: CINAHL and MEDLINE were searched in May 2020 using terms such as safety culture, safety climate, intervention development. Gray literature was searched between May and September 2020. An additional search in Cochrane Library was conducted in September 2022. Only intervention studies feasible to enhance the safety culture were included. Intervention study criteria were met when an organized, planned action to prevent or change a specific behavior took place and when this action was transparently and systematically evaluated. The screening, data extraction, and rating processes were conducted by two researchers independently. The ROBINS-I tool was utilized to assess the risk of bias of the studies. Results: Seven intervention studies were included, all evaluated with a critical risk of bias. Strategies found to enhance the safety culture in care settings include collegial exchange of experiences and learnings, integration of staff's perceptions, external facilitation, staff training, and a structured, multi-step procedure of the intervention process. Some studies were unable to show statistically significant enhancement in safety culture from the interventions implemented. Factors facilitating the implementation of interventions include good connections and trust between staff and managers, and the manager's active support of the project goals, as well as targeting achievable ideas considering time and resources. Time pressure, heavy workloads and high staff turnover may inhibit the process. Conclusions: All included studies had a high risk of bias, and possible effects must be considered accordingly. Overall, there was considerable heterogeneity in interventions aiming to enhance safety culture. Despite these aspects, promising approaches are training staff's knowledge and competencies regarding open communication and teamwork as part of a multifaceted program. Future research would benefit from participative, carefully developed, comprehensively evaluated interventions for enhancing safety culture, specifically within in-home care settings. Registration: The review was not pre-registered but described on the website of the Center for Quality in Care. Tweetable abstract: Participatory change management & staff training help ensure momentum & trust in endeavours to enhance safety culture in long-term care.

Expanding the Health Information National Trends Survey Research Program Internationally to Examine Global Health Communication Trends: Comparing Health Information Seeking Behaviors in the U.S. and Germany.

The Health Information National Trends Survey (HINTS) is a well-established U.S.-based research program administered by the National Cancer Institute to track the public access to and use of health information. This paper introduces a German research initiative, part of the International Studies to Investigate Global Health Information Trends (INSIGHTS) research consortium. This adaptation of the HINTS is important for initiating analyses of global health communication practices and comparing health information seeking behaviors (HISB) across nations to pinpoint potentials and challenges of health information provision and contribute to a deeper understanding of socio-contextual determinants of HISB. First cross-country comparisons revealed that the share of residents seeking for health information is high in the U.S. (80%) and Germany (74%), but different primary sources are used. Whereas a clear majority of U.S. residents chose the Internet to gather health information (74.9%), Germans most often turn to health professionals (48.0%). Socio-structural and health(care)-related predictors were found to contribute to the explanation of HISB in both countries, whereas information-related predictors were only relevant in Germany. The results indicate the need to engage in patient-provider communication to initiate HISB and to improve the access to information for residents with lower socio-economic backgrounds.

The Development and Evaluation of an e-Learning Course That Promotes Digital Health Literacy in School-age Children: Pre-Post Measurement Study.

BACKGROUND: Experts agree that the promotion of (digital) health literacy should be an integral part of the school curriculum. However, promoting (digital) health literacy within the German school system is difficult because (digital) health education is not a mandatory school subject in all the German states. Therefore, experts suggest that (digital) health literacy could be addressed as part of the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz). OBJECTIVE: The goal of this study was to evaluate a newly developed e-learning course that was designed to improve (digital) health literacy in school-age children and concurrently to teach skills specified in the mandatory framework for digital education and digital literacy in schools. It was hypothesized that participants' health literacy and digital health literacy levels would be higher after completing the e-learning course than they were before doing the course. Furthermore, it was hypothesized that after completing the e-learning course, participants' subjective and objective knowledge in the domain of (digital) health literacy would be higher than it was before doing the course. METHODS: The pre-post measurement study was conducted online. After participants (N=323) gave their informed consent to participate in the study, they provided demographic information and answered all measures (premeasurement). Following this, participants had 7 days to complete the e-learning course. After finishing the e-learning course, participants answered all the measures again (postmeasurement). RESULTS: To test the hypotheses, Bayesian paired samples t tests (1-sided) were conducted. After completing the e-learning course, participants showed higher health literacy levels. Specifically, they showed higher competency levels in the domains of theoretical knowledge (Bayes factor [BF]-0=676,000; δ=-0.316), practical knowledge (BF-0=92,300; δ=-0.294), critical thinking (BF-0=7.42e+13; δ=-0.482), self-awareness (BF-0=11,500,000; δ=-0.345), and citizenship (BF-0=266,000; δ=-0.306). Furthermore, participants achieved higher digital health literacy levels. Specifically, they achieved higher competency levels in the domains of information searching (BF-0=2.339; δ=-0.135), evaluating reliability (BF-0=2.03e+11; δ=-0.434), and determining relevance (BF-0=316,000; δ=-0.308). Moreover, participants demonstrated higher subjective (BF-0=3.58e+82; δ=-1.515) and objective knowledge (BF-0=3.82e+97; δ=-1.758) in the domain of (digital) health literacy. CONCLUSIONS: The newly designed e-learning course provides an easy way for schools and teachers from all German states to integrate (digital) health literacy education into their school curriculums and lessons. The evaluated course is especially attractive because it was designed to improve (digital) health literacy and at the same time to teach skills specified in the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz).

Patient safety in home care: A multicenter cross-sectional study about medication errors and medication management of nurses.

Studies assume that up to 30% of home care recipients are exposed to a possible medication error. For the home care sector, the study situation regarding such errors is limited. The aim of the study was to find out how often medication errors occur and whether they are related to training, quality assurance measures (use of the double-check principle (DCP)), and other structural conditions of home care services. A cross-sectional study was conducted, comprising 485 fully trained nurses of 107 randomly selected home care services. Potential influencing factors were analyzed in a multiple logistic regression model. Of 485 fully qualified nurses, 41.6% reported medication errors within a 12-month period, while 14.8% did not answer this question. Nurses who had attended medication training within the last 2 years compared to a longer period (frequently to rather rarely applied DCP); the odds ratio of not making medication-related errors was 1.79[1.42-3.09] (OR 3.13; [1.88-5.20]). Years of professional experience, amount of patients per shift, and type of work contract (full/part-time) were not statistically significantly associated with reported medication errors. Medication-related errors occur frequently in home care. Regular training and adequate quality management measures increase patient safety. Nursing managers and other responsible individuals of home care institutions have to make sure that nursing staff take part in regular medication training and apply the DCP when they give out medication in home care.

[Sexual abuse of care-dependent patients : Results of a nationwide cross-sectional study among general practitioners on responsibility and subjective confidence in dealing with suspected abuse]. / Sexueller Missbrauch Pflegebedürftiger : Ergebnisse einer bundesweiten Querschnittsstudie bei Hausärzten/-ärztinnen zu Verantwortung und subjektiven Sicherheit im Verdachtsfall.

BACKGROUND: Violence against people in need of care is a challenge for long-term care situations. Sexual violence in particular, is subject to strong taboos and has so far been little researched. Family physicians can play a role in preventing violence against people in need of care. OBJECTIVE: The objective of this study was to examine family physicians' attitudes to their responsibilities in cases of sexual abuse of patients in need of care. At the same time, we also examined subjective confidence in relation to the procedure in cases of suspected abuse and family physicians' interests in further training on this topic. MATERIAL AND METHODS: A cross-sectional study addressed to 1700 family physicians in Germany with a written survey between September and November 2016. Questionnaires from 302 physicians could be evaluated for the study. FINDINGS: Almost all respondents saw it as part of their responsibility as doctors to intervene in cases of sexual abuse of patients in need of care. There is great uncertainty about how to proceed in cases of suspected sexual abuse of patients in need of care. Respondents' main interest in further training related to the differential diagnosis of sexual abuse and the correct procedure in cases where abuse is suspected. CONCLUSION: Further training provision, particularly on the signs of sexual abuse of people in need of care, could contribute to increasing family physicians' confidence to act.

Correlates of the perceived quality of patient-provider communication among German adults.

BACKGROUND: Since a higher perceived quality of patient-provider communication is known to be associated with improved health outcomes, it is essential to analyze determinants influencing patients' perceived quality of patient-provider communication. Due to the limited knowledge about patient-related influencing factors of quality perception available so far, the objective of this study is to explore and assess determinants of the perceived quality of patient-provider communication with regards to sociodemographic, health-related, healthcare-specific and information-related factors. METHODS: Linear regression of cross-sectional data from the first wave of Health Information National Trends Survey Germany (n = 2902) was conducted. Independent variables were sociodemographic, health-, healthcare- and information-related factors; the dependent variable was the perceived quality of patient-provider communication. RESULTS: Results show that age, migration background, the perceived quality of healthcare, health-related self-efficacy and trust in health information from health professionals are significantly associated with the perceived quality of patient-provider communication. CONCLUSIONS: Sociodemographic, healthcare- and health information-related factors influence the perceived quality of patient-provider communication. In particular, patients having a migration background and patients reporting low self-efficacy showed significant lower levels of their perceived patient-provider communication quality. With the aim to improve quality issues, patients of both target groups should be empowered and supported.

Informal caregivers during the COVID-19 pandemic perceive additional burden: findings from an ad-hoc survey in Germany.

BACKGROUND: While the relation between care involvement of informal caregivers and caregiver burden is well-known, the additional psychosocial burden related to care involvement during the COVID-19 pandemic has not yet been investigated. METHODS: A total of 1000 informal caregivers, recruited offline, participated in a cross-sectional online survey from April 21 to May 2, 2020. Questionnaires were used to assess COVID-19-specific changes in the care situation, negative feelings in the care situation, problems with implementation of COVID-19 measures, concerns/excessive demands, loss of support, change in informal caregivers' own involvement in care and problems with provision, comprehension & practicability of COVID-19 information, and to relate these issues to five indicators of care involvement (i.e., being the main caregiver, high expenditure of time, high level of care, dementia, no professional help). Binomial and multiple regression analyses were applied. RESULTS: Across indicators of care involvement, 25.5-39.7% reported that the care situation rather or greatly worsened during the COVID-19 pandemic, especially for those caring for someone with dementia or those usually relying on professional help. In a multiple regression model, the mean number of involvement indicators met was associated with age (ß = .18; CI .10-.25), excessive demands (ß = .10, CI .00-.19), problems with implementation of COVID-19 measures (ß = .11, CI .04-.19), an increase in caregiving by the informal caregivers themselves (ß = .14, CI .03-.24) as well as with no change in the amount of caregiving (ß = .18, CI .07-.29) and loss of support (ß = -.08, CI -.16-.00). No significant associations with the mean number of involvement indicators met were found for gender, educational level, change in the care situation, negative feelings, and provision, comprehension & practicability of COVID-19 information. CONCLUSION: Those caregivers who perceived extensive care burden were those who suffered most during the pandemic, calling for structural support by the healthcare system now and in the future. TRIAL REGISTRATION: This article does not report the results of a health care intervention on human participants.

Caregiving adult children's perceptions of challenges relating to the end of life of their centenarian parents.

BACKGROUND: The number of centenarians in Europe is increasing; many face health impairments. Adult children often play a key role in their care, but there is a lack of research into what it means for these caregiving relatives to be confronted for many years with their parents' end of life (EOL), dying and death as well as their own advancing age. AIM: This study aims to analyse the challenges of caregiving adult children regarding their parents' end of life and the related burdens and barriers they report. MATERIAL AND METHODS: Semi-structured interviews were conducted with 13 caregivers following a theory-based and tested guideline. The computer-aided coding and evaluation followed the structured content analysis approach. RESULTS: The analysis showed three main themes: 'Confronting EOL', 'Communicating about death and dying' and 'Assisting in the terminal phase'. The respondents commented on burdensome demands and concerns about the future. Further, a strong underlying presence of intra- and interpersonal conflicts relating to EOL became apparent. DISCUSSION: The results indicate several potential burdens for centenarians' caregiving offspring. They are confronted with a double challenge resulting from the combination of their own advanced age and experiencing the burdens of their parents' very old age. Further, some participants struggled with their own unclear perspective on the future because of the relative but unclear proximity of the parent's death. Multiple conflicts and overlapping conflict dimensions emphasise the potential of the EOL topic to influence the well-being of family caregivers and care recipients. LIMITATIONS: The convenience sample used for the study may cause limitations, for example, the fact that persons with a formally lower educational status are not represented. CONCLUSION: The findings suggest that interventions designed for family-related care situations should include topics like 'Finiteness and grief', 'Communicating about dying and death' and 'Decisions and dispositions at EOL'.

[How do people in Germany seek health information? Insights from the first wave of HINTS Germany]. / Wie informieren sich die Menschen in Deutschland zum Thema Gesundheit? Erkenntnisse aus der ersten Welle von HINTS Germany.

BACKGROUND: Dynamic developments in the healthcare system are associated with a more active and more participatory patient role, in which patients make informed decisions and help shape their care. This points to the increasing role of health information and health information seeking behaviors. But to date, the health information seeking behavior of people in Germany hasn't been subject to systematic survey research. The German Health Information National Trends Survey (HINTS Germany) closes this gap. METHODS: HINTS Germany was fielded as a telephone survey with a sample of N = 2902 people. The questionnaire covers various aspects of the search for and use of health information, healthcare, health status, and health-related behaviors. RESULTS: First results show regional and gender differences in health information seeking. One in four respondents reports problems concerning the process of health information seeking. The most used health information sources are doctors and other health professionals as well as the Internet, whereby respondents trust health information from doctors by far the most. DISCUSSION: The rather rare use of the Internet as the primary source corresponds to the lower level of trust that the respondents place in the Internet as a source of health information, which is also known from other studies. However, this should not hide the fact that the Internet can be of great importance as a supplementary source, i.e., used in combination with other information, for example after a doctor's visit. HINTS Germany provides a data basis representative of the adult population in Germany, with which the importance of health information seeking for health-related attitudes and behaviors can be analyzed in a differentiated manner.

Risk Profiles for Care Dependency: Cross-Sectional Findings of a Population-Based Cohort Study in Germany.

Background: Rising life expectancy in Western societies is accompanied by a rising incidence of care dependency (CD) among older people. Objective: The aim of the study was to examine which health-related and social determinants were associated with CD. Method: We used cross-sectional data from the first follow-up (N = 1,699) of a prospective, population-based cohort study of older participants (≥70 years). CD was assessed if participants required substantial assistance in at least two activities of daily living for 90+ minutes daily. Multivariate logistic regressions were applied. Results: Participants' mean age was 82 years; 18.9% were care-dependent. CD was significantly associated with older age, urinary incontinence, stroke, falls, cancer, diabetes, education level, having no partner, limited mobility, and limited physical activity. Discussion: Our research highlights the importance of promoting mobility, even in care-dependent people. Further research should investigate the role of partnership in terms of the prevention and delay of CD.

[Action-related resilience in people with longevity-sociological approach]. / Handlungsbezogene Resilienz bei Langlebigen ­ eine soziologische Annäherung.

With increasing longevity, questions about the psychosocial conditions for extraordinary life spans come to the fore. From the field of psychology the concept of resilience is used to describe special capabilities to resist as a personal competence to maintain or regain certain levels of functioning. As such, resilience is seen as a relatively stable personality trait that, however, may forfeit its relevance in old age.The present article, in contrast to the usual phases of life view, adopts a sociological perspective on the entire life span. The rational choice approach is utilized to describe and discuss conditions, foundations, strategies and results of action decisions based on 15 qualitative biographical interviews with centenarians. Resilience in this context is seen as a capacity to act.The results demonstrate that potentials for resilient action persist throughout the entire life span including oldest age but capacities to act are highly context-specific.

Complementary and Integrative Medicine in Nursing Homes: Results of a Cross-Sectional Study in Residents and Caregivers.

OBJECTIVE: Some nursing homes for the elderly in Germany integrate complex complementary and integrative medicine interventions in the form of hydrotherapy, herbal and mind-body therapies, physical activities, and healthy eating, known as Kneipp therapy (KT), in care. This pilot study explored health- and work-related characteristics and acceptance of KT amongst residents and caregivers. METHODS: Within a mixed-methods cross-sectional study in nursing homes who had integrated KT, we assessed work ability, psychosocial burden at work and health-related quality of life of caregivers, as well as a broad selection of health-related data of residents by questionnaires and assessments. Data were analyzed descriptively. RESULTS: The data from 29 female caregivers (42.0 ± 11.7 years) and 64 residents (83.2 ± 8.1 years) were analyzed. Both caregivers (96%) and residents (89%) considered KT to be beneficial for health and well-being. Ninety percent of the caregivers indicated an improved relationship to residents since implementing KT. Caregivers showed a good work ability and quality of life. Residents attained remarkable ratings in social relation and affect-related aspects of quality of life. CONCLUSION: The results of this cross-sectional study indicate a high acceptance of integrating KT by residents and caregivers. The effectiveness and safety of KT should be explored in further comparative studies.

Implementation of Intentional Touch for Geriatric Patients with Chronic Pain: A Qualitative Pilot Study.

BACKGROUND: Intentional Touch (InTouch) refers to a soft physical touch with the aim to ease complaints and enhance well-being. Central questions were perception of InTouch by nurses and patients and possible effects on pain perception. PATIENTS AND METHODS: InTouch was developed by stakeholder involvement. Nurses working in geriatric care received expert training in InTouch. Semi-structured interviews and participant observation (including video recording) were conducted with nurses applying and patients with chronic pain receiving InTouch after the beginning of the intervention and after 4 weeks. Interviews were analyzed based on Qualitative Content Analysis and video recordings based on Qualitative Visual Analysis. RESULTS: Six elderly patients with chronic pain and 6 nurses were included. Nurses and patients equally described relaxation, well-being, and a sensation of warmth during the intervention. Patients reported no pain during the intervention. After the intervention, 3 patients each experienced pain relief or no change. Patients described better drive and positive feelings, and nurses felt empowered in their nursing work. Empathetic attention had special importance for improving the therapeutic relationship. CONCLUSION: The results of this study suggest that InTouch promoted relaxation, well-being, and pain relief for elderly people suffering from chronic pain and may contribute positively to the therapeutic relationship.

Psychosocial Intervention in Couples Coping with Dementia Led by a Psychotherapist and a Social Worker: The DYADEM Trial.

BACKGROUND: Psychosocial interventions may improve the quality of life of both people with dementia (PWD) and their family caregivers. However, research is inconclusive and focused primarily on the quality of life of either the PWD or the caregiver, rather than on both. OBJECTIVE: Our aim was to evaluate the effect of couple-based interdisciplinary psychosocial intervention in patients with mild-to-moderate dementia on quality of life of both partners. METHODS: 108 community-dwelling PWD and their caregiving partners were enrolled in this pragmatic randomized controlled trial. The intervention consisted of 7 sessions at participants' homes led by a psychotherapist and a social worker. Quality of life was evaluated at baseline, one, and six-month follow-up for patients and their partners. Mixed effects models have been applied. RESULTS: Intervention allocation was not associated with an improvement in quality of life in either the patients or their partners. In subgroup analyses, intervention was negatively associated with caregiver performance. However, this was only present in those reporting poor relationship quality. Patients in the intervention group who reported good relationship quality were found to have decreased cognitive decline. CONCLUSION: A couple-based interdisciplinary intervention did not yield improvements in quality of life. This may be the result of a bias caused by an increased awareness due to the intervention. Relationship quality and support in the long-term should be considered when designing and implementing interventions for PWD and their partners.