[Flow-Experience in Old Age: An Investigation of Influencing Factors and Therapy Benefits for Geriatric Patients]. / Flow-Erleben im Alter: Eine Untersuchung von Einflussfaktoren und Nutzen für die Therapiegestaltung bei geriatrischen Patienten.

Flow experience, a feeling of being absorbed in an activity without reflection and with maximum depth, has positive effects on psychological and physical well-being, performance, and life satisfaction. Little research has been done on flow experience in old age, and there are no studies on geriatric patients. In the present study, elderly patients (mean age:81.2, SD=5.9) of a day hospital were examined with regard to their flow experience using the flow short scale. In addition to age and gender effects, flow was assessed during two different activities ( physical activity vs. memory training). Furthermore, the role of individual activity and group dynamics as well as correlations between flow and therapy success were examined in detail. The results show that flow experience is possible even in old age. Depressed patients experienced as much flow as non-depressed patients; cognitively impaired patients, on the other hand, experienced less flow than patients without cognitive deficits, and chronic pain patients even reported more flow experiences during exercise programs than patients without pain. A high level of self-activity had an overall positive effect on the flow experience. The therapy outcome could not be influenced by flow. Flow experience in old age should be given more attention, especially in physical activity therapy for pain patients; further correlations, especially with regard to depression, remain to be investigated.

Screening for depression in old age : A comparison of the geriatric depression scale and the depression in old age scale.

OBJECTIVE: Since 1996, older patients have been treated in the Nuremberg Geriatric Day Hospital. The geriatric depression scale (GDS) is an obligatory part of the geriatric assessment at admission but its use in the clinical setting has revealed some problems. The aim of the study was to compare the GDS with the depression in old age scale (DIA-S) in terms of applicability and psychometric characteristics. METHODS: As gold standard a semi-structured interview was used to record the depression criteria according to Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Using a sample of 375 patients, sensitivity and specificity as well as positive and negative predictive values were calculated for both screening tests. RESULTS: No clear superiority of any screening method could be proven. The sensitivity of the DIA­S in the overall sample was higher than that of the GDS, but the specificity was much lower. In terms of predictive values, there were slight advantages for the GDS. In the sub-samples, poorer values were found in both scales for cognitively impaired or dementia patients with slightly better values for GDS. CONCLUSION: The DIA­S can be used very easily in everyday clinical practice, but no advantages of this method compared to GDS could be demonstrated.

[Treatment of dementia patients in a geriatric day clinic : Improvement of behavioral abnormalities and distress of caring relatives]. / Therapie mit Demenzkranken in einer geriatrischen Tagesklinik : Verbesserung von Verhaltensauffälligkeiten und Belastungserleben der Angehörigen.

BACKGROUND AND OBJECTIVE: The aim of the study was to evaluate a specific treatment concept for patients suffering from dementia in a geriatric day clinic with respect to improvement of dementia-related behavioral abnormalities and effects on distress of the caring relatives. MATERIAL AND METHODS: Designed as a naturalistic study with a sample of 34 dementia patients (average age 83 years, 62% female, 82% mild dementia, 18% moderate dementia) surveyed at three time points, the dementia-related behavioral symptoms and the relatives' distress were measured using the neuropsychiatric inventory. A waiting time before treatment was implemented as a control condition. RESULTS: Compared with waiting time, a significant improvement of dementia-related behavioral abnormalities was found after treatment, especially in patients suffering from moderate dementia. The distress of caring relatives was clearly reduced. CONCLUSION: The interprofessional treatment of patients with dementia using a specific program in a geriatric day clinic leads to a clear improvement in behavioral symptoms and positively influences the distress of caring relatives.

[Effects of psychosomatic treatment for the elderly on cognition and quality of life : Naturalistic study at the psychosomatic day care hospital for the elderly in Nuremberg]. / Einfluss einer psychosomatischen Behandlung für Ältere auf Kognition und Lebensqualität : Naturalistische Studie an der Psychosomatischen Tagesklinik für Ältere am Klinikum Nürnberg.

BACKGROUND AND OBJECTIVE: In 2006 the psychosomatic day care hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of the study was to determine treatment effectiveness regarding quality of life and cognition. MATERIAL AND METHODS: Designed as a naturalistic study of a population sample of 116 patients, the cognitive capacity (memory performance and cognitive speed) and the subjective quality of life were measured by the Nuremberg aging inventory (NAI) and the World Health Organization quality of life for elderly persons (WHOQOL-OLD). The patients were surveyed at four points in time including at 8­month follow-up. A 5-week waiting time before admission to the 5­week therapy was implemented as a control condition. RESULTS: In comparison with the waiting time, after treatment significant improvement (<0.05) was found in cognitive capacity and quality of life. Effect sizes were partly small and mostly moderate (ES 0.2-1.0) with larger effect sizes in the quality of life than in the cognitive domain. Improvements of cognition and quality of life remained stable at follow-up (admission to follow-up ES 0.1-1.0). No correlation was found between cognitive improvement and reduction of depressive symptoms. CONCLUSION: The results indicate that the psychosomatic day care hospital treatment of the elderly improves subjective quality of life and cognitive capacity.

[Psychosomatic medicine in old age]. / Psychosomatik im Alter.

Approximately 25% of people over 65 years old suffer from psychiatric disorders but in cases of simultaneously occurring somatic diseases the prevalence is increased. Sickness, loss of important reference persons and life crises in older age often reactivate traumatic experiences from earlier life stages. It can be difficult to differentiate between psychological disorders and the psychological symptoms accompanying somatic illness. The biographic medical history and estimation of cognitive skills within a geriatric basis assessment should be standard in geriatric diagnostics. Psychological disorders are often overlooked or inadequately treated in older people. In the case of psychopharmacological treatment, effects on somatic sickness as well as drug-drug interactions have to be kept in mind. Psychotherapeutic approaches focusing on resources and social support particularly in group therapy seem to be very helpful.

Effectiveness of a psychosomatic day hospital treatment for the elderly: a naturalistic longitudinal study with waiting time before treatment as control condition.

OBJECTIVE: In 2006 the psychosomatic day hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of this study was to determine treatment effectiveness and identify possible effects on health care utilization. METHODS: Designed as a naturalistic study with waiting time before admission as a control condition, the primary outcome was the level of depressive symptoms as measured by the hospital anxiety and depression scale. Secondary outcomes were depressive and somatoform symptoms and syndromes as measured with the patient health questionnaire, patient perception of interpersonal problems and health care use before and after treatment. RESULTS: After treatment significant improvement (p<0.01) with moderate effect sizes (ES) was found in all variables from admission to discharge (ES from 0.3 to 0.8) and also to follow-up (ES from 0.2 to 0.6). Improvement remained stable at follow-up. Furthermore, after psychosomatic treatment a reduction in medical service usage was visible. Number of consultations (pre: 13, post: 9), number and length of hospital stays (pre: 1, 7 weeks, post: 0, 3 weeks) were both significantly (p<0.001) reduced six months after treatment as compared to the period six months prior to treatment. CONCLUSION: Results indicate that the psychosomatic day hospital treatment of the elderly is successful. Reduced usage of health care and the lower costs for day hospital treatment compared to inpatient treatment point to a positive cost-effect-ratio. Expanding this psychosomatic intervention would be useful in reducing the current gap in mental health care for the elderly.