Multimorbidity in old age and its impact on life results.

BACKGROUND: High prevalence diseases, such as high blood pressure, dementia and depression in old age can lead to multimorbidity, which is often defined as the presence of more than one health condition in an individual. Multimorbidity has negative consequences on health-related quality of life and healthcare utilization. As many age-associated diseases are not curable, therapeutic goals like preservation of autonomy, functioning, and life satisfaction become more important in old age patients. OBJECTIVE: The prevalence of multimorbidity dementia and depressive symptoms and the consequences of multimorbidity on autonomy, functioning, and life satisfaction among the oldest old were examined. MATERIAL AND METHODS: In personal computer-assisted interviews, participants of the representative study NRW80+ were asked for which health issues they received medical treatment. RESULTS: On average, people above the age of 80 years were treated for 3.62 diseases and 31.4% of older people received medical treatment for 5 or more diseases. A connection between multimorbidity and age group could not be shown. Autonomy, functioning, and life satisfaction are reduced in association with multimorbidity. CONCLUSION: Multimorbidity is a frequent phenomenon among old people. A lack of diagnostic procedures and medical treatment can be a reason for the missing age trends. The results illustrate the importance of multimorbidity for patient-relevant outcomes and reveal the need to identify patients with multimorbidity.

Elder abuse in the oldest old: prevalence, risk factors and consequences.

BACKGROUND: Experiences of abuse in relationships with an expectation of trust are a common phenomenon among older people and is called elder abuse (EA). This can take various forms, such as physical, verbal, emotional, psychological, financial, sexual abuse or neglect. Due to their high vulnerability and difficulties in receiving support, people aged over 80 years old have been pointed out as a group that needs special focus in research. OBJECTIVE: Prevalence, risk factors and consequences of EA for different aspects of quality of life are explored among the oldest old. MATERIAL AND METHODS: Computer-assisted personal interviews were conducted in a representative sample of the oldest old in North Rhine-Westphalia (Germany). 988 self-report interviews without third persons present of the NRW80+ study are used to assess EA with the help of the elder abuse and emotional consequences scale (EACS). The EACS describes EA in six dimensions that give a broad understanding of EA. RESULTS: Prevalence of experiences of EA within the last 12 months was 54.1%. In logistic regression, multimorbidity, lower functioning, age below 90 years, smaller social network size, and aggressive behaviorwere significant risk factors for EA. People experiencing EA showed less life satisfaction and autonomy and increased loneliness and depressive symptoms. CONCLUSION: EA is prevalent among the oldest old. Serious consequences of EA on life results can be shown with a broad operationalization of EA. Future research should focus on a deeper understanding of reasons for EA and reflect on the relationship between and the perspectives of perpetrators and victims.

[Family companions. New facets in accompanying relatives caring for people with dementia]. / Familienbegleitung. Neue Facette in der Begleitung pflegender Angehöriger von Menschen mit Demenz.

BACKGROUND: Support and relief options in the context of homecare settings where people with dementia are cared for by friends or relatives have become highly differentiated; however, there are significant shortcomings in networking between the various types of offers within the context of mixed care (Pflegemix). Family caregivers often feel overwhelmed and find it difficult to identify and utilize the appropriate forms and services for their individual situation. Against this background companion models seem to be an appropriate solution to provide psychosocial support for caring families and to function in the role of bridge building in the assistance system. AIM: Within the framework of the Future Workshop Dementia (Zukunftswerkstatt Demenz) program funded by the German Federal Ministry of Health during the time period 2012-2015, the new intervention was developed in the family companion for dementia in rural areas (FABEL) project carried out by volunteers. These volunteers take up the needs of caring families for a low-threshold support structure and promote networking among the various groups of participants in individual homecare settings. The preparatory training for the volunteers, which is the focus of this article, provides special knowledge about dementia and the basic principles of systemic understanding of the typical dynamics in caring families. MATERIAL AND METHODS: In the model phase the newly developed training program was aimed at qualified volunteers trained in the logistics of the model project Care Companion (Pflegebegleitung), which was successfully established from 2003 to 2008 in more than 100 pilot locations throughout Germany and is now integrated into the healthcare system. This proven model is linked to the new qualification and consists of 68 units involving thematic modules of knowledge about dementia and systemic solution-oriented thinking, for networking and the development of an understanding of the personal role. RESULTS: During the 3-year project period 27 volunteers became qualified and accompanied at least 73 families in rural areas, which was the special focus of the model project. The developed qualification enabled the volunteers to carry out the activities in a very relationship-oriented way and in a direct form of communication with the family carers and also to encourage self-care activities. This led to a significant improvement in the health-related quality of life (QoL) of family carers and stabilized the homecare setting. As part of a health economic model calculation on the effects of the new approach, the pecuniary gains outweighed the costs caused by the qualification. DISCUSSION: The concept of family companions (Familienbegleiter) has proven to be a cost-covering model of an effective intervention based on the needs of caring families, which should become more widespread in the future.

Supporting Families Living With Dementia in Rural Areas.

BACKGROUND: Family members caring for persons with dementia are subject to multiple types of stress. Psychosocial help is recommended to lighten the emotional burden of care and can be of use in stabilizing the home-care situation. In this study conducted in rural areas in Germany, we tested whether volunteers with a special qualification for the assistance of families caring for dementia patients can support family members more effectively than conventional care companions. METHODS: In a randomized, controlled trial, 63 family members caring for persons with dementia were aided by specially qualified family companions (experimental intervention) or by conventional care companions (control intervention). The family members' quality of life was the primary endpoint and was evaluated at the end of the study in an intention-to-treat (ITT) analysis with t-tests. In an additional per-protocol (PP) analysis, differences that arose between groups at the outset of the study were accounted for. Secondary endpoints included reduced stress and better integration into the support system. RESULTS: The ITT analysis revealed no differences between groups in healthrelated quality of life on either the emotional or the somatic scale. The PP analysis, however, showed that the experimental intervention improved the emotional health-related quality of life of the patients' family members compared to the control group. The effect strength was intermediate (d = 0.57; p = 0.047). CONCLUSION: The difference between the findings of the PP and ITT analyses may be explained in part by the different distribution of severity of dementia in the two groups (experimental and control).