Exploring the associations between structural and functional aspects of social relationships and cognition in very old age.

OBJECTIVES: Few studies have examined the associations between social relationships and cognition in very old adults (80+ years). Moreover, limited research has considered structural and functional aspects of social relationships together when exploring their associations with cognition. Therefore, the present study aimed to investigate the associations between structural and functional social aspects and cognition in very old age. METHOD: The sample comprised 518 two-wave participants of the NRW80+ Study, who showed no indication of dementia and an average age of 85 years at baseline (range: 80-97 years). They were assessed twice over an approximate 2-year interval. Multilevel linear growth curve analysis was employed to model cognitive development over very old age and to examine the associations between structural and functional aspects of social relationships and cognitive development. It was controlled for demographic and health characteristics. RESULTS: A larger social network size (ß = 0.05, 95% CI [0.02, 0.08], p = 0.002) and frequent compared with occasional, seldom, and no contact with others (ß = 0.16, 95% CI [0.03, 0.28], p = 0.013) were associated with higher global cognition in the fully-controlled model. Model comparisons further revealed that structural aspects better predicted global cognition in very old age compared to functional aspects (χ2(2) = 16.17, p < 0.001). CONCLUSION: The findings underline the positive association between structural aspects of social relationships and global cognition in very old age. They also highlight the need for interventions promoting a socially active lifestyle to prevent cognitive decline in this vulnerable age group.

Falls in hospitalized geriatric psychiatry patients: high incidence, but only a few fractures.

Fall rates from 3.2 to 17.1 falls per 1,000 hospital days in geriatric psychiatry facilities have been reported to date. Up to 5% of the falls result in severe injuries, but data concerning medical consequences are scare. This brief report presents a retrospective analysis of one year fall protocols from a geriatric psychiatry department focusing on consequences of falls. Fall-induced injuries were rated in four categories: no injuries, mild injuries (contusions, hematomas, abrasions), moderate injuries (lacerations, dislocations), and severe injuries (fractures, cerebral hemorrhages). In total, 510 falls were registered during the study period, indicating a fall rate of 17.7 falls per 1,000 hospital days. Overall, 375 falls (73.5%) resulted in no injuries, 67 (13.1%) resulted in mild injuries, 59 (11.6%) resulted in moderate injuries, and only 9 (1.8%) falls led to severe injuries (fractures and cerebral hemorrhages). These results indicate a quite high fall rate in our sample of hospitalized geriatric psychiatry patients with only a relatively small number of severe injuries resulting from the falls. These results raise the question about the use of physical restraints and the use of bedrails in geriatric patients to prevent falls as the medical implications of falls may be less problematic than previously thought.

[Caregiving relatives of people with dementia: which factors influence the transfer from home-care to nursing home?]. / Pflegende Angehörige von demenziell Erkrankten: Welche Faktoren beeinflussen den Transfer von der häuslichen in die stationäre Pflege?

Recent research on institutionalization of family members with dementia has shown caregiving-need, caregiver's burden and role conflicts as important influence factors. However, current knowledge is still superficial because most studies used highly aggregated indicators. Logistic regression was used to explore whether differentiated measures of caregiving-needs, caregiver-burden and role conflicts were risk factors for institutionalization of demented elderly people (N=373). A greater distance between households, increased need in housekeeping, a higher income, increased caregiver-burden and low self-evaluation of caregiving-quality are related to an increase in chance for institutionalization. A constant need for supervision and lack of social appreciation are associated with a smaller chance. The results illustrate the dilemma of many caregiving relatives. A future enhancement of the given regression model by including prior decline in caregiving-burden is discussed.

Communicating with parents in neonatal intensive care units: The impact on parental stress.

OBJECTIVE: To analyse stress in parents whose infants with very low birth weight have just concluded high-level care in a Neonatal Intensive Care Unit (NICU). More specifically, we aimed 1) to identify groups of parents in the NICU who are particularly at risk of experiencing stress, and 2) to explore the effects of clinical staffs communication on parental stress. METHODS: Our multi-center-study evaluated views from 1277 parents about care for 923 infants in 66 German NICUs. Answers were linked with separately evaluated medical outcomes of the infants. Separate generalised mixed models estimated the influence of personal, medical and communication-related characteristics on specific parental stress. RESULTS: Parents of a younger age and those of infants with severe prognoses were more likely to experience stress. While empathetic communication as one aspect of staffs communication was shown as appropriate in reducing parental stress, an initial introduction and the quantity of information were only slightly associated with lower levels of stress. CONCLUSION: Results provide evidence for the need to involve parents empathetically from the beginning of their child's stay in the NICU. PRACTICE IMPLICATIONS: Staff in the NICU should communicate empathetically and help to reduce stress in parents particularly at risk.