Gender-specific association of loneliness and health care use in community-dwelling older adults.

BACKGROUND: Loneliness in older adults is common, particularly in women. In this article, gender differences in the association of loneliness and health care use are investigated in a large sample of community-dwelling older adults. METHODS: Data of 2525 persons (ages 55-85 years)-participants of the fourth follow- up (2011-2014) of the ESTHER study- were analyzed. Loneliness and health care use were assessed by study doctors in the course of a home visit. Gender-specific regression models with Gamma-distribution were performed using loneliness as independent variable to predict outpatient health care use, adjusted for demographic variables. RESULTS: In older women, lonely persons were shown to have significantly more visits to general practitioners and mental health care providers in a three-month period compared to less lonely persons (p = .005). The survey found that outpatient health care use was positively associated with loneliness, multimorbidity, and mental illness in older women but not in older men. Older men had significantly more contact with inpatient care in comparison to women (p = .02). CONCLUSIONS: It is important to consider gender when analyzing inpatient and outpatient health care use in older persons. In older women loneliness is associated with increased use of outpatient services.

[Psychosomatic Specialist Consultation in the General Practitioner's Office - A New Model of Integrated Care]. / Psychosomatische Sprechstunde in der Hausarztpraxis ­ ein neues Kooperationsmodell von Psychosomatik und Allgemeinmedizin.

A high number of patients with mental health disorders currently do not receive minimally adequate treatment, but remain solely in general practice. This is often due to long waiting times for psychotherapy, patient related barriers or diagnostic insecurity. For this reason, we have developed a care model that is applied directly in the general practitioner's (GP) office and is open to any form of psychosomatic disorder. The cornerstone of the model consists of a psychosomatic specialist consultation in the GP's office. Preliminary results concerning utilization and the target population show a high level of acceptance among patients, GPs, and psychosomatic specialists.

[Evaluation of the German Version of the "INTERMED-Self-Assessment"-Questionnaire (IM-SA) to Assess Case Complexity]. / Evaluation der deutschsprachigen Version des "INTERMED-Self-Assessment"- Fragebogens (IM-SA) zur Erfassung von Patienten mit komplexem Versorgungsbedarf.

INTRODUCTION: The INTERMED- interview (IM-CAG=INTERMED complexity assessment grid) is a well validated instrument for the identification of complex patients in need of integrated health care (score ≥21). The IM-SA (INTERMED self-assessment)-questionnaire, derived from the INTERMED- interview, was developed in cooperation with the international INTERMED group in order to facilitate its use in various clinical settings and to foster the patients' perspective on health-care needs. METHODS: The German version of the IM-SA was evaluated in a clinical sample (n=136) of psychosomatic outpatients and compared to the IM-CAG. Construct validity was examined by analyzing the correlations of the IM-SA with quality-of-life (SF-36) and anxiety/depression (HADS). Sensitivity and specificity for the identification of complex patients were examined by using ROC (Receiver Operating Characteristic) analysis. RESULTS: The correlations between the total score and the subscales of the IM-SA, compared to the INTERMED, were high (total score r=0.79 (95%-KI: [0.70; 0.85]). Cronbach's α was 0.77, and construct validity was high (SF-36 mental component score: r=-0.57; HADS Depression: r=0.59). The IM-SA total score was significantly lower compared to IM-CAG, mainly because of low IM-SA scores in the somatic domain. According to ROC analysis, the IM-SA-cut-off for identifying complex patients has to be lowered (score ≥17). DISCUSSION: The IM-SA can be used as an instrument to identify complex patients in need of integrated bio-psycho-social care. CONCLUSION: The IM-SA is a reliable instrument to be used in various clinical settings to identify complex patients and to provide integrated, bio-psycho-social care.