Traumatic experiences and post-traumatic stress disorder among elderly Germans: results of a representative population-based survey.

BACKGROUND: Only a few population-based studies on the epidemiology of post-traumatic stress disorders (PTSDs) are available to date. Most of the existing studies are from the U.S.A. Against the background of World War II, the extent and long-term effects of war-related traumatic experiences in the German elderly population are of special interest. Nevertheless, population-based data on this topic are lacking to date. METHODS: This study examines the occurrence of traumatic experiences and the prevalence rates of PTSD according to DSM-IV and of partial PTSD in a randomly selected sample of the German general population aged 60 years and over (N = 814) using self-rating instruments. RESULTS: PTSD is apparent in 3.4%; when partial post-traumatic stress syndromes are included, a total of 7.2% of the aged population are involved. The most common individual symptoms resulting from war-induced trauma are avoidance of thoughts and feelings, sleep disturbances, distressing dreams and intrusive thoughts. The most frequently mentioned traumatic experiences of the generation examined in this study were war-related trauma experienced as children or in early adulthood during World War II. As a person's age increases, so does the prevalence of war-related traumatic experiences. There are some gender differences in traumatic experiences, but not in post-traumatic symptoms. CONCLUSION: The results emphasize the importance of war-related traumatic experiences from World War II in the German elderly population and their impact on the prevalence of PTSD more than 60 years later.

[Body image and physical well-being in old age]. / Körperbild und körperliches Wohlbefinden im Alter.

The present paper examined the connection between a negative body image and body complaints in N = 788 persons above 60 years of age from the general population. From a psychosomatic view, it is to be expected that psychological adjustment problems to the aging body are accompanied by physical complaints. A cluster analysis resulted in a group of older people with a strongly negative body image and a high degree of body complaints. This group is mainly formed by women, persons in high age, elderly alone living and persons with little social support. A second cluster includes persons with a positive body image and few body complaints. These are mainly younger persons, men, persons with a high degree of social support and older people living in a partnership. A further cluster includes persons with a very negative body image, however, with few body complaints. These persons are younger and more often live in a partnership, compared to the elderly with negative body image and a high degree of body complaints. A fourth cluster represents persons with a low degree of a negative body image and few body complaints. Their vitality and physical well-being, however, are also low. The study confirms that body complaints are partly determined by the body image. Sex, life in partnership and social support are risk or protective factors, respectively.

[The prevalence of depressive symptomatology in the german elderly population and the impact of methodical aspects on the identified prevalence]. / Die Prävalenz depressiver Beschwerden in der älteren Bevölkerung der Bundesrepublik Deutschland und die Bedeutung methodischer Aspekte für die identifizierten Prävalenzen.

OBJECTIVES: The issue of whether depression increases or decreases with age remains unclear. Methodical aspects play an important role in the research on depression in the elderly. METHODS: In a representative survey of the German general population aged 50 years and older (n = 1.156) depressive symptomatology was assessed using the CES-D and the PHQ-2, generalized anxiety (GA) was assessed using the GAD-7. RESULTS: According the CES-D 15.9 % and according to the PHQ-2 9.6 % of the population under study are classified as depressed. Prevalence rates increase with increasing age, but only few age groups show significant differences. The CES-D reveals higher prevalence rates than the PHQ-2. Nevertheless depending on the age group 3.6-7.8 % of the sample exclusively identified by the PHQ-2, and 9.0-14.9 % of the sample are exclusively identified by the CES-D. 4.8 (50-59 yrs.) to 10.3 % (80+ yrs.) report a moderate symptomatology of GA. GA is highly comorbid with depressive symptomatology. CONCLUSIONS: The prevalence rates in our study are consistent with previous findings of other studies. Moreover our study underpins the importance of methodical aspects for the prevalence rates identified.

[The impact of mental disorders on health care utilization and illness behaviour in the elderly]. / Die Bedeutung psychischer Beschwerden für die medizinische Inanspruchnahme und das Krankheitsverhalten Alterer.

OBJECTIVE: The differential impact of mental disorders on health care utilization and illness behaviour in old age should be studied. METHODS: In a representative population sample of men and women aged 50 years and older (n = 1.185) mental disorders (depression, somatisation and panic syndrome), health care utilization and illness behaviour were assessed by means of self rating instruments. RESULTS: About 10 % of the study sample fulfil the criteria of at least one mental disorder. Older people with mental disorders showed a significantly increased health care utilization compared to people without mental disorders. They especially visit general practitioners but did not show an extended number of psychiatrists' or psychotherapists' visits. Mental disorders are associated with divergent illness behaviour. Regression analysis revealed that somatic complaints and depression were independent predictors of illness behaviour and health care utilization. CONCLUSIONS: General practitioners get a central function in the health care system for older people with mental disorders. More attention should be paid to the detection of mental disorders in older people and the special requirements of this subgroup of patients.

Subjective health in older people.

The Nottingham Health Profile (NHP [1]) is a widely used instrument to measure subjective health in clinical research. However, there are no age-specific norms for older adults in Germany. The present study was conducted to analyze the psychometric properties of the German version of the Nottingham Health Profile (NHP) in older people. Age-specific reference values for the elderly are presented. Subjects were drawn from the general population of older German people aged 61 to 95 years (n=630; mean age 69.5 years; 55.7% female). Five of the six NHP scales revealed a good internal consistency (.70≤α≤.92). The subscales (with the exception of the subscale social isolation) showed moderate relations with instruments measuring somatization disorders and subjective body complaints (Screening for Somatoform Disorders SOMS [2]); Giessen Subjective Complaints List GBB-24 [3]). Compared to younger subjects, subjective health decreases with age. Therefore age-specific reference data for older people are necessary. Differential reference data are reported for four age groups above 60 years of age and for male and female older people. The outcome confirms that the NHP is a reliable, valid instrument to measure subjective health in older people.

Differential effects of single versus combined cognitive and physical training with older adults: the SimA study in a 5-year perspective.

The present study evaluates the effect of cognitive training, of psychoeducational training and of physical training on cognitive functioning, physical functioning, physical health, independent living and well-being in older people. Also the combination of physical training with cognitive training or psychoeducational training, respectively, was evaluated. In contrast to most training studies with older people, training effects were evaluated in a longitudinal perspective over 5 years to analyse long-term-results of cognitive and physical activity on older adults. Training effects were evaluated compared to a no-treatment-control group. Subjects were 375 community residents aged 75-93 years. Up to 5 years after baseline examination, significant training effects were observed in the group exposed to the combined cognitive and physical training. The physical and cognitive status in the participants of this group could be preserved on a higher level compared to baseline, and the participants displayed fewer depressive symptoms than the no-treatment-control group. The results are discussed in the light of recent research regarding the effects of mental and physical activity on brain function in older adults.

[Resilience as a protective personality characteristic in the elderly]. / Resilienz als protektives Persönlichkeitsmerkmal im Alter.

In a sample of elderly from the general population aged 60 years and older (N = 599, 53.6 % female; mean age 69.6 years) resilience was assessed as a protective personality factor for physical well-being by means of the resilience scale (RS; Wagnild and Young, 1993). The elderly reported lower subjective body complaints, when the amount of resilience was higher. The results of a regression analysis showed that resilience was a significant predictive variable for physical well-being besides age and sex. The amount of resilience was lower in women as in men. An age-related effect could not be found.

Alexithymia in the elderly general population.

Alexithymia was investigated in a random population sample of 566 people over 60 years of age (average, 69.73 years; range, 61 to 95 years) with the help of a German version of the Toronto Alexithymia Scale (TAS-26), and the results were compared with those from a group of 1,481 people under 60 years of age (average, 38.86 years; range, 14 to 60 years). The average alexithymia values in the elderly were not significantly higher than those of the younger subjects under 60 years of age. A total of 15.2% of the elderly and 18% of the younger group registered more than 1 SD over the mean value of all those sampled. This difference is also not statistically significant. Levels of alexithymia were not associated with age, gender, or education in the over-60 groups. The alexithymia scales "difficulties with identifying feelings" and "difficulties with describing feelings" correlated significantly with negative mood and negative body experience. These results confirm the assumption that there is a connection between alexithymia and depression, and correspond to the findings of other studies, that alexithymia is associated with a tendency to psychosomatic illness.