[Psychosocial effects of the pandemic on staff and residents of nursing homes as well as their relatives-A systematic review]. / Psychosoziale Auswirkungen der Pandemie auf Pflegekräfte und Bewohner von Pflegeheimen sowie deren Angehörige ­ Ein systematisches Review.

BACKGROUND: Following the COVID-19 pandemic residents of nursing homes, their visitors and families as well as employees are faced with new challenges. Protective measures have a strong impact on the well-being of all these groups of persons. MATERIAL AND METHODS: A systematic search was carried out for studies investigating the psychosocial consequences of the COVID-19 pandemic for residents, their visitors and families as well as nursing home staff. Results were analyzed by narrative synthesis. RESULTS: A total of 756 studies were screened and 15 studies were included. These studies were conducted between February and June 2020 with participants from 14 countries. Participants reported loneliness, grief and depressive symptoms among residents. Some gave an account of fear as a reaction of residents to social distancing. Residents with cognitive impairment suffered more although there are conflicting reports. The well-being of visitors and friends was compromised and their feeling of loneliness increased. Nursing home personnel reported fear of getting infected and of infecting residents or their own families. Infected workers in the USA expressed anger about a lack of protection. Furthermore, an increase in workload was reported. CONCLUSION: Studies conducted during the first months of the pandemic reported negative consequences for the psychosocial well-being of residents, their visitors and nursing home staff. Individual needs for future support of these groups are distinct and need further evaluation during the on-going pandemic.

SPMSQ for risk stratification of older patients in the emergency department : An exploratory prospective cohort study.

BACKGROUND: Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. OBJECTIVE: To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). METHOD: This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. RESULTS: The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46-0.63) but at 3 months (AUC 0.61, 95% CI 0.54-0.68), 6 months (AUC 0.63, 95% CI 0.56-0.70) and 12 months (AUC 0.63, 95% CI 0.56-0.70) after initial contact. CONCLUSION: For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own.

Incident depression and mortality among people with different types of dementia: results from a longitudinal cohort study.

PURPOSE: The aim of this study was to investigate the independent and combined association of incident depression and dementia with mortality and to explore whether the magnitude of the association varies according to different types of dementia, including Alzheimer's disease and vascular dementia. METHODS AND DESIGN: The study was based on a population-based longitudinal cohort consisting of 9940 participants at baseline and followed for over 14 years. The sample used for the analyses included 6114 participants with available information on diagnosis of incident dementia and depression. For survival analyses, Cox regression models with incident dementia (n = 293; 5%) and incident depression (n = 746; 12%) as time-dependent variables were used. RESULTS: Cox models adjusted for relevant confounders indicated that comorbidity of incident vascular dementia and incident depression was associated with a much higher mortality risk (HR 6.99; 95% CI 3.84-12.75) than vascular dementia in the absence of depression (HR 2.80; 95% CI 1.92-4.08). In contrast, estimates for comorbidity of Alzheimer's disease and depression were slightly lower than those for Alzheimer in absence of depression (HR 3.56; 95% CI 1.83-6.92 and HR 4.19; 95% CI 2.97-5.90, respectively). Incident depression in the absence of incident dementia was only weakly associated with mortality. CONCLUSIONS: These findings indicate that depression and vascular dementia might have synergistic effects on mortality. The results have relevant public health implications for prevention, routine screening for and early treatment of depression among older people, especially those at risk of vascular dementia.

[Perspectives of psychological aging research]. / Perspektiven der psychologischen Alternsforschung.

Psychological aging research (PAF) focuses on age-related changes and behavioral stability (e.g. structure of social relations), performance and competences (e.g. cognitive functioning) as well as experiences (e.g. well-being) in advanced age. Knowledge is based in particular on currently available longitudinal studies, which historically for the first time allow very long observational periods (nearly across the complete life span). Additionally, innovative statistical analytical methods co-developed in the PAF nowadays allow a better understanding of the dynamics of change than ever before. This results in a new picture of psychological aging that confirms the multifaceted strengths of human aging but also reveals new risks of the current "prolonged aging".

[Structural lag and room for possibilities in old age exemplified by central transitions. Initial results of a novel discipline trialogue between diaconal studies, psychology and theology]. / "Structural Lag" und Möglichkeitsräume des Alterns am Beispiel zentraler Transitionen. Erste Befunde eines neuartigen Disziplinentrialogs zwischen Diakoniewissenschaft, Psychologie und Theologie.

BACKGROUND: Although the need for interdisciplinary research is generally accepted in gerontology, such interdisciplinary communication is often limited to various combinations of psychological, sociological and biomedical scientific approaches. We argue that gerontology requires a continuous examination of novel disciplinary constellations to obtain a better understanding of aging in its complexity and to further develop this scientific field in its entirety. OBJECTIVE: The present study introduced and tested for the first time an innovative disciplinary trialogue, i.e. the combination of psychology, theology and diaconal studies. In particular, it is assumed that this combination can contribute to a more profound interpretation of the prominent concept of structural lag which is underresearched in gerontology. MATERIAL AND METHODS: The analysis of structural lag with another overarching concept, "room for possibilities", can provide a synergy-rich interpretation category for a range of challenges connected with old age. In this respect, three major transitions were selected to shed light on these concepts and examined by means of three focus group interviews: transition to retirement, need for long-term care in the private home context and transition to nursing home life. The data were evaluated using qualitative content analysis. RESULTS: The interdisciplinary-oriented evaluation of the interviews and the qualitative data analysis revealed the relevance of different perceptions of time in all three transitions. In addition, different dynamics in terms of the interplay of gains and losses as well as participation were found to be important for a better understanding of the three transitions. In particular, the subjective interpretation of the time remaining for living and the predetermined or self-selected time structuring of the daily routine were important factors for the perception of one's own potential. The results also underline a range of unused room for possibilities and the existence of structural lag for each transition. CONCLUSION: By the cooperation of the participating disciplines aspects of aging and their interdependence became visible. At the same time this pilot-like disciplinary trialogue revealed the challenges in combining interdisciplinary perspectives by the combination of empirical and hermeneutical methods.

[Evaluation of new technologies by residents and staff in an institutional setting. Findings of the BETAGT project]. / Bewertung neuerer Technologien durch Bewohner und Pflegemitarbeiter im institutionellen Kontext : Befunde des Projekts BETAGT.

BACKGROUND: The aim of the substudy that was conducted as part of the project "Bewertung neuer Technologien durch Bewohner und Personal im Altenzentrum Grafenau der Paul Wilhelm von Keppler-Stiftung und Prüfung des Transfers ins häusliche Wohnen" (BETAGT) was to have residents and staff members in nursing homes with limited technological equipment complete a questionnaire about their life-long technological experiences and their general technological attitude. Furthermore, specific technological devices and systems were evaluated in terms of their potential with respect to safety, privacy, or help in decreasing burden. Data were collected using a newly developed brief questionnaire. SAMPLE AND METHODS: A total of 84 residents and 109 staff members sampled from 11 different institutions were asked about their life-long technology experiences, general attitudes towards technology as well as attitudes towards specific technological devices. Residents' opinions were assessed via brief structured interviews; a structured questionnaire was given to the staff members to complete. The technological devices to be evaluated were introduced via pictured descriptions. RESULTS: Residents and staff members showed a positive attitude towards technology. With regard to the potential of new technologies, residents and staff members expect different effects on several dimensions of quality of life. Both groups rated the potential of the dimension of safety to be highest. CONCLUSION: Contrary to widely held opinion, older adults living in institutions do not, in general, seem to be too critical about new technology. From the staff members' point of view, modern technology can be integrated into daily care routines of a nursing home, but the potentials of new technologies are considered in a very differential manner.

[Quality of life by limited vision in old age: the example of age-related macula degeneration]. / Lebensqualität bei Seheinschränkung im Alter: Das Beispiel altersabhängige Makuladegeneration.

Age-related macula degeneration (AMD) is accompanied by considerable consequences regarding the psychosocial quality of life. A considerable body of research literature now indicates, for instance, an increased rate of depression and substantial loss of everyday capabilities in AMD patients. However, inter-individual differences are large and part of the explanation lies in differences in the ability to cope with and detach oneself from aims in life. The negative impact of AMD on the qualify of life is associated with a need for psychosocial support, but this need is barely met at present. A series of studies nevertheless supports the view that successful intervention is possible even with very old patients. In this respect the problems at present have less to do with recognition than with application and implementation.

[The compatibility of housing needs and housing conditions and and its impact on experiencing attachment to a district]. / Die Ubereinstimmung von Wohnbedürfnissen und Wohnbedingungen und ihr Einfluss auf die erlebte Stadtteilverbundenheit.

Based on the "complementary-congruence model" of person-environment (p-e) fit, this study focuses on housing in old age as an interaction between housing needs and housing conditions in urban settings. The research aims are: (1) To establish a set of housing-related p-e fit indices based on the relationship between environmental needs and existing conditions in different physical and social domains, and to describe housing among elders aged 51-80 years and in different urban districts with these indices. The study distinguishes between basic, higher-order and social needs relating to housing; (2) To explain outdoor place attachment as an indicator for quality of life in different urban districts with a set of predictors including these person-environment fit indices. Data were drawn from telephone-based interviews with 365 older adults (51-80 years) who were questioned about individual housing needs and housing conditions. Results revealed higher p-e fit scores in the domains of higher-order and social housing needs and conditions in the districts which were considered to be more pleasant but had poor access to the city and to public transportation. In contrast, age was more important in explaining differences in the domain of basic housing needs and conditions with higher p-e fit scores among older participants in all settings. In explaining outdoor place attachment, the fit between basic and social housing needs and conditions was important, but the higher-order fit did not play a role.

[Development and perspectives of gerontological research: the sample case of housing research]. / Entwicklung und Perspektiven der gerontologischen Forschung: Das Beispiel Wohnforschung.

The present work addresses the historical development of environmental gerontology and housing research. Emphasis is placed on the development of ecological perspectives in gerontology as a research program, its scientific reception and acknowledgment in gerontology, the unfolding of housing-related theories and housing studies. Furthermore, the situation in Germany is juxtaposed against the situation in the US. As is found, between the 1930s and 1960 housing research gained substantial importance predominantly in the US as a consequence of the emergence of the field of social gerontology. There was however not much theoretical impetus from housing research on social and behavioral gerontology at large. In the time period between the 1960s and the mid 1980s many large-scale studies focused on housing in old age. At the same time, grand theories related to housing were introduced with the Ecological Theory of Aging (Lawton) as its flagship conception, able to have an impact on gerontology and its research guiding fundamental ideas (person-environment view of aging). Germany's social and behavioral gerontology saw during this time period the profound discussion of, as was frequently said, social-ecological approaches, while empirical studies tended to concentrate on institutions for the aged. Since the beginning of the 1990s dementia-related themes have largely been taken over as a driving force of North American housing research. In some contrast, gerontological housing research in Germany has strongly addressed the diversity of aging in the private household situation. In conclusion, housing research was important for gerontology in terms of the promotion of a person-environment perspective of aging on the conceptual and empirical level. This function should continue into the future.

[A psychosocial training program for elderly patients with age-related macular degeneration: findings of a pilot evaluation study]. / Ein psychosoziales Trainingsprogramm für ältere Menschen mit altersabhängiger Makuladegeneration: Befunde einer Pilot-Evaluationsstudie.

The purpose of this work was to develop and evaluate a psychosocial intervention aimed to improve quality of life of AMD patients. A total of 22 outpatients (age 62 to 80 years) treated in the University Eye Clinic in Heidelberg were divided into an intervention group (n=14) and a comparison group without intervention (n=8). The intervention program was based on six modules carried out in five weekly group sessions. These modules included: (1) progressive muscle relaxation, (2) exchange of disease-related experiences, (3) connection between thought, emotion, and behavior, (4) activation of available resources, (5) general problem solving skills and (6) information exchange. Pre-post assessment addressed a set of standardized emotional and behavioral outcome measures. Findings revealed that the intervention group showed improvement or prevention of additional loss in emotional as well as in behavioral outcomes, while the comparison group did not. Results are interpreted as initial evidence that the developed program is able to improve the quality of life in patients suffering from AMD.

Article predictors of wellbeing and autonomy before and after geriatric rehabilitation.

The aim of this study was to explore changes in the correlational association between predictors (i.e. sociodemographics, subjective health, social support, anxiety and coping) and outcome measures (i.e. subjective wellbeing and autonomy) before and after rehabilitation treatment. The data came from a sample of 90 patients (mean age 78.8 years; 84 percent female; 37 percent stroke, 44 percent fracture, 19 percent other diagnoses), who were assessed before and after rehabilitative treatment. Results revealed that although changes between predictors and outcomes were not prevalent with respect to subjective wellbeing, they were clearly evident with respect to autonomy. Whereas psychological variables, such as state anxiety and behavioural coping, played no predictive role at entry, they became the strongest predictors of autonomy at discharge.

[Success and variability of success of inpatient rehabilitation of the elderly: an empirical study based on medical-psychiatric and psychosocial indicators]. / Erfolg und Erfolgsvariabilität stationärer Rehabilitation alter Menschen: Eine empirische Studie auf der Basis medizinisch-geriatrischer und psychosozialer Indikatoren.

This study considers findings of psychological gerontology as particularly important for geriatric rehabilitation research. Its concrete aim was to describe the course and outcome of geriatric rehabilitation based on a wide range of success criteria, to explore the influencing role of age, sex, and diagnosis as well as to describe the variability pattern of success. The data were gathered from a sample of 100 older adults who underwent treatment in a German inpatient rehabilitation unit. Participants were assessed across five measurement occasions by use of a state-of-the-art geriatric assessment and a psychological data collection part. The results underline, for one, that significant improvements of functional as well as psychological capacity were obtained. Second, age and sex played practically no role concerning the course of the success criteria, whereas diagnosis revealed some statistically meaningful effects. Third, it was found that the variability of success was characterized by a relatively homogeneous pattern of gain with regard to functional criteria; with respect to psychological variables, heterogeneity was more pronounced and some participants show loss as well, a chance for further improvement of the geriatric rehabilitation.

[Changes in aging today and tomorrow--contributions of interventional gerontology]. / Zur Veränderung des Alterns heute und morgen--Beiträge der Interventionsgerontologie.

This paper starts with the insight that today's intervention gerontology provides a very broad scope of strategies with impact on the course of normal aging as well as aging with competence losses. Also, it is assumed that this impact of intervention gerontology will grow even further in the future. In the following, current intervention gerontology research is discussed by particularly highlighting its connection with basic gerontology findings, the contextual view of aging, the interdisciplinary orientation, and the methodological standard. With respect to the potential of gero-intervention in the future, three prototypical domains are considered: (1) health and everyday competence, (2) living environments, and (3) communication.

[III. Social relationships]. / III. Soziale Beziehungen.

In this four-part review article, an update of psychological gerontology from 1988 to 1997/1998 in German speaking countries is given. Part III of this review focuses on social relationships in old age. Two perspectives are chosen for this analysis. The first perspective describes the process of actively coping with developmental tasks in social relationship - the elderly are not seen as a "passive" but as an "active" part in social relationships. Moreover, this perspective focuses on empirical relations between different patterns of social integration and the psychological situation in old age. The second perspective stresses on a special aspect of social engagement: the engagement and productivity in intergenerational relationships. Empirical data make clear that the elderly not only receive (emotional and instrumental) support, but also give a lot of support in these relationships.