[Physical activity in the German National Cohort (NAKO): use of multiple assessment tools and initial results]. / Körperliche Aktivität in der NAKO Gesundheitsstudie: erste Ergebnisse des multimodalen Erhebungskonzepts.

BACKGROUND: Physical activity is a complex behavior that is difficult to measure validly and reliably in large, population-based studies. Data on physical activity are available for the initial 100,000 participants of the German National Cohort. OBJECTIVES: To describe the baseline physical activity assessment in the cohort and to present initial descriptive results. MATERIAL AND METHODS: Physical activity was assessed using a combination of tools, including two self-administered questionnaires, the Questionnaire on Annual Physical Activity Pattern (QUAP) and the Global Physical Activity Questionnaire (GPAQ); a computer-based 24­h physical activity recall (cpar24); and 7­day accelerometry (Actigraph GT3X/+; ActiGraph, Pensacola, FL, USA). RESULTS: The availability of data varied between assessment instruments (QUAP: n = 16,372; GPAQ: n = 90,900; cpar24: n = 23,989; accelerometry: n = 35,218). Analyses across measurement tools showed that on average, women spent 75 to 216 min/d, and men spent 73 to 224 min/d in moderate or higher intensity total physical activity. Persons aged 20-39 years spent 66 to 200 min/d, and persons aged 40-69 years spent 78 to 244 min/d in moderate or higher intensity total physical activity. CONCLUSIONS: Initial baseline analyses of physical activity in this cohort show the value of using a combination of questionnaires, 24­h recalls, and a movement sensor. The comprehensive data collection represents a valuable resource for future analyses and will improve our understanding of the association between physical activity and disease prevention.

[Measuring physical fitness in the German National Cohort-methods, quality assurance, and first descriptive results]. / Messung der körperlichen Fitness in der NAKO Gesundheitsstudie ­ Methoden, Qualitätssicherung und erste deskriptive Ergebnisse.

Physical fitness is defined as an individual's ability to be physically active. The main components are cardiorespiratory fitness (CRF), muscle strength, and flexibility. Regardless of physical activity level, physical fitness is an important determinant of morbidity and mortality.The aim of the current study was to describe the physical fitness assessment methodology in the German National Cohort (NAKO) and to present initial descriptive results in a subsample of the cohort.In the NAKO, hand grip strength (GS) and CRF as physical fitness components were assessed at baseline using a hand dynamometer and a submaximal bicycle ergometer test, respectively. Maximum oxygen uptake (VO2max) was estimated as a result of the bicycle ergometer test. The results of a total of 99,068 GS measurements and 3094 CRF measurements are based on a data set at halftime of the NAKO baseline survey (age 20-73 years, 47% men).Males showed higher values of physical fitness compared to women (males: GS = 47.8 kg, VO2max = 36.4 ml·min-1 · kg-1; females: GS = 29.9 kg, VO2max = 32.3 ml · min-1 · kg-1). GS declined from the age of 50 onwards, whereas VO2max levels decreased continuously between the age groups of 20-29 and ≥60 years. GS and VO2max showed a linear positive association after adjustment for body weight (males ß = 0.21; females ß = 0.35).These results indicate that the physical fitness measured in the NAKO are comparable to other population-based studies. Future analyses in this study will focus on examining the independent relations of GS and CRF with risk of morbidity and mortality.

Pain, Fear of Falling, and Functional Performance Among Nursing Home Residents: A Longitudinal Study.

The aim of this study was to analyze the impact of being pain-affected and fear of falling on functional performance among nursing home residents, longitudinally. We used 6-month follow-up data from a cluster-randomized trial of 12 nursing homes (cluster level) with 239 nursing home residents at baseline (mean age, 95% confidence interval [CI] = 83.04 [81.40, 84.69], 70% women). The longitudinal analysis provided data on pain, fear of falling, functional mobility, and activities of daily living (individual level). The data revealed a trend indicating that pain-relieved nursing home residents showed better functional mobility over time. The results on fear of falling demonstrate obvious differences in the functional performance of nursing home residents cross-sectionally but not longitudinally. Nevertheless, the results underline the importance of an effective pain treatment to prevent decline in functional mobility among nursing home residents. Further longitudinal surveys are needed to verify the findings on functional performance.

Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents.

AIM: Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany. METHODS: In a cluster-randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians. RESULTS: The primary objective of reducing the mean pain intensity by 2 points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6-month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores >0 on three pain intensity items decreased significantly. CONCLUSIONS: Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long-term implementation appears necessary. Geriatr Gerontol Int 2017; 17: 1534-1543.

Validation of a Modified German Version of the Brief Pain Inventory for Use in Nursing Home Residents with Chronic Pain.

UNLABELLED: The Brief Pain Inventory (BPI) has been psychometrically evaluated worldwide in adult patients with cancer-related and chronic pain in several languages, but never in nursing home residents with chronic pain. To address this gap, we evaluated the validity of a modified version of the BPI, the BPI for nursing home residents (BPI-NHR) in individuals who resided in German nursing homes. One analytic sample included 137 nursing home residents (mean age, 83.3 years; SD, 8.0 years) without any missing values. An extended sample also included individuals with previous missing values that were substituted with the personal mean (n = 163; mean age, 83.3 years; SD, 8.3 years). Principal axis factoring with oblimin rotation was used to compute the final 2-factor solution for the substituted sample. These factors explained 71.7% of the variance. Internal consistency was calculated using Cronbach α, and showed excellent results. Concurrent validity was tested using nonparametric correlation analyses of the BPI-NHR with the pain medication scale. The present findings support the reliability and validity of the BPI-NHR for very old nursing home residents. Further evaluation of this measure is needed to examine face validity and the effect of multimorbidity on pain interference with function. PERSPECTIVE: In this article we present psychometric properties of the BPI originally developed to assess cancer pain, extended to measure chronic nonmalignant pain in younger and middle-aged patients, and now further developed to measure pain intensity and interference with function among very old nursing home residents. Thus, the BPI-NHR might assist clinicians and researchers interested in assessment of pain intensity and interference in elderly individuals who reside in nursing homes.

Falls Self-Efficacy in German Nursing Home Residents: Assessment of Validity and Determination of a Cutoff Point.

Approximately one in every two German nursing home residents falls at least once in a 1-year period and just as many report a fear of falling. It has been hypothesized that falls self-efficacy mediates the relationship between fear of falling and functional ability. The aim of the current study was to develop the German Nursing Home Falls Self-Efficacy Scale, examine its validity, and estimate a cutoff point to differentiate nursing home residents with low or high falls self-efficacy. Nursing home residents were assessed at baseline (n = 178, mean age = 83.7 years) and 6-month follow up (n = 115, mean age = 83.9 years). Factorial and construct validity analyses provided preliminary support for the validity of the scale. A cutoff point of 11.5 was generated by receiver operating characteristic curve analysis. This scale may assist health care professionals in differentiating between nursing home residents with low and high falls self-efficacy and supporting residents in providing appropriate interventions. [Res Gerontol Nurs. 2016; 9(3):134-144.].

Nonpharmacologic Pain Management Interventions in German Nursing Homes: A Cluster Randomized Trial.

The reported prevalence of pain among nursing home residents (NHRs) is high. Insufficient use of analgesics, the conventional pain management strategy, is often reported. Whether and to what extent nonpharmacologic therapies (NPTs) are used to manage the pain of NHRs in Germany is largely unknown. The aim of this cluster-randomized trial was to assess the NPTs provided and to enhance the application and prescription of NPTs in NHRs on an individual level. There were six nursing homes in the intervention group and six in the control group. There were 239 NHRs, aged ≥65 years, with an average Mini-Mental State Examination score of at least 18 at baseline. Pain management interventions (cluster level) included an online course for physicians and 1-day seminar for nurses. Data on NPT applied by nurses and therapeutic NPT prescribed by physicians were obtained from residents' nursing documentation. Face-to-face interviews with NHRs assessed the NPT received. At baseline, 82.6% of NHR (mean age 83 years) were affected by pain, but less than 1 in 10 received NPT. The intervention did not result in a significant increase in the NPT applied by nurses, but did significantly increase the therapeutic NPT prescribed by physicians. Residents were active in using NPT to self-manage their pain. Given the prevalence of pain in NHRs, there is a clear need to improve pain management in this population. Extended use of NPT offers a promising approach. We recommend that nurses provide residents with education on pain-management techniques to support them in taking a proactive role in managing their pain.

[What are the reasons for patient dropout in nursing home residents in an intervention study. An analysis of unit nonresponders in 12 German nursing homes]. / Welche Ausfallursachen liegen bei Pflegeheimbewohner(inne)n in einer Interventionsstudie vor? Eine Analyse der Unit-Nonresponder in zwölf deutschen Pflegeheimen.

BACKGROUND: Non-response bias is a major problem for the validity of survey answers. Analyses of reasons for non-response in surveys with nursing home residents (NHR) are scarce. AIM AND METHOD: The aim of this study was to develop reliable and valid categories which represent reasons for non-response in nursing homes using the "Prozessmodell induktiver Kategorienbildung" following Mayring (2010). Furthermore, characteristics of unit non-responder and responder were compared. RESULTS: Forming of categories of reasons for non-response was conducted with 522 NHR, longitudinally. Four major categories were identified (general refusal, health reasons, accessibility, excessive demand) and further 17 subcategories. Unit-non-responder and responder did not differ in age and sex; however follow-up non-responder showed differences in marital status, training qualification, and cognitive status. CONCLUSIONS: The presented scheme of categories can be used to assess reasons for non-response in nursing homes. Standardised assessment of reasons for non-response may contribute to higher response rates in this setting.

Perceived enactment of autonomy of nursing home residents: A German cross-sectional study.

Recognizing the ageing of populations and expected increase in prevalence of dementia, the necessity of research involving persons with dementia is widely agreed upon. Autonomy is key to nursing home residents' well-being and quality of life, but this phenomenon has not been thoroughly assessed from the residents' perspective. The aim of this cross-sectional study was to investigate perceived autonomy of nursing home residents. Data on 560 randomly selected residents in 40 nursing homes in two German federal states were generated by face-to-face interviews, psychological and physical assessments, analysis of nursing records, and acquisition of institutional parameters. This paper reports on a subsample (n = 179) that met screening requirements, including subjects with and without mild cognitive impairment (Mini Mental Status Examination score 30-18), who completed the Hertz Perceived Enactment of Autonomy Scale (HPEAS). The mean score of HPEAS was 101.1 ± 14.5 (range 54-122). In our population, Cronbach's alpha was 0.89. Scores in HPEAS were not related to demographical factors but positively associated with increasing self-efficacy and absence of pain. The novel findings contribute to an understanding of autonomy from the residents' perspective.

Physical activity in nursing homes--barriers and facilitators: a cross-sectional study.

PURPOSE: To explore different institutional barriers to and facilitators of physical activity (PA) in nursing homes. METHODS: Cross-sectional survey of 40 German nursing homes and 217 nursing-home residents (NHRs; M ± SD age 80 ± 10.2 yr, 55% women, MMSE ≥20). Quantitative data were collected on the structural characteristics of nursing homes and the PA services available. RESULTS: Forms of exercise available were not adequately communicated to residents. Overall participation was below 50%. Awareness was significantly higher in residents with informed relatives (p = .003). A broad range of forms of exercise was generally available (M ± SD 5 ± 2.22, range 0-10), but they were rarely tailored to NHRs' needs and their effectiveness remains questionable. CONCLUSION: Multidimensional opportunities to promote PA in NHRs are identified.

[Autonomy in the nursing home--conceptual considerations regarding self-determination and capacity to act on the basis of a model]. / Autonomie im Pflegeheim--Konzeptionelle Uberlegungen zu Selbstbestimmung und Handlungsfähigkeit anhand eines Modells.

Autonomy is an exceptionally complex philosophical concept which is present in ethical considerations in health care settings. Currently, no consistent definition of autonomy exists. From the perspective of the authors, self-determination and capacity to act independently are essential aspects of autonomy. While there are limited general results regarding autonomy in old age, autonomy of nursing home residents and the corresponding critical influence factors still lack in-depth examination. The aim of this article is to contribute to a more thorough understanding of autonomy of nursing home residents. Due to the high percentage of residents with cognitive impairment, this population plays a crucial role regarding the conceptualisation of autonomy. Various approaches combined with the perspectives developed by the interdisciplinary PAiN-Project team (Pain and Autonomy in the Nursing Home), led to the formulation of a novel conceptualisation of autonomy. Based on theoretical and discursive considerations, the model "Determination Factors of Autonomy" focuses on the residents' self-determination and ability to perform activities of daily living in the nursing home context. According to the author's conceptualisation, autonomy occurs in various ranges in regard to self-awareness as well as the appreciation of autonomy by others.