Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey.

BEACKGROUND: Older adults with mental health problems may benefit from psychotherapy; however, their perceived need for treatment in relation to rates of non-utilization of outpatient psychotherapy as well as the predisposing, enabling, and need factors proposed by Andersen's Model of Health Care Utilization that account for these differences warrant further investigation. METHODS: We used two separate cohorts (2014 and 2019) of a weighted nationwide telephone survey in Germany of German-speaking adults with N = 12,197 participants. Across the two cohorts, 12.9% (weighted) reported a perceived need for treatment for mental health problems and were selected for further analyses. Logistic Generalized Estimation Equations (GEE) was applied to model the associations between disposing (age, gender, single habiting, rural residency, general health status), enabling (education, general practitioner visit) non-utilization of psychotherapy (outcome) across cohorts in those with a need for treatment (need factor). RESULTS: In 2014, 11.8% of 6087 participants reported a perceived need for treatment due to mental health problems. In 2016, the prevalence increased significantly to 14.0% of 6110 participants. Of those who reported a perceived need for treatment, 36.4% in 2014 and 36.9%in 2019 did not see a psychotherapist - where rates of non-utilization of psychotherapy were vastly higher in the oldest age category (59.3/52.5%; 75+) than in the youngest (29.1/10.7%; aged 18-25). Concerning factors associated with non-utilization, multivariate findings indicated participation in the cohort of 2014 (OR 0.94), older age (55-64 OR 1.02, 65-74 OR 1.47, 75+ OR 4.76), male gender (OR 0.83), lower educational status (OR 0.84), rural residency (OR 1.38), single habiting (OR 1.37), and seeing a GP (OR 1.39) to be related with non-utilization of psychotherapy; general health status was not significantly associated with non-utilization when GP contact was included in the model. CONCLUSION: There is a strong age effect in terms of non-utilization of outpatient psychotherapy. Individual characteristics of both healthcare professionals and patients and structural barriers may add to this picture. Effective strategies to increase psychotherapy rates in those older adults with unmet treatment needs are required.

Patients' health literacy in relation to the preference for a general practitioner as the source of health information.

BACKGROUND: For many patients, the general practitioner (GP) is the most important point of contact for obtaining information about a wide range of health topics. However, patients with different characteristics may seek health information from different sources, such as friends or the internet. The relationship between patient characteristics and preferences for information sources is understudied. We investigate which information sources are used by patients for health-related questions and how this relates to patients' sociodemographics, health, and health literacy. METHODS: A stratified and population-based survey was conducted to investigate health information sources within the German population over 35 years (n = 4144). Sociodemographics, use of technology, health-related indicators, and health literacy (including self-efficacy and action planning), as well as questions regarding the ratings of multiple health-related information sources, were investigated in personal interviews and analyzed using logistic regression. RESULTS: In our study, GPs were the most important source of information for the patients, followed by medical specialists, pharmacists and the internet. Patient age and number of illnesses were associated with the choice of information source. Furthermore, action planning and self-efficacy for acquiring health knowledge were associated with the selected source of information. CONCLUSIONS: Information provider appears to be an important role for GPs, particularly among old and chronically ill patients. GPs should have the specific capabilities to fill this role and should be trained and referred to accordingly. Self-efficacy and action planning for acquiring health knowledge are important patient factors doctors can use for brief inventions during consultations.

Centenarians Differ in Their Comorbidity Trends During The 6 Years Before Death Compared to Individuals Who Died in Their 80s or 90s.

Background: While compression of morbidity has now been studied in multiple cohorts, we hypothesize that centenarians might also have fewer chronic conditions as well. We assume that individuals who die as centenarians have less comorbidities and have a less steep rise of the number of comorbidities over the final years before death compared to those who died as nonagenarians (90-99 years) or octogenarians (80-89 years of age). Methods: This German cohort study used health insurance data. The data contain complete information on diagnoses and health care transactions for the 6 years prior to death. The sample (N = 1,398; 34,735-person calendar quarters) is comprised of three groups of individuals; those who died as centenarians were compared with random samples of individuals who died as nonagenarians or as octogenarians. Community-dwelling and institutionalized individuals were included. Results: One quarter prior to death, individuals who died as centenarians had, on average, 3.3 comorbidities. Octogenarians had 4.6 comorbidities one quarter prior to death. Further, there was a significant time-to-death by age-at-death interaction (B = -.03, p < .001), where centenarians showed a less steep increase in the number of comorbidities than the comparison groups in their last 6 years prior to death. Conclusions: The lower prevalence of comorbidities in individuals who died as centenarians compared with those who died at a younger age reinforces the notion of centenarians as a selective group. Avoiding the confounding and potentially synergistic effects of having multiple chronic illnesses is likely vital to being able to survive to extreme ages.

Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey.

BACKGROUND: Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions. OBJECTIVE: The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors. METHODS: A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied. RESULTS: It was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctor's advice. CONCLUSIONS: Although there were many smartphone and health app users, a substantial proportion of the population was not engaged. Findings suggest age-related, socioeconomic-related, literacy-related, and health-related disparities in the use of mobile technologies. Health app use may reflect a user's motivation to change or maintain health behaviors. App developers and researchers should take account of the needs of older people, people with low health literacy, and chronic conditions.

Development and psychometric properties of a health knowledge test on six chronic conditions.

OBJECTIVES: The aim of this study was to develop and test the psychometric properties of a health knowledge test on common chronic conditions in the general population. METHODS: Operationalization based on a facet design led to 108 knowledge items on six conditions: cardiovascular disease, cancer, respiratory diseases, musculoskeletal system conditions, depression, and chronic pain. We refined the items (qualitative study 1; N=20) and selected the items by applying a mixed Rasch model (study 2; N=861). The psychometric properties (Study 3; N=4144) of the remaining 24 items were tested using exploratory (split sample N=2110) and confirmatory factor analyses (split sample N=2034). RESULTS: 108 items were refined within study 1, 24 of which were selected in study 2. In study 3, a general health knowledge factor was confirmed based on six subscales on specific conditions. Convergent validity was confirmed by the overlap of health knowledge with education and perceived health knowledge. CONCLUSION: The development and evaluation of the psychometric properties of a health knowledge test on six common conditions will improve future research on health knowledge. PRACTICAL IMPLICATIONS: Chronic conditions present a challenge; assessing the level of health knowledge is the first step to prevent and to cope with these conditions.