Development of a self-assessment tool to address the functioning of community-dwelling older adults in general practice: a validation study of the EFA23 questionnaire.

BACKGROUND: Multimorbidity is increasingly prevalent among ageing patients, leading to reduced daily functioning. To address the challenges posed by multimorbidity in older adults, a person- and context-centred approach is needed. This study aimed to develop a questionnaire as a self-assessment tool for older adults focusing on functioning in general practice based on the International Classification of Functioning, Disability and Health (ICF). METHODS: A mixed-methods approach was employed in the development and validation of the German EFA23 (Erfassung Funktionaler Gesundheit im Alter - 23 Fragen; Assessing Functional Health in Old Age - 23 questions) questionnaire. Based on an ICF subset developed in a preparatory phase and consensus study, questionnaire items were formulated and tested in a qualitative pretest, followed by a validation study. A workshop with general practitioners (GPs) was held to develop a supplementary manual for GPs on how to interpret the questionnaire results and discuss them with the patients. RESULTS: A total of 69 items were developed and tested in the qualitative pretest with 15 respondents, resulting in 37 items for the validation study. The validation study, involving 237 older adults, showed the presence of one significant principal component. It demonstrated good internal consistency (Cronbach's alpha = 0.967) and construct validity, showing positive correlations with established assessment tools. Descriptive statistics showed differences between the means of self-assessment by patients and an external GP assessment. The final EFA23 questionnaire consists of 23 items assessing limitations in functioning. CONCLUSIONS: The EFA23 questionnaire can be used as a valid self-assessment instrument to measure functioning in older adults, supporting a person- and context-centred approach in general practice.

Detecting Medication Risks among People in Need of Care: Performance of Six Instruments.

INTRODUCTION: Numerous tools exist to detect potentially inappropriate medication (PIM) and potential prescribing omissions (PPO) in older people, but it remains unclear which tools may be most relevant in which setting. OBJECTIVES: This cross sectional study compares six validated tools in terms of PIM and PPO detection. METHODS: We examined the PIM/PPO prevalence for all tools combined and the sensitivity of each tool. The pairwise agreement between tools was determined using Cohen's Kappa. RESULTS: We included 226 patients in need of care (median (IQR age 84 (80-89)). The overall PIM prevalence was 91.6 (95% CI, 87.2-94.9)% and the overall PPO prevalence was 63.7 (57.1-69.9%)%. The detected PIM prevalence ranged from 76.5%, for FORTA-C/D, to 6.6% for anticholinergic drugs (German-ACB). The PPO prevalences for START (63.7%) and FORTA-A (62.8%) were similar. The pairwise agreement between tools was poor to moderate. The sensitivity of PIM detection was highest for FORTA-C/D (55.1%), and increased to 79.2% when distinct items from STOPP were added. CONCLUSION: Using a single screening tool may not have sufficient sensitivity to detect PIMs and PPOs. Further research is required to optimize the composition of PIM and PPO tools in different settings.

Inspired to Lend a Hand? Attempts to Elicit Prosocial Behavior Through Goal Contagion.

Helping often occurs in a broader social context. Every day, people observe others who require help, but also others who provide help. Research on goal contagion suggests that observing other people's goal-directed behavior (like helping) activates the same goal in the observer. Thus, merely observing a prosocial act could inspire people to act on the same goal. This effect should be even stronger, the more the observer's disposition makes him or her value the goal. In the case of prosocial goals, we looked at the observer's social value orientation (SVO) as a moderator of the process. In three studies (N = 126, N = 162, and N = 371), we tested the hypothesis that prosocial observations (vs. control) will trigger more subsequent casual prosocial behavior the more the observer is prosocially oriented. In line with the original research, we used texts as stimulus material in Study 1 and short video clips in Study 2 and 3. In Study 1 and 2, SVO was measured directly before the manipulation was induced and in Study 3 even a week prior to the actual experiment. Additionally, we included a second control condition video clip in Study 3, which did not depict human beings. Despite thoroughly developed stimulus material and methods, we found no support for an effect of the interaction, nor of the prosocial observation, but some support for an effect of SVO on casual helping behavior in Study 1 and 2. A mini meta-analysis revealed an effect equivalent to zero for goal contagion and a small, but robust SVO effect across studies. The main implication for the theory of goal contagion is that prosocial goals might not be as contagious as other goals addressed in the literature. We suggest a meta-analytic review of the literature to identify suitable goals and moderators for the goal contagion process.