Recruiting people with selected citizenships for the health interview survey GEDA Fokus throughout Germany: evaluation of recruitment efforts and recommendations for future research.

BACKGROUND: Germany is the second most common country of immigration after the US. However, people with own or familial history of migration are not represented proportionately to the population within public health monitoring and reporting. To bridge this data gap and enable differentiated analyses on migration and health, we conducted the health interview survey GEDA Fokus among adults with Croatian, Italian, Polish, Syrian, or Turkish citizenship living throughout Germany. The aim of this paper is to evaluate the effects of recruitment efforts regarding participation and sample composition. METHODS: Data collection for this cross-sectional and multilingual survey took place between 11/2021 and 5/2022 utilizing a sequential mixed-mode design, including self-administered web- and paper-based questionnaires as well as face-to-face and telephone interviews. The gross sample (n = 33436; age range 18-79 years) was randomly drawn from the residents' registers in 120 primary sampling units based on citizenship. Outcome rates according to the American Association for Public Opinion Research, the sample composition throughout the multistage recruitment process, utilization of survey modes, and questionnaire languages are presented. RESULTS: Overall, 6038 persons participated, which corresponded to a response rate of 18.4% (range: 13.8% for Turkish citizenship to 23.9% for Syrian citizenship). Home visits accounted for the largest single increase in response. During recruitment, more female, older, as well as participants with lower levels of education and income took part in the survey. People with physical health problems and less favourable health behaviour more often took part in the survey at a later stage, while participants with symptoms of depression or anxiety more often participated early. Utilization of survey modes and questionnaire languages differed by sociodemographic and migration-related characteristics, e.g. participants aged 50 years and above more often used paper- than web-based questionnaires and those with a shorter duration of residence more often used a translated questionnaire. CONCLUSION: Multiple contact attempts, including home visits and different survey languages, as well as offering different modes of survey administration, increased response rates and most likely reduced non-response bias. In order to adequately represent and include the diversifying population in public health monitoring, national public health institutes should tailor survey designs to meet the needs of different population groups considered hard to survey to enable their survey participation.

Long-term health consequences among individuals with SARS-CoV-2 infection compared to individuals without infection: results of the population-based cohort study CoMoLo Follow-up.

BACKGROUND: Most of the previous studies on health sequelae of COVID-19 are uncontrolled cohorts and include a relatively short follow-up. This population-based multi-center cohort study examined health consequences among individuals about 1 to 1.5 years after SARS-CoV-2 infection compared with non-infected. METHODS: The study population consisted of adults (≥ 18 years) from four municipalities particularly affected by the COVID-19 pandemic in the year 2020 who completed a detailed follow-up questionnaire on health-related topics. Exposure was the SARS-CoV-2 infection status (based on IgG antibodies, PCR test, or physician-diagnosis of COVID-19) at baseline (May to December 2020). Outcomes assessed at follow-up (October 2021 to January 2022; mean: 452 days) included recurrent or persistent health complaints, incident diseases, health-related quality of life (PROMIS-29), subjective health, and subjective memory impairment. Logistic and linear regression models were adjusted for baseline sociodemographic and lifestyle characteristics (age, sex, municipality, education, smoking, body mass index), pre-existing health conditions (chronic disease/health problem, health-related activity limitation, depressive/anxiety disorder), and follow-up time. RESULTS: Among 4817 participants, 350 had a SARS-CoV-2 infection at baseline and 4467 had no infection at baseline or during follow-up. Those with an infection statistically significantly more often reported 7 out of 18 recurrent or persistent health complaints at follow-up: smell/taste disorders (12.8% vs. 3.4%, OR 4.11), shortness of breath (23.0% vs. 9.5%, 3.46), pain when breathing (4.7% vs. 1.9%, 2.36), fatigue (36.9% vs. 26.1%, 1.76), weakness in legs (12.8% vs. 7.8%, 1.93), myalgia/joint pain (21.9% vs. 15.1%, 1.53) and cough (30.8% vs. 24.8%, 1.34) and 3 out of 6 groups of incident diseases: liver/kidney (2.7% vs. 0.9%, 3.70), lung (3.2% vs. 1.1%, 3.50) and cardiovascular/metabolic (6.5% vs. 4.0%, 1.68) diseases. Those with an infection were significantly more likely to report poor subjective health (19.3% vs. 13.0%, 1.91), memory impairment (25.7% vs. 14.3%, 2.27), and worse mean scores on fatigue and physical function domains of PROMIS-29 than non-infected. CONCLUSION: Even after more than one year, individuals with SARS-CoV-2 infection showed an increased risk of various health complaints, functional limitations, and worse subjective well-being, pointing toward profound health consequences of SARS-CoV-2 infection relevant for public health.

The Role of Sex and Age in Moderating the Outcome of In-Person and Computer-Based Brief Alcohol Interventions at General Hospitals: Reanalysis of a Brief Intervention Study.

INTRODUCTION: The aim of this study was to test whether brief alcohol interventions at general hospitals work equally well for males and females and across age-groups. METHODS: The current study includes a reanalysis of data reported in the PECO study (testing delivery channels of individualized motivationally tailored alcohol interventions among general hospital patients: in PErson vs. COmputer-based) and is therefore of exploratory nature. At-risk drinking general hospital patients aged 18-64 years (N = 961) were randomized to in-person counseling, computer-generated individualized feedback letters, or assessment only. Both interventions were delivered on the ward and 1 and 3 months later. Follow-ups were conducted at months 6, 12, 18, and 24. The outcome was grams of alcohol/day. Study group × sex and study group × age interactions were tested as predictors of change in grams of alcohol/day over 24 months in latent growth models. If rescaled likelihood ratio tests indicated improved model fit due to the inclusion of interactions, moderator level-specific net changes were calculated. RESULTS: Model fit was not significantly improved due to the inclusion of interaction terms between study group and sex (χ2[6] = 5.9, p = 0.439) or age (χ2[6] = 5.5, p = 0.485). DISCUSSION: Both in-person counseling and computer-generated feedback letters may work equally well among males and females as well as among different age-groups. Therefore, widespread delivery of brief alcohol interventions at general hospitals may be unlikely to widen sex and age inequalities in alcohol-related harm.

Sick days in general hospital patients two years after brief alcohol intervention: Secondary outcomes from a randomized controlled trial.

Little is known about the long-term impact of brief alcohol interventions (BAIs) on health and on sick days in particular. The aim was to investigate whether BAIs reduce sick days in general hospital patients over two years, and whether effects depend on how BAIs are delivered; either through in-person counseling (PE) or computer-generated written feedback (CO). To investigate this, secondary outcome data from a three-arm randomized controlled trial with 6-, 12-, 18- and 24-month follow-ups were used. The sample included 960 patients (18-64 years) with at-risk alcohol use identified through systematic screening on 13 hospital wards. Patients with particularly severe alcohol problems were excluded. Participants were allocated to PE, CO and assessment only (AO). Both interventions were tailored according to behavior change theory and included three contacts. Self-reported number of sick days in the past 6 months was assessed at all time-points. A zero-inflated negative binomial latent growth model adjusted for socio-demographics, substance use related variables and medical department was calculated. In comparison to AO, PE (OR = 2.18, p = 0.047) and CO (OR = 2.08, p = 0.047) resulted in statistically significant increased odds of reporting no sick days 24 months later. Differences between PE and CO, and concerning sick days when any reported, were non-significant. This study provides evidence for the long-term efficacy of BAIs concerning health, and concerning sick days in particular. BAIs have the potential to reduce the occurrence of sick days over 2 years, independent of whether they are delivered through in-person counseling or computer-generated written feedback.

Can brief alcohol interventions in general hospital inpatients improve mental and general health over 2 years? Results from a randomized controlled trial.

BACKGROUND: Little is known about the impact of brief alcohol interventions on mental and general health. The aim was to investigate whether brief interventions for general hospital inpatients with at-risk drinking can improve mental and general health over 2 years; and whether effects are dependent on how they are delivered: in-person or through computer-generated feedback letters (CO). METHODS: Three-arm randomized controlled trial with 6-, 12-, 18-, and 24-month follow-ups. Data were collected on 13 general hospital wards from four medical departments (internal medicine, surgical medicine, trauma surgery, and ear-nose-throat) of one university hospital in northeastern rural Germany. A consecutive sample of 961 18- to 64-year-old general hospital inpatients with at-risk alcohol use was recruited through systematic screening. Inpatients with particularly severe alcohol problems were excluded. Participants were allocated to: in-person counseling (PE), CO, and assessment only (AO). PE and CO included three contacts: on the ward, 1, and 3 months later. Mental and general health were assessed using the five-item mental health inventory (0-100) and a one-item general health measure (0, poor - 4, excellent). RESULTS: Latent growth models including all participants revealed: after 24 months and in contrast to AO, mental and general health were improved in PE (change in mean difference, ΔMmental = 5.13, p = 0.002, Cohen's d = 0.51; ΔMgeneral = 0.20, p = 0.005, d = 0.71) and CO (ΔMmental = 6.98, p < 0.001, d = 0.69; ΔMgeneral = 0.24, p = 0.001, d = 0.86). PE and CO did not differ significantly. CONCLUSIONS: Beyond drinking reduction, PE and CO can improve general hospital inpatients' self-reported mental and general health over 2 years.

Indicator-based public health monitoring in old age in OECD member countries: a scoping review.

BACKGROUND: The scoping review was conducted as part of the project "Improving Health Monitoring in Old Age" (IMOA) which aims at developing a conceptual framework with key indicators for a public health monitoring of the population aged 65 years and older in Germany. We systematically identified indicator-based monitoring systems that focus on health and wellbeing of older populations in member countries of the Organisation for Economic Co-operation and Development (OECD) and analysed them with regard to structure, development and content. METHODS: A systematic search strategy included searching the websites of national public health institutes, an additional internet search and a MEDLINE search via PubMed. Indicator systems were included if they presented data on a national level, if they were published or updated after 01/01/2007, if they relied on more than one data source and if they were available in English or German. Data on the structure and development of the indicator sets were extracted using a standardized documentation form, and a content analysis of the indicators was conducted using a pre-defined conceptual framework with three health areas and 11 health domains that is based on the Worlds Health Organization's "World Report on Ageing and Health" and on the International Classification of Functioning, Disability and Health (ICF). RESULTS: Ten indicator-based monitoring systems met our inclusion criteria. Of these, six systems focused exclusively on older populations, and four offer a specific subset of indicators for older age. The number of indicators varied between 22 and 53 (median 32.5). Four systems were directly related to national public health or healthy ageing strategies, and two systems had been developed in consensus processes involving multiple stakeholders. The highest numbers of indicators could be assigned to the domains "health care", "nursing and community care", "wealth and poverty" and "physical health". Overall, 47 different concepts could be identified in the monitoring systems. CONCLUSION: Among indicator-based monitoring systems of health in older age identified in member countries of the OECD, there is considerable variation with regard to structure, development and content. The results will inspire the development of a public health monitoring of the older population in Germany.

Behavioral health risk factor profiles in general hospital patients: identifying the need for screening and brief intervention.

BACKGROUND: Little is known about the clustering of behavioral health risk factors (HRFs), namely the occurrence of 16 specific combinations of tobacco smoking, at-risk alcohol use, overweight and physical inactivity in general hospital patients. Furthermore, social inequalities in HRFs, health and life expectancy are a major concern in public health. In order to establish the need for screening and intervention in general hospital care, the study aimed to determine the co-occurrence of HRFs in patients in four medical departments, and to investigate differences by gender, age and socio-economic characteristics. METHODS: Over 17 months, a systematic multiple HRF screening was conducted at one general hospital in northeastern Germany. In total, 6251 18-64 year old patients (92% of eligibles) participated. Proportions and confidence intervals were calculated for all 16 HRF profiles stratified by department, gender, age group, school education, and employment status. RESULTS: In total, 92.2% of the participants (58.6% male) reported ≥1 HRF, and 65.7% ≥2 HRFs. Men (71.2%), patients aged 35-49 (67.9%) and 50-64 years (69.5%), lower educated (79.0%), and unemployed (77.8%) patients had larger proportions of ≥2 HRFs than their counterparts. In all departments, the most common HRF profiles included overweight. HRF profiles that included alcohol and/ or smoking were more common in ear-nose-throat and trauma surgery than in internal medicine and general surgery patients. Men had higher rates concerning almost all HRF profiles including ≥2 HRFs and alcohol; women concerning profiles that included ≤2 HRFs and inactivity. In older patients, profiles with ≥2 HRFs including overweight; and in younger patients, profiles with smoking and/or alcohol were more common. In lower educated patients, profiles with ≥2 HRFs including inactivity; and in higher educated patients profiles with ≤2 HRFs including alcohol were more common. Compared to others, unemployed patients had higher rates of profiles with ≥3 HRFs including smoking. CONCLUSIONS: Two in three patients require interventions targeting two or more HRFs. The findings help to develop screening and brief intervention for patients with specific health risk profiles, that can reach most patients, including those most in need and those most hard to reach, with socio-economically disadvantaged people in particular. REGISTRY: clinicaltrials.gov: NCT01291693.

Experiences with combined personal-online case management and the self-reliance of older people with multimorbidity living alone in private households: results of an interpretative-hermeneutical analysis.

BACKGROUND: To date in Germany, only few studies have been conducted concerning the efficacy of care and case management (CCM) for older people and about using communication technology during monitoring. AIM: With this study, it is intended to gain a better understanding of how CCM in general is perceived by older people (65+) living alone and in particular what they think about the CCM monitoring process used during video conferences. METHOD: The sampling and work cycle were based on the Grounded Theory. Two different subsamples (each n = 20; total sample: 70% women; age range: 64-92 years) were recruited. Interviews were conducted with the focus on CCM contributions (Subsample I) and monitoring supported by video conferences (Subsample II). All participants had received CCM from external providers (care support centres) in two German federal states. The intervention of CCM ranged between four and twelve months. Participants of Subsample II received additionally moderated video conferences via tablet PCs for and with older people over an intervention period of nine months. RESULTS: Care and case management was experienced as a possibility for receiving individual support and for improving the user's everyday life. Within a short time, video conferences were a familiar communication tool. They enabled particularly people with reduced mobility to get barrier-free access to case managers, compensated for isolation and enabled participation. CONCLUSIONS: According to the view of older CCM users with multimorbidity living alone, CCM offers formative and organisational support in various life-domains. Combined with video conferences, the exchange of information becomes barrier-free and instantaneous, and the sense of security in health questions is reinforced.

Do brief alcohol interventions among unemployed at-risk drinkers increase re-employment after 15 month?

Background: At-risk alcohol use is associated bi-directionally to unemployment, and decreases chances of re-employment. Brief alcohol interventions (BAI) can reduce at-risk alcohol use. This study aimed to investigate 15-month effects of BAI on unemployment among persons with at-risk alcohol use. Methods: As part of the randomized controlled 'Trial on proactive alcohol interventions among job-seekers, TOPAS', 1243 18- to 64-year-old job-seekers with at-risk alcohol use were systematically recruited at three job agencies in Germany (2008/09), and randomized to (i) a stage tailored intervention based on the trans-theoretical model of intentional behavior change (ST), (ii) a non-stage tailored intervention based on the theory of planned behavior (NST) and (iii) assessment only (AO). To test the effects of ST and NST on employment status 15 months after baseline, latent growth models were calculated among those initially unemployed (n = 586). Results: In all three groups, unemployment significantly decreased over 15 months (ST: odds ratio, OR = 0.06; 95% confidence interval, CI: 0.01-0.27; NST: OR = 0.04; 95% CI: 0.01-0.18; AO: OR = 0.05; 95% CI: 0.01-0.21). No intervention effects were found on unemployment. Age (P = 0.002), school education (P = 0.001), self-rated health (P = 0.04), the Alcohol Use Disorder Identification Test-Consumption score (P = 0.02) and motivation to change (P = 0.04) significantly affected the development of unemployment over time. Conclusion: After 15 months, no BAI effect on unemployment was found. The mediated effect of BAIs on unemployment could be a longsome process needing longer follow-ups to be detected.

[Developing a framework for a public health monitoring of the population aged 65 years and older : Results of the IMOA workshop on concepts and indicators]. / Entwicklung eines Rahmenkonzepts für ein Public-Health-Monitoring der Bevölkerung ab 65 Jahren : Ergebnisse des IMOA-Workshops zu Konzepten und Indikatoren.

Main goal of the Improving Health Monitoring in Older Age (IMOA) project is to provide a framework for an indicator-based public health monitoring of the population aged 65 years and older. The workshop served as a forum to discuss and agree upon relevant concepts with gerontologists, nursing care and public health scientists.

Baseline participation in a health examination survey of the population 65 years and older: who is missed and why?

BACKGROUND: Public health monitoring depends on valid health and disability estimates in the population 65+ years. This is hampered by high non-participation rates in this age group. There is limited insight into size and direction of potential baseline selection bias. METHODS: We analyzed baseline non-participation in a register-based random sample of 1481 inner-city residents 65+ years, invited to a health examination survey according to demographics available for the entire sample, self-report information as available and reasons for non-participation. One year after recruitment, non-responders were revisited to assess their reasons. RESULTS: Five groups defined by participation status were differentiated: participants (N = 299), persons who had died or moved (N = 173), those who declined participation, but answered a short questionnaire (N = 384), those who declined participation and the short questionnaire (N = 324), and non-responders (N = 301). The results confirm substantial baseline selection bias with significant underrepresentation of persons 85+ years, persons in residential care or from disadvantaged neighborhoods, with lower education, foreign citizenship, or lower health-related quality of life. Finally, reasons for non-participation could be identified for 78% of all non-participants, including 183 non-responders. CONCLUSION: A diversity in health problems and barriers to participation exists among non-participants. Innovative study designs are needed for public health monitoring in aging populations.

In-person and computer-based alcohol interventions at general hospitals: reach and retention.

BACKGROUND: High reach of target populations is relevant for public health impact of interventions. Concerning intervention programs requiring multiple contacts, little is known about how many persons may be kept in the intervention program over multiple time points. The aim of this study was to investigate (i) the reach of general hospital inpatients with at-risk alcohol use through screening and brief intervention and (ii) whether their continued intervention participation after hospital discharge differs by in-person vs. computer-based intervention (CO) delivery. METHODS: As part of a randomized controlled trial, general hospital inpatients aged 18-64 years were screened for at-risk alcohol use on 13 wards. Participants were allocated to in-person intervention (PE), CO and assessment only. Both interventions were provided on site, and 1 and 3 months after baseline. RESULTS: Ninety-two percent of all eligible inpatients ( N: = 6251) completed the screening. Eighty-one percent ( N: = 961) of the screening-positives participated in the trial and received their allocated intervention. At months 1 and 3, interventions were delivered to 83 and 79% of the CO participants and to 74 and 64% of the PE participants. The delivery of CO and PE required an average of 5.2 and 7.7 contact attempts per delivered intervention, respectively. CONCLUSION: General hospital inpatients with at-risk alcohol use were well reached through proactive interventions. COs may result in higher retention rates over 1 and 3 months and may require less contact attempts than PEs. Public health efforts that aim to achieve high intervention retention should consider proactive COs.

[Frailty in Germany: status and perspectives : Results from a workshop of the German Society for Epidemiology]. / Frailty in Deutschland: Stand und Perspektiven : Ergebnisse eines Workshops der Deutschen Gesellschaft für Epidemiologie.

BACKGROUND: A standardized, valid and comparable operationalization and assessment of frailty in population-based studies is essential in order to describe the prevalence and determinants of frailty in the population. AIM: After an introduction to the subject the main goal of a workshop at the 9th annual meeting of the German Society for Epidemiology (DGEpi) was to present approaches and results from four different studies in Germany. MATERIAL AND METHODS: The following four population-based studies were used to describe frailty in Germany: the German health interview and examination survey for adults (DEGS1), the epidemiological study on the chances of prevention, early recognition and optimized treatment of chronic diseases in the older population (ESTHER), the cooperative health research in the region Augsburg (KORA Age) study and the longitudinal urban cohort ageing study (LUCAS) in Hamburg. RESULTS: The four studies consistently showed that frailty is widespread in older and oldest-old persons in Germany. It is obvious that frailty represents a relevant concept in Germany even if there is currently no uniform basis for operationalization. CONCLUSION: Concepts and instruments for the collation of frailty should be included in future population-based studies in order to make a better assessment of older people's health situation and to describe the unused potential for prevention in an aging society.

Prevalence and correlates of frailty among older adults: findings from the German health interview and examination survey.

BACKGROUND: Despite having the third highest proportion of people aged 60 years and older in the world, Germany has been recently reported as having the lowest prevalence of frailty of 15 European countries. The objective of the study is to describe the prevalence of frailty in a large nationwide population-based sample and examine associations with sociodemographic, social support and health characteristics. METHODS: We performed a cross-sectional analysis of the first wave of the German Health Interview and Examination Survey for Adults (DEGS1) conducted 2008-2011. Participants were 1843 community-dwelling people aged 65-79 years. Frailty and pre-frailty were defined, according to modified Fried criteria, as 3 and more or 1-2 respectively, of the following: exhaustion, low weight, low physical activity, low walking speed and low grip strength. The Oslo-3 item Social Support Scale (OSS-3) was used. Patient Health Questionnaire (PHQ-9) measured depressive symptoms and the Digit Symbol Substitution Test (DSST) measured cognition. Associations between participants' characteristics and frailty status were examined using unadjusted and adjusted multinomial logistic regression models estimating relative risk ratios (RRR) of frailty and pre-frailty. RESULTS: The prevalence of frailty among women was 2.8% (CI 1.8-4.3) and pre-frailty 40.4% (CI 36.3-44.7) and among men was 2.3% (CI 1.3-4.1) and 36.9% (CI 32.7-41.3) respectively. Independent determinants of frailty, from unadjusted models, included older age, low socioeconomic status, poor social support, lower cognitive function and a history of falls. In adjusted models current depressive symptoms (RRR 12.86, CI 4.47-37.03), polypharmacy (RRR 7.78, CI 2.92-20.72) and poor hearing (RRR 5.38, CI 2.17-13.35) were statistically significantly associated with frailty. CONCLUSIONS: Frailty prevalence is relatively low among community-dwelling older adults in Germany. Modifiable characteristics like low physical activity provide relevant targets for individual and population-level frailty detection and intervention strategies.

The Stability of Social Desirability: A Latent Change Analysis.

Social desirability has been shown to be stable in samples with higher school education. However, little is known about the stability of social desirability in more heterogeneous samples differing in school education. This study aimed to investigate the stability of social desirability and which factors predict interindividual differences in intraindividual change. As part of a randomized controlled trial, 1,243 job seekers with unhealthy alcohol use were systematically recruited at three job agencies. A total of 1,094 individuals (87.8%) participated in at least one of two follow-ups (6 and 15 months after baseline) and constitute this study's sample. The Social Desirability Scale-17 was applied. Two latent change models were conducted: Model 1 tested for interindividual differences in intraindividual change of social desirability between both follow-ups; Model 2 included possible predictors (age, sex, education, current employment status) of interindividual differences in intraindividual change. Model 1 revealed a significant decrease of social desirability over time. Model 2 revealed school education to be the only significant predictor of change. These findings indicate that stability of social desirability may depend on school education. It may not be as stable in individuals with higher school education as in individuals with lower education.

'We can do only what we have the means for' general practitioners' views of primary care for older people with complex health problems.

BACKGROUND: Due to demographic change, general practitioners (GPs) are increasingly required to care for older people with complex health problems. Little is known about the subjective appraisals of GPs concerning the demanded changes. Our objective is to explore how general practitioners view their professional mandates and capacities to provide comprehensive care for older people with complex health problems. Do geriatric training or experience influence viewpoints? Can barriers for the implementation of changes in primary care for older people with complex health problems be detected? METHODS: Preceding a controlled intervention study on case management for older patients in the primary care setting (OMAHA II), this qualitative study included 10 GPs with differing degrees of geriatric qualification. Semi structured interviews were conducted and audio-taped. Full interview transcripts were analyzed starting with open coding on a case basis and case descriptions. The emerging thematic structure was enriched with comparative dimensions through reiterated inter-case comparison and developed into a multidimensional typology of views. RESULTS: Based on the themes emerging from the data and their presentation by the interviewed general practitioners we could identify three different types of views on primary care for older people with complex health problems: 'maneuvering along competence limits', 'Herculean task', and 'cooperation and networking'. The types of views differ in regard to role-perception, perception of their own professional domain, and action patterns in regard to cooperation. One type shows strong correspondence with a geriatrician. Across all groups, there is a shared concern with the availability of sufficient resources to meet the challenges of primary care for older people with complex health problems. CONCLUSIONS: Limited financial resources, lack of cooperational networks, and attitudes appear to be barriers to assuring better primary care for older people with complex health problems. To overcome these barriers, geriatric training is likely to have a positive impact but needs to be supplemented by regulations regarding reimbursement. Most of all, general practitioners' care for older people with complex health problems needs a conceptual framework that provides guidance regarding their specific role and contribution and assisting networks. For example, it is essential that general practice guidelines become more explicit with respect to managing older people with complex health problems.

[Case management studies for individuals 65 years and older in Germany: Systematic review of the currently published state of research]. / "Case-management"-Studien für Personen ab 65 Jahren in Deutschland : Systematische Übersicht zum aktuell publizierten Forschungsstand.

BACKGROUND: The aim of this systematic review was to provide an overview on the current state of published research on case management (CM) according to the definition of the German Association of Care and Case Management (DGCC) for individuals 65 years and older in Germany. MATERIAL AND METHODS: A systematic literature search was carried out for CM studies according to the DGCC in Germany since 2000 including individuals aged 65 years and older. RESULTS: Of the 249 abstracts retrieved a total of 14 evaluation and intervention studies of 10 different projects fulfilled the inclusion criteria. According to the results of the five evaluation studies, CM was feasible and barriers to implementation as well as satisfaction and positive effects of CM were described. The quality and outcome criteria of the intervention studies were heterogeneous. The results of the intervention studies can be interpreted as CM having positive effects on, for example hospital admissions and mortality. CONCLUSION: Only few and qualitatively heterogeneous studies are currently available on the intervention effects of CM in Germany among this age group. So far robust scientific evidence of this method in Germany seems to be lacking.

Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the Stroke in Young Fabry Patients study.

BACKGROUND AND PURPOSE: Although many stroke patients are young or middle-aged, risk factor profiles in these age groups are poorly understood. METHODS: The Stroke in Young Fabry Patients (sifap1) study prospectively recruited a large multinational European cohort of patients with cerebrovascular events aged 18 to 55 years to establish their prevalence of Fabry disease. In a secondary analysis of patients with ischemic stroke or transient ischemic attack, we studied age- and sex-specific prevalences of various risk factors. RESULTS: Among 4467 patients (median age, 47 years; interquartile range, 40-51), the most frequent well-documented and modifiable risk factors were smoking (55.5%), physical inactivity (48.2%), arterial hypertension (46.6%), dyslipidemia (34.9%), and obesity (22.3%). Modifiable less well-documented or potentially modifiable risk factors like high-risk alcohol consumption (33.0%) and short sleep duration (20.6%) were more frequent in men, and migraine (26.5%) was more frequent in women. Women were more often physically inactive, most pronouncedly at ages <35 years (18-24: 38.2%; 25-34: 51.7%), and had high proportions of abdominal obesity at age 25 years or older (74%). Physical inactivity, arterial hypertension, dyslipidemia, obesity, and diabetes mellitus increased with age. CONCLUSIONS: In this large European cohort of young patients with acute ischemic cerebrovascular events, modifiable risk factors were highly prevalent, particularly in men and older patients. These data emphasize the need for vigorous primary and secondary prevention measures already in young populations targeting modifiable lifestyle vascular risk factors.

Health status of the old and very old people in Germany: results of the Gesundheit 65+ study.

Background: The demographic change makes comprehensive health reporting on health at older age an important topic. Methods: Gesundheit 65+ is a longitudinal epidemiological study on the health status of persons aged 65 and older in Germany. Based on a two-stage stratified random sample from 128 local population registers, 3,694 persons participated in the baseline survey between June 2021 and April 2022 (47.9 % women, mean age 78.8 years). Weighted prevalences for 19 indicators of the baseline survey are presented overall and by age, sex, education and region of residence. Results: Overall, 52.0 % of all participants of the baseline survey reported to be in good or very good health, and 78.5 % reported high or very high satisfaction with their life. This was in contrast to the large number of health/functional limitations whose prevalences ranged from 5.3 % for severe visual limitations to 69.2 % for multimorbidity. The health status of women was clearly worse than that of men, and the health status of persons aged 80 and older was worse than between 65 and 79 years of age. There was a clear educational gradient evident in the health status, but there were no differences between West and East Germany. Conclusions: Gesundheit 65+ provides a comprehensive database for description of the health status of old and very old people in Germany, on the basis of which recommendations for action for policy and practice can be derived.

Informal caregivers in Germany - who are they and which risks and resources do they have?

Background: The aim of this study is to describe the social characteristics, the health and living situation and the prevalence of behavioral risk factors of adult informal caregivers compared to non-caregivers in Germany. Methods: We used data from the German Health Update (GEDA 2019/2020-EHIS survey) which is a cross-sectional population-based health interview survey conducted between 04/2019 and 09/2020. The sample comprised 22,646 adults living in private households. Three mutually exclusive groups of providing informal care or assistance were differentiated: intense caregivers (informal care ≥10 h/week), less-intense caregivers (informal care<10 h/week) and non-caregivers. For the three groups weighted prevalences of social characteristics, health status (self-perceived health, health-related activity limitations, chronic diseases, low back disorder or other chronic back defect, depressive symptoms), behavioral risk factors (at-risk drinking, current smoking, insufficient physical activity, non-daily fruit and vegetable consumption, obesity) and social risk factors (single household, low social support) were calculated and stratified by gender. Separate regression analyses adjusted for age-group were conducted to identify significant differences between intense and less-intense caregivers vs. non-caregivers, respectively. Results: Overall, 6.5% were intense caregivers, 15.2% less-intense caregivers and 78.3% non-caregivers. Women provided care more often (23.9%) than men (19.3%). Informal care was most frequently provided in the age group of 45 to 64 years. Intense caregivers reported worse health status, were more often current smokers, physical inactive, obese and lived less often alone than non-caregivers. However, in age-group adjusted regression analyses only few significant differences were seen: Female and male intense caregivers had more often a low back disorder and lived less often alone compared to non-caregivers. In addition, male intense care-givers reported more often worse self-perceived health, health-related activity limitation, and the presence of chronic diseases. In contrast, less-intense caregivers and non-caregivers differed in favor of the less-intense caregivers. Discussion: A substantial proportion of the adult German population provides informal care regularly, especially women. Intense caregivers are a vulnerable group for negative health outcomes, especially men. In particular measures to prevent low back disorder should be provided. As the necessity of providing informal care will probably increase in the future, this will be important for the society and public health.