Adelheid Kuhlmey

Quality of life in dementia care – differences in quality of life measurements performed by residents with dementia and by nursing staff

Objectives: Quality of life (QoL) is a major outcome parameter in dementia care. Self-ratings are considered the best way to evaluate QoL, but staff-ratings also provide valid results. In particular, the discrepancies between self-ratings and staff-ratings are underrepresented. The aim was to identify characteristics of people with dementia that improve the probability of completing a self rating QoL instrument on the ‘Quality of Life – Alzheimers’ Disease’ (QoL-AD). Additionally, a level of agreement was set between self-rated and staff-rated QoL-AD and possible influencing factors. Method: A cross-sectional study was conducted in 2010 in Berlin. Using the instrument QoL-AD, the self- and staff-rated QoL of people with dementia was assessed. Results: 104 residents (73.1% female, mean age: 79.0 years, mean cognitive function (MMSE): 11.5) were included in this research project. 49 (47.1%) residents were able to complete the QoL-AD questionnaire. A predictor to complete the QoL-AD was the MMSE-part ‘language’. Residents rated their QoL as significantly higher than the nursing staff did. If the primary nurse rated the QoL, a significantly better agreement was identified. Conclusion: The study generated new findings concerning a better understanding of QoL measurements. The results suggest the usefulness of performing self-ratings whenever possible. If proxy-ratings have to be used, these should be performed by primary nurses only in order to get reliable results.

Herausforderungen an die Gesundheitsforschung für eine alternde Gesellschaft am Beispiel „Multimorbidität“

ZusammenfassungIndem ein wachsender Anteil der Bevölkerung ein hohes Alter erreicht, ändern sich Krankheitsspektrum und Versorgungsbedarf. Besondere Herausforderungen für das Gesundheitssystem ergeben sich durch Mehrfacherkrankung (Multimorbidität) älterer Menschen. Im Gegensatz zu krankheitsspezifischen Endpunkten treten Funktion im Alltag und subjektive Ergebnisdimensionen wie selbstbestimmte Lebensführung (Autonomie), soziale Teilhabe und Lebensqualität als Präventions- und Behandlungsziel in den Vordergrund. Die Gesundheitsforschung hat die Aufgabe, auf die Bedürfnisse spezifischer Zielgruppen alter Menschen abgestimmte Präventions- und Versorgungsmodelle zu entwickeln. Entscheidend dabei ist die Stärkung von personalen, sozialen und organisatorischen Ressourcen. Voraussetzung hierfür sind genaue Kenntnisse zur Entwicklung und zum Verlauf des Krankheitsgeschehens und zu zentralen Einflussfaktoren auf der Grundlage epidemiologischer Beobachtungsstudien. Gezielte Maßnahmen sind in Interventions- und Evaluationsstudien auf Wirksamkeit, Wirkung und Wirtschaftlichkeit zu überprüfen. Der vom Bundesministerium für Bildung und Forschung (BMBF) initiierte Förderungsschwerpunkt „Gesundheit im Alter“ fördert insgesamt sechs Forschungsverbünde zum Thema Multimorbidität, die hier kurz vorgestellt werden.AbstractPatterns of morbidity and health care needs are changing as the proportion of the population reaching old age increases. A particular challenge to the health care system results from coexisting health problems (multimorbidity) among the elderly. Regarding prevention and treatment goals, the focus needs to shift from disease-specific outcomes to function in daily life and subjective outcome dimensions, such as self-determination (autonomy), social participation, and quality of life. Health research faces the task of developing prevention and health care models adapted to the needs of specific subgroups of older people. Strengthening personal, social, and organizational resources is crucial. This requires precise knowledge about the development, course, and main determinants of disease processes based on observational epidemiological studies. Strategies need to be tested in intervention and evaluation studies with respect to efficacy, effectiveness, and efficiency. A targeted research funding program “Health in older age” was initiated by the Federal Ministry of Education and Research and is currently funding six multimorbidity research consortia, which are briefly presented here.

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.

Quality of life in nursing homes: results of a qualitative resident survey

PurposeThe growing importance of residential nursing care has been accompanied by an increasing demand for instruments measuring quality of life in nursing homes. Quality of life is a complex construct with both subjective and objective aspects that does not lend itself to being determined by a single measure. The aim of this study was therefore to identify dimensions of life that nursing home residents perceive as having a particular impact on their overall quality of life.MethodsData were obtained from 9 men and 33 women from eight nursing homes by means of semi-structured narrative interviews. The interviews were analyzed using the documentary method.ResultsTen central dimensions of subjective quality of life were derived from the interview data: social contacts, self-determination and autonomy, privacy, peace and quiet, variety of stimuli and activities, feeling at home, security, health, being kept informed, and meaningful/enjoyable activity. Some of these dimensions are multifaceted and have further subdimensions.ConclusionThe aspects emerging as relevant to residents’ subjective quality of life extend far beyond care- and health-related aspects. Nevertheless, some of the quality of life dimensions reconstructed are within the direct influence of the home (e.g., variety of stimuli and activities or being kept informed) and can possibly be improved by attending to the residents’ objective situation.

Prescribing of inappropriate medication in nursing home residents in Germany according to a French consensus list: a cross-sectional cohort study

The current use of inappropriate medication in elderly nursing home residents (NHRs) in Germany is unclear. We therefore set out to analyse the frequency and patterns of potentially inappropriate drug prescriptions in elderly NHRs in Germany.

Dementia-Specific Quality of Life Instruments and Their Appropriateness in Shared-Housing Arrangements—A Literature Study

Shared-housing arrangements (SHA) in Germany are a specific type of housing arrangement that belongs to the global concept of small-scale living arrangements. This caring approach comprises characteristics of both home and institutional care for persons with dementia. To evaluate the impact of SHA on the quality of life (QoL) of residents, an appropriate setting- and dementia-specific QoL instrument is needed. This article aims to identify QoL instruments that relate to the core domains of SHA. After a comprehensive literature review, existing dementia-specific QoL instruments were evaluated to determine whether any have been specifically designed for or applied in SHA. Additionally, each domain of the instruments was matched with the core domains of SHA. None of the existing instruments was identified as having been developed for SHA. Matching of the instrument domains with the SHA core domains leads to the conclusion that Quality of Life-Alzheimers Disease, Dementia Quality of Life, Alzheimer Disease-Related Quality of Life, and QUALIDEM are adequate instruments for measuring the dementia-specific QoL of persons living in SHA. For the first time, a basis has been created for valid QoL evaluations of residents with dementia living in SHA. The 4 identified instruments are considered applicable in SHA. Conducting a performance test and evaluating further attributes according to the Scientific Advisory Committee of the Medical Outcomes Trust (e.g., reliability and validity) will further elucidation of the appropriateness of the instruments for SHA.

Pflegestützpunkte – Impuls zur Weiterentwicklung der Pflege

ZusammenfassungIm Pflege- Weiterentwicklungsgesetz ist die Einrichtung von Pflegestützpunkten geplant. In dem nachfolgenden Beitrag werden die damit verbundenen Chancen thesenartig diskutiert und erste konzeptionelle Überlegungen angestellt.AbstractThe recent reform act on long-term care insurance includes plans for the establishment of Community Care Access Centers. This paper addresses chances and challenges of these centers and proposes some important steps for program development.The recent reform act on long-term care insurance includes plans for the establishment of Community Care Access Centers. This paper addresses chances and challenges of these centers and proposes some important steps for program development.

Complaints as indicators of health care shortcomings: which groups of patients are affected?

OBJECTIVE Patient complaints about the health care system and medical services are regarded as indicators of shortcomings in health care systems. This article examines the topics of complaint raised most frequently and analyzes which groups of persons were most affected. DESIGN Quantitative content analysis using a category system. Logistic regression was used for statistical analysis. SETTING AND PARTICIPANTS 13 505 letters of complaint directed to the Federal Commissioner for Patient Issues in Germany between 2004 and 2007. MAIN OUTCOME MEASURES Letters of complaint covering at least one topic were categorized to a total of 20 topics. RESULTS The issues most frequently raised were unjust policies (23.8%), refusal or restriction of drugs (23.8%) and refusal or restriction of non-drug treatments (23.9%). The relative proportion of complaints about the physician-patient relationship increased over the period of analysis (over all 4 years: 9.3%). Multivariate analysis showed that complaints about the topics under examination were more likely to be lodged by people with statutory health insurance, people in a precarious financial situation, people with chronic disease or multimorbidity and women. CONCLUSIONS These results provide important insights into shortcomings in the German health care system that should be seen in the context of recent reform measures. Policy makers should be made aware that certain groups of the population are particularly affected by these changes and take steps to ensure that inequalities in the health care system are not exacerbated.

Skin health promotion in the elderly

ZusammenfassungHintergrundHautalterung ist mit anatomischen und physiologischen Veränderungen assoziiert. Diese Veränderungen sind nicht pathologisch, doch die verminderte funktionale Kapazität der Haut erhöht die Anfälligkeit gegenüber Hauterkrankungen und Funktionsstörungen. Gleichzeitig sind die klinischen Ausprägungen von Hautveränderungen insbesondere bei Hochaltrigkeit hochindividuell verschieden.ZielDieser Beitrag zielt auf eine kritische Reflexion und auf die Auseinandersetzung mit dem Konzept der präventiven Hautpflege und Förderung der Hautgesundheit im Alter ab.ErgebnissePräventive Hautpflege im Alter umfasst alle Maßnahmen zur Reinigung und Pflege der Haut, welche der Gesunderhaltung dienen und die Wahrscheinlichkeit der Entwicklung von Hautstörungen und Krankheiten reduzieren. Präventive Hautpflege lässt sich in primäre, sekundäre und tertiäre Prävention unterteilen, doch die empirische Evidenz für einzelne Interventionen ist heterogen.SchlussfolgerungBislang gibt es keine formal entwickelten Leitlinien oder Empfehlungen zur allgemeinen Hautpflege im Alter. Ein unzureichend genutztes Potential präventiver Hautpflege im höheren Lebensalter scheint sehr wahrscheinlich.AbstractBackgroundSkin aging is associated with anatomical and physiological changes. These changes are not pathological; nevertheless, reduced functional skin capacity increases the susceptibility to skin diseases and functional disorders. Especially in old age, the clinical manifestation of skin changes differs greatly between individuals.PurposeThis contribution focuses on a critical reflection of the concept of preventative skin care and skin health promotion in the aged.ResultsPreventive skin care in the aged includes all activities to cleanse and care for the skin which contribute to health promotion and which reduce the probability developing skin disorders or diseases. Preventive skin care in the aged can be classified into primary, secondary, and tertiary prevention, but the empirical evidence supporting individual interventions is heterogeneous.ConclusionThere are no formally developed guidelines or recommendations for basic skin care in the aged. Thus, preventive skin care in the elderly is very likely to be underused.BACKGROUND Skin aging is associated with anatomical and physiological changes. These changes are not pathological; nevertheless, reduced functional skin capacity increases the susceptibility to skin diseases and functional disorders. Especially in old age, the clinical manifestation of skin changes differs greatly between individuals. PURPOSE This contribution focuses on a critical reflection of the concept of preventative skin care and skin health promotion in the aged. RESULTS Preventive skin care in the aged includes all activities to cleanse and care for the skin which contribute to health promotion and which reduce the probability developing skin disorders or diseases. Preventive skin care in the aged can be classified into primary, secondary, and tertiary prevention, but the empirical evidence supporting individual interventions is heterogeneous. CONCLUSION There are no formally developed guidelines or recommendations for basic skin care in the aged. Thus, preventive skin care in the elderly is very likely to be underused.

[Challenges to health research for aging populations using the example of "multimorbidity"].

ZusammenfassungIndem ein wachsender Anteil der Bevölkerung ein hohes Alter erreicht, ändern sich Krankheitsspektrum und Versorgungsbedarf. Besondere Herausforderungen für das Gesundheitssystem ergeben sich durch Mehrfacherkrankung (Multimorbidität) älterer Menschen. Im Gegensatz zu krankheitsspezifischen Endpunkten treten Funktion im Alltag und subjektive Ergebnisdimensionen wie selbstbestimmte Lebensführung (Autonomie), soziale Teilhabe und Lebensqualität als Präventions- und Behandlungsziel in den Vordergrund. Die Gesundheitsforschung hat die Aufgabe, auf die Bedürfnisse spezifischer Zielgruppen alter Menschen abgestimmte Präventions- und Versorgungsmodelle zu entwickeln. Entscheidend dabei ist die Stärkung von personalen, sozialen und organisatorischen Ressourcen. Voraussetzung hierfür sind genaue Kenntnisse zur Entwicklung und zum Verlauf des Krankheitsgeschehens und zu zentralen Einflussfaktoren auf der Grundlage epidemiologischer Beobachtungsstudien. Gezielte Maßnahmen sind in Interventions- und Evaluationsstudien auf Wirksamkeit, Wirkung und Wirtschaftlichkeit zu überprüfen. Der vom Bundesministerium für Bildung und Forschung (BMBF) initiierte Förderungsschwerpunkt „Gesundheit im Alter“ fördert insgesamt sechs Forschungsverbünde zum Thema Multimorbidität, die hier kurz vorgestellt werden.AbstractPatterns of morbidity and health care needs are changing as the proportion of the population reaching old age increases. A particular challenge to the health care system results from coexisting health problems (multimorbidity) among the elderly. Regarding prevention and treatment goals, the focus needs to shift from disease-specific outcomes to function in daily life and subjective outcome dimensions, such as self-determination (autonomy), social participation, and quality of life. Health research faces the task of developing prevention and health care models adapted to the needs of specific subgroups of older people. Strengthening personal, social, and organizational resources is crucial. This requires precise knowledge about the development, course, and main determinants of disease processes based on observational epidemiological studies. Strategies need to be tested in intervention and evaluation studies with respect to efficacy, effectiveness, and efficiency. A targeted research funding program “Health in older age” was initiated by the Federal Ministry of Education and Research and is currently funding six multimorbidity research consortia, which are briefly presented here.