Andreas Kruse

A randomized controlled trial of Tai chi for balance, sleep quality and cognitive performance in elderly Vietnamese

Objective To evaluate the effects of Tai chi exercise on balance, sleep quality, and cognitive performance in community-dwelling elderly in Vinh city, Vietnam. Design A randomized controlled trial. Participants One hundred two subjects were recruited. Intervention Subjects were divided randomly into two groups. The Tai chi group was assigned 6 months’ Tai chi training. The control group was instructed to maintain their routine daily activities. Outcome measures The Falls Efficacy Scale (FES), Pittsburgh Sleep Quality Index (PSQI), and Trail Making Test (TMT) were used as primary outcome measures. Results Participants in the Tai chi group reported significant improvement in TMT (part A) (F [1, 71] = 78.37, P < 0.001) and in TMT (part B), (F [1, 71] = 175.00, P < 0.001) in comparison with the control group. Tai chi participants also reported better scores in FES (F [1, 71] = 96.90, P < 0.001) and in PSQI (F [1,71] = 43.69, P = 0.001) than the control group. Conclusion Tai chi is beneficial to improve balance, sleep quality, and cognitive performance of the elderly.

Potenziale des Alters in Wirtschaft und Gesellschaft

Der vorliegende Beitrag gibt einen Uberblick uber zentrale Fragestellungen und Ergebnisse des Funften Altenberichts der Bundesregierung. Mit diesem Bericht sollten Potenziale des Alters in Wirtschaft und Gesellschaft aufgezeigt und Handlungsempfehlungen fur eine effektivere Nutzung dieser Potenziale erarbeitet werden. Den Aussagen zur Entwicklung, Aufrechterhaltung und Nutzung von Potenzialen wurden von der Expertenkommission funf Leitbilder zugrunde gelegt, die als mitverantwortliches Leben alterer Menschen und Solidaritat, Alter als Innovationsmotor starken, Nachhaltigkeit und Generationensolidaritat, Lebenslanges Lernen und Pravention beschrieben werden. Des Weiteren werden zentrale Befunde der von der Altenberichtskommission geleisteten Lageanalyse zur Bildung, zur Einkommenslage im Alter und deren kunftiger Entwicklung, zu den Chancen der Seniorenwirtschaft in Deutschland, zu den Potenzialen des Alters in Familie und privaten Netzwerken, zu Engagement und Teilhabe alterer Menschen sowie zu den Potenzialen von Menschen mit Migrationshintergrund skizziert und die aus diesen abgeleiteten Handlungsempfehlungen benannt.

The Prevalence and Differential Diagnosis of Subclinical Depressive Syndromes in Inpatients 60 Years and Older

Background: Depressive syndromes that do not comply with the diagnostic criteria for specific depressive disorders are designated as ‘subclinical’ or ‘subsyndromal’ depressive syndromes. Using our own data from a clinical study, this paper outlines the significance of subclinical depressive syndromes and demonstrates the problems of differentiating between depressive and subclinical depression (SD) syndromes and organic mood disorders especially in an elderly population with medical comorbidity. Methods: Two hundred and sixty-two patients aged 60 years and older in a general hospital were investigated, using a clinical psychiatric interview, expert ratings and self-report scales after extensive internal medical diagnostic evaluation. Results: When, without further differentiation as to their origin, all symptoms required by symptom checklists according to ICD-10 were considered for the diagnosis of major depression (MD), 35.5% of the study participants fulfilled the diagnostic criteria. After differentiating for etiology of symptoms, MD was found in only 14.1%, SD was diagnosed in 17.6% and organic mood disorder in 12.2% of the study participants. In another 41 patients (15.6%), symptoms of depression not fulfilling ICD-10 criteria were classified as being of organic or drug-induced origin. SD patients were in a mean position between nondepressive and depressive patients with regard to social isolation and physical impairment; women were overrepresented in the depressive and subdepressive groups. Conclusions: SD and organic mood disorder are common and helpful diagnostic categories in the elderly. The results show that in old age there is substantial danger of confounding MD, SD and organic mood disorder, thus leading to erroneously high prevalence rates of MD and underestimations of organic mood disorder if depressive symptoms are recorded only by self-report scales or a symptom checklist. Both internal and psychosomatic-psychotherapeutic competence as well as a liaison service in general hospitals are necessary for the differential diagnosis of MD, SD and organic mood disorder in the elderly with medical comorbidity.

A multidimensional scale for the measurement of agreement with age stereotypes and the salience of age in social interaction

This paper presents a new scale for the assessment of the salience of age in social interaction and of levels of agreement with four age stereotypical assertions, about the characteristics of people in the ‘third age’ and the ‘fourth age’, about older peoples social roles and social participation, and about the problems for society produced by population ageing. The scale was constructed by testing the agreement of a national sample of 804 German respondents aged 41–84 years with over 60 item-statements in two pilot studies. The final scale has 24 items, and was tested using a stratified sample of 1,275 subjects aged 40–75 years. Five postulated subscales were confirmed using principal components analysis: ‘age salience’ in social interaction, old age as a time of ‘developmental gains and potentials of development’, old age as a time of ‘developmental losses and risks of development’, ‘the social downgrading of older people’, and believing that ‘older people are a burden on society’. For age stereotypes and age salience, no significant sex differences were found, but those aged 58–64 years held more optimistic views about old age and population ageing than both the younger and the older age groups (with no differences between the latter). Moreover, age stereotypes and age salience varied by several social-economic variables, particularly occupational status, the rate of unemployment in the region of residence, and being resident in the eastern or western part of Germany. No significant interactions between age group and sex were found for any of the five subscales.

Das Heidelberger Instrument zur Erfassung von Lebensqualität bei Demenz (H.I. L.DE.)

ZusammenfassungDer Beitrag beschreibt den theoretischen Hintergrund und das methodische Vorgehen der H.I.L.DE.-Studie. In diesem Forschungsprojekt soll ein umfassendes Instrumentarium zur Messung von Lebensqualität bei demenzkranken Heimbewohnern entwickelt und erprobt werden. Ausgehend von der Annahme, dass auch in fortgeschrittenen Stadien der Erkrankung Emotionen erlebt und auf der Grundlage des mimischen Ausdrucks gedeutet werden können, wurden in Zusammenarbeit mit 11 Pflegeeinrichtungen unterschiedlicher Trägerschaft drei Stichproben von Untersuchungsteilnehmern gezogen: 121 demenzkranke Heimbewohner, 97 Pflegekräfte und 101 Angehörige haben an der ersten Projektphase teilgenommen. Bei der operationalen Definition von Lebensqualität geht das H.I.L.DE.-Projekt von einer Differenzierung der folgenden acht Dimensionen von Lebensqualität aus: räumliche Umwelt, soziale Umwelt, Betreuungsqualität, Verhaltenskompetenz, medizinisch-funktionaler Status, kognitiver Status, Psychopathologie und Verhaltensauffälligkeiten sowie subjektives Erleben und emotionale Befindlichkeit. Die Messung dieser acht Dimensionen beruht auf medizinischen Untersuchungen, Interviews mit Bewohnern, Pflegekräften und Angehörigen, ökopsychologischen Einschätzungen räumlicher Umwelt und Analysen von Pflegedokumenten. Erste Ergebnisse der H.I.L.DE.-Studie werden zur Illustration der Potenziale eines derart umfassenden methodischen Ansatzes genutzt.SummaryThe contribution is intended to describe the theoretical background and measurement approach of H.I.L.DE., a research project aimed to develop and validate a comprehensive assessment of quality of life in nursing home residents suffering from dementia. Proceeding from the assumption that emotions are felt even in advanced stages of dementia and can be interpreted on the basis of peoples’ mimic expressions, three samples of participants were recruited from 11 nursing homes of varying maintenance: 121 nursing home residents suffering from dementia, 97 professional caregivers and 101 relatives participated in the first wave of this study. Operational definition of quality of life in H.I.L.DE. proceeds from the differentiation of eight dimensions of quality of life: physical environment, social environment, quality of care, behavioral competence, medical and functional status, cognitive status, psychopathology and behavior disturbances, and subjective experiences of physical and social environment and emotional well-being. Measures of the eight dimensions involve data from medical examination, interviews with residents, professional caregivers and relatives, ecopsychological assessment of physical environment and analysis of care documents. First results from the H.I.L.DE.-study are used as an illustration of the potentials of such a comprehensive approach to the measurement of quality of life.

[The Heidelberg instrument for the assessment of quality of life in dementia (H. I. L. DE.)--dimensions of quality of life and methods of organization].

ZusammenfassungDer Beitrag beschreibt den theoretischen Hintergrund und das methodische Vorgehen der H.I.L.DE.-Studie. In diesem Forschungsprojekt soll ein umfassendes Instrumentarium zur Messung von Lebensqualität bei demenzkranken Heimbewohnern entwickelt und erprobt werden. Ausgehend von der Annahme, dass auch in fortgeschrittenen Stadien der Erkrankung Emotionen erlebt und auf der Grundlage des mimischen Ausdrucks gedeutet werden können, wurden in Zusammenarbeit mit 11 Pflegeeinrichtungen unterschiedlicher Trägerschaft drei Stichproben von Untersuchungsteilnehmern gezogen: 121 demenzkranke Heimbewohner, 97 Pflegekräfte und 101 Angehörige haben an der ersten Projektphase teilgenommen. Bei der operationalen Definition von Lebensqualität geht das H.I.L.DE.-Projekt von einer Differenzierung der folgenden acht Dimensionen von Lebensqualität aus: räumliche Umwelt, soziale Umwelt, Betreuungsqualität, Verhaltenskompetenz, medizinisch-funktionaler Status, kognitiver Status, Psychopathologie und Verhaltensauffälligkeiten sowie subjektives Erleben und emotionale Befindlichkeit. Die Messung dieser acht Dimensionen beruht auf medizinischen Untersuchungen, Interviews mit Bewohnern, Pflegekräften und Angehörigen, ökopsychologischen Einschätzungen räumlicher Umwelt und Analysen von Pflegedokumenten. Erste Ergebnisse der H.I.L.DE.-Studie werden zur Illustration der Potenziale eines derart umfassenden methodischen Ansatzes genutzt.SummaryThe contribution is intended to describe the theoretical background and measurement approach of H.I.L.DE., a research project aimed to develop and validate a comprehensive assessment of quality of life in nursing home residents suffering from dementia. Proceeding from the assumption that emotions are felt even in advanced stages of dementia and can be interpreted on the basis of peoples’ mimic expressions, three samples of participants were recruited from 11 nursing homes of varying maintenance: 121 nursing home residents suffering from dementia, 97 professional caregivers and 101 relatives participated in the first wave of this study. Operational definition of quality of life in H.I.L.DE. proceeds from the differentiation of eight dimensions of quality of life: physical environment, social environment, quality of care, behavioral competence, medical and functional status, cognitive status, psychopathology and behavior disturbances, and subjective experiences of physical and social environment and emotional well-being. Measures of the eight dimensions involve data from medical examination, interviews with residents, professional caregivers and relatives, ecopsychological assessment of physical environment and analysis of care documents. First results from the H.I.L.DE.-study are used as an illustration of the potentials of such a comprehensive approach to the measurement of quality of life.

Psychologie des Alters

In den zahlreichen Beitragen zur Gerontologie besteht Einigkeit daruber, das der Alternsprozs nicht einseitig als ein Abbau von Funktionen, Fahigkeiten und Fertigkeiten verstanden werden darf. Vielmehr besteht auch im Alter die Moglichkeit der Weiterentwicklung und damit der Zunahme von Erfahrungen, von Wissen und von Kompetenz. Vor allem aber ist zu bedenken, das der Alternsprozes in den einzelnen Funktionsbereichen unterschiedlich verlauft, so das sich bei jeder Person eine ganz individuelle Entwicklung im Alter ergibt, die in einzelnen Funktionsbereichen zu einem Ruckgang von Kompetenz sowie zu vermehrten Einschrankungen fuhrt, die aber in anderen Funktionsbereichen mit einem hohen Mas an Konstanz oder sogar mit einer Zunahme von Fahigkeiten und Fertigkeiten verbunden ist. „Defizit-Modelle“ des Alters — die lediglich den Funktionsabbau betonen — mussen aus diesem Grunde durch „Kompetenz-Modelle“ erganzt werden (Lehr 1972; Olbrich 1987). Daruber hinaus ist es notwendig, das an die Stelle von universellen (d. h. uber alle Personen verallgemeinernden) und generalisierenden (d. h. uber alle Bereiche verallgemeinernden) Aussagen differentielle Analysen treten (Birren u. Cunningham 1985; Svanborg 1985; Thomae 1976, 1983; Thomae u. Maddox 1982).

Verlängerung der Lebensarbeitszeit - eine realistische Perspektive?

Zusammenfassung. Dieser Beitrag geht zunachst auf einige zentrale demografische Entwicklungen ein, die eine alternde Gesellschaft kennzeichnen. Er macht deutlich, dass das Altern der Gesellschaft nicht mit einem Ruckgang an Innovationsfahigkeit gleichgesetzt werden darf. Vielmehr verfugen viele altere Menschen uber Wissen und Erfahrungen, die sie in die Lage versetzen, sich mit neuen Anforderungen kreativ auseinanderzusetzen. Diese Wissens- und Erfahrungselemente werden hier fur den beruflichen Bereich dargestellt. Zugleich werden potenzielle Risiken alterer Arbeitnehmerinnen und Arbeitnehmer aufgezeigt, die bei der Personalplanung besonders berucksichtigt werden mussen. Der Beitrag pladiert dafur, eine alternde Gesellschaft auch als eine Chance zu begreifen.

Generativity as a route to active ageing.

We elucidate the significance of active ageing from an individual as well as from a societal perspective. Taking an individual perspective, maintaining activity in later years is linked to successful ageing because of empirical relationships to positive self-perception, satisfaction with life, and development of competences, whereas from a societal perspective, active ageing implies usage of older peoples life competences as a human capital of society—a societal imperative, particularly in times of demographic change but also more basically substantiated in an ethics of responsibility, intergenerational solidarity, and generation equity. We focus on the psychological construct of generativity which is interpreted as an aspect of the philosophical-anthropological category of joint responsibility. Our own research in Mexico and the Baltic States supports the notion that maintaining access to the public sphere and active engagement for others is a more basic individual concern than a life-stages specific developmental task. We report background and results of a Dialogue Forum Project Funding, a research cooperation between our institute and the Foundation Remembrance, Responsibility, and Future aimed to improve generativity in Belarus, Russia, and Ukraine by implementing and supporting local initiatives offering opportunities for intergenerational dialogue.

Shared Responsibility and Civic Engagement in Very Old Age

Although late-life potentials are increasingly recognized as a valuable resource for shaping social change, contributions of the very old to civil society are still regularly overlooked. The authors outline a comprehensive perspective on very old age (or the fourth age), which integrates vulnerability and developmental potential, and report findings from the Generali study of the very old in Germany. This mixed-methods study included 400 qualitative biographical interviews with people aged 85+ and a standardized survey of 800 employees of municipalities and voluntary organizations. The authors found that feelings of shared responsibility and motives for engagement in family and community, especially for younger generations, were highly prevalent among the very old participants. Approximately one half of them reported being civically engaged, mostly in informal settings, and many had been engaged before. The very old participants emphasized the importance of positive intergenerational relationships, physical health, positive perceptions of aging, and supportive environments as major factors that might promote their civic engagement. However, perspectives of institutional staff were different. Institutional staff rated the very old more negatively as compared with the young-old and saw the barriers to civic engagement primarily within the individuals (e.g., in their old age and poor health). The authors’ findings indicate that lacking institutional opportunity structures may contribute to the exclusion of some very old people from civic life.