Jennifer Anders

A Randomized Trial of Effects of Health Risk Appraisal Combined With Group Sessions or Home Visits on Preventive Behaviors in Older Adults

BACKGROUND To explore effects of a health risk appraisal for older people (HRA-O) program with reinforcement, we conducted a randomized controlled trial in 21 general practices in Hamburg, Germany. METHODS Overall, 2,580 older patients of 14 general practitioners trained in reinforcing recommendations related to HRA-O-identified risk factors were randomized into intervention (n = 878) and control (n = 1,702) groups. Patients (n = 746) of seven additional matched general practitioners who did not receive this training served as a comparison group. Patients allocated to the intervention group, and their general practitioners, received computer-tailored written recommendations, and patients were offered the choice between interdisciplinary group sessions (geriatrician, physiotherapist, social worker, and nutritionist) and home visits (nurse). RESULTS Among the intervention group, 580 (66%) persons made use of personal reinforcement (group sessions: 503 [87%], home visits: 77 [13%]). At 1-year follow-up, persons in the intervention group had higher use of preventive services (eg, influenza vaccinations, adjusted odds ratio 1.7; 95% confidence interval 1.4-2.1) and more favorable health behavior (eg, high fruit/fiber intake, odds ratio 2.0; 95% confidence interval 1.6-2.6), as compared with controls. Comparisons between intervention and comparison group data revealed similar effects, suggesting that physician training alone had no effect. Subgroup analyses indicated favorable effects for HRA-O with personal reinforcement, but not for HRA-O without reinforcement. CONCLUSIONS HRA-O combined with physician training and personal reinforcement had favorable effects on preventive care use and health behavior.

Decubitus Ulcers: Pathophysiology and Primary Prevention

BACKGROUND Pressure sores are a serious complication of multimorbidity and lack of mobility. Decubitus ulcers have become rarer among bed-ridden patients because of the conscientious use of pressure-reducing measures and increased mobilization. Nonetheless, not all decubitus ulcers can be considered preventable or potentially curable, because poor circulation makes some patients more susceptible to them, and because cognitive impairment can make prophylactic measures difficult to apply. METHODS A systematic literature search was performed in 2004 and 2005 in the setting of a health technology assessment, and a selective literature search was performed in 2009 for papers on the prevention of decubitus ulcers. RESULTS Elderly, multimorbid patients with the immobility syndrome are at high risk for the development of decubitus ulcers, as are paraplegic patients. The most beneficial way to prevent decubitus ulcers, and to treat them once they are present, is to avoid excessive pressure by encouraging movement. At the same time, the risk factors that promote the development of decubitus ulcers should be minimized as far as possible. CONCLUSIONS Malnutrition, poor circulation (hypoperfusion), and underlying diseases that impair mobility should be recognized if present and then treated, and accompanying manifestations, such as pain, should be treated symptomatically. Over the patients further course, the feasibility, implementation, and efficacy of ulcer-preventing measures should be repeatedly re-assessed and documented, so that any necessary changes can be made. Risk factors for the development of decubitus ulcers should be assessed at the time of the physicians first contact with an immobile patient, or as soon as the patients condition deteriorates; this is a prerequisite for timely prevention. Once the risks have been assessed, therapeutic measures should be undertaken on the basis of the patients individual risk profile, with an emphasis on active encouragement of movement and passive relief of pressure through frequent changes of position.

Active health promotion in old age: methodology of a preventive intervention programme provided by an interdisciplinary health advisory team for independent older people

People live longer today and, therefore, have more opportunity to a quire non-fatal disabilities in old age. Disability in old age has multifactorial causes, including physiological, psychological and social risk factors. An innovative health promotion and prevention programme designed for elderly people was developed at the Albertinen-Haus Geriatrics Centre in Hamburg in 2001 and offered to residents of the city aged 60 years and over who were living in their own homes. Eligible individuals were independent, i.e. without disabilities (not in need of care or support according to the German health system’s categorization), and without cognitive impairment. The programme focuses on areas of health behaviour that are interrelated and target self-efficacy and empowerment. The programme used an interdisciplinary approach in group sessions. The team of health promotion advisers (Gesundheitsberater-Team) consisted of members of four professions, i.e. physician, social worker, physiotherapist, and nutrition and home economics specialist. We decided to work in group sessions because of the potential for positive dynamic effects between group participants and for reasons of cost. We also developed a curriculum to train professional members of interdisciplinary geriatric teams to work as health promotion advisers for elderly people.

The longitudinal urban cohort ageing study (LUCAS): study protocol and participation in the first decade

BackgroundWe present concept, study protocol and selected baseline data of the Longitudinal Urban Cohort Ageing Study (LUCAS) in Germany. LUCAS is a long-running cohort study of community-dwelling seniors complemented by specific studies of geriatric patients or diseases. Aims were to (1) Describe individual ageing trajectories in a metropolitan setting, documenting changes in functional status, the onset of frailty, disability and need of care; (2) Find determinants of healthy ageing; (3) Assess long-term effects of specific health promotion interventions; (4) Produce results for health care planning for fit, pre-frail, frail and disabled elderly persons; (5) Set up a framework for embedded studies to investigate various hypotheses in specific subgroups of elderly.Methods/DesignIn 2000, twenty-one general practitioners (GPs) were recruited in the Hamburg metropolitan area; they generated lists of all their patients 60 years and older. Persons not terminally ill, without daily need of assistance or professional care were eligible. Of these, n = 3,326 (48 %) agreed to participate and completed a small (baseline) and an extensive health questionnaire (wave 1). In 2007/2008, a re-recruitment took place including 2,012 participants: 743 men, 1,269 women (647 deaths, 197 losses, 470 declined further participation). In 2009/2010 n = 1,627 returned the questionnaire (90 deaths, 47 losses, 248 declined further participation) resulting in a good participation rate over ten years with limited and quantified dropouts. Presently, follow-up data from 2007/2008 (wave 2) and 2009/2010 (wave 3) are available. Data wave 4 is due in 2011/2012, and the project will be continued until 2013. Information on survival and need of nursing care was collected continuously and cross-checked against official records. We used Fisher’s exact test and t-tests. The study served repeatedly to evaluate health promotion interventions and concepts.DiscussionLUCAS shows that a cohort study of older persons is feasible and can maintain a good participation rate over ten years, even when extensive self-reported health data are collected repeatedly through self-filled questionnaires. Evidently individual health developments of elderly persons can be tracked quantifying simultaneously behaviour, co-morbidity, functional competence and their changes. In future, we expect to generate results of significance about the five study aims listed above.

Long-term prediction of changes in health status, frailty, nursing care and mortality in community-dwelling senior citizens—results from the Longitudinal Urban Cohort Ageing Study (LUCAS).

BackgroundThe detection of incipient functional decline in elderly persons is not an easy task. Here, we propose the self-reporting Functional Ability Index (FA index) suitable to screen functional competence in senior citizens in the community setting. Its prognostic validity was investigated in the Longitudinal Urban Cohort Ageing Study (LUCAS).MethodsThis index is based equally on both, resources and risks/functional restrictions which precede ADL limitations. Since 2001, the FA index was tested in the LUCAS cohort without any ADL restrictions at baseline (n = 1,679), and followed up by repeated questionnaires in Hamburg, Germany.ResultsApplying the index, 1,022 LUCAS participants were initially classified as Robust (60.9%), 220 as postRobust (13.1%), 172 as preFrail (10.2%) and 265 as Frail (15.8%). This classification correlated with self-reported health, chronic pain and depressive mood (rank correlations 0.42, 0.26, 0.21; all p < .0001). Survival analyses showed significant differences between these classes as determined by the FA index: the initially Robust survived longest, the Frail shortest (p < .0001). Analyses of the time to need of nursing care revealed similar results. Significant differences persisted after adjustment for age, sex and self-reported health.ConclusionsDisability free lifetime and its development over time are important topics in public health. In this context, the FA index presented here provides answers to two questions. First, how to screen the heterogeneous population of community-dwelling senior citizens, i.e. for their functional ability/competence, and second, how far away they are from disability/dependency. Furthermore, the index provides a tool to address the urgent question whether incipient functional decline/incipient frailty can be recognized early to be influenced positively.The FA index predicted change in functional status, future need of nursing care, and mortality in an unselected population of community-dwelling seniors. It implies an operational specification of the classification into Robust, postRobust, preFrail and Frail. Based on a self-administered questionnaire, the FA index allows easy screening of elderly persons for declining functional competence. Thereby, incipient functional decline is recognized, e.g. in GPs’ practices and senior community health centers, to initiate early appropriate preventive action.

Range and specificity of war-related trauma to posttraumatic stress; depression and general health perception: Displaced former World War II children in late life

BACKGROUND Dose-response relation of war experiences and posttraumatic stress, depression and poor health functioning in late life is well documented in war-affected populations. The influence of differing trauma types experienced by war-affected population in the study of dose-response relation of war trauma and psychological maladaptation in late life has not been investigated. We examined a subgroup of displaced elders and investigated whether specific trauma types were associated with differential health outcomes. METHODS From representative practitioner lists, matched groups of former displaced and non-displaced World War II children were assigned, yielding a total sample of 417 participants (response rate 50%). Measurement encompassed a self-report survey including the Impact of Event Scale-Revised, the Patient Health Questionnaire and the Harvard Trauma Questionnaire. RESULTS Consistent dose-relation between war-related experiences and posttraumatic stress or depressive symptoms in late life was found for both, displaced and non-displaced elders, whereas a gradient for poor health perception was only found in displaced people. Trauma types derived from principal component analysis showed differential associations with health outcomes. Human Right Violations emerged as risk factor for posttraumatic stress symptoms and Deprivation & Threat to Life as risk factor for depressive symptoms. Poor self-rated health was associated with multiple trauma types. LIMITATIONS Non-random recruitment, retrospective design and use of self-report. CONCLUSIONS Posttraumatic stress and depression are associated with war-related experiences more than 60 years after World War II. Results suggest that different trauma types lead to unique variants of syndrome configurations, which may result from different etiological factors.

Geriatrische Gesundheitsförderung und Prävention für selbstständig lebende Senioren

ZusammenfassungHintergrundNahezu alle epidemiologisch wichtigen Erkrankungen im Alter können erfolgversprechend durch konsequente Änderungen des individuellen Lebensstils, die systematische Versorgung mit Maßnahmen der Primärmedizin sowie die Schaffung gesundheitsfördernder Lebenswelten gemindert bzw. unterbunden werden. Diese erheblichen Potenziale präventiver Interventionen werden allerdings in Deutschland bisher weder systematisch noch hinreichend genutzt.MethodikAnhand einer eindeutig definierten Stichprobe selbstständiger Senioren ohne Pflegestufe und ohne kognitive Auffälligkeiten aus Hausarztpraxen wurden parallel zwei unterschiedliche präventive Ansätze an einem geriatrischen Zentrum unter Einbeziehung der behandelnden Hausärzte implementiert und wissenschaftlich begleitet: A) eine multidimensionale Beratung in Kleingruppen am geriatrischen Zentrum durch ein interdisziplinäres Expertenteam (Angebot als Kommstruktur) oder B) eine multidimensionale Einzelberatung durch einen Experten des geriatrischen Zentrums im präventiven Hausbesuch (Angebot als Bringstruktur). Die Kombination soziodemographischer, medizinischer, psychologischer und räumlicher Datenbestände der Stichprobe ermöglichte umfangreiche statistische Analysen für die differenzierte Beurteilung zielgruppenspezifischer Angebote zur Gesundheitsförderung und Prävention im Alter.ErgebnisseMit 72,1% entschied sich die überwiegende Mehrheit der Senioren (580/804) für die Teilnahme an einem der beiden präventiven Angebote, darunter 503/580 (86,7%) für die Teilnahme an der Kommstruktur und 77/580 (13,3%) für die Teilnahme an der Bringstruktur. 224 Senioren (27,9%) lehnten beide präventiven Angebote ab. Die Charakterisierung der drei Zielgruppen umfasst empirisch ermittelte Daten aller 804 Senioren zu Alter, Geschlecht, Bildung, sozialer Lage, Gesundheitszustand, - vorsorge und -verhalten und persönlichen Einstellungen zur Gesundheit, körperlichen Einschränkungen und Selbstständigkeit, sozialem Netz und sozialer Teilhabe sowie räumliche Parameter (Distanz, Erreichbarkeit, Verkehrsmittelverfügbarkeit). Die Teilnehmer der Komm-Struktur (Ressourcen- Förderer) sind mobil und motiviert, nehmen aktiv an ihrer Umwelt teil und sind offen und fähig, gesundheitsfördernde Empfehlungen anzunehmen und umzusetzen (health literacy). Die Nicht-Teilnehmer (Ressourcen-Verbraucher) unterscheiden sich nicht in Alter und Geschlecht von den Ressourcen- Förderern, zeigen allerdings weniger Selbstverantwortung und Selbsterkenntnis sowie typische Verhaltensweisen, die die Gesundheit aktiv (z.B. durch Rauchen) und passiv (z. B. durch Bewegungsmangel) gefährden. Bei den Teilnehmern der Bring-Struktur finden sich kaum noch Reserven. Ihre Mobilität ist deutlich eingeschränkt, so dass sich die Autonomie auf die Wohnung be schränkt. Diese Gruppe repräsentiert mit vielen Risikofaktoren aus unterschiedlichen Bereichen gebrechliche ältere Menschen (Ressourcen-Verarmte).SchlussfolgerungenBei den Nicht-Teilnehmern ist die persönliche Einstellung zur eigenen Gesundheit ausschlaggebend für die Ablehnung beider präventiver Angebote. Bei der Berücksichtigung der Wünsche und Bedürfnisse nannten mehr Nicht-Teilnehmer den Ablehnungsgrund „kein Interesse“ am präventiven Hausbesuch als an der Kleingruppenberatung am Zentrum. Zukünftig verstärkt werden sollte das Verständnis für und die Motivation zur Gesundheitsförderung über den Hausarzt als Vertrauensperson oder über verhältnisorientierte Ansätze. Dies könnte in Kooperation mit geriatrischen Einrichtungen und der Etablierung von Gesundheitszentren für selbstständige Senioren in der Kommune gelingen.AbstractBackgroundNearly all diseases in old age that are epidemiologically important can be reduced or prevented successfully through consequent changes in individual lifestyle, a systematic provision of measures in primary prevention (i.e. vaccination programmes) and the creation of health promoting settings. However, at the moment the amount of potential for preventative interventions is neither systematically nor sufficiently utilised in Germany.MethodsTwo different preventative approaches: a) multidimensional advice session in small groups through an interdisciplinary team at a geriatric centre (seniors come to seek advice offered at a centre) or b) multidimensional advice at the seniors home through one member of the interdisciplinary team from the geriatric centre (expert takes advice to seniors home) were tested simultaneously with a well-described study sample of 804 independent community-dwelling senior citizens aged 60 years or over, without need of care and cognitive impairments recruited from general practices. Information about target group specific approaches in health promotion and prevention for senior citizens were retrieved from analyses of sociodemographic, medical, psychological and spacial characteristics of this study sample.ResultsThe majority of the study sample (580 out of 804 or 72.1%) decided to participate: a) 86.7% (503 out of 580) attended at the geriatric centre and sought advice in group sessions and b) 13.3% (77 out of 580) decided to receive advice in a preventive home visit. A total of 224 seniors (224 out of 804 or 27.9%) refused to participate at all. These three target groups were characterised on the basis of their age, gender, education, social background, health status, health behaviour, use of preventive care, self perceived health, functional disabilities, social net and social participation and distance or accessibility of preventative approaches. The 503 senior citizens who participated in small group sessions at the geriatric centre were characterised as “investors into their health resources”. They were mobile and participated actively in their environment. They were open for health promoting advice and capable of understanding and incorporating it into their daily routines (health literacy). Those 224 seniors who refused any participation were characterised as “consumers of their health resources”. They did not differ in age and gender from the health investors, but showed less self-efficacy and less self-responsibility and typical behaviour that endangers health in an active way, i.e. smokers or in a passive way, i.e. low physical activity. The 77 seniors who received a preventive home visit were characterised as “people with exhausted health resources”. Their mobility was clearly restricted and autonomy was confined to their home environment. This group represented frail elderly people with many risk factors in different domains.ConclusionThe strongest reason to refuse participation in health promoting programmes was the personal attitude related to one’s own personal health. Taking account of needs and wants of the seniors who refused to participate more people expressed the reason “no interest” in the preventive home visit than in the small group session at the geriatric centre. To strengthen the integration of the GP as a trustworthy person would seem to be more successful to motivate senior citizens to participate in health promoting and preventative programmes in the future. This could succeed in a cooperation with geriatric centres to establish community centres for generally healthy senior citizens.

Einfluss von Sturzgefährdung und Sturzangst auf die Mobilität selbstständig lebender, älterer Menschen am Übergang zur Gebrechlichkeit

ZusammenfassungHintergrundMobilität und Gangsicherheit stehen miteinander und mit der selbstständigen Lebensführung im Alter in Wechselwirkung. Gangunsichere Personen mit Sturzangst schränken ihre Mobilität und Reichweite innerhalb ihrer Wohngemeinde ein, oft bevor sich tatsächlich Stürze ereigneten. Ziel dieser Studie war es, ein Selbstausfüller- Instrument zur Erfassung der Sturzgefährdung bei noch selbstständig lebenden, älteren Bürgern, das bereits auf seine Machbarkeit, Akzeptanz und Reliabilität hin getestet worden war, nun bezüglich seiner Validität und prognostischen Wertigkeit hin zu prüfen.MethodikZur Testung des Selbstausfüller-Instrumentes zur Sturzgefährdung wurden BewohnerInnen einer Hamburger Einrichtung für Betreutes Wohnen ohne bekannte Pflegebedürftigkeit (Pflegestufe 1–3 laut MDK-Begutachtung) rekrutiert. Alle so gewonnenen Angaben der älteren TeilnehmerInnen zum Sturzrisiko wurden verglichen mit telefonisch erhobenen Angaben zu Ausrichtung und Reichweite von zu Fuß zurückgelegten Strecken, Nutzung von Transportmitteln sowie instrumentellen Fähigkeiten des täglichen Lebens (I-ADL mod. nach Lawton, Brody 1969). Nach Anzahl und Gewicht der vorkommenden Risikofaktoren wurden die älteren TeilnehmerInnen in Gruppen mit einer geringen, mittleren oder hohen Sturz-Gefährdung eingeteilt und diese Bewertung anhand tatsächlicher Sturzereignisse in einem schriftlichen 1-Jahres-Follow-Up überprüft.ErgebnisseAngaben von 79 Teilnehmern und Teilnehmerinnen, die das Screening „Sturz-Risiko- Check“ ausfüllten und telefonisch zum I-ADL-Status (n=79) befragt wurden, sind in dieser Untersuchung berücksichtigt. Der Rücklauf war mit 76,1% überdurchschnittlich hoch. Das Alter betrug im Median 78 Jahre (64 bis 93 Jahre) und korrespondierte mit dem hohen Frauenanteil in dieser Stichprobe (75,9% Frauen). Die Personen bejahten im Durchschnitt 5 (Spannweite 0 bis 13) von insgesamt 13 abgefragten Risikofaktoren. Besonders häufig wurde als Risikofaktor die Aufgabe des Fahrradfahrens (78,5%) genannt. Es folgten Herzerkrankungen (75,9%) sowie Seh- und Hörstörungen (zusammen 64,6%). Mit zunehmendem Sturzrisiko innerhalb der Gesamtstichprobe (Teilstichproben mit geringem, mittlerem und hohem Sturzrisiko) kumulierten Anzeichen für einen beschleunigten Alterungsprozess (frailty) wie langsameres Gehen (6,3 vs. 36,8 vs. 72,0%) oder nachlassende Muskelkraft (Aufsteh- Test verfehlt 0 vs. 18,4 vs. 28%) sowie erlebte Stürze (0 vs. 5,3% vs 56,0%). Nach einem Jahr (Follow Up) bestätigte sich diese Entwicklung mit einer Zunahme der Sturzrate in allen Teilstichproben (12,5 vs. 31,6 vs. 28%), wobei sich nur 2 Teilnehmer mit hohem Sturzrisiko bei etwaigen Sturzereignissen auch schwere Verletzungen (Frakturen) zuzogen.DiskussionSturzangst und fehlende Möglichkeit zum gezielten Training von Balance erwiesen sich in dieser Erhebung als die ersten Anzeichen einer Gangunsicherheit mit erhöhtem Sturzrisiko. Dabei wirkten sich langfristig weniger chronische Erkrankungen wie die Herzinsuffizienz aus, als vielmehr eine Kumulation von Anzeichen eines beschleunigten funktionellen Abbaus (frailty). Je mehr Risikofaktoren einer Gangunsicherheit angegeben worden waren, desto höher lag nicht nur die Wahrscheinlichkeit weiterer Sturzereignisse, sondern desto deutlicher schränkten die Betroffenen ihre Mobilität (Frequenz und Reichweite von aus eigener Kraft bewältigten Strecken) und Selbständigkeit (I ADL) ein.SchlussfolgerungenDer Fragebogen „Sturz-Risiko-Check“ ist geeignet als Screening-Instrument in Projekten der Freien und Hansestadt Hamburg und des Albertinen- Hauses zur Primär- und Sekundärprävention von Stürzen bei selbstständig lebenden, älteren Hamburger Bürgern. Begleitet wird die Implementierung von Fortbildungen für niedergelassene Ärzte sowie Angeboten der Gesundheitsförderung für ältere Menschen.AbstractProblemThere is a strong relation between mobility, walking safety and living independently in old age. People with walking problems suffer from fear of falling and tend to restrict their mobility and performance level in the community environment – even before falls occur. This study was planned to test the validity and prognostic value of a fall risk screening instrument (“Sturz-Risiko-Check©”) that has already shown its feasibility, acceptance and reliability, targeting independently living senior citizens.MethodsThe study sample was recruited from a sheltered housing complex in Hamburg (with written consent). Persons with need of professional care („Pflegestufe“ in Germany) were excluded. The residents were asked to fill in the multidimensional questionnaire (“Sturz-Risiko- Check©”). In a second step, a trained nurse asked the participants in a phone call about their competence in the instrumental activities of daily living (I-ADL mod. from Lawton, Brody 1969) and about their usual mobility performance level (e.g. frequency and distance of daily walks, use of public transport). According to the number and weight of selfreported risk-factors for falling, three groups: “low fall risk”, “medium fall risk” and “high fall risk” were classified. Finally, this classification was re-tested after one year, asking for falls and fall related injuries.ResultsA total of 112 senior citizens without need of personal care, living in a sheltered housing facility were asked to participate. Acceptance was high (76.1%). Self-reported data from 79 participants concerning falls, fall-risk, mobility and instrumental activities of daily living were included in the statistical analyses. Mean age was 78 (64 to 93) years and associated by a high percentage of women (75.9%) in this sample. The older participants reported 0 to 13 different factors (mean 5) related to a high risk of future falls. Most participants (78.5%) quit cycling because of fear of falling. There was a high incidence in the study sample and over the three risk groups of chronic disorders like cardiac failure (75.9%) and disturbed vision or hearing (64.6%). According to the rising risk of falling over the three risk groups (low, medium and high), there were symptoms of fast functional decline or frailty like diminished walking speed (6.3 vs 36.8 vs 72.0%), sarcopenia (failed chairrise test: 0 vs 18.4 vs 28%) or already perceived fall events (0 vs 5.3 vs 56.0%) and ongoing restriction in basic activities. Those results were proven by the data on fall frequencies after one year (follow-up). We found an increase in falls over all three risk groups (12.5 vs 31.6 vs 28%) with fall-related severe injuries (fractures) in two persons classified in the high fall-risk group.DiscussionThe results of the fall-risk screening were useful to classify groups with different probability to fall in the near future. Fear-offalling and symptoms of frailty were related to an increasing risk of falling and loss of mobility and autonomy in still independently living senior citizens.ConclusionThe fall-risk screening instrument („Sturz-Risiko-Check“ questionnaire) was useful and valid to predict risk of falling and functional decline in independently living senior citizens transitioning to frailty. This screening will be part of a prevention approach in the City of Hamburg to offer primary and secondary prevention interventions adapted to special target groups of community- dwelling elder people (robust in contrast to frail elderly). The implementation should be accompanied by training sessions for physicians in the primary care sector and health improvement programmes for elder citizens.

Einschätzung der Sturzgefährdung gebrechlicher, noch selbstständig lebender, älterer Menschen

ZusammenfassungHintergrundLebensqualität und Autonomie älterer Menschen werden wesentlich bestimmt vom Ausmaß ihrer Mobilität. Einschränkungen der Mobilität, Sturzereignisse mit und ohne Folgen wie Frakturen oder Sturzangst besitzen daher prognostischen Wert. Ziel der Studie war es, ein Selbstausfüller-Instrument zur Erfassung der relativen Sturzgefährdung bei noch selbstständig lebenden, älteren Bürgern zu entwickeln, zu testen und ggf. zu optimieren.MethodikDazu wurden ausgehend von einer systematischen Literaturrecherche Risikofaktoren für Stürze identifiziert. Die Risikofaktoren, die einem präventiven Ansatz zugänglich sind, wurden zunächst in einem neuartigen Selbstausfüller- Fragebogen (Screening) – dem „Sturz-Risikocheck“- zusammengefasst. Risikofaktoren, die eng mit Pflegebedürftigkeit im Alter assoziiert sind wie z.B. demenzielle Erkrankungen oder aber einer Erfassung mittels Selbsteinschätzung schwer zugänglich sind, wurden nicht weiter berücksichtigt. Das so zusammengestellte Instrument wurde Pre-Tests zur Lesbarkeit, Verständlichkeit etc. unterzogen und angepasst mit anschließender Pilot-Testung mit BewohnerInnen einer Hamburger Einrichtung für Betreutes Wohnen ohne bekannte Pflegebedürftigkeit (Pflegestufe 1–3 laut MDK-Begutachtung). Alle Angaben wurden zur Überprüfung der Plausibilität und Reliabilität des Instrumentes in einem Telefonat durch eine in der Forschungsarbeit erfahrene Pflegekraft verifiziert.ErgebnisseAngaben von 117 Teilnehmern und Teilnehmerinnen, die das Screening „Sturz-Risikocheck“ (Test) ausfüllten und telefonisch befragt wurden (Retest), wurden in dieser Untersuchung berücksichtigt. Das durchschnittliche Alter betrug 82,9 Jahre (68,2–98,2 Jahre) und korrespondiert mit dem hohen Frauenanteil in dieser Stichprobe (83,8% Frauen). Die Personen bejahten im Durchschnitt 6 der insgesamt 13 abgefragten Risikofaktoren (Range 0 bis 12). Besonders häufig wurde als Risikofaktor das langsamere Gehen (64,1%) genannt, das mit zunehmender Gebrechlichkeit (frailty) assoziiert wird. Bereits 30,8% der Teilnehmer erinnerten einen oder mehr Stürze innerhalb der letzten 12 Monate, davon 22,2% mit Verletzungsfolge (Hämatome, Schmerzen oder Frakturen). Die Test-Retest- Reliabilität (Cohen’s Kappa) war sehr gut (10 der 13 Items) bzw. gut (2 der 13 Items). Lediglich die Frage nach der Aufgabe des Fahrradfahrens wurde schlecht verstanden.SchlussfolgerungenMit geringfügigen Änderungen im Druckbild wird der Fragebogen „Sturz-Risikocheck“ als Screening-Instrument in einem Projekt der Freien und Hansestadt Hamburg und des Albertinen- Hauses zur Primär- und Sekundärprävention von Stürzen bei selbstständig lebenden, älteren Hamburger Bürgern validiert und eingesetzt.SummaryMobility is one of the most important factors for well-being and autonomy in old age. Impairments in mobility, falls and fear of falling are, therefore, of prognostic value. Falls generally result from an interaction of multiple risk factors. However, older people are often not aware of the risks of falling. They neither recognize risk factors nor report these factors to their physicians. The aim of this study was to develop and to test a self-reported multidimensional screening instrument to evaluate risk factors of falling in community-dwelling older people. Therefore, we identified multiple risk factors of falls based on a systematic literature review and then developed a new questionnaire – the Senior Citizen Risk of Falling Check. Risk factors, i.e. cognitive disorders, that are closely associated with the demand of nursing care were not covered in this relatively healthy target group. We pretested this instrument and adapted it before its use in a pilot test in residents of a sheltered housing complex in Hamburg. A group of 117 residents (average age 82.9 years, range 68.2–98.2 years, 83.8% women), all without care needs (assessed by the German health and care insurance system) returned the Senior Citizen Risk of Falling Check. Within 2 weeks all 117 participants were interviewed by telephone to analyze the test-retest reliability of the instrument (Cohen’s kappa). We administered 13 questions on visual and hearing deficits, neurological impairment, depressive mood, medication use, muscle weakness, gait and balance deficits, nutrition, and history of falls. On average, 6 risk factors were reported (range 0–12). Reductions in gait speed (64.1%) was most frequently mentioned. Of the participants, 30.8% fell at least once during the last year and 22.2% of these falls resulted in injuries (fractures, hematomas, laceration, pain). Cohen’s kappa was good (2/13 questions) to excellent (10/13 questions) with one exception (balance question κ=0.20). The study results confirm good test-retest reliability of the fall risk screening Senior Citizen Risk of Falling Check. At the moment we are working on the validation of this questionnaire to provide it to senior citizens throughout Hamburg in cooperation with the City of Hamburg.

Inkontinenz als Risikofaktor für Dekubitus hält kritischer Überprüfung nicht stand

Die Assoziation zwischen Urininkontinenz und Dekubitus wird auf verschiedene Ursachen zuruckgefuhrt. Am haufigsten wird die Nasse durch den Urin und in der Folge die Mazeration der Haut genannt. Denkbar ist jedoch auch, dass die Urininkontinenz nur ein Indikator fur andere Risikofaktoren oder ein Mas fur Pflegebedurftigkeit ist, ohne kausalen Bezug zur Entstehung des Dekubitus. Problematisch bei diesen theoretischen Erwagungen ist die fehlende wissenschaftliche Evidenz, denn kontrollierte oder randomisierte Studien liegen kaum vor. Die vorliegende Arbeit versucht, mit den vorhanden Erklarungsmodellen und mit den Daten von 200 Patienten einer Fall-Kontroll-Studie dem Zusammenhang von Dekubitus und Inkontinenz kritisch nachzugehen. In der Studienpopulation waren 97,5 % der Patienten inkontinent. Unterschiedliche Kategorisierungen und Dichotomisierungen des Risikofaktors Urininkontinenz fuhren zu unterschiedlichen statistischen Ergebnissen. Aussagen zum Zusammenhang zwischen Urininkontinenz und Dekubitus mus...