Klaus Pfeiffer

Maximum step length as a potential screening tool for falls in non-disabled older adults living in the community

Background and aims: Identification of the risk of falls in a cohort of interest is a prerequisite for a targeted fall prevention study. Motor tasks are widely used as baseline assessment in such studies, but there are only a few well-evaluated tests of motor performance to predict falls prospectively. This study was conducted to find out if the potential of the maximum step length (MSL) test can predict future falls in non-disabled older persons. Methods: A modified version of the MSL test was used for baseline assessment in 56 community-dwelling, non-disabled elderly persons (mean age 67.7 yrs, SD 6 yrs; 57% women). During a follow-up of 1 year, falls were recorded in a daily calendar. Results: During the follow-up, 30 persons (54%) fell, with no gender difference in reporting of falls between men and women. The adjusted mean valid step length and adjusted maximum valid step length were predictive of future falls with a sensitivity/specificity of 77%/62% and 70%/69%, respectively. Combining MSL test results with fall history increased sensitivity to 93% and 90%, respectively, but decreased specificity to 54% and 58%, respectively. Conclusions: The MSL test is a feasible tool, with low requirements in space, predicting future falls in community-dwelling older persons. In combination with history of falls, the sensitivity of the test increased considerably.

Telephone-based problem-solving intervention for family caregivers of stroke survivors: a randomized controlled trial.

OBJECTIVE Intervention trials for stroke caregivers after the early poststroke period are lacking. To address this gap, we examined the effectiveness of a problem-solving intervention (PSI) for stroke caregivers who provided care for at least 6 months and who experienced significant strain in their role. METHOD One hundred twenty-two family caregivers (age = 66.2 years, 77.9% female) were randomly allocated to a PSI or control group. The PSI was composed of 2 home visits and 18 telephone calls delivered over a 3-month intensive intervention and a 9-month maintenance period. PSI and control groups received monthly information letters in addition to usual care. Primary caregiver outcomes were depressive symptoms (measure: Center for Epidemiologic Studies-Depression Scale) and sense of competence (measure: Sense of Competence Questionnaire). RESULTS In covariance analyses, caregivers of the PSI group showed significantly lower levels of depressive symptoms after 3 months (p < .01, d = -.48) and after 12 months (p < .05, d = -.37), but no better sense of competence compared with the control group. Latent growth curve analyses revealed positive significant (p < .05) linear and quadratic effects of PSI on both primary outcomes. No effects, however, were found on caregiver social-problem-solving abilities. CONCLUSIONS Although beneficial effects were observed among caregivers in the PSI group, the lack of effects on problem-solving abilities implies other characteristics of the intervention might account for these benefits. The relative intensity and therapeutic contact during the first 3 months of the intervention may be particularly helpful to caregivers of stroke survivors.

Dementia Caregiver Interventions: A Systematic Review of CaregiverOutcomes and Instruments in Randomized Controlled Trials

A variety of psychosocial interventions have been developed to support dementia caregivers. Compar- ing positive effects on caregivers across these intervention studies are difficult because of the diverse endpoints. The objectives of this review were: (1) to show what types of interventions were conducted in international randomized controlled trails with dementia caregivers; (2) to provide an overview of what main caregiver outcome dimensions can be categorized; and (3) what validated instruments are most frequently used to assess these outcomes. A sys- tematic, computerized literature search was conducted using the electronic databases PubMed, Medline, EBSCO, and PsycINFO. Records of interest were randomized controlled trials for informal caregivers of home dwelling care recipients with any type of dementia. In the 69 identified studies 82 different validated assessments were used, which were categorized in 15 dimensions. About two out of three studies examined psychoeducational interventions. The five most prevalent outcomes were: depressive symptoms (N = 34); burden (N = 33); self-efficacy/coping/mastery (N = 19); emotional distress (N = 19); and quality of life (N = 17). These outcomes were mostly assessed with: the Center for Epidemiologic Studies Depression Scale (N = 23); the Zarit Burden Interview (N = 24); the Revised Scale for Caregiving Self-Efficacy (N = 4); the Cohen Perceived Stress Scale (N = 7); and the WHO Quality of Life (N = 5). This literature review serves as the first step to identify outcomes and assessments which have actually been used. An important next step to improve comparability between studies could be the development of taxonomy to classify and describe the key influential components of interventions in this research field.

Der Problemlöse-Ansatz in der Beratung pflegender Angehöriger von Schlaganfall-Betroffenen – Eine inhaltliche Analyse bearbeiteter Themen

Problem-solving therapies for family caregivers have been described for different dyads and care recipients with various chronic conditions. Only little attention is directed to the specific topics worked on with informal caregivers. This study focuses on the intensive intervention period of 3 months of an individualized mainly telephone-based problem-solving training for informal carers of stroke survivors (TIPS-Study). We present data of 47 strained caregivers who cared for their spouses and partners (n=42) or (grand-)parents (n=5). Results show that effective changes in burden can be achieved with only few contacts concentrating on problems that can be controlled by problem-focused coping mechanisms. Problems that require emotion-focused coping were processed rarely. Future perspectives of the approach are discussed.

Hip and pelvic fracture patients with fear of falling: development and description of the “Step by Step” treatment protocol:

Objective: Based on a theoretical framework and sound evidence, this article describes a rehabilitation programme for patients with fear of falling after hip and pelvic fracture. Rationale: Based on exercise science principles, current knowledge from fall prevention, emotion regulation, and the Health Action Process Approach we developed a theoretical framework, from which the components of the intervention were derived. Description of the intervention: The intervention consists of 6 components: (1) relaxation, (2) meaningful activities and mobility-based goals, (3) falls related cognitions and emotions, coping with high risk tasks and situations, (4) individual exercise programme, (5) planning and implementing exercises and activities, and (6) fall risks and hazards. The intervention comprises of 8 individual sessions during 3 to 5 weeks of inpatient rehabilitation and 4 telephone calls and 1 home visit over a 2-month post-discharge period. Each session or telephone call takes about 30-60 minutes. It is provided to geriatric hip and pelvic fracture patients with concerns about falling and no cognitive impairment. To ensure completeness of reporting, the Template for Intervention Description and Replication (TIDierR) is used. Results: Fifty-seven patients were assigned to the intervention group. All 46 completers met all pre-defined criteria for an intervention per protocol. Conclusion: The programme is feasible to administer. We have completed a randomised controlled trial, which will be submitted in due time (for trial protocol: www.isrctn.org; ISRCTN79191813).

Depressive symptoms and fear of falling in previously community-dwelling older persons recovering from proximal femoral fracture

Background and aims: Depression and fear of falling are common problems following proximal femoral fracture. The role of fear of falling in depressive symptoms after such a fracture has not yet been investigated. The aim of this study was to establish possible changes during recovery in fear of falling and depressive symptoms following rehabilitation in this population and to explore their association. Methods: Observational study with pre-post design at a single geriatric rehabilitation hospital in Germany. Data were collected during in-hospital rehabilitation and four months later at participants’ home. The data of 51 participants living in the community at the time of fracture could be analysed. Main measures: Fear of falling, depressive symptoms, cognition, pain, ADL functioning, and physical performance. Results: Although physical and ADL performance improved between admission to rehabilitation and follow-up four months later, the prevalence of depressive symptoms increased, and levels of fear of falling remained at the same level. There was a significant correlation between fear of falling and depressive symptoms at follow-up, but the two were not significantly correlated at baseline. Fear of falling and depressive symptoms were not significantly associated in a path analysis model. Conclusions: Fear of falling and depressive symptoms are highly prevalent after proximal femoral fracture. Yet there seems to be no simple association between either psychological parameter in older persons recovering from fall-related fractures. Further research is warranted, in order to develop interventions targeting these psychological outcomes.

Family caregiver adjustment and stroke survivor impairment: A path analytic model.

Objective: Depressive symptoms are a common problem among family caregivers of stroke survivors. The purpose of this study was to examine the association between care recipient’s impairment and caregiver depression, and determine the possible mediating effects of caregiver negative problem-orientation, mastery, and leisure time satisfaction. The evaluated model was derived from Pearlin’s stress process model of caregiver adjustment. Method: We analyzed baseline data from 122 strained family members who were assisting stroke survivors in Germany for a minimum of 6 months and who consented to participate in a randomized clinical trial. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale. The cross-sectional data were analyzed using path analysis. Results: The results show an adequate fit of the model to the data, &khgr;2(1, N = 122) = 0.17, p = .68; comparative fit index = 1.00; root mean square error of approximation: p < .01; standardized root mean square residual = 0.01. The model explained 49% of the variance in the caregiver depressive symptoms. Results indicate that caregivers at risk for depression reported a negative problem orientation, low caregiving mastery, and low leisure time satisfaction. The situation is particularly affected by the frequency of stroke survivor problematic behavior, and by the degree of their impairments in activities of daily living. Conclusion: The findings provide empirical support for the Pearlin’s stress model and emphasize how important it is to target these mediators in health promotion interventions for family caregivers of stroke survivors.