Martina Schäufele

Current alcohol consumption and its relationship to incident dementia: results from a 3-year follow-up study among primary care attenders aged 75 years and older

OBJECTIVE to investigate prospectively the relationship between current alcohol consumption (quantity and type of alcohol) and incident overall dementia and Alzheimer dementia. METHOD the study is based on individuals (75+) attending general practitioners in Germany: 3,202 subjects free of dementia were studied at baseline, 1.5 years and 3 years later by means of structured clinical interviews including detailed assessment of current alcohol consumption and DSM-IV dementia diagnoses. Associations between alcohol consumption (in grams of ethanol), type of alcohol (wine, beer, mixed alcohol beverages) and incident dementia were examined using Cox proportional hazard models, controlling for several confounders. RESULTS incident overall dementia occurred in 217 of 3,202 participants over a mean follow-up period of 3 years. Significant relationships were found between alcohol consumption (prevalence at baseline: 50.0%) and incident overall dementia (adjusted hazard ratio (HR) 0.71, 95% CI 0.53-0.96), respectively, incident Alzheimer dementia (adjusted HR 0.58, 95% CI 0.38-0.89). With regard to quantity of alcohol and type of alcohol, all hazard ratios were found to be lower than 1. CONCLUSION in agreement with meta-analyses that include younger age groups, our study suggests that light-to-moderate alcohol consumption is inversely related to incident dementia, also among individuals aged 75 years and older.

Predictors of mortality among demented elderly in primary care.

To evaluate a wide range of sociodemographic, neurological and clinical variables as to whether they predict mortality in a representative sample of demented elderly.

Besondere und traditionelle stationäre Betreuung demenzkranker Menschen im Vergleich

ZusammenfassungNeueren Untersuchungen zufolge leiden etwa zwei Drittel der Bewohner und Bewohnerinnen in deutschen Altenpflegeheimen an einer mittelschweren oder schweren Demenz. Neben den kognitiven Einbußen treten häufig auch psychiatrische Symptome und Verhaltensauffälligkeiten auf, die die Lebensqualität der Betroffenen, der Mitbewohner und Pflegepersonen erheblich beeinträchtigen können.Vor dem Hintergrund dieser Probleme wurden beispielsweise im Rahmen der besonderen Dementenbetreuung in Hamburg neue Versorgungskonzepte für Demenzkranke mit Verhaltensauffälligkeiten entwickelt. Im Rahmen einer umfassenden Verlaufsstudie (Follow-up-Zeitraum etwa ein halbes Jahr) einer Stichtagspopulation von Pflegeheimbewohnern und -bewohnerinnen und konsekutiven Heimaufnahmen wurde untersucht,inwieweit sich die Lebens- und Betreuungsqualität demenziell Erkrankter in Hamburg unterscheidet, je nachdem, ob sie segregativ (Domusprinzip) oder teilsegregativ (Integrationsprinzip) betreut werden;welche Unterschiede in der besonderen Dementenbetreuung in Hamburg bestehen im Vergleich zu traditionell integrativ versorgten Demenzkranken in der Stadt Mannheim. Um ein möglichst vollständiges Bild—auch über kognitiv stark beeinträchtigte Personen—zu gewinnen, basierte die Informationsgewinnung hauptsächlich auf Einschätzungen des qualifizierten Pflegepersonals.In der Stadt Hamburg fanden sich jeweils unterschiedliche Vorund Nachteile zwischen segregativer Betreuung (Domusprinzip) und teilsegregativer Betreuung (Integrationsprinzip): Im Integrationsprinzip war die Aktivitätenrate höher als im Domusprinzip und konnte im zeitlichen Verlauf besser aufrechterhalten werden. Die Besuchshäufigkeit von Angehörigen und ihre Einbindung bei der Pflege und Betreuung war im integrativen Bereich ebenfalls höher als im Domusbereich. Bei den Bewohnern und Bewohnerinnen im Domusbereich wurden dagegen signifikant häufiger Informationen zur Biografie erhoben. Der Anteil der geronto-psychiatrisch behandelten Demenzkranken war bei der Versorgung nach dem Domusprinzip höher. Außerdem erhielten Demenzkranke im Domusbereich mehr psychotrope Medikamente, wobei signifikant häufiger Antidementiva und Antidepressiva und weniger Neuroleptika verordnet wurden.Der Vergleich zwischen der besonderen Dementenbetreuung in Hamburg und traditionell integrativ versorgten Demenzkranken in Mannheim ergab bei einer Reihe von Indikatoren der Lebensqualität deutliche Unterschiede zugunsten des Hamburger Modellprogramms. Dies zeigte sich in einem häufigeren Ausdruck von positiven Gefühlen, mehr kompetenzfördernden Aktivitäten, einer stärkeren Einbindung von Angehörigen und Ehrenamtlichen, mehr Sozialkontakten zum Personal, weniger freiheitsentziehenden Maßnahmen und einer besseren gerontopsychiatrischen Versorgung. Entgegen der Erwartung nahmen jedoch im zeitlichen Verlauf die Verhaltensauffälligkeiten bei den traditionell versorgten Demenzkranken stärker ab als bei den Demenzkranken des Hamburger Modellprogramms.SummaryRecent studies reveal that approximately two thirds of the residents in German nursing homes suffer from some type of moderate to severe dementia. In addition to cognitive impairments, other psychiatric symptoms and behavior problems frequently impact the quality of life of the affected residents, their fellow residents and the nursing staff.Novel concepts of nursing care for dementia patients with behavior problems have been developed against this backdrop, e. g. within the framework of the program of special care for dementia patients in Hamburg. A comprehensive course study (follow-up period: approximately six months) of a sample population of nursing home residents and consecutive admissions focused upon:the degree to which the quality of life and care for dementia patients in Hamburg differs according to the type of care given, i. e. segregative (domus philosophy), or partially segregative (integration philosophy), andthe differences between the special care of dementia patients as provided in Hamburg, as opposed to the traditionally integrative care of dementia patients as practiced in the city of Mannheim. In order to gain the most complete picture possible—also for persons with severe cognitive impairments—information was collected primarily on the basis of the assessments made by qualified nursing staff.In the city of Hamburg there were advantages and disadvantages, respectively, between segregative care (domus philosophy) and partially segregative care (integration philosophy): the activity rates were higher for care in integrative than in domus environments, and could be maintained better over time. Moreover, the number of visits from relatives and their involvement in the nursing and social care was also higher for the integrative, as opposed to the domus setting. Among the residents of domus-care homes, however, significantly more biographical information was collected, and the proportion of dementia patients receiving gerontopsychiatric care also was higher. Dementia patients in these homes also received more psychotropic medication, with antidementia drugs and antidepressants being prescribed significantly more frequently and antipsychotic drugs less frequently.The comparison of the special dementia care available in Hamburg with the traditional, integrative care available to dementia patients in Mannheim revealed a number of visible indicators for the quality of life that point in favor of the model program in Hamburg. This is apparent in the more frequent expression of positive feelings, the greater number of activities fostering competency, the significant involvement of relatives and volunteers, the greater number of social contacts with the staff, fewer use of physical restraint, and better gerontopsychiatric care. Contradictory to our expectation, however, dementia patients cared for in the traditional setting exhibited fewer behavior problems over time than did their counterparts cared for within the framework of the Hamburg model.

A comparison of special and traditional inpatient care of people with dementia

ZusammenfassungNeueren Untersuchungen zufolge leiden etwa zwei Drittel der Bewohner und Bewohnerinnen in deutschen Altenpflegeheimen an einer mittelschweren oder schweren Demenz. Neben den kognitiven Einbußen treten häufig auch psychiatrische Symptome und Verhaltensauffälligkeiten auf, die die Lebensqualität der Betroffenen, der Mitbewohner und Pflegepersonen erheblich beeinträchtigen können.Vor dem Hintergrund dieser Probleme wurden beispielsweise im Rahmen der besonderen Dementenbetreuung in Hamburg neue Versorgungskonzepte für Demenzkranke mit Verhaltensauffälligkeiten entwickelt. Im Rahmen einer umfassenden Verlaufsstudie (Follow-up-Zeitraum etwa ein halbes Jahr) einer Stichtagspopulation von Pflegeheimbewohnern und -bewohnerinnen und konsekutiven Heimaufnahmen wurde untersucht,inwieweit sich die Lebens- und Betreuungsqualität demenziell Erkrankter in Hamburg unterscheidet, je nachdem, ob sie segregativ (Domusprinzip) oder teilsegregativ (Integrationsprinzip) betreut werden;welche Unterschiede in der besonderen Dementenbetreuung in Hamburg bestehen im Vergleich zu traditionell integrativ versorgten Demenzkranken in der Stadt Mannheim. Um ein möglichst vollständiges Bild—auch über kognitiv stark beeinträchtigte Personen—zu gewinnen, basierte die Informationsgewinnung hauptsächlich auf Einschätzungen des qualifizierten Pflegepersonals.In der Stadt Hamburg fanden sich jeweils unterschiedliche Vorund Nachteile zwischen segregativer Betreuung (Domusprinzip) und teilsegregativer Betreuung (Integrationsprinzip): Im Integrationsprinzip war die Aktivitätenrate höher als im Domusprinzip und konnte im zeitlichen Verlauf besser aufrechterhalten werden. Die Besuchshäufigkeit von Angehörigen und ihre Einbindung bei der Pflege und Betreuung war im integrativen Bereich ebenfalls höher als im Domusbereich. Bei den Bewohnern und Bewohnerinnen im Domusbereich wurden dagegen signifikant häufiger Informationen zur Biografie erhoben. Der Anteil der geronto-psychiatrisch behandelten Demenzkranken war bei der Versorgung nach dem Domusprinzip höher. Außerdem erhielten Demenzkranke im Domusbereich mehr psychotrope Medikamente, wobei signifikant häufiger Antidementiva und Antidepressiva und weniger Neuroleptika verordnet wurden.Der Vergleich zwischen der besonderen Dementenbetreuung in Hamburg und traditionell integrativ versorgten Demenzkranken in Mannheim ergab bei einer Reihe von Indikatoren der Lebensqualität deutliche Unterschiede zugunsten des Hamburger Modellprogramms. Dies zeigte sich in einem häufigeren Ausdruck von positiven Gefühlen, mehr kompetenzfördernden Aktivitäten, einer stärkeren Einbindung von Angehörigen und Ehrenamtlichen, mehr Sozialkontakten zum Personal, weniger freiheitsentziehenden Maßnahmen und einer besseren gerontopsychiatrischen Versorgung. Entgegen der Erwartung nahmen jedoch im zeitlichen Verlauf die Verhaltensauffälligkeiten bei den traditionell versorgten Demenzkranken stärker ab als bei den Demenzkranken des Hamburger Modellprogramms.SummaryRecent studies reveal that approximately two thirds of the residents in German nursing homes suffer from some type of moderate to severe dementia. In addition to cognitive impairments, other psychiatric symptoms and behavior problems frequently impact the quality of life of the affected residents, their fellow residents and the nursing staff.Novel concepts of nursing care for dementia patients with behavior problems have been developed against this backdrop, e. g. within the framework of the program of special care for dementia patients in Hamburg. A comprehensive course study (follow-up period: approximately six months) of a sample population of nursing home residents and consecutive admissions focused upon:the degree to which the quality of life and care for dementia patients in Hamburg differs according to the type of care given, i. e. segregative (domus philosophy), or partially segregative (integration philosophy), andthe differences between the special care of dementia patients as provided in Hamburg, as opposed to the traditionally integrative care of dementia patients as practiced in the city of Mannheim. In order to gain the most complete picture possible—also for persons with severe cognitive impairments—information was collected primarily on the basis of the assessments made by qualified nursing staff.In the city of Hamburg there were advantages and disadvantages, respectively, between segregative care (domus philosophy) and partially segregative care (integration philosophy): the activity rates were higher for care in integrative than in domus environments, and could be maintained better over time. Moreover, the number of visits from relatives and their involvement in the nursing and social care was also higher for the integrative, as opposed to the domus setting. Among the residents of domus-care homes, however, significantly more biographical information was collected, and the proportion of dementia patients receiving gerontopsychiatric care also was higher. Dementia patients in these homes also received more psychotropic medication, with antidementia drugs and antidepressants being prescribed significantly more frequently and antipsychotic drugs less frequently.The comparison of the special dementia care available in Hamburg with the traditional, integrative care available to dementia patients in Mannheim revealed a number of visible indicators for the quality of life that point in favor of the model program in Hamburg. This is apparent in the more frequent expression of positive feelings, the greater number of activities fostering competency, the significant involvement of relatives and volunteers, the greater number of social contacts with the staff, fewer use of physical restraint, and better gerontopsychiatric care. Contradictory to our expectation, however, dementia patients cared for in the traditional setting exhibited fewer behavior problems over time than did their counterparts cared for within the framework of the Hamburg model.

Evaluation of special and traditional dementia care in nursing homes: results from a cross-sectional study in Germany.

Two‐thirds of all residents in nursing homes in Germany suffer from some type of dementia. We investigated whether or not dementia patients receiving special (segregated or partially segregated) care exhibited a better quality of life than their counterparts residing in traditional nursing homes.

Prävalenz von Demenzen und ärztliche Versorgung in deutschen Pflegeheimen: eine bundesweite repräsentative Studie.

OBJECTIVE The study aimed to determine the prevalence of dementia and the degree of medical care among residents of nursing homes based on a nationally representative sample of nursing homes in Germany for the first time. METHODS Based on a probability sample of 609 long-term care institutions in Germany, we drew a sample of 86 facilities by applying a two-stage random procedure. All residents of the participating care facilities were comprehensively assessed by qualified nurses using a standardized Care and Behavior Assessment (CBA). RESULTS Of the 4,481 residents assessed in 58 care facilities (mean age 82.6 years;78 % female) on average 68.6 % (95 % CI: 67.0 - 69.8) were affected by a dementia-syndrome, 56.6 % by a severe dementia-syndrome. There were frequent contacts between residents and general practitioners, but provision of specialized medical care seemed to be deficient in many aspects. CONCLUSION People with dementia form the major group of residents in German nursing homes. The study provides important data on need for care and health care planning.

At-risk alcohol drinking in primary care patients aged 75 years and older

Little is known about the prevalence and risk factors of alcohol problems among older people (especially those aged 75 years and more). The aims of this study were to report alcohol consumption patterns and to determine their association with socio‐demographic variables and health characteristics.

The assessment of quality of life in dementia.

In the past decade, pharmacological, behavioral, educational, and environmental interventions for individuals with dementia have addressed a variety of goals: improving cognitive status, delaying the onset of symptoms, reducing behavioral problems such as depression and agitation, and maximizing activities of daily living. It is important not only to ameliorate symptoms but also to evaluate the extent to which an intervention improves the quality of life (QOL) of the person being treated (Logsdon et al.,

Alcohol problems among residents in old age homes in the city of Mannheim, Germany

Objective: This study aims to determine the prevalence of alcohol problems among residents in old age homes, its demographic and clinical features, and its association with the risk of falling. Method: All residents (n = 1922) living in 20 randomly selected residential and nursing homes in the city of Mannheim, Germany, were included. Based on routine documentation, details of their sociodemographic features, medical diagnoses made upon admission, and current medication were compiled. The home staff filled out for each resident a standardised assessment sheet on activities of daily living-impairment (Barthel Index), behaviour problems, alcohol consumption, and frequency of falls. Results: According to the diagnoses of the primary care physicians, 7.4% of the residents had mental and behavioural disorders due to alcohol (ICD-10: F10). Rates were particularly high among men, and younger and single or divorced residents. A high percentage of those with a diagnosis of alcohol abuse/dependence (41.1%) were transferred from mental hospitals. Home staff reported current alcohol abuse/dependence among 3.4% of all residents. The risk of falling was significantly elevated (Odds ratio: 2.65; p < 0.01) among those with current alcohol problems. Conclusion: The results corroborate the findings from other studies wherein residents of old age homes constitute a group at risk of alcohol abuse and dependence. Alcohol problems were more the cause for, rather than the consequence of, home admission.

Behavioural and psychological symptoms in general hospital patients with dementia, distress for nursing staff and complications in care: results of the General Hospital Study

AIMS Little is known about how behavioural and psychological symptoms of dementia (BPSD) manifest in the general hospital. The aim was to examine the frequency of BPSD in general hospitals and their associations with nursing staff distress and complications in care. METHODS Cross-sectional representative study with 1469 patients aged ≥65, including 270 patients with dementia, of 33 randomly selected general hospitals in Germany. BPSD and complications were reported by nurses. RESULTS Overall frequency of BPSD was higher in patients with dementia (76%) than without (38%). The most frequent symptoms in patients with dementia were nighttime disturbances (38%), depression (29%) and aberrant motor behaviour (28%) and the most distressing symptoms for nursing staff were delusions, aggression and nighttime disturbances. The overall frequency of BPSD increased from 67% in mild dementia, to 76% in moderate dementia and to 88% in severe dementia. The most frequent symptoms in patients without dementia were depression (19%), nighttime disturbances (13%) and irritability (13%). The most distressing symptoms were aggression and delusions, while the same symptoms were consistently rated as less distressing than in patients with dementia. Factor analysis revealed three independent groups of BPSD that explained 45% of the total variance. First, expansive symptoms (aggression, irritability, nighttime disturbances, aberrant motor behaviour and disinhibition) were frequent, distressing for nursing staff and associated with many complications. Second, psychotic symptoms (delusions and hallucinations) were infrequent, distressing and associated with some complications. Third, affective symptoms (apathy, anxiety and depression) were frequent, non-distressing and associated with few complications. The results did not change when cases with delirium were excluded from both groups. CONCLUSIONS BPSD are common in older hospital patients with dementia and associated with considerable distress in nursing staff, as well as a wide range of special treatments needs and additional behavioural and medical complications. Management strategies are needed to improve the situation for both patients and hospital staff.