Petra Platen

Correlation between BMI, leisure habits and motor abilities in childhood (CHILT-Project)

INTRODUCTION: The prevalence of childhood obesity is increasing with its negative medical and psychosocial consequences. This paper examines the association between body mass index (BMI), motor abilities and leisure habits of 668 children within the CHILT (Childrens Health InterventionaL Trial) project.APPROACH: A total of 668 children (51.0% boys; 49.0% girls) and their parents were questioned on sport and leisure behaviour of the children. The anthropometric data were measured. Motor abilities were determined by a body gross motor development test for children (Köperkoordinationstest für Kinder; KTK) and a 6-min run.RESULTS: The children were 6.70±0.42 y old, 122.72±5.36 cm tall and weighed 24.47±4.59 kg, the average BMI was 16.17±2.27 kg/m2. KTK showed an average motor quotient (MQ) of 93.49±15.01, the 6-min run an average of 835.24±110.87 m. Both tests were inversely correlated with BMI (KTK and BMI r=−0.164 (P<0.001); 6-min run and BMI r=−0.201 (P<0.001)); the group of overweight/obese children showed poorer results than the normal/underweight ones, even after adjustment for gender and age (in each case P<0.001). Children with the greatest extent of exercise achieve the highest MQ (P=0.035).SUMMARY: Overweight/obesity is associated with a poorer body gross motor development and endurance performance. On the other hand, an active lifestyle is positively correlated with a better gross motor development in first-grade children. Therefore, to prevent the negative consequences of physical inactivity and overweight/obesity early intervention to support exercise and movement is recommended.

Determination of 13C/12C ratios of endogenous urinary steroids : method validation, reference population and application to doping control purposes

The application of a comprehensive gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS)-based method for stable carbon isotopes of endogenous urinary steroids is presented. The key element in sample preparation is the consecutive cleanup with high-performance liquid chromatography (HPLC) of underivatized and acetylated steroids, which allows the isolation of ten analytes (11beta-hydroxyandrosterone, 5alpha-androst-16-en-3beta-ol, pregnanediol, androsterone, etiocholanolone, testosterone, epitestosterone, 5alpha-androstane-3alpha,17beta-diol, 5beta-androstane-3alpha,17beta-diol and dehydroepiandrosterone) from a single urine specimen. These steroids are of particular importance to doping controls as they enable the sensitive and retrospective detection of steroid abuse by athletes. Depending on the biological background, the determination limit for all steroids ranges from 5 to 10 ng/mL for a 10 mL specimen. The method is validated by means of linear mixing models for each steroid, which covers repeatability and reproducibility. Specificity was further demonstrated by gas chromatography/mass spectrometry (GC/MS) for each analyte, and no influence of the sample preparation or the quantity of analyte on carbon isotope ratios was observed. In order to determine naturally occurring (13)C/(12)C ratios of all implemented steroids, a reference population of n = 61 subjects was measured to enable the calculation of reference limits for all relevant steroidal Delta values.

Intensive exercise induces changes of endothelial nitric oxide synthase pattern in human erythrocytes

The synthesis of nitric oxide (NO) in the circulation has been attributed exclusively to the vascular endothelium, especially to endothelial cells. Recently, it has been demonstrated that red blood cells (RBCs) express the endothelial NOS isoform (eNOS). In addition, RBCs have been assumed to metabolize large quantities of NO due to their high content of hemoglobin. In addition to its known action on endothelial cells, NO seems to possess cardiovascular effects via regulation of RBC deformability. To get a better understanding of the question whether RBCs endothelial NOS (eNOS) is affected by intensive exercise undertaken by elite athletes, the present study aimed to investigate eNOS content, activated eNOS, phosphorylation states of eNOS (eNOSSer(116), eNOSSer(1177), eNOSThr(495)) and nitrotyrosine in erythrocytes of international-class field hockey players following a two-day long intensive training camp. Blood samples were taken before and immediately after the training camp. The athletes were required to complete at least two training sessions per day. The results showed that eNOS content, activated eNOS, eNOSSer(1177), and nitrotyrosine were significantly (p<0.05) down-regulated after the training camp. In contrast, eNOSSer(116), and eNOSThr(495) did not show significant changes, although eNOSThr(495) (p=0.081) tended to decrease. Hemoglobin and hematocrit were significantly decreased after training camp. In conclusion, this study gains new insights into a possible down-regulation of eNOS and NO production in human RBCs following high intensity exercises. It can be speculated that the reduction of eNOS and the combined reduction of eNOS activity influence erythrocyte deformability and lead subsequently to a rheological impairment.

Physical activity patterns in older men and women in Germany: a cross-sectional study

BackgroundData on physical activity in older adults in Germany is scarce. The aim of this study was to analyze physical activity patterns and to explore factors associated with physical activity in different domains, i.e. sporting activities (SA) and domestic activities (DA), in older men and women.MethodsAs part of the 7-year follow-up telephone interviews of the getABI cohort (community-dwelling older adults in Germany), the PRISCUS-PAQ was used to survey participants about their everyday physical activity patterns. Time per week (hh:mm) spent in SA and DA (heavy housework, gardening) was analyzed for men and women. Multivariate logistic regression analyses were performed in order to assess the odds of participating in SA and DA for at least 2.5 hours/week in association with sociodemographic factors, a broad range of physical health-related factors and interview date (season of the year).ResultsA total of 1,610 primary health care patients (51.6% women) with a median age of 77 (range 72-93) years were included in the analyses. Men engaged in SA more often than women (01:45 vs. 01:10), whereas women did more DA per week than men (04:00 vs. 03:00).Being interviewed in spring or summer was associated with increased performance of DA in both sexes. Participation in these activities was reduced in more highly educated men and women. Living alone increased the odds of sports participation in women, but not in men. Most physical health-related factors were only selectively associated with either SA or DA, in men or women, respectively. The need for a walking aid was the only factor that consistently lowered the odds of being active in both activity domains and sexes.ConclusionsThis exploratory study delivers reliable and relevant data on the participation in and correlates of sporting and domestic activities of community-dwelling older adults for whom there had previously been only limited information at a population level in Germany. Findings are discussed and implications for epidemiological research and health promotion practice are provided.

Prerequisites for a new health care model for elderly people with multimorbidity: the PRISCUS research consortium.

Fragestellung Das gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbiditat stellt den betroffenen Patienten, seine Angehorigen sowie Arzte und Therapeuten vor grose Herausforderungen. Das Gesundheitssystem wird durch die steigende Zahl Betroffener und ihre komplexen Bedurfnisse, aber auch durch die Vielfalt haufig schlecht koordinierter Interventionen zunehmend belastet. Zur Verbesserung der medizinischen Versorgung bietet sich das fur chronisch Kranke entwickelte „Chronic Care Model“ an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen fur ein daran orientiertes, neues Versorgungsmodell fur multimorbide, altere Patienten zu schaffen.BackgroundMultimorbidity, the concurrent manifestation or presence of multiple chronic conditions, poses huge challenges to affected patients, their relatives, physicians, and practitioners alike. The growing number of affected persons and the complexity of their needs places just as much of a burden on the health care system as does the plethora of often poorly coordinated interventions. The Chronic Care Model developed for different chronic diseases is suited for improving medical care. The PRISCUS research consortium was established to create the prerequisites for a new care model for multimorbid, elderly patients oriented along those lines.MethodsThe research consortium utilizes data gathered in a large-scale epidemiological study on peripheral arterial disease (getABI study) and from the Dortmund and Münster stroke registries, by extracting epidemiologic and health economic data, quality-of-life parameters, and data on the extent and quality of medication. Additional projects evaluate the implementation of a multidimensional geriatric assessment in primary care, the functional consequences of multimorbidity in stroke patients along with options for prevention and therapy afforded by physical activity. Systematic reviews of the literature are used to describe quality of life and patient preferences. Experts will work on an initial draft treatment standard for patients with multimorbidity and a list of potentially inappropriate medication for the elderly in Germany.ConclusionThe results of the PRISCUS research consortium will enable an epidemiologic characterization and description of consequences of multimorbidity, while illustrating new approaches towards prevention, diagnosis, and management of multimorbid patients. With this, some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model will be fulfilled.ZusammenfassungFragestellungDas gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbidität stellt den betroffenen Patienten, seine Angehörigen sowie Ärzte und Therapeuten vor große Herausforderungen. Das Gesundheitssystem wird durch die steigende Zahl Betroffener und ihre komplexen Bedürfnisse, aber auch durch die Vielfalt häufig schlecht koordinierter Interventionen zunehmend belastet. Zur Verbesserung der medizinischen Versorgung bietet sich das für chronisch Kranke entwickelte „Chronic Care Model“ an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen für ein daran orientiertes, neues Versorgungsmodell für multimorbide, ältere Patienten zu schaffen.MethodikDer Verbund nutzt unter anderem Daten einer großen epidemiologischen Studie zur peripheren arteriellen Verschlusskrankheit (getABI-Studie) und Daten des Dortmunder und Münsteraner Schlaganfallregisters. Ermittelt werden epidemiologische und gesundheitsökonomische Daten, Parameter der Lebensqualität und Umfang und Qualität der medikamentösen Versorgung. In weiteren Projekten werden die Implementierung eines multidimensionalen Assessments in Hausarztpraxen, die funktionellen Auswirkungen von Multimorbidität bei Schlaganfallpatienten sowie Möglichkeiten der Prävention und Therapie mittels körperlicher Aktivität evaluiert. Über systematische Literaturübersichten werden Lebensqualität und Patientenpräferenzen dargestellt. Mit Hilfe von Experten wird ein erster Behandlungsstandard für Patienten mit Multimorbidität und eine Liste potentiell inadäquater Medikamente im Alter erarbeitet.FazitDie Ergebnisse des Forschungsverbunds werden eine epidemiologische Charakterisierung und eine Abschätzung der Krankheitsfolgen von Multimorbidität erlauben. Der Verbund wird neue Ansätze zu Prävention, Diagnostik und Therapie bei Multimorbidität aufzeigen können. Damit werden erste Voraussetzungen geschaffen, durch Anpassung der Versorgungsstruktur nach Vorbild des „Chronic Care Model“ ein verbessertes Management von Patienten mit Multimorbidität zu erreichen.

General practitioner advice on physical activity: Analyses in a cohort of older primary health care patients (getABI)

BackgroundAlthough the benefits of physical activity for health and functioning are recognized to extend throughout life, the physical activity level of most older people is insufficient with respect to current guidelines. The primary health care setting may offer an opportunity to influence and to support older people to become physically active on a regular basis. Currently, there is a lack of data concerning general practitioner (GP) advice on physical activity in Germany. Therefore, the aim of this study was to evaluate the rate and characteristics of older patients receiving advice on physical activity from their GP.MethodsThis is a cross-sectional study using data collected at 7 years of follow-up of a prospective cohort study (German epidemiological trial on ankle brachial index, getABI). 6,880 unselected patients aged 65 years and above in the primary health care setting in Germany were followed up since October 2001. During the 7-year follow-up telephone interview, 1,937 patients were asked whether their GP had advised them to get regular physical activity within the preceding 12 months. The interview also included questions on socio-demographic and lifestyle variables, medical conditions, and physical activity. Logistic regression analysis (unadjusted and adjusted for all covariables) was used to examine factors associated with receiving advice. Analyses comprised only complete cases with regard to the analysed variables. Results are expressed as odds ratios (ORs) with 95% confidence intervals (95% CI).ResultsOf the 1,627 analysed patients (median age 77; range 72-93 years; 52.5% women), 534 (32.8%) stated that they had been advised to get regular physical activity. In the adjusted model, those more likely to receive GP advice on physical activity were men (OR [95% CI] 1.34 [1.06-1.70]), patients suffering from pain (1.43 [1.13-1.81]), coronary heart disease and/or myocardial infarction (1.56 [1.21-2.01]), diabetes mellitus (1.79 [1.39-2.30]) or arthritis (1.37 [1.08-1.73]), and patients taking a high (> 5) number of medications (1.41 [1.11-1.80]).ConclusionsThe study revealed a relatively low rate of older primary health care patients receiving GP advice on physical activity. GPs appeared to focus their advice on patients with chronic medical conditions. However, there are likely to be many more patients who would benefit from advice.

Feasibility of a multidimensional home-based exercise programme for the elderly with structured support given by the general practitioner's surgery: Study protocol of a single arm trial preparing an RCT (ISRCTN58562962)

BackgroundPhysical activity programmes can help to prevent functional decline in the elderly. Until now, such programmes use to target either on healthy community-dwelling seniors or on elderly living in special residences or care institutions. Sedentary or frail people, however, are difficult to reach when they live in their own homes. The general practitioners (GP) practice offers a unique opportunity to acquire these people for participation in activity programmes. We conceptualised a multidimensional home-based exercise programme that shall be delivered to the target group through cooperation between GPs and exercise therapists. In order to prepare a randomised controlled trial (RCT), a feasibility study is being conducted.MethodsThe study is designed as a single arm interventional trial. We plan to recruit 90 patients aged 70 years and above through their GPs. The intervention lasts 12 weeks and consists of physical activity counselling, a home-exercise programme, and exercise consultations provided by an exercise therapist in the GPs practice and via telephone. The exercise programme consists of two main components: 1. a combination of home-exercises to improve strength, flexibility and balance, 2. walking for exercise to improve aerobic capacity. Primary outcome measures are: appraisal by GP, undesirable events, drop-outs, adherence. Secondary outcome measures are: effects (a. motor tests: timed-up-and-go, chair rising, grip strength, tandem stand, tandem walk, sit-and-reach; b. telephone interview: PRISCUS-Physical Activity Questionnaire, Short Form-8 Health Survey, three month recall of frequency of falls, Falls Efficacy Scale), appraisal by participant, exercise performance, focus group discussion. Data analyses will focus on: 1. decision-making concerning the conduction of a RCT, 2. estimation of the effects of the programme, detection of shortcomings and identification of subgroups with contrary results, 3. feedback to participants and to GPs.ConclusionA new cooperation between GPs and exercise therapists to approach community-dwelling seniors and to deliver a home-exercise programme is object of research with regard to feasibility and acceptance. In case of success, an RCT should examine the effects of the programme. A future implementation within primary medical care may take advantage from the flexibility of the programme.Trial registrationCurrent Controlled Trials ISRCTN58562962.

Prerequisites for a new health care model for elderly people with multimorbidity

Fragestellung Das gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbiditat stellt den betroffenen Patienten, seine Angehorigen sowie Arzte und Therapeuten vor grose Herausforderungen. Das Gesundheitssystem wird durch die steigende Zahl Betroffener und ihre komplexen Bedurfnisse, aber auch durch die Vielfalt haufig schlecht koordinierter Interventionen zunehmend belastet. Zur Verbesserung der medizinischen Versorgung bietet sich das fur chronisch Kranke entwickelte „Chronic Care Model“ an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen fur ein daran orientiertes, neues Versorgungsmodell fur multimorbide, altere Patienten zu schaffen.BackgroundMultimorbidity, the concurrent manifestation or presence of multiple chronic conditions, poses huge challenges to affected patients, their relatives, physicians, and practitioners alike. The growing number of affected persons and the complexity of their needs places just as much of a burden on the health care system as does the plethora of often poorly coordinated interventions. The Chronic Care Model developed for different chronic diseases is suited for improving medical care. The PRISCUS research consortium was established to create the prerequisites for a new care model for multimorbid, elderly patients oriented along those lines.MethodsThe research consortium utilizes data gathered in a large-scale epidemiological study on peripheral arterial disease (getABI study) and from the Dortmund and Münster stroke registries, by extracting epidemiologic and health economic data, quality-of-life parameters, and data on the extent and quality of medication. Additional projects evaluate the implementation of a multidimensional geriatric assessment in primary care, the functional consequences of multimorbidity in stroke patients along with options for prevention and therapy afforded by physical activity. Systematic reviews of the literature are used to describe quality of life and patient preferences. Experts will work on an initial draft treatment standard for patients with multimorbidity and a list of potentially inappropriate medication for the elderly in Germany.ConclusionThe results of the PRISCUS research consortium will enable an epidemiologic characterization and description of consequences of multimorbidity, while illustrating new approaches towards prevention, diagnosis, and management of multimorbid patients. With this, some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model will be fulfilled.ZusammenfassungFragestellungDas gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbidität stellt den betroffenen Patienten, seine Angehörigen sowie Ärzte und Therapeuten vor große Herausforderungen. Das Gesundheitssystem wird durch die steigende Zahl Betroffener und ihre komplexen Bedürfnisse, aber auch durch die Vielfalt häufig schlecht koordinierter Interventionen zunehmend belastet. Zur Verbesserung der medizinischen Versorgung bietet sich das für chronisch Kranke entwickelte „Chronic Care Model“ an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen für ein daran orientiertes, neues Versorgungsmodell für multimorbide, ältere Patienten zu schaffen.MethodikDer Verbund nutzt unter anderem Daten einer großen epidemiologischen Studie zur peripheren arteriellen Verschlusskrankheit (getABI-Studie) und Daten des Dortmunder und Münsteraner Schlaganfallregisters. Ermittelt werden epidemiologische und gesundheitsökonomische Daten, Parameter der Lebensqualität und Umfang und Qualität der medikamentösen Versorgung. In weiteren Projekten werden die Implementierung eines multidimensionalen Assessments in Hausarztpraxen, die funktionellen Auswirkungen von Multimorbidität bei Schlaganfallpatienten sowie Möglichkeiten der Prävention und Therapie mittels körperlicher Aktivität evaluiert. Über systematische Literaturübersichten werden Lebensqualität und Patientenpräferenzen dargestellt. Mit Hilfe von Experten wird ein erster Behandlungsstandard für Patienten mit Multimorbidität und eine Liste potentiell inadäquater Medikamente im Alter erarbeitet.FazitDie Ergebnisse des Forschungsverbunds werden eine epidemiologische Charakterisierung und eine Abschätzung der Krankheitsfolgen von Multimorbidität erlauben. Der Verbund wird neue Ansätze zu Prävention, Diagnostik und Therapie bei Multimorbidität aufzeigen können. Damit werden erste Voraussetzungen geschaffen, durch Anpassung der Versorgungsstruktur nach Vorbild des „Chronic Care Model“ ein verbessertes Management von Patienten mit Multimorbidität zu erreichen.

Measurements of lactate in exhaled breath condensate at rest and after maximal exercise in young and healthy subjects

Arterial lactate concentrations, taken as indicators of physical fitness, in athletes as well as in patients with cardio-respiratory or metabolic diseases, are measured invasively from arterialized ear lobe blood. Currently developed micro enzyme detectors permit a non-invasive measurement of hypoxia-related metabolites such as lactate in exhaled breath condensate (EBC). The aim of our study is to prove whether this technology will replace the traditional measurement of lactate in arterialized blood. Therefore, we determined the functional relation between lactate release in EBC and lactate concentration in blood in young and healthy subjects at rest and after exhausting bicycle exercise. During resting conditions as well as after exhausting bicycle exercise, 100 L of exhaled air along with blood samples from the ear lobe was collected after stationary load conditions in 16 healthy subjects. EBC was obtained by cooling the expired air volume with an ECoScreen I (FILT GmbH, Berlin) condenser. The analysis was performed within 90 min using an ECoCheck ampere meter (FILT GmbH, Berlin). Lactate measurements were performed using a bi-enzyme sensor after lactate oxidase-induced oxidation of lactate to pyruvate and H2O2. The rates of lactate release via the exhaled air were calculated from the lactate concentration, the volume and the collection time of the EBC. The functional relation of lactate release in exhaled air and lactate concentration of arterial blood was computed. At rest, the mean lactate concentration in arterialized blood was 0.93 ± 0.30 mmol L(-1). At a resting ventilation of 11.5 ± 3.4 L min(-1), the collection time for 100 L of exhaled air, Ts, was 8.4 ± 2.9 min, and 1.68 ± 0.40 mL EBC was obtained. In EBC, the lactate concentration was 21.4 ± 7.7 µmol L(-1), and the rate of lactate release rate in collected EBC was 4.5 ± 1.7 nmol min(-1). After maximal exercise load (220 ± 20 W), the blood lactate concentration increased to 10.9 ± 1.8 mmol L(-1) and the ventilation increased to 111.6 ± 21.4 L min(-1). The EBC collection time decreased to 3.9 ± 1.9 min, and 1.20 ± 0.44 mL EBC were obtained in the recovery period after termination of exercise. The lactate concentration in EBC increased to 40.3 ± 23.0 µmol L(-1), and the lactate release in EBC increased to 13.6 ± 8.6 nmol min(-1) (p < 0.01). Assuming a volume of 4.3 mL water in 100 L of exhaled air (saturated with water at 37 °C), we calculated a lactate release at rest of 11.5 ± 4.3 nmol min(-1) and 48.6 ± 30.7 nmol min(-1) (p < 0.01) after exhausting exercise. Detectable releases of lactate in exhaled breath condensate were found already under resting conditions. During exhausting external load on a bicycle spiroergometer, an increase in the lactate concentration was found in arterialized blood along with an increased lactate release in EBC. The correlation between expiratory lactate release via EBC and lactate concentration in arterialized blood is studied in pursuing investigations.

[Prerequisites for a new health care model for elderly people with multiple morbidities: results and conclusions from 3 years of research in the PRISCUS consortium].

BACKGROUND The concurrent presence or manifestation of multiple chronic conditions, i.e. multimorbidity, poses a challenge to affected patients and their relatives, physicians, and practitioners, and to the health care system in general. Aiming to improve medical care for different chronic diseases, the Chronic Care Model also appears to be suited for multimorbidity. The established research consortium PRISCUS is trying to create some of the prerequisites for a new care model for multimorbid, elderly patients oriented along the lines of the Chronic Care Model. METHODS AND RESULTS Four out of seven subprojects of the research consortium provide an overview of some of their findings. Topics in a sports medicine subproject were the assessment of physical activity by means of a newly developed questionnaire and the development and feasibility testing of an exercise program for elderly people with chronic conditions and mobility impairment. Partners from family medicine implemented geriatric assessment in a primary care setting and evaluated its consequences. In a pharmacological subproject, potentially inappropriate medication as well as drug-drug interactions and dosing errors were addressed. The health economic subproject investigated quality of life impairment due to multiple chronic diseases and the effects of multimorbidity on costs. CONCLUSIONS The results of the PRISCUS research consortium allow a better description of consequences of multimorbidity and illustrate at least some new approaches towards prevention, diagnosis, and treatment of patients suffering from multimorbidity. Ongoing projects will test the efficacy of a physical activity program and a new complex intervention to reduce potentially inappropriate medication in the elderly. With this, the research consortium will create some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model.ZusammenfassungHintergrundDas gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbidität stellt den Betroffenen und seine Angehörigen, Ärzte und Therapeuten, aber auch das Gesundheitssystem vor große Herausforderungen. Für eine verbesserte medizinische Versorgung bietet sich das für chronisch Kranke entwickelte Chronic Care Modell an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen für ein daran orientiertes, neues Versorgungsmodell für multimorbide, ältere Patienten zu schaffen.Methoden und ErgebnisseÜbersichtsartig werden Ergebnisse aus vier der insgesamt sieben Teilprojekte des Forschungsverbunds dargestellt. Im sportmedizinischen Teilprojekt geht es um die Erfassung körperlicher Aktivität über ein neues Fragebogeninstrument sowie die Entwicklung eines Heimübungsprogramms für chronisch kranke und in der Mobilität eingeschränkte Ältere. Das allgemeinmedizinische Teilprojekt befasst sich mit der Implementierung eines geriatrischen Assessments in der hausärztlichen Versorgung sowie dessen Auswirkungen. Im pharmakologischen Teilprojekt geht es um potenziell inadäquate Medikation für Ältere, Interaktionen und Nebenwirkungen. Das gesundheitsökonomische Teilprojekt eruiert Auswirkungen von Multimorbidität bei Älteren auf Lebensqualität und gesundheitsassoziierte Kosten.SchlussfolgerungDie Ergebnisse des Forschungsverbunds erlauben eine Abschätzung der Krankheitsfolgen von Multimorbidität und zeigen einige neue Ansätze zu Prävention, Diagnostik und Therapie bei Multimorbidität auf. Folgeprojekte werden sich mit der Wirksamkeit eines hausärztlich vermittelten, multidimensionalen Bewegungsprogramms sowie mit einem Interventionsprogramm zur Reduktion potenziell inadäquater Medikation bei Älteren befassen. Damit werden erste Voraussetzungen geschaffen, durch Anpassung der Versorgung nach Vorbild des Chronic Care Modell ein verbessertes Management von Patienten mit Multimorbidität zu erreichen.AbstractBackgroundThe concurrent presence or manifestation of multiple chronic conditions, i.e. multimorbidity, poses a challenge to affected patients and their relatives, physicians, and practitioners, and to the health care system in general. Aiming to improve medical care for different chronic diseases, the Chronic Care Model also appears to be suited for multimorbidity. The established research consortium PRISCUS is trying to create some of the prerequisites for a new care model for multimorbid, elderly patients oriented along the lines of the Chronic Care Model.Methods and resultsFour out of seven subprojects of the research consortium provide an overview of some of their findings. Topics in a sports medicine subproject were the assessment of physical activity by means of a newly developed questionnaire and the development and feasibility testing of an exercise program for elderly people with chronic conditions and mobility impairment. Partners from family medicine implemented geriatric assessment in a primary care setting and evaluated its consequences. In a pharmacological subproject, potentially inappropriate medication as well as drug–drug interactions and dosing errors were addressed. The health economic subproject investigated quality of life impairment due to multiple chronic diseases and the effects of multimorbidity on costs.ConclusionsThe results of the PRISCUS research consortium allow a better description of consequences of multimorbidity and illustrate at least some new approaches towards prevention, diagnosis, and treatment of patients suffering from multimorbidity. Ongoing projects will test the efficacy of a physical activity program and a new complex intervention to reduce potentially inappropriate medication in the elderly. With this, the research consortium will create some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model.