Search

Background: There is a lack of studies investigating death anxiety among the oldest old based on a large, nationally representative sample during the pandemic. Thus, our aim was to investigate the prevalence and determinants of death anxiety among the oldest old in Germany during the Covid‐19 pandemic. Methods: Cross‐sectional data were taken from the 'Old Age in Germany' (D80+) study. This is a large, nationwide representative study including individuals 80 years and over living at home and individuals in institutionalised settings (N = 9542 individuals in the analytic sample). Results: Overall, 30% of the respondents reported the absence of death anxiety, 45.5% reported a rather not strong death anxiety, 20.2% reported a rather strong death anxiety, and 4.3% reported a very strong death anxiety. Linear regressions revealed that higher death anxiety was significantly associated with being female (β = 0.21, P < 0.01), younger age (β = −0.02, P < 0.001), being married (β = 0.09, P < 0.001), high education (compared to low education, β = 0.07, P < 0.05), the presence of meaning in life (β = 0.13, P < 0.001), higher loneliness levels (β = 0.18, P < 0.001), the presence of multimorbidity (β = 0.07, P < 0.05), and poorer self‐rated health (β = −0.07, P < 0.001). A further analysis showed that probable depression (β = 0.31, P < 0.001) is also associated with higher death anxiety. Conclusion: About one in four individuals had a strong or very strong fear of death during the pandemic. Several sociodemographic, psychosocial, and health‐related factors are associated with higher death anxiety. This better understanding of the determinants of death anxiety can be relevant for, among others, the affected individuals, informal and professional carers, as well as friends and relatives. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Dementia risk scores constitute promising surrogate outcomes for lifestyle interventions targeting cognitive function. We investigated whether dementia risk, assessed using the LIfestyle for BRAin health (LIBRA) index, was reduced by the AgeWell.de intervention. METHODS: Secondary analyses of the AgeWell trial, testing a multicomponent intervention (including optimization of nutrition, medication, and physical, social, and cognitive activity) in older adults with increased dementia risk. We analyzed data from n = 461 participants with complete information on risk/protective factors comprised by LIBRA at the 24‐month follow‐up. Intervention effects on LIBRA and LIBRA components were assessed using generalized linear models. RESULTS: The intervention reduced LIBRA scores, indicating decreased dementia risk at follow‐up (b = –0.63, 95% confidence interval [CI]: –1.14, –0.12). Intervention effects were particularly due to improvements in diet (odds ratio [OR]: 1.60, 95% CI: 1.16, 2.22) and hypertension (OR: 1.61, 95% CI: 1.19, 2.18). DISCUSSION: The AgeWell.de intervention reduced dementia risk. However, several risk factors did not improve, possibly requiring more intensive interventions. Highlights: The AgeWell.de intervention reduced dementia risk according to LIfestyle for BRAin health (LIBRA) scores.Beneficial effects on LIBRA are mainly due to changes in diet and blood pressure.A pragmatic lifestyle intervention is apt to reduce dementia risk in an at‐risk population. [ABSTRACT FROM AUTHOR]

Background: To date, most studies examining the prevalence and determinants of depression among individuals aged 80 and over have used geographically limited samples that are not generalisable to the wider population. Thus, our aim was to identify the prevalence and the factors associated with probable depression among the oldest old in Germany based on nationally representative data. Methods: Data were taken from the nationally representative 'Old Age in Germany (D80+)' study (n = 8386; November 2020 to April 2021) covering both community‐dwelling and institutionalised individuals aged 80 and over. The Short Form of the Depression in Old Age Scale was used to quantify probable depression. Results: Probable depression was found in 40.7% (95% CI: 39.5% to 42.0%) of the sample; 31.3% were men (95% CI: 29.7% to 32.9%) and 46.6% women (95% CI: 44.9% to 48.3%). The odds of probable depression were positively associated with being female (odds ratio (OR): 1.55, 95% CI: 1.30 to 1.84), being divorced (compared to being married, OR: 1.33, 95% CI: 1.01 to 1.76), being widowed (OR: 1.14, 95% CI: 1.00 to 1.30), having a low education (e.g., medium education compared to low education, OR: 0.86, 95% CI: 0.74 to 0.99), living in an institutionalised setting (OR: 2.36, 95% CI: 1.84 to 3.02), living in East Germany (OR: 1.21, 95% CI, 1.05 to 1.39), not having German citizenship (German citizenship compared to other citizenship, OR: 0.55, 95% CI: 0.31 to 0.95), poor self‐rated health (OR: 0.31, 95% CI: 0.28 to 0.34), and the number of chronic conditions (OR: 1.12, 95% CI: 1.09 to 1.14). Conclusion: About four out of 10 individuals aged 80 and over in Germany had probable depression, underlining the importance of this challenge. Knowledge of specific risk factors for this age group may assist in addressing older adults at risk of probable depression. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between pet ownership and psychosocial outcomes among the oldest old in Germany during the Covid‐19 pandemic. Methods/Design: Data from the "Old Age in Germany (D80+)" study were used, a large, nationwide representative study covering both individuals living at home and individuals in nursing homes aged 80 years and above (n = 2867 individuals). The telephone interviews were conducted from May to October 2021. Established tools (e.g., "Short Form of the Depression in Old Age Scale", DIA‐S4) were used to quantify the outcomes. Five groups were generated: (1) no pet ownership, (2) having at least one dog (but no other pets), (3) having at least one cat (but no other pets), (4) having at least one other pet (but neither dogs nor cats), (5) having at least two different types of pets (in any combination). Results: Multiple linear regressions showed that compared to individuals without a pet, individuals having at least one dog had significantly lower loneliness levels (β = −0.21, p < 0.01). In the fully‐adjusted models, other forms of pet ownership were not significantly associated with the outcomes examined. Conclusion: Particularly living with a dog was associated with lower loneliness among the oldest old people in Germany. If living with a dog is in line with the preferences and attitudes of the very old, this could be a strategy for reducing loneliness in this age group. Key points: There is a dearth of studies examining the association between pet ownership and psychosocial outcomes based on nationally representative data.Using nationally representative data of the D80+, our aim was to explore the association between pet ownership and psychosocial outcomes during the Covid‐19 pandemic ‐ an area in which literature is extremely limited.Living with a dog was associated with lower loneliness.Multiple pet ownership may help to maintain life satisfaction.This could indicate a strategy for reducing loneliness in this age group. [ABSTRACT FROM AUTHOR]

Objectives: The 25‐item Hikikomori Questionnaire (HQ‐25) is an instrument developed to measure a condition characterized by extreme social withdrawal that was first described in Japan. This study aimed to translate the HQ‐25 into German and validate the German version (HQ‐25‐G). Methods: Translation was conducted according to established guidelines. Validation was based on data from a quota sample of individuals living in Germany, ranging from 18 to 74 years old (representing the distribution of age, sex and federal state, n = 5000). Data collection occurred during August and September 2023. We tested reliability, construct validity and concurrent validity. Moreover, HQ‐25 scores for key sociodemographic group were reported. Results: Internal reliability for the HQ‐25‐G was excellent (Cronbach's alpha = 0.93). We confirmed the original three‐factor model. Moreover, higher hikikomori levels were significantly associated with more depressive symptoms (r = 0.50), more anxiety symptoms (r = 0.45), higher loneliness levels (r = 0.56), higher levels of objective social isolation (r = −0.47), higher levels of perceived social isolation (r = 0.59) and a higher preference for solitude (r = 0.45). Conclusions: In a large population‐based sample (including younger adults, middle‐aged adults and older adults), the HQ‐25‐G version proves to be a psychometrically robust instrument, which is useful for further exploring the phenomenon of hikikomori within the German‐speaking population. [ABSTRACT FROM AUTHOR]

Objectives: To examine the factors associated with institutionalization among individuals aged 80 years and over in Germany (total sample and stratified by sex). Methods/Design: We used data from the nationally representative 'Old Age in Germany (D80+)' (analytic sample: n = 9572 individuals), including individuals aged 80 years and over in Germany. Institutionalization (private living vs. institutionalization) served as an outcome measure. For the written interview, data collection took place from November 2020 to April 2021. Multiple logistic regressions of the overall sample (also stratified by sex) were applied. Results: In the analytic sample, 10.2% (95% CI: 9.2%–11.3%) of the participants were institutionalized. The odds of being institutionalized were positively associated with being female (OR: 2.02, 95% CI: 1.08 to 3.80), being 90 years and over (compared to 80–84 years, OR: 1.67, 95% CI: 1.17 to 2.40), not being married (e.g., being single compared to being married: OR: 14.06, 95% CI: 6.73 to 29.37), higher education (e.g., high education compared to low education: OR: 1.88, 95% CI: 1.25 to 2.84), more favorable self‐rated health (OR: 1.32, 95% CI: 1.07 to 1.62) and greater functional impairment (OR: 15.34, 95% CI: 11.91 to 19.74). Sex‐stratified regressions were also conducted, mostly yielding similar results. Conclusion: Our study highlighted the role of several sociodemographic factors (particularly marital status, e.g., being single) and functional impairment for the risk of institutionalization among the oldest old in Germany. This study confirms findings in studies in younger samples that functional decline is the main factor associated with institutionalization. As functional decline may be modifiable, efforts to maintain functional abilities may be important. This knowledge is important for relevant groups (such as clinicians and policy‐makers) because it may guide early intervention and prevention efforts, can help allocate healthcare resources effectively and shape policies to support independent living. Further insights using longitudinal data is recommended. Key points: Based on nationally representative data of the D80+, the objective of this study was to investigate the determinants of institutionalization among the oldest oldMarital status and functional impairment: key risk factors for institutionalizationStrategies to delay functional limitations can help individuals to live at home for as long as possible [ABSTRACT FROM AUTHOR]

Objectives: There are few studies investigating the determinants of psychosocial outcomes using data exclusively from the oldest old; and even fewer that use longitudinal data. Thus, our aim was to explore the determinants of psychosocial factors (in terms of life satisfaction, loneliness, and depressive symptoms) amongst the oldest old (also stratified by sex) based on representative, longitudinal data from Germany. Methods/Design: Data from "Survey on quality of life and subjective well‐being of the very old in North Rhine‐Westphalia (NRW80+)" were used. This study includes community‐dwelling and institutionalized individuals aged 80 years and above (n = 1760 observations in the analytical sample) located in North Rhine‐Westphalia (the most populous state in Germany). The mean age was 86.6 years (SD: 4.3 years). Established instruments were used to quantify life satisfaction, loneliness, and depressive symptoms. Linear FE regressions were used in this study to mitigate the challenge of unobserved heterogeneity. Sex‐stratified regressions were also conducted. Results: Regressions showed that the loss of a spouse was significantly associated with worsening psychosocial factors (in terms of increases in depressive symptoms and loneliness). Furthermore, regressions revealed that increases in functional impairment were significantly associated with poorer psychosocial outcomes. Conclusions: This longitudinal study enhanced our understanding of the factors contributing to poorer psychosocial outcomes among the oldest old. Efforts to avoid or postpone functional impairment may contribute to more favorable psychosocial outcomes. Moreover, our current study underlines the importance of spousal relationships for psychosocial outcomes in the oldest age group. Key points: Using longitudinal, representative data of the North Rhine‐Westphalia (NRW80+), the objective of this study was to investigate the determinants of psychosocial outcomes among the oldest oldEstablished tools were used to quantify the key variables. Gender‐stratified regressions were also conductedPoorer psychosocial outcomes: linked to spousal loss and functional impairment in particularEfforts to avoid or postpone functional impairment may contribute to more favorable psychosocial outcomes [ABSTRACT FROM AUTHOR]

Background: Reduced physical activity and having a migration background are both associated with higher loneliness; however, the moderating role of migration background in the association between loneliness and physical activity remains largely unknown. Methods: We used cross‐sectional data from the sixth wave (year 2017) of the German Ageing Survey (DEAS). Loneliness was measured using the De Jong Gierveld tool and physical activity was dichotomised into either of the following (i.e., at least 150 min of moderate physical activity per week) or not following physical activity recommendations of the World Health Organization (WHO). For evaluation of the associations we applied adjusted linear regression models with robust standard errors. Results: We included 6257 (average age = 67 years, 50% female) and 285 (average age = 63 years, 51% female) participants without and with migration background, respectively. In multiple linear regressions both migration background (ß = 0.13, P = 0.001), as well as not following the WHO physical activity recommendations (ß = 0.06, P < 0.001) were associated with increased loneliness. Moreover, the respective interaction term reached statistical significance (ß = −0.27, P = 0.013). Participants with migration background have a more pronounced association between following the WHO physical activity recommendations and reduced loneliness compared to participants without migration background. Conclusion: Among middle‐aged and older individuals, those with migration background benefit to a larger extent from following physical activity recommendations than the population without migration background regarding loneliness. Thus, motivating individuals with migration background to follow the WHO physical activity guidelines could particularly assist in reducing loneliness. [ABSTRACT FROM AUTHOR]

Background: There is limited knowledge regarding the association between oral health and mental health in terms of depressive symptoms and particularly anxiety symptoms. Therefore, our aim was to close this gap in knowledge. Methods: Cross‐sectional data were used from wave 5 of the pan‐European Survey of Health Ageing, and Retirement in Europe (SHARE) (n = 62 358 observations). The Beck Anxiety Inventory was used to quantify anxiety symptoms and the Euro‐D was used to measure depressive symptoms. Oral health was quantified based on the presence of missing natural teeth, the number of missing natural teeth and the extent of replaced teeth. It was adjusted for several covariates in regression analysis. Results: Multiple linear regressions revealed that the presence of missing natural teeth was associated with higher anxiety symptoms (β = 0.11, P < 0.001) and higher depressive symptoms (β = 0.22, P < 0.001) among the total sample. Among individuals with at least one missing natural tooth, the number of missing natural teeth was positively associated with higher anxiety symptoms (β = 0.02, P < 0.001) and higher depressive symptoms (β = 0.02, P < 0.001) – and fully replaced teeth (compared to not at all replaced teeth) were associated with lower anxiety symptoms (β = −0.35, P < 0.001) and lower depressive symptoms (β = −0.36, P < 0.001). Conclusion: Our study stresses the association between lower oral health and lower mental health among older adults in Europe. Future studies based on longitudinal data are required. [ABSTRACT FROM AUTHOR]

Objectives: Restricted knowledge exists with regard to the association between grandchild care and loneliness among older Europeans. Hence, our goal was to investigate the association between the onset of grandchild care and loneliness in different European regions and stratified by sex longitudinally.Methods/design: Longitudinal data were taken from waves 5 to 6 of the 'Survey of Health Ageing, and Retirement in Europe' (SHARE) (n = 83,416 observations). Loneliness was assessed using the established three-item version of the Revised UCLA Loneliness scale. Transitions into grandchild care (= onset of grandchild care) served as key independent variable. It was adjusted for several covariates in regression analysis. Linear FE regressions with cluster-robust standard errors were used to mitigate the challenge of unobserved heterogeneity.Results: Linear FE regressions showed that the onset of grandchild care was significantly associated with an increase in loneliness levels among women (but not men) in Southern Europe (β = 0.28, p = 0.01), whereas the onset of grandchild care was not significantly associated with changes in loneliness levels in both sexes in Western Europe, Eastern Europe, Northern Europe and Israel.Conclusions: Our study emphasized the association between the onset of grandchild care and increases in loneliness among women in Southern Europe. Efforts (e.g., respite services) are required to support this group to avoid loneliness. [ABSTRACT FROM AUTHOR]

Introduction: Subjective cognitive decline (SCD) and depressive symptoms (DS) frequently co‐occur prior to dementia. However, the temporal sequence of their emergence and their combined prognostic value for cognitive decline and dementia is unclear. Methods: Temporal relationships of SCD, DS and memory decline were examined by latent difference score modeling in a high‐aged, population‐based cohort (N = 3217) and validated using Cox‐regression of dementia‐conversion. In 334 cognitively unimpaired SCD‐patients from memory‐clinics, we examined the association of DS with cognitive decline and with cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarkers. Results: In the population‐based cohort, SCD preceded DS. High DS were associated with increased risk of dementia conversion in individuals with SCD. In SCD‐patients from memory‐clinics, high DS were associated with greater cognitive decline. CSF Aß42 predicted increasing DS. Discussion: SCD typically precedes DS in the evolution to dementia. SCD‐patients from memory‐clinics with DS may constitute a high‐risk group for cognitive decline. Highlights: Subjective cognitive decline (SCD) precedes depressive symptoms (DS) as memory declines.Emerging or persistent DS after SCD reports predict dementia.In SCD patients, more amyloid pathology relates to increasing DS.SCD patients with DS are at high risk for symptomatic progression. [ABSTRACT FROM AUTHOR]

Introduction: There is a dearth of studies examining the association between the use of community centers for older adults and psychosocial factors. Thus, our aim was to examine the association between the use of community centers for older adults and psychosocial factors (in terms of loneliness, perceived social isolation, and life satisfaction; also stratified by sex)—which is important for successful aging. Methods/Design: Data were taken from a nationally representative sample—the German Ageing Survey—including older community‐dwelling individuals. The De Jong Gierveld tool was used to measure loneliness, the Bude and Lantermann tool was used to measure perceived social isolation, and the Satisfaction with Life Scale was used to quantify life satisfaction. Multiple linear regressions were used to evaluate the hypothesized associations. Results: In the analytical sample, n equaled 3246 individuals (mean age was 75 years, 65–97 years). After adjusting for various socioeconomic, lifestyle‐related, and health‐related covariates, multiple linear regressions showed that the use of community centers was associated with higher life satisfaction among men (β = 0.12, p < 0.01), but not women. The use of community centers was not associated with loneliness or perceived social isolation for either gender. Conclusions: The use of community centers was positively associated with satisfaction with one's own life among male older adults. Thus, encouraging older men to use such services may be beneficial. This quantitative study provides an initial basis for further research in this neglected area. For example, longitudinal studies are required to confirm our present findings. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to examine socioeconomic and health-related variables associated with psychosocial factors among the oldest old.Methods: Cross-sectional data were used from the representative "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" consisting of individuals aged 80 years and over (n = 952, average age was 86 years) living in North Rhine-Westphalia (most populous state of Germany). Established tools were used to quantify loneliness, life satisfaction and depressive symptoms. Socioeconomic and health-related determinants were included in regression analysis.Results: Multiple linear regressions showed that higher life satisfaction was associated with a greater network size, lower functional impairment and better self-rated health. Moreover, higher loneliness was associated with being unmarried, a smaller network size, worse self-rated health and higher functional impairment. Additionally, more depressive symptoms were associated with lower age (i.e., 80-84 years compared to 90 years and over), asset poverty, the presence of multimorbidity, higher functional impairment and worse self-rated health.Conclusions: Our study identified various socioeconomic and health-related factors associated with worse psychosocial factors among the oldest old. This knowledge may assist in targeting oldest old individuals at risk for worse psychosocial factors. [ABSTRACT FROM AUTHOR]

Thus far, the prevalence and correlates of obesity among the oldest have been identified in several studies. Nevertheless, there is a lack of a systematic review, meta‐analysis and meta‐regression synthesizing the existing observational studies. Consequently, our aim was to fill this knowledge gap. Three electronic databases were searched (Medline, PsycINFO, CINAHL) and an additional hand search was performed. Observational studies (both, cross‐sectional and longitudinal) determining the prevalence and (preferably) the correlates of obesity in the oldest old (≥80 years) were included. Data extraction covered study design, measurement of obesity, analytical approach, sample characteristics and main results. In total, 19 studies were included. Reported prevalence of obesity in the community varied greatly (range 0.7%–71.5%). The pooled prevalence of obesity was 17.8% (95% CI: 13.3%−22.2%), with significant heterogeneity between studies (I2 = 99.7%, P < 0.001). There is evidence of a publication bias. Meta‐regressions showed that some of the heterogeneity was explained by the types of measures of obesity and country of the respective sample. In conclusion, obesity remains a key challenge among the oldest old. Future research in this age bracket is urgently required in regions mostly neglected thus far (e.g., South America, Africa or Asia). Moreover, studies based on longitudinal data are required to clarify the determinants of obesity among the oldest old. Furthermore, studies based on objectively recorded obesity (e.g., waist circumference) are also required. Geriatr Gerontol Int 2022; 22: 373–383. [ABSTRACT FROM AUTHOR]

Objectives: Many studies have investigated the impact of spousal care on the caregiver's (sometimes care recipient's) life, whereas only few studies took its effect on the partnership into account. Therefore, the aim of the study was to examine whether the onset of spousal caregiving or care receipt in a person's life is associated with a change of the own partnership characteristics. Method: A longitudinal design was set up which included 4573 participants of 2014 and 2017 (fifth and sixth wave) of the DEAS (German Ageing Survey – a nationally representative sample). Receipt of spousal care or spousal caregiving activity was detected by dichotomous questions, and the partnership characteristics (partnership satisfaction, conflict frequency and partnership bond) were measured by three 5‐point scales. For estimating the effect of spousal care on the own partnership characteristics, linear fixed effects (FE) regressions were used for each of the independent subgroups (caregiver and care recipient). Thus, the analysis was performed with an unpaired sample of caregivers and care recipients. Results: Adjusted for potential confounders, regression analysis showed that while the caregivers' satisfaction with partnership decreased, partnership satisfaction of the care recipients increased with the onset of spousal care. A decrease of the conflict frequency and the partnership bond were only identified among caregivers. Conclusion: This longitudinal study extends previous knowledge in the field of spousal care research and underlines the importance of appropriate interventions in these care situations. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to identify whether the onset and the end of fear of falling (FOF) are associated with psychosocial consequences (in terms of depressive symptoms, loneliness, social isolation, autonomy, and subjective well-being).Methods/design: Longitudinal data for this study were taken from the nationally representative German Ageing Survey which included community-dwelling individuals ≥40 years (wave 5 and wave 6). Psychosocial outcome measures were assessed using widely established and well-validated scales. The presence of FOF was used as the main explanatory variable. It was adjusted for age, family status, labor force participation, self-rated health, physical functioning, as well as the number of chronic conditions.Results: Linear fixed effects regressions revealed that FOF was associated with adverse psychosocial outcomes (increased depressive symptoms, lower life satisfaction, lower positive affect, higher negative affect, and lower perceived autonomy). Asymmetric fixed effects regressions analysis showed that the onset of FOF was associated with reduced life satisfaction as well as reduced autonomy, whereas the end of FOF was associated with reduced depressive symptoms, decreased loneliness scores, as well as decreased negative affect.Conclusions: The study findings suggest that future studies should analyze the consequences of FOF differently (onset and end of FOF) which has practical important implications. More specifically, while strategies to avoid the onset of FOF may help to maintain satisfaction with life and autonomy, strategies to end FOF may contribute to avoid increased loneliness, feelings of negative affect, as well as increased depressive symptoms. J Am Geriatr Soc 68:-, 2020. [ABSTRACT FROM AUTHOR]

Objectives: There is a lack of longitudinal studies, which are both based on nationally representative samples and use standardized instruments to quantify social isolation. Thus, the purpose of this study was to determine the link between perceived social isolation and cognitive functioning longitudinally.Methods/design: Longitudinal data with n = 6420 from 2014 (wave 5) to 2017 (wave 6) were drawn from the German Ageing Survey (nationally representative sample of individuals aged 40 years and over). Perceived social isolation was assessed using a scale by Bude and Lantermann. Cognitive functioning was quantified using the established digit symbol test. To reduce the problem of unobserved heterogeneity, linear fixed effects regressions were used.Results: Regressions showed that increases in perceived social isolation were associated with decreases in cognitive functioning. With regard to covariates, decreases in cognitive functioning were associated with increases in aging and worsening self-rated health, whereas changes in marital status, employment status, income, physical functioning, and physical illnesses were not associated with the outcome measure.Conclusions: Based on a nationally representative sample and exploiting the panel data structure, the study findings extend current knowledge by showing that increasing perceived social isolation contributes to decreases in cognitive functioning among individuals aged 40 years and over longitudinally. Future longitudinal studies based on panel data methods are required to validate the study findings. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is important for healthy ageing. Nonetheless, recommended PA guidelines from the World Health Organization are not met by many older adults. To increase PA, influencing factors have been investigated. But it is still unknown how the onset or disappearance of pain within an individual is associated with different PA intensities in older men and women. Method: We used longitudinal data from the nationwide representative German Ageing Survey, waves 2014 and 2017 (analytical sample, n = 6194, 45% women). PA was assessed with questions on low, moderate, and vigorous PA per week and converted into metabolic equivalent of task (MET) values. Pain was dichotomized from a 5‐point scale into no pain versus some pain. The association between the onset or disappearance of pain from 2014 to 2017 on total, vigorous, moderate, and low PA was investigated using sex stratified asymmetric fixed effects models. Results: The onset of pain in older men (ß = 977.84, P = 0.041), and the disappearance of pain in older women (ß = 1531.69, P = 0.025), were associated with increased total PA. The results for men were driven by increases in vigorous (ß = 592.62, P = 0.035) PA, while the change in women was driven by low (ß = 242.16, P = 0.020) and moderate (ß = 496.48, P = 0.034) PA intensities. However, the observed differences between men and women were not statistically significant. Conclusion: The divergent associations between the onset and disappearance of pain and PA, driven by different PA intensities in men and women, suggest the existence of factors such as PA intensity influencing the association. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have examined the association between frequency of contact with friends and relatives via internet and psychosocial factors (in terms of loneliness, life satisfaction and depressive symptoms). However, far less is known about such a link during the COVID‐19 pandemic, particularly based on nationally representative samples. Therefore, the aim of this study was to examine this association among middle‐aged/older adults. Methods/Design: Data were taken from the short survey of the German Ageing Survey (June/July 2020, 3134 individuals in the analytical sample). The De Jong Gierveld scale was used to quantify loneliness, the Satisfaction with Life Scale was used to quantify life satisfaction and the 10‐item version of the Center for Epidemiological Studies‐Depression was used to quantify depressive symptoms. Results: Regressions showed that—compared to daily users—less frequent users of the internet for contact with friends and relatives reported increased loneliness, lower life satisfaction and more depressive symptoms. With regard to covariates, better psychosocial factors were associated with medium education (compared to low education), living with partner in the same household (compared to singles), better self‐rated health, and favourable COVID‐19 factors (in terms of decreased feeling that the Corona crisis is a threat for oneself, not having an infection with the coronavirus and an increased feeling that you can influence an infection with the coronavirus yourself). Conclusions: Data suggest that individuals with a high frequency of contact with friends and relatives via internet reported better psychosocial factors. Future research in other cultural settings are required. Key points: Nationally representative data were used (collected during the pandemic).Compared to daily users‐less frequent users of the internet for contact with friends and relatives reported increased loneliness, lower life satisfaction and more depressive symptoms.Daily contact with friends and relatives via internet may be particularly helpful when other ways to stay in regular contact (e.g., personal contact) are difficult or nearly impossible.Knowledge about such associations may assist in addressing individuals at risk for adverse psychosocial outcomes. [ABSTRACT FROM AUTHOR]

Background: Mounting evidence suggests that dementia can be prevented. Targeting several risk factors simultaneously constitutes a promising strategy for preserving cognitive function. The AgeWell.de‐study was a cluster‐randomized trial applying a multi‐domain intervention to preserve cognitive function in older adults at risk for dementia in Germany. Method: Individuals with a Cardiovascular Risk Factors, Aging and Dementia (CAIDE) dementia risk score ≥ 9 points aged 60‐77 years were recruited. According to randomization of their general practitioner (GP) practice, patients received either a multi‐domain intervention (optimization of nutrition and medication, physical, social and cognitive activity, cardiovascular risk management, intervention in case of depressive symptoms and/or grief) or general health advice and GP treatment as usual over 24 months. Primary outcome was global cognitive performance, assessed using a composite score based on z‐scores of domain‐specific neuropsychological tests. Result: Of 1,030 participants at baseline (intervention/control: n = 487/543), n = 819 (intervention/control: n = 378/441) completed the follow‐up assessment. Intervention and control group did not differ regarding global cognitive performance (β = 0·010, 95% CI: ‐0·085; 0·105) at follow‐up. However, post‐hoc analyses revealed beneficial effects for social cognition (β = 0·132, 95% CI: 0·012; 0·252) and health‐related quality of life (β = 0·194, 95% CI: 0·065; 0·323). The intervention improved global cognitive performance (β = 0·221, 95% CI: 0·015; 0·428), social cognition (β = 0·259, 95% CI: 0·024; 0·494) and health‐related quality of life (β = 0·421; 95% CI: 0·114; 0·728) in participants with low education, and reduced depressive symptoms in highly educated participants (β = ‐0·431; 95% CI: ‐0·781; ‐0·082). Younger participants benefitted from the intervention regarding social cognition (β = 0·174, 95% CI: 0·010; 0·337) and health‐related quality of life (β = 0·405, 95% CI: 0·241; 0·570). Conclusion: No effect of the multi‐domain intervention on global cognitive performance was found for the overall sample. The intervention benefitted global cognitive functioning in individuals with low education and social cognition and health‐related quality of life across the sample. Further benefits regarding specific subgroups point towards the usefulness of tailored interventions. [ABSTRACT FROM AUTHOR]

Background: To date, only a few studies have investigated the association between personality and functional impairment. Therefore, our purpose was to add to this knowledge. Methods: Data from wave 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used (70 028 individuals in the analytical sample). Personality was measured using the 10‐item Big Five Inventory (BFI‐10). Functional impairment was quantified using activities of daily living (ADL) and instrumental activities of daily living (IADL) indices. Multiple linear regressions were conducted. Results: Regressions showed that an increased likelihood of limitations in ADL was associated with higher extraversion, higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience. Similarly, an increased likelihood of limitations in IADL was associated with higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience (only with one IADL index). Conclusions: This knowledge of associations between personality and functional limitations may help in determining individuals at risk for increased functional impairment (e.g., individuals with low conscientiousness or high neuroticism). Future research is needed to clarify the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Aim: Little is known about the link between obesity and loneliness as well as perceived social isolation. Therefore, the objective of this longitudinal study is to clarify whether the onset and the end of obesity is associated with changes in perceived social isolation as well as loneliness (stratified by sex) in older age. Methods: Longitudinal data were used from wave 5 (year 2014) and 6 (year 2017) of the German Ageing Survey – a nationally representative sample of community‐dwelling individuals aged ≥40 years in Germany. Established tools were used to quantify loneliness and perceived social isolation. A body mass index ≥30 kg/m2 was used to classify individuals as being obese. Asymmetric fixed effects regressions were used. Results: Regressions showed that the end of obesity was associated with decreases in perceived social isolation among women (β = −0.24, P = 0.01), but not in men (with significant sex differences). The onset of obesity was not associated with changes in perceived social isolation. Neither the beginning of obesity nor the end of obesity was associated with changes in loneliness. Conclusions: Our findings emphasize the importance of overcoming obesity for women in the second half of life. As most of the existing studies were conducted in Germany, studies from other countries are of importance to understand this association better. Geriatr Gerontol Int 2021; 21: 836–841. [ABSTRACT FROM AUTHOR]

Background: Loneliness and social isolation both have been linked to morbidity and mortality. However, there is a lack of studies investigating whether these factors are associated with expectations of longevity. Therefore, we aimed to clarify this association. Methods: Cross‐sectional data were taken from a nationally representative sample of middle‐aged and older individuals (analytical sample, n = 4857). Well‐established scales were used to measure loneliness and social isolation. Equally to other large cohort studies, expectations of longevity were assessed using the question 'What age do you think you will live to?' It was adjusted for various socioeconomic and health‐related factors. Results: After adjusting for various socioeconomic and health‐related covariates, multiple linear regressions showed that both loneliness (total sample: β = −0.97, P < 0.001; men: β = −1.04, P < 0.001; women: β = −0.97, P < 0.01) and social isolation (total sample: β = −0.93, P < 0.001; men: β = −0.86, P < 0.001; women: β = −0.91, P < 0.01) were associated with lower expectations of longevity in the total sample and stratified by gender. Furthermore, lower expectations of longevity were consistently associated with younger age (β = 0.32, P < 0.001), being retired (β = −2.39, P < 0.001), not being employed (β = −1.97, P < 0.001), worse self‐rated health (β = −1.31, P < 0.001), and a higher number of chronic illnesses (β = −0.38, P < 0.001) in the total sample, and in both genders. Conclusions: Even after adjusting for various covariates, findings still indicate an association between both loneliness and social isolation and markedly lower expectations of longevity. Future studies based on longitudinal data are required to gain further insights. [ABSTRACT FROM AUTHOR]

Objectives: Global judgements of life satisfaction are a core aspect of subjective well-being, and of central relevance to understanding how those in need of care view their lives. Therefore, this study aimed to investigate the association between the receipt of informal care and life satisfaction in a longitudinal setting.Design: Longitudinal analysis of a population-based data set of community-dwelling individuals aged 40 years and older.Methods: Data from the German Ageing Survey were used (Waves 2002, 2008, 2011, 2014). Fixed effects regression analysis was implemented to investigate the longitudinal association between receipt of informal care (no/yes) and life satisfaction (Satisfaction with Life Scale), while controlling for sociodemographic data (e.g., age) and health-related factors (e.g., physical and mental health).Results: Results from fixed effects longitudinal models revealed that transitioning from not receiving informal care to receiving informal care predicted a decrease in life satisfaction. This result remained stable when specific types of receipt of informal care were used as predictors.Conclusions: Receiving informal care is associated with a decrease in life satisfaction, irrespective of the type of informal care received. These results highlight the necessity of taking the care recipient's perception into consideration, and indicate the imminent need for the care situation to be improved, if the life satisfaction of care recipients is to be maintained. Statement of contribution What is already known on the topic? In general, few studies investigate the care recipients' perspective regarding outcomes associated with the receipt of informal care. Particularly, studies on the association between receipt of informal care and life satisfaction, and especially longitudinal population-based studies, are rare. What does this study add? Evidence of a population-based longitudinal study in a sparsely investigated field of research Our longitudinal study found recipients of informal care to report reduced life satisfaction This negative association remained stable when investigating different tasks of informal care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the association between the onset of multimorbidity with loneliness and social network size longitudinally.Methods: Longitudinal data was used from the German Ageing Survey, a representative sample of adults aged 40 and over, residing in private households. The presence of two or more illnesses indicated multimorbidity. A 6-item version of the validated De Jong Gierveld Loneliness scale was used to assess perceived loneliness. The network size of respondents was represented by counts of important people in regular contact. Fixed-effects regressions adjusted for time-varying socio-demographic, life style, and health-related variables were used.Results: The regression analysis yielded, when controlling for possible confounders, that the onset of multimorbidity led to increased loneliness (β = .06, p < .001). However, the results revealed as well that the onset of multimorbidity was associated with an increased network size (β = .29, p < .001).Conclusion: Results demonstrate a complex relationship of the variables examined. Efforts to target multimorbidity, eg, to postpone or prevent it, could be helpful to decrease loneliness. [ABSTRACT FROM AUTHOR]

Objectives: It has been shown that negative health comparisons (i.e., when one's health is viewed as worse than the health of relevant others) are associated with subjective well-being (SWB). However, it remains an open question whether negative consequences of health comparisons on SWB might be attenuated by moderating resilience factors. Thus, the aim of this study was to investigate whether optimism, self-esteem, and self-efficacy moderate the relationship between health comparisons and SWB using a longitudinal approach.Design: Data from wave 3 (2008) to wave 5 (2014) of the German Ageing Survey which is a representative sample of community-dwelling individuals in Germany (≥40 years) were investigated.Methods: Validated scales were used to measure optimism, self-esteem, self-efficacy, and SWB. Linear fixed effects regressions were used (with n = 17,136 observations).Results: Regressions revealed that optimism moderates the relationship between negative health comparisons and negative as well as positive affect. Furthermore, self-efficacy moderates the relationship between negative health comparisons and life satisfaction as well as negative affect. Self-esteem moderates the relationship between health comparisons and negative as well as positive affect.Conclusion: The study findings suggest that the negative consequences of negative health comparisons might be attenuated by optimism, self-esteem, and self-efficacy. Thus, programs aiming at increasing optimism, self-esteem, and self-efficacy might be helpful to maintain SWB. Statement of contribution What is already known on this subject? One recent study has investigated the relation between health comparisons and subjective well-being (SWB). Longitudinal studies are missing investigating the moderating factors in this relation. What does this study add? Our longitudinal study examined whether resilience factors moderate the relationship between health comparisons and SWB. Optimism moderates the relationship between health comparisons and negative as well as positive affect. Self-efficacy moderates the relation between health comparisons and cognitive well-being and negative affect. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have observed protective effects of high mental demands at work on cognitive functioning and dementia risk. However, it is unclear what types of demands drive this effect and whether this effect is subject to a person's genetic risk. We investigated to what extent eight different types of mental demands at work together with the APOE e4 allele, a major risk gene for late-onset Alzheimer's disease, affect cognitive functioning in late life.Methods/design: The population-based German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe, n = 2 154) followed cognitively healthy individuals aged 75 years and older in seven assessment waves. Cognitive functioning was assessed via the mini-mental status examination.Results: Mixed-effects modeling (adjusted for education, gender, marital status, stroke, depression, and diabetes) indicated that participants who had an occupational history of working in jobs with high compared to low demands in "Language & Knowledge", "Pattern detection", "Information processing", and "Service" had a slower cognitive decline. APOE e4-allele carriers had an accelerated cognitive decline, but this decline was significantly smaller if they had a medium compared to a low level of demands in contrast to non-carriers.Conclusions: Our longitudinal observations suggest that cognitive decline could be slowed by an intellectually enriched lifestyle even in risk gene carriers. Fostering intellectual engagement throughout the life-course could be a key prevention initiative to promote better cognitive health in old age. [ABSTRACT FROM AUTHOR]

Introduction: Subjective cognitive decline (SCD) is a risk condition for dementia, including dementia of Alzheimer type (DAT). Methods: We report sensitivity, specificity, positive and negative predictive values (PPV, NPV) for conversion to all‐cause dementia, and DAT in different SCD types (decline in memory, assocated worries, longitudinal consitency, of the AgeCoDe study (n = 2.402, 12 years follow‐up). Results: 82.7% of those converting to any dementia and 84.4% of those converting with DAT at follow‐up, reported memory decline and fulfilled criteria of SCD at least at one time point before. SCD with worries at two consecutive time points showed a specificity of 92.2% for any dementia and also for DAT as well as a PPV of 44.3% for any dementia and of 36.9% for DAT at follow‐up at the expense of low sensitivity. Discussion: Different SCD subtypes were either sensitive or specific for future all‐cause dementia and DAT in cognitively unimpaired individuals. Modest PPV of the most specific SCD subtypes were achieved in this low prevalence population. [ABSTRACT FROM AUTHOR]

Background: Pain is a frequent phenomenon in old age. It has been shown that increases in pain are longitudinally associated with depressive symptoms. This strong link can be attenuated by coping strategies like resilience. However, to date, there is a lack of longitudinal studies, based on nationally representative samples that have examined whether flexible goal adjustment moderates the relation between pain and depressive symptoms. Thus, the purpose of this study was to identify whether there is a longitudinal association between pain and depressive symptoms, and to examine whether flexible goal adjustment moderates this link. Methods: Longitudinal data (wave 3 and wave 4; 5582 observations) were taken from a sample (German Ageing Survey) which is nationally representative for middle‐aged and older adults (40 years and over). A widely used pain measurement (single‐item measure) served as the key independent variable. An instrument created by Brandstaedter and Renner was used to quantify flexible goal adjustment. The 15‐item version of the Centre for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Results: Linear fixed effects regressions demonstrated that an increase in pain was associated with an increase in depressive symptoms (β = 0.42, P < 0.001). Moreover, flexible goal adjustment significantly moderated this association (β = −0.39, P < 0.01). With regard to potential confounders, an increase in depressive symptoms was associated with increasing age and worsening self‐rated health. Conclusion: The study findings showed that increasing pain leads to more depressive symptoms using a longitudinal approach. In addition, flexible goal adjustment moderated this link. Therefore, programs aiming at improving flexible goal adjustment may assist in avoiding an increase in depressive symptoms alongside pain increases among older adults. [ABSTRACT FROM AUTHOR]

Aim: Dual sensory impairment (DSI) is a common phenomenon in later life. However, only a few studies investigated whether DSI is associated with healthcare use. Therefore, our purpose was to determine whether DSI is associated with healthcare use among older adults. Methods: Data were taken from the most recent sixth wave of the German Ageing Survey. When self‐reported hearing problems and visual impairment were both present, individuals were classified as dual sensory impaired. The frequency of general practitioner (GP) visits, frequency of specialist visits and hospitalization were used as outcome measures. Covariates (mainly based on self‐reports) were selected based on Andersen's behavioral model. In total, 5081 observations were in our analytical sample. Results: Among individuals with DSI, mean ± SD number of GP visits was 4.4 ± 4.7, mean ± SD number of specialist visits was 3.7 ± 5.0, and 23.2% were hospitalized in the past 12 months. Among individuals without sensory impairment, mean ± SD number of GP visits was 3.0 ± 3.6, mean ± SD number of specialist visits was 2.4 ± 3.4, and 17% were hospitalized in the past 12 months. Negative binomial regressions revealed that the presence of DSI was associated with increased specialist visits (incidence rate ratio = 1.17 [95% confidence interval: 1.06–1.28]), whereas it was not associated with GP visits and hospitalization. Conclusions: Even after adjusting for several covariates, individuals with DSI had higher specialist visits than individuals without DSI. As the presence of DSI is associated with an increased economic burden, efforts to prevent or delay DSI may be beneficial. Geriatr Gerontol Int ••; ••: ••–••Geriatr Gerontol Int 2020; ••: ••–••. [ABSTRACT FROM AUTHOR]

Objective: Little attention has been given to psychological factors as correlates of health care use, which could be an important key to manage it. We analyzed the association of psychological factors with health care use.Data Sources: Primary data were obtained from three follow-ups (2002, 2008, and 2011) of a large population-based study with participants aged 40+.Study Design: Using a longitudinal observational study, we analyzed the psychological factors of negative and positive affect (affective well-being), life satisfaction (cognitive well-being), self-efficacy, loneliness, self-esteem, optimism, and flexible goal adjustment using fixed-effects regressions.Data Collection: The participants provided data on health care use (visits to general practitioners [GPs] and specialists as well as hospitalization) and psychological factors via self-administered questionnaires and personal interviews (7,116 observations). The sample was drawn using national probability sampling.Principal Findings: Controlling for self-rated health, chronic diseases and sociodemographics, increases in affective well-being, and optimism decreased health care use of GPs, specialists, and hospital treatment. Increases in cognitive well-being decreased health care use of GPs and specialists. Increases in self-efficacy decreased hospitalization.Conclusions: The study underlines the influence of psychological factors on health care use. Thus, whenever possible, future studies of health care use should include psychological factors, and efforts to reduce health care use might focus on such factors. [ABSTRACT FROM AUTHOR]

Objectives: To examine the role of internal and external locus of control (LOC) in the frequency of physician visits longitudinally.Design: A nationally representative, longitudinal cohort study of German households. Data were used from the years 2005 and 2010.Methods: Data were gathered from the German Socio-Economic Panel (GSOEP). The ten internal and external LOC items in the SOEP are based on a scale by Krampen. The number of physician visits in the last 3 months was used as outcome variable. According to Andersen's behavioural model, predisposing characteristics, enabling resources, and need factors were included as control variables.Results: Fixed-effects Poisson regressions showed that physician visits increased with increasing external LOC, whereas changes in internal LOC were not associated with changes in physician visits. Furthermore, physician visits increased with need factors (decreased self-rated health; onset of disability), whereas predisposing characteristics and the enabling resources were not associated with physician visits.Conclusions: Our findings emphasize the meaning of changes in external LOC for physician visits. As there is evidence that interventions can change the LOC, efforts to modify external LOC might be beneficial for the health care system. Statement of contribution What is already known on this subject? A few cross-sectional studies have investigated the association between locus of control (LOC) and health care use. Longitudinal studies are needed to get a deeper understanding of the causal relationship between these factors. What does this study add? Our longitudinal study provides insights into the impact of general internal and external LOC on physician visits. This is the first study examining the long-term relation in Germany using a population-based sample. [ABSTRACT FROM AUTHOR]

Objective: To investigate factors affecting willingness to pay (WTP) for health insurance of older adults in a longitudinal setting in Germany.Data Sources: Survey data from a cohort study in Saarland, Germany, from 2008-2010 and 2011-2014 (n1  = 3,124; n2  = 2,761) were used.Study Design: Panel data were taken at two points from an observational, prospective cohort study.Data Collection: WTP estimates were derived using a contingent valuation method with a payment card. Participants provided data on sociodemographics, lifestyle factors, morbidity, and health care utilization.Principal Findings: Fixed effects regression models showed higher individual health care costs to increase WTP, which in particular could be found for members of private health insurance. Changes in income and morbidity did not affect WTP among members of social health insurance, whereas these predictors affected WTP among members of private health insurance.Conclusions: The fact that individual health care costs affected WTP positively might indicate that demanding (expensive) health care services raises the awareness of the benefits of health insurance. Thus, measures to increase WTP in old age should target at improving transparency of the value of health insurances at the moment when individual health care utilization and corresponding costs are still relatively low. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to investigate whether transpersonal trust (TPT) moderates the relationship between chronic conditions and general practitioner (GP) visits among the oldest old in Germany. Methods: The multicenter prospective cohort Study on Needs, health service use, costs and health‐related quality of life in a large sample of oldest old primary care patients (85+) (AgeQualiDe) was carried out. Individuals were recruited through GP offices at six study centers in Germany (follow‐up wave 7). Primary care patients were aged ≥85 years (n = 861, mean age 89.0 years; range 85–100 years). The self‐reported number of outpatient visits to the GP was used as the outcome measure. To explore religious and spiritual beliefs, the short form of the Transpersonal Trust scale was used. The presence or absence of 36 chronic conditions was recorded by the GP. Results: Multiple Poisson regressions showed that GP visits were positively associated with the number of chronic conditions (incidence rate ratio 1.03, P < 0.05). TPT moderated the relationship between chronic conditions and GP visits (incidence rate ratio 1.01, P < 0.05). The association between chronic conditions and GP visits was significantly more pronounced when TPT was high. Conclusion: Our findings highlight the importance of TPT in the relationship between chronic conditions and GP visits. Future longitudinal studies are required to clarify this subject further. Geriatr Gerontol Int 2019; 19: 705–710. [ABSTRACT FROM AUTHOR]

Objective: To analyze the association of anxiety symptoms with health care use and costs in people aged 85 and older. Methods: Baseline data from AgeQualiDe (N = 856), a multicenter prospective cohort study of primary care patients aged 85 and older, were analyzed. Anxiety symptoms (Geriatric Anxiety Inventory—Short Form) and health care use were assessed via questionnaires. Health care use was monetarily valued using German unit costs to obtain sectoral (inpatient, outpatient, nursing care, medical supplies, and medication) and total costs. Health care use and costs were analyzed in regression models as a function of anxiety symptoms, as well as relevant covariates (predisposing, enabling, and other need characteristics based on the Behavioral Model of Health Care Use). Results: On a descriptive level, people with increased anxiety symptoms (12% of the sample) incurred on average € 10 909 (SD: 16 023) in the last 6 months, 31% more than those without increased anxiety (€ 8303, SD: 11 175; P = 0.12). Adjusting for predisposing, enabling, and other need characteristics, anxiety symptoms were not significantly associated with health care use or costs. Specifically, need characteristics (morbidity, cognitive decline, and functional impairment) were associated with total or sectoral costs, depending on the cost category analyzed. Conclusion: In a sample of people of the oldest‐old age group, the severity of anxiety symptoms was not associated with health care use or costs, when adjusting for relevant covariates. A longitudinal analysis could assess whether a change in anxiety symptom severity is associated with health care use or costs in old age. [ABSTRACT FROM AUTHOR]

Aim: Little is known about whether changes to obesity are associated with changes in loneliness scores. Therefore, using a longitudinal approach, we aimed to determine whether the onset of obesity (explanatory variable) is associated with changes in loneliness (outcome measure) among older adults. Methods: For the present study, data from wave 2 (2002) to wave 5 (2014) of the German Ageing Survey were analyzed. This is a representative sample of community‐dwelling individuals in Germany (≥40 years). A validated six‐item scale by Gierveld and van Tilburg was used to quantify loneliness. Obesity was defined as body mass index ≥30 kg/m2. Fixed effects regressions were used. Results: Fixed effects regressions showed that loneliness increased with the onset of obesity among men but not among women. The sex × obesity interaction term was significant (P = 0.02). Conclusions: Findings stress the importance of the onset of obesity for loneliness among older men. Weight management strategies might also be a promising strategy to reduce loneliness scores. [ABSTRACT FROM AUTHOR]

Objective: Subjective cognitive decline (SCD), the earliest symptom in preclinical Alzheimer's disease (AD), is insufficient to identify individuals at risk for AD dementia. Therefore, we aimed to investigate whether function in instrumental activities of daily living (IADL) contributes to identification.Methods: We analysed data of cognitively unimpaired participants of the prospective German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe) and its extension, the Study on Needs, Health Service Use, Costs and Health-related Quality of Life in a Large Sample of Oldest-old Primary Care Patients (AgeQualiDe), collected over 10.5 years. Development of AD dementia was quantified as incidence rates (IRs) per 1000 person-years. Cox regression was used to assess the association of SCD and IADL function in regard to incident AD dementia.Results: Of 1467 included individuals, 792 (54.0%) reported SCD at baseline. Impaired IADL were present in 50 (3.4%) individuals. IR for AD dementia was highest in individuals with SCD and impaired IADL (49.7; 95% CI, 24.8-99.3). Unadjusted and adjusted Cox analyses revealed an increased AD dementia risk for individuals with SCD and impaired IADL (uHR = 6.1; 95% CI, 2.9-13.0; P < 0.001; aHR = 2.5; 95% CI, 1.1-5.7; P < 0.05).Conclusions: Consistent with the SCD concept, IADL function was largely well preserved in the majority of individuals with SCD. However, if difficulties in IADL were present, risk for AD dementia was increased. Therefore, screening for IADL impairment could serve as an economically viable indicator to assess AD dementia risk above and beyond SCD. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine the impact of falls on depressive symptoms among the oldest old in Germany longitudinally.Methods: Data were used from 2 waves of the multicenter prospective cohort "Study on needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe). This study covers primary care patients ≥85 years (at baseline: n = 547, average age of 88.9 ± 3.0 years; ranging from 85 to 100 years). General practitioner-diagnosed falls were used as explanatory variable. The Geriatric Depression Scale was used as outcome measure.Results: Linear fixed effects regressions showed that the occurrence of falls is associated with an increase in depressive symptoms (β = .60, P = .02), whereas changes in marital status, ageing, social support, functional decline (instrumental activity of daily living), cognitive impairment, and an increase in chronic diseases did not affect depressive symptoms. In sensitivity analysis, an increase in depressive symptoms was associated with functional impairment (basic activities of daily living; Barthel index; β = -.04, P = .005).Conclusions: Based on a large, population-based longitudinal study, this study underlined the impact of falls on depressive symptoms and consequently extended previous knowledge about an association between falls and depressive symptoms in the oldest old. Developing strategies to prevent falls might also help to prevent depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: While it is known that informal caregiving is associated with care‐derived self‐esteem cross‐sectionally, little is known about the impact of informal caregiving on general self‐esteem longitudinally. Thus, we aimed at examining whether informal caregiving affects general self‐esteem using a longitudinal approach. Methods: Data were gathered from a population‐based sample of community‐dwelling individuals aged 40 and over in Germany from 2002 to 2014 (n = 21 271). General self‐esteem was quantified using the Rosenberg scale. Individuals were asked whether they provide informal care regularly. Results: Fixed effects regressions showed no significant effect of informal caregiving on general self‐esteem longitudinally. General self‐esteem decreased with increasing morbidity, increasing age, decreasing social ties, whereas it was not associated with changes in employment status, marital status and body mass index. Additional models showed that decreases in self‐esteem were associated with decreases in functional health and increases in depressive symptoms. Conclusion: Our longitudinal study emphasises that the occurrence of informal caregiving did not affect general self‐esteem longitudinally. Further research is needed in other cultural settings using panel data methods. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to identify general psychological factors related to fear of falling. Methods: Data drawn from national probability sampling of the German population aged ≥40 years were used (German Aging Survey; n = 7779). The fear of falling and the psychological factors of loneliness, life satisfaction, positive affect, negative affect, optimism, self‐efficacy, self‐esteem, self‐regulation and perceived stress were collected in self‐administered questionnaires. Multiple logistic regression models controlling for sociodemographic, lifestyle and health‐related variables were used to determine the psychological correlates of fear of falling. Results: The prevalence of fear of falling was 18% for all individuals. All psychological factors showed strong bivariate associations with fear of falling. In the multiple regression analyses, higher levels of loneliness, lower life satisfaction, lower positive affect and higher negative affect, as well as lower levels of optimism, self‐efficacy, self‐esteem, self‐regulation and more perceived stress, were associated with increased fear of falling after controlling for sociodemographic factors, various lifestyle factors and morbidity. Conclusions: The psychological factors considered in the present study are important for characterizing people with fear of falling. Because effective interventions to treat the fear of falling are available, our study might help to address this target group more accurately. Geriatr Gerontol Int 2018; 18: 396–406. [ABSTRACT FROM AUTHOR]

Abstract: An accurate diagnosis is essential for the management of late‐life depression in primary care. This study aims to (1) provide information on the agreement on depression diagnoses between general practitioners (GPs), dimensional tools (Geriatric Depression Scale [GDS], Hospital Anxiety and Depression Scale [HADS]) and a categorical tool (Structured Clinical Interview for DSM‐IV criteria [SCID]) and (2) identify factors associated with different diagnoses. As part of the multicenter study “Late‐life depression in primary care: needs, health care utilization and costs (AgeMooDe)” a sample of 1113 primary care patients aged 75 years and older was assessed. The proportion of depression was 24.3% according to GPs, 21.8% for the GDS, 18.9% for the HADS and 8.2% for the SCID. Taking GDS, HADS and SCID as reference standards, recognition of GPs was 47%, 48% and 63%. Cohen's Kappa values indicate slight to moderate agreement between diagnoses. Multinomial logistic regression models showed that patient related factors of depression were anxiety, intake of antidepressants, female gender, a low state of health, intake of medication for chronic diseases and functional impairment. GPs performed better at ruling out depression than ruling in depression. High levels of disagreement between different perspectives on depression indicate that they may be sensitive to different aspects of depression. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the cost‐effectiveness of individual face‐to‐face cognitive behavioral therapy (CBT) compared to therapist guided Internet‐based self‐help (GSH‐I) in overweight or obese adults with binge‐eating disorder (BED). Method: Analysis was conducted alongside the multicenter randomized controlled INTERBED trial. CBT (n = 76) consisted of up to 20 individual therapy sessions over 4 months. GSH‐I (n = 71) consisted of 11 modules combining behavioral interventions, exercises including a self‐monitoring food diary, psychoeducation, and 2 face‐to‐face coaching sessions over 4 months. Assessments at baseline, after 4 months (post‐treatment), as well as 6 and 18 months after the end of treatment included health care utilization and sick leave days to calculate direct and indirect costs. Binge‐free days (BFD) were calculated as effect measure based on the German version of the Eating Disorder Examination. The incremental cost‐effectiveness ratio (ICER) was determined, and net benefit regressions, adjusted for comorbidities and baseline differences, were used to derive cost‐effectiveness acceptability curves. Results: After controlling for baseline differences, CBT was associated with non‐significantly more costs (+€2,539) and BFDs (+40.1) compared with GSH‐I during the 22‐month observation period, resulting in an adjusted ICER of €63 per additional BFD. CBTs probability of being cost‐effective increased above 80% only if societal willingness to pay (WTP) was ≥€250 per BFD. Discussion: We did not find clear evidence for one of the treatments being more cost‐effective. CBT tends to be more effective but also more costly. If the societal WTP for an additional BFD is low, then our results suggest that GSH‐I should rather be adopted. [ABSTRACT FROM AUTHOR]

Within the framework of the health-belief model, some studies exist investigating the association between illness-specific psychosocial factors and the use of cancer screenings. However, studies investigating the association between general psychosocial factors and the use of cancer screenings are missing. Thus, this study aimed at examining the association between well-established general psychosocial factors and the use of cancer screenings. Data were gathered from a large, population-based sample of community-dwelling individuals aged 40 and above in Germany ( n = 7673; in 2014). Loneliness, cognitive well-being, affective well-being (negative and positive affect), optimism, self-efficacy, self-esteem, self-regulation, perceived autonomy, perceived stress, and perceived social exclusion were used as general psychosocial factors. Furthermore, individuals were asked whether they regularly underwent early cancer screening in the past years (yes; no). A total of 65.6% of the individuals used cancer screening. Adjusting for sociodemographic factors, self-rated health, morbidity and lifestyle factors, multiple logistic regressions revealed that the use of cancer screening is positively associated with decreased loneliness, cognitive well-being, optimism, self-efficacy, self-esteem, self-regulation, perceived autonomy, decreased perceived stress, decreased perceived social exclusion, and positive affect, while it is not associated with negative affect. This study stresses the strong association between general psychosocial factors and the use of cancer screening. This knowledge might be fruitful to address individuals at risk for underuse. [ABSTRACT FROM AUTHOR]

In this paper we analysed healthcare costs in a sample of elderly patients suffering from multimorbidity. On the one hand, multimorbid individuals consume a disproportionally large share of healthcare resources. On the other hand, the patient specific number and combination of co-occurring single diseases result in inhomogeneous data leading to biased estimates when using traditional regression techniques. Therefore, we applied a mixture of regressions in order to control for unobserved heterogeneity focussing on the identification of multimorbidity patterns. We used a subsample of N = 1050 patients from a multicentre prospective cohort study of randomly selected multimorbid primary care patients aged 65 to 85 years in Germany (ISRCTN 89818205) who completed a detailed questionnaire on healthcare utilization during the 6-month period preceding the interview. Disease combinations of 1047 were included. We detected four different groups of patients with regard to total costs. These groups corresponded largely to findings from the epidemiological literature. The effect of the presence of an additional disease on costs differed between groups. Moreover, two diametrically opposed cost trends were detected with respect to the number of co-occurring diseases. While in one group costs increased with the number of co-occurring diseases, in a second group cost tended to decrease. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction Previous studies have demonstrated that an overall high level of mental work demands decreased dementia risk. In our study, we investigated whether this effect is driven by specific mental work demands and whether it is exposure dependent. Methods Patients aged 75+ years were recruited from general practitioners and participated in up to seven assessment waves (every 1.5 years) of the longitudinal AgeCoDe study. Analyses of the impact of specific mental work demands on dementia risk were carried out via multivariate regression modeling (n = 2315). Results We observed a significantly lower dementia risk in individuals with a higher level of “information processing” (HR, 0.888), “pattern detection” (HR, 0.878), “mathematics” (HR, 0.878), and “creativity” (HR, 0.878). Yet, exposure-dependent effects were only significant for “information processing” and “pattern detection.” Discussion Our longitudinal observations suggest that dementia risk may be reduced by some but not all types of mental work demands. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to compare the predictive accuracy of different methods suggested for approximation of drug prescription durations in claims data. Methods We expanded a well-established modeling and simulation framework to compare approximated drug prescription durations with 'true' (i.e., simulated) durations. Real claims data of persons aged ≥65 years insured by the German nationwide 'Statutory Health Insurance Fund' AOK between 2010 and 2012 provided empiric input parameters that were completed with missing information on actual dosing patterns from an observational cohort. The distinct approximation methods were based on crude measures (one tablet a day), population-averaged measures (defined daily doses), or individually-derived measures (longitudinal coverage approximation of the applied dose, COV). As a proof-of-principle, we assessed the methods' performance to predict the well-characterized bleeding risks of anticoagulant, antiplatelet, and/or non-steroidal anti-inflammatory drugs. Results When applied to modeling and simulation data sets, the closest, least biased, and thus most accurate approximation was observed using the COV approximation. In a real-data example, rather similar results to an external reference were obtained for all methods. However, some of the differences between methods were meaningful, and the most reasonable and consistent results were obtained with the COV approach. Conclusion Based on theoretically most accurate approximations and practically reasonable estimates, the individual COV approach was preferable over the population-averaged defined daily dose technique, although the latter might be justified in certain situations. Advantages of the COV approach are expected to be even bigger for drug therapies with particularly large dosing heterogeneity. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives To examine how visual impairment affects physical and cognitive function in old age. Design A longitudinal population-based prospective cohort study. Setting General practitioner offices at six study centers in Germany. They were observed every 1.5 years over four waves. Participants Individuals aged 77-101 at follow-up Wave 2 (N = 2,394). Measurements Physical and cognitive function were assessed using an adapted scale that had been previously developed, and visual impairment was rated on a Likert scale (none, mild, severe or profound). Results Adjusting for sociodemographic factors and comorbidity, linear fixed-effects regression showed that the onset of severe visual impairment was associated with a decline in physical function score in the total sample ( β = −0.15, P = .01) and in women ( β = −.15, P = .03). Moreover, the onset of severe visual impairment was associated with decline in cognitive function score in the total sample ( β = −0.38, P < .001) and in women ( β = −0.38, P < .001) and men ( β = −0.37, P = .001). Conclusion Visual impairment affects physical and cognitive function in old age. Interventional strategies to postpone visual impairment may contribute to maintaining physical and cognitive function. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective We examined the association between disorder specific factors, comorbidity and health related quality of life (HRQoL) in anorexia nervosa (AN). Method HRQoL was assessed using the EuroQol-5D visual analog scale (EQ-VAS) in this cross-sectional study. Three regression models were estimated to determine the association between AN subtype (restrictive vs. binge/purge), duration of the eating disorder (ED), age (adolescents vs. adults), ED pathology (EDE-Q), Body Mass Index (BMI), depressive symptoms (PHQ-9), somatic complaints (PHQ-15), anxiety (GAD-7) and EQ-VAS. Results The sample comprised 218 female AN patients (mean age = 23.3 years [SD = 8.2]; mean EQ-VAS score = 53.4 [SD = 21.4]). A lower BMI, higher levels of depressive symptoms, and somatic complaints were significantly associated with lower EQ-VAS scores. Discussion Findings of the present study suggest that BMI and comorbidity might be more relevant to HRQoL impairments in AN than age, diagnostic subtype, duration of the ED or current psychopathology. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:630-634) [ABSTRACT FROM AUTHOR]