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Family-centered values are important for caregiving. However, findings on their association with burden are inconsistent. We aim to analyze whether positive aspects of caregiving are mediating the effect of familism on burden among informal caregivers of older adults in Germany. Participants (n = 277) were drawn from the Attitudes Toward Informal Caregivers (ATTIC) project and include informal long-term caregivers of older relatives (aged ≥ 60) quota-sampled from Germany (December 2023). Mediation analyses (linear OLS regression) with robust standard errors were conducted with the classic and the counterfactual causal mediation framework. The classic approach indicated a significant positive direct effect of familism on burden, a significant negative direct effect of PAC on burden and a significant negative indirect effect of familism via PAC on burden; the total effect was not significant. The causal mediation approach supports this; the interaction between familism and PAC was not significant. Thus, sociocultural family-centered values seemed to worsen burden but also to reduce it through positive experiences of caregiving, which did not depend on the strength of familism values. The findings advance our understanding of the mechanisms underlying the stress appraisal of the informal care situation and emphasize the role of positive experiences of care. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) play a crucial role in identifying cognitive impairment and dementia and providing post-diagnostic care. This study investigates (1) how promising GP consider lifestyle changes to maintain cognitive performance in general, (2) GP beliefs about the power of modifiable health and lifestyle factors to maintain cognitive performance, and (3) whether those beliefs vary by GP age. Methods: As part of the AgeWell.de trial, GPs (n = 72) completed a process evaluation questionnaire assessing their perspectives on lifestyle changes to preserve cognitive performance in elderly patients. In greater detail, their perceived efficacy of established risk and protective factors was investigated using a 5-point Likert scale. Descriptive statistical analyses were performed for research question (1) and (2). Spearman´s rank correlations and ordinal logistic regressions were used to answer research question (3). All results were interpreted exploratively. Results: GPs rated the overall chance of lifestyle changes maintaining cognitive performance quite neutral with a median score of 3.0 (IQR = 2.0). They rated the efficacy of all the modifiable health and lifestyle factors high, with increase in physical and social activity ((Mdn = 5.0, IQR = 1.0) receiving the highest ratings with the narrowest range. Spearman's rank correlation indicated a significant positive relationship between age and the belief in "Optimization of nutrition" for preventing cognitive decline and dementia (ρ =.255, p =.041). However, ordinal logistic regressions showed no significant relationships between age and GP ratings of lifestyle change efficacy. Conclusion: These findings highlight the positive perception of GPs on the efficacy of modifiable health and lifestyle factors for preventing cognitive decline and dementia. Trial registration: The AgeWell.de trial is registered in the German Clinical Trials Register (DRKS; trial identifier: DRKS00013555, Registration Date 07 December 2017). [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]

Background: Listing tools have been developed to improve medications in older patients, including the Fit fOR The Aged (FORTA) list, a clinically validated, positive-negative list of medication appropriateness. Here, we aim to validate MyFORTA, an automated tool for individualized application of the FORTA list. Methods: 331 participants of a multi-center cohort study (AgeCoDe) for whom the FORTA score (sum of overtreatment and undertreatment errors) had been determined manually (gold standard [GS]) were reassessed using the automated MyFORTA (MF) tool. This tool determines the score from ATC and ICD codes combined with clinical parameters. Results: The FORTA scores were 9.01 ± 2.91 (mean ± SD, MF) versus 6.02 ± 2.52 (GS) (p < 0.00001). Removing undertreatment errors for calcium/vitamin D (controversial guidelines) and influenza/pneumococcal vaccinations (no robust information in the database), the difference decreased: 7.5 ± 2.7 (MF) versus 5.98 ± 2.55 (GS) (p < 0.00001). The remaining difference was driven by, for example, missing nitro spray in coronary heart disease/acute coronary syndrome as the related information was rarely found in the database, but notoriously detected by MF. Three hundred and forty errors from those 100 patients with the largest score deviation accounted for 68% of excess errors by MF. Conclusion: MF was more sensitive to detect medication errors than GS, all frequent errors only detected by MF were plausible, and almost no adaptations of the MF algorithm seem indicated. This automated tool to check medication appropriateness according to the FORTA list is now validated and represents the first clinically directed algorithm in this context. It should ease the application of FORTA and help to implement the proven beneficial effects of FORTA on clinical endpoints. [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]

Background Patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and dementia are underrepresented in specialist palliative home care (SPHC). However, the complexity of their conditions requires collaboration between general practitioners (GPs) and SPHC teams and timely integration into SPHC to effectively meet their needs. Objective To facilitate joint palliative care planning and the timely transfer of patients with advanced chronic non-malignant conditions to SPHC. Methods A two-arm, unblinded, cluster-randomised controlled trial. 49 GP practices in northern Germany were randomised using web-based block randomisation. We included patients with advanced CHF, COPD and/or dementia. The KOPAL intervention consisted of a SPHC nurse–patient consultation followed by an interprofessional telephone case conference between SPHC team and GP. The primary outcome was the number of hospital admissions 48 weeks after baseline. Secondary analyses examined the effects on health-related quality of life and self-rated health status, as measured by the EuroQol 5D scale. Results A total of 172 patients were included in the analyses. 80.4% of GP practices had worked with SHPC before, most of them exclusively for cancer patients. At baseline, patients reported a mean EQ-VAS of 48.4, a mean quality of life index (EQ-5D-5L) of 0.63 and an average of 0.80 hospital admissions in the previous year. The intervention did not significantly reduce hospital admissions (incidence rate ratio = 0.79, 95%CI: [0.49, 1.26], P  = 0.31) or the number of days spent in hospital (incidence rate ratio = 0.65, 95%CI: [0.28, 1.49], P  = 0.29). There was also no significant effect on quality of life (∆ = −0.02, 95%CI: [−0.09, 0.05], P  = 0.53) or self-rated health (∆ = −2.48, 95%CI: [−9.95, 4.99], P  = 0.51). Conclusions The study did not show the hypothesised effect on hospitalisations and health-related quality of life. Future research should focus on refining this approach, with particular emphasis on optimising the timing of case conferences and implementing discussed changes to treatment plans, to improve collaboration between GPs and SPHC teams. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is often provided by physiotherapists. Yet, an overview of the cost-effectiveness of treatments for musculoskeletal conditions offered by physiotherapists is missing. This review aims to provide an overview of full economic evaluations of interventions for musculoskeletal conditions offered by physiotherapists. Methods: We systematically searched for publications in Medline, EconLit, and NHS-EED. Title and abstracts, followed by full texts were screened independently by two authors. We included trial-based full economic evaluations of physiotherapeutic interventions for patients with musculoskeletal conditions and allowed any control group. We extracted participants' information, the setting, the intervention, and details on the economic analyses. We evaluated the quality of the included articles with the Consensus on Health Economic Criteria checklist. Results: We identified 5141 eligible publications and included 83 articles. The articles were based on 78 clinical trials. They addressed conditions of the spine (n = 39), the upper limb (n = 8), the lower limb (n = 30), and some other conditions (n = 6). The most investigated conditions were low back pain (n = 25) and knee and hip osteoarthritis (n = 16). The articles involved 69 comparisons between physiotherapeutic interventions (in which we defined primary interventions) and 81 comparisons in which only one intervention was offered by a physiotherapist. Physiotherapeutic interventions compared to those provided by other health professionals were cheaper and more effective in 43% (18/42) of the comparisons. Ten percent (4/42) of the interventions were dominated. The overall quality of the articles was high. However, the description of delivered interventions varied widely and often lacked details. This limited fair treatment comparisons. Conclusions: High-quality evidence was found for physiotherapeutic interventions to be cost-effective, but the result depends on the patient group, intervention, and control arm. Treatments of knee and back conditions were primarily investigated, highlighting a need for physiotherapeutic cost-effectiveness analyses of less often investigated joints and conditions. The documentation of provided interventions needs improvement to enable clinicians and stakeholders to fairly compare interventions and ultimately adopt cost-effective treatments. Key Points: Several high-quality economic evaluations of physiotherapeutic treatments for the back and knee exist Economic evaluations of other joints are rare Physiotherapeutic interventions are often cost-effective over treatments provided by other health professionals The description of provided interventions in cost-effectiveness analyses needs improvement, to allow fair treatment comparisons [ABSTRACT FROM AUTHOR]

Summary: Orthogeriatric co-management (OGCM) may provide benefits for geriatric fragility fracture patients in terms of more frequent osteoporosis treatment and fewer re-fractures. Yet, we did not find higher costs in OGCM hospitals for re-fractures or antiosteoporotic medication for most fracture sites within 12 months, although antiosteoporotic medication was more often prescribed. Purpose: Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence for other fractures is rare. The aim of our study was to conduct an evaluation of economic and health outcomes after the German OGCM for geriatric fragility fracture patients. Methods: This retrospective cohort study was based on German health and long-term care insurance data. Individuals were 80 years and older, sustained a fragility fracture in 2014–2018, and were treated in hospitals certified for OGCM (ATZ group), providing OGCM without certification (OGCM group) or usual care (control group). Healthcare costs from payer perspective, prescribed medications, and re-fractures were investigated within 6 and 12 months. We used weighted gamma and two-part models and applied entropy balancing to account for the lack of randomization. All analyses were stratified per fracture site. Results: We observed 206,273 patients within 12-month follow-up, of whom 14,100 were treated in ATZ, 133,353 in OGCM, and 58,820 in other hospitals. Total average inpatient costs per patient were significantly higher in the OGCM and particularly ATZ group for all fracture sites, compared to control group. We did not find significant differences in costs for re-fractures or antiosteoporotic medication for most fracture sites, although antiosteoporotic medication was significantly more often observed in the OGCM and particularly ATZ group for hip, pelvic, and humerus fractures. Conclusion: The observed healthcare costs were higher in ATZ and OGCM hospitals within 12 months. Antiosteoporotic medication was prescribed more often in both groups for most fracture sites, although the corresponding medication costs did not increase. [ABSTRACT FROM AUTHOR]

Background: There is very limited knowledge regarding pain among the oldest old. Aims: To investigate the prevalence and correlates of pain among the oldest old. Methods: Data were taken from the "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)", including individuals living in North Rhine-Westphalia aged 80 years and over. Pain was categorized as no pain, moderate pain and severe pain. Its prevalence was stratified by sex, age groups, marital status, place of residence and education. A multinomial logistic regression analysis was conducted. Results: 28.50% of the participants reported no pain, 45.06% moderate pain and 26.44% severe pain. Regressions showed that being 85 years or older and a better self-rated health status decreased the likelihood of moderate pain. Being 85–89 years old, being male, highly educated and a better self-rated health status decreased the likelihood of severe pain. The likelihood of moderate and severe pain increased with a higher number of chronic diseases. Discussion: Study findings showed a high prevalence of pain in the oldest old living in North Rhine-Westphalia, Germany. The likelihood of having moderate or severe pain was reduced among those who were older and presented with a better self-rated health but increased with a growing number of comorbidities. Severe pain was less likely among men and those with a higher education. Conclusion: This cross-sectional representative study adds first evidence of prevalence and correlations of pain among the oldest old. Longitudinal studies are required to further explore the determinants of pain in this age group. [ABSTRACT FROM AUTHOR]

Background: Studies have shown an association between a person's religiosity, and physical as well as psychological, health status. However, results differ between certain religious affiliations. While good oral health is important for our overall health and wellbeing, research on religious affiliation and oral health status, specifically oral health-related quality of life (OHRQoL), is lacking. Thus, our aim was to investigate the association between religious affiliation and OHRQoL. Methods: A nationally representative online survey (n = 3,075 individuals) was conducted in August/September 2021. The mean age was 44.5 years (SD: 14.8 years, 18 to 70 years) and 51.1% of the individuals were female. OHRQoL was measured using the Oral Health Impact Profile (OHIP-G5). Religious affiliation served as key explanatory variable. Several covariates were included in regression analyses. Results: Regressions revealed that compared to individuals with no religious affiliation, individuals belonging to Christianity had poorer OHRQoL (β = 0.31, p < 0.01), individuals belonging to Islam had poorer OHRQoL (β = 2.62, p < 0.01) and individuals belonging to another religious affiliation also had poorer OHRQoL (β = 1.89, p < 0.01). Conclusion: Our study demonstrated an association between religious affiliation and OHRQoL. Individuals with specific religious affiliations should be addressed to avoid low OHRQoL. [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 a complete lack of studies focusing on the association between care degree (reflecting the long-term care need) and loneliness or social isolation in Germany. Aims: To investigate the association between care degree and loneliness as well as perceived social isolation during the COVID-19 pandemic. Methods: We used data from the nationally representative German Ageing Survey, which covers community-dwelling middle-aged and older individuals aged 40 years or over. We used wave 8 of the German Ageing Survey (analytical sample: n = 4334 individuals, mean age was 68.9 years, SD: 10.2 years; range 46–100 years). To assess loneliness, the De Jong Gierveld instrument was used. To assess perceived social isolation, the Bude and Lantermann instrument was used. Moreover, the level of care was used as a key independent variable (absence of care degree (0); care degree 1–5). Results: After adjusting for various covariates, regressions showed that there were no significant differences between individuals without a care degree and individuals with a care degree of 1 or 2 in terms of loneliness and perceived social isolation. In contrast, individuals with a care degree of 3 or 4 had higher loneliness (β = 0.23, p = 0.034) and higher perceived social isolation scores (β = 0.38, p < 0.01) compared to individuals without a care degree. Discussion/conclusions: Care degrees of 3 or 4 are associated with higher levels of both loneliness and perceived social isolation. Longitudinal studies are required to confirm this association. [ABSTRACT FROM AUTHOR]

Here, we report the prevalence of loneliness and social isolation and investigate the levels of loneliness and social isolation among transgender and gender diverse people using cross-sectional data from the HH-TPCHIGV study. Using the De Jong Gierveld tool, we assess loneliness, using the Bude and Lantermann tool, we assess perceived social isolation and using the Lubben Social Network Scale, we assess objective social isolation. The prevalence rate of loneliness was 83.3% (perceived social isolation: 77.7%; objective social isolation: 34.4%). Regressions revealed that favorable outcomes (i.e., lower loneliness levels, lower perceived social isolation, and lower objective social isolation) were consistently associated with higher school education. Beyond that, we identify an association between particularly poor health-related factors and higher loneliness and objective social isolation levels. We also report that unemployment was significantly associated with higher levels of perceived social isolation. In conclusion, we show high prevalence rates of loneliness and social isolation among transgender and gender diverse people. Additionally, important correlates (e.g., education, health-related factors, or unemployment) were identified. Such knowledge may provide help to address transgender and gender diverse people at risk for loneliness and social isolation. [ABSTRACT FROM AUTHOR]

Background: The German multi-centre cluster-randomised controlled trial interprof ACT investigated interventions to increase inter-professional collaboration between nursing home (NH) staff and local general practitioners to reduce hospitalisations and improve nursing homes residents’ (NHRs) quality of life. The trial was funded by the German Health Care Innovation Fund. Methods: Cost-effectiveness of interprofACT interventions was evaluated and compared to current standard of care (SOC) over 12 months, including 622 NHRs in 34 NHs in Germany. Multiplying resource use of healthcare services with German-specific unit costs generated costs. Health outcome was measured in quality-adjusted life-years QALYs), utility by multiplying EQ-5D-5L values with German-specific utility weights. Incremental cost-effectiveness analysis used an intention-to-treat approach and scenario analyses (SAs). Net-benefit-regression and cost-effectiveness acceptability curves addressed uncertainty. A German healthcare insurance perspective was assumed. Results: Base case results showed non-significant cost savings of 851.88€ and nonsignificant QALY loss of –0,056. Discussion: Dependency levels at baseline were non-significantly higher in IG compared to control group (CG). Lack of baseline costing data eliminated possibility to evaluate changes in costs due to the interprof ACT measures for both groups. Conclusion: Interprof ACT interventions are not cost-effective compared to current SOC. [ABSTRACT FROM AUTHOR]

Background and Objectives The aim of our study was to fill the gap in knowledge regarding the association between sexual orientation and psychosocial outcomes (loneliness and subjective well-being) based on nationally representative samples. Research Design and Methods Cross-sectional data collected in 2017 were taken from a nationally representative sample of individuals in the second half of life (>40 years) in Germany (n = 4,785, average age 66.4 years, standard deviation [ SD ]: 10.5 years). Outcomes were assessed using well-established tools (life satisfaction: Satisfaction with Life Scale; positive and negative affect: Positive and Negative Affect Schedule; loneliness: De Jong Gierveld Loneliness Scale). Sexual orientation was dichotomized (heterosexual; sexual minorities including gay/lesbian, bisexual, and other). Analyses were adjusted for socioeconomic factors, lifestyle-related factors, and health-related factors. Results In total, around 7.8% of respondents belonged to sexual minorities. Adjusted for various several socioeconomic, lifestyle-related and health-related covariates, linear regressions showed that sexual minority older adults reported higher loneliness scores (β = 0.07, p <.05), whereas sexual orientation was not associated with subjective well-being (life satisfaction, as well as positive and negative affect). Furthermore, our analysis showed that gender, age, marital status, and depressive symptoms were consistently associated with loneliness and subjective well-being. Discussion and Implications In accordance with minority stress theory, our study showed that sexual minority older adults report higher loneliness scores. This finding is important as loneliness has become widely acknowledged as a new geriatric giant, which could increase, for example, the risk of morbidity and mortality. Moreover, reducing loneliness is important for successful aging. [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: The aim was to investigate the prevalence of probable depression and probable anxiety and to investigate the determinants of depressive symptoms and anxiety symptoms among transgender people. Methods: In this "Transgender Survey" (n = 104) we included transgender people who had joined self-help groups to obtain and share information about the gender-affirming surgeries performed at the Division of Plastic, Reconstructive and Aesthetic Surgery at the University Medical Center Hamburg-Eppendorf. Data collection took place between April and October 2022. To measure probable depression, the patient health questionnaire-9 was used. The generalized anxiety disorder-7 was used to quantify probable anxiety. Results: The prevalence of probable depression was 33.3% and it was 29.6% for probable anxiety. Multiple linear regressions showed that both more depressive symptoms and anxiety symptoms were significantly associated with younger age (β = −0.16, p < 0.01; β = −0.14, p < 0.01), being unemployed (e.g., full-time employed compared to unemployment: β = −3.05, p < 0.05; β = −2.69, p < 0.05), worse self-rated health (β = −3.31, p < 0.001; β = −1.88, p < 0.05), and having at least one chronic disease (β = 3.71, p < 0.01; β = 2.61, p < 0.05). Conclusions: Remarkably high prevalence rates were identified among transgender people. Furthermore, risk factors of poor mental health (e.g., unemployment or younger age) were identified—which can help to address transgender people at risk for poor mental health. [ABSTRACT FROM AUTHOR]

This study analyzed the conspiracy mentality of informal caregivers for older persons compared to non-caregivers and whether this association was dependent on age. The sample was collected randomly from a population-based online panel (forsa.omninet) and represents individuals aged ≥40 years from Germany. In total, 3022 participants were questioned about conspiracy mentality (Conspiracy Mentality Questionnaire), informal care provision (N = 489 informal caregivers of older adults), and sociodemographic background. Data assessment took place between 4th and 19th March 2021 and the questions referred to the time between December 2020 and March 2021. No significant differences were found between informal caregivers and non-caregivers. A significant interaction effect was found, indicating a decrease of conspiracy mentality among non-caregivers and an increase among informal caregivers with higher age. After stratifying by gender, this effect was found only among female informal caregivers. Middle-aged informal caregivers had a lower, and older-aged a higher, susceptibility to conspiracy theories during the COVID-19 pandemic compared to non-caregivers. The results indicate that providing care could be protective among middle-aged individuals, whereas older informal caregivers may benefit from interventions to reduce susceptibility to conspiracy theories and the associated risks for health and wellbeing. [ABSTRACT FROM AUTHOR]

Objectives We analyzed whether spousal and adult child caregivers of older adults differed from each other and from noncaregivers in terms of the social support available to them during the coronavirus disease 2019 pandemic, whether available support differed by gender, and whether the perception of pandemic restrictions moderated these differences. Methods Participants (≥40 years) were randomly drawn from the population-based German online panel forsa.omninet. Between March 4 and 19, 2021, 2,520 noncaregivers, 337 adult child caregivers, and 55 spousal caregivers were questioned about social support, perception of pandemic restrictions, health, and sociodemographic information. Adjusted regression analyses and moderator analyses were conducted. Results Adult child caregivers had higher social support from family and friends than noncaregivers, and more support from friends than spousal caregivers. Spousal caregivers had less social support from friends compared to both groups. The perceived restrictions of the pandemic moderated the differences in support from family and friends between spousal caregivers and noncaregivers, and the differences between spousal and adult child caregivers in support from friends. Gender moderated the difference in support by friends between caregiving and noncaregiving wives and sons(-in-law). Discussion Informal caregivers seemed to have a supportive informal network during the pandemic. However, spousal caregivers only had similar levels of support as adult child caregivers if they strongly perceived restrictions of the pandemic, and had the lowest support level of all 3 groups—in particular from friends. Thus, spousal caregivers may benefit most from support actions, and these should focus on their wider social network. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to clarify the link between oral health and quality of life among older adults in Europe. Methods: Cross-sectional data from wave 5 (n = 59,048 observations) were used from the representative Survey of Health, Ageing and Retirement in Europe. Oral health was quantified by three questions: presence of all natural teeth (yes; no); among individuals with missing natural teeth, the number of missing teeth and the extent of replaced natural teeth were quantified. Quality of life was quantified using the widely used CASP-12. Multiple linear regressions were used to determine the association between oral health and quality of life, adjusting for various potential confounders. Results: Multiple linear regressions showed that higher quality of life was associated with (1) the presence of all natural teeth and among individuals with missing natural teeth, with (2) a lower number of missing natural teeth and (3) completely replaced natural teeth. Additionally, quality of life was positively associated with younger age, being female, being married or in a partnership, higher income, higher educational level, not currently smoking, a lower number of functional impairments, better self-rated health, a lower number of depressive symptoms and a lower number of chronic diseases. Conclusion: Study findings showed an association between oral health and quality of life among older adults in Europe. Thus, the importance of good oral health for successful ageing was stressed. Future research is required to clarify the underlying mechanisms. Moreover, longitudinal studies are required to confirm our current findings. [ABSTRACT FROM AUTHOR]

Background: There is limited knowledge regarding the association between oral health-related quality of life and probable depression and anxiety. Our objective was to examine the association between oral health-related quality of life and probable depression and anxiety in the German population (stratified by sex). Methods: In sum, n = 3,075 individuals took part in a nationally representative survey (August/September 2021). The well-established Patient Health Questionnaire-9 (PHQ-9; cut-off of 10) and the Generalized Anxiety Disorder-7 (GAD-7; cut-off of 10) were used to quantify probable depression and anxiety, respectively. Results: The likelihood of probable depression was significantly associated with lower oral health-related quality of life in the total sample (OR: 1.21, 95% CI: 1.18–1.25) and in both women and men. Additionally, the likelihood of probable anxiety was significantly associated with lower oral health-related quality of life in the total sample (OR: 1.17, 95% CI: 1.14–1.21) and in both women and men. Conclusions: Our study emphasized the association between lower oral health-related quality of life and probable depression as well as anxiety in the general adult population in Germany. Future longitudinal studies are required to confirm our findings. [ABSTRACT FROM AUTHOR]

Purpose : Higher Fit fOR The Aged (FORTA) scores have been shown to be negatively associated with adverse clinical outcomes in older hospitalized patients. This has not been evaluated in other health care settings. The aim of this study was to examine the association of the FORTA score with relevant outcomes in the prospective AgeCoDe–AgeQualiDe cohort of community-dwelling older people. In particular, the longitudinal relation between the FORTA score and mortality and the incidence of dementia was evaluated. Methods: Univariate and multivariate correlations between the FORTA score and activities of daily living (ADL) or instrumental activities of daily living (IADL) as well as comparisons between high vs. low FORTA scores were conducted. Results: The FORTA score was significantly correlated with ADL/IADL at baseline and at all follow-up visits (p < 0.0001). ADL/IADL results of participants with a low FORTA score were significantly better than in those with high FORTA scores (p < 0.0001). The FORTA score was also significantly (p < 0.0001) correlated with ADL/IADL in the multivariate analysis. Moreover, the mean FORTA scores of participants with dementia were significantly higher (p < 0.0001) than in those without dementia at follow-up visits 6 through 9. The mean FORTA scores of participants who died were significantly higher than those of survivors at follow-up visits 7 (p < 0.05), 8 (p < 0.001), and 9 (p < 0.001). Conclusion: In this study, an association between higher FORTA scores and ADL as well as IADL was demonstrated in community-dwelling older adults. Besides, higher FORTA scores appear to be linked to a higher incidence of dementia and even mortality. [ABSTRACT FROM AUTHOR]

Our aim was to examine the association between religious affiliation and the likelihood of taking the flu vaccine. Cross-sectional data (year 2014 with n = 7172) were used from the nationally representative German Ageing Survey—covering community-dwelling individuals aged 40 years and over. Multiple logistic regressions showed that compared with individuals without a religious affiliation, individuals with certain religious affiliations had a lower likelihood of taking the flu vaccine. More precisely, the likelihood of taking a flu shot was significantly associated with belonging to the Roman Catholic Church (OR: 0.50, 95% CI: 0.44–0.57), the Protestant Church (OR: 0.68, 0.60–0.77), the Evangelic Free Church (OR: 0.54, 0.35–0.82) and other religious communities (OR: 0.25, 0.14–0.45). The results remained nearly the same when we restricted our analyses to individuals aged 60 years and over (according to existing recommendations for flu vaccination). The association between religious affiliation and the likelihood of taking the flu vaccine was moderated by thoughts about religion and deeds for religion. This knowledge could help to improve the immunization coverage by addressing individuals with certain religious affiliations. [ABSTRACT FROM AUTHOR]

This study investigates how the COVID-19 pandemic has affected the informal caregiving situation in terms of prevalence of caregivers, infection rates, perception of impairment and danger by the pandemic, and changes in the caregiving performance among long-term caregivers from before to during the peak of the pandemic. Informal caregivers (N = 489 during the pandemic) from a population-based sample, representative for individuals aged ≥40 years from Germany (N = 3022, assessed March 2021), were questioned. Sociodemographic information, prevalence and performance of informal care before and during the second pandemic wave, infection rates and perceived impairment and danger of the pandemic were assessed. Results indicate no significantly different prevalence of informal caregiving during the pandemic compared to before. Few caregivers and few of their care recipients were infected. Overall, a low to moderate level of impairment was reported by caregivers, but a moderately high perceived danger, particularly for care recipients. Among long-term caregivers, caregiving intensity and time increased during the pandemic, less ambulatory care but more shopping help was used and care task distribution and use of support changed. While the prevalence of informal caregivers remained unchanged, the caregiving situation worsened among long-term caregivers. Infection rates among caregivers were low, but they perceived themselves and their care recipients to be endangered. Future research and policy should focus more on this vulnerable group during a health crisis, primarily on long-term caregivers, in order to effectively support them in their care provision for the high risk group of older care recipients. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the link between individuals with and without migration background and oral health-related quality of life (also stratified by sex). Methods: Data in this cross-sectional study were taken from a nationally representative survey (n = 3075, August/September 2021). The Oral Health Impact Profile (OHIP-G5) was used to measure oral health-related quality of life. Two-part models were calculated, adjusting for various covariates. Results: Individuals with migration background had lower oral health-related quality of life (total sample, Cohen's d = − 0.30; in men, d =− 0.44; in women, d =− 0.22). Two-part models also revealed that the migration background was associated with a higher likelihood of OHIP-G5 scores of one or higher (total sample and in both sexes). Moreover, migration background was positively associated with the extent of oral health-related quality of life (conditional on OHIP-G5 scores of one or higher; total sample and in men). Furthermore, regressions showed that migration background was associated with lower oral health-related quality of life (total sample and in both sexes). Conclusions: Our study emphasized the link between having a migration background and lower oral health-related quality of life among both women and men. Maintaining oral health among individuals with a migration background is a key challenge. Culturally and socially sensitive actions should provide easy accessible oral health information and preventive measures in order to lower access barriers in dental care for individuals with migration background. [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]

Depressive symptoms and chronic pain are common among patients with multimorbidity creating a complex medical condition for both the patient and the general practitioner. Perceived social support may function as a protective measure. To examine the impact of perceived social support as a potential moderator between depressive symptoms and pain intensity and pain disability in daily activities in multimorbid patients aged 75+. Data from 3,189 patients of the German longitudinal cohort study MultiCare were obtained at baseline and follow-ups during 5 years. Multilevel linear mixed-effects analyses were conducted for pain intensity (model 1) and pain disability in daily activities (model 2). The interaction term social support by depression score was included to test for moderation. The interaction between social support and depressive symptoms was significantly associated with the pain intensity score 0.41 (SE=.17; 95-CI[.08;.74]) but not with the pain disability score 0.35 (SE=.19; 95-CI[-.01;.72]). Additionally, men and individuals with medium or higher educational level showed reduced pain intensity and disability scores. Pain disability scores increased with age and depressive symptoms. Increased pain scores were also found for body mass index and burden of multimorbidity. Perceived social support amplified the association of depressive symptoms on pain intensity and did not show a protective function. The high scores of perceived social support among the participants may point to the practice of secondary gain due to the patients immense health burden. [ABSTRACT FROM AUTHOR]

Depression in older adults is becoming an increasing concern. As depressive symptoms change over time, it is important to understand the determinants of change in depressive symptoms. The aim of our study is to use a longitudinal study design to explore the predictors of change, remission and incident depression in older patients with multimorbidity. Data from the MultiCare cohort study were used. The cohort studied 3,189 multimorbid general practice patients aged 65-85. Data were collected during personal interviews. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS-15). Predictors of change in depressive symptoms were determined using multivariate linear regression, while multivariate logistic regression was used to analyze predictors of remission and incident depression. Models included depressive symptoms at baseline and follow-up, socio-demographics and data on health status and social support. Overall, 2,746 participants with complete follow-up data were analyzed. Mean age was 74.2 years, 59.2% were female, and 11.3% were classified as depressed at baseline. Burden of multimorbidity and social support were statistically significant predictors in all regression analyses. Further predictors of change in depressive symptoms were: income, pain, nursing grade, self-rated health and self-efficacy. The sample size for prediction of remission limited statistical certainty. Assessment of depressive symptoms using GDS-15 differs from routine clinical diagnoses of depression. Predictors of change in depressive symptoms in older multimorbid patients are similar to those predicting remission and incident depression, and do not seem to differ significantly from other older patient populations with depressive symptoms. [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]

Various cross-sectional studies exist examining the association between informal caregiving and sleep quality. However, there is a lack of longitudinal studies investigating whether beginning and ceasing of informal caregiving is associated with changes in sleep quality. Investigating whether beginning and ceasing of informal caregiving of individuals in poor health is associated with changes in sleep quality in both sexes. Data were taken from a nationally representative sample of individuals ≥ 40 years in Germany from 2008 to 2017. In our analytical sample, n equaled 22,910 observations. Based on the Pittsburgh Sleep Quality Index, the sleep quality was assessed by the difficulties falling asleep during the last month, difficulties with sleep because of waking up during the last month (in both cases: (from 1 = not during the last month to 4 = three or more times a week) and the overall assessment of sleep quality during the last month (from 1 = very good to 4 = very bad). Asymmetric fixed effects regressions showed that in men beginning to provide informal care was associated with decreased overall sleep quality (β=-.09 (95% CI: −.15 – −.03), p<.01) and an increased likelihood of difficulties because of waking up (OR: 1.54 (95% CI: 1.07–2.20), p<.05), whereas ceasing to provide informal care was not associated with the outcome measures (both, in women and in men). Starting informal caregiving had deleterious effects on sleep quality in men. Efforts to assist men in maintaining sleep quality may be beneficial. [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 In the light of an increasingly diverse older population in the United States, there is an ongoing discussion on how cultural factors contribute to individual long-term care (LTC) needs and service use. This study empirically assesses whether the level of acculturation and cultural differences in the importance of the family shape foreign-born immigrants' intention to use certain LTC services. Methods We correlated immigrants' intention to use certain LTC services to the cultural strength of family ties that prevails in their region of origin. We used data from the National Health Interview Survey and the World Values Survey/European Values Study for analysis. Multinomial logit models were estimated and predisposing, enabling, and need factors were controlled for. Estimations were weighted to account for the sampling structure, and sensitivity analyses were conducted. Results Immigrants from cultures with stronger family ties are significantly more likely to intend the use of LTC options that include the family. Furthermore, immigrants are less likely to intend the use of exclusively family care when having lived in the United States for a longer time. Discussion We conclude that cultural differences in family ties shape immigrants' intention to use certain LTC services. If policymakers aim at increasing the provision of specific LTC services or support to family caregivers, there should be a careful evaluation of demand-side factors in an increasingly culturally diverse society. [ABSTRACT FROM AUTHOR]

The aim of this longitudinal study was to examine whether the onset and the end of obesity was associated with loneliness. Nationally representative longitudinal data from Germany were taken from the Survey of Health, Ageing and Retirement in Europe (wave 5 to wave 7; n = 10,446 observations in the analytical sample). Using the three item loneliness scale (UCLA), loneliness was measured. According to the WHO thresholds, obesity was defined as BMI ≥ 30 kg/m2. Asymmetric fixed effects (FE) regressions were used. Conventional FE regression analysis revealed that changes in obesity status were associated with changes in loneliness (men: β = −.19, p <.05; women: β =.19, p <.05). Asymmetric FE regressions showed that in men the onset of obesity was associated with a decrease in loneliness (β = –.31, p <.05), whereas the end of obesity was not associated with loneliness. Asymmetric FE regressions showed that in women, the onset of obesity was associated with an increase in loneliness (β =.33, p <.01), whereas the end of obesity was not associated with loneliness. Findings showed that the onset of obesity has different consequences in terms of loneliness for older women and men in Germany, whereas the end of obesity was not associated with changes in loneliness scores. We recommend that future studies should distinguish between the onset and the end of obesity – which comes along with important practical implications. When older women report transitions to obesity, efforts to prevent loneliness may be of importance. [ABSTRACT FROM AUTHOR]

Finding a balance between care and personal needs is often challenging for individuals caring for a person with dementia. The present study aimed to understand how primary and secondary family carers of people with dementia perceive the reconciliation of informal care and their personal life throughout the course of care. Narrative interviews with 14 carers (n =10 female, mean age: 48.79) from seven care networks were conducted. The interviews were analysed using the documentary method. The result was a relational type formation which comprises different process types: 'Respect your boundaries, stay calm, but plan ahead', 'Acting strategic is making it work', 'Reflect the situation, deal with it, and pull it through' and 'There is no alternative, you have to live with it'. This typology was based on two related dimensions: the way people negotiate their own needs against the demands of care (prospective, strategic, reflective and limited) and the resulting attitudes towards reconciling informal care and personal life (accepting, withstanding and enduring). The results yield implications for practice, such as considering individual needs and the care network to provide effective support and promoting the importance of self-care behaviours to achieve a balance between care and personal life. [ABSTRACT FROM AUTHOR]

Background: The 'Lifestyle-integrated Functional Exercise' (LiFE) program successfully reduced risk of falling via improvements in balance and strength, additionally increasing physical activity (PA) in older adults. Generally being delivered in an individual one-to-one format, downsides of LiFE are considerable human resources and costs which hamper large scale implementability. To address this, a group format (gLiFE) was developed and analyzed for its non-inferiority compared to LiFE in reducing activity-adjusted fall incidence and intervention costs. In addition, PA and further secondary outcomes were evaluated. Methods: Older adults (70 + years) at risk of falling were included in this multi-center, single-blinded, randomized non-inferiority trial. Balance and strength activities and means to enhance PA were delivered in seven intervention sessions, either in a group (gLiFE) or individually at the participant's home (LiFE), followed by two "booster" phone calls. Negative binomial regression was used to analyze non-inferiority of gLiFE compared to LiFE at 6-month follow-up; interventions costs were compared descriptively; secondary outcomes were analyzed using generalized linear models. Analyses were carried out per protocol and intention-to-treat. Results: Three hundred nine persons were randomized into gLiFE (n = 153) and LiFE (n = 156). Non-inferiority of the incidence rate ratio of gLiFE was inconclusive after 6 months according to per protocol (mean = 1.27; 95% CI: 0.80; 2.03) and intention-to-treat analysis (mean = 1.18; 95% CI: 0.75; 1.84). Intervention costs were lower for gLiFE compared to LiFE (-€121 under study conditions; -€212€ under "real world" assumption). Falls were reduced between baseline and follow-up in both groups (gLiFE: -37%; LiFE: -55%); increases in PA were significantly higher in gLiFE (+ 880 steps; 95% CI 252; 1,509). Differences in other secondary outcomes were insignificant. Conclusions: Although non-inferiority of gLiFE was inconclusive, gLiFE constitutes a less costly alternative to LiFE and it comes with a significantly larger enhancement of daily PA. The fact that no significant differences were found in any secondary outcome underlines that gLiFE addresses functional outcomes to a comparable degree as LiFE. Advantages of both formats should be evaluated in the light of individual needs and preferences before recommending either format. Trial registration: The study was preregistered under clinicaltrials.gov (identifier: NCT03462654) on March 12th 2018 [ABSTRACT FROM AUTHOR]

The aim of this study was to clarify the link between self-perceptions of ageing and the number of general practitioner (GP) visits, as well as frequent GP visits, longitudinally. In this study, longitudinal data with n = 7,062 observations from 2014 (wave 5) to 2017 (wave 6) were taken from the German Ageing Survey (representative sample of middle aged and older individuals residing in private households). The five-item Attitudes Toward Own Ageing subscale of the Philadelphia Geriatric Center Morale Scale (PGCMS) was used to quantify self-perceptions of ageing. The frequency of GP visits in the past 12 months served as outcome measure (first model: measured continuously; second model: top 10% were defined as frequent attenders). To exploit the features of panel data, and to mitigate the problem of unobserved heterogeneity, fixed effects regressions were used. Adjusting for predisposing characteristics, enabling resources and need-factors, regressions showed that an increase in self-perceptions of ageing was associated with decreases in the number of GP visits (IRR=.83 (95% CI:.77-.91)), and a decreased likelihood of becoming a frequent attender (OR=.44 (95% CI:.29-.66)). Using data from a longitudinal study and exploiting the longitudinal data structure, the current study adds to our current knowledge by demonstrating that self-perceptions of ageing contribute to the frequency of GP visits as well as frequent attendance. Since self-perceptions of ageing are modifiable, this may help to manage health care use. [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]

To determine whether flexible goal adjustment moderates the link between self-rated health and subjective well-being longitudinally. Longitudinal data from 2002 to 2011 taken from a nationally representative sample of middle aged and older adults (≥ 40 years) – the German Ageing Survey. A single-item measure was used to assess self-rated health (ranging from 1 = very good to 5 = very bad). Flexible goal adjustment was measured using a scale developed by Brandstaedter and Renner. Subjective well-being was quantified using the Positive and Negative Affect Schedule and the Satisfaction with Life Scale. Fixed effects (FE) regressions showed that worsening self-rated health is associated with a decrease in positive affect (β=-.07, p<.001) and life satisfaction (β=-.09, p<.001) as well as an increase in negative affect (β=.04, p<.001). Flexible goal adjustment significantly moderated the link between self-rated health and positive (β=.03, p<.05) as well as negative affect (β=-.05, p<.01), i. e., the higher flexible goal adjustment is, the weaker the link is between self-rated health and well-being. Study findings suggest that strategies to enhance flexible goal adjustment may be useful in maintaining well-being among older adults suffering from worsening self-rated health. [ABSTRACT FROM AUTHOR]

Background: Sensory impairments have been associated with dementia in older adults. However, the contribution of different impairments and how they interact in the development of dementia is not clear. We examined the independent and interaction effects of hearing impairment (HI) and visual impairment (VI) on incident dementia. Design: Multi‐centric population‐based prospective cohort study. Setting: Data were taken from the AgeDifferent.de platform, pooling participants aged 75 and older from the German LEILA75+ and AgeCoDe/AgeQualiDe cohorts. Participants: Older adults (N = 3497) with mean age 79.8 years, 67.2% female. Measurements: Standardized interviews and questionnaires were used to assess self‐reported HI and VI at baseline and all‐cause dementia in 9 follow‐ups, spanning over 20 years. Methods: Competing risk regression models were conducted to test the main and interaction effects of HI and VI on dementia incidence, adjusting for established risk factors of dementia and accumulated mortality. Results: HI and VI at baseline were reported by 30.3% and 16.6% of individuals, respectively. Adjusting for baseline information on sociodemographics, substance use, cognitive functioning and morbidity, and controlling for accumulated mortality risk, HI (sHR 1.16, 95% CI 1.04–1.30, p = 0.011) but not VI (sHR 1.07, 95% CI 0.90–1.28, p = 0.462) was significantly associated with incident dementia. There was no interaction between HI and VI (sHR 1.09, 95% CI 0.81–1.46, p = 0.567). Conclusions: Hearing impairment is associated with an increased incidence of all‐cause dementia in older adults. There is no excess risk or risk compensation through the additional presence or absence of visual impairment. Early prevention measures for hearing impairment might help to reduce the long‐term risk of dementia. [ABSTRACT FROM AUTHOR]

Background Qualitative studies showed that community-dwelling Lesbian, Gay, Bisexual and Transgender (LGBT) individuals perceive that LGBT individuals are discriminated against in nursing homes (NHs) due to their sexual orientation. Therefore, the objective of this quantitative, population-based study was to investigate the link between sexual orientation and planning to move into a NH in old age. Methods Cross-sectional data from the most recent sixth wave of the nationally representative German Ageing Survey (n  = 4,645) were used. The sexual orientation was dichotomized (heterosexual; sexual minorities including gay/lesbian, bisexual and other). Planning to move into a NH in the future (yes/no) was our outcome measure. Multiple logistic regressions were performed (adjusting for various socioeconomic, psychosocial and health-related covariates). Results Regressions showed that sexual orientation was not significantly associated with plans to move to a NH. Preference to move into NH were consistently positively associated with age (OR: 1.04 (1.02–1.07), not having at least one child (OR: 2.17 (1.41–3.36)), high education (OR: 3.82 (1.32–11.11)), greater loneliness (OR: 1.44 (1.05–1.96)) and worse physical functioning (OR: 0.99 (0.98–1.00)). Conclusions Unexpectedly, our results showed that plans to move to a NH did not differ significantly between heterosexual individuals and sexual minorities. This indicates that sexual orientation does not play a significant role in shaping preferences around moving into a NH 'in general'. In contrast, other factors like age, greater loneliness and worse physical functioning were important. Those factors should be taken into account when shaping and updating policies on nursing homes. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to determine whether the onset and the end of income poverty were associated with psychosocial factors (depressive symptoms, optimism, loneliness, social isolation, and subjective well-being). Method: For this study, nationally representative longitudinal data were drawn from the German Ageing Survey (wave 5 and wave 6 with n = 8534 in the analytical sample), covering community-dwelling individuals 40 years and over. Widely used and well-established measures were used to quantify psychosocial factors. Asymmetric linear fixed effects (FE) regressions were used. Results: Conventional linear FE regressions showed that changes in income poverty were associated with changes in life satisfaction (β = –0.11, p <.05), changes in positive affect (β = –0.06, p < 0.05), changes in social isolation (β = 0.10, p < 0.05) and changes in optimism (β = –0.06, p < 0.05). Asymmetric linear FE regressions showed that the beginning of income poverty was associated with increases in social isolation (β = 0.14, p < 0.05) and decreases in optimism (β = –0.08, p < 0.05), whereas the end of income poverty was associated with increases in life satisfaction (β = 0.11, p < 0.05). Conclusion: Findings indicate that the onset and the end of income poverty can affect psychosocial factors. More broadly, our findings suggest that upcoming studies should disentangle the consequences of income poverty (distinguishing between the start and the end of income poverty). This has important practical consequences. When individuals fall into poverty, strategies to avoid social isolation and the loss of optimism seems to be important. Furthermore, approaches to leave income poverty may help to rise life satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To examine the influence of a change in one's caregiving status, i.e. beginning to provide grandchild care or ceasing to provide grandchild care, on feelings of loneliness and one's social network size. Method: A longitudinal study was conducted, using data drawn from a population-based sample of community-based individuals ≥ 40 years. This data was analyzed using asymmetric fixed effects models (n = 8,678 observations). Perceived loneliness was measured using a short version of the De Jong Gierveld Loneliness Scale. The number of important people with whom respondents have regular contact was used an outcome variable. All respondents were asked whether they privately cared for children that were not their own. Results: Beginning to undertake care of a grandchild was associated with an increase in loneliness scores among men (β = 0.10, p < 0.001). Beginning to undertake care of a grandchild also increased the social network size among male grandparents (β = 0.68, p < 0.001). Ceasing to undertake grandchild care was not found to have an impact on feelings of loneliness or social network size among male, nor female, grandparents. Conclusion: This study identifies a positive association between caring for one's grandchild and one's social network. Men were found to experiences increases in feelings of loneliness, where women did not, suggesting possible divergences and experiences of this role. Grandfathers in particular should receive additional support when commencing the care of a grandchild to mitigate possible feelings of loneliness. This study builds on the growing literature exploring the implications of a grandparents undertaking supplementary care of their grandchildren. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine aspects of help-seeking for psychological distress and its association with increased anxiety symptoms in the oldest old. Method: Baseline data from AgeQualiDe, a multicenter cohort study of people aged 85 and over recruited in primary care, were analyzed. Help-seeking for psychological distress (items from the Camberwell Assessment of Need for the Elderly) was analyzed using ordinal and logistic regression models as a function of increased anxiety symptoms (Geriatric Anxiety Inventory-Short Form ≥ 3), as well as relevant socio-demographic and health-related covariates. Results:N = 155 (18.1% of the sample) reported having experienced psychological distress recently and were thus included in the analysis. Among those, 26.5% reported experiencing increased anxiety symptoms. On a descriptive level, 76.8% sought informal, 29.0% sought formal, and 18.1% sought no help for psychological distress. In covariate-adjusted regression models, increased anxiety was significantly associated with increased use of informal support (OR: 2.92, 95% CI: 1.31–6.48), but was neither associated with formal (OR: 0.72, 95% CI: 0.26–1.97) nor no help-seeking (OR: 0.28, 95% CI: 0.08–1.05). Conclusion: A large proportion of those experiencing psychological distress sought support from informal sources in this study. Anxiety symptoms in the oldest old were associated with the increased use of informal support, but not formal support or no help-seeking. Training and support for people providing informal help to those with mental health problems should be promoted to reduce a possible burden. However, future research addressing underlying mechanisms is needed. [ABSTRACT FROM AUTHOR]

Background: Oral health care of older adults is of rising importance due to ongoing demographic changes. There is a lack of studies examining the determinants of dental treatment avoidance in this age group. Therefore, the objective of this study was to identify those determinants. Methods: Cross-sectional data were drawn from the second wave (year 2002) of the German Ageing Survey which is a population-based sample of community-dwelling individuals ≥ 40 years in Germany (n = 3398). Dental treatment avoidance was quantified using the question "Did you need dental treatments in the past twelve months, but did not go to the dentist?" [no; yes, once; yes, several times]. Socioeconomic and health-related determinants were adjusted for in the analysis. Multiple logistic regressions were performed. Results: In terms of need, 6.7% of individuals avoided dental treatment in the preceding twelve months. Multiple logistic regressions revealed that dental treatment avoidance was associated with younger age (total sample [OR 0.978; 95% CI 0.958–0.998] and men [OR 0.970; 95% CI 0.942–0.999]), unemployment (total sample [OR 1.544; 95% CI 1.035–2.302] and men [OR 2.004; 95% CI 1.085–3.702]), lower social strata (women [OR 0.814; 95% CI 0.678–0.977]), increased depressive symptoms (men [OR 1.031; 95% CI 1.001–1.062]), and increased physical illnesses (total sample [OR 1.091; 95% CI 1.006–1.183] and men [OR 1.165; 95% CI 1.048–1.295]). The outcome measure was not associated with income poverty, marital status and physical functioning. Conclusions: The present study highlights the association between dental treatment avoidance and different socioeconomic and health-related factors. These results suggest that it is necessary to promote the importance of dental visits. [ABSTRACT FROM AUTHOR]

Background whilst previous studies have investigated the determinants of sexual satisfaction (i) using longitudinal data or (ii) among older adults, only a few studies have done both at the same time. Objective the purpose of this study was to investigate the determinants of sexual satisfaction longitudinally among middle-aged and older adults. Design nationally representative longitudinal study (German Ageing Survey—DEAS). Setting community-dwelling individuals in Germany. Data drawn from three waves (2002, 2008, 2011). Subjects individuals aged 40–95 (36.9% age group 65+). At wave 2 in the year 2002, n  = 3,843 individuals took part. Methods well-established and widely used scales were used to quantify the independent variables. We included variables such as sociodemographic factors, self-rated health, physical functioning, depression and loneliness in our analysis. Sexual satisfaction was our outcome measure. Results were stratified by age (40–64, 65+). To take into account the multilevel data structure, we used random coefficient models. Results random-effects regressions showed that increased sexual satisfaction was consistently associated with the following variables in both age groups: lower number of physical illnesses, β  = −0.03, P  < 0.001 (betas coefficients given for individuals 65 years and over); better self-rated health, β  = −0.06, P  < 0.001; absence of depression, β  = −0.16, P  < 0.01; and higher importance of sexuality and intimacy, β  = 0.08, P  < 0.001. Moreover, sexual satisfaction was associated with having a partner: β  = 0.16, P  < 0.001; living with a partner in the same household, β  = 0.26, P  < 0.001; and a lower score of loneliness, β  = −.28, P  < 0.001. In contrast, sexual satisfaction was, for example, not associated with cognitive functioning. Conclusions the most surprising findings were that among both middle-aged and older adults, almost the same determinants (with exception of sociodemographic factors) were associated with satisfaction with sex life. [ABSTRACT FROM AUTHOR]

Background: The evaluation of care strategies at the end of life is particularly important due to the globally increasing proportion of very old people in need of care. The ICECAP-Supportive Care Measure is a self-complete questionnaire developed in the UK to evaluate palliative and supportive care by measuring patient's wellbeing in terms of 'capability'. It is a new measure with high potential for broad and international use. The aims of this study were the translation of the ICECAP-Supportive Care Measure from English into German and the content validation of this version. Methods: A multi-step and team-based translation process based on the TRAPD model was performed. An expert survey was carried out to assess content validity. The expert panel (n = 20) consisted of four expert groups: representative seniors aged 65+, patients aged 65+ living in residential care, patients aged 65+ receiving end-of-life care, and professionals in end-of-life care. Results: The German version of the ICECAP-Supportive Care Measure showed an excellent content validity on both item- and scale-level. In addition, a high agreement regarding the length of the single items and the total length of the questionnaire as well as the number of answer categories was reached. Conclusions: The German ICECAP-SCM is a valid tool to assess the quality of life at the end of life that is suitable for use in different settings. The questionnaire may be utilized in multinational clinical and economic evaluations of end-of-life care. [ABSTRACT FROM AUTHOR]

To examine whether the incidence of stroke influences affective well-being (positive affect and negative affect), and whether such a relationship is moderated by general self-efficacy. Longitudinal data from 2008, 2011 and 2014 were used from a population-based sample of community-residing individuals ≥ 40 years in Germany (n = 9,659 in regression analysis). Affective well-being was quantified using the established Positive and Negative Affect Schedule (PANAS). A well-established scale by Schwarzer and Jerusalem was used to assess general self-efficacy. General practitioner diagnosed stroke was reported. Fixed effects regressions showed that the incidence of stroke was associated with a decrease in positive affect in the total sample (β = –.17, p <.001) and in both sexes (men: β = –.16, p <.05; women: β = –.19, p <.01). In contrast to these findings, the incidence of stroke was not associated with changes in negative affect (total sample; stratified by sex). Moreover, general self-efficacy moderated the relation between stroke and positive affect. Panel regression models showed that the incidence of stroke was associated with a decline in positive affect in the total sample and in both sexes. As the general self-efficacy moderated this association, it may be beneficial to enhance self-efficacy and prioritize coping strategies among stroke survivals. [ABSTRACT FROM AUTHOR]

Background: The current study aimed to identify whether needs are associated with health care costs in late life longitudinally. Methods: Data were gathered from two waves (at baseline, n = 1199; at follow-up, n = 958) of a multicenter prospective cohort study ('Late-life depression in primary care: needs, health care utilization and costs', AgeMooDe) in Germany. Individuals aged 75 years and above were recruited via general practitioners. The 'Camberwell Assessment of Need for the Elderly' (CANE) was used to assess needs. Based on a questionnaire, the health-related resource use was assessed retrospectively from a societal perspective. The assessment covered outpatient services, inpatient treatment, pharmaceuticals, as well as formal and informal nursing care. Random effects regressions were used. Results: Regressions showed that the number of 'no needs' is inversely associated with total health care costs from a societal perspective (β = –584.0, p <.001). When a health care perspective was adopted, this association was also significant (β = –298.8, p <.001). The association between needs and health care costs persisted in all health care sectors considered in this study. Limitations: It might be difficult to generalize our findings to individuals residing in institutional settings. Conclusion: Adjusting for several potential confounders (e.g. sociodemographic and health-related factors), our study showed that needs – quantified using the CANE – are important for health care costs. Interventions should be developed to reduce needs in late life. These interventions may be beneficial for the health care system. [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]