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OBJECTIVES There is a lack of knowledge on coping with pain and sub-group specific pain-coping profiles among older home care receivers with chronic pain. To describe pain-coping strategies, identify subgroups based on cognitive and behavioral pain-coping strategies and pain-related psychological impairment and to compare these groups with regard to socio-demographic, medical, pharmacological and psychological characteristics. METHOD Data of 212 care receivers were examined using the German pain-coping questionnaire (FESV) to determine how they cope with pain. Subgroups were identified using hierarchic agglomerative cluster analysis, using Ward's algorithm and squared Euclidean distance, and characterized using socio-demographic, medical, pharmacological and psychological parameters. Multinomial logistic regression was used to identify variables associated with the subgroups. RESULTS Older care receivers apply cognitive and behavioral strategies to manage pain. Three subgroups were identified: Cluster 1 (25.9%) with good coping competences and little psychological impairment, Cluster 2 (40.1%) with poor coping competences and high psychological impairment, and Cluster 3 (34%) with good coping competences and high psychological impairment. Significant differences between the clusters were observed for age, pain intensity, pain-related interference, daily activities, depression and resilience. Logistic regression demonstrated that belonging to Cluster 2 was associated with the number of pain-reducing medications, depression and resilience. Belonging to Cluster 3 was significantly linked to daily activities, the number of pain medications, depression and the level of care required. CONCLUSION Differentiating between pain-coping profiles in the group of older care receivers with chronic pain necessitates target group-specific pain-oriented psychotherapeutic interventions, which can result in improved pain management.

Fur ambulant versorgte Altere (≥60 Jahre) finden sich Schmerzpravalenzraten bis zu 53 %. Pflegebedurftige in Deutschland stellen unter den Schmerzbetroffenen mit Pravalenzen um 70 % eine relevante Gruppe dar. Zur Geschlechtsspezifik liegen differierende Aussagen vor. Ziel war die Ermittlung von Schmerzparametern auskunftsfahiger alterer Pflegebedurftiger im grosstadtischen Raum unter Berucksichtigung von Geschlechtsunterschieden sowie relevanter medizinischer und medikamentoser Versorgungsaspekte. Durchgefuhrt wurde eine Querschnittsuntersuchung (strukturierte Interviews) bei ≥ 65-jahrigen auskunftsfahigen (MMST ≥ 18) Pflegebedurftigen (SGB XI) mit chronischen Schmerzen (n = 225) in der eigenen Hauslichkeit. Schmerzparameter wurden mit der deutschen Version des Brief Pain Inventory (BPI-NHR) erfasst. Die Prufung des erklarenden Einflusses soziodemografischer und medizinischer Parameter, psychischer und physischer Beeintrachtigungen sowie der Analgetikaversorgung auf den starksten Schmerz erfolgte mittels multipler Regressionsanalyse. Analysen zeigen eine durchschnittliche Schmerzintensitat von 5,3 (SD ± 2,0). Der starkste Schmerz erreicht im Mittel einen Wert von 7,0 (SD ± 2,2). Signifikante Geschlechtsunterschiede waren geringfugig vorhanden (z. B. Schmerzorte, Medikamentenanzahl). Anzahl der Schmerzorte (≥14), Alltagsfahigkeiten und Schmerzmedikation (bei Bedarf, keine) waren im finalen Modell mit dem starksten Schmerz assoziiert. Lediglich bei 24,6 % der Schmerzbetroffenen wird eine mehr als 70 %ige Schmerzlinderung unter Behandlung erreicht. Die Ergebnisse verweisen auf ausgepragte Schmerzleiden bei alteren ambulant versorgten Pflegebedurftigen. Es besteht dringender Bedarf fur interdisziplinare Versorgungskonzepte.

Was ist neu? Schmerz und Schmerzfolgen Chronische Schmerzen bei älteren Pflegebedürftigen, die in der eigenen Häuslichkeit leben, sind aufgrund ihrer Häufigkeit und Intensität von hoher Relevanz. Schmerzfolgen werden in dieser vulnerablen Gruppe insbesondere in Form von ausgeprägten Beeinträchtigungen der Mobilität und Aktivität deutlich. Schmerzkommunikation in der ambulanten Versorgung Sowohl die versorgenden Ärztinnen und Ärzte als auch das Pflegepersonal ambulanter Pflegedienste kommunizieren zu selten mit den schmerzbetroffenen Pflegebedürftigen über Schmerzen, ihre Intensität und Dauer sowie über das Schmerzmanagement. Medikamentöse Schmerztherapie Die in der ambulanten Versorgung schmerzbetroffener Pflegebedürftiger defizitäre Schmerztherapie bedarf einer Überprüfung der Angemessenheit schmerzreduzierender Arzneistoffe, der gleichzeitigen Verordnung von Dauer- und Bedarfsmedikation sowie klarer Angaben zu Dosis und Dosisintervallen auf verbindlichen Medikationsplänen. Interdisziplinäre Ressourcen Den Herausforderungen einer interdisziplinären Versorgung älterer Pflegebedürftiger im ambulanten Setting wurde bisher zu wenig Beachtung geschenkt, obwohl die Interdisziplinarität im Schmerzmanagement schon lange gefordert wird. Multidisziplinäres Handeln, basierend auf abgestimmten Leitlinien und Standards, stellt den Schlüssel für ein angemessenes Schmerzmanagement dar. Die Schnittstellenkommunikation zwischen den Berufsgruppen ist optimierungsbedürftig.

Context. There are no available data regarding pain-associated clusters among nursing home residents and older adults receiving home care with chronic pain. Objectives To identify and describe pain-associated clusters in nursing home residents and older adults receiving home care with chronic pain, and to explore associations with clusters in both settings. Methods We surveyed 137 nursing home residents and 205 older adults receiving home care. Clusters were identified using hierarchical agglomerative cluster analysis, utilizing Ward’s method with Squared Euclidean Distances in the proximities matrix. The clusters were characterized based on socio-demographic and clinical characteristics. Multinomial logistic regression was used to identify variables associated with different clusters. Results In each setting, we identified three clusters: pain-relieved, pain-impaired, and suffering severe pain. In the nursing home study and the home care study, respectively, the participant distributions were 46.72% and 11.71% in the pain-relieved cluster, 22.63% and 33.66% in the pain-impaired cluster, and 30.66% and 54.63% in the severe-pain cluster. Appropriate pain medication was only detected among pain-relieved nursing home residents. Conclusion Overall, differences in pain management exist within the two care settings presented here. There is potential for improvement in both settings. Moreover, there exists a need for clinical interventions aiming at shifting from pain-affected clusters to pain-relieved status.

Zusammenfassung. Hintergrund: Die Prävalenzraten von chronischem Schmerz liegen international bei ambulant versorgten älteren Menschen (> 65-Jährigen) bei bis zu 50 %. Eine erste nationale Studie mit auskunftsfähigen Pflegebedürftigen (≥ 18 Jahre) ermittelte für den ambulanten Bereich eine Prävalenzrate von 68,5 %. Eine bedeutende Rolle beim Schmerzmanagement kommt der pflegerischen Versorgung zu. Der bisherige Forschungsstand zur Qualität des pflegerischen Schmerzmanagements ist jedoch unzureichend. Ziel: Somit ist das Ziel der vorliegenden Untersuchung, die Angemessenheit des pflegerischen Schmerzmanagements bei älteren Pflegebedürftigen mit und ohne kognitive Einschränkungen für den ambulanten Bereich zu prüfen. Methode: Die vorliegende Querschnittstudie basiert auf den Daten des Projektes ACHE. In die Untersuchung wurden 219 Pflegebedürftige einbezogen. Mittels persönlich-mündlicher Interviews sowie einer Analyse der Pflegedokumentation wurden Informationen zum subjektiven Schmerzerleben sowie dem Schmerzmanagement eingeholt. Ergebnisse: Die Befragung der Pflegebedürftigen und die Analyse der Pflegedokumentation weisen auf deutliche Defizite hinsichtlich des pflegerischen Schmerzmanagements hin. Defizite zeigten sich vor allem in einer fehlenden systematischen Schmerzerfassung sowie fehlenden Dokumentation von Therapiezielen und der Dokumentation durchgeführter schmerztherapeutischer Maßnahmen. Schlussfolgerungen: Eine mögliche Ursache für die identifizierten Defizite eröffnet sich über derzeitige Rahmenbedingungen, welche das pflegerische Handeln in SGB V und SGB XI Leistungen trennt. Ein angemessenes pflegerisches Schmerzmanagement kann nur gewährleistet werden, wenn Rahmenbedingungen optimiert werden.

Die steigende Zahl langlebiger Menschen wirft Fragen zu psychosozialen Bedingungen eines ausergewohnlich langen Lebens auf. In diesem Zusammenhang wird aus psychologischer Perspektive das Konzept der Resilienz genutzt, um besondere Widerstandsfahigkeit als individuelle Kompetenz zum Erhalt oder zur Wiederherstellung des Funktionsniveaus zu beschreiben. Resilienz wird aus dieser Sicht als relativ stabiles Personlichkeitsmerkmal verstanden, das allerdings im hoheren Alter an Bedeutung verlieren kann. Im vorliegenden Beitrag wird – im Gegensatz zur ublichen Lebensphasenbetrachtung – eine soziologische Perspektive uber den gesamten Lebensverlauf eingenommen. Dies erfolgt unter Einbeziehung des „Rational-choice“-Ansatzes, um Bedingungen, Grundlagen, Strategien und Ergebnisse von Handlungsentscheidungen aus qualitativen biografischen Schilderungen (Leitfadeninterviews) 15 hundertjahriger Frauen und Manner zu beschreiben und zu diskutieren. Resilienz wird in diesem Sinne als Handlungsfahigkeit begriffen. Es zeigt sich, dass uber die gesamte Lebensspanne hinweg bis ins hochste Alter Potenziale fur resilientes Handeln bestehen, Handlungsfahigkeit dabei jedoch in hohem Mase kontextabhangig ist.

Chronic pain experienced by care receivers who live in their own homes is an issue of great importance, due to its frequency and intensity. The impacts of pain in this vulnerable group are manifested particularly in the form of marked adverse effects on mobility and activity.Both physicians and staff of the ambulatory care services involved communicate too rarely about pain, its intensity and duration, with the pain-affected care receiver.The deficient pain therapy provided by ambulatory care services for pain-affected care receivers needs to be checked to ensure that medication is appropriate, that the simultaneous prescription of continuous and acute medication, and the clear information on dosage and dosing intervals is given on binding medication charts.Too little attention has been paid up to now to the challenges of interdisciplinary care for older care receivers in the ambulatory care setting, although interdisciplinarity in pain management has long been a stated requirement. Multidisciplinary action based on agreed guidelines and standards is the key to appropriate pain management. The interface communication between professional groups needs to be optimized in order to provide adequate care for the care receiver.Chronische Schmerzen bei älteren Pflegebedürftigen, die in der eigenen Häuslichkeit leben, sind aufgrund ihrer Häufigkeit und Intensität von hoher Relevanz. Schmerzfolgen werden in dieser vulnerablen Gruppe insbesondere in Form von ausgeprägten Beeinträchtigungen der Mobilität und Aktivität deutlich.Sowohl die versorgenden Ärztinnen und Ärzte als auch das Pflegepersonal ambulanter Pflegedienste kommunizieren zu selten mit den schmerzbetroffenen Pflegebedürftigen über Schmerzen, ihre Intensität und Dauer sowie über das Schmerzmanagement. MEDIKAMENTöSE SCHMERZTHERAPIE: Die in der ambulanten Versorgung schmerzbetroffener Pflegebedürftiger defizitäre Schmerztherapie bedarf einer Überprüfung der Angemessenheit schmerzreduzierender Arzneistoffe, der gleichzeitigen Verordnung von Dauer- und Bedarfsmedikation sowie klarer Angaben zu Dosis und Dosisintervallen auf verbindlichen Medikationsplänen. INTERDISZIPLINäRE RESSOURCEN: Den Herausforderungen einer interdisziplinären Versorgung älterer Pflegebedürftiger im ambulanten Setting wurde bisher zu wenig Beachtung geschenkt, obwohl die Interdisziplinarität im Schmerzmanagement schon lange gefordert wird. Multidisziplinäres Handeln, basierend auf abgestimmten Leitlinien und Standards, stellt den Schlüssel für ein angemessenes Schmerzmanagement dar. Die Schnittstellenkommunikation zwischen den Berufsgruppen ist optimierungsbedürftig.

BACKGROUND The number of centenarians in Europe is increasing; many face health impairments. Adult children often play a key role in their care, but there is a lack of research into what it means for these caregiving relatives to be confronted for many years with their parents' end of life (EOL), dying and death as well as their own advancing age. AIM This study aims to analyse the challenges of caregiving adult children regarding their parents' end of life and the related burdens and barriers they report. MATERIAL AND METHODS Semi-structured interviews were conducted with 13 caregivers following a theory-based and tested guideline. The computer-aided coding and evaluation followed the structured content analysis approach. RESULTS The analysis showed three main themes: 'Confronting EOL', 'Communicating about death and dying' and 'Assisting in the terminal phase'. The respondents commented on burdensome demands and concerns about the future. Further, a strong underlying presence of intra- and interpersonal conflicts relating to EOL became apparent. DISCUSSION The results indicate several potential burdens for centenarians' caregiving offspring. They are confronted with a double challenge resulting from the combination of their own advanced age and experiencing the burdens of their parents' very old age. Further, some participants struggled with their own unclear perspective on the future because of the relative but unclear proximity of the parent's death. Multiple conflicts and overlapping conflict dimensions emphasise the potential of the EOL topic to influence the well-being of family caregivers and care recipients. LIMITATIONS The convenience sample used for the study may cause limitations, for example, the fact that persons with a formally lower educational status are not represented. CONCLUSION The findings suggest that interventions designed for family-related care situations should include topics like 'Finiteness and grief', 'Communicating about dying and death' and 'Decisions and dispositions at EOL'.

Pain management in nursing care in outpatient older adults in need of care

Aim Evidence on antithrombotic therapy use in centenarians diagnosed with atrial fibrillation (AF) is sparse. Our objective was to investigate a possible underprescribing in centenarians relative to younger cohorts of the oldest-old. We assumed lower AF rates; and, within AF patients, lower use of anticoagulants in those who died as centenarians (aged ≥100 years) than in those who died aged in their 80s (≥80 years) or 90s (≥90 years). Methods The present study was a quarterly structured cohort study over the 6 years before death using administrative data from German institutionalized and non-institutionalized insured patients (whole sample n = 1398 and subsample of AF patients n = 401 subclassified according to age-of-death groups [≥80, ≥90, ≥100 years]). AF, medication, stroke risk (Congestive heart failure; Hypertension; 2 × Age ≥75 years; Diabetes mellitus; 2 × Stroke; Vascular disease; Age 65-74 years; Sex [female] (CHA2 DS2 -VASc)) and risk of major bleeding (Hypertension; Abnormal renal and liver function; Stroke; Bleeding; Labile International Normalized Ratio [omitted in the present analysis]; Elderly; Drugs or alcohol (HAS-BLED)) were calculated. Generalized estimation equations were used to model the trajectories. Results Half a year before death (T1), AF rates were higher in patients aged ≥80 years (31.8%) and ≥90 years (30.6%) compared with patients aged ≥100 years (22.4%), whereas there were no significant differences between age groups 6 years before death (T0). Of all AF patients with AF at T1, 26.7% received anticoagulants; 11.2% vitamin K antagonists; 15.7% non-vitamin K antagonist oral anticoagulants; and 17.5% platelet inhibitors; yet 58.1% received none of these drugs. Centenarians received significantly fewer anticoagulants compared with the other age groups. Prescriptions of anticoagulants were not associated with CHA2 DS2 -VASc with and without adjustment for HAS-BLED. Conclusions The present findings highlight the need for more appropriate use of anticoagulation therapy in older patients, as well as for new treatment guidelines taking the heterogeneity of very old patients into account. Geriatr Gerontol Int 2018; 18: 1634-1640.

The aim of this study was to analyze the impact of being pain-affected and fear of falling on functional performance among nursing home residents, longitudinally. We used 6-month follow-up data from a cluster-randomized trial of 12 nursing homes (cluster level) with 239 nursing home residents at baseline (mean age, 95% confidence interval [CI] = 83.04 [81.40, 84.69], 70% women). The longitudinal analysis provided data on pain, fear of falling, functional mobility, and activities of daily living (individual level). The data revealed a trend indicating that pain-relieved nursing home residents showed better functional mobility over time. The results on fear of falling demonstrate obvious differences in the functional performance of nursing home residents cross-sectionally but not longitudinally. Nevertheless, the results underline the importance of an effective pain treatment to prevent decline in functional mobility among nursing home residents. Further longitudinal surveys are needed to verify the findings on functional performance.

Objectives: Multimorbidity in centenarians is common; although investigations of the prevalence of morbidity in centenarians are accumulating, research on profiles of co-occurrence of morbidities is still sparse. Our aim was to explore profiles of comorbidities in centenarians. Method: Health insurance data from 1,121 centenarians comprising inpatient and outpatient diagnoses from the past 5 years (2009-2013) were analyzed using latent class analysis with adjustments for sex, age, hospitalization, and long-term care. Results: Four distinct comorbidity profiles emerged from the data: 36% of centenarians were categorized as “age-associated”; 18% had a variety of comorbidities but were not diabetic were labeled “multimorbid without diabetes”; 9% were labeled “multimorbid with diabetes”; and 36% “low morbidity.” Conclusion: Patterns of comorbidities describe the complexity of geriatric multimorbidity more appropriately than an approach focused on a single disease. The profiles described by this specific research may inform clinicians and health care planners for the oldest old.

Background While compression of morbidity has now been studied in multiple cohorts, we hypothesize that centenarians might also have fewer chronic conditions as well. We assume that individuals who die as centenarians have less comorbidities and have a less steep rise of the number of comorbidities over the final years before death compared to those who died as nonagenarians (90-99 years) or octogenarians (80-89 years of age). Methods This German cohort study used health insurance data. The data contain complete information on diagnoses and health care transactions for the 6 years prior to death. The sample (N = 1,398; 34,735-person calendar quarters) is comprised of three groups of individuals; those who died as centenarians were compared with random samples of individuals who died as nonagenarians or as octogenarians. Community-dwelling and institutionalized individuals were included. Results One quarter prior to death, individuals who died as centenarians had, on average, 3.3 comorbidities. Octogenarians had 4.6 comorbidities one quarter prior to death. Further, there was a significant time-to-death by age-at-death interaction (B = -.03, p < .001), where centenarians showed a less steep increase in the number of comorbidities than the comparison groups in their last 6 years prior to death. Conclusions The lower prevalence of comorbidities in individuals who died as centenarians compared with those who died at a younger age reinforces the notion of centenarians as a selective group. Avoiding the confounding and potentially synergistic effects of having multiple chronic illnesses is likely vital to being able to survive to extreme ages.

Die Population der Hundertjahrigen ist in Deutschland stark wachsend, findet aber in der Forschung zu Sterben und Tod bisher kaum Berucksichtigung. Hundertjahrige sind aufgrund ihres sehr hohen Alters in besonders verdichteter Form mit der Herausforderung Lebensende konfrontiert. Ziel dieser Studie ist zu analysieren, wie Hundertjahrige mit der existenziellen Herausforderung Lebensende umgehen und welche Aspekte dabei fur sie besonders bedeutsam sind, um Anhaltspunkte fur die Verbesserung einer bedurfnisorientierten Versorgung zu gewinnen. Mit 15 in Berlin lebenden Hundertjahrigen wurden semistrukturierte Interviews auf Basis eines theoriebasiert entwickelten und getesteten Leitfadens von geschulten Interviewern durchgefuhrt. Die Interviews wurden transkribiert sowie in Anlehnung an das Verfahren der qualitativen Inhaltsanalyse nach Kuckartz computergestutzt kodiert und analysiert. Als bedeutsam zeigt sich unter den Kategorien Erfahrung mit Sterben und Tod und Vorbereitung auf das Lebensende zum einen, dass die Befragten oftmals Erlebnisse zum Sterben Dritter als Bezugspunkt fur die eigenen Sorgen und Wunsche zum Lebensende nehmen. Zum anderen offenbarten sich die 3 Subkategorien Ordnung schaffen, Versorgung klaren und Gesprache fuhren als fur die Studienteilnehmer sehr relevant. Entscheidungen in Bezug auf die Versorgung im Sterbeprozess – z. B. durch Patientenverfugungen, die Regelung von Nachlass und Bestattung sowie Kommunikation uber Sterben und Tod sind zentrale Bedurfnisfelder von Hundertjahrigen in der Vorbereitung auf das Lebensende. Hier besteht teilweise offenbar besonderer professioneller Unterstutzungs- und Schutzbedarf.

Self-reporting is the gold standard in pain assessment. However, this is not possible among adults who are unable to respond. Thus, the method of choice is to observe behavior in order to assess pain. Nurses rarely conduct pain observations because they do not feel educated enough to use such tools in vulnerable groups. The aim of the study is to analyze the pain situation among older adults (≥65 years) in need of care who are cognitively or physically unable to respond in the outpatient care setting.Our cross-sectional study is based on data from ACHE, a study on pain in outpatient older adults in need of care. Of 355 care-dependent older adults with chronic pain, 81 (22.8%) who were unable to respond received a pain assessment with the Pain Assessment in Advanced Dementia (PAINAD, German: Beurteilung von Schmerz bei Demenz [BESD]) scale.The study population (n = 81) was very old (mean age = 84.2 years), female (77.8%), and widowed (50.0%). We observed pain-related behavior among 61.7% of older adults in need of care. The mean BESD score was 2.8 ± 2.5 (range 0-8). We identified a significant difference in the BESD score observed calmly (mean = 1.7 ± 2.5) and under mobilization (mean = 3.4 ± 2.3, p = 0.001). Moreover, only 21 older adults in need of care received a pain assessment 4 weeks prior to our study.Our findings indicate a deficit in regularly conducted pain assessment among older adults who are unable to respond and are in need of care in the outpatient care setting. An observation tool in that setting is urgently needed and would be a first step in optimizing pain assessment. We recommend conducting observations during regular nursing mobilization.

With increasing longevity, questions about the psychosocial conditions for extraordinary life spans come to the fore. From the field of psychology the concept of resilience is used to describe special capabilities to resist as a personal competence to maintain or regain certain levels of functioning. As such, resilience is seen as a relatively stable personality trait that, however, may forfeit its relevance in old age.The present article, in contrast to the usual phases of life view, adopts a sociological perspective on the entire life span. The rational choice approach is utilized to describe and discuss conditions, foundations, strategies and results of action decisions based on 15 qualitative biographical interviews with centenarians. Resilience in this context is seen as a capacity to act.The results demonstrate that potentials for resilient action persist throughout the entire life span including oldest age but capacities to act are highly context-specific.

Chronic pain is common in older adults, particularly among nursing home residents (NHR). Internationally, the reported pain prevalence among NHR ranges from 3.7% to 79.5%. At least one in two German NHR are diagnosed with pain. Unrelieved chronic pain is associated with reduced physical functioning and psychological parameters. Given the high prevalence of pain among NHR, we hypothesized that there were likely pain-associated clusters in our target group. Clustering is an opportunity to identify differences in pain management and may enable better targeted health-service delivery for professionals. There are no available data regarding pain-associated clusters (sub-groups of NHR) based on different items measuring pain. This study was performed using baseline data, and was part of a cluster-randomized controlled trial conducted in 12 nursing homes in Berlin. We assessed pain using the German Brief Pain Inventory (BPI-NHR) among 137 NHR (mean age, 83.33 years) capable of self-report. We performed hierarchical agglomerative cluster analysis to generate three clusters (naming is based on the mean value of each BPI-NHR item in each cluster): pain-relieved (46.72 %), pain-restricted (22.63 %), and severe pain (30.66 %). Body-Mass-Index (F(2,129) = 4.274, P = 0.016), Barthel-Index (F(2,133) = 3.246, P = 0.042), and appropriateness of pain medication (F(2,119) = 12.007, P = 0.000) differed between clusters. Parameters associated with an increased or decreased risk of being in a pain-diagnosed cluster will be discussed. The observed need for clinical interventions aiming at shifting from pain-diagnosed clusters to pain-relieved status will be reflected.

Centenarians are considered as models of successful aging and represent a special group of patients. The aim of this study was to analyze heart failure epidemiology and treatment trajectories in centenarians compared to nonagenarians (90–99 years of age) and octogenarians (80–89 years of age) with heart failure and with heart failure and kidney disease combined. This cohort study used quarterly structured routine data from 1398 German insurants over 6 years prior to death (398 centenarians were compared with 500 nonagenarians and 500 octogenarians). Of those, 525 individuals were diagnosed with heart failure before death; 164 had heart failure and kidney disease combined. Generalized estimation equations were used to assess the association of diagnoses of heart failure and other diseases with medication prescriptions. Across age groups, heart failure was significantly more prevalent in centenarians compared with octogenarians and nonagenarians. Prevalence of heart failure increased over time. Female sex [odds ratio (men) = 0.70, p = 0.024], kidney disease (odds ratio = 1.31, p < 0.001), and hypertension (odds ratio = 1.52, p < 0.001) were all associated with heart failure. Overall, heart failure treatment changed significantly over time with an increased prescription rate of loop diuretics and a decreased rate of renin-angiotensin-system inhibitors. Centenarians were significantly less likely to receive treatment with renin-angiotensin-system inhibitors, loop diuretics, or beta-blockers compared with nonagenarians and octogenarians. Furthermore, aldosterone inhibitors were seldom prescribed; If-channel and neprilysin inhibitors were not routinely used in our sample. For those with heart failure and kidney disease combined, our data revealed that the prevalence of kidney disease was lower in centenarians than in younger patients before death. However, differences in prescription rates across age groups were non-significant, although numerically large. Finally, half of the patients in all three age groups with heart failure and kidney disease received treatment with renin-angiotensin-system inhibitors; about two out of five patients received beta-blockers, while prescription rates of aldosterone inhibitors were low. While heart failure prevalence shows a continuous increase with age, prescription rates are lower in centenarians, emphasizing the need for further studies considering the quality of care and outcomes in this patient population. Disease management programs and trials are needed to develop guidelines that address the medically challenging treatment for very old patients with comorbid heart failure and kidney disease.

Die Schmerzversorgung von Pflegeheimbewohnerinnen ist nachweislich inadaquat. Um diesem Defizit zu begegnen, wurden im Projekt PAIN-Intervention eine Handlungsempfehlung zum angemessenen Schmerzmanagement entwickelt und auf dieser Basis Fortbildungen fur Pflegende angeboten. Nach Durchfuhrung der Ganztagsworkshops in der Interventionsgruppe bzw. der Basisinformation in der Kontrollgruppe zum Schmerzmanagement in Pflegeheimen schloss sich die anonyme, freiwillige Evaluation mit einem standardisierten Fragebogen an. Der Ganztagsworkshop zur Optimierung des Schmerzmanagements wurde besser bewertet als die Basisinformation. Signifikante Unterschiede zugunsten der Interventionsgruppe zeigten sich bei der Bewertung der Austauschmoglichkeiten, der erlebten Sicherheit im Umgang mit den Schmerzen der Bewohnerinnen und bezuglich der Informationen uber nichtmedikamentose Masnahmen. Trotz positiver Bewertung wird vielfach der Veranderungsbedarf im Schmerzmanagement als nichtnotwendig erachtet. Vorkenntnisse der Pflegenden zum Thema Schmerz fuhrten in der Kontrollgruppe zu einer geringeren Erweiterung der Kenntnisse. Unterschiede in der Methodik und des Zeitrahmens sowie der damit verbundene Umfang der Inhalte nehmen Einfluss auf die Bewertung. Eine multiperspektivische und interaktive Herangehensweise ermoglicht auch bei heterogenen Gruppen bessere Evaluationsergebnisse.

The reported prevalence of pain among nursing home residents (NHRs) is high. Insufficient use of analgesics, the conventional pain management strategy, is often reported. Whether and to what extent nonpharmacologic therapies (NPTs) are used to manage the pain of NHRs in Germany is largely unknown. The aim of this cluster-randomized trial was to assess the NPTs provided and to enhance the application and prescription of NPTs in NHRs on an individual level. There were six nursing homes in the intervention group and six in the control group. There were 239 NHRs, aged ≥65 years, with an average Mini-Mental State Examination score of at least 18 at baseline. Pain management interventions (cluster level) included an online course for physicians and 1-day seminar for nurses. Data on NPT applied by nurses and therapeutic NPT prescribed by physicians were obtained from residents' nursing documentation. Face-to-face interviews with NHRs assessed the NPT received. At baseline, 82.6% of NHR (mean age 83 years) were affected by pain, but less than 1 in 10 received NPT. The intervention did not result in a significant increase in the NPT applied by nurses, but did significantly increase the therapeutic NPT prescribed by physicians. Residents were active in using NPT to self-manage their pain. Given the prevalence of pain in NHRs, there is a clear need to improve pain management in this population. Extended use of NPT offers a promising approach. We recommend that nurses provide residents with education on pain-management techniques to support them in taking a proactive role in managing their pain.

Hintergrund: Nonresponse verursacht zweifelsohne ein Bias in Studienergebnissen. Ausfallursachen in Studien mit Pflegeheimbewohner(inne)n sind bisher unzureichend untersucht. Ziel und Methode: Ziel dieser Studie war es, nach dem Prozessmodell induktiver Kategorienbildung nach Mayring (2010) reliable und valide Kategorien zu entwickeln, welche detailliert Ausfallgründe von Pflegeheimbewohner(inne)n abbilden. Zudem wurden Charakteristika der Unit-Nonresponder und der Responder verglichen. Ergebnisse: Die Kategorisierung der Ausfallgründe erfolgte im Längsschnitt mit insgesamt 522 Pflegeheimbewohner(inne)n. Identifiziert wurden vier Oberkategorien («generelle Ablehnung», «gesundheitliche Aspekte», «Erreichbarkeit», «Überforderung») sowie 17 Subkategorien. Unit-Nonresponder und Responder unterscheiden sich hinsichtlich Alter und Geschlecht nicht; jedoch zeigten sich Unterschiede im Follow-up bei Familienstand, Berufsabschluss und kognitivem Status. Schlussfolgerungen: Das vorgelegte Kategorienschema kann zukünftig zur Erfassung von Ausfallgründen im Setting Pflegeheim verwendet werden. Die detaillierte Erfassung der Ausfallursachen kann zur Optimierung der Responserate beitragen.

BACKGROUND AND AIM Arterial hypertension is a common health problem in older nursing home residents (NHR). The aim of this study was to prospectively analyze blood pressure (BP) patterns, antihypertensive therapy, and visit-to-visit BP variability in NHR. METHODS BP, visit-to-visit variability (estimated by standard deviation of means) of systolic BP (SBP) were analyzed in 12 nursing homes in Germany. NHR who were at least 65 years old and had no moderate or severe dementia were studied at baseline (T0), after 3 and 6 months, respectively. RESULTS BP data were available for 177 NHR (mean age 83.8, 69.5% female) at T0. A total of 90.4% NHR was affected by hypertension. Mean systolic/diastolic blood pressure was 130,1/75,5 mmHg. BP values of ≥ 140/90 mmHg were found in 29.9%, while 33.9% of NHR exhibited SBP values

The objective of this cross-sectional study was to examine the benefits of, and barriers to, moderate physical activity across stages of change in a sample of 103 caregivers in Germany, aged 50 years and older (Mage = 63.95 years, SD = 9.39, age range 50 – 83 years, 82.5 % female). The exploratory factor analysis yielded a two-factor structure encompassing perceived benefits and barriers. While both perceived benefits and barriers were significantly related to stages of change with regard to levels of activity, perceived benefits showed a stronger positive relationship. Thus, interventions that promote moderate physical activity in older family caregivers should consider strategies that maximize the perceived advantages of activity rather than refuting the disadvantages.

BACKGROUND The pain medication appropriateness scale (PMASD) was developed in 2006 in the USA to evaluate the quality and appropriateness of pain treatment in nursing home residents (NHR). This tool can be used to identify potential problems with the pharmacological treatment of pain. METHODS We developed a German version (PMASD) adapted to the German setting and applied it in Germany to NHR with and without cognitive impairment for the first time. In agreement with the original instrument a test result of >67 % was considered as appropriate pain treatment. RESULTS For the 560 analyzed NHR the average SPMAS score was 39±1,7 (range from -67 to +100). Overall 72% of the study population did not achieve the defined threshold for appropriate pain management. CONCLUSIONS An appropriate tool for quantitative evaluation of pain treatment was so far not available in Germany. The PMASD analysis showed deficits of pain management in NHR. This tool showed good practicability in Germany and could provide a valuable tool for pain treatment in clinical research and practice.

Recognizing the ageing of populations and expected increase in prevalence of dementia, the necessity of research involving persons with dementia is widely agreed upon. Autonomy is key to nursing home residents' well-being and quality of life, but this phenomenon has not been thoroughly assessed from the residents' perspective. The aim of this cross-sectional study was to investigate perceived autonomy of nursing home residents. Data on 560 randomly selected residents in 40 nursing homes in two German federal states were generated by face-to-face interviews, psychological and physical assessments, analysis of nursing records, and acquisition of institutional parameters. This paper reports on a subsample (n = 179) that met screening requirements, including subjects with and without mild cognitive impairment (Mini Mental Status Examination score 30-18), who completed the Hertz Perceived Enactment of Autonomy Scale (HPEAS). The mean score of HPEAS was 101.1 ± 14.5 (range 54-122). In our population, Cronbach's alpha was 0.89. Scores in HPEAS were not related to demographical factors but positively associated with increasing self-efficacy and absence of pain. The novel findings contribute to an understanding of autonomy from the residents' perspective.

Schmerz und Sturzangst sind beeinflussbare Faktoren, die sehr bedeutsam für die funktionellen Fähigkeiten von Pflegeheimbewohner(inne)n sein können. Nationale Studien zu entsprechenden Zusammenhängen fehlen. Die Versorgung der Betroffenen wird in internationalen Studien als unzureichend dokumentiert. Ziel dieser Studie war es, Unterschiede in den funktionellen Fähigkeiten von Pflegeheimbewohner(inne)n mit und ohne Schmerzen beziehungsweise Sturzangst zu untersuchen. Quantitative Daten von Bewohner(inne)n wurden mit Hilfe eines Querschnittsdesign in Berlin und Brandenburg erhoben. Der kognitive Status wurde durch den Mini Mental Status Test erfasst; Schmerz und Sturzangst wurden erfragt. Die funktionellen Fähigkeiten wurden anhand des Barthel-Index und des Timed «up & go»-Tests erhoben. Mittels multipler linearer Regressionsanalysen wurden die Fragestellung sowie der Einfluss weiterer erklärender Variablen (Alter, Geschlecht, somatische Morbidität) untersucht. 217 Pflegeheimbewohner(innen) ohne bedeutsame kognitive Beeinträchtigungen (MMST >= 20) wurden eingeschlossen. 65 % waren von Schmerzen und 48 % von Sturzangst betroffen. Schmerzen/Sturzangst und eine geringere funktionelle Mobilität waren signifikant miteinander assoziiert. Bei den Gehfähigen waren überdies Schmerzen/Sturzangst und geringere Fähigkeiten in den grundlegenden Alltagsfunktionen signifikant miteinander assoziiert. Eine verbesserte Schmerzversorgung sowie Interventionen zur Reduktion der Sturzangst stellen Maßnahmen dar, die sich potenziell positiv auf die funktionellen Fähigkeiten auswirken könnten.

Background there is limited data comparing conditions and health service use across care settings in centenarians. To improve health service delivery in centenarians, the aim of this study was to compare the proportion of centenarians who have chronic conditions, take medication and use health care services across different care settings. Methods this cohort study uses routine data from a major health insurance company serving Berlin, Germany and the surrounding region, containing almost complete information on health care transactions. The sample comprised all insured individuals aged 100 years and older (N = 1,121). Community-dwelling and institutionalised individuals were included. Charlson comorbidity index was based on 5 years of recordings. Hospital stays, medical specialist visits and medication prescribed in the previous year were analysed. Results while 6% of the centenarians did not receive any support; 45% received family homecare or homecare by professional care services; 49% were in long-term care. The most frequent conditions were dementia and rheumatic disease/arthritis, with the highest prevalence found among long-term care residents. A total of 97% of the centenarians saw a general practitioner in the previous year. Women were more often in long-term care and less often without any care. Centenarians with long-term care showed higher proportions of comorbidities, greater medication use, and more visits to medical specialists compared with centenarians in other care settings. Conclusions the higher prevalence of dementia and rheumatic disease/arthritis in long-term care compared to other care settings emphasises the role of these diseases in relation to the loss of physical and cognitive functioning.

The population of centenarians has grown immensely in Germany but has yet hardly been considered in research on dying and death. Due to their very old age centenarians are especially intensively confronted with the challenge of the end of life.The aim of this study was to analyze how centenarians handle the existential challenge of the end of life and which aspects are especially significant for them. Conclusions drawn from this analysis were used to identify factors to improve the needs-based provision of care.Trained interviewers interrogated 15 centenarians living in Berlin using semi-structured interviews based on theoretically developed and tested guidelines. Subsequently, the interviews were transcribed, computer coded and analyzed following the method of the qualitative content analysis according to Kuckartz.In the categories "experience with dying and death" and "preparing for the end of life" it was shown to be significant that respondents often referred to the dying of others with respect to their worries and wishes at the end of their life. Additionally, the subcategories "putting things in order", "settling provision of care" and "having conversations" were shown to be highly relevant for the participants in the study.Decisions related to care in the process of dying, for example by advance directives, arrangements for inheritance and funeral as well as communication about dying and death, are central needs of centenarians when preparing for the end of life. There is sometimes considerable need for professional support and protection.

Objectives This study assessed the frequency of physician contacts for individual nursing home residents (NHRs) and investigated whether the frequency of contacts influences the appropriateness of pain medication in NHRs. Design Observational cross-sectional study conducted between March 2009 and April 2010. Setting Forty nursing homes in Berlin and Brandenburg, Germany. Participants A total of 560 NHRs. Measurements The number and type of NHR physician contacts were obtained by face-to-face interviews. To assess the appropriateness of pain medication, the German version of the Pain Medication Appropriateness Scale (PMASD) was used. The influence of physician contacts on the appropriateness of pain medication was calculated with a linear mixed-effect model. Results The proportions of NHRs with at least 1 contact with their attending physicians were 61.8% (primary care physicians), 55.2% (general practitioners), 9.6% (neurologists), 9.4% (other), 5.4% (internists), 2.2% (orthopedic surgeons), and 0.7% (psychiatrists). The number of all physician contacts correlated weakly with the appropriateness of pain medication (r = 0.166, P = .039). With every physician contact, the PMASD score rose by about 2 points (P = .056). Conclusions Physician care in German nursing homes is mainly provided by primary care physicians. A higher number of physician contacts had a modest impact on more appropriate pain medication use.

Glaucoma comprises age-related neurodegenerative diseases of retinal ganglion cells, the worldwide prevalence of which is increasing. Local pharmacotherapy is the primary treatment option, especially in the elderly. But this therapeutic approach may include risks for adverse drug effects and drug–drug interactions, of particular importance in frail nursing home resident populations. The aim of the present study was to investigate anti-glaucoma pharmacotherapy in nursing home residents in the context of multi-morbidity and related systemic co-medication. Data for 8,685 nursing home residents with 88,695 drug prescriptions were analysed according to diagnosis and local or systemic pharmacotherapy. Data were provided in anonymous form by a German public health insurance company. The study cohort was characterized by a mean age of 83.6 ± 7.3 years (range: 65–106 years), 21 % of nursing home residents were at least 90 years old and 83.7 % were women. For each nursing home resident, an average of 6.0 ± 3.3 different drugs were registered. A diagnosis of glaucoma was recorded in 520 (6.0 %) nursing home residents; all subjects had co-existing medical conditions. Dementia was a frequent co-morbidity, diagnosed in 51.7 % of nursing home residents with glaucoma. Anti-glaucoma drugs contributed to 0.5 % of all prescriptions and were prescribed to 341 nursing home residents. The most frequently used anti-glaucoma ophthalmics were β-blockers (n = 219), followed by prostaglandin analogues (n = 101) and carbonic anhydrase inhibitors (n = 86). Local anti-glaucoma therapy was co-prescribed with a systemic pharmacotherapy in 338 nursing home residents. An ophthalmic agent was, on average, combined with 6.5 ± 3.2 prescriptions for systemic agents. Thus, 71.9 % of nursing home residents were prescribed ophthalmic β-blockers and a concomitant antihypertensive medication; local and systemic β-blockers were combined in 20.2 % of these patients. Co-treatment with cardiac glycosides or calcium antagonists was found in 13 % of nursing home residents prescribed ophthalmic parasympathomimetics, and in 14 % of those prescribed ophthalmic β-blockers, with the potential for drug–drug interactions to influence cardiac function. Anti-glaucoma pharmacotherapy in nursing home residents is frequently prescribed in the context of polypharmacy. This may modify the efficacy and safety of local and systemic therapies. Therefore, individualized pharmacotherapy that integrates anti-glaucoma drug therapy into the overall treatment rationale in nursing home residents is necessary. However, to realize this concept, further clinical research in nursing home residents is warranted.

Ungunstige Wohnbedingungen im Alter wirken sich physisch, psychisch und sozial aus und bergen eine erhohte Institutionalisierungsgefahr. Ziel dieser Studie ist die Untersuchung der Umzugsbereitschaft zugunsten altersgerechter Wohnumwelten (Service Wohnen, Mehrgenerationenhaus, Alten WG) im Fall einer Pflegebedurftigkeit. Befragt wurden 5657 Pflegeversicherungsnehmer (50 +) zu Wohnpraferenzen im Fall einer Pflegebedurftigkeit. Die Stichprobe wurde bivariat und multifaktoriell ausgewertet. Der Anteil der Sesshaften (Stayers) ubersteigt mit 63,9 % den der Umzugsbereiten (Movers), der 19,6 % betragt. Stayers und Movers zeigen unterschiedliche soziodemographische Profile. Altere Manner ab dem 69. Lebensjahr sind wenig umzugsbereit (19,3 % der Manner >69 Jahre). Zu den Movers zahlen dagegen v. a. Frauen

Studien zum subjektiven Autonomieerleben aus Sicht der Heimpopulation sind unterrepräsentiert. Es besteht eine Forschungslücke hinsichtlich der Selbsteinschätzung von Autonomie von Bewohnern und Bewohnerinnen mit unterschiedlichen kognitiven Fähigkeiten. Bereits bestehende Instrumente sind sehr umfangreich oder noch nicht für diese Zielgruppe getestet. Die Darstellung der Entwicklung einer Testversion der Kurzform der deutschen Version der Hertz Perceived Enactment of Autonomy Scale (HPEASD) für die Erfassung und Analyse subjektiv wahrgenommener Autonomie ist Ziel dieses Beitrages. Im Rahmen der Studie „Pain and Autonomy in the Nursing Home (PAIN)” wurden quantitative Daten in einer Zufallsstichprobe von 560 Heimbewohnern und -bewohnerinnen in 40 Einrichtungen in Berlin/Brandenburg durch mündliche Befragung und Analyse der Pflegedokumentation von März 2009 bis April 2010 generiert. Die Studienteilnehmenden der Teilstichprobe (n = 179), welche für die Entwicklung der Testkurzversion zur Verfügung standen, hatten keine (MMSE Wert > 23) bis leichte Einschränkungen (MMSE Wert 23 – 18) in ihren kognitiven Fähigkeiten. Für die Itemanalyse wurden die Schwierigkeitsindizes (pi) und Trennschärfekoeffizienten (rit) bestimmt. Die verbleibenden Items wurden einer Hauptkomponentenanalyse unterzogen, die relevanten Faktoren mit dem Screetest ermittelt und deren Ladungsmuster interpretiert. Die Eignung der Items wurde anhand des Kaiser-Meyer-Olkin-Kriteriums und des Bartlett-Tests überprüft. Die Kurzversion (HPEASKD) besteht aus acht Items. Sie korreliert signifikant mit der gemessenen Selbstwirksamkeitserwartung (rs = .58) ebenso wie die Gesamtskala des HPEASD (rs = .53) und bildet gleichermaßen das Autonomieerleben der Bewohner/innen ab. Mittels der Testversion der Kurzfassung HPEASKD ist es möglich, die subjektiv wahrgenommene Autonomie der Bewohner/innen ohne und mit leichten kognitiven Beeinträchtigungen zu erfassen. Somit stellt die Kurzform HPEASKD eine mit vergleichbarer Zuverlässigkeit aber mit weitaus geringerem Aufwand einsetzbare Skala dar. Diese Skala kann sowohl in Forschungsprojekten zur Operationalisierung von Autonomie verwendet als auch als ein praktisches Instrument für den Einsatz in stationären Pflegeeinrichtungen für die Erfassung von Autonomie aus Bewohnerperspektive betrachtet werden.

Pain management in nursing home residents (NHR) is insufficient. Hence, this guidance summarizes latest research results and guidelines of particular requirements on treatment of pain in the elderly. The purpose is to improve health care processes and outcomes on individual and institutional level. To reach this aim a multidisciplinary collaboration is essential. The prerequisite for adequate pain treatment is to conduct a standardized pain assessment. Likewise, the application of all opportunities of non-medical pain treatment strategies contributes to the reduction of occurrence of pain and therefore to the preservation of quality of life in NHR. Age-related changes in physiology may affect tolerance and effects of analgesics. Besides, drug interactions need to be considered. After all, education of NHR and involvement of their relatives in pain management foster successful management and treatment of pain.

Im Rahmen des Forschungsprojekts „Gesundheitsforderung fur altere pflegende Angehorige“ wurde ein Assessment-Instrument zur Ermittlung individueller gesundheitsbezogener physischer und psychischer Ressourcen und Risiken pflegender Angehoriger entwickelt. Daraus wird der personliche Bedarf an Gesundheitsforderung ableitbar und ein entsprechendes Angebot unterbreitet. Die Implementierung des softwaregestutzten Assessments erfolgte in die Strukturen der gesetzlichen Krankenkasse Deutsche BKK in Wolfsburg.

Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany.In a cluster-randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians.The primary objective of reducing the mean pain intensity by 2 points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6-month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores0 on three pain intensity items decreased significantly.Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long-term implementation appears necessary. Geriatr Gerontol Int 2017; 17: 1534-1543.

Background Current knowledge about the quality and appropriateness of pharmacological pain treatment in nursing home residents (NHR), particularly in NHR with moderate to severe cognitive impairment, is poor. Methods This observational cross-sectional study assessed pain treatment in a random sample of NHR with or without cognitive impairment from nursing homes in Germany. Prescribed drugs, pain intensity and frequency, diagnoses, and surgical procedures and injuries during the last 4 weeks were documented. Quality and appropriateness of pain medication were assessed by analysis of pain medications and the Pain Medication Appropriateness Scale (PMAS) score (SPMAS), with a cut-off value of >67% indicating appropriate pain treatment. Results A total of 321 residents (62% women) were studied, including 152 (47%) with severe cognitive impairment. The most frequently prescribed analgesics were dipyrone, fentanyl, tramadol and ibuprofen. The mean SPMAS was 48.5 ± 1.5 (range, −33 to +100). Residents with prescribed scheduled analgesics had a significantly better SPMAS than patients without such treatment (SPMAS 58 ± 1.5 vs. 37 ± 2.5, p

Mit zunehmendem Alter steigt der Anteil mehrfach erkrankter Menschen und immer mehr Menschen erreichen ein sehr hohes Lebensalter. Trotz des medizinischen Fortschritts und verbesserter Lebenslagen mussen viele alte Menschen korperliche, psychische und soziale Einschrankungen bewaltigen. Es ist eine grose gesundheits- und sozialpolitische Herausforderung, diese alten Frauen und Manner mit gesundheitlichen Beeintrachtigungen in ihrem Bestreben nach einer weitestgehend autonomen Lebensgestaltung zu unterstutzen und zu starken.

Objective To analyse and evaluate the use of antihypertensive medication in elderly patients of nursing homes in Germany. Methods Data from a large German health insurance company were collected in a cross sectional study. Included were all insured persons aged 65 years or older, who were residents of a nursing home between 1 April and 30 June 2007 throughout Germany. Antihypertensive drugs were those classified according to the current guidelines published by the German Hypertension Society. Results The study comprised 8,685 residents of nursing homes, 84 % women. The mean age was 84 years (range 65 - 106 years). Antihypertensive drug prescriptions accounted for 17 % of all drug prescriptions and about 70 % of all residents received at least one prescription for antihypertensive drugs. The most frequently prescribed antihypertensive drugs were diuretics, of which 70 % were loop diuretics. Potentially inappropriate combinations of antihypertensive drugs were noted in 5.2 % of patients receiving these drugs. Conclusion Antihypertensive drugs account for a notable part (17 %) of all drug prescriptions in elderly residents of nursing homes throughout Germany. These results indicate that only a minority of all residents were treated with potentially inappropriate or potentially harmful drug combinations. However, the relatively high rate of prescriptions for loop diuretics is a matter of potential concern in this vulnerable group of patients.

Purpose The current use of inappropriate medication in elderly nursing home residents (NHRs) in Germany is unclear. We therefore set out to analyse the frequency and patterns of potentially inappropriate drug prescriptions in elderly NHRs in Germany. Methods We utilised prescription data for NHRs 65 years or older from a large German health insurance company during a period of 3 months. Inappropriate drugs were identified from a recently reported French consensus list. Results Data for 7271 (83.7%) females and 1414 (16.3%) males were available for analysis. The average age was 83.6 ± 7.3 years. Overall 48 inappropriate drugs were prescribed resulting in a total of 3825 inappropriate drug prescriptions which accounted for 4.3% of all documented prescriptions (n = 88 695). One thousand nine hundred and three (21.9%) residents received at least one inappropriate drug prescription. Using logistic regression we detected no significant influence of gender or level of care on frequency of inappropriate prescriptions. However, age had a significant influence; with increasing age the frequency of residents receiving inappropriate medications decreased steadily (r = −0.92, p = 0.003) and ranged from a maximum of 32.8% in the group between 65 and 69 years to a minimum of 15.2% in residents older than 94 years. This observation was paralleled by a significant and continuous decrease of drug prescription rates with increasing age (r = −0.88, p = 0.009). Conclusion The present analysis demonstrates that about one out of five elderly NHRs received at least one inappropriate drug prescription. Additional studies may aim to establish a list of frequently prescribed inappropriate drugs for Germany. Copyright © 2010 John Wiley & Sons, Ltd.

Autonomie ist ein äußerst komplexer, zentraler philosophischer Begriff, welcher unter anderem in ethischen Fragestellungen auch im pflegerischen Kontext seine praktische Anwendung findet. Es kann derzeit nicht von einer einheitlichen Definition von Autonomie ausgegangen werden. Aus Sicht der Autorinnen sind Selbstbestimmung und Handlungsfähigkeit zentrale Aspekte von Autonomie. Während einige Erkenntnisse zu Autonomie im Alter vorliegen, ist zu Autonomie von Pflegeheimbewohnern/-bewohnerinnen sowie wichtigen Einflussfaktoren im Setting Pflegeheim noch wenig bekannt. Ziel dieses Artikels ist es, zu einem besseren Verständnis von Autonomie von Pflegeheimbewohner/-innen beizutragen. Aufgrund des hohen Anteils von Menschen mit kognitiven Beeinträchtigungen in Pflegeheimen spielt insbesondere diese Population bei der Konzeptionalisierung von Autonomie eine wichtige Rolle. Unterschiedliche bestehende Ansätze und die im Rahmen des PAiN-Projekts (Pain and Autonomy in the Nursing Home) entwickelten Perspektiven haben zur Erarbeitung eines eigenen konzeptionellen Verständnisses von Autonomie geführt. Das im interdisziplinären Projektteam entwickelte Modell zu «Bestimmungsfaktoren von Autonomie» gründet sich auf theoretischen und diskursiven Auseinandersetzungen und fokussiert Selbstbestimmung und Handlungsfähigkeit der Bewohner/-innen im Kontext des Setting Pflegeheim. Dieser Konzeption wesentlich ist die unterschiedliche Ausprägungsmöglichkeit von Autonomie sowohl hinsichtlich Selbstwahrnehmung als auch hinsichtlich der Zuschreibung von Autonomie.

Pain is the most common health-related complaint in older persons. International estimations mention up to 80% of nursing home residents suffering from pain. In the meantime, no reliable epidemiological data on pain in nursing home residents are available for Germany, because of restricted access to the nursing-home population. This pilot study aimed to evaluate whether routine data from a German statutory health insurance fund can be used to generate data on pain prevalence and analgesic therapy in nursing home residents. To this end, data of all insured persons of Deutsche BKK who received long-term care insurance benefits for nursing-home care between April and June 2007 were selected anonymously. These data were combined with data on diagnoses and analgesic prescriptions. 3 pain-related diagnoses were selected: R 52 (pain, not elsewhere classified), M 16 (coxarthrosis) and G 53.0 (postherpetic neuralgia) and analysed for corresponding prescriptions. The study sample shows similar characteristics regarding age distribution and care needs in terms of long-term care insurance benefits compared to the official data on nursing-home residents for Germany in 2007. The rate of dementia was within the expected range, too. Therefore, external validity of the sample is assumed. One of the 3 selected diagnoses had been documented in 15% of the sample. About 58% of those received an analgesic prescription. Deficits were discovered regarding the documentation of postherpetic neuralgia, the combination of different analgesics and prescriptions for adjuvant drugs. Prevalence rate and numbers of prescriptions were as frequent as expected. The routine method for this analysis proved to be practicable and reliable. Data quality is deemed sufficient so that the main study will proceed to include a longer period of time and additional data.

Vielfaltige Ursachen sind fur eine Unterversorgung im Bereich der Bewegungsforderung in deutschen Pflegeheimen verantwortlich. Die Ressourcenforschung verspricht in diesem Zusammenhang nachhaltige Handlungsmoglichkeiten und sollte deshalb als ein Paradigma sportwissenschaftlicher Forschung im Bereich der Gerontologie begriffen werden.