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Die korperliche Aktivitat stellt ein komplexes Verhalten dar, dessen valide und reliable Erfassung in gros angelegten populationsbasierten Studien mit besonderen Herausforderungen einhergeht. In der bundesweiten NAKO Gesundheitsstudie liegen zur Halbzeit der Basiserhebung die Daten zur korperlichen Aktivitat fur 100.000 Teilnehmende vor. Beschreibung der Erfassung der korperlichen Aktivitat und Prasentation erster deskriptiver Ergebnisse. Das multimodale Erhebungskonzept bestand aus zwei Fragebogen, dem Questionnaire on Annual Physical Activity Pattern (QUAP) und dem Global Physical Activity Questionnaire (GPAQ), einem computerbasierten Erinnerungsprotokoll der vergangenen 24 h (cpar24) und einer 7‑Tage-Akzelerometrie (Actigraph GT3X/+; Fa. ActiGraph, Pensacola, FL, USA). Fur die einzelnen Erhebungsmodule lagen auswertbare Datensatze in unterschiedlicher Zahl vor (QUAP: n = 16.372; GPAQ: n = 90.900; cpar24: n = 23.989; Akzelerometrie: n = 35.218). Die Analysen der einzelnen Module ergaben unterschiedliche Durchschnittswerte fur die moderate oder intensive korperliche Gesamtaktivitat der Teilnehmenden: Bei Frauen wurden 75–216 min/Tag gemessen, bei Mannern 73–224 min/Tag. Personen der Altersgruppe 20–39 Jahre verbrachten 66–200 min/Tag in moderater oder intensiver korperlicher Gesamtaktivitat, wahrend Personen der Altersgruppe 40–69 Jahre 78–244 min/Tag aufwendeten. Erste modulubergreifende Analysen der korperlichen Aktivitat in der NAKO zeigen den Nutzen komplementar eingesetzter Erhebungsmethoden. Die umfangreichen Daten stellen eine wertvolle Ressource fur die Charakterisierung der Zusammenhange zwischen korperlicher Aktivitat und Krankheitspravention dar, die in der Zukunft erfolgen soll.

Die körperliche Fitness ist das Maß für die individuelle Fähigkeit, körperlich aktiv zu sein. Ihre wesentlichen Komponenten sind die kardiorespiratorische Fitness (Cardiorespiratory Fitness, CRF), die Muskelkraft und die Beweglichkeit. Neben der körperlichen Aktivität ist die körperliche Fitness ein wesentlicher Prädiktor für Morbidität und Mortalität. Ziel der Arbeit sind die Beschreibung der Erhebungsmethoden körperlicher Fitness in der NAKO Gesundheitsstudie und die Darstellung erster deskriptiver Ergebnisse. In der NAKO-Basiserhebung wurden die maximale Handgreifkraft (Grip Strength, GS) und die CRF als Komponenten der körperlichen Fitness über ein Handdynamometer bzw. über einen Fahrradergometertest mit submaximaler Belastung erhoben. Daraus wurde die maximale Sauerstoffaufnahme (VO2max) zur Beurteilung der CRF abgeleitet. Die Ergebnisse von insgesamt 99.068 GS-Messungen und 3094 Messungen der CRF beruhen auf einem Datensatz zur Halbzeit der Basiserhebung der NAKO (Alter 20–73 Jahre, 47 % Männer). Männer zeigten im Vergleich zu Frauen höhere Werte der körperlichen Fitness (Männer: GS = 47,8 kg, VO2max = 36,4 ml·min−1 · kg−1; Frauen: GS = 29,9 kg, VO2max = 32,3 ml·min−1 · kg−1). Ungefähr ab dem 50. Lebensjahr konnte ein Rückgang der GS verzeichnet werden, wohingegen die CRF ab der Altersgruppe 20–29 Jahre bis zu den ≥60-Jährigen kontinuierlich abfiel. Die GS und die VO2max zeigten nach Korrektur für das Körpergewicht einen linear positiven Zusammenhang (Männer β = 0,21; Frauen β = 0,35). Die Analysen zeigten eine gute Übereinstimmung der Verteilung der körperlichen Fitness in der NAKO im Vergleich zu anderen bevölkerungsbasierten Studien. Zukünftige Auswertungen werden insbesondere die unabhängige Bedeutung der GS und CRF bei der Prädiktion von Morbidität und Mortalität beleuchten. Physical fitness is defined as an individual’s ability to be physically active. The main components are cardiorespiratory fitness (CRF), muscle strength, and flexibility. Regardless of physical activity level, physical fitness is an important determinant of morbidity and mortality. The aim of the current study was to describe the physical fitness assessment methodology in the German National Cohort (NAKO) and to present initial descriptive results in a subsample of the cohort. In the NAKO, hand grip strength (GS) and CRF as physical fitness components were assessed at baseline using a hand dynamometer and a submaximal bicycle ergometer test, respectively. Maximum oxygen uptake (VO2max) was estimated as a result of the bicycle ergometer test. The results of a total of 99,068 GS measurements and 3094 CRF measurements are based on a data set at halftime of the NAKO baseline survey (age 20–73 years, 47% men). Males showed higher values of physical fitness compared to women (males: GS = 47.8 kg, VO2max = 36.4 ml·min−1 · kg−1; females: GS = 29.9 kg, VO2max = 32.3 ml · min−1 · kg−1). GS declined from the age of 50 onwards, whereas VO2max levels decreased continuously between the age groups of 20–29 and ≥60 years. GS and VO2max showed a linear positive association after adjustment for body weight (males β = 0.21; females β = 0.35). These results indicate that the physical fitness measured in the NAKO are comparable to other population-based studies. Future analyses in this study will focus on examining the independent relations of GS and CRF with risk of morbidity and mortality.

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HINTERGRUND: Arterielle Hypertonie ist einwichtiger Risikofaktor für Herz-Kreislauf-Er-krankungen. Epidemiologische Studien führen meist drei konsekutive Blutdruckmessungen durch. Der 1. Messwert wird für Auswertungen verworfen, da dieser am stärksten durch vorhergehende Aktivitäten beeinflusst sein kann. Aus zeitlichen Gründen wurden in der NAKO Gesundheitsstudie nur zwei Messungen durchgeführt. FRAGESTELLUNG: Die vorliegende Analyse untersucht Auswirkungen methodischer Unterschiede bei der Blutdruckmessungauf die Hypertoniehäufigkeit und mittlere Blutdruckwerte anhand eines Vergleichsder ersten Hälfte der NAKO-Teilnehmenden(nur 2 Messungen) mit 5 deutschen populationsbasierten Studien (3 Messungen). MATERIAL UND METHODEN: Es wurden Daten der Teilnehmenden aus der NAKO (erste 101.816 Personen), der bundesweiten Studie zur Gesundheit Erwachsener des Robert Koch-Instituts (DEGS1) und aus 4 regionalen populationsbasierten Kohortenstudien (CARLA, HNR, KORA, SHIP) analysiert. Alters- und geschlechtsspezifische mittlere Blutdruckwerte und Hypertoniehäufigkeiten wurden auf Basis des 2. Messwertes, des Mittelwerts aus 1. und 2. sowie aus 2. und 3. Messung berechnet. ERGEBNISSE: Die mittleren Blutdruckwerte der beiden aktuellsten Studien (NAKO und DEGS1) sind sehr ähnlich und niedriger als in den anderen Studien. Die Differenz zwischen dem 2. Messwert und dem Mittelwert aus 2. und 3. Messung ist gering (maximale mittlere Abweichung: 1,5mmHg systolisch), jedoch ist die mittels des 2. Messwertes berechnete Hypertoniehäufigkeit der Bevölkerung höher als bei Verwendung des Mittelwertsaus 2. und 3. Messung. DISKUSSION: Die Ergebnisse der vorliegenden Analyse zeigen, dass für die wissenschaftliche Auswertung der NAKO-Daten die Verwendung des 2. Blutdruckmesswerts zu empfehlen ist. BACKGROUND: Arterial hypertension is an important risk factor for cardiovascular diseases. Epidemiological studies typically perform three consecutive blood pressure measurements. The first measurement is discarded in subsequent analyses, as this value may be strongly affected by previous activities. Due to time constraints the German National Cohort (GNC NAKO) performed only two blood pressure measurements. OBJECTIVES. The present analysis examined the possible effects of methodological differences in blood pressure measurement by comparing the first 101,816 GNC participants (two blood pressure measurements) with those of five German population-based studies (three measurements). MATERIALS AND METHODS: Blood pressure data from participants aged 20 to 79 years from the GNC, the German Health Interview and Examination Survey for Adults by the Robert Koch Institute (DEGS1), and four regional population-based cohort studies (CARLA, HNR, KORA, SHIP) were used to calculate age-and sex-specific mean blood pressure values and hypertension frequencies based on the second blood pressure measurement, the arithmetic mean of the first and second value and of the second and third (the latter not available in the GNC). RESULTS: The mean blood pressure values of the two most recent studies (GNC, DEGS1) were very similar and lower than in the other studies. The difference of the second measurement and the mean of second and third measurement was small (maximum mean difference: 1.5mmHg systolic blood pressure), but leads to higher estimated hypertension frequencies. CONCLUSIONS: The current results show that using the second blood pressure measurement should be recommended for scientific analyses of GNC data.

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.

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 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.

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

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.

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.

The Brief Pain Inventory (BPI) has been psychometrically evaluated worldwide in adult patients with cancer-related and chronic pain in several languages, but never in nursing home residents with chronic pain. To address this gap, we evaluated the validity of a modified version of the BPI, the BPI for nursing home residents (BPI-NHR) in individuals who resided in German nursing homes. One analytic sample included 137 nursing home residents (mean age, 83.3 years; SD, 8.0 years) without any missing values. An extended sample also included individuals with previous missing values that were substituted with the personal mean (n = 163; mean age, 83.3 years; SD, 8.3 years). Principal axis factoring with oblimin rotation was used to compute the final 2-factor solution for the substituted sample. These factors explained 71.7% of the variance. Internal consistency was calculated using Cronbach α, and showed excellent results. Concurrent validity was tested using nonparametric correlation analyses of the BPI-NHR with the pain medication scale. The present findings support the reliability and validity of the BPI-NHR for very old nursing home residents. Further evaluation of this measure is needed to examine face validity and the effect of multimorbidity on pain interference with function. Perspective In this article we present psychometric properties of the BPI originally developed to assess cancer pain, extended to measure chronic nonmalignant pain in younger and middle-aged patients, and now further developed to measure pain intensity and interference with function among very old nursing home residents. Thus, the BPI-NHR might assist clinicians and researchers interested in assessment of pain intensity and interference in elderly individuals who reside in nursing homes.

Approximately one in every two German nursing home residents falls at least once in a 1-year period and just as many report a fear of falling. It has been hypothesized that falls self-efficacy mediates the relationship between fear of falling and functional ability. The aim of the current study was to develop the German Nursing Home Falls Self-Efficacy Scale, examine its validity, and estimate a cutoff point to differentiate nursing home residents with low or high falls self-efficacy. Nursing home residents were assessed at baseline ( n = 178, mean age = 83.7 years) and 6-month follow up ( n = 115, mean age = 83.9 years). Factorial and construct validity analyses provided preliminary support for the validity of the scale. A cutoff point of 11.5 was generated by receiver operating characteristic curve analysis. This scale may assist health care professionals in differentiating between nursing home residents with low and high falls self-efficacy and supporting residents in providing appropriate interventions. [Res Gerontol Nurs. 2016; 9(3):134–144.]

Non-response bias is a major problem for the validity of survey answers. Analyses of reasons for non-response in surveys with nursing home residents (NHR) are scarce.The aim of this study was to develop reliable and valid categories which represent reasons for non-response in nursing homes using the "Prozessmodell induktiver Kategorienbildung" following Mayring (2010). Furthermore, characteristics of unit non-responder and responder were compared.Forming of categories of reasons for non-response was conducted with 522 NHR, longitudinally. Four major categories were identified (general refusal, health reasons, accessibility, excessive demand) and further 17 subcategories. Unit-non-responder and responder did not differ in age and sex; however follow-up non-responder showed differences in marital status, training qualification, and cognitive status.The presented scheme of categories can be used to assess reasons for non-response in nursing homes. Standardised assessment of reasons for non-response may contribute to higher response rates in this setting.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 To evaluate the effect of interventions for general practitioners and nursing home staff to improve pain severity and appropriateness of pain medication in nursing home residents (NHR). Methods This cluster-randomized controlled trial was conducted in six nursing homes in the intervention and control group, respectively. Pain management was analysed before (T0) and after (T1, T2) an educational intervention in 239 NHR, aged ≥65 years, without moderate or severe cognitive impairment. Primary and secondary outcomes were average pain severity and appropriateness of pain medication as determined with the Numeric Rating Scale and Pain Medication Appropriateness Scale (PMASD), respectively. Results At T0, 72.2% and 73.7% of NHR (mean age 83 years) reported pain (average pain severity 2.4) in the intervention and control group, respectively. The PMASD at T0 was 53.9 in the intervention group and 60.8 in the control group (p = 0.12), while 20.6% compared to 6.9% (p = 0.009) received no pain medication in the two groups. At T2, non-significant improvements in the average pain severity (1.59) and PMASD (61.07) were observed in the intervention group. Moreover, the mean individual PMASD increased by 8.09 (p = 0.03) and the proportion of NHR without pain medication decreased by 50% (p = 0.03) in the intervention group. No appreciable changes were found in the control group at T2. Conclusions NHR exhibited a high prevalence of pain with overall low severity, while a high proportion of individuals received inappropriate pain medications. Both findings were not significantly improved by the intervention, although some aspects of drug treatment were meaningful improved.

Purpose:To explore different institutional barriers to and facilitators of physical activity (PA) in nursing homes.Methods:Cross-sectional survey of 40 German nursing homes and 217 nursing-home residents (NHRs; M ± SD age 80 ± 10.2 yr, 55% women, MMSE ≥20). Quantitative data were collected on the structural characteristics of nursing homes and the PA services available.Results:Forms of exercise available were not adequately communicated to residents. Overall participation was below 50%. Awareness was significantly higher in residents with informed relatives (p = .003). A broad range of forms of exercise was generally available (M ± SD 5 ± 2.22, range 0–10), but they were rarely tailored to NHRs’ needs and their effectiveness remains questionable.Conclusion:Multidimensional opportunities to promote PA in NHRs are identified.

The aim of this study was to investigate the frequency of benzodiazepines, antidementia and antipsychotic drug prescriptions in nursing home residents (NHR).Data of a German health insurance company were retrospectively analyzed for the year 2008.The study cohort comprised 13,042 NHR (82% women, mean age 83.6 ± 7 years). Following analgetics, antipsychotic drugs were the second most frequently prescribed drug group with 13.3% of all prescriptions. Dementia was diagnosed in 8 017 (61.5%) NHR. Thereof 51.6% received an antipsychotic, 17.3% a benzodiazepine and 15.2% an antidementia pharmaceutical, respectively. 18.1% of NHR with dementia and antipsychotic drug prescriptions were in combined treatment with antidementia pharmaceuticals. The rate of antipsychotic drug prescribing was significantly doubled in NHR with dementia compared to those without this diagnosis (p0.01); the most frequently prescribed antipsychotics were melperone, risperidone and pipamperone.This study demonstrates the wide-spread use of psychotropic drugs in NHR. Moreover, dementia in NHR was associated with antipsychotic drug prescribing in every second patient. This highlights the need for further studies analyzing alternative treatments for dementia-related symptoms.

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.

Autonomy is an exceptionally complex philosophical concept which is present in ethical considerations in health care settings. Currently, no consistent definition of autonomy exists. From the perspective of the authors, self-determination and capacity to act independently are essential aspects of autonomy. While there are limited general results regarding autonomy in old age, autonomy of nursing home residents and the corresponding critical influence factors still lack in-depth examination. The aim of this article is to contribute to a more thorough understanding of autonomy of nursing home residents. Due to the high percentage of residents with cognitive impairment, this population plays a crucial role regarding the conceptualisation of autonomy. Various approaches combined with the perspectives developed by the interdisciplinary PAiN-Project team (Pain and Autonomy in the Nursing Home), led to the formulation of a novel conceptualisation of autonomy. Based on theoretical and discursive considerations, the model "Determination Factors of Autonomy" focuses on the residents' self-determination and ability to perform activities of daily living in the nursing home context. According to the author's conceptualisation, autonomy occurs in various ranges in regard to self-awareness as well as the appreciation of autonomy by others.