TY - JOUR A1 - Booker, Anke A1 - Jacob, Louis E. C. A1 - Rapp, Michael Armin A1 - Bohlken, Jens A1 - Kostev, Karel T1 - Risk factors for dementia diagnosis in German primary care practices JF - International psychogeriatrics N2 - Background: Dementia is a psychiatric condition the development of which is associated with numerous aspects of life. Our aim was to estimate dementia risk factors in German primary care patients. Methods: The case-control study included primary care patients (70-90 years) with first diagnosis of dementia (all-cause) during the index period (01/2010-12/2014) (Disease Analyzer, Germany), and controls without dementia matched (1:1) to cases on the basis of age, sex, type of health insurance, and physician. Practice visit records were used to verify that there had been 10 years of continuous follow-up prior to the index date. Multivariate logistic regression models were fitted with dementia as a dependent variable and the potential predictors. Conclusions: Risk factors for dementia found in this study are consistent with the literature. Nevertheless, the associations between statin, PPI and antihypertensive drug use, and decreased risk of dementia need further investigations. KW - dementia KW - Alzheimer KW - risk factors KW - statins Y1 - 2016 U6 - https://doi.org/10.1017/S1041610215002082 SN - 1041-6102 SN - 1741-203X VL - 28 SP - 1059 EP - 1065 PB - Cambridge Univ. Press CY - New York ER - TY - GEN A1 - Booker, Anke A1 - Jacob, Louis E. C. A1 - Rapp, Michael Armin A1 - Bohlken, Jens A1 - Kostev, Karel T1 - Risk factors for dementia diagnosis in German primary care practices T2 - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe N2 - Background: Dementia is a psychiatric condition the development of which is associated with numerous aspects of life. Our aim was to estimate dementia risk factors in German primary care patients. Methods: The case-control study included primary care patients (70-90 years) with first diagnosis of dementia (all-cause) during the index period (01/2010-12/2014) (Disease Analyzer, Germany), and controls without dementia matched (1:1) to cases on the basis of age, sex, type of health insurance, and physician. Practice visit records were used to verify that there had been 10 years of continuous follow-up prior to the index date. Multivariate logistic regression models were fitted with dementia as a dependent variable and the potential predictors. Results: The mean age for the 11,956 cases and the 11,956 controls was 80.4 (SD: 5.3) years. 39.0% of them were male and 1.9% had private health insurance. In the multivariate regression model, the following variables were linked to a significant extent with an increased risk of dementia: diabetes (OR: 1.17; 95% CI: 1.10-1.24), lipid metabolism (1.07; 1.00-1.14), stroke incl. TIA (1.68; 1.57-1.80), Parkinson's disease (PD) (1.89; 1.64-2.19), intracranial injury (1.30; 1.00-1.70), coronary heart disease (1.06; 1.00-1.13), mild cognitive impairment (MCI) (2.12; 1.82-2.48), mental and behavioral disorders due to alcohol use (1.96; 1.50-2.57). The use of statins (OR: 0.94; 0.90-0.99), proton-pump inhibitors (PPI) (0.93; 0.90-0.97), and antihypertensive drugs (0.96, 0.94-0.99) were associated with a decreased risk of developing dementia. Conclusions: Risk factors for dementia found in this study are consistent with the literature. Nevertheless, the associations between statin, PPI and antihypertensive drug use, and decreased risk of dementia need further investigations. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 449 KW - dementia KW - Alzheimer KW - risk factors KW - statins Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-413441 IS - 449 ER - TY - THES A1 - Deeken, Friederike T1 - Relevance of non-pharmacological interventions that modify environmental factors in order to prevent and treat mental disorders in older patients and their caregivers N2 - We live in an aging society. The change in demographic structures poses a number of challenges, including an increase in age-associated diseases. Delirium, dementia, and depression are considered to be of particular interest in the field of aging and mental health. A common theory regarding healthy aging and mental health is that the highest satisfaction and best performance is achieved when a person's abilities match the demands of their environment. In this context, the person's environment includes both the physical and the social environment. Based on this assumption, this dissertation focuses on the investigation of non-pharmacological interventions that modify environmental factors in order to facilitate the prevention and treatment of mental disorders in older patients and their caregivers. The first part of this dissertation consists of two publications and deals with the prevention of postoperative delirium in elderly patients. The PAWEL study investigated the use of a multimodal, non-pharmacological intervention in the routine care of patients aged 70 years or older undergoing elective surgery. The intervention included an interdepartmental delirium prevention team, daily use of seven manualized “best practice” procedures, structured staff training on delirium, and the adaptation of the hospital environment to the patients’ needs. The second part of the dissertation used a meta-analysis to investigate whether technology-based interventions are a suitable form of support for informal caregivers of people with dementia. Subgroup analyses were conducted to examine the effect of different types of technology on caregiver burden and depressive symptoms. The following main results were found: The PAWEL study showed that the use of a multimodal, non-pharmacological intervention resulted in a significantly lower incidence rate of postoperative delirium and reduced days with delirium in the intervention group compared to the control group. However, this difference could not be observed in the group of patients undergoing elective cardiac surgery. The results of the meta-analysis showed that technology-based interventions offer a promising alternative to traditional “face-to-face” services. Significant effect sizes could be found in relation to both the burden and the depressive symptoms of caregiving relatives. These results provide further important information on the significant impact of non-pharmacological interventions that modify environmental factors on mental health, and support the consideration of such interventions in the prevention and treatment of mental disorders in both older patients and their caregivers. N2 - Wir leben in einer alternden Gesellschaft. Die Veränderung von demografischen Strukturen bringt eine Reihe von Herausfordergungen mit sich, unter anderem die Zunahme von alters-assoziierten Erkrankungen. Den drei Erkrankungen Delir, Demenz und Depression wird für den Bereich mentale Gesundheit im Alter eine besondere Bedeutung zugesprochen. Eine gängige Theorie für gesundes Altern und mentale Gesundheit bildet die Annahme, dass die höchste Zufriedenheit und beste Leistung gezeigt werden kann, wenn eine Passung zwischen den Anforderungen aus der Umwelt und den Fähigkeiten der Person gegeben ist. Zur Umwelt der Person zählen hierbei sowohl die physikalische Umgebung als auch das soziale Umfeld. Auf dieser Annahme basierend, widmet sich diese Dissertation der Untersuchung nicht-pharmakologischer Interventionen zur Modifikation von Umweltfaktoren zur Prävention und Behandlung psychischer Erkrankungen bei älteren Patienten und ihren pflegenden Angehörigen. Der erste Teil der Dissertation besteht aus zwei Publikationen und beschäftigt sich mit der Prävention von postoperativem Delir bei älteren PatientInnen. Die PAWEL-Studie untersuchte eine multimodale, nicht-pharmakologische Intervention in der Regelversorgung von PatientInnen über 70 Jahren, bei denen eine Elektivoperation durchgeführt wurde. Die Intervention umfasste den Einsatz eines interdisziplinären Delirium-Präventionsteams, die tägliche Anwendung von sieben manualisierten "Best-Practice"-Verfahren, strukturierte Mitarbeiterschulungen zum Thema Delirium und die Anpassung der Krankenhausumgebung an die Bedürfnisse der PatientInnen. Im zweiten Teil der Dissertation wurde mit Hilfe einer Meta-Analyse untersucht, ob technologie-basierte Interventionen geeignet sind, um pflegende Angehörige von Menschen mit Demenz zu unterstützen. In Subgruppen-Analysen wurde geprüft, wie unterschiedliche Technologiearten die Belastung und depressive Symptomatik der Angehörigen beeinflussen. Folgende Hauptergebnisse wurden gefunden: Die PAWEL-Studie zeigte, dass der Einsatz einer multimodalen, nicht-pharmakologischen Intervention zu einer signifikant niedrigeren Inzidenzrate von postoperativen Delirien sowie insgesamt weniger Delirtagen in der Interventionsgruppe im Vergleich zur Kontrollgruppe führte. Dieser Unterschied konnte jedoch nicht in der Gruppe der PatientInnen gezeigt werden, bei denen eine Herz- oder Gefäßoperation durchgeführt wurde. Die Ergebnisse der Meta-Analyse belegen, dass technologie-basierte Interventionen eine vielversprechende Alternative zu traditionellen „face-to-face“-Angeboten bieten. Es zeigten sich signifikante Effekte sowohl in Bezug auf die Belastung als auch auf die depressive Symptomatik der pflegenden Angehörigen. Die Ergebnisse dieser Dissertation belegen die Relevanz von nicht-pharmakologischen Interventionen zur Modifikation von Umweltfaktoren bei der Prävention und Behandlung von psychischen Erkankungen sowohl bei älteren PatientInnen als auch deren pflegenden Angehörigen. KW - delirium KW - prevention KW - old age KW - caregiver KW - dementia Y1 - 2022 ER - TY - JOUR A1 - Deeken, Friederike A1 - Häusler, Andreas A1 - Nordheim, Johanna A1 - Rapp, Michael Armin A1 - Knoll, Nina A1 - Rieckmann, Nina T1 - Psychometric properties of the Perceived Stress Scale in a sample of German dementia patients and their caregivers JF - International psychogeriatrics N2 - Background: The aim of the present study was to investigate the psychometric characteristics of the Perceived Stress Scale (PSS) in a sample of dementia patients and their spousal caregivers. Methods: We investigated the reliability and validity of the 14-item PSS in a sample of 80 couples, each including one spouse who had been diagnosed with mild to moderate dementia (mean age 75.55, SD = 5.85, 38.7% female) and one spousal caregiver (mean age 73.06, SD = 6.75, 61.3% female). We also examined the factor structure and sensitivity of the scale with regard to gender differences. Results: Exploratory factor analysis of the PSS revealed a two-factor solution for the scale; the first factor reflected general stress while the second factor consisted of items reflecting the perceived ability to cope with stressors. A confirmatory factor analysis verified that the data were a better fit for the two-factor model than a one-factor model. The two factors of the PSS showed good reliability for patients as well as for caregivers ranging between alpha = 0.73 and alpha = 0.82. Perceived stress was significantly positively correlated with depressive symptomatology in both caregivers and patients. Mean PSS scores did not significantly differ between male and female patients nor did they differ between male and female caregivers. Conclusion: The present data indicate that the PSS provides a reliable and valid measure of perceived stress in dementia patients and their caregivers. KW - Perceived Stress Scale KW - psychometric properties KW - dementia KW - caregiver Y1 - 2017 U6 - https://doi.org/10.1017/S1041610217001387 SN - 1041-6102 SN - 1741-203X VL - 30 IS - 1 SP - 39 EP - 47 PB - Cambridge Univ. Press CY - New York ER - TY - JOUR A1 - Bookers, Anke A1 - Jacob, Louis A1 - Bohlken, Jens A1 - Rapp, Michael Armin A1 - Kostev, Karel T1 - Persistence with antipsychotics in dementia patients in Germany JF - International journal of clinical pharmacology and therapeutics N2 - Background/Aims: To analyze the duration of treatment with antipsychotics in German dementia patients. Methods: This study included patients aged 60 years and over with dementia who received a first-time antipsychotic prescription by psychiatrists between 2009 and 2013. The main outcome measure was the treatment rate for more than 6 months following the index date. Results: A total of 12,979 patients with dementia (mean age 82 years, 52.1% living in nursing homes) were included. After 2 years of follow-up, 54.8%, 57.2%, 61.1%, and 65.4% of patients aged 60 - 69, 70 - 79, 80 - 89, and 90 - 99 years, respectively, received antipsychotic prescriptions. 63.9% of subjects living in nursing homes and 55.0% of subjects living at home also continued their treatment (p-value < 0.001). Conclusion: The percentage of dementia patients treated with anti psychotics is very high. KW - persistence KW - antipsychotics KW - dementia Y1 - 2016 U6 - https://doi.org/10.5414/CP202631 SN - 0946-1965 VL - 54 SP - 835 EP - 840 PB - Dustri-Verlag Dr. Karl Feistle CY - Deisenhofen-München ER - TY - JOUR A1 - Häusler, Andreas A1 - Sánchez, Alba A1 - Gellert, Paul A1 - Deeken, Friederike A1 - Rapp, Michael Armin A1 - Nordheim, Johanna T1 - Perceived stress and quality of life in dementia patients and their caregiving spouses: does dyadic coping matter? JF - International psychogeriatrics N2 - Background: Given the well-established association between perceived stress and quality of life (QoL) in dementia patients and their partners, our goal was to identify whether relationship quality and dyadic coping would operate as mediators between perceived stress and QoL. Results: We found negative correlations between stress and QoL in both partners (QoL-AD: r = -0.62; p < 0.001; WHO-QOL Overall: r = -0.27; p = 0.02). Spousal caregivers had a significantly lower DCI total score than dementia patients (p < 0.001). Dyadic coping was a significant mediator of the relationship between stress and QoL in spousal caregivers (z = 0.28; p = 0.02), but not in dementia patients. Likewise, relationship quality significantly mediated the relationship between stress and QoL in caregivers only (z = -2.41; p = 0.02). Conclusions: This study identified dyadic coping as a mediator on the relationship between stress and QoL in (caregiving) partners of dementia patients. In patients, however, we found a direct negative effect of stress on QoL. The findings suggest the importance of stress reducing and dyadic interventions for dementia patients and their partners, respectively. KW - dementia KW - dyadic coping KW - perceived stress KW - quality of life Y1 - 2016 U6 - https://doi.org/10.1017/S1041610216001046 SN - 1041-6102 SN - 1741-203X VL - 28 SP - 1857 EP - 1866 PB - Cambridge Univ. Press CY - New York ER - TY - GEN A1 - Häusler, Andreas A1 - Sánchez, Alba A1 - Gellert, Paul A1 - Deeken, Friederike A1 - Nordheim, Johanna A1 - Rapp, Michael Armin T1 - Perceived stress and quality of life in dementia patients and their caregiving spouses BT - does dyadic coping matter? T2 - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe N2 - Background: Given the well-established association between perceived stress and quality of life (QoL) in dementia patients and their partners, our goal was to identify whether relationship quality and dyadic coping would operate as mediators between perceived stress and QoL. Methods: 82 dyads of dementia patients and their spousal caregivers were included in a cross-sectional assessment from a prospective study. QoL was assessed with the Quality of Life in Alzheimer's Disease scale (QoL-AD) for dementia patients and the WHO Quality of Life-BREF for spousal caregivers. Perceived stress was measured with the Perceived Stress Scale (PSS-14). Both partners were assessed with the Dyadic Coping Inventory (DCI). Analyses of correlation as well as regression models including mediator analyses were performed. Results: We found negative correlations between stress and QoL in both partners (QoL-AD: r = -0.62; p < 0.001; WHO-QOL Overall: r = -0.27; p = 0.02). Spousal caregivers had a significantly lower DCI total score than dementia patients (p < 0.001). Dyadic coping was a significant mediator of the relationship between stress and QoL in spousal caregivers (z = 0.28; p = 0.02), but not in dementia patients. Likewise, relationship quality significantly mediated the relationship between stress and QoL in caregivers only (z = -2.41; p = 0.02). Conclusions: This study identified dyadic coping as a mediator on the relationship between stress and QoL in (caregiving) partners of dementia patients. In patients, however, we found a direct negative effect of stress on QoL. The findings suggest the importance of stress reducing and dyadic interventions for dementia patients and their partners, respectively. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 448 KW - dementia KW - dyadic coping KW - perceived stress KW - quality of life Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-413464 IS - 448 ER - TY - JOUR A1 - Niemann-Mirmehdi, Mechthild A1 - Häusler, Andreas A1 - Gellert, Paul A1 - Nordheim, Johanna T1 - Perceived Overprotection and Its Association With Quality of Life in Dementia JF - Geropsych - The Journal of gerontopsychology and geriatric psychiatry N2 - To date, few studies have focused on perceived overprotection from the perspective of people with dementia (PwD). In the present examination, the association of perceived overprotection in PwD is examined as an autonomy-restricting factor and thus negative for their mental well-being. Cross-sectional data from the prospective DYADEM study of 82 patient/partner dyads (mean age = 74.26) were used to investigate the association between overprotection, perceived stress, depression, and quality of life (QoL). The analyses show that an overprotective contact style with PwD has a significant positive association with stress and depression, and has a negative association with QoL. The results emphasize the importance of avoiding an overprotective care style and supporting patient autonomy. KW - dementia KW - perceived overprotection KW - perceived stress KW - depression KW - quality of life Y1 - 2019 U6 - https://doi.org/10.1024/1662-9647/a000207 SN - 1662-9647 SN - 1662-971X VL - 32 IS - 3 SP - 125 EP - 134 PB - Hogrefe CY - Göttingen ER - TY - JOUR A1 - Gellert, Paul A1 - Häusler, Andreas A1 - Gholami, Maryam A1 - Rapp, Michael Armin A1 - Kuhlmey, Adelheid A1 - Nordheim, Johanna T1 - Own and partners’ dyadic coping and depressive symptoms in individuals with early-stage dementia and their caregiving partners JF - Aging & Mental Health N2 - Objectives: In patients with early-stage dementia and their caregiving partners, reciprocal dyadic coping (DC) is crucial for preventing or reducing depressive symptoms in both partners. This study examines the relationships between ‘own DC’ and ‘perceived partner DC’ with depressive symptoms in couples coping with dementia on individual (actor effects) and cross-person (partner effects) levels. Method: 164 individuals (82 patients with early-stage dementia and their 82 caregiving partners; ND = 82 dyads) participated in this prospective study with measures (DC, depressive symptoms, and dementia severity) taken at baseline and at six months. Each partner evaluated their own and the perceived partner DC. Actor–partner interdependence models were applied to the resulting four independent evaluations. Results: Results differed substantially between patients and caregivers. DC was significantly related to patients’ but not to caregivers’ depressive symptoms, when adjustments were made for individual coping. Perceived partner DC showed a negative association with depressive symptoms in patients, whereas own DC was adversely related for actor as well as for partner effects across individuals. Conclusion: The adverse association between the own DC of the caregiver and the patient on depressive symptoms of the patient might be due to inappropriate efforts or to the loss of autonomy as a care-receiver. DC is important in both patients and caregivers, as shown by the negative association between perceived partner DC and depressive symptoms in the patients, which might inform interventions that target the couple as a whole. KW - Dyadic coping KW - dementia KW - actor-partner interdependence model KW - caregiver KW - quality of life KW - depression Y1 - 2017 U6 - https://doi.org/10.1080/13607863.2017.1334759 SN - 1360-7863 SN - 1364-6915 VL - 22 IS - 8 SP - 1008 EP - 1016 PB - Routledge, Taylor & Francis Group CY - Abingdon ER - TY - GEN A1 - Baltes, Paul B. A1 - Kliegl, Reinhold T1 - Lernen und Gedächtnis im Alter : über Plastizität und deren Grenzen T1 - Learning and memory in old age N2 - Gedächtnishöchstleistungen sind auch im Alter möglich. Dies konnte am Beispiel der »Methode der Orte« experimentell bestätigt werden. Hierbei hat sich gezeigt, daß das Gehirn über große kognitive Kapazitätsreserven verfügt. In einer speziellen Testmethode (»testing the limits«) zeigt sich aber im Hochleistungsbereich, trotz der grundsätzlichen Plastizität, ein altersbezogenes Nachlassen der Gedächtnismechanik. Offenbar gibt es biologische Grenzen in der Schnelligkeit der menschlichen Vorstellungskraft. Vielleicht gelingt es auf der Grundlage dieser Erkentnnis, einen zuverlässigen Markierungsindikator für das hirnphysiologische Altern zu finden. Daraus könnten sich auch neue Methoden zur Früherkennung von Demenzen ableiten lassen. N2 - A very high level of performance in memory is also possible in old age. This could be confirmed, for example, by experiments using the »method of loci«. It was shown that the human brain has available a large cognitive developmental reserve capacity. Nevertheless, a special method of assessment (»testing the limits«) revealed a robust age related decrease of memory mechanics at the high performance level despite this basic plasticity. Obviously, there are biologic limits of the speed of human imagination. Perhaps it will be possible to find a reliable marker of brainphysiologic aging based on this knowledge. Furthermore, new methods in early detection of dementias might be derived from the approach described. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - paper 150 KW - Lernen KW - Gedächtnis KW - Alter KW - Plastizität KW - Methode der Orte KW - Testing the limits KW - Demenz KW - Learning KW - memory KW - old age KW - plasticity KW - method of places KW - testing the limits KW - dementia Y1 - 1988 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus-40277 ER -