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 - 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 - 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 - JOUR A1 - Bohlken, Jens A1 - Jacob, Louis A1 - Schaum, Peter A1 - Rapp, Michael Armin A1 - Kostev, Karel T1 - Hip fracture risk in patients with dementia in German primary care practices JF - Dementia N2 - The aim was to analyze the risk of hip fracture in German primary care patients with dementia. This study included patients aged 65-90 from 1072 primary care practices who were first diagnosed with dementia between 2010 and 2013. Controls were matched (1:1) to cases for age, sex, and type of health insurance. The primary outcome was the diagnosis of hip fracture during the three-year follow-up period. A total of 53,156 dementia patients and 53,156 controls were included. A total of 5.3% of patients and 0.7% of controls displayed hip fracture after three years. Hip fracture occurred more frequently in dementia subjects living in nursing homes than in those living at home (9.2% versus 4.3%). Dementia, residence in nursing homes, and osteoporosis were risk factors for fracture development. Antidementia, antipsychotic, and antidepressant drugs generally had no significant impact on hip fracture risk when prescribed for less than six months. Dementia increased hip fracture risk in German primary care practices. KW - hip fracture KW - dementia KW - nursing homes KW - osteoporosis KW - risk factors Y1 - 2015 U6 - https://doi.org/10.1177/1471301215621854 SN - 1471-3012 SN - 1741-2684 VL - 16 SP - 853 EP - 864 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Meiberth, Dix Urs A1 - Rapp, Michael Armin A1 - Jessen, Frank T1 - Gedächtnisambulanzstrukturen in Deutschland – Ergebnisse einer Klinikbefragung JF - Psychiatrische Praxis N2 - Ziel der Studie Erfassung der Strukturen zur Frühdiagnostik von Demenzen an Krankenhäusern in Deutschland. Methodik Fragebogenerhebung. Ergebnisse 14 % von 1758 kontaktierten Einrichtungen antworteten. 52 % berichteten über ein entsprechendes Angebot, zum großen Teil mit leitlinienorientierten Verfahren, wie Liquordiagnostik. Das Diagnosespektrum umfasste zu 46 % Demenzen und zu 41 % Diagnosen der leichten oder subjektiven kognitiven Störung. Schlussfolgerung Leitlinienbasierte Diagnostik und Früherkennungskonzepte sind in Gedächtnisambulanzen weitgehend etabliert. N2 - Objective To assess the structures for early and differential diagnosis of dementia in hospitals in Germany. Methods Written questionnaire to all German hospitals. Results 14 % of 1.758 hospitals responded. Of those, 52 % reported to offer a special service for early dementia diagnosis, mostly on an outpatient basis. The applied methods were in agreement with the national guideline for diagnosis and treatment of dementias, including technical diagnostics, such as neuroimaging and cerebrospinal fluid examinations. 46 % of the diagnostic spectrum were dementia. 41 % were either diagnosed as mild cognitive impairment (MCI) or as subjective cognitive decline (SCD). Conclusion Despite mostly insufficient reimbursement, a large proportion of the responding hospitals offer a specialized service, which largely adheres to guideline-based diagnostic procedures. The concepts of at-risk and prodromal stages of dementia seem to be largely established. T2 - Memory Clinics in Germany - Results of a Hospital Survey KW - dementia KW - Alzheimer KW - memory clinic KW - early diagnosis KW - Demenz KW - Alzheimer KW - Gedächtnisambulanz KW - Frühdiagnose Y1 - 2019 U6 - https://doi.org/10.1055/a-0825-9049 SN - 0303-4259 SN - 1439-0876 VL - 46 IS - 4 SP - 213 EP - 216 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Deeken, Friederike A1 - Rezo, Anna A1 - Hinz, Matthias A1 - Discher, Robert A1 - Rapp, Michael Armin T1 - Evaluation of technology-based interventions for informal caregivers of patients with dementia BT - a Meta-Analysis of Randomized Controlled Trials JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry N2 - Objective: The aim of this study was to estimate the efficacy of technology-based interventions for informal caregivers of people with dementia (PWD). Methods: PubMed, PsycINFO, and Cochrane Library databases were searched in August 2018, with no restrictions in language or publication date. Two independent reviewers identified 33 eligible randomized controlled trials (RCTs) conducting a technology-based intervention for informal carers of PWD. Meta-analyses for the outcome measures caregiver depression and caregiver burden were conducted with subgroup analyses according to mode of delivery (telephone, computer/web-based, combined interventions). To assess methodologic quality, the Cochrane risk-of-bias assessment was rated. Results: Meta-analyses revealed a small but significant postintervention effect of technology-based interventions for caregiver depression and caregiver burden. Combined interventions showed the strongest effects. Conclusion: Technology-based interventions have the potential to support informal caregivers of PWD. Because of advantages such as high flexibility and availability, technology-based interventions provide a promising alternative compared with "traditional services," e.g., those for people living in rural areas. More high-quality RCTs for specific caregiver groups are needed. KW - Caregiver KW - dementia KW - technology KW - meta-analysis Y1 - 2019 U6 - https://doi.org/10.1016/j.jagp.2018.12.003 SN - 1064-7481 SN - 1545-7214 VL - 27 IS - 4 SP - 426 EP - 445 PB - Elsevier CY - New York ER -