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Hintergrund: Die Gefahr (drohender) hausärztlicher Unterversorgung ist kein Phänomen, das erst in ferner Zukunft eine bedarfsgerechte Versorgung erschweren könnte, sondern eine Realität, die schon jetzt insbesondere ländliche und strukturschwache Gegenden vor große Herausforderungen [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Nicht pharmakologische Interventionen sind ein zentraler Pfeiler der Maßnahmen zur Eindämmung der COVID-19-Pandemie. Die schrittweise Öffnung der Schulen im Mai 2020 wurde begleitet von strengen Hygienemaßnahmen, die unter anderem das Tragen von Mund-Nasenschutz (MNS) [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund und Stand (inter)nationaler Forschung: Um eine informierte Entscheidung auf Grundlage ihrer individuellen Präferenzen treffen zu können, sollten PatientInnen hinreichend über Behandlungsoptionen und potenzielle Auswirkungen auf den eigenen Lebensalltag informiert sein. Dazu [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: John Snow gilt wegen seines Engagements in der Cholera-Epidemie von 1854 in London als Pionier in Bezug auf räumliche Analysen in der Gesundheitsforschung. Seitdem werden geographische Methoden zunehmend angewendet. Seit den 1950er-Jahren wurden diese durch Geographische Informationssysteme [zum vollständigen Text gelangen Sie über die oben angegebene URL]

BackgroundClinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse.AimTo ascertain whether a GP’s global clinical judgement of future cognitive status has an added value for predicting a patient’s likelihood of experiencing dementia.Design and settingMulticentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016.MethodPatients without baseline dementia were assessed with neuropsychological interviews over 12 years; 138 GPs rated the future cognitive decline of their participating patients. Associations of baseline predictors with follow-up incident dementia were analysed with mixed-effects logistic and Cox regression.ResultsA total of 3201 patients were analysed over the study period (mean age = 79.6 years, 65.3% females, 6.7% incident dementia in 3 years, 22.1% incident dementia in 12 years). Descriptive analyses and comparison with other cohorts identified the participants as having frequent and long-lasting doctor–patient relationships and being well known to their GPs. The GP baseline rating of future cognitive decline had significant value for 3-year dementia prediction, independent of cognitive test scores and patient’s memory complaints (GP ratings of very mild (odds ratio [OR] 1.97, 95% confidence intervals [95% CI] = 1.28 to 3.04); mild (OR 3.00, 95% CI = 1.90 to 4.76); and moderate/severe decline (OR 5.66, 95% CI = 3.29 to 9.73)). GPs’ baseline judgements were significantly associated with patients’ 12-year dementia-free survival rates (Mantel–Cox log rank testPConclusionIn this sample of patients in familiar doctor–patient relationships, the GP’s clinical judgement holds additional value for predicting dementia, complementing test performance and patients’ self-reports. Existing and emerging primary care-based dementia risk models should consider the GP’s judgement as one predictor. Results underline the importance of the GP-patient relationship.

Hospitalization is a key driver of health care costs. Thus far, there are only a few longitudinal studies investigating whether changes in explanatory variables lead to hospitalization. Moreover, these longitudinal studies did not focus on individuals in highest age. The purpose of the current study was to examine the correlates of hospitalization among the oldest old in Germany longitudinally. A multicenter prospective cohort study [“Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)”, AgeQualiDe]. Primary care patients ≥ 85 years took part [n = 861 at follow-up (FU) 7, average age of 89.0 years; 85–100 years]. Two waves were used. Hospitalization in the last 6 months was used as outcome measure. Well-established scales were used to quantify the independent variables such as Instrumental Activities of Daily Living Scale, Global Deterioration Scale or Geriatric Depression Scale. Logistic random effects regressions showed that the probability of hospitalization in the preceding 6 months significantly increased with increases in the social network, more depressive symptoms, functional decline, and increase in chronic conditions, whereas it was not significantly associated with age, sex, marital status, education, and cognitive impairment. Social networks moderate the relationship between functional decline and hospitalization. The results of the present longitudinal study emphasize the association of depressive symptoms, functional decline, more social networks, and chronic conditions with hospitalization among the oldest old. Treatments with the aim to reduce or postpone these factors might also help to reduce hospitalization.

Innerhalb kurzer Zeit hat sich die Coronavirusinfektion COVID-19 zu einer weltweiten Pandemie entwickelt, die auch den Hausarzt vor große Herausforderungen stellt. Auf Basis der aktuellen Kenntnislage hat die Deutsche Gesellschaft für Allgemeinmedizin (DEGAM) praktische Handlungsempfehlungen entwickelt. MMW-Schriftleiter Prof. Klaus Weckbecker stellt zusammen mit Dr. Johannes Just die Leitlinie im folgenden Report vor.

Additional file 1: Supplementary Table 4: Association between positive COVID-19 PCR and different factors using logistic regression – alternative calculation excluding asymptomatic patients

Background: Risk factor research is a relevant aspect of dementia prevention. Hormone therapy – intake as well as suppression of hormones – is widely used in the treatment of diseases such as benign prostatic hyperplasia (BPH), menopausal symptoms, and thyroid disorders. Existing population-based[for full text, please go to the a.m. URL], 26. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

Hintergrund: In Deutschland wird die Zahl der Überschuldeten derzeit auf rund 6,9 Millionen geschätzt. Demnach weist etwa jeder zehnte Erwachsene schwerwiegende Zahlungsschwierigkeiten bis hin zur Zahlungsunfähigkeit auf. Für diese Bevölkerungsgruppe besteht laut Studien ein[zum vollständigen Text gelangen Sie über die oben angegebene URL], 53. Kongress für Allgemeinmedizin und Familienmedizin

Table S2. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) of sleep problems and sleep medication use (nâ =â 7985) Additional multiple logistic regression model for sleep problems and sleep medication use, adjusted for sleep medication use and sleep problems respectively. (DOCX 16 kb)

Table S1. Complete case analysis (nâ =â 7680) Sensitivity analysis, complete case analysis to validate the approach to handle missing data. (DOCX 16 kb)

Table S1. Predictors of having no General Practitioner: Adjusted odds ratios (aOR) with 95% confidence intervals (DEGS1) based on complete data (n=7.176). (DOCX 24 kb)

ObjectivesTo examine how visual impairment affects physical and cognitive function in old age. DesignA longitudinal population-based prospective cohort study. SettingGeneral practitioner offices at six study centers in Germany. They were observed every 1.5 years over four waves. ParticipantsIndividuals aged 77-101 at follow-up Wave 2 (N = 2,394). MeasurementsPhysical and cognitive function were assessed using an adapted scale that had been previously developed, and visual impairment was rated on a Likert scale (none, mild, severe or profound). ResultsAdjusting for sociodemographic factors and comorbidity, linear fixed-effects regression showed that the onset of severe visual impairment was associated with a decline in physical function score in the total sample ( = -0.15, P = .01) and in women ( = -.15, P = .03). Moreover, the onset of severe visual impairment was associated with decline in cognitive function score in the total sample ( = -0.38, P < .001) and in women ( = -0.38, P < .001) and men ( = -0.37, P = .001). ConclusionVisual impairment affects physical and cognitive function in old age. Interventional strategies to postpone visual impairment may contribute to maintaining physical and cognitive function.

Study population: having no GP with adjusted odds ratios (aOR) and 95% confidence intervals (CI) estimated from logistic regression stratified by gender (DEGS1) – complete case analysis (n = 7111). Results of the complete case analysis (n = 7111) (DOCX 22 kb)

Background; The prevalence of pain is very common in the oldest age group. Managing pain successfully is a key topic in primary care, especially within the ageing population. Different care settings might have an impact on the prevalence of pain and everyday life. Methods: Participants from the German longitudinal cohort study on Needs, Health Service Use, Costs and Health-related Quality of Life in a large Sample of Oldest-old Primary Care Patients (85+) (AgeQualiDe) were asked to rate their severity of pain as well as the impairment with daily activities. Besides gender, age, education, BMI and use of analgesics we focused on the current housing situation and on cognitive state. Associations of the dependent measures were tested using four ordinal logistic regression models. Model 1 and 4 consisted of the overall sample, model 2 and 3 were divided according to no cognitive impairment (NCI) and mild cognitive impairment (MCI). Results: Results show a decline in pain at very old age but nonetheless a high prevalence among the 85+ year olds. Sixty-three per cent of the participants report mild to severe pain and 69% of the participants mild to extreme impairment due to pain with daily activities. Use of analgesics, depression and living at home with care support are significantly associated with higher and male gender with lower pain ratings. Conclusions: Sufficient pain management among the oldest age group is inevitable. Outpatient care settings are at risk of overlooking pain. Therefore focus should be set on pain management in these settings.

Migration population: having no GP with adjusted odds ratios (aOR) and 95% confidence intervals (CI) estimated from logistic regression (DEGS1) – complete case analysis (n = 1001). Results of the complete case analysis (n = 1001) (DOCX 18 kb)

Background Completion of advance directives (ADs) and power of attorney (POA) documents may protect a person’s autonomy in future health care situations when the individual lacks decisional capacity. As such situations become naturally much more common in old age, we specifically aimed at providing information on (i) the frequency of ADs/POA in oldest-old individuals and (ii) factors associated with having completed ADs/POA. Methods We analyzed data of oldest-old primary care patients (85+ years; including community-dwelling and institutionalized individuals) within the German AgeQualiDe study. Patients were initially recruited via their general practitioners (GPs). We calculated frequencies of ADs and POA for health care with 95% confidence intervals (CI) and used multivariable logistic regression analysis to evaluate the association between having ADs and POA and participants’ socio-demographic, cognitive, functional, and health-related characteristics. Results Among 868 GP patients participating in AgeQualiDe (response = 90.9%), n = 161 had dementia and n = 3 were too exhausted/ill to answer the questions. Out of the remaining 704 (81.1%) dementia-free patients (mean age = 88.7 years; SD = 3.0), 69.0% (95%-CI = 65.6–72.4) stated to having ADs and 64.6% (95%-CI = 61.1–68.2) to having a POA for health care. Individual characteristics did not explain much of the variability of the presence/absence of ADs and POA (regression models: Nagelkerke’s R2 = 0.034/0.051). The most frequently stated reasons for not having ADs were that the older adults trust their relatives or physicians to make the right decisions for them when necessary (stated by 59.4% and 44.8% of those without ADs). Among the older adults with ADs, the majority had received assistance in its preparation (79.0%), most frequently from their children/grandchildren (38.3%). Children/grandchildren were also the most frequently stated group of designated persons (76.7%) for those with a POA for health care. Conclusions Our findings suggest a high dissemination of ADs and POA for health care in the oldest-old in Germany. Some adults without ADs/POA perhaps would have completed advance care documents, if they had had received more information and support. When planning programs to offer advanced care planning to the oldest old, it might be helpful to respond to these specific needs, and also to be sensitive to attitudinal differences in this target group.

Background Thus far, only a few longitudinal studies investigated the impact of social engagement on health-related quality of life (HRQoL) and depressive symptoms in old age. Therefore, we aimed to examine the impact of social engagement on HRQoL and depressive symptoms in late life. Methods Individuals aged 75 years and over at baseline were interviewed every 1.5 years in a multicenter prospective cohort study in Germany. While HRQoL was quantified by using the Visual Analogue Scale (EQ VAS) of the EQ-5D instrument, depressive symptoms was assessed by using the Geriatric Depression Scale (GDS). Individuals reported the frequency (“never” to “every day”) of social engagement (e.g., engagement in the church, as a volunteer, in a party, or in a club) in the last four weeks. Fixed effects regressions were used to estimate the effect of social engagement on the outcome variables. Results After adjusting for age, marital status, functional status and chronic diseases, fixed effects regressions revealed that the onset of social engagement markedly increased HRQoL and considerably decreased depressive symptoms in the total sample and in women, but not men. Conclusions Our findings corroborate the relevance of social engagement for HRQoL and depressive symptoms in old age. Encouraging the individuals to start, maintain and expand social engagement in late life might help to maintain and improve HRQoL and decrease depressive symptoms.

Methodological details. The additional file provides methodological procedures in more detail. (PDF 260 kb)