BACKGROUND:Geriatric care requires coordinated, interprofessional and person-centered approaches; however, geriatric competencies among healthcare professionals (HCP) vary considerably across Europe, and only limited data are available for the DACH (D: Deutschland, Germany; A: Austria; CH: Confoederatio Helvetica, Switzerland) region. OBJECTIVES:To investigate self-perceived knowledge, relevance and interest regarding key geriatric topics and skills among HCPs in the DACH region and to compare findings with other European countries. MATERIAL AND METHODS:Secondary data analyses of the PROGRAMMING COST Action 21122 online survey. The DACH responses (n = 291) were compared with those from other European countries (n = 5134) and 33 geriatric topics and skills were analyzed to identify educational priorities. RESULTS:The HCPs working in the DACH region rated their perceived geriatric knowledge higher than HCPs working in other European countries. Nevertheless, substantial perceived knowledge gaps remained, particularly in the areas of dementia, depression, chronic pain, cognitive screening and sarcopenia. Perceived relevance and interest in further education exceeded self-assessed knowledge levels. In contrast, topics such as oncogeriatrics, gerodontology and geriatric emergency care were assigned lower priority. CONCLUSION:Despite overall high self-perceived competence, important gaps persist, especially in complex, interdisciplinary areas. Continuing education needs appear to be strongly influenced by clinical practice and system structures. Given the large number of medical doctors in our data, some implications are intraprofessional; nevertheless, targeted competency-based cross-professional educational initiatives and frameworks are needed to strengthen geriatric care and support workforce mobility across Europe.
Geriatric care requires coordinated, interprofessional and person-centered approaches; however, geriatric competencies among healthcare professionals (HCP) vary considerably across Europe, and only limited data are available for the DACH (D: Deutschland, Germany; A: Austria; CH: Confoederatio Helvetica, Switzerland) region. To investigate self-perceived knowledge, relevance and interest regarding key geriatric topics and skills among HCPs in the DACH region and to compare findings with other European countries. Secondary data analyses of the PROGRAMMING COST Action 21122 online survey. The DACH responses (n = 291) were compared with those from other European countries (n = 5134) and 33 geriatric topics and skills were analyzed to identify educational priorities. The HCPs working in the DACH region rated their perceived geriatric knowledge higher than HCPs working in other European countries. Nevertheless, substantial perceived knowledge gaps remained, particularly in the areas of dementia, depression, chronic pain, cognitive screening and sarcopenia. Perceived relevance and interest in further education exceeded self-assessed knowledge levels. In contrast, topics such as oncogeriatrics, gerodontology and geriatric emergency care were assigned lower priority. Despite overall high self-perceived competence, important gaps persist, especially in complex, interdisciplinary areas. Continuing education needs appear to be strongly influenced by clinical practice and system structures. Given the large number of medical doctors in our data, some implications are intraprofessional; nevertheless, targeted competency-based cross-professional educational initiatives and frameworks are needed to strengthen geriatric care and support workforce mobility across Europe.
Delirium is a frequent acute neurocognitive syndrome in older adults, associated with morbidity, mortality, and long-term cognitive decline. Its pathophysiology is multifactorial and not yet fully understood. To summarize clinically relevant concepts of delirium pathophysiology and emerging biomarkers. Narrative review of literature from 2010–2026, prioritizing human studies, reviews, meta-analyses, and clinically relevant pathophysiological literature relevant to older hospitalized or perioperative patients. Delirium arises from the interaction of predisposing vulnerability and acute triggers. Relevant mechanisms include neuroinflammation, neurotransmitter imbalance, neurodegeneration, metabolic dysfunction and blood–brain barrier impairment. Biomarker research has identified promising candidates, including inflammatory, neurodegenerative, metabolic and stress-related markers but none is currently established for routine clinical use. Delirium prevention remains clinically driven. Multimodal biomarkers may support future risk stratification but require prospective validation.
Kognitives Altern, die erwartbaren Veränderungen kognitiver Fähigkeiten mit dem Alter, kann die Bewältigung alltäglicher Anforderungen beeinträchtigen, Pflegebedarf hervorrufen oder eine Demenz nahelegen. In der Vorbereitung auf das Altern und der Begleitung alter Menschen sollten daher mentale Veränderungen genauso berücksichtigt werden wie körperliche Veränderungen. Auf der Basis kognitionspsychologischer Übersichtsarbeiten werden erwartbare Altersveränderungen wesentlicher Kompetenzen für die Alltagsbewältigung wie Intelligenz, Gedächtnis, soziale Kognition und die darauf aufbauende Entscheidungs- und Handlungsfähigkeit zusammengefasst. Die Flexibilität des Denkens geht zurück, Handlungen richten sich auf den Erhalt, nicht den Neuerwerb von nötigen Ressourcen, was sich beispielsweise im Festhalten an nicht mehr adäquaten Routinen der Alltagsbewältigung und der Abwehr notwendiger Veränderungen wie der Nutzung technischer Hilfsmittel zeigt. Persönliche und soziale Ressourcen können diese Veränderungen ausgleichen und eine selbstbestimmte Lebensführung ermöglichen. An Beispielen wie der Nutzung strukturierter Eigenbeobachtung oder der Vorsorgevollmacht, der Form von Informationsvermittlung und Beratung sowie der Beziehungsarbeit wird aufgezeigt, wie psychologische Erkenntnisse zum kognitiven Altern in eine integrative Altenhilfe übertragen werden können.
Der Begriff des Liegetraumas wird im deutschsprachigen Raum häufig verwendet, obwohl bislang keine einheitliche nationale oder internationale Definition existiert. Aufgrund der klinischen Relevanz sturzbedingter Liegeereignisse im höheren Lebensalter und den erheblichen Folgen für die Betroffenen ist eine klare begriffliche Abgrenzung erforderlich. Ziel dieser Studie ist es, eine einheitliche deutschsprachige Definition des Liegetraumas bei älteren Personen (> 65 Jahre) zu entwickeln. In einer dreirundigen Delphi-Studie bewerteten 50 Expert:innen aus verschiedenen Professionen zentrale Merkmale des Begriffs hinsichtlich der Relevanz. Als Konsenskriterien wurden eine Zustimmung von mindestens 75
Cognitive aging, the expectable changes in cognitive abilities with age, can impair the capacity to manage everyday demands, result in the need for care or resemble dementia. Therefore, age-related mental changes should be considered as well as physical changes in preparing for aging and accompanying old people. Based on reviews in cognitive psychology, expectable age-related changes in relevant cognitive domains for everyday management, such as intelligence, memory and social cognition as well as the resulting effect on decision-making and executive functioning are summarized. The flexibility of thinking declines; actions focus on exploitation rather than necessary exploration of resources as evidenced, for example, by clinging to routines for managing everyday demands that are no longer adequate or resisting necessary changes such as the use of assistive technologies. Personal and social resources can balance these changes and promote a self-determined lifestyle. Examples such as the use of structured self-observation or of lasting power of attorney, information provision, counselling and relationship-building demonstrate how knowledge on cognitive aging can be transferred to integrative assistance for old persons.
BACKGROUND:The term "long lie" is frequently used in German-speaking countries although no standardized national or international definition currently exists. Given the high prevalence of long lies among older adults and the significant effects for those affected, a definition is necessary. The aim of this study is to develop a standardized German language definition of the term long lie in older adults. METHODS:In a three-round Delphi study 50 experts from various professions evaluated key components of the term in relation to their relevance. The consensus criteria were defined as a minimum agreement rate of 75% and an interquartile range of ≤ 1. Characteristics that met these criteria were carried over to the next round and integrated into the final definition. RESULTS:In the final round 77.6% of the experts approved the definition. The interquartile ranges for all assessed components were consistently ≤ 1. There was consensus regarding the components of acute impaired mobility, the inability to free oneself, the resulting loss of control, the traumatic experience and the multidimensional effects. Disagreement existed regarding the significance of a temporal component as well as the prioritization of physical effects in comparison to psychological and emotional effects. CONCLUSION:A consensus-based definition of long lies in older adults has been developed. The results also show interprofessional differences in the assessment of key components and underscore the need for further conceptual and interprofessional coordination in research and care.
Hyponatremia is frequent in very old patients ≥ 80 years (VOP). Data for hyponatremia associated with moderate heat in VOP are scarce. We aimed to provide epidemiological data, to identify risk factors of hyponatremia and to present outcomes in VOP after hot and cold days in northern Germany. Of 22,085 VOP admitted unplanned to the departments of internal medicine and trauma surgery in 2011–2023, we studied those admitted 1–2 days after hot (N = 308) and cold days (N = 253) in June-August of these years (57.9
This paper builds upon the principles and dimensions presented in the paper, “The distinctiveness of human aging I”, which is intended to provide a foundation for apprehending and understanding variation in individual and population patterns of human aging. Given the clearly established role of contextual factors and context-related dynamics as key explanatory factors to account for such variation, this paper sets forth key dimensions of the socioenvironmental regulation of processes of human aging and their interactions across micro, meso and macro levels of social organization. We focus on one specific domain of age-related challenges and one (albeit broad) institutional domain: rapid population aging and on the institutional level, the attendant expansion of geriatric diagnoses and elder care institutions, focusing especially on nursing homes. Through this discussion, we demonstrate that human aging entails a distinctly flexible and in key ways modifiable set of processes. It is thus continually reconstituted for individuals and for social groups and populations as existing social arrangements are continuously reproduced, regardless of the value (positive or negative) of such arrangements for human aging.
BACKGROUND:The timely diagnostics of cognitive impairments and dementia syndromes are central to geriatric care. Memory clinics typically perform differential diagnostics following positive case findings in the general practitioner's practice; however, care pathways do not function smoothly, as shown by the "iCreate" project. Of 95 patients with positive case findings only 68 utilized the referral to the memory clinic; 27 were no shows. While barriers before the first doctor's visit are well-researched, analysis of the transition between primary and specialist care settings is lacking. The aim was to understand why further differential diagnostics after positive case findings were not pursued and to derive recommendations for action. METHOD:Qualitative design with semi-structured interviews (n = 9) and telephone surveys (n = 15) of 24 of the 27 no shows or relatives from "iCreate". Software-assisted evaluation using qualitative content analysis according to Kuckartz and Rädiker. RESULTS:Affected individuals experience a care gap with uncertainties and an individual interplay of barriers on three levels: a) psychosocial: fear of loss of autonomy/stigma, denial/ambivalence, desire/right not to know; b) structural and organizational: transport/appointment/coordination problems and c) care-related and process-related: unclear benefits, lack of follow-up options. CONCLUSION:Case finding programs require standardized communication pathways with written summaries (working diagnosis, next steps, contact persons). Stepwise shared decision-making supported by dementia care managers could reduce the perceived barriers and drop-outs while closing care gaps.
Die rechtzeitige Diagnostik kognitiver Beeinträchtigungen und dementieller Syndrome ist zentral in der geriatrischen Versorgung. Gedächtnisambulanzen übernehmen meist die Differenzialdiagnostik nach positivem case finding in der Hausarztpraxis. Doch Versorgungspfade funktionieren nicht reibungslos, wie im Projekt „iCreate“ gezeigt. Von 95 Patient*innen mit positivem case finding nahmen nur 68 die Überweisung zur Gedächtnisambulanz wahr; 27 waren „No shows“. Während Hürden vor dem ersten Arztbesuch gut erforscht sind, fehlt die Analyse des Übergangs zwischen haus- und fachärztlichem Setting. Ziel war es zu verstehen, warum eine weiterführende Differenzialdiagnostik nach positivem case finding nicht in Anspruch genommen wurde, und Handlungsempfehlungen abzuleiten. Qualitatives Design mit leitfadengestützten Interviews (n = 9) und telefonischen Befragungen (n = 15) von 24 der 27 „No shows“ bzw. Angehörigen aus „iCreate“. Software-gestützte Auswertung mittels qualitativer Inhaltsanalyse nach Kuckartz und Rädiker. Die Betroffenen erleben eine Versorgungslücke mit Unklarheiten sowie ein individuelles Geflecht aus Hürden auf drei Ebenen: a) psychosozial: Angst vor Autonomieverlust/Stigma, Abwehr/Ambivalenz, Wunsch/Recht auf Nichtwissen; b) strukturell und organisatorisch: Transport‑/Termin‑/Koordinationsprobleme sowie c) versorgungs- und prozessbezogen: unklarer Nutzen, fehlende Anschlussoptionen. Case-finding-Programme benötigen standardisierte Kommunikationspfade mit schriftlichen Zusammenfassungen (Arbeitsdiagnose, nächste Schritte, Ansprechpersonen). Ein gestuftes shared decision-making, unterstützt durch Dementia Care Manager, könnte die empfundenen Hürden und Drop-outs reduzieren sowie Versorgungslücken schließen.
High inflation following the war in Ukraine has posed a major economic challenge, particularly for older adults in Austria who rely heavily on pensions and fixed social benefits. Individuals with low incomes are especially vulnerable to rising living costs. This study examines changes in subjective income adequacy among older adults during the 2022/2023 inflation period and identifies key risk factors for perceived financial deterioration. Data were obtained from a representative telephone survey of 841 adults aged 60+ years in Austria conducted between January and February 2023. Changes in income adequacy were assessed by comparing respondents’ financial situation before and after the onset of high inflation. Hierarchical logistic regression models were applied to identify relevant factors. Overall, 42
In Deutschland werden Pflegebedürftige überwiegend zu Hause versorgt, bei Menschen mit türkischer Migrationsgeschichte (MG) häufig durch Angehörige. Selbsthilfegruppen (SHG) bieten Unterstützung, werden jedoch selten genutzt. Identifikation von Strategien, Barrieren und Unterstützungsbedarfen zur Förderung der Teilnahme pflegender Angehöriger mit MG. Mittels einer Online-Befragung wurden 1029 SHG-Verantwortliche zu strukturellen Merkmalen, Förderstrategien, Barrieren und Unterstützungsbedarfen befragt. Geschlossene Fragen wurden deskriptiv, offene Antworten qualitativ ausgewertet. Daten von 176 Verantwortlichen lagen für die Auswertung vor. 44,9
BACKGROUND:In Germany, most people in need of long-term care are cared for at home. Among people with a Turkish migration background, care is particularly often provided by family members. Although self-help groups offer valuable support, they are rarely utilized. OBJECTIVE:Identification of strategies, barriers and support needs to enhance participation in self-help groups among family caregivers with a migration background. METHODS:A total of 1029 providers of self-help groups were invited to participate in an online survey addressing structural characteristics, strategies to promote participation, perceived barriers and support needs. Closed questions were analyzed descriptively, while open-ended responses were examined using qualitative content analysis. RESULTS:Data from 176 providers were available for the analysis and 44.9% reported actively involving family caregivers with a migration background. Frequent strategies included direct outreach through disseminators and cooperation with migrant organizations. Key barriers compromised language barriers (62.5%), lack of awareness of available services (56.8%) and cultural differences (48.9%). Important support measures included public outreach, network building and interpreting services. CONCLUSION:The results highlight the need for structural support and intercultural approaches to improve access to and sustained participation in self-help groups among family caregivers with a migration background.
Delir ist ein häufiges neuropsychiatrisches Störungsbild, insbesondere bei älteren hospitalisierten und schwer kranken Patient:innen, mit negativen Folgen wie erhöhter Sterblichkeit und Morbidität. Bei steigendem Altersdurchschnitt der Bevölkerung ist mit einer Zunahme der Delirfälle zu rechnen, was die Notwendigkeit einer standardisierten stationären Delirversorgung weiter erhöht. Bislang ist die Umsetzung eines strukturierten Delirmanagements im stationären Setting jedoch unzureichend untersucht. Im Rahmen der Delir Awareness-Kampagne der Initiative Qualitätsmedizin (IQM) wurde eine retrospektive, deskriptive, multizentrische Analyse auf Basis strukturierter Peer Reviews durchgeführt. Akten von Fällen mit dokumentiertem Delir und Delirrisiko aus deutschen und Schweizer IQM-Mitgliedskrankenhäusern wurden durch ärztliche und pflegerische Fachpersonen anhand eines standardisierten Bewertungsbogen bewertet. Es konnten 115 Bewertungsbogen aus 8 Peer Reviews deskriptiv ausgewertet werden. In 90
BACKGROUND:Delirium is a frequent neuropsychiatric disorder, particularly in older hospitalized and critically ill patients, which is associated with negative consequences such as increased mortality and morbidity. Due to the ageing population, an increase in delirium cases is to be expected, further increasing the need for standardized inpatient delirium care; however, the implementation of structured delirium management in an inpatient setting has not been sufficiently examined. METHOD:As part of the Delirium Awareness Campaign launched by the Initiative on Quality in Medicine (Initiative Qualitätsmedizin, IQM) a retrospective, descriptive, multicenter analysis was carried out based on peer reviews. Case files from German and Swiss IQM member hospitals were retrospectively evaluated by medical and nursing professionals using a standardized questionnaire. RESULTS:In this study 115 questionnaires from 8 peer reviews could be descriptively evaluated. In 90% of cases risk factors for delirium were present, in particular advanced age, surgical procedures and pre-existing cognitive disorders. In 26% of cases structured delirium screening was used, mostly once. Guideline-compliant diagnostics and treatment were determined by IQM peers in 13.9% of cases. Delirium was documented in the discharge letter in 19.1% of cases. In almost half of the cases (46.1%) a clear potential for improvement was identified during the course of inpatient treatment. DISCUSSION:The IQM peer review revealed a relevant gap in the routine clinical inpatient treatment and underscored the need to structurally embed delirium management as an interprofessional and standardized care process.
