This study investigates determinants of self-reported SARS-CoV-2 infection, addressing a gap in understanding how social and care-related factors are associated with infection risk among older people. We analyzed the baseline wave of “Gesundheit 65+”, a German nationwide population-registry survey. This wave was performed between June 2021 and April 2022, with a sample of 3450 participants aged 65 to 100 living in private households. SARS-CoV-2 infection prevalence was 3.5% (95% confidence interval, CI 2.6–4.5), slightly higher among those aged 85+, and higher among those receiving home care, and not having double vaccination. We identified with multivariable logistic regression that not having double vaccination (odds ratio, OR = 9.72; CI 4.81–19.61), receiving in-person visits (OR = 2.96; CI 1.12–7.80), and not living alone (OR = 1.96; CI 1.02–3.76) were independently associated with SARS-CoV-2 infection, but receiving formal or informal care at home, and participating in work and social activities were not. Our results emphasize the importance of vaccination and caution during in-person interactions. Despite receiving formal or informal care at home implying close personal contact, we did not detect increased infection risk in those receiving care at home.

Background. Demographic ageing is leading to a marked increase in the population aged 65 and older, which, in turn, is expected to result in a rise in chronic diseases and functional limitations. To avoid overburdening of the healthcare system, supporting the health of people of working age (20-66), who represent the future older adult population, through preventive measures is essential. Methods. Based on a selective literature search, a narrative review was conducted to synthesize current evidence on the anticipated effects of demographic change as well as on preventive measures relevant to the working-age population. Results. Key at-risk groups include, alongside older adults, people with a migration background, men with low levels of education, and women in unskilled occupations or facing a dual burden of paid work and caregiving responsibilities. The workplace can facilitate access to hard-to-reach at-risk populations. Occupational physicians therefore play a crucial role in informing employees about the range of available preventive options. This encompasses prevention at the primary, secondary (e.g., screenings), and tertiary (e.g., rehabilitation) levels. Prevention should not be viewed solely as a health-related intervention, but should ultimately enable participation in society, including in gainful employment. Digital platforms represent a promising complement to the broad spectrum of available options. Equitable access to all preventive measures must be ensured. Ultimately, a well-coordinated care pathway is essential to preventive success. Epidemiological research can help identify challenges, detect risk factors, and contribute to the evaluation of preventive interventions. Conclusion. Prevention during working age represents a key lever for improving population health in the future. Epidemiological research is essential for identifying at-risk groups and ensuring that preventive measures are evidence-based.

INTRODUCTION:Physical functional capacity is central to autonomy and participation in very old age. The aim of this study is to describe functional limitations among the oldest old in Germany using a global indicator (Global Activity Limitation Indicator - GALI) and domain-specific indicators (activities of daily living, mobility, sensory function, urinary incontinence). In addition, frailty is examined as a risk factor. METHODS:The analyses are based on data from the 2023 German Ageing Survey (DEAS) (n = 938) and the 2021/22 Health 65+ study (n = 2028) for persons aged 80 and older living in private households. GALI is analysed across datasets, while further indicators are analysed separately for each dataset. Results are stratified by gender and income. RESULTS:About one quarter of the oldest old have severe functional limitations; this finding is consistent across both datasets. In daily living activities, men show significantly better scores than women. Around one third are severely limited in walking more than one kilometre, and just under one sixth are severely limited in climbing stairs. Severe sensory limitations affect 10% in vision and 27% in hearing. Urinary incontinence is reported by 40% of the oldest old, more often by women than by men. According to the selected criteria, almost half are robust, 43% are pre-frail and 8.6% are frail. Differences between income groups are only partly evident and are not consistent. DISCUSSION:Functional limitations are widespread among the oldest old living in private households, particularly among women and, in some cases, among those with low income. Sensory impairments, urinary incontinence and frailty are common and highly relevant for health and social care. Prevention and care should start early and take gender and socioeconomic position into account.

Behavioural risk factors (BRFs) negatively impact health and well-being across life course, including older age. Data on their prevalence among older adults in Germany are scarce. This study examines prevalence of single BRFs — alcohol use, smoking, insufficient vegetable and fruit consumption, physical inactivity, and obesity — and identifies BRF combinations with a focus on sociodemographic disparities in adults aged 65 years and older. The nationwide Gesundheit 65 + study (06/2021–04/2022) used a two-stage, stratified random sample from residents’ registration offices, and a design tailored to older adults. Data from 3,139 participants with complete information on all BRFs were analysed. Weighted prevalence estimates and 95

Angesichts des demografischen Wandels gewinnt die Prävention von Stürzen bei Hochaltrigen zunehmend an Bedeutung. Der Beitrag beschreibt das Sturzgeschehen bei Personen ab 80 Jahren in Deutschland und untersucht relevante Risikofaktoren mit besonderem Fokus auf den Arzneimittelgebrauch. Grundlage sind Daten der epidemiologischen Längsschnittstudie Gesundheit 65+ zur gesundheitlichen Lage älterer Menschen in Deutschland. Analysiert wurden die 12-Monats-Sturzprävalenz bei Personen ab 80 Jahren sowie Risikofaktoren wie vorangegangene Stürze, Polypharmazie (dauerhafte Einnahme von ≥ 5 Arzneimitteln), sturzbegünstigende Arzneimittel (Fall-Risk-Increasing Drugs, FRIDs), körperliche und kognitive Einschränkungen sowie soziodemografische Merkmale. Die Studienpopulation umfasste 1742 Personen ab 80 Jahren. Für die Medikamentenanalyse standen Daten von 742 Teilnehmenden zur Verfügung. 38,1

ABSTRACT Antihypertensive medication use is highly prevalent among older adults, with treatment patterns evolving over time. This study examines trends in antihypertensive medication use in the general population and among treated hypertensive individuals aged 66–79 years, based on two nationwide German population‐based surveys conducted in 2008–2011 and 2021–2023. Data were derived from the German Health Interview and Examination Survey for Adults (DEGS1; n = 1733) and the Study on Health of Older People in Germany (Gesundheit 65+; n = 680). Both surveys provide comparable information on antihypertensive drug classes—angiotensin‐converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), diuretics, beta‐blockers, and others—as well as blood pressure (BP) control (<140/90 mmHg) assessed using standardized oscillometric measurements. The prevalence of antihypertensive medication use in the general population remained relatively stable between 2008–2011 (68.7%) and 2021–2023 (64.5%). However, treatment patterns changed, with decreased use of diuretics and ACE inhibitors and increased use of ARB. Among treated hypertensive individuals, BP control remained largely unchanged at approximately two‐thirds (69.1% vs. 63.6%). Notably, there was a shift from single‐pill combination therapy toward monotherapy, accompanied by a decline in BP control among women (73.8%–58.0%). Overall, approximately two‐thirds of adults aged 66–79 years in Germany use antihypertensive medication. Over the past decade, BP control has not improved among treated hypertensive men and has worsened among women. Furthermore, the use of single‐pill combination therapies remains low and has declined among treated hypertensive individuals.

Die demografische Alterung führt zu einem deutlichen Anstieg der Bevölkerung im Alter ab 65 Jahren, was wiederum mit einer zu erwartenden Zunahme chronischer Erkrankungen und Einschränkungen einhergeht. Um einer Überlastung des Gesundheitssystems entgegenzuwirken, ist es von zentraler Bedeutung, die Gesundheit von Menschen im erwerbsfähigen Alter (20–66 Jahre) als zukünftige ältere Erwachsene mit präventiven Maßnahmen zu unterstützen. In einem narrativen Review wurden mittels selektiver Literaturrecherche aktuelle Erkenntnisse zu den zu erwartenden Auswirkungen des demografischen Wandels sowie Erkenntnisse zu präventiven Maßnahmen im erwerbsfähigen Alter zusammengetragen. Zu den besonders zu berücksichtigenden Risikogruppen zählen, neben Älteren, Menschen mit Migrationsgeschichte, Männer mit niedrigem Bildungsstand und Frauen in ungelernter Tätigkeit oder mit doppelter Belastung durch Sorgearbeit. Der Arbeitsplatz kann den Zugang zu schwer erreichbaren Risikogruppen ermöglichen. Betriebsärztinnen und -ärzten kommt daher eine entscheidende Rolle bei der Aufklärung zu den Möglichkeiten der Prävention zu. Dies umfasst Prävention auf primärer, sekundärer (z. B. Screenings) und tertiärer (z. B. Rehabilitation) Ebene. Prävention sollte dabei nicht als streng gesundheitsbezogene Maßnahme gesehen werden, sondern letztlich die Teilhabe am gesellschaftlichen Leben, inklusive Erwerbsarbeit ermöglichen. Digitale Angebote sind eine vielversprechende Ergänzung des breiten Felds der Möglichkeiten. Der Zugang zu allen präventiven Maßnahmen muss niedrigschwellig gestaltet werden. Entscheidend für den präventiven Erfolg ist letztlich eine wohl koordinierte Behandlungskette. In einer begleitenden Funktion kann epidemiologische Forschung Herausforderungen erfassen, Risikofaktoren identifizieren sowie zur Evaluation von Präventionsmaßnahmen beitragen. Prävention im erwerbsfähigen Alter stellt einen zentralen Hebel zur zukünftigen Verbesserung der Bevölkerungsgesundheit dar. Epidemiologische Forschung ist essenziell zur Identifikation der Risikogruppen und Sicherstellung der Evidenzbasierung präventiver Maßnahmen.

Background:Hypertension is highly prevalent in older adults; therefore, hypertension management remains essential. Nevertheless, population data is scarce. Until recently, population blood pressure (BP) monitoring in Germany only included the population up to age 79. This study investigates BP and hypertension management in octogenarians and nonagenarians in Germany from the study Gesundheit 65+. Methods:In 2022-2023, brachial BP measurements (Mobil-O-Graph, IEM GmbH, Aachen/Germany) and health questionnaires were conducted in 807 participants aged 80-99 years of the German population-based Gesundheit 65+ study. Hypertension was defined as BP ≥ 140/90 mmHg, or antihypertensive treatment in participants with self-reported hypertension. Hypertension control was defined as BP < 140/90 mmHg among participants with hypertension. Weighted prevalence of hypertension, awareness, treatment and control by sex were estimated with 95% confidence intervals (CIs). Partitioning Around Medoids cluster analysis was performed to identify distinct subtypes among participants with hypertension. Results:The prevalence of hypertension in women was 77.8% [95% CI: 71.4-83.2] and in men 72.3% [65.7-78.0]. Among those with hypertension, 85.2% were aware, 81.7% treated, and 57.3% controlled. Control was significantly lower in women compared to men, with half of women having controlled hypertension, compared to two-thirds of men. The cluster analysis revealed two subgroups among women with hypertension: a well-treated/controlled but multimorbid group and an untreated/uncontrolled but subjectively healthier group. Three clusters emerged among men with hypertension: treated/controlled, less treated/uncontrolled and a severely multimorbid cluster with high treatment and control rates. Conclusion:Among octogenarians and nonagenarians in Germany, hypertension prevalence is higher in women than in men, while hypertension control among women is lower. This underscores the need for more attention to BP in older women. Furthermore, our findings indicate that high BP, as a largely asymptomatic health risk, may be inadequately controlled among otherwise healthy older adults.

AIMS:The study aims (1) to evaluate the quality of diabetes care considering guideline-recommended medical therapies, cardiometabolic factors, and self-management of health behaviours among older adults with diabetes in Germany, and (2) to examine time trends. MATERIALS AND METHODS:People aged 66 years and older with diabetes were identified from the examination part of the German national Study on Health of Older People (Gesundheit65+) in 2022/2023. Diabetes care indicators included physical exercise, non-smoking, non-obesity, blood pressure (BP) control, guideline-based medication use for statins, ACEI/ARB, GLP-1RA/SGLT2i, and aspirin. Temporal trends were examined in a subgroup aged 66-79 years using national health survey data from 1997 to 1999 and 2008 to 2010. RESULTS:Of 292 older adults with diabetes in Gesundheit65+, 90.6% were non-smokers, 69.6% were non-obese, 74.2% achieved BP control, and 45.5% engaged in physical exercise. Overall, 73.6% reported use of antidiabetics, with 24.3% treated by mono-metformin therapy, 16.9% with insulin (alone or in combination), and 32.4% by other glucose-lowering medication. Guideline-recommended medication use was 65.7% for statins overall and 88.4% for ACEI/ARB among individuals with hypertension. Among individuals with cardiovascular disease, it was 36.8% for GLP-1 RA/SGLT2i and 55.4% for aspirin. Trend analysis in 66- to 79-year-olds showed a decrease in insulin use and improvements regarding physical exercise, non-obesity, BP control and guideline-based medications. CONCLUSIONS:In Germany, most older adults with diabetes meet targets of non-smoking, non-obesity and BP control. Use of novel glucose-lowering medications with cardiorenal benefits is low. Despite improvements over time, guideline-based medication use should be further improved.

Körperliche Funktionsfähigkeit ist zentral für Autonomie und Teilhabe im hohen Alter. Ziel der Arbeit ist es, funktionale Einschränkungen bei Hochaltrigen in Deutschland anhand eines globalen Indikators (Global Activity Limitation Indicator - GALI) und bereichsspezifischer Indikatoren (Alltagsfunktionalität, Mobilität, Sensorik, Harninkontinenz) zu beschreiben. Ergänzend wird Gebrechlichkeit (Frailty) als Risikofaktor untersucht. Die Analysen basieren auf Daten des Deutschen Alterssurveys (DEAS) 2023 (n = 938) und der Studie Gesundheit 65+ 2021/2022 (n = 2028) für Personen ab 80 Jahren in Privathaushalten. Der GALI wird datensatzübergreifend, weitere Indikatoren datensatzspezifisch ausgewertet. Die Ergebnisse werden nach Geschlecht und Einkommen differenziert. Etwa ein Viertel der Hochaltrigen ist stark funktional eingeschränkt; dies zeigt sich konsistent in beiden Datensätzen. Bei der Alltagsfunktionalität zeigen Männer signifikant bessere Werte als Frauen. Rund ein Drittel ist beim Gehen von mehr als einem Kilometer und knapp ein Sechstel beim Treppensteigen stark eingeschränkt. Schwere sensorische Einschränkungen betreffen 10

In Germany, about 14% of people aged 55 years and older were born abroad in 2022. Aging is associated with a number of health problems, often leading to limitations in basic and instrumental activities of daily living (ADL/IADL) and a need for support in conducting these activities. Up to now, research in Germany focused especially on older migrants from Türkiye or (late) repatriates. Our aim is to explore the prevalence of limitations in ADL/IADL among older migrants with selected citizenships and their need for support. Data of the multilingual, mixed-mode interview survey GEDA Fokus (11/2021 – 05/2022) was used, considering people with Croatian, Italian, Polish, Syrian or Turkish citizenship aged 55 to 79 years (n = 1,089). Five ADL and seven IADL were analysed. Limitations were defined as reporting at least some difficulties in conducting at least one ADL or IADL, respectively. Using Poisson regressions, adjusted for citizenship, differences in the prevalence of limitations were analysed for gender, age and education. For participants reporting limitations, additionally receiving support was examined. Overall, 23.2% of participants reported limitations in ADL and 36.4% in IADL. Older age (65 – 79 years) as well as low or medium education were associated with limitations, in IADL additionally female gender. Among those reporting limitations in ADL, 44.8% received support and 60.4% among those with limitations in IADL. Support was provided mainly from household members (>80%) and less often by formal home care (ADL 14.0%; IADL 5.4%). Within this sample, prevalence of limitations was lower compared to the general population (GEDA 2019/2020-EHIS: ADL 38.5%, IADL 59.9%), with comparable differences according to gender, age and education. Results in terms of receiving support confirm the literature: support is mainly provided by household members. Thus, the burden for caregivers in migrant families should be explored in further research.

Abstract Background There are scarce analyses on COVID-19 infection risk factors for the older adult population. This study aims to examine COVID-19 infection risk factors in the older adult general population. Methods The data for this analysis came from the population-representative Study on Health of Older People in Germany (Gesundheit65+) conducted by the Robert Koch Institute from 10/2021 to 08/2022. We considered information on COVID-19 infection status (self-reported infection confirmed by PRC test at least once vs. never), socio-demographic factors, health risk factors, and different face-to-face interactions. The analysis was restricted to 2,976 individuals aged 65+ years with complete infection status information. We assessed weighted prevalences and used univariable and multivariable logistic regressions to evaluate infection risk factors. Results The overall prevalence of infection was 7.2% (95% confidence interval, 6.0-8.7). Infection prevalences were significantly higher (compared to their respective reference group) among participants living in assisted living facilities (24.7% vs. 6.7%), individuals who got help to perform basic activities of daily living (10.8% vs. 6.8%), COVID-19 unvaccinated individuals (25.2% vs. 6.9%), individuals who did not meet family or friends in the last month (12.7% vs. 6.7%), and participants who did not smoke (7.8% vs. 2.6%). No other variable was significantly related to COVID-19 infection. In multivariable analysis, variables independently associated with higher odds ratio (OR) of COVID-19 infection were: living in an assisted living facility OR 3.6 (1.8-7.2), not being vaccinated against COVID-19 OR 4.6 (1.5-14.1), and not smoking OR 1.6 (1.1-2.6). Conclusions The preliminary results of this study align with the prevalence of COVID-19 infection found in concomitant studies. A noteworthy element of our study is the vaccine’s protective effect. The pandemic had a particularly detrimental effect on residents of assisted living facilities Key messages • Improvement in quality of care and infection preventive measures in nursing homes is necessary. • Pandemic preparedness must consider the need for help in the daily life of the older population.

Abstract Background Functional capacity decreases with increasing age. Hand grip strength (HGS) is considered as an objective general measure of health and a parameter of muscle strength, a component of functional capacity and is part of the evaluation of frailty. HGS is important for many everyday functions, such as holding heavy objects or supporting oneself to prevent a fall. Low HGS is associated with a higher mortality risk. In our study we describe HGS in people aged 66 to 101 years in Germany and identify groups with low HGS. Methods Gesundheit 65+ is a longitudinal epidemiologic study of the health status of persons 65 years and older in Germany by the Robert Koch Institute. In 2022/23, one year after baseline, isometric HGS was measured during the examination part of the study using a hand-held dynamometer (Smedley, Scandidact, Denmark, 100 kg). Two values were recorded for each hand. Maximum HGS from all attempts was used for analyses. Weighted prevalence estimates and 95% confidence interval (CI) for grip strength are reported by sex, age-group, height, self-rated health, chronic conditions, and difficulties in activities of daily living (ADL). Results HGS was measured in 1,457 persons aged 66 to 101 (48% women). Mean maximum HGS was 28.8 kg (CI 28.4-29.3). HGS was significantly related to sex (men: 35.4 kg, CI 34.8-36.0, women 21.8 kg, CI 21.4-22.2) and age (66-79: 31.0 kg, CI 30.1-31.9, 80+: 23.9 kg, CI 23.0-24.7). In both sexes, shorter persons and persons with bad self-rated health, chronic conditions or difficulties in ADL showed lower HGS than their reference group. Conclusions HGS was reduced in very old people, people with support needs, and people with poor health or chronic diseases, identifying these people as important risk groups for preventive measures. These should aim to improve not only endurance but also strength in older and very old people. In the long term, this could also maintain independence and reduce serious injuries from falls. Key messages • We found sex and age-related differences in hand grip strength in older people in Germany. • Based on the results, planning of prevention and intervention could be enhanced.

Abstract Background The National Study on Health of Older People in Germany “Gesundheit 65+” included blood pressure (BP) measurements at home by a study nurse and classification of all current medication. Methods Nationally representative examination survey of the population aged 65 years and older residing in Germany using two-stage population registry sampling from 128 sample points, with a standardized examination at home from June 2022 to April 2023. Three standardized blood pressure measurements at two-minute intervals were taken after 5 minutes rest with an oscillometric device (Mobil-O-Graph) using one of five cuffs according to upper arm circumference. The mean of the second and third measurement was used for analysis. Hypertension was defined as mean systolic BP (SBP) at or above 140 mmHg, or mean diastolic BP (DBP) at or above 90 mmHg, or the use of antihypertensives (antihypertensives, diuretics, beta-blockers, calcium-channel blockers, ACEI and ARB) in participants with self-reported hypertension diagnosis. Provisional weights account for unequal sampling and participation probabilities. Results The “Gesundheit 65+” examination part included 1,493 participants of whom 1,475 (98.8%) had successful BP measurements (763 men and 712 women, aged 66 to 101 years). Based on self-reported diagnoses alone, the prevalence of hypertension would be 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. However, overall hypertension prevalence was estimated at 70.4% [65.8-74.7] in men and 72.3% [66.9-77.1] in women based on the study definition which combines self-reported diagnoses, standardized BP measurements and medication. Conclusions The prevalence of hypertension is greatly underestimated in the absence of examination survey data with standardized measurements and recording of medication use. In addition, measurement and medication data are needed for monitoring the hypertension cascade, i.e. awareness, treatment and control of hypertension. Key messages • Hypertension prevalence is underestimated in the absence of health examination surveys with measurements and medication data. • The hypertension cascade, i.e. assessment of awareness, treatment and control of hypertension needs population surveys with measurements and medication assessment.

Abstract Background The COVID-19 pandemic has exposed the vulnerability of older people living in long-term care facilities (LTCF), highlighting the urgent need for research on the quality of care for this group of the population. There is no universal definition for quality of care in LTCF, and yet, multiple tools and indicators have been developed to measure it. In this rapid scoping review, we aim to provide a comprehensive overview of the current knowledge on quality of care concepts and indicators for older people in LTCF in OECD countries. Methods This review follows the World Health Organization (WHO) guide for rapid reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) extension for scoping reviews, including protocol registration (https://doi.org/10.17605/OSF.IO/34B2S). The electronic bibliographic databases MEDLINE (PubMed), EMBASE, and CINAHL were searched in September 2023 for studies published between 2013 and 2023 for quality indicators in LTCF. Experts in quality of care in LTCF were contacted and consulted to retrieve sources of grey literature. Information on the definition or framework of quality of care, quality of care dimensions, measurement instruments, context and purpose of the measurement will be extracted. Results Of the 8,516 identified records, 6,449 were screened by title and abstract after removing duplicates. A total of 469 publications will be screened in full-text. Experts recommended 40 websites to be screened for quality indicators. The PRISMA flowchart diagram will be provided to describe the selection process. Conclusions This review aims to improve the quality of care for older people living in LTCF. Our results will identify which concepts and dimensions of care are currently being measured in OECD countries, whether they are backed by any definition and scientific framework of quality of care for older residents of LTCF, and whether there is consideration of closing gaps in quality measurement. Key messages • Quality of care is an understudied field in the context of long-term care facilities for older people. • In order to further improve quality in long-term care for older people, it is necessary to systematically review the current state of knowledge on quality concepts and indicators.

Abstract Background Cognitive function is fundamental to healthy aging and independent living. As there is no cure for dementia, prevention of risk factors (e. g. physical inactivity, obesity, hypertension, diabetes, social isolation, depression) is crucial. The aim of our study was to analyze selected dementia risk factors and their association with cognitive function in people aged 65 years and older. Methods Cross-sectional data from the nationally representative examination Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2022-2023 by the Robert Koch Institute (n = 1.493; 48% women; mean age 78.8 years). Cognitive function was assessed by the Letter Digit Substitution Test (LDST), a measure of general speed of information processing, and of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) 10-word list delayed recall (WLR), a measure of memory. Weighted associations between age, sex, education, dementia risk scores and z-standardized test scores were examined using linear regression analysis. Results Higher age, male sex and lower level of education were significantly associated with lower z-scores in both tests (all p < 0.001). In separate models, all adjusted for age, sex and education, social isolation was associated with lower performance on both LDST (ß=-0.22; 95% confidence interval -0.42, -0.01) and CERAD WLR (ß=-0.21; -0.41, -0.01); depressive symptoms were associated with lower LDST z-scores (ß=-0.40; -0.67, -0.13), and physical inactivity with lower CERAD WLR z-scores (ß=-0.12; -0.24, -0.01). Obesity, hypertension, and diabetes were not significantly associated with any test. Conclusions Our findings from this nationwide general population study of old and very old adults show a clustering of reduced cognitive function with social isolation, symptoms of mental health impairments, and physical inactivity in old age which call for coordinated intersectoral health promotion and prevention activities. Key messages • The clustering of reduced cognition with dementia risk factors calls for intersectoral health actions. • Limitations in cognition should only be defined by age-, sex-, and education-specific norms.

Abstract Background Potentially inappropriate medications (PIM) are medicines for which the risks for adverse events (AEs) usually outweigh the clinical benefits in older adults. PIM is associated with an increased risk of AEs, hospitalizations, mortality and higher health care costs. This analysis presents the prevalence of PIM use and associated factors in people aged 66+ years living in Germany. Methods Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter (OTC), in the 7 days before the interview were classified into anatomical therapeutic chemical codes. PIM use was identified based on the PRISCUS 2.0 list. Weighted prevalences and associated factors for PIM use are presented. Results 96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. The prevalence of PIM use was 29% (95% CI: 26%-32%), 23% took 1 PIM and 6% 2+. There were no sex differences but a significant increase with age: 23% in the age group 66-74, 33% in the age group 75-84, and 39% in the age group 85 + (29% 1 PIM and 10% 2+). People with a low educational level had a PIM prevalence of 32% compared to 21% in those with a high educational level. Among those reporting having chronic diseases, the PIM prevalence was 34% compared to 19% among those not reporting them. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines. The most frequently used PIM in this sample was ginkgo biloba leaf extract (plant-based antidementia drug) followed by diclofenac (non-steroidal anti-inflammatory drug), and then by tricyclic antidepressant drugs (opipramol and amitriptyline). Conclusions PIM use was higher than suggested by prescription data analysis. It was associated with higher age, chronic diseases, polypharmacy and a low educational level. Key messages • PIM use was common, affecting more people with chronic diseases, older age groups and people with a low educational level. • Strategies to promote and monitor appropriate medication use are needed.

Abstract Background Polypharmacy, the use of 5 or more medications simultaneously, favors the risk of adverse drug events, drug interactions, potentially inappropriate medication (PIM), hospitalizations, falls, frailty, and mortality. This analysis presents the prevalence of polypharmacy and associated factors in people aged 66+ years living in Germany. Methods Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter, in the 7 days before the interview were documented and classified into anatomical therapeutic chemical codes. Weighted prevalences and associated factors for polypharmacy are presented. Results 96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. Of these, 39% took up to 4 medications, 39% 5-9 and 22% 10+. The overall prevalence of polypharmacy was 61% (95%CI 58-65%) and was significantly higher in women (64%) than in men (59%). Polypharmacy increased with age, from 52% in the age group 66-74 (53% in men, 51% in women), 66% in the age group 75-84 (63% in men, 69% in women) to 81% in the age group 85 + (72% in men, 86% in women). People with low educational level had a polypharmacy prevalence of 63% (58% in men, 66% in women) compared to 56% (55% in men, 58% in women) in those with high educational level. Severe difficulties in organizing daily medication intake were reported in 1% of people taking up to 4 medicines, in 4% of people taking between 5-9 medicines and in 16% of people taking 10+. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines. Conclusions Polypharmacy was more frequent in women, older age groups and in people with low educational level. It was associated with increased difficulty in organizing medication intake and with PIM use. Key messages • Polypharmacy is very common, affecting more women, older age groups, people with a low educational level and is associated with PIM use. • Strategies to promote appropriate medication use are needed.