ABSTRACT Background: A computerized Intervention-Management-System (IMS) has been developed and implemented to facilitate dementia care management. IMS is a rule-based expert decision support system that matches individual patient characteristics to a computerized knowledge base. One of the most important functionalities of IMS is to support the compilation of the individual intervention plan by systematically identifying unmet needs and suggesting the corresponding specific interventions for recommendation to the general practitioner (GP). The present analysis aimed to determine if the implementation of IMS improves the identification of unmet needs and the recommendation of adequate specific interventions. In addition, the feasibility and acceptability of the IMS were evaluated. Methods: Delphi-MV is an on-going GP-based, cluster-randomized, controlled intervention trial to implement and evaluate a collaborative dementia care management program for community-dwelling PWDs and their caregivers. IMS was developed and implemented over the course of the DelpHi-trial. The identified unmet needs and the interventions that were recommended to the GP before and after the implementation of IMS were compared. To evaluate the feasibility and acceptability of the IMS, a survey was conducted among the current users of IMS. Results and Conclusions: After the implementation of IMS, the number of specific interventions recommended to the GP increased by 85%. Our findings provide evidence that IMS improves the systematic identification of unmet needs and the subsequent recommendation of interventions to address these needs. The users evaluated IMS as very helpful and would like to use it for their future work. However, the usability could be further improved.

ABSTRACT Background: Increasing prevalence of dementia is a major challenge for the German healthcare system. The study DelpHi-MV (“Dementia: life- and person-centered help in Mecklenburg-Western Pomerania”) aims to implement and evaluate an innovative subsidiary support system for persons with dementia (PwDs) living at home and their caregivers. Methods: DelpHi-MV is a GP-based cluster randomized controlled intervention trial. DelpHi-Intervention aims to provide “optimum care” by integrating multi-professional and multimodal strategies to individualize and optimize treatment of dementia within the framework of the established healthcare and social service system. The intervention is conducted by Dementia Care Managers (DCMs) – nurses with dementia-specific training – at the people's homes. Based on German guidelines for evidence-based diagnoses and treatment of dementia, a comprehensive set of 95 intervention modules – the “DelpHi-Standard” – was defined. Each module consists of predefined trigger condition(s), a subsequent intervention task, as well as at least one criterion for its completion. The intervention begins with a comprehensive assessment of the care situation, needs, and resources. The DCM develops and implements an intervention plan tailored to the individual conditions in close cooperation with the GP. Expected Results and Conclusions: We expect statistically significant differences between control and intervention group in primary outcomes (quality of life, behavioral and psychological symptoms of dementia, pharmacotherapy, caregiver burden). Results can provide evidence for the effectiveness and efficacy of dementia care management according to the “Delphi-Standard” – prerequisites for implementing this concept into routine healthcare.

BACKGROUND Primary data about rates of formal diagnosis of dementia in the German primary care sector are widely lacking. OBJECTIVES Main objectives are to analyze the rate of syndrome diagnosis in primary care patients who screened positive for dementia, the distribution of differential diagnoses, and factors associated with undiagnosed dementia. METHODS DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) is an ongoing general practitioner (GP)-based, randomized, controlled intervention trial. A total of 4,064 patients (≥70 years, living at home) recruited from 108 participating GP practices were screened for dementia (DemTect < 9). Of 692 eligible patients (17%), a total of 406 subjects (59%) provided informed consent. Present analyses are based on the data of 243 patients with complete baseline assessment on January 1, 2014 (preliminary data). Formal diagnoses were retrieved from the medical records of the treating GPs. A conditional fixed effect regression analysis was performed to analyze factors associated with undiagnosed dementia. RESULTS A total of 40% of patients who screened positive for dementia had been formally diagnosed with dementia. Unspecified dementia was diagnosed in 53%, vascular dementia in 24%, and Alzheimer's disease in 19% of these patients. Undiagnosed dementia was significantly associated with a higher mean score in the Mini-Mental State Examination (odds ratio, 1.11; p < 0.01, 95% confidence interval 1.04-1.18). CONCLUSIONS The diagnosis rate of dementia in German primary care (40%) is well within the range of the international data (20-50%). The results emphasize the need for action to enhance recognition and differential diagnosis of dementia.

Background: Most persons with dementia live at home and are treated in the primary care. However, the ambulatory health care system in Germany contains a lot of "interface problems" and is not optimized for the future challenges. Innovative concepts like regional networks in dementia care exist on a project level and need to be tested for efficacy to encourage implementation. The goal of the study is the scientific evaluation of an already existing regional dementia network. Methods: Prospective randomized controlled trial of 235 community-living elderly with dementia and their family caregivers of network treatment (n=117) compared to usual care (n=118) in a predominantly rural region. The allocation to intervention or control group was based on network membership of their General Practitioner. Intervention patients received diagnostic evaluation and subsequent treatment according to network guidelines. Main outcome measures were the early contact with a neurologic or psychiatric specialist and dementia-specific medication as well as quality of life of the patients, and as secondary outcomes caregiver burden and caregiver health-related quality of life. Results: Network patients were more likely to receive antidementive drugs (50.5 % vs. 35.8 %; p=0.035) and had more often contact to a neurologist (18.6 % vs. 2.8 %; p<0.001). No group differences were found on patient's quality of life nor overall effects or treatment by time effects. Intervention caregivers reported no significant improvements in health related quality of life measured by SF-36 and EQ-5D. Conclusion: The management of dementia patients in an interdisciplinary regional network solelyprovides measurable advantages with respect to the provision of dementia-specific medication and utilization of medical treatment i.e. referral rates to specialists. Further evaluation research is needed to identify relevant mechanisms of collaborative processes with respect to their impact on patient and caregiver related outcomes.

The study aimed to determine the prevalence of dementia and the degree of medical care among residents of nursing homes based on a nationally representative sample of nursing homes in Germany for the first time.Based on a probability sample of 609 long-term care institutions in Germany, we drew a sample of 86 facilities by applying a two-stage random procedure. All residents of the participating care facilities were comprehensively assessed by qualified nurses using a standardized Care and Behavior Assessment (CBA).Of the 4,481 residents assessed in 58 care facilities (mean age 82.6 years;78 % female) on average 68.6 % (95 % CI: 67.0 - 69.8) were affected by a dementia-syndrome, 56.6 % by a severe dementia-syndrome. There were frequent contacts between residents and general practitioners, but provision of specialized medical care seemed to be deficient in many aspects.People with dementia form the major group of residents in German nursing homes. The study provides important data on need for care and health care planning.

Objective: The study aimed to determine the prevalence of dementia and the degree of medical care among residents of nursing homes based on a nationally representative sample of nursing homes in Germany for the first time.Methods: Based on a probability sample of 609 long-term care institutions in Germany, we drew a sample of 86 facilities by applying a two-stage random procedure. All residents of the participating care facilities were comprehensively assessed by qualified nurses using a standardized Care and Behavior Assessment (CBA).Results: Of the 4,481 residents assessed in 58 care facilities (mean age 82.6 years; 78% female) on average 68.6% (95% CI: 67.0-69.8) were affected by a dementia-syndrome, 56.6% by a severe dementia-syndrome. There were frequent contacts between residents and general practitioners, but provision of specialized medical care seemed to be deficient in many aspects.Conclusion: People with dementia form the major group of residents in German nursing homes. The study provides important data on need for care and health care planning.

Fragestellung: Ziel der Studie war es, erstmals in Deutschland auf der Grundlage einer bundesweiten repräsentativen Stichprobe die Prävalenz alkoholbezogener Störungen und damit assoziierte Charakteristika in der Bewohnerschaft von Altenpflegeheimen zu ermitteln. </p><p> Methodik: Ausgehend von einer für Deutschland repräsentativen Zufallsstichprobe von 609 vollstationären Pflegeeinrichtungen (Erhebung durch TNS Infratest Sozialforschung), wurde durch ein zweistufiges geschichtetes Zufallsverfahren eine Substichprobe (Stufe 1: N=185 Heime; Stufe 2: N=86 Heime) für die vorliegende Untersuchung gewonnen. Davon nahmen 67,4 % (N=58 Heime) an der Studie teil (untersuchte Bewohnerzahl: 4.481; Durchschnittsalter: 82,6 Jahre; 78 % Frauen). Zentrales Untersuchungsinstrument war ein standardisiertes Pflege- und Verhaltensassessment (PVA), das durch qualifizierte Pflegekräfte bearbeitet wurde. Mittels des PVA wurden für alle Bewohnerinnen und Bewohner³ unter anderem die ärztlichen Diagnosen sowie der aktuelle Alkoholkonsum und Rauchen erhoben. </p><p> Ergebnisse: Im Mittel lagen bei 5,8 % der Bewohner (Spanne zwischen den Einrichtungen: 0–31 %) ärztlich diagnostizierte (lifetime) alkoholbezogene Störungen nach ICD-10: F10 vor. Aktueller riskanter Alkoholkonsum (&gt;20 g/&gt;30 g bei Frauen/Männern) wurde bei 0,3 % der Personen festgestellt. Die Wahrscheinlichkeit einer (lifetime) Alkoholdiagnose war positiv assoziiert mit: männlichem Geschlecht, jüngerem Alter, weniger sozialen Kontakten von außerhalb des Heims, geringerem Grad funktioneller Einschränkungen, tendenziell ausgeprägterer neuropsychiatrischer Symptomatik, häufigerem riskanten Alkoholkonsum sowie Rauchen und teilweise mit erhöhter somatischer Morbidität. </p><p> Schlussfolgerungen: Alkoholbezogene Störungen sind unter der Bewohnerschaft von stationären Altenpflegeeinrichtungen vergleichsweise häufig. Die Betroffenen bilden eine besondere Gruppe, die spezielle Anforderungen an Therapie und Versorgung stellt.

BACKGROUND:Little is known about the prevalence and risk factors of alcohol problems among older people (especially those aged 75 years and more). The aims of this study were to report alcohol consumption patterns and to determine their association with socio-demographic variables and health characteristics. METHOD:3224 non-demented subjects aged 75 and over and attending general practitioners (GPs) (n = 138) in an urban area of Germany were studied by structured clinical interviews including detailed assessment of alcohol consumption patterns distinguishing between abstainers, moderate drinkers and at-risk drinkers (>20 g of alcohol for women and >30 g of alcohol for men). RESULTS:A high proportion (50.1%) of the sample were abstainers, 43.4% were moderate drinkers. The prevalence of at-risk alcohol consumption was 6.5% (95% CI 5.6-7.4). Rates were significantly higher for men (12.1%; 95% CI 10.2-14.0) compared to women (3.6%; 95% CI 2.8-4.4). After full adjustment for confounding variables we found that compared to moderate drinking abstaining from alcohol was significantly associated with female gender, lower education, and mobility impairment. Compared to moderate drinking at-risk drinking was significantly higher among men, individuals with a liver disease, and current smokers. CONCLUSIONS:Multivariate analysis revealed that, apart from liver disease, at-risk drinking in a non-demented population aged 75 and over was associated with relatively good physical and mental health. Nevertheless, public prevention measures should focus on at-risk drinkers to make them aware of potential risks of high alcohol consumption in old age.

Background: Depression among the elderly is an important public health issue. The aims of this study were to report the prevalence of depression and to determine the impact of socio-demographic variables. functional impairment and medical diagnoses, lifestyle factors, and mild cognitive impairment oil depression as part of the German Study oil Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe Study).Methods: Included in the cross-sectional survey were 3327 non-demented Subjects aged 75 and over attending general practitioners (GPs) (n = 138) in an urban area of Germany. The GDS-15 Geriatric Depression Scale was used to measure depression with a threshold of <6/6+. Associations with social and clinical risk factors were assessed by means of multiple logistic regression models.Results: The prevalence of depression was 9.7% (95% confidence interval 8.7-10.7). In a univariate analysis, the following variables were significantly associated with depression: female gender, increasing age, living alone, divorce, lower educational status, functional impairment, comorbid somatic disorder, mild cognitive impairment, smoking, and abstinence from alcohol. After full adjustment for confounding variables, odds ratios for depression were significantly higher only for functional impairment, smoking, and multi-domain mild cognitive impairment.Limitations: Recruitment procedures might have led to an Underestimation OF current prevalence. The cross-sectional data did not allow LIS to analyze the temporal relationship between risk factors and depression.Conclusions: The prevalence of depression in the elderly is high and remains high into old age prevention programs, it is important to call more attention to the impact of functional and cognitive impairment on depression. (C) 2008 Elsevier B.V. All rights reserved.

BACKGROUND:Despite the high true prevalence of dementia, demential disorders of residents of old age homes may often be not recognized. There is a need for a standardised tool which includes observations of nursing staff.OBJECTIVE:To describe and validate the Dementia Screening Scale (DSS) for use by nursing staff in old-age homes.METHODS:All residents of 20 randomly selected old age homes in the city of Mannheim, Germany (n = 1, 922) were rated by nurses using the seven-item proxy dementia rating scale. Based on a subset of residents (n = 598) the DSS was validated against independent diagnostic assessments made by trained psychologists including the Mini-Mental-State-Examination (MMSE), the Dementia Scale of the Brief Assessment Schedule (BAS DEM), and the Washington University Clinical Dementia Rating (CDR).RESULTS:Using the CDR as a gold standard, the DSS correctly classified at a cut-off of 2/3, 85.8% of the mildly, moderately, or severely demented residents. The accuracy of the DSS was only a little worse than that of the MMSE and the BAS DEM.CONCLUSION:The DSS is well-suited for the recognition of dementia in old age homes. It achieved a better validity than global diagnosis-related staff assessments and compared to performance-based instruments. It is easier to apply, more economic, and associated with a fewer rate of non-response.

Objective: To provide representative data on the situation of informal caregivers of cognitively impaired old people in Germany. Furthermore, to identify (modifiable) factors related to the extent of the subjective burden of care and depression in the informal caregivers. Methods: Based on a probability sample of the German population (N = 52,916), we contacted all people who were 60 years of age and older and who screened positively for at least one deficit in a range of (instrumental) activities of daily living as well as for cognitive impairment. The participating frail persons and their main informal caregivers (MCG) were interviewed using a standardised research interview, which comprised the Burden Scale for Family Caregivers and a German version of the CES Depression Scale. Results: The care of the frail old people was provided mostly by family caregivers (n = 262; mean age: 61 years; female: 73 %). Multiple linear regression analyses revealed the following factors which were significantly associated with increased burden-and depression-scores: more pronounced non-cognitive symptoms (such as apathy, depression, agitation/aggression) of the care recipient and female gender of the MCG. Decreased burden-and depression-scores, on the other hand, were associated with the subjective perception of the MCG of being highly supported by family and friends. Conclusion: Interventions aimed at the prevention and alleviation of non-cognitive symptoms of the care recipient as well as cognitive and other psychosocial interventions for the caregivers should relieve the MCG and should promote the care of cognitively impaired old people in the community.

Ziele: Ziel der vorliegenden Studie war es, erstmals für Deutschland repräsentative Daten zur Situation von privaten Pflegepersonen kognitiv beeinträchtigter älterer Menschen bereit zu stellen. Dabei sollten (modifizierbare) Faktoren ermittelt werden, die mit der subjektiven Belastung und Depressivität der Pflegenden assoziiert sind. Methode: Ausgehend von einer Zufallsstichprobe der deutschen Bevölkerung (N = 52,916) wurden alle über 60-jährigen Personen mit mindestens einer (I)ADL-Beeinträchtigung und kognitiven Auffälligkeiten kontaktiert. Die teilnehmenden Personen und ihre Hauptpflegepersonen (HPP) wurden mittels eines standardisierten Instrumentariums, das u. a. die Häusliche Pflegeskala (subjektive Belastung) und die Allgemeine Depressionsskala (Depressivität) enthielt, befragt. Ergebnisse: Die HPP der gepflegten Personen waren zumeist nahe Familienangehörige (N = 262; mittleres Alter = 61 Jahre; 73 % Frauen). Multivariate Regressionsanalysen erbrachten folgende Faktoren, die signifikant mit erhöhten Belastungs- und erhöhten Depressivitätswerten bei den HPP assoziiert waren: schwerere nicht kognitive Symptomatik (z. B. Apathie, Depression, Agitiertheit/Aggression) bei der gepflegten Person und weibliches Geschlecht der HPP. Verminderte Belastungs- und Depressionswerte resultierten, wenn die HPP die Wahrnehmung hatte, von ihrem privaten Umfeld gut unterstützt zu werden. Schlussfolgerungen: Maßnahmen zur Prävention und Linderung nicht kognitiver Symptome bei den gepflegten Personen sowie kognitive und andere psychosoziale Interventionen bei den Pflegenden könnten die HPP entlasten und die häusliche Pflege kognitiv beeinträchtigter älterer Menschen insgesamt fördern.