Um Stürze und deren Folgen zu reduzieren und zu behandeln, sind evidenz- und konsensbasierte Empfehlungen zu Risikostratifizierung, Screening, Assessment sowie zu Sturzprävention und -behandlung wichtig. Die Bundesinitiative Sturzprävention (BIS) hat 2020 Empfehlungspapiere für das körperliche Training zur Sturzprävention als Gruppen- bzw. Einzelangebot bei älteren, zu Hause lebenden Menschen veröffentlicht. Im Jahr 2022 wurden die „World guidelines for falls prevention and management for older adults“ (WFG) publiziert. Aktualisierung der Empfehlungen der BIS. Die Empfehlungen der BIS wurden mit denen der WFG abgeglichen und bei Bedarf um methodische und fachspezifische Aspekte erweitert. Folgende Bereiche wurden berücksichtigt: 1) Screening und Risikostratifizierung, 2) Interventionen, 3) multifaktorielles Assessment und Interventionen sowie 4) spezifische Zielgruppen. Die Empfehlungen der BIS entsprechen weitgehend denen der WFG. Hauptursache für Unterschiede ist die bisherige Fokussierung der BIS-Empfehlungspapiere auf das körperliche Training. Der multifaktorielle Ansatz, der in den WFG ausführlich beschrieben wird, wurde bisher im Empfehlungspapier zum körperlichen Training im Einzelsetting erwähnt, jedoch nicht im Detail ausgeführt. Die BIS-Empfehlungen werden dahingehend ergänzt bzw. präzisiert. Durch das Update der Empfehlungen der BIS können die Einrichtung und Förderung von Sturzpräventionsangeboten für ältere Menschen in Deutschland weiter vorangebracht werden. Die Implementierung kann somit einheitlich und wissenschaftlich abgesichert erfolgen.

Abstract Nutrition and hydration are fundamental aspects of healthcare, especially in the care of older people, particularly those in hospitals or in long-term care facilities. Worldwide, nurses are ‘best-placed’ coordinators of interdisciplinary nutritional management and care processes. Even so, it is essential that nurses collaborate with other healthcare specialists as an interdisciplinary team to provide high-quality care that reflects patients’ needs for assessment, intervention, and health promotion. When an interdisciplinary team work collaboratively, care is more successful, improves patient outcomes, and reduces the risk of in-hospital and long-term mortality. The care process begins with screening and monitoring of the nutritional status and fluid intake of all older people within 24 h of admission. In the case of positive screening, comprehensive assessment and involvement of other team members should undertake to understand the underlying problem. Appropriate food and appealing meals, snacks, and drinks should be available and offered with recommended amounts of energy, protein, vitamins, minerals (particularly calcium), and water. This should be complemented with supplementary drinks if intake is not adequate. The prescription of vitamin D and calcium should be discussed. Patient-centred and evidence-based information should provide and interventions in the case of end-of-life care should be appropriate discussed. Educating, informing, and involving patients and families increases their level of health literacy. Malnutrition and/or dehydration management should be included in the discharge plan. The aim of this chapter is to increase awareness of nurses’ responsibility, within a multidisciplinary team, for assessment and intervention of nutrition and hydration, examine the issues pertaining to nutrition and fluid balance in older people and outline the nature, assessment and interventions relating to malnutrition and dehydration.

Background Fragility fractures are one of the leading causes of disability in older adults. Yet, evidence for effectiveness and cost-effectiveness of preventive approaches combining bone health and fall prevention is rare. Objective To conduct a health-economic evaluation of the German osteoporotic fracture prevention program in rural areas (OFRA). Design Secondary cluster–randomized intervention study based on routine data. Participants All districts in five federal states in Germany were cluster-randomized as intervention or control districts. OFRA was offered to community-living (a) women aged 75–79 years or (b) women and men aged 70–84 years with a prior fragility fracture in the intervention districts. Individuals who meet these criteria in the control districts were assigned to the control group. Intervention OFRA comprised mobility and falls prevention classes, examination of bone health by bone density measurement, and consultation on safety in the home living environment. Main Measures We measured health-care costs and effectiveness in terms of time to fragility fracture or death within 1 year after initial contact, based on health insurance claims data. Implementation costs were recorded by the intervention performers. We calculated an incremental cost-effectiveness ratio (ICER) and employed the net-benefit approach to construct a cost-effectiveness acceptability curve (CEAC). Key Results There were 9408 individuals in the intervention group and 27,318 in the control group. Mean time to fragility fracture or death (difference: 0.82 days) and health-care costs (difference: 111.73€, p < .01) were reduced, but mean intervention costs (difference: 260.10€) increased total costs (difference: 148.37€, p < .001) in the intervention group. The ICER per fracture-free year of survival was 66,094.63€. The CEAC showed no acceptable probability of cost-effectiveness at a reasonable willingness to pay. Conclusion OFRA showed reduced rates of fragility fractures, but had high implementation costs, resulting in an unfavorable ICER. The cost-effectiveness of OFRA may improve with a longer follow-up.

OBJECTIVE:To investigate variation of care dependency after hip fracture across German regions based on the assessment by the German statutory long-term care insurance. DATA SOURCES/STUDY SETTING:Patient-level statutory health and long-term care insurance claims data from 2009-2011 and official statistical data from Germany. STUDY DESIGN:We performed a retrospective cohort study. Investigated multinomial outcome categories were increase in care dependency (new onset or a higher care dependency than pre-fracture), no change as reference and death as competing risk in the quarterly period following hip fracture (follow-up 3 months). Regional variation was operationalized with the variance of regional-level random intercepts based on generalized linear mixed models. We adjusted for patient and regional characteristics. PRINCIPAL FINDINGS:The study included 122,887 hip fracture patients in 95 German postal code regions. Crude outcomes were 30.87% increase in care dependency and 14.35% death. Results indicated modest variation on regional level. Male sex, increasing age, increasing comorbidity, pertrochanteric and subtrochanteric fracture site compared to femoral neck, time from hospital admission to surgery of 3 or more days, as well as increasing inpatient length of stay, non-participation in rehabilitation and regions with lower hospital density were positively associated with an increase in care dependency. CONCLUSIONS:Several characteristics on patient and regional level associated with the outcome were identified. Variation in the increase in care dependency after hip fracture appeared to be attributable primarily to patient characteristics. Variation on regional level was only modest.

Zusammenfassung Hintergrund Stürze und sturzbedingte Verletzungen gehören zu den großen Herausforderungen heutiger industrieller Gesellschaften. Die bekanntermaßen effektiven gruppenbasierten Trainingsprogramme sind jedoch gerade in ländlichen Gebieten unzureichend verfügbar. Ziel Nach erfolgreicher Implementation der Trittsicher-Bewegungskurse in ausgewählten ländlichen Regionen Deutschlands war das Ziel der Analyse, die Gründe der Teilnahme und Adhärenz durch 6 Fokusgruppeninterviews zu identifizieren. Methode Die Daten wurden mittels inhaltlich-strukturierender Analyse nach Mayring 1 analysiert und einem deduktiv gebildeten Kategoriensystem zugeordnet. Zusätzlich wurden quantitative Daten deskriptiv analysiert. Ergebnisse In den Kategorien erwarteter und wahrgenommener Nutzen, Merkmale der Kursleitung, sozialer Zusammenhang, Empowerment sowie Motivation und Design des Programms fanden sich Kriterien, die eine Teilnahmewahrscheinlichkeit und Adhärenz erhöhten. Schlussfolgerung Die hier analysierten Kriterien sollten bereits bei der Planung von neuen Bewegungsprogrammen mit den Erwartungen der Zielgruppe abgeglichen werden.

Background Falls and fall-related injuries belong to the big challenges in industrial societies. The well-known effective fall preventive group-based exercises programmes are often insufficiently implemented, especially in rural areas in Germany.Objective After a successful implementation of the "Trittsicher" mobility classes in selected rural areas in Germany the aim of this analysis was to identify the participants' reasons for participation and adherence using 6 focus group interviews.Method Data were analysed using content-structuring analysis according to Mayring [1] and then allocated to a deductively developed category system. In addition, quantitative data were descriptively analysed.Results The categories expected and perceived benefit, instructors' characteristics, social coherence, empowerment as well as motivation and programme design included criteria which increase the probability of participation and adherence.Conclusion The currently discussed aspects should be adjusted to the target groups' expectations already during planning of future mobility programmes.

ZusammenfassungHintergrundGezieltes Training reduziert das Risiko fur Sturze und sturzbedingte Verletzungen bei alteren Menschen. Die Verfugbarkeit von spezifischen Bewegungsangeboten ist in Deutschland gering. Dies trifft insbesondere fur landliche Regionen zu. Deshalb wurde das krankenkasseninitiierte Programm Trittsicher durchs Leben in landlichen Regionen in 47Landkreisen in 5Bundeslandern implementiert. Die wichtigste Komponente des Programms sind die Trittsicher-Bewegungskurse, die als Gruppenprogramm von LandFrauen organisiert und von ubungsleitern/ubungsleiterinnen ortlicher Sportvereine oder Physiotherapeuten/Physiotherapeutinnen seit Oktober 2015 durchgefuhrt werden. Seit Start des Programms im Oktober 2015 wurden mehr als 2300 Trittsicher-Bewegungskurse durchgefuhrt.ZielDie Studie analysiert die strukturellen Eigenschaften der ersten 1092 Trittsicher-Bewegungskurse sowie die Charakteristika der 12.246 TeilnehmerInnen.Material und MethodenDie Analysen basieren auf Daten eines standardisierten Kurs-Dokumentationsbogens und auf Informationen einer krankenkasseninternen Datenbank. Zudem wurde die Distanz zwischen Kurs- und Wohnort bei einer Subgruppe von Teilnehmern/Teilnehmerinnen bestimmt.ErgebnisseDie Kurse fanden in kommunalen und konfessionellen Raumen, bei Sportvereinen, aber auch in Kindergarten oder Gaststatten statt. Der uberwiegende Anteil der TeilnehmerInnen war weiblich (89,1%); das mediane Alter lag bei 75Jahren. Im Durchschnitt nahmen 11,2 TeilnehmerInnen/Kurs teil. uber die Halfte der TeilnehmerInnen besuchten alle 6Kursstunden. Die Distanz vom Wohn- zum Kursort betrug fur die Halfte der TeilnehmerInnen 1,7km oder weniger.ZusammenfassungTrittsicher-Bewegungskurse sind ein neues spezifisches Angebot zur Verbesserung der Mobilitat und Reduktion des Sturzrisikos und tragen damit zu einer besseren Versorgung alterer Menschen im landlichen Raum bei. AbstractBackgroundSpecific training reduces the risk of falls and fall-related injuries in older persons. The availability of specific exercise programs in Germany, especially in rural areas is scarce. Therefore, ahealthcare fund driven program osteoporotic fracture prevention program in rural areas (OFRA) (German name: Trittsicher durchs Leben) was implemented in rural areas in 47counties of 5federal states. The most important components of the program are the Trittsicher mobility course and falls prevention classes organized by members of the German Association of Rural Women and executed by exercise instructors of the German Gymnastics Association or physiotherapists. Since the start of the program in October 2015 more than 2300 classes have been carried out.AimThe study analyzed the structural characteristics of the first 1092 Trittsicher mobility courses and the characteristics of the 12,246 participants.MethodThe analysis is based on data of astandardized course documentation sheet and information from an internal database of a health insurance company. Additionally, the distance between the location of the course and place of residence was determined for a subgroup of the participants.ResultsThe classes were conducted in communal and confessional rooms, in sports associations, kindergartens and restaurants. The majority of the 12,246 participants were female (89.1%), the median age was 75years. The average size of the classes was 11.2 participants per course. More than half of the participants attended all six sessions. Half of the participants of the courses had to travel less than 1.7km between the place of residence and the location of the courses. ConclusionTrittsicher mobility courses are anew specific offer to improve mobility and reduce the risk of falling. They contribute to abetter care of older people in rural areas.

Background Falls are common in long-term care facilities. Therefore, a multifactorial fall and fracture prevention programme ("Ulmer Modell") was implemented in nearly 1000 Bavarian long-term care facilities between 2007 and 2010. A core component of the programme was a group-based strength and balance training. Objective The aim of this study was to analyse the exercises' availability and fidelity according to the standards of the "Ulmer Modell" several years after the programme start. Method The cross-sectional study took place in 40 randomly selected Bavarian long-term care facilities between January and June 2016. A standardized observation of the exercise classes was performed. The evaluation was stratified using the exercise instructor's qualification. Results Nearly all of the contacted long-term care facilities offered exercise classes (94.3%) frequently including strength training components. However, only 30% of the classes used weight cuffs for lower extremities strength training. In many groups only few or no balance exercises at all were used. Balance exercises were more frequently performed when the instructors had a therapeutic qualification. Only 10% of the groups completely met the requirements of a fall prevention training according to the "Ulmer Modell" standards. Conclusions Mobility classes are by now regular components in long-term care facilities. Long-term fidelity of the fall and fracture prevention programme related to balance training is yet often poor. In the case of instructors with a therapeutic qualification the training quality seems to be better.