BACKGROUND:The increasing demand for geriatric health services, particularly in rehabilitation, has led to significant delays in the delivery of care across many regions of Germany. In response, Germany has introduced several initiatives, including innovative care models such as the telemedicine integrating multimodal, home-based geriatric aftercare programs GeRas that aimed at improving service efficiency and accessibility in geriatric rehabilitation. While such programs may increase geriatric health services capacity further exploration is needed to assess the scalability of such programs. Thus, the objective of this study was to obtain the perspective of key stakeholders (e.g., health services provider) on the requirements for scaling up of geriatric aftercare programs including a telemedicine component. METHODS:In a qualitative interview study, 12 key stakeholders were interviewed to obtain their perspectives on the requirement for such geriatric aftercare programs, as well as their scalability, including the integration of telemedicine, taking the GeRas program as an example. The interview data were analysed using Qualitative Content Analysis according to Kuckartz. RESULTS:A total of four main themes emerged from the qualitative content analysis. Theme two, including six subthemes, addressed the requirements for scalability of geriatric aftercare programs. Stakeholders emphasized the need to address financial requirements and establish transparent remuneration models for healthcare providers (1). Personnel requirements (2), and structural needs, including cross-sectional collaboration, were also highlighted (3). Additionally, the development and implementation of educational concepts for both providers and participants were discussed (4). Key requirements for a geriatric aftercare program (5) and the role of telemedicine (6) were also considered. CONCLUSION:Clear definitions of structural, personnel, and financial requirements, along with interprofessional collaboration, were essential for the scalability and success of geriatric aftercare programs. However, findings show that the scalability of these programs remains complex, yet essential. TRIAL REGISTRATION:German Clinical Trials Register (DRKS00029559). Registered 5/10/2022.

Abstract:Falls and their consequences have significant health-economic implications in Germany. Tailored exercise training is among the most effective interventions for fall prevention in older adults. However, conventional in-person training programs alone are insufficient to provide nationwide fall prevention and effectively reduce fall-related injuries. Digital interventions have the potential to complement and enhance traditional fall prevention programs, improving accessibility and reaching a broader population. Despite this potential, no evidence-based digital fall prevention programs are currently available in Germany. Moving forward, it is essential to develop, evaluate, and implement digital, evidence-based solutions to strengthen fall prevention efforts. Achieving this goal requires regulatory frameworks that support innovation rather than impede it with excessive bureaucratic hurdles. Additionally, digital applications should be designed to be intuitive and accessible for users while ensuring compliance with current data protection standards.

This study examined the association between the availability of an orthogeriatric co-management and secondary fractures in 97,976 hip fracture patients. We found that the presence of orthogeriatric co-management was associated with a small but sustainable reduction in secondary fragility fractures in patients with an initial hip fracture. The risk of experiencing a subsequent fracture is particularly high immediately following an initial fragility fracture. Geriatricians are increasingly involved in the management of fragility fractures. However, there is currently no evidence indicating whether this orthogeriatric co-management (OGCM) can reduce the incidence of secondary fracture. This study aimed to analyse the association between OGCM and the occurrence of secondary fragility fractures in patients with an initial hip fracture. Nationwide health insurance data from Germany were used to identify hip fracture patients aged ≥ 80 years. According to the presence of an OGCM, hospitals were categorised into those with OGCM and those without OGCM. Outcomes were secondary fragility fractures (i.e. humerus, forearm, hip, pelvis, spine) within different time periods after an initial hip fracture. Crude incidences and hazard rate ratios for a secondary fragility fracture were calculated. The dataset included 97,976 hip fracture patients aged 80 and older from 716 hospitals (71

This study determined the proportions of fall-related and insufficiency-related vertebral fractures among 325 older hospitalized patients. The fracture etiology was determined by a comprehensive interview focusing on the circumstances at the onset of fracture-related pain. Falls were a markedly more frequent cause of vertebral fractures than insufficiency. The majority of vertebral fractures in older adults occur either as insufficiency fracture or as a consequence of a fall. The objective of this study was to determine the proportions of fall-related and insufficiency-related fractures among patients hospitalized with clinically symptomatic vertebral fractures. This cross-sectional study included 325 hospitalized patients aged ≥ 65 years with vertebral fractures from three hospitals. The fracture etiology (fall-related vs. insufficiency-related) was determined using a comprehensive clinical interview that focused on the circumstances surrounding the initial onset of fracture-related pain. The proportion of these two etiologies was analyzed for all fractures, across different fracture locations, and within various strata of personal and functional parameters. The mean age was 83 ± 6 years and 73

Zusammenfassung Stürze und ihre Folgen haben in Deutschland erhebliche gesundheitsökonomische Auswirkungen. Maßgeschneidertes Bewegungstraining gehört zu den effektivsten Maßnahmen zur Sturzprävention bei älteren Erwachsenen. Vor-Ort-Trainings-Programme allein reichen jedoch nicht aus, um eine flächendeckende Sturzprävention zu gewährleisten und sturzbedingte Verletzungen wirksam zu reduzieren. Digitale Angebote haben das Potenzial, herkömmliche Sturzpräventionsprogramme zu ergänzen und zu verbessern, die Zugänglichkeit zu verbessern und eine breitere Bevölkerung zu erreichen. Trotz dieses Potenzials gibt es in Deutschland derzeit keine evidenzbasierten digitalen Sturzpräventionsprogramme. In Zukunft ist es wichtig, digitale, evidenzbasierte Lösungen zu entwickeln, zu evaluieren und umzusetzen. Um dieses Ziel zu erreichen, sind rechtliche Rahmenbedingungen erforderlich, die Innovationen unterstützen und nicht durch übermäßige bürokratische Hürden behindern. Darüber hinaus sollten digitale Anwendungen so gestaltet werden, dass sie für die Nutzer intuitiv zugänglich sind und gleichzeitig die geltenden Datenschutzstandards einhalten.

Rehabilitationsmaßnahmen in der Kurzzeitpflege (KuP), z. B. in Form einer Mobilen Geriatrischen Rehabilitation (MoGeRe), werden selten durchgeführt. Das liegt u. a. daran, dass der Rehabilitationsbedarf im Vorfeld nicht identifiziert wird. Das Projekt MosaiK – Mobile Geriatrische Rehabilitation in der Kurzzeitpflege hatte zum Ziel, den Rehabilitationsbedarf von Personen, die für eine KuP angemeldet waren, frühzeitig zu erkennen, eine MoGeRe zu initiieren und die Qualität der beiden Leistungsbereiche zu verbessern. Es wurde eine Checkliste zur Identifikation des Rehabilitationsbedarfs vom Einzugsmanagement der KuP angewendet. Bei positivem Ergebnis wurden Zuweiser aufgefordert, für den zukünftigen KuP-Gast eine MoGeRe zu beantragen. Bei Genehmigung der MoGeRe fanden Fallkonferenzen statt, an denen sich Mitarbeitende der KuP beteiligten. Videovisiten zwischen der MoGeRe und den Patienten sowie ein Arm- und Beintrainer für das Eigentraining in der therapiefreien Zeit ergänzten das Programm. Die Evaluation der Prozesse erfolgte qualitativ in Form von Fokusgruppen und deskriptiv-quantitativ. In 40 Fällen wurde vom Einzugsmanagement der KuP auf Basis der Ergebnisse der Checkliste eine Überprüfung des Rehabilitationsbedarfs angeregt. Bei 27 von 28 Anträgen kam es zu einer Genehmigung der MoGeRe. Bei 70,0

BACKGROUND:Rehabilitation measures in short-term care (KuP), e.g., in the form of mobile geriatric rehabilitation (MoGeRe), are rarely carried out. One of the reasons for this is that the need for rehabilitation is not identified in advance. RESEARCH QUESTION AND OBJECTIVE:The MosaiK (mobile geriatric rehabilitation in short-term care) project aimed to identify the rehabilitation needs of people registered for a KuP at an early stage, initiate a MoGeRe and improve the quality of the two health service areas. MATERIAL AND METHODS:A checklist was used to identify the need for rehabilitation by the KuP admission management. If the results were positive, referring physicians were asked to apply for a MoGeRe for the future KuP guest. If the MoGeRe was approved, case conferences were held in which KuP personnel participated. Video visits between the MoGeRe and the patients and an arm and leg trainer for self-training during the therapy-free period supplemented the program. The processes were evaluated qualitatively in the form of focus groups as well as descriptively and quantitatively. RESULTS:In 40 cases a review of the need for rehabilitation was suggested by the KuP admission management based on the results of the checklist. The MoGeRe was approved in 27 out of 28 applications. The joint case conference was held at least once for 70.0% of MosaiK patients and a video visit was carried out for 75.0%; the arm and leg trainer was used in 64% of cases. CONCLUSION:The implementation of the newly implemented processes was largely successful and required relatively little additional effort compared to (remunerated) routine care. The approach should therefore also be transferable to other forms of MoGeRe.

Orthogeriatric co-management (OGCM) has been proposed as care model for geriatric patients with fragility fractures. However, its impact on nursing home (NH) admissions following non-hip fractures is unclear. This study aims to assess the association between OGCM and the probability of NH admissions within 6 months in older patients with fragility fractures other than the hip. This retrospective cohort study utilized nationwide insurance claims data from Germany (from years 2014–2018), covering individuals aged 80 years or older with fractures of the humerus, forearm, pelvis, or vertebrae. Based on the number of OGCM claims per year, hospitals were categorized as either OGCM or no OGCM. The primary outcome was the incidence of NH admissions within 6 months of the index fracture. Quasi-Poisson regression models were used to calculate incidence rate ratios (IRRs) with 95

Abstract Background In Germany, geriatricians deliver acute geriatric care during acute hospital stay and post-acute rehabilitation after transfer to a rehabilitation clinic. The rate patients receive acute geriatric care (AGC) or are transferred to post-acute rehabilitation (TPR) differs between hospitals. This study analyses the association between the two geriatric treatment systems (AGC, TPR) and second hip fracture in patients following an index hip fracture. Methods Nationwide health insurance data are used to identify the rate of AGC and TPR per hospital following hip fracture surgery in patients aged ≥ 80 years. Outcomes are a second hip fracture after surgery or after discharge within 180 or 360 days and new specific anti-osteoporotic drugs. Cox proportional hazard models and generalised linear models are applied. Results Data from 29,096 hip fracture patients from 652 hospitals were analysed. AGC and TPR are not associated with second hip fracture when follow-up started after surgery. However, during the first months after discharge patients from hospitals with no AGC or low rates of TPR have higher rates of second hip fracture than patients from hospitals with high rates of AGC or high rates of TPR (Hazard Ratio (95% CI) 1.35 (1.01–1.80) or 1.35 (1.03–1.79), respectively). Lower rates of AGC are associated with lower probabilities of new prescriptions of specific anti-osteoporotic drugs. Conclusions Our study suggests beneficial relationships of geriatric treatment after hip fracture with a) the risk of second hip fractures during the first months after discharge and b) an improvement of anti-osteoporotic drug treatment.

BACKGROUND:In Germany, different models of orthogeriatric co-management have been implemented in certified geriatric trauma centers. So far, it is not clear how the different models are implemented and what influence the certification has on the structures and processes within the centers. The present study examined the extent of cooperation between surgery and geriatrics and if the quality of care had changed since the certification of the centers. METHODS:In this study 4 guided focus group interviews (FGI) were conducted in different teams of certified geriatric trauma centers in 3 federal states with 16 participants. To specify the content of the FGI, two additional interviews were conducted with system auditors. Both types of interview were analyzed by content analysis. RESULTS:The certification supported the implementation of structures and processes in the different orthogeriatric models; however, the quality of care and cooperation between surgery and geriatrics depends on the spatial proximity and the orthogeriatric care model in the geriatric trauma centers. Simultaneously, challenges in the area of geriatric syndromes and the recruitment of skilled staff became relevant. DISCUSSION:The results can help to reflect processes in the certified geriatric trauma centers and to treat geriatric syndromes more effectively. In the future, the challenge will be to establish geriatric care under the existing shortage of skilled staff.

ZusammenfassungDie Bedeutung der Wirbelkörperfrakturen, die zu einer Krankenhauseinweisung führen nimmt zu. Dieser Anstieg ist nicht nur demographisch bedingt. Die Fallzahlen der LWK-, BWK- und HWK Frakturen sind altersadjustiert in den letzten 15 Jahren um weit mehr als 100% angestiegen. Ein ähnlicher Anstieg wird auch für die Beckenfrakturen beobachtet. Im gleichen Zeitraum war die Zahl der Hüftfrakturen altersadjustiert leicht rückläufig. Hierfür gibt es bislang keine schlüssige/n Erklärungen. Die Epidemiologie deutet jedoch daraufhin, dass Osteoporose keine alleinige Erklärung hierfür bietet. Die häufigste Lokalisation der Frakturen ist die LWS gefolgt von der BWS und HWS. Die Zahl der LWS-Frakturen entspricht in etwa den Beckenfrakturen. Die beste Erklärung für diesen Trend bieten video- und sensorbasierte Daten, die zeigen, dass ältere und vor allem hochaltrige Patienten versuchen beim Sturz mit dem Gesäß aufzuprallen und dann häufig einen zweiten und dritten Aufprall im Bereich der Wirbelsäule haben. Der Hauptgrund ist vermutlich die lebenslange Erfahrung, dass die Muskulatur und die Weichteile der Beckenregion, den besten Schockabsorber bieten und im höheren Alter Abwehrreaktionen der Arme meist nicht mehr erfolgreich sind. Die Entwicklungen zeigen, dass die alterstraumatologische Versorgung nicht nur der Hüftfrakturen wichtig sind, sondern die Organisation der Versorgung der Wirbelkörperfrakturen eine hohe Priorität hat.

BackgroundGeriatric rehabilitation aims at increasing physical and social activity and maintaining the functional reserve of older people. However, the continuity of geriatric rehabilitation in the outpatient setting is limited due to a lack of structured aftercare programs. In order to overcome this, a three-month multimodal home-based intervention program (GeRas) was implemented. The aim of this early qualitative process evaluation was to assess GeRas in terms of perceived reach, effectiveness/efficacy, adoption/uptake, implementation, and maintenance/sustainability (Domains within the RE-AIM Framework) from the perspective of patients who received the intervention and healthcare providers who were involved in the delivery of the intervention.MethodsIn a qualitative process evaluation, 13 healthcare providers and 10 patients were interviewed throughout the beginning of the implementation period of GeRas to capture early experiences using a semi-structured interview guide. The interview guide and qualitative content analysis was guided by the RE-AIM Framework.ResultsThe GeRas program was perceived to be largely well implemented and beneficial by healthcare providers and patients. According to healthcare providers, GeRas showed more advantages compared to usual care. Additionally, outcome expectations were mainly met (Domain 1: Effectiveness). However, the implementation of the intervention delivered via the eHealth system was perceived as challenging (Domain 2: Adoption). Nevertheless, the outpatient physical exercise, the outpatient counselling, and the continuous care after discharge improved perceived well-being regardless of the intervention type (Domain 3: Implementation). To facilitate the continued use of GeRas, technical requirements should be created to increase user-friendliness and to motivate patients to continue the training in the long term (Domain 4: Maintenance).ConclusionAlthough initial experiences with the implementation and effectiveness of GeRas were positive in general, organisational and technical issues need to be resolved to enhance sustainable and successful implementation of the GeRas program.Trial registrationGerman Clinical Trials Register (DRKS00029559). Registered 5/10/2022.

In Deutschland wurden verschiedene Modelle des unfallchirurgisch-geriatrischen Co-Managements in zertifizierten alterstraumatologischen Zentren (zATZ) implementiert. Bisher ist es unklar, welchen Einfluss die Zertifizierung auf die Strukturen und Prozesse in den Zentren hat. In der vorliegenden Arbeit wurde untersucht, welchen Einfluss die unfallchirurgisch-geriatrischen Kooperationsmodelle und die Zertifizierung der zATZ auf die Qualität der Patient*innenversorgung haben. Es wurden 4 leitfadengestützte Fokusgruppeninterviews (FGI) in unterschiedlichen Teams von zATZ in 3 Bundesländern mit insgesamt 16 Teilnehmenden geführt. Zur Spezifizierung der Inhalte aus den FGI wurden 2 Einzelinterviews mit am Auditprozess beteiligten Auditoren geführt. Die Auswertung des jeweiligen Materials erfolgte inhaltsanalytisch nach Mayring. Die Zertifizierung hat dazu beigetragen, dass in den unterschiedlichen Versorgungsmodellen zentrale Anforderungen der Zertifizierung umgesetzt wurden. Die Qualität der Leistungserbringung und Zusammenarbeit von Unfallchirurgie und Geriatrie ist jedoch abhängig von der räumlichen Nähe und vom Versorgungsmodell des zATZ. Gleichzeitig wurden Herausforderungen in den Bereichen geriatrischer Syndrome und Fachkräftegewinnung deutlich. Die Ergebnisse können dazu beitragen, Prozesse in den ATZ zu reflektieren und geriatrische Syndrome effektiver zu behandeln. Zukünftig besteht die Herausforderung darin, eine geriatrische Versorgung unter dem bestehenden Fachkräftemangel und der Krankenhausreform flächendeckend zu etablieren.

Background: Geriatricians are increasingly involved in the treatment of fragility fractures. In Germany, hospitals that meet specific standards for orthogeriatric co-management (OGCM) are additionally certified as 'geriatric trauma centers.' One responsibility of OGCM is the appropriate management of osteoporosis through medication. We aimed to analyse the association between prescription frequencies of anti-osteoporotic drugs in hospitals with certified OGCM, those with non-certified OGCM, and those with no OGCM at all. Methods: Claims data from nearly 200,000 patients aged 80 and older with an incident index fracture of the humerus, forearm, hip, pelvis, or spine, were obtained from a German health insurance. Hospitals were categorized into three groups: no OGCM, with OGCM, and with certified OGCM. The outcomes were new prescriptions for specific anti-osteoporotic drugs and vitamin D within 180 days after the index fracture. Crude incidences and adjusted incidence rate ratios (IRR) were calculated. Results: Prescription rates of specific anti-osteoporotic drugs and vitamin D increased from hospitals with no OGCM to hospitals with OGCM and were highest in hospitals with certified OGCM. This pattern was observed across all fracture types, age groups, and both men and women, except for forearm fractures. For example, in hip fractures, the IRR for prescriptions of specific anti-osteoporotic drugs in hospitals with certified OGCM compared to those with no OGCM was 2.17 (95 % CI: 1.90-2.48). Conclusion: OGCM, especially when coupled with certification as a 'Geriatric Trauma Center,' is associated with higher prescription rates of specific anti-osteoporotic drugs and vitamin D after fragility fractures in Germany.

Background Geriatric rehabilitation aims to maintain the functional reserves of older adults in order to optimize social participation and prevent disability. After discharge from inpatient geriatric rehabilitation, patients are at high risk for decreased physical capacity, increased vulnerability, and limitations in mobility. As a result, ageing in place becomes uncertain for a plethora of patients after discharge from geriatric rehabilitation and effective strategies to prevent physical decline are required. Collaboration between different health-care providers is essential to improve continuity of care after discharge from inpatient geriatric rehabilitation. The aim of this study is to evaluate the effectiveness of a multi-professional home-based intervention program (GeRas) to improve functional capacity and social participation in older persons after discharge from inpatient geriatric rehabilitation. Methods The study is a multicenter, three-arm, randomized controlled trial with a three-month intervention period. Two hundred and seventy community-dwelling older people receiving inpatient geriatric rehabilitation will be randomized with a 1:1:1 ratio to one of the parallel intervention groups (conventional IG or tablet IG) or the control group (CG). The participants of both IGs will receive a home-based physical exercise program supervised by physical therapists, a nutritional recommendation by a physician, and social counseling by social workers of the health insurance company. The collaboration between the health-care providers and management of participants will be realized within a cloud environment based on a telemedicine platform and supported by multi-professional case conferences. The CG will receive usual care, two short handouts on general health-related topics, and facultative lifestyle counseling with general recommendations for a healthy diet and active ageing. The primary outcomes will be the physical capacity measured by the Short Physical Performance Battery and social participation assessed by the modified Reintegration to Normal Living Index, three months after discharge. Discussion The GeRas program is designed to improve the collaboration between health-care providers in the transition from inpatient geriatric rehabilitation to outpatient settings. Compared to usual care, it is expected to improve physical capacity and participation in geriatric patients after discharge from inpatient geriatric rehabilitation. Trial registration German Clinical Trials Register (DRKS00029559). Registered on October 05, 2022.

BACKGROUND:Vertebral and pelvic fractures are associated with a significant burden of negative health and psychosocial outcomes. The number of vertebral and pelvic fractures is increasing in an aging society. Vertebral and pelvic fractures are increasingly significant injuries for individuals and society. However, few epidemiological studies have examined the clinical course of vertebral and pelvic fractures. This is the protocol for a study that observes patients who have been admitted to the hospital with an incident vertebral or pelvic fracture for a period of 12 months. METHODS:The observational cohort study is conducted at three study sites in Germany. Patients affected by vertebral or pelvic fractures are recruited within the first few days of hospital admission. Data collection takes place at four-time points: baseline, before discharge, after 4 months, and after 12 months after admission to the hospital. Particular emphasis is laid on the assessment of the fall mechanisms, physical function, physical activity, life space, mobility, treatment approach, and quality of life. The hospital stay involves the collection of biomaterials (blood and urine). DISCUSSION:The study aims to enhance understanding of the clinical progression and outcomes in patients with fractures in the vertebrae or pelvis.

AbstractNutrition 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.