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Mobilität ist für ältere Menschen ein hohes Gut und wirkt sich positiv auf ihre Lebensqualität aus. Wer mobil bleibt – und sei es nur im engeren Umkreis seines eigenen Wohnquartiers –, fühlt sich wohler und bleibt gesünder. Alternsforscher analysieren individuelle Verhaltensweisen und Bedürfnisse hochbetagter Menschen (80 Jahre und älter), sie schauen aber auch in die Zukunft: Wie sieht das Mobilitätsprofil der "jungen Alten" zwischen 65 und 80 Jahren aus, und wie wird es sich entwickeln, wenn die "Baby Boomer"-Generation, also die heute Fünfzigjährigen, Rentner sind?
Background and Objectives: Valuation of life (VOL) represents a construct capturing individuals’ active attachment to their life. The majority of studies on VOL were conducted in North America and Europe where personal autonomy and independence are highly valued, leaving open the question about the relevance of this construct in interdependence-oriented cultures. Using a framework of cross-cultural and life-span theories, the present study compared levels and predictors of VOL between the young-old and old-old individuals from Germany and Japan.
Research Design and Methods: Two hundred fifty-seven Germans and 248 Japanese, matched by age, gender, education, and IADL, answered a 5-item VOL scale and shared information on sociodemographic, social, and health resources.
Results: Germans’ VOL levels were higher than in Japanese participants. Both culture- and age-moderated predictions of VOL: education was significant only in the young-old Japanese, and close social partners mattered in the old-old, not in the young-old. Health determined VOL irrespective of culture and age.
Discussion and Implications: The findings suggest that cultural values and aging processes should be considered to better understand how individuals value their life and to help older adults to feel that his/her life is meaningful and worth living.
The present study concerns the development of a computerized tool targeting housing accessibility issues. A user-centered approach involving professionals from the housing sector and senior citizens from four European countries resulted in a fully functional prototype of a mobile application (app) including an apartment database. The app raises awareness on housing accessibility and has the potential to support decision making and strengthen all citizens regardless of functional capacity to be more active in their endeavors for a satisfying housing solution. Further refinements and additional features are needed to enhance the potential benefits; they include addressing potential challenges facing senior citizens, developing interactive features that allow users to provide input and adapting to different national contexts to make the app applicable for the European market.
As some cognitive functions decline in old age, the ability to decide about important life events such as medical treatment is endangered. Environmental support to improve the comprehension of health-related information is therefore necessary. With a small-scale explorative approach, the present survey study aimed at investigating person-environment fit (PE-fit) of support provided during medical consultations. This fit was calculated by assessing the match between aids provided by five medical practitioners during medical consultations and aids most appreciated by the geriatric patients (N = 88). The results showed that the largest discrepancies of used and appreciated aids could be found concerning the opportunity to discuss decisions with relatives, the possibility to take notes, the use of objects, pictures and a keyword list. Female patients indicated a lower PE-fit. These findings highlight discrepancies between the use of specific aids and the wishes of patients and call for thoughtful use of aids during consultations with geriatric patients.
As some cognitive functions decline in old age, the ability to decide about important life events such as medical treatment is endangered. Environmental support to improve the comprehension of health-related information is therefore necessary. With a small-scale explorative approach, the present survey study aimed at investigating person-environment fit (PE-fit) of support provided during medical consultations. This fit was calculated by assessing the match between aids provided by five medical practitioners during medical consultations and aids most appreciated by the geriatric patients (N = 88). The results showed that the largest discrepancies of used and appreciated aids could be found concerning the opportunity to discuss decisions with relatives, the possibility to take notes, the use of objects, pictures and a keyword list. Female patients indicated a lower PE-fit. These findings highlight discrepancies between the use of specific aids and the wishes of patients and call for thoughtful use of aids during consultations with geriatric patients.
The physical housing environment is important to facilitate activities of daily living (ADL) for older people. A hindering environment may lead to ADL dependence and thus increase the need for home services, which is individually restricting and a growing societal burden. This study presents simulations of policy changes with regard to housing accessibility that estimates the potential impact specifically on instrumental activities of daily living (I-ADL), usage of home services, and related costs. The models integrate empirical data to test the hypothesis that a policy providing funding to remove the five most severe environmental barriers in the homes of older people who are at risk of developing dependence in I-ADL, can maintain independence and reduce the need for home services. In addition to official statistics from state agencies in Sweden and Germany, we utilized published results from the ENABLE-AGE and other scientific studies to generate the simulations. The simulations predicted that new policies that remove potentially hindering housing features would improve I-ADL performance among older people and reduce the need for home services. Our findings suggest that a policy change can contribute to positive effects with regard to I-ADL independence among older people and to a reduction of societal burden.
The policy review is part of the project EQualCare: Alone but connected? Digital (in)equalities in care work and generational relationships among older people living alone, a three-year international project involving four countries: Finland, Germany, Latvia and Sweden. EQualCare interrogates inequalities by gender, cultural and socio-economic background between countries, with their different demographics and policy backgrounds. As a first step into empirical analysis, the policy review aims to set the stage for a better understanding of, and policy development on, the intersections of digitalisation with intergenerational care work and care relationships of older people living alone in Germany.
The policy review follows a critical approach, in which the problems policy documents address are not considered objective entities, but rather discursively produced knowledge that renders visible some parts of the problem which is to be solved as other possible perspectives are simultaneously excluded. Twenty publicly available documents were studied to analyse the processes in which definitions of care work and digital (in)equalities are circulated, translated and negotiated between the different levels of national government, regional governments and municipalities as well as other agencies in Germany.
The policy review consists of two parts: a background chapter providing information on the social structure of Germany, including the historical development of Germany after the Second World War, its political structure, information on the demographic situation with a focus on the 60+ age group, and the income of this age group. In addition, the background presents the structure of work and welfare, the organisation of care for old people, and the state of digitalisation in Germany. The analysis chapter includes a description of the method used as well as an overview of the documents chosen and analysed. The focus of this chapter is on the analysis of official documents that deal with the interplay of living alone in old age, care, and digitalisation.
The analysis identified four themes: firstly, ageing is framed largely as a challenge to society, whereas digitalisation is framed as a potential way to tackle social challenges, such as an ageing society. Secondly, challenges of ageing, such as need of care, are set at the individual level, requiring people to organise their care within their own families and immediate social networks, with state support following a principle of subsidiarity. Thirdly, voluntary peer support provides the basis for addressing digital support needs and strategies. Publications by lobby organisations highlight the important work done by voluntary peer support for digital training and the benefits this approach has; they also draw attention to the over-reliance on this form of unpaid support and call for an increase in professional support in ensuring all older people are supported in digital life. Fourthly, ageing as a hinderance to participation in digital life is seen as an interim challenge among younger old people already online.
In summary, the analysis shows that the connection between ageing and digitalisation remains a marginal topic in current politics. The focus on older people merely as a potential group at risk of being left behind implies a deficit perspective on ageing and a homogenising of a large and diverse age group. Lessons learnt from the pandemic should not be interpreted in a one-sided way, by merely acknowledging the increasing number of (older) people moving online, but by acknowledging intersecting inequalities that mitigate social participation.
Objectives: Investigate the effectiveness of a complex intervention aimed at improving the appropriateness of medication in older patients with multimorbidity in general practice.
Design: Pragmatic, cluster randomised controlled trial with general practice as unit of randomisation.
Setting: 72 general practices in Hesse, Germany.
Participants: 505 randomly sampled, cognitively intact patients (≥60 years, ≥3 chronic conditions under pharmacological treatment, ≥5 long-term drug prescriptions with systemic effects); 465 patients and 71 practices completed the study.
Interventions: Intervention group (IG): The healthcare assistant conducted a checklist-based interview with patients on medication-related problems and reconciled their medications. Assisted by a computerised decision support system, the general practitioner optimised medication, discussed it with patients and adjusted it accordingly. The control group (CG) continued with usual care.
Outcome measures: The primary outcome was a modified Medication Appropriateness Index (MAI, excluding item 10 on cost-effectiveness), assessed in blinded medication reviews and calculated as the difference between baseline and after 6 months; secondary outcomes after 6 and 9 months’ follow-up: quality of life, functioning, medication adherence, and so on.
Results: At baseline, a high proportion of patients had appropriate to mildly inappropriate prescriptions (MAI 0–5 points: n=350 patients). Randomisation revealed balanced groups (IG: 36 practices/252 patients; CG: 36/253). Intervention had no significant effect on primary outcome: mean MAI sum scores decreased by 0.3 points in IG and 0.8 points in CG, resulting in a non-significant adjusted mean difference of 0.7 (95% CI −0.2 to 1.6) points in favour of CG. Secondary outcomes showed non-significant changes (quality of life slightly improved in IG but continued to decline in CG) or remained stable (functioning, medication adherence).
Conclusions: The intervention had no significant effects. Many patients already received appropriate prescriptions and enjoyed good quality of life and functional status. We can therefore conclude that in our study, there was not enough scope for improvement.
Trial registration number: ISRCTN99526053. NCT01171339; Results.
People with Parkinson’s disease (PD) experience a gradual loss of functional abilities that affects all facets of their daily life. There is a lack of longitudinal studies on coping styles in relation to the disease progression among people with PD. The aim of this study was to explore how coping styles in PD evolve over a 3-year period. Data from the longitudinal project “Home and Health in People Ageing with PD” was utilized (N = 158), including baseline and 3-year follow-up assessments. Coping was captured by ratings of 13 different coping styles. A factor analysis was conducted to analyse patterns of coping styles. Stability and change were analysed for each of the 13 styles with respect to the course of the disease. The factor analysis revealed four coping patterns: pessimistic, optimistic, persistent and support-seeking. The stability of each coping style over time ranged from 75.3% to 90.5%. Those who experienced a worsening of the disease were most inclined to change their coping style (p = 0.006). The results suggest that even when facing severe challenges due to PD in daily life, coping styles remain relatively stable over time. However, a worsening in PD severity appeared to trigger a certain re-evaluation of coping styles.