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Die vorliegende Untersuchung behandelt ein spezifisches Problem aus dem Bereich des Bruchunterrichts, nämlich das Problem der Bezeichnungsweise sogenannter „gemischter Zahlen“. Wir werden – nach der Klärung der Terminologie – zunächst die relevanten Daten vorstellen, die wir den Bruchalben von Schüler(innen) einer 6.Klasse entnommen haben (Abschnitt 3). Nach der Darstellung des Fehlerphänomens werden wir dann die kognitiven Fehlerursachen analysieren:2 Die aufgefundenen Normabweichungen werden als Folge eines spezifischen „Interpretationsproblems“ diskutiert, das wir mithilfe linguistischer Analysen auf verbalsprachliche Parallelen der betreffenden Bruchzahlbezeichnungen mit Anzahlangaben zurückführen (Abschnitt 4); auf dieser Basis skizzieren wir Vorschläge für den Mathematikunterricht, die zur Bewältigung des diskutierten Problems beitragen sollen (Abschnitt 5).
How far can language-specific structures influence conceptualisation? After a period of time where the discussion of any ‘Whorfian’ effects tended to be considered of little scientific merit, the recent decade has seen a renewed interest in this question. In particular, studies have aimed to tease apart ‘thinking for speaking’ from general cognition (cf. Slobin 1996, Stutterheim & Nüse 2002) and have shown that language-specific differences can often be observed in verbalisation as well as in the preverbal preparation phase of speech production, rather than in non-linguistic tasks.
What role does language play in the development of numerical cognition? In the present paper I argue that the evolution of symbolic thinking (as a basis for language) laid the grounds for the emergence of a systematic concept of number. This concept is grounded in the notion of an infinite sequence and encompasses number assignments that can focus on cardinal aspects ("three pencils"), ordinal aspects ("the third runner"), and even nominal aspects ("bus #3"). I show that these number assignments are based on a specific association of relational structures, and that it is the human language faculty that provides a cognitive paradigm for such an association, suggesting that language played a pivotal role in the evolution of systematic numerical cognition.
I discuss the status of WH-words for interrogative interpretations, and show that the derivation of constituent questions evolves from a specific interplay of syntactic and semantic representations with pragmatics. I argue that WH-pronouns are not ‘interrogative’. Rather, they are underspecified elements; due to this underspecification, WH-words can form a constitutive part not only of interrogative, but also of exclamative and declarative clauses. WH-words introduce a variable of a particular conceptual domain into the semantic representation. Accordingly, they have to be specified for interpretation. Different WH-contexts give rise to different interpretations. In a cross-linguistic overview, I discuss the characteristic elements contributing to the derivation of interrogatives. I argue that specific particles or their phonologically empty counterparts in the head of CP contribute the interrogative aspect. The speech act of ‘asking’ is then carried out via an intonational contour that identifies a question. By default, this intonational contour operates on interrogative sentences; however, other sentence formats – in particular, those of declarative sentences – are possible as well. The distinction of (a) grammatical (syntactic, semantic and phonological) sentence formats for interrogative and declarative sentences, and (b) intonational contours serving the discrimination of speech acts like questions and assertions, can be related to psychological and neurological evidence.
This paper discusses constructions like “We’ll have two beers and a coffee.” that are typically used for beverage orders in restaurant contexts. We compare the behaviour of nouns in these constructions in three Germanic languages, English, Icelandic, and German, and take a closer look at the correlation of the morpho-syntactic and semantic-conceptual changes involved here. We show that even within such a closely related linguistic sample, one finds three different grammatical options for the expression of the same conceptual transition. Our findings suggest an analysis of coercion as a genuinely semantic phenomenon, a phenomenon that is located on a level of semantic representations that serves as an interface between the conceptual and the grammatical system and takes into account inter- and intralinguistic variations.
Humans possess a number concept that differs from its predecessors in animal cognition in two crucial respects: (1) it is based on a numerical sequence whose elements are not confined to quantitative contexts, but can indicate cardinal/quantitative as well as ordinal and even nominal properties of empirical objects (e.g. ‘five buses’: cardinal; ‘the fifth bus’: ordinal; ‘the #5 bus’: nominal), and (2) it can involve recursion and, via recursion, discrete infinity. In contrast to that, the predecessors of numerical cognition that we find in animals and human infants rely on finite and iconic representations that are limited to cardinality and do not support a unified concept of number. In this paper, I argue that the way such a unified number concept could evolve in humans is via verbal sequences that are employed as numerical tools, that is, sequences of words whose elements are associated with empirical objects in number assignments. In particular, I show that a certain kind of number words, namely the counting sequences of natural languages, can be characterised as a central instance of verbal numerical tools. I describe a possible scenario for the emergence of such verbal numerical tools in human history that starts from iconic roots and that suggests that in a process of co-evolution, the gradual emergence of counting sequences and the development of an increasingly comprehensive number concept supported each other. On this account, it is language that opened the way for numerical cognition, suggesting that it is no accident that the same species that possesses the language faculty as a unique trait, should also be the one that developed a systematic concept of number.
Sprachvermögen und Zahlbegriff : zur Rolle der Sprache für die Entwicklung numerischer Kognition
(2004)
In welchem Zusammenhang stehen Sprache und Zahl als kognitive Domänen? Welche Rolle spielt das menschliche Sprachvermögen für die Entwicklung des Zahlbegriffs? In den letzten Jahrzehnten haben verschiedene Disziplinen aus dem Gebiet der Kognitionswissenschaft – darunter Psycholinguistik, Entwicklungspsychologie, Ethologie und kognitive Neurowissenschaft – wesentlich zu unserem Verständnis der Beziehung zwischen Sprache und numerischer Kognition beigetragen. Die unterschiedlichen Ergebnisse liefern Evidenz für eng verknüpfte ebenso wie für autonome Bereiche in den beiden Domänen.
I give a unified account of numeral classifiers as lexical items that are reduced to the function of individuation in cardinal counting constructions with transnumeral nouns. I argue that individuation is a lexical-semantic phenomenon that triggers a focus shift from a whole set to its individual elements, but does not affect the conceptual representation. The semantic reduction of numeral classifiers to individuation functions is, on the one hand, reflected by a morpho-syntactic reduction; numeral classifiers do not project to full NPs, but occur as headadjuncts in QPs. On the other hand, it leads to a loss of conceptual features. As a result, nouns that are used as numeral classifiers are conceptually divorced from their NP counterparts. They integrate the nominal concept not as part of their interpretation, but via agreement features that govern the distribution of nouns in classifierconstructions. I show that the selection of conceptual features relevant for the distribution of numeral classifiers and nouns is lexically, not conceptually governed, supporting a model that distinguishes lexical-semantic and conceptual aspects in the generation of meaning.
Gegenstand des vorliegenden Beitrags ist der Zusammenhang der beiden Bereiche Sprache und außersprachliches Begriffssystem: Wie sind sprachliche und konzeptuelle Module verknüpft, und wie lässt sich ihr Zusammenhang theoretisch erfassen? Ich skizziere zwei alternative Ansätze zur Modellierung dieser Schnittstelle: das „Zwei-Ebenen-Modell“ und das Modell der „Conceptual Semantics“. Vor dem Hintergrund der beiden Ansätze diskutiere ich die Notwendigkeit eines vom konzeptuellen unterschiedenen „semantischen“ Systems, das sprachliche Aspekte der Bedeutung erfasst. Ich entwickele auf dieser Basis ein Modell, in dem die semantische Ebene als integrierter Teil des konzeptuellen Systems CS definiert ist: Semantische Repräsentationen werden durch einen Filter über CS generiert; sie etablieren eine Schnittstellen-Ebene, die CSElemente sprachlichen Strukturen zugänglich macht. Das Modell, das als Elaboration des „Tripartite Parallel Architecture“-Modells (Jackendoff 1997) verstanden werden kann, differenziert sprachliche und nicht-sprachliche Bedeutungsaspekte innerhalb eines komplexen Moduls (“2 in 1”-Ansatz).
Im Rahmen philosophisch-mathematischer Ansätze steht häufig der kardinale Aspekt natürlicher Zahlen im Vordergrund, auf den sprachlich mit Kardinal-Konstruktionen („sieben Zwerge“) referiert wird. Zahlen werden jedoch nicht nur in solchen quantitativen, sondern auch in ordinalen („der dritte Mann“) oder nominalen Kontexten („Bus Nr.129“) gebraucht. Bei einer umfassenden Analyse des Zahlkonzepts sind daher auch diese Komponenten zu berücksichtigen.
In linguistics and the philosophy of language, the mass/count distinction has traditionally been regarded as a bi-partition on the nominal domain, where typical instances are nouns like "beef" (mass) vs."cow" (count). In the present paper, we argue that this partition reveals a system that is based on both syntactic features and conceptual features, and present experimental evidence suggesting that the discrimination of the two kinds of features has a psychological reality.
Der Beitrag behandelt diminuierte Partikeln, etwa „Hallöchen“, „Tschüssi“ oder „Jaui“. Die Diminuierung von Partikeln durch -chen und -i ist ein produktives und häufig auftretendes Phänomen im Deutschen, wird in grammatischen Beschreibungen jedoch weitgehend vernachlässigt; diese konzentrieren sich in erster Linie auf nominale Kontexte der Diminuierung. Betrachtet man jedoch die vollständige Distribution von -chen und -i, so ergibt sich ein interessantes Problem für die morphologische Beschreibung, da sie auf einen hybriden Status der Suffixe zwischen Kopf und Modifikator hinweist. Ich diskutiere die Implikationen dieses Befundes für die Charakterisierung des morphologischen Systems und zeige, dass ein verbindendendes Moment der Distribution auf der morphopragmatischen Ebene liegt, nämlich in der Expressivität von Diminutivsuffixen. Im Fall diminuierter Partikeln geht dies so weit, dass der Bedeutungsbeitrag ein rein pragmatischer ist, auf Kosten der semantischen Komponente. Ich zeige, dass die Diminuierung von Grußpartikeln wie „Tschüssi“ zudem wesentlich durch einen metrischen Aspekt motiviert ist, nämlich die Anpassung an das in Grüßen vorherrschende trochäische Muster, das durch die Diminutivsuffigierung ermöglicht wird, und argumentiere, dass diese metrische Anpassung durch den Status von Grüßen als sozialen Ritualen ausgelöst wird. Partikeldiminuierung weist damit auf ein komplexes Zusammenspiel grammatischer, pragmatischer und genereller kognitiver Aspekte hin.
Ein zentrales Thema in den Arbeiten Klaus Welkes ist die Analyse formal bestimmter Relationen, die semantisch interpretierbar sind (vgl. etwa WELKE 1988, 1992, 1994, 2001, 22005). Wichtige Fragestellungen sind hier insbesondere: Wie ist die Hierarchie logisch-pragmatischer Rollen, wie die syntaktischer Funktionen? Wie hängen die beiden Bereiche zusammen? Wie können wir dies mit Hilfe von Argumentstrukturen erfassen? Der vorliegende Beitrag wird sich mit dem hierfür zentralen Aspekt der Verknüpfung syntaktischer und semantischer Relationen aus einer evolutionären Perspektive befassen. In Übereinstimmung mit WELKE (22005) gehe ich davon aus, „daß es neben einer Syntax formaler Strukturen auch eine Syntax semantischer Strukturen gibt“ (WELKE 22005, 4) und untersuche vor diesem Hintergrund, wie eine Entstehung dieser beiden Domänen und die Verknüpfung der betreffenden Strukturen im Rahmen der Evolution menschlicher Sprache aussehen könnte.
Ich werde im folgenden einige Überlegungen zur konzeptuellen und semantischen Struktur von Numeralkonstruktionen im Deutschen anstellen, in deren Rahmen ich sowohl die Repräsentation von Zahlen und die Modellierung von Numeralkonstruktionen diskutieren als auch einige Aspekte der Schnittstelle Syntax-Semantik erhellen will. Ich führe meine Untersuchung im Rahmen des „Zwei-Ebenen-Modells“ der Semantik durch (vgl. Bierwisch 1983;1987;1988; Lang 1987; Zimmermann 1987; 1992), nehme also neben dem semantischen System SEM ein autonomes konzeptuelles System CS an, das „die mentale Form dessen, was durch sprachliche Äußerungen wiedergegeben wird, [determiniert]“ (Bierwisch 1987:6).
„Ich mach dich Messer“ ist eine jugendsprachliche Wendung, die als ritualisierte Drohung im Sinne von „Ich greife dich mit einem Messer an.“ zu verstehen ist. Diese Wendung, bei der sowohl die semantische Bleichung („semantic bleaching“) des Verbs als auch das Fehlen des Determinierers in der NP auffällt, verweist auf Merkmale morpho-syntaktischer Reduktion, wie man sie häufig in Kontaktsprachen findet. Wie ich zeigen werde, handelt es sich hierbei jedoch nicht um eine bloße sprachliche Simplifizierung, sondern um ein komplexes und produktives grammatisches Phänomen: In „Ich mach dich Messer“ manifestiert sich ein spezifisches Zusammenwirken syntaktischer und semantischer Phänomene, das ich im folgenden als sprachliche Arbeitsteilung nach dem Muster von Funktionsverbgefügen beschreiben werde.
"Ich mag so Wasserpfeifeladen" : the interaction of grammar and information structure in Kiezdeutsch
(2008)
In the present paper, I will discuss the semantic structure of nouns and nominal number markers. In particular, I will discuss the question if it is possible to account for the syntactic and semantic formation of nominals in a parallel way, that is I will try to give a compositional account of nominal semantics. The framework that I will use is "twolevel semantics". The semantic representations and their type-theoretical basis will account for general cross-linguistic characteristics of nouns and nominal number and will show interdependencies between noun classes, number marking and cardinal constructions. While the analysis will give a unified account of bare nouns (like dog / water), it will distinguish between the different kinds of nominal terms (like a dog / dogs / water). Following the proposal, the semantic operations underlying the formation of the SR are basically the same for DPs as for CPs. Hence, from such an analysis, independent semantic arguments can be derived for a structural parallelism of nominals and sentences - that is, for the "sentential aspect" of noun phrases. I will first give a sketch of the theoretical background. I will then discuss the cross-linguistic combinatorial potential of nominal constructions, that is, the potential of nouns and number markers to combine with other elements and form complex expressions. This will lead to a general type-theoretical classification for the elements in question. In the next step, I will model the referential potential of nominal constructions. Together with the combinatorial potential, this will give us semantic representations for the basic elements involved in nominal constructions. In an overview, I will summarize our modeling of nouns and nominal number. I will then discuss in an outlook the "sentential aspect" of noun phrases.
Die Bezeichnung von Anzahlen durch Numeralia und andere sprachliche Mittel ist ein universelles Charakteristikum natürlicher Sprachen, ein Sachverhalt, der bereits auf die große Bedeutung des Zahlkonzepts für das menschliche Denken hinweist: Der Begriff der Zahl, der in der Auffassung diskreter Objekte wurzelt, bildet nach neueren kognitionswissenschaftlichen Ansätzen neben dem Begriff des Raumes - der kontinuierlichen Einheit - das grundlegende Mittel zur Erfassung der Wirklichkeit.
Seit Frege (1891, 1892) werden generelle Termini wie „Tisch“, „Einhorn“ u.ä. logisch als Prädikate analysiert, d.h. sie werden als Begriffswörter angesehen, deren wesentliches Merkmal ihr Status als ungesättigter Ausdruck ist. Als solcher eröffnen sie eine Leerstelle für einen Argumentausdruck. Dieser muß einen Gegenstand denotieren; der so gesättigte Begriffsausdruck bezeichnet dann einen Wahrheitswert. Nach dieser Analyse werden generelle Termini somit als Bezeichnungen für Funktionen analysiert, deren Definitionsbereich Gegenstände und deren Wertebereich Wahrheitswerte sind. Ebenso wie intransitive Verben gelten sie damit als Ausdrücke, die zusammen mit einem Eigennamen einen assertorischen Satz bilden.
Aufgrund ihres spezifischen Verhaltens stellen Numeralia häufig ein Problem für die Wortartenklassifikation dar: Einerseits stimmen sie in Kernaspekten ihrer Bedeutung überein - alle Numeralia referieren wesentlich auf Zahlen -, andererseits bestehen zwischen den einzelnen Numeralklassen trotz enger lexikalisch-phonologischer Zusammengehörigkeit zum Teil große morpho-syntaktische Diskrepanzen. Es gibt im wesentlichen zwei Möglichkeiten, diesem Problem zu begegnen: Entweder nimmt man eine spezifische Wortart „Numeralia“ für diese Lexeme an, oder man subsumiert die einzelnen Numeralklassen unter verschiedene andere Wortarten. Beide Ansätze sind letztlich etwas unbefriedigend. Klassifiziert man Numeralia aufgrund morpho-syntaktischer Merkmale als Elemente unterschiedlicher Wortarten, so scheint der enge Zusammenhang der verschiedenen Numeralklassen nicht genügend berücksichtigt zu werden. Im anderen Fall, bei der Postulation einer eigenen Wortart, wird dagegen die morphosyntaktische Heterogenität von Numeralia kaum erfaßt. Aufgrund des charakteristischen Aufbaus von Numeralsequenzen ist darüber hinaus die Anzahl der Elemente einer solchen Wortart möglicherweise stark reduziert: Anders als andere Ausdrücke bilden Numeralia eine Reihe, deren Elemente eng auf einander bezogen sind; höhere Elemente bauen auf niedrigeren auf und erlangen ihre Bedeutung wesentlich erst durch diese. Man könnte daher argumentieren, daß Elemente einer Numeralklasse, beispielsweise die Kardinalia, keine Menge, sondern nur ein (komplexes) Element bilden, nämlich die Sequenz „ein-, zwei, drei,...“. Eine eigenständige Wortart „Kardinalia“, wie etwa Schmid (1987) sie vorschlägt, hätte dann streng genommen nur ein einziges Element.
Die folgende Untersuchung wird Parallelen in der semantisch-konzeptuellen Struktur von Nominalgruppen und Sätzen aufzeigen und so unabhängige, semantische Argumente für den „sentential aspect“ von Nominalgruppen liefern, wie er bereits von Abney (1987) auf syntaktischer Seite motiviert wurde. Ich werde im ersten Teil die semantische und syntaktische Struktur von Sätzen skizzieren und hierbei insbesondere die zentralen semantisch-konzeptuellen Operationen identifizieren, die die Generierung von CPs begleiten. Vor diesem Hintergrund werden im zweiten Teil die zentralen übereinzelsprachlichen Merkmale von Nominalgruppen diskutiert und durch semantisch-konzeptuelle (sowie - in einer Skizze - syntaktische) Repräsentationen erfasst. Das Modell zur Struktur von Nominalgruppen wird in Bezug zu den zuvor skizzierten Annahmen über Sätze gestellt. Es wird sich hierbei zeigen, dass bei der Generierung von DPs die gleichen semantisch- konzeptuellen Operationen wirksam werden, wie sie für CPs festgehalten wurden. Ein zentraler Punkt der Diskussion wird das Problem der semantischen Kompositionalität sein. Im Rahmen eines Zwei-Ebenen-Modells der Semantik soll mithilfe semantischer Repräsentationen zugleich die Korrelation sprachlicher und konzeptueller Strukturen erfasst werden.
This volume brings together a cross-section of recent research on the grammar and representation of pronouns, centering around the typology of pronominal paradigms, the generation of syntactic and semantic representations for constructions containing pronouns, and the neurological underpinnings for linguistic distinctions that are relevant for the production and interpretation of these constructions. In this introductory chapter we first give an exposition of our topic (section 2). Taking the interpretation of pronouns as a starting point, we discuss the basic parameters of pronominal representations, and draw a general picture of how morphological, semantic, discourse-pragmatic and syntactic aspects come together. In section 3, we sketch the different domains of research that are concerned with these phenomena, and the particular questions they are interested in, and show how the papers in the present volume fit into the picture. Section 4 gives summaries of the individual papers, and a short synopsis of their main points of convergence.
This paper presents an account of semantics as a system that integrates conceptual representations into language. I define the semantic system as an interface level of the conceptual system CS that translates conceptual representations into a format that is accessible by language. The analysis I put forward does not treat the make up of this level as idiosyncratic, but subsumes it under a unified notion of linguistic interfaces. This allows us to understand core aspects of the linguistic-conceptual interface as an instance of a general pattern underlying the correlation of linguistic and non-linguistic structures. By doing so, the model aims to provide a broader perspective onto the distinction between and interaction of conceptual and linguistic processes and the correlation of semantic and syntactic structures.
Is language the key to number? This article argues that the human language faculty provides the cognitive equipment that enables humans to develop a systematic number concept. Crucially, this concept is based on non-iconic representations that involve relations between relations: relations between numbers are linked with relations between objects. In contrast to this, language-independent numerosity concepts provide only iconic representations. The pattern of forming relations between relations lies at the heart of our language faculty, suggesting that it is language that enables humans to make the step from these iconic representations, which we share with other species, to a generalised concept of number.
Cross-linguistically, numerals differ from other linguistic expressions in various aspects of their grammatical behavior and their acquisition. What is so special about them? I will show that a closer look at the status of numbers and numerals not only gives an answer to this question, but can also shed some light onto the syntax-semantics interface. Taking into account philosophical approaches from the foundations of mathematics, I will set forth a definition of number as a function that can be fulfilled by certain sequences. This will lead us (i) to dispense with abstract entities “numbers“ and (ii) to regard numeral sequences as sets that can function as numbers. I will show that this OCCAMiam view captures the peculiar features of numeral sequences as a reflex of their “number function”. On the other hand, the integration of number words into complex syntactic structures leads to a morpho-syntactic behavior of cardinals, ordinals and numerals in “#”-constructions that comes close to that of different word classes, depending on parallels in their semantic-conceptual structure.
Auf der Grundlage der bisherigen Forschungsergebnisse zu Transfer und Interferenz wird die Übertragung sprachlichen Wissens in die Interimsprache in eine Theorie des Zweitspracherwerbs integriert. Transfer wird dabei als interlinguale Ausprägung der Generalisierung verstanden, eine Sichtweise, die die Untersuchungsergebnisse zu Bedingungen und Ursachen des Transfers in einen Erklärungszusammenhang mit anderen Phänomenen des Zweitspracherwerbs stellt. Darüberhinaus ermöglicht es diese Interpretation, eine Verbindung zu kognitiven Leistungen des Lerners beim Erstspracherwerb sowie beim Lernen überhaupt herzustellen.
Background: In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.
Methods: This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice).
Results: The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice.
Conclusions: This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient’s assessment is associated not only with practice-level factors, but also with individual, patient-level factors.
Background: It is not well established how psychosocial factors like social support and depression affect health-related quality of life in multimorbid and elderly patients. We investigated whether depressive mood mediates the influence of social support on health-related quality of life.
Methods: Cross-sectional data of 3,189 multimorbid patients from the baseline assessment of the German MultiCare cohort study were used. Mediation was tested using the approach described by Baron and Kenny based on multiple linear regression, and controlling for socioeconomic variables and burden of multimorbidity.
Results: Mediation analyses confirmed that depressive mood mediates the influence of social support on health-related quality of life (Sobel's p < 0.001). Multiple linear regression showed that the influence of depressive mood (beta = -0.341, p < 0.01) on health-related quality of life is greater than the influence of multimorbidity (beta = -0.234, p < 0.01).
Conclusion: Social support influences health-related quality of life, but this association is strongly mediated by depressive mood. Depression should be taken into consideration in research on multimorbidity, and clinicians should be aware of its importance when caring for multimorbid patients.
Obesity and associated lifestyle in a large sample of multi-morbid German primary care attendees
(2014)
Background: Obesity and the accompanying increased morbidity and mortality risk is highly prevalent among older adults. As obese elderly might benefit from intentional weight reduction, it is necessary to determine associated and potentially modifiable factors on senior obesity. This cross-sectional study focuses on multi-morbid patients which make up the majority in primary care. It reports on the prevalence of senior obesity and its associations with lifestyle behaviors.
Methods: A total of 3,189 non-demented, multi-morbid participants aged 65–85 years were recruited in primary care within the German MultiCare-study. Physical activity, smoking, alcohol consumption and quantity and quality of nutritional intake were classified as relevant lifestyle factors. Body Mass Index (BMI, general obesity) and waist circumference (WC, abdominal obesity) were used as outcome measures and regression analyses were conducted.
Results: About one third of all patients were classified as obese according to BMI. The prevalence of abdominal obesity was 73.5%. Adjusted for socio-demographic variables and objective and subjective disease burden, participants with low physical activity had a 1.6 kg/m2 higher BMI as well as a higher WC (4.9 cm, p<0.001). Current smoking and high alcohol consumption were associated with a lower BMI and WC. In multivariate logistic regression, using elevated WC and BMI as categorical outcomes, the same pattern in lifestyle factors was observed. Only for WC, not current but former smoking was associated with a higher probability for elevated WC. Dietary intake in quantity and quality was not associated with BMI or WC in either model.
Conclusions: Further research is needed to clarify if the huge prevalence discrepancy between BMI and WC also reflects a difference in obesity-related morbidity and mortality. Yet, age-specific thresholds for the BMI are needed likewise. Encouraging and promoting physical activity in older adults might a starting point for weight reduction efforts.
Background: Multimorbidity is a common phenomenon in primary care. Until now, no clinical guidelines for multimorbidity exist. For the development of these guidelines, it is necessary to know whether or not patients are aware of their diseases and to what extent they agree with their doctor. The objectives of this paper are to analyze the agreement of self-reported and general practitioner-reported chronic conditions among multimorbid patients in primary care, and to discover which patient characteristics are associated with positive agreement.
Methods: The MultiCare Cohort Study is a multicenter, prospective, observational cohort study of 3,189 multimorbid patients, ages 65 to 85. Data was collected in personal interviews with patients and GPs. The prevalence proportions for 32 diagnosis groups, kappa coefficients and proportions of specific agreement were calculated in order to examine the agreement of patient self-reported and general practitioner-reported chronic conditions. Logistic regression models were calculated to analyze which patient characteristics can be associated with positive agreement.
Results: We identified four chronic conditions with good agreement (e.g. diabetes mellitus κ = 0.80;PA = 0,87), seven with moderate agreement (e.g. cerebral ischemia/chronic stroke κ = 0.55;PA = 0.60), seventeen with fair agreement (e.g. cardiac insufficiency κ = 0.24;PA = 0.36) and four with poor agreement (e.g. gynecological problems κ = 0.05;PA = 0.10).Factors associated with positive agreement concerning different chronic diseases were sex, age, education, income, disease count, depression, EQ VAS score and nursing care dependency. For example: Women had higher odds ratios for positive agreement with their GP regarding osteoporosis (OR = 7.16). The odds ratios for positive agreement increase with increasing multimorbidity in almost all of the observed chronic conditions (OR = 1.22-2.41).
Conclusions: For multimorbidity research, the knowledge of diseases with high disagreement levels between the patients' perceived illnesses and their physicians' reports is important. The analysis shows that different patient characteristics have an impact on the agreement. Findings from this study should be included in the development of clinical guidelines for multimorbidity aiming to optimize health care. Further research is needed to identify more reasons for disagreement and their consequences in health care.
Background: Multimorbidity is a phenomenon with high burden and high prevalence in the elderly. Our previous research has shown that multimorbidity can be divided into the multimorbidity patterns of 1) anxiety, depression, somatoform disorders (ADS) and pain, and 2) cardiovascular and metabolic disorders. However, it is not yet known, how these patterns are influenced by patient characteristics. The objective of this paper is to analyze the association of socio-demographic variables, and especially socio-economic status with multimorbidity in general and with each multimorbidity pattern.
Methods: The MultiCare Cohort Study is a multicentre, prospective, observational cohort study of 3.189 multimorbid patients aged 65+ randomly selected from 158 GP practices. Data were collected in GP interviews and comprehensive patient interviews. Missing values have been imputed by hot deck imputation based on Gower distance in morbidity and other variables. The association of patient characteristics with the number of chronic conditions is analysed by multilevel mixed-effects linear regression analyses.
Results: Multimorbidity in general is associated with age (+0.07 chronic conditions per year), gender (-0.27 conditions for female), education (-0.26 conditions for medium and -0.29 conditions for high level vs. low level) and income (-0.27 conditions per logarithmic unit). The pattern of cardiovascular and metabolic disorders shows comparable associations with a higher coefficient for gender (-1.29 conditions for female), while multimorbidity within the pattern of ADS and pain correlates with gender (+0.79 conditions for female), but not with age or socioeconomic status.
Conclusions: Our study confirms that the morbidity load of multimorbid patients is associated with age, gender and the socioeconomic status of the patients, but there were no effects of living arrangements and marital status. We could also show that the influence of patient characteristics is dependent on the multimorbidity pattern concerned, i.e. there seem to be at least two types of elderly multimorbid patients. First, there are patients with mainly cardiovascular and metabolic disorders, who are more often male, have an older age and a lower socio-economic status. Second, there are patients mainly with ADS and pain-related morbidity, who are more often female and equally distributed across age and socio-economic groups.
Background Multimorbidity is a highly frequent condition in older people, but well designed longitudinal studies on the impact of multimorbidity on patients and the health care system have been remarkably scarce in numbers until today. Little is known about the long term impact of multimorbidity on the patients' life expectancy, functional status and quality of life as well as health care utilization over time. As a consequence, there is little help for GPs in adjusting care for these patients, even though studies suggest that adhering to present clinical practice guidelines in the care of patients with multimorbidity may have adverse effects. Methods The study is designed as a multicentre prospective, observational cohort study of 3.050 patients aged 65 to 85 at baseline with at least three different diagnoses out of a list of 29 illnesses and syndromes. The patients will be recruited in approx. 120 to 150 GP surgeries in 8 study centres distributed across Germany. Information about the patients' morbidity will be collected mainly in GP interviews and from chart reviews. Functional status, resources/risk factors, health care utilization and additional morbidity data will be assessed in patient interviews, in which a multitude of well established standardized questionnaires and tests will be performed. Discussion The main aim of the cohort study is to monitor the course of the illness process and to analyse for which reasons medical conditions are stable, deteriorating or only temporarily present. First, clusters of combinations of diseases/disorders (multimorbidity patterns) with a comparable impact (e.g. on quality of life and/or functional status) will be identified. Then the development of these clusters over time will be analysed, especially with regard to prognostic variables and the somatic, psychological and social consequences as well as the utilization of health care resources. The results will allow the development of an instrument for prediction of the deterioration of the illness process and point at possibilities of prevention. The practical consequences of the study results for primary care will be analysed in expert focus groups in order to develop strategies for the inclusion of the aspects of multimorbidity in primary care guidelines.