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Hajek A, König HH, Sutin AR, Terracciano A, Luchetti M, Stephan Y, Gyasi RM. Prevalence and factors associated with probable depression among the oldest old during the Covid-19 pandemic: evidence from the large, nationally representative 'Old Age in Germany (D80+)' study. Psychogeriatrics 2024. [PMID: 38699978 DOI: 10.1111/psyg.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/09/2024] [Accepted: 04/21/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND To date, most studies examining the prevalence and determinants of depression among individuals aged 80 and over have used geographically limited samples that are not generalisable to the wider population. Thus, our aim was to identify the prevalence and the factors associated with probable depression among the oldest old in Germany based on nationally representative data. METHODS Data were taken from the nationally representative 'Old Age in Germany (D80+)' study (n = 8386; November 2020 to April 2021) covering both community-dwelling and institutionalised individuals aged 80 and over. The Short Form of the Depression in Old Age Scale was used to quantify probable depression. RESULTS Probable depression was found in 40.7% (95% CI: 39.5% to 42.0%) of the sample; 31.3% were men (95% CI: 29.7% to 32.9%) and 46.6% women (95% CI: 44.9% to 48.3%). The odds of probable depression were positively associated with being female (odds ratio (OR): 1.55, 95% CI: 1.30 to 1.84), being divorced (compared to being married, OR: 1.33, 95% CI: 1.01 to 1.76), being widowed (OR: 1.14, 95% CI: 1.00 to 1.30), having a low education (e.g., medium education compared to low education, OR: 0.86, 95% CI: 0.74 to 0.99), living in an institutionalised setting (OR: 2.36, 95% CI: 1.84 to 3.02), living in East Germany (OR: 1.21, 95% CI, 1.05 to 1.39), not having German citizenship (German citizenship compared to other citizenship, OR: 0.55, 95% CI: 0.31 to 0.95), poor self-rated health (OR: 0.31, 95% CI: 0.28 to 0.34), and the number of chronic conditions (OR: 1.12, 95% CI: 1.09 to 1.14). CONCLUSION About four out of 10 individuals aged 80 and over in Germany had probable depression, underlining the importance of this challenge. Knowledge of specific risk factors for this age group may assist in addressing older adults at risk of probable depression.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Angelina R Sutin
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | | | - Martina Luchetti
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | | | - Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
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Gyasi RM, Odei J, Hambali MG, Gyasi-Boadu N, Obeng B, Asori M, Hajek A, Jacob L, Adjakloe YAD, Opoku-Ware J, Smith L, Koyanagi A. Diabetes mellitus and functional limitations among older adults: Evidence from a large, representative Ghanaian aging study. J Psychosom Res 2023; 174:111481. [PMID: 37677886 DOI: 10.1016/j.jpsychores.2023.111481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 08/04/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Literature linking diabetes mellitus (DM) to functional status is limited in low- and middle-income countries. Importantly, factors influencing this association are even less understood. This study aims to examine the association of DM with functional limitations (FL) in older adults and to identify potential factors influencing this association. METHODS In a cross-sectional analysis, we examined the association between DM and basic and instrumental activities of daily living-related FL in 1201 adults aged ≥50 years from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study. DM was defined as a self-report of physician diagnosis. The associations were assessed using hierarchical regression estimates and bootstrapping technique via the Hayes PROCESS macro program. RESULTS The prevalence of DM and FL was 10.1% and 36.1%, respectively, with OR = 2.50 (95%CI = 1.59-3.92) after accounting for sociodemographic factors, smoking, alcohol use, self-rated health, loneliness, and sleep quality. After full adjustment, polytomous regressions showed that the association of DM with FL increased with the number of FL (i.e., OR = 1.60 for 1-2, OR = 1.88 for 3-5, and OR = 2.0o for >5 FL compared with no FL). However, this association was attenuated after controlling for physical activity (OR = 2.06, 95%CI = 1.28-3.31), hypertension (OR = 1.87, 95%CI = 1.14-2.99), stroke (OR = 1.82, 95%CI = 1.20-2.93), and pain facets (OR = 1.80, 95%CI = 1.04-3.02). PA thus mediated 40.39% of the DM-FL association. CONCLUSIONS In this representative study, older adults with DM showed higher odds for FL, and this association was partially explained by physical activity and health variables. Investing in a holistic management approach might be helpful for public health planning efforts to address DM-induced FL in old age.
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Affiliation(s)
- Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya; National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, Australia.
| | - Julius Odei
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mohammed Gazali Hambali
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nelson Gyasi-Boadu
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bernard Obeng
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Moses Asori
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States of America
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, Hamburg 20246, Germany
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | | | - Jones Opoku-Ware
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys 23, Barcelona, Spain
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Alabadi B, Civera M, De la Rosa A, Martinez-Hervas S, Gomez-Cabrera MC, Real JT. Low Muscle Mass Is Associated with Poorer Glycemic Control and Higher Oxidative Stress in Older Patients with Type 2 Diabetes. Nutrients 2023; 15:3167. [PMID: 37513585 PMCID: PMC10383462 DOI: 10.3390/nu15143167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Body composition changes that occur during aging, such as loss of lean mass, are unfavorable at metabolic level and they can explain, in part, the appearance of certain age-associated diseases such as type 2 diabetes (T2D). Separately, T2D is associated with an increase in oxidative stress (OS) which negatively affects skeletal muscle. Our aim was to study the differences in clinical and nutritional parameters, disease control, and OS in a cohort of older patients with T2D classified according to the amount of lean mass they had. We included 100 adults older than 65 years with T2D. We found that women with low fat-free mass and muscle mass have worse T2D metabolic control. Moreover, the patients with a low percentile of muscle mass present a high value of OS. The study shows that the presence of low lean mass (LM) in the geriatric population diagnosed with T2D is associated with poorer glycemic control and greater OS.
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Affiliation(s)
- Blanca Alabadi
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario of Valencia, 46010 Valencia, Spain
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, 28029 Madrid, Spain
| | - Miguel Civera
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario of Valencia, 46010 Valencia, Spain
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Adrián De la Rosa
- Laboratory of Applied Sciences of Sport and Innovation Research Group (GICED), Unidades Tecnológicas de Santander (UTS), Bucaramanga 680006, Colombia
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Sergio Martinez-Hervas
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario of Valencia, 46010 Valencia, Spain
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, 28029 Madrid, Spain
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Mari Carmen Gomez-Cabrera
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), ISCIII, 28029 Madrid, Spain
| | - José T Real
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario of Valencia, 46010 Valencia, Spain
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, 28029 Madrid, Spain
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
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Brenner RJ, Hansen J, Brintz BJ, Bouldin ED, Pugh MJ, Rupper R, Munoz R, Garcia-Davis S, Dang S. Association between specific unmet functional needs and desire to institutionalize among caregivers of older veterans. J Am Geriatr Soc 2023. [PMID: 36815450 DOI: 10.1111/jgs.18307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/23/2022] [Accepted: 01/28/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To evaluate the associations between specific functional needs of older Veterans and the desire to institutionalize (DTI) among their caregivers. METHODS Cross-sectional multivariable logistic regression analysis of 3579 Hero Care survey responses from caregivers of Veterans at five US sites from July to December 2021. Unmet needs were areas in which the caregiver reported the Veteran needed a little more or a lot more help. Caregiver DTI was defined as the caregiver reporting that they had discussed, considered, or taken steps toward a nursing home or assisted living placement for the Veteran or that they felt the Veteran would be better off in such a setting or they were likely to move the Veteran to another living arrangement. RESULTS Caregivers were largely white, retired, females with an average age of 71 and with some college education who spent an average of 8-9 h per day 6 days a week caring for a Veteran spouse. There was evidence of associations between the following needs and a DTI: managing incontinence, using the telephone, transportation, and arranging services in the home such as visiting nurses, home care aides, or meals on wheels. Unmet functional needs in other selected domains were not associated with the DTI. CONCLUSION Among caregivers of older Veterans, a need for more assistance managing incontinence, telephone use, transportation, and arranging in-home services were associated with the DTI. These may represent functional markers of important clinical determinants for institutionalization as well as potential targets for intervention to reduce caregiver DTI, such as programs that provide more caregiver or Veteran support in the home to meet these needs and reduce caregiver burden.
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Affiliation(s)
- Rachel J Brenner
- Salt Lake City VA Geriatric Research Education and Clinical Center, Division of Geriatrics, University of Utah, Salt Lake City, Utah, USA
| | - Jared Hansen
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Ben J Brintz
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Erin D Bouldin
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Mary Jo Pugh
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Randall Rupper
- Division of Geriatrics, Salt Lake City VA Geriatric Research Education and Clinical Center, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Richard Munoz
- Department of Health Policy & Management, Florida International University, Robert Stempel College of Public Health & Social Work, Miami, Florida, USA
| | - Sandra Garcia-Davis
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stuti Dang
- Miami VA Geriatric Research Education and Clinical Center, University of Miami Miller School of Medicine, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Miami, Florida, USA
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Kim HJ, Fredriksen-Goldsen K, Jung HH. Determinants of Physical Functioning and Health-Related Quality of Life among Sexual and Gender Minority Older Adults with Cognitive Impairment. J Aging Health 2023; 35:138-150. [PMID: 35766354 PMCID: PMC9771910 DOI: 10.1177/08982643221108658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: To examine risk and protective factors predicting physical functioning and physical and psychological health-related quality of life (HRQOL) among sexual and gender minority (SGM) older adults with cognitive impairment. Methods: This study analyzed longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study with a sub-sample of 855 SGM older adults who reported difficulties in cognitive performance. Results: Physical functioning and HRQOL linearly declined over time, and the decline of physical functioning was steeper for those with low levels of physical and outdoor leisure activities. The overall levels of physical functioning and HRQOL over time were associated with physical and outdoor leisure activities, optimal sleep, and sufficient food intake. HRQOL was negatively associated with lifetime discrimination and victimization, identity stigma, and smaller social network. Discussion: These findings can be used to develop interventions to improve physical functioning and HRQOL of SGM older adults living with cognitive impairment.
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Affiliation(s)
- Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Hailey H. Jung
- School of Social Work, University of Washington, Seattle, WA, USA
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Hajek A, König HH. What factors are associated with functional impairment among the oldest old? Front Med (Lausanne) 2022; 9:1092775. [PMID: 36619629 PMCID: PMC9815796 DOI: 10.3389/fmed.2022.1092775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Most of the existing studies did not explicitly focus on the oldest old who are at high risk of functional impairment. Moreover, some potential risk factors (such as financial poverty) of functional impairment have been neglected so far. Thus, our aim was to clarify the determinants (with a particular emphasis on financial poverty) of functional impairment exclusively among the oldest old. Methods Data were taken from the "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" - a representative sample of individuals ≥80 years (community-dwelling and in institutionalized settings) in North Rhine-Westphalia (n = 1,863, average age was 86.5 years, ranging from 80 to 102 years). Common tools were used to quantify functional impairment. In regression analysis, these determinants were included: sex, age, marital status, educational level, income poverty, asset poverty, depressive symptoms, cognitive impairment, and the number of chronic conditions. Results Multiple linear regressions showed that higher functional impairment was associated with being female (ADL, β = 0.06, p < 0.01; IADL, β = 0.09, p < 0.01), higher age (ADL, β = 0.02, p < 0.001; IADL, β = 0.04, p < 0.001), low education (compared to high education: IADL, β = -0.10, p < 0.05), the presence of income poverty (ADL, β = 0.09, p < 0.05; IADL, β = 0.16, p < 0.01), more depressive symptoms (ADL, β = 0.12, p < 0.001; IADL, β = 0.14, p < 0.001), higher cognitive impairment (ADL, β = -0.03, p < 0.001; IADL, β = -0.06, p < 0.001), and a higher number of chronic conditions (ADL, β = 0.03, p < 0.001; IADL, β = 0.05, p < 0.001). Conclusion Several determinants of functional impairment among the oldest old have been identified (i.e., being female, higher age, low education, presence of income poverty, more depressive symptoms, higher cognitive impairment, and more chronic conditions). Such knowledge (e.g., regarding the association between income poverty and functional impairment) may assist in characterizing individuals aged 80 years and over at high risk for functional impairment. Ultimately, such knowledge may help to design specific interventions for high risk groups. Moreover, such knowledge may enrich the research areas addressing inequalities.
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Buczak-Stec EW, Hajek A, Pabst A, Brettschneider C, van den Bussche H, Wiese B, Weyerer S, Werle J, Hoell A, Pentzek M, Fuchs A, Luppa M, Löbner M, Stein J, Förster F, Weeg D, Mösch E, Heser K, Scherer M, Maier W, Angermeyer MC, Wagner M, Riedel-Heller SG, König HH. Frequency and gender differences in the use of professional home care in late life. Findings from three German old-age cohorts. Front Med (Lausanne) 2022; 9:924818. [PMID: 36117967 PMCID: PMC9478461 DOI: 10.3389/fmed.2022.924818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
AimThe aim of this study was to investigate the frequency of and the gender differences in the use of professional home care in Germany.MethodsWe used harmonized data from three large cohort studies from Germany (“Healthy Aging: Gender-specific trajectories into the latest life”; AgeDifferent.de Platform). Data were available for 5,393 older individuals (75 years and older). Mean age was 80.2 years (SD: 4.1 years), 66.6% were female. Professional homecare outcome variables were use of outpatient nursing care, paid household assistance, and meals on wheels' services. Logistic regression models were used, adjusting for important sociodemographic variables.ResultsAltogether 5.2% of older individuals used outpatient nursing care (6.2% women and 3.2% men; p < 0.001), 24.2% used paid household assistance (26.1% women and 20.5% men; p < 0.001) and 4.4% used meals on wheels' services (4.5% women and 4.0% men; p = 0.49). Regression analysis revealed that women had higher odds of using paid household assistance than men (OR = 1.48, 95% CI: [1.24–1.76]; p < 0.001), whereas they had lower odds of using meals on wheels' services (OR = 0.64, 95% CI: [0.42–0.97]; p < 0.05). No statistically significant differences in using outpatient nursing care between women and men were found (OR = 1.26, 95% CI: [0.87–1.81]; p = 0.225). Further, the use of home care was mainly associated with health-related variables (e.g., stroke, Parkinson's disease) and walking impairments.ConclusionsOur study showed that gender differences exist in using paid household assistance and in culinary dependency. For example, meals on wheels' services are of great importance (e.g., for individuals living alone or for individuals with low social support). Gender differences were not identified regarding outpatient nursing care. Use of professional home care services may contribute to maintaining autonomy and independence in old age.
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Affiliation(s)
- Elżbieta W. Buczak-Stec
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Elżbieta W. Buczak-Stec
| | - André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik van den Bussche
- Department of General Practice and Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Andreas Hoell
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Michael Pentzek
- Institute of General Practice (ifam), Centre for Health and Society (chs), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Angela Fuchs
- Institute of General Practice (ifam), Centre for Health and Society (chs), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Margit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Franziska Förster
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Dagmar Weeg
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Kathrin Heser
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Martin Scherer
- Department of General Practice and Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Maier
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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