The Longitudinal Urban Cohort Ageing Study (LUCAS): study protocol and participation in the first decade

WHO ICOPE Programme Adherence of 8672 Older Age People Over 2-Years of Follow-Up

AIM

To compare the characteristics of participants who discontinued prematurely with those who remained in the ICOPE program (Integrated Care for Older PEople) in France and to compare completely adherent participants with partially adherent ones after 2 years of follow-up.

DESIGN

Retrospective observational study.

METHODS

We analysed the data of older age people participating during 2 years from the ICOPE MONITOR database. The study compared the population that discontinued follow-up with the population currently in follow-up. Among the population in follow-up, a comparison was made between the completely adherent and partially adherent populations.

RESULTS

In total, 8672 participants had a follow-up period of at least 2 years. After 2 years, three-quarters of the participants were still in follow-up with varying levels of adherence. Participants who discontinued follow-up are older and had more compromised Step 1 levels across all domains of intrinsic capacity (IC). Partially adherent participants were older and generally more compromised in IC than completely adherent participants. Those participants least adherent to ICOPE presented higher declines in clinical parameters.

CONCLUSION

Among autonomous older age people, the most impaired in intrinsic capacity domains and aged participants were more likely to discontinue follow-up, highlighting the need to focus efforts on this group. On the other hand, younger robust and healthier older age people represent a good target for ICOPE program, in terms of adherence and primary prevention.

REPORTED METHOD

EQUATOR guidelines: STROBE.

PATIENT OF PUBLIC CONTRIBUTION

No patient or public contribution.

Community-based complex interventions to sustain independence in older people, stratified by frailty: a systematic review and network meta-analysis

Background

Sustaining independence is important for older people, but there is insufficient guidance about which community health and care services to implement.

Objectives

To synthesise evidence of the effectiveness of community services to sustain independence for older people grouped according to their intervention components, and to examine if frailty moderates the effect.

Review design

Systematic review and network meta-analysis.

Eligibility criteria

Studies: Randomised controlled trials or cluster-randomised controlled trials. Participants: Older people (mean age 65+) living at home. Interventions: community-based complex interventions for sustaining independence. Comparators: usual care, placebo or another complex intervention.

Main outcomes

Living at home, instrumental activities of daily living, personal activities of daily living, care-home placement and service/economic outcomes at 1 year.

Data sources

We searched MEDLINE (1946-), Embase (1947-), CINAHL (1972-), PsycINFO (1806-), CENTRAL and trial registries from inception to August 2021, without restrictions, and scanned reference lists.

Review methods

Interventions were coded, summarised and grouped. Study populations were classified by frailty. A random-effects network meta-analysis was used. We assessed trial-result risk of bias (Cochrane RoB 2), network meta-analysis inconsistency and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation for network meta-analysis).

Results

We included 129 studies (74,946 participants). Nineteen intervention components, including 'multifactorial-action' (multidomain assessment and management/individualised care planning), were identified in 63 combinations. The following results were of low certainty unless otherwise stated. For living at home, compared to no intervention/placebo, evidence favoured: multifactorial-action and review with medication-review (odds ratio 1.22, 95% confidence interval 0.93 to 1.59; moderate certainty) multifactorial-action with medication-review (odds ratio 2.55, 95% confidence interval 0.61 to 10.60) cognitive training, medication-review, nutrition and exercise (odds ratio 1.93, 95% confidence interval 0.79 to 4.77) and activities of daily living training, nutrition and exercise (odds ratio 1.79, 95% confidence interval 0.67 to 4.76). Four intervention combinations may reduce living at home. For instrumental activities of daily living, evidence favoured multifactorial-action and review with medication-review (standardised mean difference 0.11, 95% confidence interval 0.00 to 0.21; moderate certainty). Two interventions may reduce instrumental activities of daily living. For personal activities of daily living, evidence favoured exercise, multifactorial-action and review with medication-review and self-management (standardised mean difference 0.16, 95% confidence interval -0.51 to 0.82). For homecare recipients, evidence favoured the addition of multifactorial-action and review with medication-review (standardised mean difference 0.60, 95% confidence interval 0.32 to 0.88). Care-home placement and service/economic findings were inconclusive.

Limitations

High risk of bias in most results and imprecise estimates meant that most evidence was low or very low certainty. Few studies contributed to each comparison, impeding evaluation of inconsistency and frailty. Studies were diverse; findings may not apply to all contexts.

Conclusions

Findings for the many intervention combinations evaluated were largely small and uncertain. However, the combinations most likely to sustain independence include multifactorial-action, medication-review and ongoing review of patients. Some combinations may reduce independence.

Future work

Further research is required to explore mechanisms of action and interaction with context. Different methods for evidence synthesis may illuminate further.

Study registration

This study is registered as PROSPERO CRD42019162195.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128862) and is published in full in Health Technology Assessment; Vol. 28, No. 48. See the NIHR Funding and Awards website for further award information.

[Mobility, driving, and functional competence in older people-selected results from the Longitudinal Urban Cohort Ageing Study (LUCAS)]

Mobility is crucial for independent living in old age. Older people with reduced physical ability (frailty) begin to limit their personal range of activities to their immediate living environment and ultimately to their immediate home. Diseases of the musculoskeletal system as well as neurological, psychological, cognitive, sensory, and circulatory disorders can limit functional competence (ability to live independently).In the Longitudinal Urban Cohort Ageing Study (LUCAS), from which selected results are reported in this article, participants were categorized into different functional classes (Robust, postRobust, preFrail, Frail) using the LUCAS functional index. The results show that losses in functional competence were associated with impaired mobility and reduced car driving. Impaired mobility led to restricted radius of action.The aim of healthcare in old age is to preserve independence and quality of life as long as possible. Car driving is an important part of older peoples' activities of daily living. Therefore, primary care physicians should address car driving regularly because preventive measures to strengthen functional health also strengthen car driving ability in older persons.

Patient-centered evaluation of an expectation-focused intervention for patients undergoing heart valve surgery: a qualitative study

Objective

Randomized controlled trials demonstrate the effectiveness of expectation-focused interventions in improving recovery outcomes following cardiac surgery. For dissemination in routine health care, it is important to capture the perspective of affected individuals. This qualitative study explores the perceived benefits and intervention-specific needs of patients who received expectation-focused intervention in the context of heart valve surgery. In addition, it explores potential barriers and adverse effects.

Methods

As part of an Enhanced Recovery After Surgery (ERAS) program within a multicentered randomized controlled trial, patients undergoing minimally invasive heart valve surgery received an intervention focused on their expectations. Six weeks after the intervention, semi-structured interviews were conducted with 18 patients to assess its feasibility, acceptance, barriers, benefits, and side effects. The transcribed interviews were analyzed using qualitative content analysis.

Results

The results indicate that both the intervention and the role of the patient and psychologist are key aspects in evaluating the expectation-focused intervention. Five key themes emerged from the patients' perspective: personal needs, expectations and emotions, relationship, communication, and individuality. Patients valued the preparation for surgery and recovery and the space for emotions. Establishing a trustful relationship and addressing stigmatization were identified as primary challenges within the intervention.

Conclusion

Overall, patients experienced the expectation-focused intervention as helpful and no adverse effects were reported. Perceived benefits included enhanced personal control throughout the surgery and recovery, while the potential barrier of stigmatization towards a psychologist may complicate establishing a trustful relationship. Addressing personal needs, as a relevant topic to the patients, could be achieved through additional research to identify the specific needs of different patient subgroups. Enhancing the expectation-focused intervention could involve the implementation of a modular concept to address individual needs better.

Funktionale Krankheitsfolgen von Menschen im Alter ab 70 Jahren und die Akzeptanz eines neuen Unterstützungs-Netzwerkes, das NetzWerk GesundAktiv (NWGA)

Einleitung  Häufigere Pflegebedürftigkeit bei steigender Lebenserwartung ist problematisch. Das NetzWerk GesundAktiv (NWGA) nimmt positive Beeinflussbarkeit der Entwicklung von Pflegebedürftigkeit an. In einer Pilotregion Hamburgs luden gesetzliche Krankenversicherungen ihre Versicherten im Alter ab 70 Jahren zur Teilnahme am NWGA Hilfs- und Betreuungsnetzwerk ein. Hier werden die Ergebnisse der Akzeptanzanalyse dargestellt.

Methoden  Zur Fokussierung auf die Zielgruppe der für die Entwicklung von Pflegebedürftigkeit gefährdeten Personen wurde der LUCAS Funktions-Index (Selbstausfüll-Fragebogen) als Screening für den Grad funktionaler Kompetenz verwendet. Die retrospektive Beobachtungsstudie untersuchte explorativ NWGA Teilnehmende, Ablehnende, Interessenten (Ausschluss, da funktional kompetent) und Non-Responder anhand sozio-demografischer sowie Morbiditätsbezogener Routinedaten. Dafür wurden ICD-Diagnosen anlässlich stationärer Krankenhausaufenthalte, die Anzahl ambulanter Arztkontakte sowie Pflegegrade innerhalb 12 Monaten vor Rekrutierung verwendet.

Ergebnisse  Von 13 100 angeschriebenen Versicherten waren 962 Teilnehmende (7,4 %), 948 Ablehnende (7,2 %), 2437 Interessenten (18,6 %) und 8753 Non-Responder (66,8 %). Bezüglich soziodemografischer Merkmale unterschieden sich diese Gruppen. Die Diagnosen von 5422 Krankenhausaufenthalten zeigten unterschiedlich häufige ICD-Codes funktionaler Beeinträchtigungen. Interessenten waren praktisch nicht pflegebedürftig und wiesen die niedrigste Morbidität auf.

Diskussion  Die Ergebnisse weisen darauf hin, dass Beeinträchtigungen insbesondere motorischer und kognitiver Funktionen sowie soziodemografische Merkmale die NWGA-Akzeptanz beeinflussen. Die Ansprache zur Teilnahme sollte entsprechend differenziert verbessert werden. Die Berücksichtigung funktionaler Störungen als Krankheitsfolgen und Schrittmacher von Pflegebedürftigkeit könnte Gesundheitsförderung und Prävention im Alter generell stärken. Das Interesse für präventive Aktivitäten war unter den 70-jährigen und älteren Menschen nennenswert häufig.

Reference values of gait characteristics in community-dwelling older persons with different physical functional levels

Background

Mobility is one major component of healthy ageing of older persons. It includes gait speed, nowadays valued as the sixth vital sign of ageing. Quantitative gait analysis can support clinical diagnostics, monitor progression of diseases and provide information about the efficacy of interventions. Fast gait speed is an additional marker in the area of functional ability. Our aim was to contribute reference values of gait parameters of older persons based on their functional ability.

Methods

We visualised and combined three different established frameworks that assess gait characteristics into a new framework based approach that comprises eight gait parameters: gait speed, stride length, walk ratio, single and double support time, step width, step width CV (coefficient of variance), stride length CV. Gait parameters were stratified by two instruments that indicate levels of functional ability: First, the LUCAS Functional Ability Index (FAI), a self-administered screening tool easy to apply to a public-health orientated approach and second the Short Physical Performance Battery (SPPB), an established performance test widely used in comprehensive geriatric assessments (CGA). Gait parameters of older community-dwelling persons were measured with an objective Gait system (GAITRite) across differing functional ability ranging from robust to transient (postrobust and prefrail) to frail physical status.

Results

Of 642 community-dwelling participants (age 78.5 ± 4.8; n = 233 male, n = 409 female) categorisations by SPPB were 27.1% for robust (11–12 points), 44.2% for transient (8–10 points), 28.7% for frail (0–7 points), and 16.2, 50.3, 33.5% for robust, transient, frail by LUCAS FAI. Overall, our results showed that distinction by functional level only uncovers a wide spectrum of functional decline for all investigated gait parameters. Stratification by functional ability (biological age) revealed a greater range of differentiation than chronological age.

Conclusions

Gait parameters, carefully selected by literature, showed clinically meaningful differences between the functional featuring a gradient declining from robust over transient to frail in most gait parameters. We found discriminative power of stratifications by SPPB to be the highest, closely followed by LUCAS FAI, age groups and dichotomous age making the application of the LUCAS FAI more cost and time effective than conducting SPPB.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03373-0.

Self-report of chronic diseases in old-aged individuals: extent of agreement with general practitioner medical records in the German AugUR study

BACKGROUND

To estimate prevalence and incidence of diseases through self-reports in observational studies, it is important to understand the accuracy of participant reports. We aimed to quantify the agreement of self-reported and general practitioner-reported diseases in an old-aged population and to identify socio-demographic determinants of agreement.

METHODS

This analysis was conducted as part of the AugUR study (n=2449), a prospective population-based cohort study in individuals aged 70-95 years, including 2321 participants with consent to contact physicians. Self-reported chronic diseases of participants were compared with medical data provided by their respective general practitioners (n=589, response rate=25.4%). We derived overall agreement, over-reporting/under-reporting, and Cohen's kappa and used logistic regression to evaluate the dependency of agreement on participants' sociodemographic characteristics.

RESULTS

Among the 589 participants (53.1% women), 96.9% reported at least one of the evaluated chronic diseases. Overall agreement was >80% for hypertension, diabetes, myocardial infarction, stroke, cancer, asthma, bronchitis/chronic obstructive pulmonary disease and rheumatoid arthritis, but lower for heart failure, kidney disease and arthrosis. Cohen's kappa was highest for diabetes and cancer and lowest for heart failure, musculoskeletal, kidney and lung diseases. Sex was the primary determinant of agreement on stroke, kidney disease, cancer and rheumatoid arthritis. Agreement for myocardial infarction and stroke was most compromised by older age and for cancer by lower educational level.

CONCLUSION

Self-reports may be an effective tool to assess diabetes and cancer in observational studies in the old and very old aged. In contrast, self-reports on heart failure, musculoskeletal, kidney or lung diseases may be substantially imprecise.

[The "Hamburg home visit for older citizens" : Development, execution and acceptance in 4716 older people in 15 months]

BACKGROUND

Preventive home visits are part of communal programs for older citizens. The city of Hamburg promoted the pilot project "The Hamburg home visit for older citizens" in two city districts. The voluntary program is offered to persons on their 80th birthday, without comprehensive assessment and is performed by visitors with a background in healthcare or social work. The aim is to provide information, to identify need of help and to initiate contact with officials for support if wanted.

METHODS

The structural and administrative prerequisites were defined together with officials of the city of Hamburg and the two city districts. The data safety concept, provision of addresses, birthday letter, information to be provided, recruitment, qualification and training of the visitors, timing and performance of visits, guiding how to communicate during the home visit, documentation and quarterly reports are described in detail.

RESULTS

From September 2018 to December 2019, 1636 (35%) out of 4716 persons contacted were visited by 59 visitors. The most frequent reasons for refusal were no need because of good health (40%) or satisfaction with existing support (14%). Most issues addressed were health situation (51%), mobility (43%), housing conditions (42%) and social contacts (41%). There was need of support as documented in 399 out of 1636 home visits, and contacts for support were initiated as required by 55 persons.

CONCLUSION

The acceptance of this new approach was 10% higher than 25% per month that had been expected in both the concentrated urban as well as the more rural city districts. Home visits on the 80th birthday appear to be feasible provided that structural and operational prerequisites are considered. In 2020, they were offered to all districts of the city, i.e. to about 15,000 persons per year.

The inter-relationship between depressed mood, functional decline and disability over a 10-year observational period within the Longitudinal Urban Cohort Ageing Study (LUCAS)

Background

The WHO defines ‘healthy ageing’ as ‘the process of developing and maintaining the functional ability’. Late-life depression and frailty compromise well-being and independence of older people. To date, there exists little research on the interaction of the dynamic processes of frailty and depression and only a few studies were longitudinal. Conclusions about the direction of effects remained uncertain.

Methods

Data were obtained from each of the last six biyearly waves (2007–2017) of the Longitudinal Urban Cohort Ageing Study (LUCAS) in Hamburg, Germany, a prospective observational cohort study of manifold aspects of ageing. Screening of predictor and event variables: depressed mood: one question from the 5-item Mental Health Inventory Screening Test; frailty: LUCAS Functional Ability Index, status ‘frail’; disability: one question on need for human help with basic activities of daily living. Kaplan-Meier curves and Cox’s proportional hazards regression were used for time-to-event analyses with shifting baseline.

Results

Sample size in 2007 was 2012, average age 76.2 years; ±6.5. Main results were as follows: (1) depression significantly increased the hazard of subsequent frailty (HR=1.581; 95% CI 1.257 to 1.988; p<0.001); (2) frailty significantly increased the hazard of subsequent depression (HR=2.324; 95% CI 1.703 to 3.172; p<0.001); (3) depression significantly increased the hazard of subsequent disability (HR=2.589; 95% CI 1.885 to 3.557; p<0.001) and (4) disability did not significantly increase the hazard of subsequent depression (HR=1.540; 95% CI 0.917 to 2.579; p=0.102).

Conclusion

Our results suggest an interdependence of the processes of depression and frailty/disability rather than unidirectional dependencies. These observable processes may be representative of underlying unobservable profound life changes. Obviously, there is a need for early screening to initiate appropriate interventions.

Improvement of perioperative care of the elderly patient (PeriAge): protocol of a controlled interventional feasibility study

INTRODUCTION

Geriatric patients have a pronounced risk to suffer from postoperative complications. While effective risk-specific perioperative measures have been studied in controlled experimental settings, they are rarely found in routine healthcare. This study aims (1) to implement a multicomponent preoperative and intraoperative intervention, and investigate its feasibility, and (2) exploratorily assess the effectiveness of the intervention in routine healthcare.

METHODS AND ANALYSIS

Feasibility and exploratory effectiveness of the intervention will be investigated in a monocentric, prospective, non-randomised, controlled trial. The intervention includes systematic information for patients and family about measures to prevent postoperative complications; preoperative screening for frailty, malnutrition, strength and mobility with nutrient supplementation and physical exercise (prehabilitation) as needed. Further components focus on potentially inadequate medication, patient blood-management and carbohydrate loading prior to surgery, retainment of orientation aids in the operating room and a geriatric anaesthesia concept. Data will successively be collected from control, implementation and intervention groups. Patients aged 65+ with impending surgery will be included. A sample size of 240, n=80 per group, is planned. Assessments will take place at inclusion and 2, 30 and 180 days after surgery. Mixed-methods analyses will be performed. Exploratory effectiveness will be assessed using mixed segmented regressions. The primary endpoint is functional status. Secondary endpoints include cognitive performance, health-related quality of life, length of inpatient stay and occurrence of postoperative complications. Feasibility will be assessed through semi-structured interviews with staff and patients and quantitative analyses of the data quality, focussing on practicability, acceptance, adoption and fidelity to protocol.

ETHICS AND DISSEMINATION

The study will be carried out in accordance with the Helsinki Declaration and to principles of good scientific practice. The Ethics Committee of the Medical Association Hamburg, Germany, approved the protocol (study ID: PV5596). Results will be disseminated in scientific journals and healthcare conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT03325413.

Health status and associated factors among the community-dwelling elderly women in China

The purpose of this study was to evaluate the health status and associated factors of the elderly women in China. A cross-sectional survey from cluster random sampling method was performed between March 2013 and December 2013. 1910 elderly people aged 60 years and over were selected in a community of Nanjing, China, including 977 elderly women. The self-designed elderly health assessment scale questionnaire was used. The data were analyzed through χ2-test and ordinal logistic regression. The results showed that the older women were higher in proportion than older men, the elderly women had lower in education, higher in divorced or widowed proportions, higher in living alone, and higher in no occupations. The proportion of elderly women suffering from chronic disease was lower than that of elderly men. The proportion of the elderly woman suffering from high cholesterol was higher, lower in high blood pressure. Elderly women were poorer than men in Physiological health, Memory and Multidimensional health status. The elderly women who had older, lower-education level, non-couples living, general employees or workers had poorer Multidimensional health status. This study demonstrated that the health status of elderly women of Nanjing, China were in a vulnerable position, especially some associated factors. We need pay more attention on these in improving the health of elderly women.

[Effectiveness of "Active health promotion in old age" : Results regarding compression of morbidity by target groups in 13.8 years of observation in LUCAS]

BACKGROUND AND OBJECTIVE

Healthy ageing as defined by the World Health Organization (WHO) is the development and maintenance of functional competence. Unfavourable ageing is described by the term frailty and is characterised by a decline in functional reserves. The frailty process can be influenced in a positive way. Previous interventions concerned mostly hospital patients and residents of nursing homes. In this study we examined the maintenance of functional competence in an urban community setting.

MATERIAL AND METHODS

The programme "Active health promotion in old age" was carried out by a health advisory team with geriatric expertise for independent persons 60 years and older without disabilities. Its effectiveness was evaluated in the Longitudinal Urban Cohort Ageing Study (LUCAS) over a period of 13.8 years. Survival and disability-free survival were calculated separately for persons with a high level of functional competence (many reserves) and persons with few functional reserves, using Kaplan-Meier curves. Adjustments were made for unequal distribution of age, gender, educational level, chronic diseases and functional status using multivariate Cox regressions. This methodology facilitates the study of interrelationships between mortality and morbidity (compression of morbidity) including an impact from life style interventions.

RESULTS

Participants with a high level of functional competence had longer disability-free lifes (p < 0.001), and their average proportion of life time with disability was shorter than either for non-participants, or those with low functional competence.

CONCLUSION

There is evidence from these analyses on compression of morbidity that the health promotion programme had its strongest effects in persons with high functional competence, exactly those people for whom it has been developed.

MINDMAP: establishing an integrated database infrastructure for research in ageing, mental well-being, and the urban environment

Background

Urbanization and ageing have important implications for public mental health and well-being. Cities pose major challenges for older citizens, but also offer opportunities to develop, test, and implement policies, services, infrastructure, and interventions that promote mental well-being. The MINDMAP project aims to identify the opportunities and challenges posed by urban environmental characteristics for the promotion and management of mental well-being and cognitive function of older individuals.

Methods

MINDMAP aims to achieve its research objectives by bringing together longitudinal studies from 11 countries covering over 35 cities linked to databases of area-level environmental exposures and social and urban policy indicators. The infrastructure supporting integration of this data will allow multiple MINDMAP investigators to safely and remotely co-analyse individual-level and area-level data.

Individual-level data is derived from baseline and follow-up measurements of ten participating cohort studies and provides information on mental well-being outcomes, sociodemographic variables, health behaviour characteristics, social factors, measures of frailty, physical function indicators, and chronic conditions, as well as blood derived clinical biochemistry-based biomarkers and genetic biomarkers. Area-level information on physical environment characteristics (e.g. green spaces, transportation), socioeconomic and sociodemographic characteristics (e.g. neighbourhood income, residential segregation, residential density), and social environment characteristics (e.g. social cohesion, criminality) and national and urban social policies is derived from publically available sources such as geoportals and administrative databases.

The linkage, harmonization, and analysis of data from different sources are being carried out using piloted tools to optimize the validity of the research results and transparency of the methodology.

Discussion

MINDMAP is a novel research collaboration that is combining population-based cohort data with publicly available datasets not typically used for ageing and mental well-being research. Integration of various data sources and observational units into a single platform will help to explain the differences in ageing-related mental and cognitive disorders both within as well as between cities in Europe, the US, Canada, and Russia and to assess the causal pathways and interactions between the urban environment and the individual determinants of mental well-being and cognitive ageing in older adults.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5031-7) contains supplementary material, which is available to authorized users.

Health Risk Appraisals With Aging Adults: An Integrative Review

Identification of risk factors unique to the aging experience is vital to support health promotion efforts and prevent loss of independence for the increasing aging population. Health risk appraisals are tools capable of identifying a broad range of factors that affect health; however, these tools were designed for use with predominantly healthy working-age adults. The purpose of this integrative review was to describe uses and adaptations of health risk appraisals with aging adults. A total of 43 articles met inclusion criteria, identifying multiple adaptations necessary to effectively identify the risks faced by aging adults, including those related to activities of daily living, pain, depression, social support/network, vision, hearing, and cognitive status. Uses included support for health promotion efforts and to determine risk for depression, falls, and loss of independence. Further research needs to be done to evaluate impact when used as a health promotion and prevention tool for aging adults.

The MINDMAP project: mental well-being in urban environments : Design and first results of a survey on healthcare planning policies, strategies and programmes that address mental health promotion and mental disorder prevention for older people in Europe

Background

The MINDMAP consortium (2016–2019) aims to identify opportunities provided by the urban environment for the promotion of mental well-being and functioning of older people in Europe by bringing together European cities with urban longitudinal ageing studies: GLOBE, HAPIEE, HUNT, LASA, LUCAS, RECORD, Rotterdam Study, Turin Study. A survey on mental healthcare planning policies and programmes dedicated to older persons covering the range from health promotion to need of nursing care was performed for profound data interpretation in Amsterdam, Eindhoven, Hamburg, Helsinki, Kaunas, Krakow, London, Nord-Trøndelag, Paris, Prague, Rotterdam and Turin.

Objectives

To collect detailed information on healthcare planning policies and programmes across these European cities to evaluate variations and to delineate recommendations for sciences, policies and planners using experience from evidence-based practice feedback from the MINDMAP cities.

Materials and methods

The MINDMAP partners identified experts in the 12 cities with the best background knowledge of the mental health sector. After pretesting, semi-structured telephone interviews (1–2 h) were performed always by the same person. A structured evaluation matrix based on the geriatric functioning continuum and the World Health Organization (WHO) Public Health Framework for Healthy Ageing was applied.

Results

A complete survey (12 out of 12) was performed reporting on 41 policies and 280 programmes on the city level. It appeared from extensive analyses that the focus on older citizens, specific target groups, and multidimensional programmes could be intensified.

Conclusion

There is a broad variety to cope with the challenges of ageing in health, and to address both physical and mental capacities in older individuals and their dynamic interactions in urban environments.

Health Promotion and Preventive Care Intervention for Older Community-Dwelling People: Long-Term Effects of a Randomised Controlled Trial (RCT) within the LUCAS Cohort

OBJECTIVES

An RCT of a health promotion and preventive care intervention was done in 2001-2002. Here, long-term analyses based on 12 years of follow-up of survival and of change in functional competence between intervention and control group are presented. Positive 1-year results (significantly higher use of preventive services and better health behaviour) were presented earlier.

DESIGN

Parallel group randomised controlled trial (RCT) with 878 participants in the intervention and 1,702 participants in the control group.

SETTING

The study took place in Hamburg, Germany and made use of health care structures and professionals of a geriatrics centre.

PARTICIPANTS

Study participants were initially community-dwelling, aged 60 years and older and without B-ADL-restrictions, cognitive impairment, or need of nursing care, with sufficient command of the German language.

INTERVENTIONS

Health promotion and preventive care interventions relied on an extensive health questionnaire and the subsequent offer to participate in multi-topic personal reinforcement performed in small group sessions or at preventive home visits.

MEASUREMENTS

Primary outcome: Survival time; in some analyses, adjustments were made for gender, age and self-perceived health. Secondary outcome: Functional competence (LUCAS Functional Ability Index) based on responses to self-administered questionnaires at 1-year follow-up and 12 years after 1-year follow-up (2013/2014).

RESULTS

Mean time under observation was 10.3 years. 38.3% (987/2,580) of the participants died; intervention group (IG): 35.7% (313/878), control group (CG): 39.6% (674/1,702); HR=0.89; p=0.09. Functional competence at 1-year follow-up: IG: ROBUST 67.4% (391/580), FRAIL 11.9% (69/580) vs. CG: ROBUST 62.9% (861/1,368), FRAIL 14.8% (203/1,368); p=0.12. 12-years after 1-year follow-up: IG: ROBUST 50.0% (160/320), FRAIL 30.9% (99/320) vs. CG: ROBUST 48.9% (307/628), FRAIL 34.1% (214/628); p=0.56.

CONCLUSIONS

Insignificant but consistent effects on survival and the dynamics of functional competence suggest effectivity of the complex intervention. We plan to take a closer look at the effect of each reinforcement separately.

Prevention of frailty through narrative intervention

BACKGROUND

Frailty is a syndrome of increased vulnerability with adverse outcomes, increasing with age for elderly people. So far, intervention programs have mainly addressed the physical components of frailty. As biographical writing approaches have shown positive effects on cognition and health, the aim of this study is to investigate the effects of a biographical disclosure intervention on psychological frailty and health in older adults.

METHODS

In total, 198 elderly people (mean age = 75.1 years) were recruited and randomly assigned to four disclosure conditions: oral biographical disclosure, written structured and unstructured biographical disclosure, daily diary and a control group. Frailty was measured with the Tilburg Frailty Indicator, and physical and mental health were assessed with the Short Form (12-item) Health Survey. Measurements were assessed pre- and post-intervention, and at a three month follow-up. Mixed design ANOVAs with repeated measures, correlations and Wilcoxon tests were calculated.

RESULTS

The sample showed a frailty prevalence of 39.9% pre-intervention. Participants in the oral biographical disclosure, structured biographical writing, and daily diary groups showed improvements in their frailty and mental health, with small effect sizes. No effect for physical health was evident. People with high frailty symptoms and low mental health benefitted from the intervention. Frailty was negatively correlated with physical and mental health components.

CONCLUSIONS

The results of the intervention indicate a short-term positive effect on frailty and mental health in elderly people, who benefitted from the disclosure intervention in terms of improved mental health and lower frailty levels. Early frailty detection is therefore crucial in the treatment and care of older adults, and biographical disclosure approaches can help to maintain health at old age.

[Frailty in Germany: status and perspectives : Results from a workshop of the German Society for Epidemiology]

BACKGROUND

A standardized, valid and comparable operationalization and assessment of frailty in population-based studies is essential in order to describe the prevalence and determinants of frailty in the population.

AIM

After an introduction to the subject the main goal of a workshop at the 9th annual meeting of the German Society for Epidemiology (DGEpi) was to present approaches and results from four different studies in Germany.

MATERIAL AND METHODS

The following four population-based studies were used to describe frailty in Germany: the German health interview and examination survey for adults (DEGS1), the epidemiological study on the chances of prevention, early recognition and optimized treatment of chronic diseases in the older population (ESTHER), the cooperative health research in the region Augsburg (KORA Age) study and the longitudinal urban cohort ageing study (LUCAS) in Hamburg.

RESULTS

The four studies consistently showed that frailty is widespread in older and oldest-old persons in Germany. It is obvious that frailty represents a relevant concept in Germany even if there is currently no uniform basis for operationalization.

CONCLUSION

Concepts and instruments for the collation of frailty should be included in future population-based studies in order to make a better assessment of older people's health situation and to describe the unused potential for prevention in an aging society.

Long-term prediction of changes in health status, frailty, nursing care and mortality in community-dwelling senior citizens—results from the Longitudinal Urban Cohort Ageing Study (LUCAS)

Background

The detection of incipient functional decline in elderly persons is not an easy task. Here, we propose the self-reporting Functional Ability Index (FA index) suitable to screen functional competence in senior citizens in the community setting. Its prognostic validity was investigated in the Longitudinal Urban Cohort Ageing Study (LUCAS).

Methods

This index is based equally on both, resources and risks/functional restrictions which precede ADL limitations. Since 2001, the FA index was tested in the LUCAS cohort without any ADL restrictions at baseline (n = 1,679), and followed up by repeated questionnaires in Hamburg, Germany.

Results

Applying the index, 1,022 LUCAS participants were initially classified as Robust (60.9%), 220 as postRobust (13.1%), 172 as preFrail (10.2%) and 265 as Frail (15.8%). This classification correlated with self-reported health, chronic pain and depressive mood (rank correlations 0.42, 0.26, 0.21; all p < .0001). Survival analyses showed significant differences between these classes as determined by the FA index: the initially Robust survived longest, the Frail shortest (p < .0001). Analyses of the time to need of nursing care revealed similar results. Significant differences persisted after adjustment for age, sex and self-reported health.

Conclusions

Disability free lifetime and its development over time are important topics in public health. In this context, the FA index presented here provides answers to two questions. First, how to screen the heterogeneous population of community-dwelling senior citizens, i.e. for their functional ability/competence, and second, how far away they are from disability/dependency. Furthermore, the index provides a tool to address the urgent question whether incipient functional decline/incipient frailty can be recognized early to be influenced positively.

The FA index predicted change in functional status, future need of nursing care, and mortality in an unselected population of community-dwelling seniors. It implies an operational specification of the classification into Robust, postRobust, preFrail and Frail. Based on a self-administered questionnaire, the FA index allows easy screening of elderly persons for declining functional competence. Thereby, incipient functional decline is recognized, e.g. in GPs’ practices and senior community health centers, to initiate early appropriate preventive action.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2318-14-141) contains supplementary material, which is available to authorized users.

Improving retention of very old participants in longitudinal research: experiences from the Newcastle 85+ study

Background

People aged 85 and over are often excluded from research on the grounds of being difficult to recruit and problematic to retain. The Newcastle 85+ study successfully recruited a cohort of 854 85-year-olds to detailed health assessment at baseline and followed them up over 3 phases spanning 5 years. This paper describes the effectiveness of its retention strategies.

Methods

Primary retention strategies involved meticulous management of contact information and active maintenance of contact with participants between research visits and between phases of the study. For statistical analysis, data on post-inclusion attrition over the 3 follow-up phases was separated into ‘death’ and ‘withdrawal’ categories, with sub-categories ‘health’ and ‘non-health’ reasons created for ‘withdrawal’. Multinomial logistic regression was used to determine if particular socio-demographic and health characteristics were associated with post-inclusion attrition due to withdrawal at each of the 3 phase-to-phase transition points.

Results

For both sexes, at successive follow-up phases there was a decrease in attrition due to withdrawal and an increase due to death. Withdrawal was most prevalent between baseline and phase 2. Across the 5 years of the study total post-inclusion (post-baseline) attrition due to death accounted for a 40% (344/854) loss to cohort and total post-inclusion attrition due to withdraw a 19% (166/854) loss to cohort, with health reasons for withdrawal becoming more dominant over time. Adjusting for sex, parsimonious modelling showed only occupational class (National Statistics Socio-economic Classification) to be associated with withdrawal and only between baseline and phase 2 (routine/manual compared to managerial (OR 3.41; 95% CI [1.23 to 9.44]).

Conclusion

Following successful recruitment, we retained a high proportion of participants from a very old age group over 5 years of longitudinal research. No strong predictors of post-inclusion attrition due to withdrawal were found, suggesting the general effectiveness of our retention strategies.

[Resources and risks in old age: the LUCAS-I marker set for a classification of elderly people as fit, pre-frail and frail. First results on validity from the Longitudinal Urban Cohort Ageing Study (LUCAS), Hamburg]

BACKGROUND

There is a need for a simple self-administered instrument to assess frailty in community-dwelling seniors.

METHODS

We present a new marker set to assess the functional state of seniors. Contrary to current literature, we focus not only on risks, but also include resources. The questions relate to facts (ways to do things), rather than on subjective information (e.g. exhaustion). It was developed in the context of the Longitudinal Urban Cohort Ageing Study (LUCAS) in Hamburg, Germany.

RESULTS

The classification based on these questions proposes operational definitions of the terms fit, pre-frail and frail and is predictive for need for nursing care as well as mortality. A wealth of results establishes the validity of the categorisation compared to other health questions. One of the classification questions concerns cycling. For areas where cycling is not suitable, we propose to replace this question with one about independently walking 500 m. However, the cycling question appears to indicate frailty earlier.

CONCLUSION

The self-administered questionnaire provides a simple, cost-effective way to screen seniors for early signs of declining function in order to start preventive action.