Achieving consensus on assessing health-related quality of life (HRQoL) in people with cognitive impairments (CI)a Delphi study

BACKGROUND

The prevalence of impairments of cognitive functions is expected to increase. Enhancing the QoL of those affected is important. HRQoL in people with CI can be assessed by self-report, proxy-report or observation but there is uncertainty how to best assess HRQoL in people with CI, and which assessment method is most appropriate. Therefore the aim of our study was to use Delphi methodology in order to achieve consensus on how HRQoL should be assessed in people with CI and which content domains should be assessed.

METHODS

The Delphi process consisted of three online survey rounds and a concluding consensus conference. Participants were experts as well as individuals and relatives of people affected by CI. The Delphi survey was developed based on existing literature and included 55 statements at the first round. Consensus was considered to be achieved when a minimum of 75 % of responses fell into the categories 6 (agree) and 7 (strongly agree) (positive consensus) or in categories 1 (strongly disagree) and 2 (disagree) (negative consensus).

RESULTS

Consensus was reached for a total of 41 of 56 statements/substatements. In the 1st survey round 102 experts and 11 relatives participated. In the 2nd survey round 68 experts and 11 relatives continued to participate. In the 3rd survey round 41 experts and 9 relatives participated. In the consensus conference 17 experts and 4 relatives of individuals with CI and in the second one-hour online conference session 14 experts and 2 relatives of individuals with CI participated.

CONCLUSION

The combination of the three assessment methods self-report, proxy-report and observation across all stages of CI is the preferred method and should be used whenever possible. As domains Physical capacity, Psychological, Level of Independence, Social Relationships, Environment and Spirituality/Relogion/Personal Beliefs should be assessed.

Understanding the relationships between dietary risk behaviour and social factors in older adults

Background

The relationships between social factors and dietary risk behaviour in older adults have not yet been thoroughly investigated. In this analysis, we aimed to develop a brief index of dietary risk behaviour and examine its associations with sociodemographic, socioeconomic, psychosocial, and behavioural factors.

Methods

A community-based postal survey was conducted to collect cross-sectional data from German adults aged 65 and older (n = 1687; 33% response proportion; 52% female). Using principal component analysis, we developed a 3-item dietary risk behaviour index (DRB), including the food groups vegetables/fruit, whole grains, and dairy products. Dietary risk behaviour was defined as food group consumption frequencies below national dietary recommendations. Multiple linear regression was used to analyse associations between dietary risk behaviour and social factors.

Results

Physical activity, female gender, education level, and social support were negatively associated with dietary risk behaviour, while alcohol consumption and smoking were positively associated (Adj. R2 = 0.16, p < 0.001). The brief DRB based on vegetables/fruit, whole grains, and dairy products has proven to be appropriate in analysing dietary behaviour among older adults.

Conclusions

A better understanding of the relationships between social factors and dietary risk behaviour among older adults can assist in group-specific targeting of dietary-related interventions. Demand-oriented dietary interventions should address underlying social factors to reduce inequities in dietary risk behaviour among older adults. The results may be transferable to municipalities in high-income European countries.

Key messages

Older German adults’ health-related quality of life and associated social factors

Background

A differentiated analysis of the structural relationships between social factors and health-related quality of life (HRQOL) in older German adults has not yet been conducted. In this analysis, we aimed to examine the relationships between sociodemographic, socioeconomic, psychosocial, and behavioural factors and both physical and mental HRQOL in older German adults.

Methods

A community-based postal survey was used to collect cross-sectional data from German adults aged 65 and older (n = 1687, 33% response proportion, 52% female). Physical and mental dimensions of HRQOL were assessed using Short Form 36, version 2. Multiple linear regression models were used to analyse the associations between social factors and both physical and mental HRQOL.

Results

Health locus of control, physical activity, and income were positively associated with both physical HRQOL (Adj. R2 = 0.34, p < 0.001) and mental HRQOL (Adj. R2 = 0.22, p < 0.001), whereas age was negatively associated with both. Alcohol use was positively associated with physical HRQOL, and social support was positively associated with mental HRQOL.

Conclusions

A differentiated understanding of the relationships between social factors and HRQOL assists in group-specific targeting of health interventions. Demand-oriented interventions should consider underlying social factors to reduce socially determined inequities in HRQOL among older German adults. Depending on the focus of the intervention, it may be helpful to take specific social conditions into account. The results may be transferable to municipalities in high-income European countries.

Key messages

Evaluation of community readiness for change prior to a participatory physical activity intervention in Germany

A lack of communities' readiness for change is reported as a major barrier toward an effective implementation of health promoting interventions in community settings. Adding an alternative readiness assessment approach to existing research practice, this study aimed to investigate how a selected community could be evaluated in-depth regarding its readiness for change based on multiple key informant perspectives, with the intention of using this knowledge for the preparation of improved local physical activity (PA) interventions for men above 50 years of age. We conducted semi-structured face-to-face key informant interviews with stakeholders and relevant persons from a local German community (N = 15). The interview guide was based on a comprehensive summary of community readiness dimensions. After verbatim transcription, we conducted thematic analysis to synthesize the complex results regarding community readiness related to PA. The data supported that the community disposed of a variety of resources regarding PA and showed signs of readiness for change. However, a certain degree of saturation regarding PA programs existed. The need for health enhancing PA interventions for men was only partly recognized. The local authority considered PA to be particularly important in the context of mobility and traffic safety. Including multiple stakeholders contributed to a balanced and in-depth assessment of community readiness and was helpful for determining starting points for tailored PA interventions due to the detection of complex relationships and structures. The study delivers preliminary evidence that a qualitative multi-perspective community readiness assessment adds value to quantified single-perspective readiness assessment research practice.

Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in day care centres – Lessons learned from a prospective analysis of outbreaks in Germany

Background

The role of children for the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still unclear. The aim of our case-ascertained study is to examine transmission dynamics of SARS-CoV-2 among children and staff based on outbreaks in day care centres in Germany.

Methods

Based on day care centres with at least one reported case of SARS-CoV-2 we include 1-6-year-old children and staff of the affected group in the day care centre as well as their respective households. We test each study participant on acute and past SARS-CoV-2 infection with innovative child friendly tests and collect data on sociodemographics and symptoms. At four further measurement points within 12 days, the participants carry out the tests on SARS-CoV-2 by themselves. From October 2020 to May 2021, 25 day care centres with SARS-CoV-2 outbreaks participated and we included n = 244 children 1-6 years and n = 72 staff members in the study.

Results

First analyses from 25 outbreaks showed that the observed infection events in the examined day care centres were very different. Often, no or only few transmissions were found among the participants in the day care group, but in one day care centre, 13 people were infected: Between 0% and 81% of close contact persons in the day care centres were tested positive for SARS-CoV-2 in the study period. Children showed a similar percentage of secondary SARS-CoV-2 infections compared to adults (both 11%).

Conclusions

The study has been successful in detecting previously undetected infections of SARS-CoV-2 in day care centres. Results of these outbreaks examinations are presented regularly in public reports to inform public health decision-makers. By studying individual day care centre-related infection dynamics the data supplement the information from national reporting data.

[Reasons for delayed and discontinued therapy in age-related macular degeneration]

BACKGROUND

Critical prerequisites for successful therapy of neovascular age-related macular degeneration (nvAMD) are an early initiation and continuous monitoring; however, delays in starting therapy and non-medically indicated discontinuation of therapy are frequent, which limits therapy efficacy and, thus, visual outcomes.

OBJECTIVE

To identify the reasons for delay in therapy and non-medically indicated termination of therapy.

MATERIAL AND METHODS

Patients who had started a new therapy (starters) and those who independently terminated therapy (dropouts) were interviewed by telephone with a specific, standardized questionnaire. Results were summarized descriptively.

RESULTS

A total of 100 starters and 55 dropouts were interviewed. The mean therapy delay was 22 (±28 SD) days. This was mainly due to the time until the decision to see an ophthalmologist was made. Main reasons for dropping out were: transportation issues (27%), poor general health (25%) and the assumption that there is no benefit from therapy (11%). Of the patients who dropped out 63% would have liked to continue therapy.

CONCLUSION

There is potential for improvement in nvAMD management regarding therapy start as well as therapy maintenance. Sensitizing for initial nvAMD symptoms is important as is reduction of barriers to therapy maintenance, since most therapy dropouts would like to continue the therapy.

[Memorandum 'Development of health services research in Bavaria from the perspective of the Bavarian State Working Group 'Health Services Research (LAGeV)': status quo - potential - strategies']

The aim of the memorandum on the development of health services research (HSR) in Bavaria is to operationalise the global objectives of the State Working Group "Health Services Research" (LAGeV) and to collectively define future topics, specific implementation steps, methods as well as ways of working for the future course of the LAGeV. The LAGeV is an expert committee that integrates and links the competencies of different actors from science, politics and health care regarding HSR and facilitates their cooperation. The memorandum is based on an explorative survey among the LAGeV members, which identified the status quo of health services research in Bavaria, potential for development, important constraints, promoting factors, specific recommendations as well as future topics for the further development of HSR in Bavaria. From the perspective of the LAGeV members, the 12 most important future topics are: 1) Interface and networking research, 2) Innovative health care concepts, 3) Health care for multimorbid patients, 4)Health care for chronically ill patients, 5) Evaluation of innovations, processes and technologies, 6) Patient orientation and user focus, 7) Social and regional inequalities in health care, 8) Health care for mentally ill patients, 9) Indicators of health care quality, 10) Regional needs planning, 11) Practical effectiveness of HSR and 12) Scientific use of routine data. Potential for development of HSR in Bavaria lies a) in the promotion of networking and sustainable structures, b) the establishment of an HSR information platform that bundles information and results in regard to current topics and aims to facilitate cooperation as well as c) in the initiation of measures and projects. The latter ought to pinpoint health care challenges and make recommendations regarding the improvement of health care and its quality. The cooperation and networking structures that were established with the LAGeV should be continuously expanded and be used to work on priority topics in order to achieve the global objectives of the LAGeV.

[Patient-centredness in health services research]

This paper provides a sketch of key research areas within health services research focusing on patient-centredness. The evaluation of patient-reported outcomes (PROs) is increasingly required for evaluating interventions in clinical trials and in routine health care. Often, however, it is un-clear which PROs are best suited for a particular research question. One of the most commonly used PRO is the construct of quality of life (QoL), which has become an established outcome in clinical trials and is also named as a health goal in the German Social Code of Law. The concept of patient empowerment implies that autonomy and room for manoeuver of the individual patient should be strengthened. However, it is un-clear how the concept is best operationalised. One prerequisite for patient empowerment in routine health care is the development and implementation of evidence-based patient information. Another prominent research area focuses on the role of self-help and patient organisations in health services. Topics of interest are aims and activities of self-help organisations, potentials and challenges of integrating self-help into professional health services, effects of organised self-help support on patients and barriers of use.