Birgitt Wiese

Background: Lifestyle interventions provide a promising approach to address higher body weight as a risk factor for dementia. Objective: The AgeWell.de-trial was primarily designed to preserve cognitive function and reduce dementia risk. In this post-hoc analysis, we investigated body weight following the multidomain intervention among older adults with overweight or obesity, as well as the role of motivation and confidence regarding weight loss. Methods: Analyses used data from the cluster-randomized AgeWell.de-trial, testing a multidomain intervention (dietary counselling, enhancement of physical, social and cognitive activity, medication review, intervention for cardiovascular risk factors, depressive symptoms/grief, if applicable) over 24 months in adults aged 60 to 77 years at risk for dementia. Associations between intervention allocation and body weight at follow-up were analyzed using linear regression, controlling for covariates, based on multiply imputed data. Results: The sample included n = 678 participants with a BMI ≥ 25 kg/m², mean age (SD): 68.9 (4.8), 52.1% female. Group allocation was not associated with body weight at 24-month follow-up (b (unstandardized regression coefficient) = -0.30, 95% CI: -0.51; 1.11). Older age (b = -0.14, 95% CI: -0.25; -0.03) and a high level of education (b = -1.28, 95% CI: -2.55; 0.00) were linked to lower body weight at follow-up, while higher baseline body weight predicted higher body weight at follow-up (b = 0.95, 95% CI: 0.91; 0.98). Levels of motivation and confidence regarding weight loss remained high but stable in both groups, regardless of group allocation. Conclusions: In this post-hoc analysis, group allocation was not associated with lower body weight at follow-up. Despite high levels of motivation and confidence regarding weight loss and favorable changes in diet and physical activity in the intervention group, these changes did not translate into measurable weight loss. Trial registration: AgeWell.de was prospectively registered in the German Clinical Trials Register on December 7th, 2017 (DRKS trial identifier DRKS00013555).

Chronic non-cancer pain (CNCP) is commonly managed in primary care with long-term opioid therapy (LTOT), despite limited effectiveness and substantial risks. Sex and gender shape pain experiences, treatment responses, and health outcomes, yet are rarely addressed in chronic pain interventions. This study aims to inform primary care pain management by addressing opioid-related harms, gender-based inequities, and the integration of biopsychosocial approaches. The development of the GESCO intervention was guided by the updated UK Medical Research Council (MRC) Framework for complex interventions. A participatory, theory-informed, and evidence-based approach was employed. Core development steps included literature reviews, qualitative interviews with patients and GPs, and a collaboratively developed Theory of Change (ToC). Intervention modules and evaluation tools were co-created and piloted with the stakeholders. The GESCO intervention is a structured, gender-sensitive, multi-component GP consultation to improve care for patients with chronic pain and LTOT. Two 30-minute consultations integrate narrative medicine, expectation management, medication review, empowerment strategies, and tools such as the Positive Health tool and Social Network Mapping. Implementation is supported by a two-day GP training program, a toolbox of practical resources, and a patient brochure, a manual on sex-/gender-sensitive pharmacotherapy, and follow-up case conferences. Intervention design and evaluation is guided by a ToC framework, drawing on the COM-B model by Michie et al. GESCO represents a theory-informed intervention that aims to integrate gender sensitivity into a structured consultation model for chronic pain care in primary care settings. Its participatory development process is intended to support applicability in routine practice. In a subsequent stage of the project, GESCO will be piloted in ten practices with 40 patients to examine feasibility and explore preliminary effects.

Background/Objectives: Obesity and depression, in conjunction with multimorbidity, are interconnected conditions increasingly managed in general practitioner (GP) settings, yet these associations remain insufficiently studied in older patients. This study investigates the prevalence of depression across different body mass index (BMI) classes and includes age and gender differences in multimorbid older patients, offering a novel perspective on subgroup-specific patterns. Further the agreement between GP depression diagnoses and the Geriatric Depression Scale (GDS) is studied and patient-specific factors that may affect the agreement are explored, aiming to improve future diagnostics for vulnerable subgroups. Methods: Data were provided by the baseline assessment of the MultiCare Study, a prospective multicenter observational cohort of multimorbid patients aged 65+ years recruited from 158 GP practices across eight study centers in Germany. Data from 2568 study participants were analyzed based on GP-coded International Classification of Diseases (ICD) diagnoses, structured GP questionnaires, and patient questionnaires. Assessments included data on the BMI and depression (15 item version of the GDS). Agreement between GP diagnoses of depression and GDS assessment was measured using Cohen’s kappa. Four logistic regression models were used to examine the effects of patient-specific factors on the agreement of depression diagnosis (match or mismatch). Results: GPs diagnosed depression in 17.3% of cases, compared to the detection of depressive symptoms in 12.4% of the patients by GDS (cut-off ≥ 6 points). The highest prevalence rates were observed in patients with obesity class III (25.0% by GP; 21.7% by GDS). Women were significantly more likely to receive a depression diagnosis by a GP across most BMI classes (except obesity classes II and III). The detection of depressive symptoms by GDS was significantly more prevalent in older multimorbid obese patients (≥75 years), except for patients with obesity class III. The overall agreement between GP diagnosis and GDS assessment was weak (κ = 0.156, p < 0.001). The highest agreement was found for people with obesity class III (κ = 0.256, p < 0.05). Factors associated with a True Positive depression diagnosis (match by both GDS and GP) were female gender (odds ratio (OR) = 1.83, p < 0.05), widowhood (OR = 2.43, p < 0.01), limited daily living skills (OR = 3.14, p < 0.001), and a higher level of education (OR = 2.48, p < 0.01). A significantly lower likelihood of a False Negative depression diagnosis was found for patients with obesity class III. Conclusions: This study highlights the significant prevalence of depression among multimorbid older adults across different BMI classes, particularly in those with obesity class III. The weak diagnostic agreement between GP diagnosis and GDS assessment suggests a need for improved diagnostic practices in primary care. Implementing standardized screening tools and fostering collaboration with mental health specialists could enhance the identification and management of depression in this vulnerable population.

Background: Healthy dietary patterns have been linked to reduced risks for cardiovascular diseases and dementia, making nutrition an essential part of a comprehensive approach for dementia prevention. Knowledge about factors associated with a healthy diet in people with increased dementia risk is scarce. Objective: To analyze dietary habits and associated factors in older adults with increased dementia risk in Germany. Methods: We used baseline-data of the AgeWell.de-trial (n = 1001, % _female = 52.2, M _age = 69.0, SD = 4.9). Nutrition was assessed using a composite score, comprising 11 components covered by national recommendations for a healthy diet (range = 0–11 points). Linear regressions assessed associations of sociodemographic, social, health-related and psychological factors with consumption of a healthy diet. Further, we assessed stages of change based on the transtheoretical model of behavior change. Results: Consumption of a healthy diet was moderate (Median = 4, IQR = 2). Female sex (b = 0.64, 95% CI: 0.41, 0.88), higher levels of motivation for healthy eating (b = 0.22, 95% CI: 0.10, 0.34) and higher self-efficacy (b = 0.33, 95% CI: 0.20, 0.46) were linked to a healthy diet. Regarding the stages of behavior change, the majority were in the maintenance stage (45.2%), followed by the contemplation (21.5%) and precontemplation (21.2%) stages. Conclusions: Results suggest room for improvement regarding a healthy diet in our sample. Lifestyle-based interventions in older adults should be tailored towards current levels of motivation and self-efficacy of participants. Including modules targeting motivation and self-efficacy might help maximize intervention effectiveness.

Background: The aim of the study was to analyze the impact of adherence to the intervention components on the effectiveness of AgeWell.de, a multi-domain lifestyle intervention against cognitive decline, on function in everyday activities, quality of life, depressiveness and social isolation. Objective: Studying the effect of adherence on health-related outcomes. Methods: Participants were aged 60–77 years at baseline and at risk (Cardiovascular Risk Factors, Ageing and Dementia Score (CAIDE) ≥9). Adherence to the components nutrition, enhancement of physical and social activities and cognitive training was analyzed in two ways, first continual within the intervention group (n = 378, mean age = 69.1 years, 52.7% female) and second as dichotomous split (75% adherence) and in reference to the control group (received infomaterial and regular health advice; n = 441, mean age = 69 years, 53% female). Generalized linear regression models were then run on the health outcomes functioning in everyday activities, quality of life, depressive symptoms, and social inclusion. Results: Health-related quality of life and depressiveness were improved in participants with better adherence to nutritional counselling and enhancement of physical and social activities. Better adherence to social activities was relevant for function in everyday activities. Effects of high adherence to cognitive training was found for improvements in depressiveness when comparing it to the control group. No effect was found on social inclusion when considering the particular components. Conclusions: The extent of adherence to most components influenced health-related outcomes such as health-related quality of life and depressiveness. With this study, the effectiveness of AgeWell.de can be understood in greater depth. Trial Registration: German Clinical Trial Register (DRKS; ID: DRKS00013555).

Purpose: The present study aimed to investigate age-group-specific incidence rates and risk factors for depressive symptoms in the highest age groups.Methods: Data were derived from a prospective multicenter cohort study conducted in primary care – the AgeCoDe/AgeQualiDe study. In total, 2,436 patients 75 years and older were followed from baseline to ninth follow-up. To assess depressive symptoms, the short version of the Geriatric Depression Scale (GDS-15, cutoff score 6) was used. Age-specific competing risk regressions were performed to analyze risk factors for incident depressive symptoms in different age groups (75 to 79, 80 to 84, 85+ years), taking into account the accumulated mortality.Results: The age-specific incidence rate of depression was 33 (95% CI 29-38), 46 (95% CI 40-52) and 63 (95% CI 45-87) per 1,000 person years for the initial age groups 75 to 79, 80 to 84 and 85+ years, respectively. In competing risk regression models, female sex, mobility as well as vision impairment, and subjective cognitive decline (SCD) were found to be risk factors for incident depression for age group 75 to 79, female sex, single/separated marital status, mobility as well as hearing impairment, and SCD for age group 80 to 84, and mobility impairment for age group 85+.Conclusion: Depressive symptoms in latest life are common and the incidence increases with increasing age. Modifiable and differing risk factors across the highest age groups open up the possibility of specifically tailored prevention concepts.

Background: Mounting evidence suggests that dementia can be prevented. Targeting several risk factors simultaneously constitutes a promising strategy for preserving cognitive function. The AgeWell.de‐study was a cluster‐randomized trial applying a multi‐domain intervention to preserve cognitive function in older adults at risk for dementia in Germany.Method: Individuals with a Cardiovascular Risk Factors, Aging and Dementia (CAIDE) dementia risk score ≥ 9 points aged 60‐77 years were recruited. According to randomization of their general practitioner (GP) practice, patients received either a multi‐domain intervention (optimization of nutrition and medication, physical, social and cognitive activity, cardiovascular risk management, intervention in case of depressive symptoms and/or grief) or general health advice and GP treatment as usual over 24 months. Primary outcome was global cognitive performance, assessed using a composite score based on z‐scores of domain‐specific neuropsychological tests.Result: Of 1,030 participants at baseline (intervention/control: n = 487/543), n = 819 (intervention/control: n = 378/441) completed the follow‐up assessment. Intervention and control group did not differ regarding global cognitive performance (β = 0·010, 95% CI: ‐0·085; 0·105) at follow‐up. However, post‐hoc analyses revealed beneficial effects for social cognition (β = 0·132, 95% CI: 0·012; 0·252) and health‐related quality of life (β = 0·194, 95% CI: 0·065; 0·323). The intervention improved global cognitive performance (β = 0·221, 95% CI: 0·015; 0·428), social cognition (β = 0·259, 95% CI: 0·024; 0·494) and health‐related quality of life (β = 0·421; 95% CI: 0·114; 0·728) in participants with low education, and reduced depressive symptoms in highly educated participants (β = ‐0·431; 95% CI: ‐0·781; ‐0·082). Younger participants benefitted from the intervention regarding social cognition (β = 0·174, 95% CI: 0·010; 0·337) and health‐related quality of life (β = 0·405, 95% CI: 0·241; 0·570).Conclusion: No effect of the multi‐domain intervention on global cognitive performance was found for the overall sample. The intervention benefitted global cognitive functioning in individuals with low education and social cognition and health‐related quality of life across the sample. Further benefits regarding specific subgroups point towards the usefulness of tailored interventions.

To develop effective dementia prevention strategies, it is necessary to understand risk factors, associated factors and early signs of dementia. Subjective cognitive decline (SCD) is the earliest form of dementia. The aim of this study is to assess depression as a factor that is significantly associated with SCD. The data of 1030 general practitioner patients from the AgeWell.de-study (60–77 years; CAIDE dementia risk score ≥ 9) were analysed. A descriptive analysis was conducted using validated instruments like the Geriatric depression scale (GDS), Lubben social network scale (LSNS-6) and education classes according to CASMIN (Comparative Analysis of Social Mobility in Industrial Nations). A multivariate regression model with the dependent variable SCD was calculated. Of the 1030 participants, 5.9% had depressive symptoms and 31.3% SCD. The group with depressive symptoms showed significantly higher body-mass-index (p = 0.005), lower education class (p = 0.022), lower LSNS-6 score (p < 0.001), higher sports activity (p < 0.001), and more sleeping problems (p = 0.026). In the regression model a higher GDS-score [Odds ratio (OR): 1.219 (p < 0.001)], more sleeping problems [OR: 1.550 (p = 0.017)] and higher education class [middle/high: OR: 1.474/1.875 (p = 0.037/0.004)] were significantly associated with SCD. This study identified depressive symptoms, sleeping problems, and higher education classes as factors associated with SCD, which can represent an early form of dementia.

Our study aims to examine the associations of sociodemographic factors, social support, resilience, and perceptions of the COVID-19 pandemic with late-life depression and anxiety symptoms in a cardiovascular risk group and a matched sample from the German general population during the beginning of the pandemic and draw a comparison regarding psychosocial characteristics. Data of n = 1236 participants (aged 64–81 years) were analyzed, with n = 618 participants showing a cardiovascular risk profile, and n = 618 participants from the general population. The cardiovascular risk sample had slightly higher levels of depressive symptoms and felt more threatened by the virus due to pre-existing conditions. In the cardiovascular risk group, social support was associated with less depressive and anxiety symptoms. In the general population, high social support was associated with less depressive symptoms. Experiencing high levels of worries due to COVID-19 was associated with more anxiety in the general population. Resilience was associated with less depressive and anxiety symptoms in both groups. Compared to the general population, the cardiovascular risk group showed slightly higher levels of depressive symptomatology even at the beginning of the pandemic and may be supported by addressing perceived social support and resilience in prevention programs targeting mental health.

Zusammenfassung: Der Beitrag stellt die quantitativen Evaluationsergebnisse des FlexiGesA-Projektes dar und zeigt inwieweit ausgewählte betriebliche Gesundheitsförderungsmaßnahmen gesundheitliche Verbesserungen bei den Beschäftigten im Zeitverlauf erzielen. Bei den Interventions- und Referenzbetrieben der Branchen IT-Services und ambulante soziale Dienste (ASD) (Unter ambulante soziale Dienste (ASD) sind im Folgenden die ambulante Pflege und auch weitere Dienste, wie insbesondere die haushaltswirtschaftliche Versorgung pflegebedürftiger Menschen in ihrer Häuslichkeit, gemeint) wurden psychische Gefährdungsbeurteilungen eingeleitet. Im linearen Multilevel-Regressionsmodell konnte insgesamt kein signifikanter Effekt für die ausgewählten Outcome-Variablen wie allgemeiner Gesundheitszustand,Präsentismus und Burnout ermittelt werden. Tendenziell zeigen allerdings die deskriptiven Auswertungen aller Skalen und im Abgleich mit einer deutschlandweit erhobenen Datenbank in einigen Bereichen positive Ergebnisse.