Susanne Zank

Zusammenfassung: Ziel der Analysen ist es, gesundheitliche Ungleichheit zwischen Ab-80-Jährigen mit und ohne Migrationserfahrung zu untersuchen. Dafür wird auf Daten der Studie D80+ „Hohes Alter in Deutschland“ mit 10.578 Teilnehmenden in Privathaushalten und Heimen zurückgegriffen. Für die Analysen werden drei Indikatoren der gesundheitlichen Lage verwendet: subjektive Gesundheitseinschätzung, Hilfebedarf bei instrumentellen Tätigkeiten des alltäglichen Lebens (funktionale Gesundheit) und das Vorhandensein eines Pflegegrades. Die große Zahl an teilnehmenden Zugewanderten ermöglicht es, zwischen bis 1949 und ab 1950 Zugewanderten sowie nach verschiedenen Geburtsregionen zu unterscheiden. Untersucht wird hierbei, ob gesundheitliche Ungleichheit ohne und mit Kontrolle wichtiger Kompositionsmerkmale wie Alter, Geschlecht, Bildung, Region und Gemeindetyp besteht und ob sich Unterschiede zwischen den Zuwanderungsgruppen zeigen. Die Ergebnisse der Regressionsanalysen zeigen keine gesundheitlichen Nachteile für bis 1949 Zugewanderte im Vergleich zu in Deutschland Geborenen. Für ab 1950 Zugewanderte hingegen zeigt sich ein deutlicher Zusammenhang zwischen Migrationserfahrung und funktionaler Gesundheit sowie dem Vorhandensein eines Pflegegrades auch nach Kontrolle der Kompositionsmerkmale. Es finden sich deutliche Unterschiede zwischen den Zuwanderungsgruppen. So haben ab 1950 Zugewanderte aus West- und Nordeuropa eine bessere funktionale Gesundheit als in Deutschland Geborene. Und ab 1950 aus den ehemaligen deutschen Ostgebieten Zugewanderte sind bezüglich der funktionalen Gesundheit weniger stark benachteiligt als aus dem übrigen Osteuropa Zugewanderte. Die Ergebnisse weisen darauf hin, dass trotz der Mechanismen, die eine Nivellierung gesundheitlicher Ungleichheit mit zunehmendem Alter begünstigen könnten (wie Healthy Migrant Effect, Unhealthy Remigration Effect, selektive Mortalität), nach Deutschland Zugewanderte aus den meisten Herkunftsregionen nicht die gleichen Chancen auf ein gesundes Altern haben wie in Deutschland Geborene.

Supervision is a burdensome aspect of family care for persons with dementia. For supervision that is both safe and bearable, potential dangers resulting from behavioral changes must be identified and tackled within the context of an ongoing family relationship. In this study, the development of the extent of supervision in the course of care is described from the perspective of family caregivers’ everyday care decisions. The influence of dementia-related behavioral changes, mobility, and relationship characteristics is investigated using existing longitudinal data. Mixed quadratic growth curve models estimated the extent of supervision in the course of up to 27 months of caregiving rated by N = 435 family caregivers. A significant quadratic trend indicated that supervision tends to increase over time in the early years of care, while it tends to decrease in later years. In the final model, this trend was entirely accounted for by four time-varying covariates: disorientation, advanced dementia symptoms, mobility, and the experience of relationship loss. In addition, spouses supervised more extensively than other family members. Confirming the results from qualitative studies, both dementia-related impairments and characteristics of the family relationship determine the extent of supervision. In particular, disorientation and burden of relationship loss appear to encourage risk-averse caregiving behavior: From the point of view of a family caregiver, it may feel safer to overestimate rather than underestimate supervisory needs as long as the care recipient stays mobile.

In current research, social relationships are increasingly recognized for their positive associations with cognitive outcomes in older adults. One of the most vulnerable groups for cognitive decline are very old adults (80+ years). However, they are relatively underrepresented in the field. Therefore, our study aimed to test if social relationships remain a protective factor against cognitive decline in very old age, using a representative sample from the Study of Quality of Life and Well-Being in North-Rhine Westphalia (NRW80+ Study). We hypothesized that social characteristics would be positively associated with global cognition and episodic memory cross-sectionally and would predict cognitive performance two years later. 1.207 very old adults were included in the representative, cross-sectional analyses, and 639 in the panel analyses. They were aged between 80 and 103 years and showed no signs of dementia. The associations between various social aspects and cognitive functions were investigated using hierarchical linear regression, controlling for relevant sociodemographic and health characteristics. Cross-sectionally, leisure engagement was positively associated with episodic memory (β = 0.53 [0.26, 0.79], p < .01) and global cognition (β = 0.50 [0.22, 0.79], p < .01), while overall network size was positively associated with global cognition (β = 0.04 [0.02, 0.07], p < .01). In contrast, we observed no associations between baseline social relationships and cognitive functions two years later. The findings suggest that while social relationships are associated with cognitive functions in very old age, short-term protective effects such as over two years may be less robust compared to other age groups.

Few studies have examined the associations between social relationships and cognition in very old adults (80+ years). Moreover, limited research has considered structural and functional aspects of social relationships together when exploring their associations with cognition. Therefore, the present study aimed to investigate the associations between structural and functional social aspects and cognition in very old age. The sample comprised 518 two-wave participants of the NRW80+ Study, who showed no indication of dementia and an average age of 85 years at baseline (range: 80-97 years). They were assessed twice over an approximate 2-year interval. Multilevel linear growth curve analysis was employed to model cognitive development over very old age and to examine the associations between structural and functional aspects of social relationships and cognitive development. It was controlled for demographic and health characteristics. A larger social network size (ß = 0.05, 95% CI [0.02, 0.08], p = 0.002) and frequent compared with occasional, seldom, and no contact with others (ß = 0.16, 95% CI [0.03, 0.28], p = 0.013) were associated with higher global cognition in the fully-controlled model. Model comparisons further revealed that structural aspects better predicted global cognition in very old age compared to functional aspects (χ²(2) = 16.17, p < 0.001). The findings underline the positive association between structural aspects of social relationships and global cognition in very old age. They also highlight the need for interventions promoting a socially active lifestyle to prevent cognitive decline in this vulnerable age group.

Social survey data on those aged 80 years or older is sparse. Based on a representative sample, this paper validates a multidimensional model proposed for understanding of quality of life (QoL) in very old age. Towards this goal, this paper estimated levels and heterogeneity of personal and environmental resources, well-being, autonomy, and perceived appreciation by society in the population of the very old in Germany. Next, the contribution of personal and environmental resources to QoL outcomes and overlap between these outcomes was estimated using a multivariate approach. Results were based on a representative survey on QoL of the very old in North Rhine-Westphalia, Germany’s most populous state. The survey included comprehensive information on socio-demographics, health, social and personal QoL resources including objective testing of cognitive function. The sample comprised 1,863 individuals (mean age 86.5 years, range 80–102 years), including 211 individuals residing in non-private dwellings. Interviews with proxy informants were conducted for 176 individuals that were willing to participate but could not conduct the interview themselves due to limited ability to communicate (PLC). Pronounced differences were found for PLC with respect to environmental and personal resources and QoL outcomes. Pronounced differences were also found both with respect to lower observed levels of QoL outcomes (e.g., autonomy) and predictors of QoL outcomes (e.g., effect of negative “external” appreciation on subjective well-being). Contrary to the deficit-oriented model of old age, a high degree of autonomy was observed. However, substantial and consequential negative “external” appreciation of very old age was also apparent.

Purpose: Diabetes is considered one of the fastest growing diseases worldwide. Especially in the treatment of type 2 diabetes, lifestyle interventions have proven to be effective. However, long-term studies in real-world contexts are rare, which is why further research is needed. The aim of the present study is to investigate whether effects achieved in the context of a long-term lifestyle intervention can be sustained by patients in the long term. Methods: In a two-arm randomized trial we compared diabetes care as usual to a lifestyle intervention combining telemedically support and individual needs-based telephone coaching. The study included 151 patients with type 2 diabetes randomized to either the intervention or control group. Intervention Group (IG; N = 86, 80.2% male, mean age: 59.7) received telemedical devices and telephone coaching over a period of 12 months, Control Group (CG; N = 65, 83.1% male, mean age: 58,8) received care as usual. The primary outcome was chance in Hb_A1c. A follow-up survey was conducted after 24 months. Results: The intervention group showed significantly better HbA1c- values compared to the control group at both 12 and 24 months (12 M: − 0.52 (-0.73; − 0.32), p < .000; 24 M: − 0.38 (-0.61; − 0.15), p = .001). The strongest change was seen in the first three months, with the best value obtained at 6 months and stable thereafter. Conclusion: Combined telephone coaching with telemedicine support could lead to better long-term glycemic control in people with type 2 diabetes. In the future, more long-term studies should be conducted in real-world settings and lifestyle interventions should be offered more widely.

Background and Objective: Making advance directives or deciding on a healthcare proxy are common instruments to assure that end-of-life care is in line with one’s own wishes. Correctly specified, these instruments help health professionals and relatives to act in the best interest of the...

This study examined trajectories of awareness of age-related change (AARC; Diehl & Wahl, 2010) across 2 years in a large representative sample of very old adults. We also examined the predictive role of health, functional status, cognitive functioning, and engagement with life for AARC change. The initial sample comprised 1,863 individuals aged 80 years or older. Of the 1,612 individuals re-contacted two years later, 912 took part in the follow-up. Measures included the AARC-Short Form, assessing perceived AARC-Gains and AARC-Losses. Measures of multimorbidity and functional health, a cognitive screening test, and indicators of engagement with life (e.g., leisure activity) were examined as predictors of AARC change, using semi-cross-lagged fixed effects modelling. Higher overall levels of AARC-Gains were observed compared to AARC-Losses for all but respondents aged 90 years or older. Intra-individual levels of AARC-Gains decreased significantly over the two-year period, whereas a significant increase was found for AARC-Losses. AARC-Losses across time were predicted by loss of IADL independence, but not by change in multimorbidity, cognitive performance, or engagement with life. One indicator of engagement with life, reduced leisure activity, predicted smaller AARC-Gains at wave 2. These results were robust in models controlling for potential reverse causation. These findings suggest that a significant increase in perceived AARC-Losses appears to be an inherent characteristic of very old age. Very old age may be a stage in life in which changes in multimorbidity and cognitive performance no longer impact individuals’ views on aging.