Cost-effectiveness of a multicomponent intervention against cognitive decline.

Introduction: The societal costs of dementia and cognitive decline are substantial and likely to increase during the next decades due to the increasing number of people in older age groups. The aim of this multicenter cluster-randomized controlled trial was to assess the cost-effectiveness of a multi-domain intervention to prevent cognitive decline in older people who are at risk for dementia.

Methods: We used data from a multi-centric, two-armed, cluster-randomized controlled trial ( trial, ID: DRKS00013555).

Dietary changes following a lifestyle-based intervention for dementia risk reduction - results from the AgeWell.de study.

Purpose: We investigated the effects of a multidomain lifestyle intervention conducted in older adults at increased risk for dementia on participants' diet.

Methods: Secondary analyses of the cluster-randomized AgeWell.de-trial, testing a multidomain intervention (optimization of nutrition and medication, enhancement of physical, social and cognitive activity) in older adults at increased dementia risk.

Comparing Different Implementation Strategies for Collaborative Dementia Care Management in Terms of Patients' Characteristics, Unmet Needs, and the Impact on Quality of Life and Costs in Germany.

Objective: To compare the implementation of collaborative dementia care management (cDCM) across two settings regarding patients' characteristics, unmet needs, and the impact on health-related quality of life (HRQoL) and costs.

Methods: This analysis was based on data from the DCM:IMPact study, implementing cDCM in a physician network (n = 22 practices) and two day care centers (DCC) for community-dwelling persons with dementia over 6 months in Germany. Participants completed comprehensive assessments at baseline and 6 months after, soliciting sociodemographic and clinical characteristics, unmet needs, HRQoL and healthcare resource utilization.

Social participation and cognitive activities as explanation factor for the association between income and self-rated health for older adults.

Introduction: Health disparities pose a considerable challenge for older adults individuals, particularly those with a heightened risk of developing dementia. Discrepancies in health status among various income brackets are only partially attributable to structural factors such as working and living conditions or the quality of food. The aim of this study was therefore to explore whether and to what extent various health-promoting behaviors can explain the association between household income and self-rated health among older people at risk of dementia.

General practitioners' perspectives on lifestyle interventions for cognitive preservation in dementia prevention.

Background: General practitioners (GPs) play a crucial role in identifying cognitive impairment and dementia and providing post-diagnostic care. This study investigates (1) how promising GP consider lifestyle changes to maintain cognitive performance in general, (2) GP beliefs about the power of modifiable health and lifestyle factors to maintain cognitive performance, and (3) whether those beliefs vary by GP age.

Methods: As part of the AgeWell.

Effects of a multidomain intervention against cognitive decline on dementia risk profiles - Results from the AgeWell.de trial.

Introduction: Dementia risk scores constitute promising surrogate outcomes for lifestyle interventions targeting cognitive function. We investigated whether dementia risk, assessed using the LIfestyle for BRAin health (LIBRA) index, was reduced by the AgeWell.de intervention.

Adherence to a lifestyle intervention - just a question of self-efficacy? Analysis of the AgeWell.de-intervention against cognitive decline.

Background: Aim of this study was to detect predictors of better adherence to the AgeWell.de-intervention, a two-year randomized multi-domain lifestyle intervention against cognitive decline.

Methods: Data of 317 intervention group-participants comprising a risk group for dementia (Cardiovascular Risk Factors, Ageing and Dementia (CAIDE) score of  ≥ 9; mean age 68.

Factors Associated with Lower Social Activity in German Older Adults at Increased Risk of Dementia: A Cross-Sectional Analysis.

Background: Studies demonstrate associations between low social activity in older adults and cognitive decline. Little has been investigated regarding which factors are associated with low social activity in older adults at increased risk of dementia.

Objective: We investigate which sociodemographic, psychological, health-related, and environmental factors are associated with low social activity in older adults at increased risk of dementia.

COVID-19 government measures and their impact on mental health: a cross-sectional study of older primary care patients in Germany.

Background: With the outbreak of COVID-19, government measures including social distancing and restrictions of social contacts were imposed to slow the spread of the virus. Since older adults are at increased risk of severe disease, they were particularly affected by these restrictions. These may negatively affect mental health by loneliness and social isolation, which constitute risk factors for depressiveness.

Design and implementation of the participatory German network for translational dementia care research (TaNDem): A mixed-method study on the perspectives of healthcare providers and dementia researchers in dementia care research.

Background: Currently, there is a lack of interaction between research and healthcare practice. As a result, research findings reach healthcare practice only late, and topics relevant to practice are often not known in research. Involving people living with dementia (PlwD), their relatives and healthcare providers in dementia care research can accelerate this process.

Impact of low-value medications on quality of life, hospitalization and costs - A longitudinal analysis of patients living with dementia.

Introduction: This study aimed to analyze the impact of low-value medications (Lvm), that is, medications unlikely to benefit patients but to cause harm, on patient-centered outcomes over 24 months.

Methods: This longitudinal analysis was based on baseline, 12 and 24 months follow-up data of 352 patients with dementia. The impact of Lvm on health-related quality of life (HRQoL), hospitalizations, and health care costs were assessed using multiple panel-specific regression models.

The long-term impact of the COVID-19 pandemic on primary and specialized care provision and disease recognition in Germany.

Background: The COVID-19 pandemic and the imposed lockdowns severely affected routine care in general and specialized physician practices.

Objective: To describe the long-term impact of the COVID-19 pandemic on the physician services provision and disease recognition in German physician practices and perceived causes for the observed changes.

Design: Observational study based on medical record data and survey data of general practitioners and specialists' practices.

Translation of Collaborative Dementia Care Management into Different Healthcare Settings: Study Protocol for a Multicenter Implementation Trial (DCM:IMPact).

Background: Collaborative care models for people living with dementia (PwD) have been developed and evaluated, demonstrating safety, efficacy, and cost-effectiveness. However, these studies are based on heterogeneous study populations and primary care settings, limiting the generalizability of the results. Therefore, this study aims to implement and evaluate collaborative care across various healthcare settings and patient populations.

Elicitation of quantitative, choice-based preferences for Person-Centered Care among People living with Dementia in comparison to physicians' judgements in Germany: study protocol for the mixed-methods PreDemCare-study.

Background: Person-Centered-Care (PCC) requires knowledge about patient preferences. Among People-living-with-Dementia (PlwD) data on quantitative, choice-based preferences, which would allow to quantify, weigh and rank patient-relevant elements of dementia-care, and identify most/least preferred choices, are limited. The Analytic-Hierarchy-Process (AHP) may be one approach to elicit quantitative, choice-based preferences with PlwD, due to simple pairwise comparisons of individual criteria from a complex decision-problem, e.

Associations Between Low-Value Medication in Dementia and Healthcare Costs.

Background: Low-value medications (Lvm) provide little or no benefit to patients, may be harmful, and waste healthcare resources and costs. Although evidence from the literature indicates that Lvm is highly prevalent in dementia, evidence about the financial consequences of Lvm in dementia is limited. This study analyzed the association between receiving Lvm and healthcare costs from a public payers' perspective.

Priorities and Preferences of People Living with Dementia or Cognitive Impairment - A Systematic Review.

Background: Knowledge about the priorities and preferences of people living with dementia (PwD) might help to individualize treatment, care, and support, which could improve patient-related outcomes. This study aimed to summarize preferences of PwD or people with mild cognitive impairment (MCI), considering all relevant aspects of health care and everyday life.

Methods: We conducted a systematic literature review and included studies about patient preferences published in English between January 1, 1990 and October 28, 2019.

Key Intervention Categories to Provide Person-Centered Dementia Care: A Systematic Review of Person-Centered Interventions.

Background: Person-centered care (PCC) is an important concept in many countries' national guidelines and dementia plans. Key intervention categories, i.e.

Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia.

Background: Low-value care (LvC) is defined as care unlikely to provide a benefit to the patient regarding the patient's preferences, potential harms, costs, or available alternatives. Avoiding LvC and promoting recommended evidence-based treatments, referred to as high-value care (HvC), could improve patient-reported outcomes for people living with dementia (PwD).

Objective: This study aims to determine the prevalence of LvC and HvC in dementia and the associations of LvC and HvC with patients' quality of life and hospitalization.

Effect of the COVID-19 pandemic on stress, anxiety, and depressive disorders in German primary care: A cross-sectional study.

Several studies revealed that mental disorders' prevalence increased during the COVID-19 pandemic, particularly in young and female individuals. Such studies represent individuals' subjective perceptions and not the number of mental health cases treated in primary care. Thus, this study aimed to describe the changes in depression, anxiety, and stress disorder diagnoses in General Practitioner (GP) practices during the COVID-19 pandemic.

The Management of Non-Dialysis-Dependent Chronic Kidney Disease in Primary Care.

Background: Approximately 10% of adults in Germany have chronic kidney disease (CKD). The prevalence of CKD among patients being cared for by general practitioners is approximately 30%, and its prevalence in nursing homes is over 50%. An S3 guideline has been developed for the management of CKD in primary care.

Effect of the COVID-19 lockdown on disease recognition and utilisation of healthcare services in the older population in Germany: a cross-sectional study.

Background: There is little evidence about the utilisation of healthcare services and disease recognition in the older population, which was urged to self-isolate during the COVID-19 lockdown.

Objectives: We aimed to describe the utilisation of physician consultations, specialist referrals, hospital admissions and the recognition of incident diseases in Germany for this age group during the COVID-19 lockdown.

Design: Cross-sectional observational study.

Preferences of Cognitively Impaired Patients and Patients Living with Dementia: A Systematic Review of Quantitative Patient Preference Studies.

Background: Treatment decisions based on guidelines rather than patients' preferences determine adherence to and compliance with treatment, which, in turn, could improve health-related outcomes.

Objectives: To summarize the stated treatment and care preferences of people with dementia (PwD).

Methods: A systematic review was conducted to assess the stated preferences of PwD.

Is the whole larger than the sum of its parts? Impact of missing data imputation in economic evaluation conducted alongside randomized controlled trials.

Outcomes in economic evaluations, such as health utilities and costs, are products of multiple variables, often requiring complete item responses to questionnaires. Therefore, missing data are very common in cost-effectiveness analyses. Multiple imputations (MI) are predominately recommended and could be made either for individual items or at the aggregate level.