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43 Publications visible to you, out of a total of 43
Cost-utility analysis of a preventive home visit program for older adults in Germany.
LIFE Adult

Abstract (Expand)

BACKGROUND: Most older adults want to live independently in a familiar environment instead of moving to a nursing home. Preventive home visits based on multidimensional geriatric assessment can be one … strategy to support this preference and might additionally reduce health care costs, due to the avoidance of costly nursing home admissions. The purpose of this study was to analyse the cost-effectiveness of preventive home visits from a societal perspective in Germany. METHODS: This study is part of a multi-centre, non-blinded, randomised controlled trial aiming at the reduction of nursing home admissions. Participants were older than 80 years and living at home. Up to three home visits were conducted to identify self-care deficits and risk factors, to present recommendations and to implement solutions. The control group received usual care. A cost-utility analysis using quality-adjusted life years (QALY) based on the EQ-5D was performed. Resource utilization was assessed by means of the interview version of a patient questionnaire. A cost-effectiveness acceptability curve controlled for prognostic variables was constructed and a sensitivity analysis to control for the influence of the mode of QALY calculation was performed. RESULTS: 278 individuals (intervention group: 133; control group: 145) were included in the analysis. During 18 months follow-up mean adjusted total cost (mean: +4,401 EUR; bootstrapped standard error: 3,019.61 EUR) and number of QALY (mean: 0.0061 QALY; bootstrapped standard error: 0.0388 QALY) were higher in the intervention group, but differences were not significant. For preventive home visits the probability of an incremental cost-effectiveness ratio <50,000 EUR per QALY was only 15%. The results were robust with respect to the mode of QALY calculation. CONCLUSIONS: The evaluated preventive home visits programme is unlikely to be cost-effective. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT00644826.

Authors: C. Brettschneider, T. Luck, S. Fleischer, G. Roling, K. Beutner, M. Luppa, J. Behrens, S. G. Riedel-Heller, H. H. Konig

Date Published: 3rd Apr 2015

Publication Type: Not specified

Weight stigma "gets under the skin"-evidence for an adapted psychological mediation framework: a systematic review.
LIFE Adult

Abstract (Expand)

OBJECTIVE: Research consistently shows a negative view of individuals with obesity in the general public and in various other settings. Stigma and discrimination can be considered chronic stressors, … as these factors have a profound impact on the psychological well-being of the affected individuals. This article proposes a framework that entails a mediation of the adverse effects of discrimination and stigmatization on mental well-being through elevated psychological risk factors that are not unique to weight but that could affect overweight and normal-weight individuals alike. METHODS: A systematic review was conducted to assess the prevalence of psychological risk factors, such as self-esteem and coping, in individuals with obesity. RESULTS: Forty-six articles were assessed and included for detailed analysis. The number of studies on these topics is limited to certain dimensions of psychological processes. The best evaluated association of obesity and psychosocial aspects is seen for self-esteem. Most studies establish a negative association of weight and self-esteem in children and adults. All studies with mediation analysis find a positive mediation through psychological risk factors on mental health outcomes. CONCLUSIONS: This review shows that elevated psychological risk factors are existent in individuals with obesity and that they may be a mediator between weight discrimination and pathopsychological outcomes.

Authors: C. Sikorski, M. Luppa, T. Luck, S. G. Riedel-Heller

Date Published: 29th Jan 2015

Publication Type: Not specified

Elevated HbA1c is associated with increased risk of incident dementia in primary care patients.
LIFE Adult

Abstract (Expand)

Type 2 diabetes mellitus (T2DM) is a risk factor of dementia. The effect of T2DM treatment quality on dementia risk, however, is unclear. 1,342 elderly individuals recruited via general practitioner … registries (AgeCoDe cohort) were analyzed. This study analyzed the association between HbA1c level and the incidence of all-cause dementia (ACD) and of Alzheimer's disease dementia (referred to here as AD). HbA1c levels >/=6.5% were associated with 2.8-fold increased risk of incident ACD (p = 0.027) and for AD (p = 0.047). HbA1c levels >/=7% were associated with a five-fold increased risk of incident ACD (p = 0.001) and 4.7-fold increased risk of incident AD (p = 0.004). The T2DM diagnosis per se did not increase the risk of either ACD or AD. Higher levels of HbA1c are associated with increased risk of ACD and AD in an elderly population. T2DM diagnosis was not associated with increased risk if HbA1c levels were below 7%.

Authors: A. Ramirez, S. Wolfsgruber, C. Lange, H. Kaduszkiewicz, S. Weyerer, J. Werle, M. Pentzek, A. Fuchs, S. G. Riedel-Heller, T. Luck, E. Mosch, H. Bickel, B. Wiese, J. Prokein, H. H. Konig, C. Brettschneider, M. M. Breteler, W. Maier, F. Jessen, M. Scherer

Date Published: 20th Dec 2014

Publication Type: Not specified

Human Diseases: diabetes mellitus, dementia, Alzheimer's disease

Risk of dementia in older adults with low versus high occupation-based motivational processes: differential impact of frequency and proximity of social network.
LIFE Adult

Abstract (Expand)

OBJECTIVES: This study investigates the impact of occupation-based motivational processes and social network variables on the incidence of dementia over 8 years. METHOD: Data were derived from the … Leipzig Longitudinal Study of the Aged (LEILA75+), a population-based longitudinal study of individuals aged 75 years and older (n=1692 at baseline). Motivational processes were estimated based on the main occupation using the Occupational Information Network database. RESULTS: In a Cox proportional hazard model, motivational processes were not associated with the risk of dementia (hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.74-1.16). Individuals with a higher frequency of social contact at baseline had a significantly lower risk of dementia (HR: 0.96, 95% CI: 0.91-0.99), while proximity of social contacts was not linked to the risk of dementia (HR: 1.03, 95% CI: 0.98-1.08). In individuals with low indices of motivational processes, the frequency of social contacts was associated with a lower risk of dementia (HR: 0.94, 95% CI: 0.88-1.00). On the other hand, proximity of social contacts was linked to a higher risk of dementia in individuals with high indices of motivational processes (HR: 1.09, 95% CI: 1.01-1.19). DISCUSSION: Results indicate that the frequency and proximity of social contacts have a differential impact on the risk of dementia according to lower or higher indices of motivational processes, while the impact of motivational processes on risk of dementia could not be confirmed. Future studies should carefully disentangle different aspects of social interactions and their association with motivational processes.

Authors: S. Fankhauser, S. Forstmeier, A. Maercker, M. Luppa, T. Luck, S. G. Riedel-Heller

Date Published: 29th Nov 2014

Publication Type: Not specified

Human Diseases: dementia

Association of the apolipoprotein E genotype with memory performance and executive functioning in cognitively intact elderly.
LIFE Adult

Abstract (Expand)

OBJECTIVE: To test for a possible effect of the apolipoprotein E epsilon 4 (APOE epsilon4) allele on memory performance and executive functioning (EF) in cognitively intact elderly. METHOD: The authors … studied 202 randomly selected and cognitively intact older adults (65+ years) of the Leipzig Research Center for Civilization Diseases Health Care Study. Intact global cognitive functioning was defined using a Mini-Mental Status Examination (MMSE) score >/= 28. Performance in memory was assessed with the CERAD Word List and Constructional Praxis Recall, performance in EF with the Trail Making Test Part B (TMT-B). Multivariable linear regressions were used to evaluate the association between cognitive performance and APOE status, controlled for covariates. RESULTS: Among the cognitively intact older adults, 21.3% (n = 43) were carriers of the APOE epsilon4 allele. Carriers did not differ significantly from noncarriers in terms of age, gender, intelligence level, or performance in memory but showed a significantly lower TMT-B performance as a measure of EF (TMT-B M time/SD = 105.6/36.2 vs. 91.9/32.7 s; Mann-Whitney U = 4,313.000; p = .009). The association between lower TMT-B performance and APOE epsilon4 genotype remained significant in multivariable linear regression analysis. Similar findings were found for the subsample of those 78 elderly, who reached a perfect MMSE-score of 30. CONCLUSIONS: A lower EF performance in cognitively intact older APOE epsilon4 allele carriers might be related to an early Alzheimer's dementia (AD) prodrome. In this case, a stronger focus on first subtle changes in EF may help to improve early AD detection in those being at genetic risk.

Authors: T. Luck, F. S. Then, M. Luppa, M. L. Schroeter, K. Arelin, R. Burkhardt, J. Thiery, M. Loffler, A. Villringer, S. G. Riedel-Heller

Date Published: 4th Nov 2014

Publication Type: Not specified

Incident subjective memory complaints and the risk of subsequent dementia.
LIFE Adult

Abstract (Expand)

OBJECTIVE: In this study, we aimed to analyze the association between new-incident-subjective memory complaints (SMC) and risk of subsequent dementia in a general population sample aged 75+ years. … METHOD: Data were derived from follow-up (FUP) waves I-V of the population-based Leipzig Longitudinal Study of the Aged (LEILA75+). We used the Kaplan-Meier survival method to estimate dementia-free survival times of individuals with and without incident SMC and multivariable Cox proportional hazards regression to assess the association between incident SMC and risk of subsequent dementia, controlled for covariates. RESULTS: Of 443 non-demented individuals, 58 (13.1%) developed dementia during a subsequent 5.4-year follow-up period. Participants with incident SMC showed a significantly higher progression to dementia (18.5% vs. 10.0%; P=0.010) and a significantly shorter mean dementia-free survival time than those without (6.2 vs. 6.8 years; P=0.008). The association between incident SMC and risk of subsequent dementia remained significant in the multivariable Cox analysis (adjusted hazard ratio=1.8; P=0.028). CONCLUSION: Our findings suggest higher progression to dementia and shorter dementia-free survival in older individuals with incident SMC. These findings support the notion that such subjective complaints should be taken seriously in clinical practice as possible early indicators of incipient dementia.

Authors: T. Luck, M. Luppa, H. Matschinger, F. Jessen, M. C. Angermeyer, S. G. Riedel-Heller

Date Published: 10th Sep 2014

Publication Type: Not specified

Human Diseases: dementia

Association between mental demands at work and cognitive functioning in the general population - results of the health study of the Leipzig research center for civilization diseases (LIFE).
LIFE Adult

Abstract (Expand)

BACKGROUND: The level of mental demands in the workplace is rising. The present study investigated whether and how mental demands at work are associated with cognitive functioning in the general … population. METHODS: The analysis is based on data of the Health Study of the Leipzig Research Centre for Civilization Disease (LIFE). 2,725 participants aged 40-80 years underwent cognitive testing (Trail-Making Test, Verbal Fluency Test) and provided information on their occupational situation. Participants over the age of 65 years additionally completed the Mini-Mental State Examination. Mental demands at work were rated by a standardized classification system (O*NET). The association between mental demands and cognitive functioning was analyzed using Generalized Linear Modeling (GENLIN) adjusted for age, gender, self-regulation, working hour status, education, and health-related factors. RESULTS: Univariate as well as multivariate analyses demonstrated significant and highly consistent effects of higher mental demands on better performance in cognitive testing. The results also indicated that the effects are independent of education and intelligence. Moreover, analyses of retired individuals implied a significant association between high mental demands at work of the job they once held and a better cognitive functioning in old age. CONCLUSIONS: In sum, our findings suggest a significant association between high mental demands at work and better cognitive functioning. In this sense, higher levels of mental demands - as brought about by technological changes in the working environment - may also have beneficial effects for the society as they could increase cognitive capacity levels and might even delay cognitive decline in old age.

Authors: F. S. Then, T. Luck, M. Luppa, K. Arelin, M. L. Schroeter, C. Engel, M. Loffler, J. Thiery, A. Villringer, S. G. Riedel-Heller

Date Published: 11th Jun 2014

Publication Type: Not specified

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