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SummaryPreviously independent living older people suffering fractures of the hip have a high risk of new admission to a nursing home during the subsequent months. This study shows that older people admitted to hospital for fractures of the pelvis and spine have a similar risk of admission to a nursing home.IntroductionFall-related fractures are a serious threat to the health and well-being of older persons. Long-term consequences of hip fractures such as institutionalization and mortality are well-known. The impact of other fragility fractures is less well-understood. The aim of this study was to estimate risks of institutionalization and death for different fragility fractures and compare them with the corresponding risks after hip fracture.MethodsData was retrieved from a German health insurance company. Between 2005 and 2008 more than 56,000 community-dwelling people with a hospital admission or discharge diagnosis of a fracture of the femur, spine, pelvis, proximal humerus, distal radius, tibia, or fibula were included. Crude and age-adjusted 6-month incidence rates for institutionalization and death were calculated. To compare the risks of institutionalization or mortality of non-hip fractures with the risk after hip fracture, multivariate regression models were applied.ResultsCrude institutionalization rates and mortality were highest in patients with hip fracture. However, after adjustment for age, functional status, and comorbidity, risks of institutionalization after fractures of pelvis (relative risk (RR), 0.94; 95% confidence interval (CI) 0.86; 1.02 in women and 0.89; 95% CI 0.70; 1.12 in men), and spine (RR, 0.95; 95% CI 0.87; 1.03 in women and 0.91; 95% CI 0.76; 1.08 in men) were not statistically different compared to the risk after hip fracture.ConclusionsThe risk of institutionalization after fractures of the spine and pelvis was similar to the risk after hip fracture. These fracture sites seem to be associated with a significant decline in physical function.

Summary To predict the burden of incident osteoporosis attributable fractures (OAF) in Germany, an economic simulation model was built. The burden of OAF will sharply increase until 2050. Future demand for hospital and long-term care can be expected to substantially rise and should be considered in future healthcare planning. Introduction The aim of this study was to develop an innovative simulation model to predict the burden of incident OAF occurring in the German population, aged >50, in the time period of 2010 to 2050. Methods A Markov state transition model based on five fracture states was developed to estimate costs and loss of quality adjusted life years (QALYs). Demographic change was modelled using individual generation life tables. Direct (inpatient, outpatient, long-term care) and indirect fracture costs attributable to osteoporosis were estimated by comparing Markov cohorts with and without osteoporosis. Results The number of OAF will rise from 115,248 in 2010 to 273,794 in 2050, cumulating to approximately 8.1 million fractures (78 % women, 22 % men) during the period between 2010 and 2050. Total undiscounted incident OAF costs will increase from around 1.0 billion Euros in 2010 to 6.1 billion Euros in 2050. Discounted (3 %) cumulated costs from 2010 to 2050 will amount to 88.5 billion Euros (168.5 undiscounted), with 76 % being direct and 24 % indirect costs. The discounted (undiscounted) cumulated loss of QALYs will amount to 2.5 (4.9) million. Conclusions We found that incident OAF costs will sharply increase until the year 2050. As a consequence, a growing demand for long-term care as well as hospital care can be expected and should be considered in future healthcare planning. To support decision makers in managing the future burden of OAF, our model allows to economically evaluate population- and risk group-based interventions for fracture prevention in Germany.

Following the COVID-19 pandemic residents of nursing homes, their visitors and families as well as employees are faced with new challenges. Protective measures have a strong impact on the well-being of all these groups of persons. A systematic search was carried out for studies investigating the psychosocial consequences of the COVID-19 pandemic for residents, their visitors and families as well as nursing home staff. Results were analyzed by narrative synthesis. A total of 756 studies were screened and 15 studies were included. These studies were conducted between February and June 2020 with participants from 14 countries. Participants reported loneliness, grief and depressive symptoms among residents. Some gave an account of fear as a reaction of residents to social distancing. Residents with cognitive impairment suffered more although there are conflicting reports. The well-being of visitors and friends was compromised and their feeling of loneliness increased. Nursing home personnel reported fear of getting infected and of infecting residents or their own families. Infected workers in the USA expressed anger about a lack of protection. Furthermore, an increase in workload was reported. Studies conducted during the first months of the pandemic reported negative consequences for the psychosocial well-being of residents, their visitors and nursing home staff. Individual needs for future support of these groups are distinct and need further evaluation during the on-going pandemic.

Summary The aim of this study was to explore the increased risk of stroke survivors to different sustained osteoporotic fractures. We used hospital data and data on functional impairment. We found a higher risk in stroke survivors without functional impairment with the risk higher for lower than for upper extremity fractures. Introduction Stroke survivors are at high risk of osteoporotic fractures due to frequent falls and an increased risk to develop osteoporosis. Data on their relative risk to sustain other than hip fractures is limited. Furthermore, the role of severe functional impairment on their fracture risk has not been considered yet. The aim of this study was to determine the relative risk of stroke survivors to sustain different osteoporotic fractures with regard to the presence of severe functional impairment. Methods Data from 2004 to 2009 of more than 1.2 million individuals aged 65 years or older and insured at a large German health insurance company were used for the analyses. Incident stroke and fractures were obtained from hospital diagnoses. Analyses were stratified by gender and information on severe functional impairment. Persons without preceding incident stroke were used as the reference group. Multistate models were used to estimate hazard ratios. Results Stroke survivors had a higher risk for fractures. However, a strong effect modification by functional impairment was apparent. Stroke survivors with functional impairment had no significantly increased risk for any fractures site compared to the corresponding reference group with functional impairment. In contrast, stroke survivors without functional impairment had a clearly and significantly increased fracture risk for most fracture sites. In these persons, the relative fracture risk for fractures of the lower extremities was higher than for fractures of the upper extremities. Conclusion To evaluate the relative risk of stroke survivors for osteoporotic fractures, functional status appears to be a relevant parameter.

Rehabilitative short-term care (REKUP) is aimed at geriatric patients in need of rehabilitation but not (yet) capable of rehabilitation after acute inpatient hospitalization with a positive rehabilitation prognosis. It was tested at two geriatric rehabilitation clinics from October 2020 to March 2022. Qualitative process evaluation with respect to acceptance (service providers, health insurance), adoption (implementation at the start of the project), practicability (processes, contents, structures) and observed patient satisfaction. A focus group and 14 semi-structured interviews with a total of 18 employees of both rehabilitation clinics and a health insurance provider were recorded, transcribed and qualitatively analyzed for content. The survey of service providers (acute care, model clinics) and the health insurance provider revealed a high level of acceptance and good practicability (processes, contents, structures). Due to the high level of acceptance and the familiar service content in the geriatric rehabilitation clinics, the implementation was feasible and patient satisfaction was rated as very good. The acceptance of REKUP was high because the basic idea was easy to understand. Nevertheless, a careful patient selection is crucial. There is a risk that REKUP could be used as a quick discharge option to avoid capacity problems. The success of treatment perceived by the service provider is based on early exercises, psychosocial care and a longer period of time before rehabilitation, which avoids excessive demands and strengthens self-efficacy. Admission to the long-term nursing home sector is avoided, which has a positive psychological and motivational effect on patients. A transfer of REKUP to other geriatric rehabilitation clinics seems to be easily possible.

Physical activity (PA) decreases with increasing age despite the fact that PA exerts beneficial effects on many age-related diseases and conditions. Consequently, there is an interest in modifiable factors that may influence PA among older persons. The purpose of this study was to examine the association between PA and the home environment in well-functioning older community-dwelling persons. Method This study used a person–environment (P–E) fit perspective to the home environment, operationalized by means of assessment of functional limitations in 81 community-dwelling persons (median age 79 years) as well as environmental barriers in their home environments and the nearby exterior surroundings. The interaction between functional limitations and environmental barriers generated a score expressing the magnitude of P–E fit problems in their home environment. PA was rated with a questionnaire covering household-related and recreational activities. Results We found a significant association between PA and the magnitude of P–E fit problems that explained 3.9 % of the variance of PA. The number of environmental barriers per se was not significantly associated with PA, while functional limitations explained 6.8 % of the variance of PA. Conclusion In well-functioning older persons living in the community environmental aspects of housing demonstrated a weak association with PA.

Zusammenfassung Hintergrund Die COVID-19-Pandemie stellt Bewohner von Altenpflegeeinrichtungen, deren Angehörige bzw. Besucher ebenso wie Mitarbeitende vor große Herausforderungen. Viruseindämmende Maßnahmen wirken sich stark auf das Wohlbefinden der betroffenen Personengruppen aus. Material und Methode Systematische Literatursuche nach Studien zu psychosozialen Folgen der Pandemie für Bewohner, deren Angehörige bzw. Besucher sowie Mitarbeitende und Zusammenführung der Ergebnisse mittels narrativer Synthese. Ergebnisse Es wurden 756 Studien gesichtet, davon 15 Arbeiten eingeschlossen. Die Daten wurden zwischen Februar und Juni 2020 mit Teilnehmenden aus 14 Ländern erhoben. Es wurden v. a. Einsamkeit, Trauer und Depressivität, aber auch Angst, als häufige Reaktionen der Bewohner auf die Kontakt- und Besuchsrestriktionen berichtet. Bewohner mit kognitiven Einschränkungen litten stärker unter den Auswirkungen, auch wenn es gegenteilige Hinweise gibt. Angehörige bzw. Besucher berichteten ebenfalls von einer Zunahme ihrer Einsamkeit und einer reduzierten Lebensqualität. In den Befragungen der Mitarbeitenden schildern diese Angst vor einer Infektion sowohl bei sich als auch bei den Bewohnern. Infizierte Mitarbeitende in den USA äußerten Wut darüber, nicht ausreichend geschützt worden zu sein. Darüber hinaus berichteten Mitarbeitende von einer erheblichen Mehrbelastung. Schlussfolgerung Infolge der Pandemie und der ergriffenen Maßnahmen wurden negative psychosozialen Folgen bei Bewohnern, deren Angehörigen bzw. Besuchern und den Mitarbeitenden berichtet. Die abzuleitenden Unterstützungsbedarfe der 3 Personengruppen sind unterschiedlich und sollten bei zukünftigen Maßnahmen hinsichtlich der Pandemie stärker mitevaluiert werden.

Background The demand for geriatric rehabilitation will drastically increase over the next years. It will be increasingly important to demonstrate the efficacy and effectiveness of geriatric rehabilitation. One component is the use of objective and valid assessment procedures. These should be understandable to patients, relevant for goal attainment, and able to document change. A number of currently used physical capacity measures have floor effects. The use of body-fixed sensor technology for monitoring physical activity is a possible supplement for the assessment during geriatric rehabilitation to overcome floor effects and directly monitor improvement of mobility as a component of geriatric rehabilitation in many patients. Methods The observational study with a pre–post design examined 65 consecutive geriatric hip fracture inpatients. Measurements were performed on admission and 2 weeks later. The capacity measures included gait speed, chair rise time, a balance test, 2-Minute-Walk test and the Timed-Up-and-Go test. Physical activity was measured over 9 h using body-fixed sensor technology and expressed as cumulated walking and walking plus standing (time on feet). Results Body-fixed sensors allowed direct measurement of physical activity in all patients available for testing. Cumulated walking and standing (time on feet) increased from a median 83.6 to 102.6 min. Cumulated walking increased from a median 7.0 to 16.3 min. The comparison with the physical capacity measures demonstrated a modest to fair correlation (r s  = 0.455 and 0.653). This indicates that physical capacity measures are not the same construct as physical activity. Conclusion Body-fixed sensor-based assessment of physical activity was feasible even in geriatric patients with severe mobility problems and decreased the number of patients with missing data both on admission and 2 weeks later. Body-fixed sensor data documented change in activity level.

Zusammenfassung Hintergrund Rehabilitative Kurzzeitpflege (REKUP) richtet sich an rehabilitationsbedürftige, aber (noch) nicht rehabilitationsfähige geriatrische Patienten nach akutstationärem Aufenthalt mit positiver Rehabilitationsprognose und wurde von Oktober 2020 bis März 2022 an 2 geriatrischen Rehabilitationskliniken erprobt. Ziel Qualitative Prozessevaluation hinsichtlich Akzeptanz (Leistungserbringer, -träger), Adoption (Umsetzung zu Projektbeginn), Praktikabilität (Prozesse, Inhalte, Strukturen) und beobachteter Zufriedenheit bei den Patienten. Methodik Eine Fokusgruppe und 14 halbstrukturierte Interviews mit insgesamt 18 Mitarbeitenden der Kliniken wie auch des Leistungsträgers wurden aufgezeichnet, transkribiert und qualitativ inhaltsanalytisch ausgewertet. Ergebnisse Bei der Befragung der Leistungserbringer (Zuweiser‑/Modellkliniken) als auch des Leistungsträgers zeigten sich eine hohe Akzeptanz sowie eine gute Praktikabilität (Prozesse, Inhalte, Strukturen). Die Umsetzung wurde aufgrund der hohen Akzeptanz sowie der in geriatrischen Rehabilitationskliniken bekannten Leistungsinhalte als gut machbar und die Zufriedenheit der Patienten als sehr hoch bewertet. Diskussion Die Akzeptanz von REKUP war hoch, da der Grundgedanke leicht nachvollziehbar war. Dennoch ist eine sorgfältige Patientenauswahl entscheidend. Es besteht die Gefahr, dass REKUP als schnelle Entlassoption genutzt wird, um Kapazitätsprobleme zu umgehen. Der von den Leistungserbringenden wahrgenommene Therapieerfolg konstituiert sich über früh beübende Anwendungen, psychosoziale Angebote und die längere Zeitspanne vor der Rehabilitation: Überforderung wird vermieden und Selbstwirksamkeit gestärkt. Die Aufnahme in den Pflegeheimsektor wird umgangen, was einen positiven psychologischen und motivationalen Effekt für Patienten birgt. Ein Transfer von REKUP in andere geriatrische Rehabilitationskliniken erscheint leicht möglich.