Search PubMed⌕ Search

Biomedical subjects

S Weyerer

Publications and source records attributed to S Weyerer.

At least 19 recordsLinked to original sources
PubMed2005

[A comparison of special and traditional inpatient care of people with dementia].

Recent studies reveal that approximately two thirds of the residents in German nursing homes suffer from some type of moderate to severe dementia. In addition to cognitive impairments, other psychiatric symptoms and behavior problems frequently impact the quality of life of the affected residents, their fellow residents and the nursing staff. Novel concepts of nursing care for dementia patients with behavior problems have been developed against this backdrop, e. g. within the framework of the program of special care for dementia patients in Hamburg. A comprehensive course study (follow-up period: approximately six months) of a sample population of nursing home residents and consecutive admissions focused upon:the degree to which the quality of life and care for dementia patients in Hamburg differs according to the type of care given, i. e. segregative (domus philosophy), or partially segregative (integration philosophy), and the differences between the special care of dementia patients as provided in Hamburg, as opposed to the traditionally integrative care of dementia patients as practiced in the city of Mannheim. In order to gain the most complete picture possible-also for persons with severe cognitive impairments-information was collected primarily on the basis of the assessments made by qualified nursing staff. In the city of Hamburg there were advantages and disadvantages, respectively, between segregative care (domus philosophy) and partially segregative care (integration philosophy): the activity rates were higher for care in integrative than in domus environments, and could be maintained better over time. Moreover, the number of visits from relatives and their involvement in the nursing and social care was also higher for the integrative, as opposed to the domus setting. Among the residents of domus-care homes, however, significantly more biographical information was collected, and the proportion of dementia patients receiving gerontopsychiatric care also was higher. Dementia patients in these homes also received more psychotropic medication, with antidementia drugs and antidepressants being prescribed significantly more frequently and antipsychotic drugs less frequently.The comparison of the special dementia care available in Hamburg with the traditional, integrative care available to dementia patients in Mannheim revealed a number of visible indicators for the quality of life that point in favor of the model program in Hamburg. This is apparent in the more frequent expression of positive feelings, the greater number of activities fostering competency, the significant involvement of relatives and volunteers, the greater number of social contacts with the staff, fewer use of physical restraint, and better gerontopsychiatric care. Contradictory to our expectation, however, dementia patients cared for in the traditional setting exhibited fewer behavior problems over time than did their counterparts cared for within the framework of the Hamburg model.

Aged↗
PubMed1999

Predictors of mortality among demented elderly in primary care.

OBJECTIVES: To evaluate a wide range of sociodemographic, neurological and clinical variables as to whether they predict mortality in a representative sample of demented elderly. DESIGN: A three-stage community survey was conducted, based on a total of 3721 elderly patients whose cognitive status was assessed by their general practitioners (stage I). A stratified random sample of patients underwent a standardized research interview, including cognitive testing and the assessment of mental status, physical illness, sensory impairment and motor disability (stage II). After a mean interval of 28 months, all patients were recontacted. For deceased patients a close reference person was interviewed and the exact date of death was recorded (stage III). The influence of the predictor variables on mortality was determined by using the Cox proportional hazards model. SUBJECTS: A stratified random sample of 117 patients in primary care (mean age 82 years) suffering from mild, moderate or severe dementia (Alzheimer type, vascular or mixed dementia). MATERIALS: Hierarchical Dementia Scale (HDS), a modified version of the Hamilton Depression Scale, other clinical rating scales and CAMDEX criteria for clinical diagnosis and a degree of severity of dementia. RESULTS: Fifty-three of the 117 demented patients had died during the follow-up interval. The mortality risk increased steeply with the degree of severity of dementia. By controlling for this variable, only age and motor disability contributed significantly to the prediction of mortality, whereas gender, social class, type of dementia, extrapyramidal signs and other clinical features showed no or only a weak effect on the outcome. CONCLUSION: The remaining life expectancy of the demented elderly depends primarily on the severity of the dementia, the patients' age and their general physical health. The influence of other clinical features which often have been hypothesized as indicators of specific subgroups of dementia was mainly due to their relationship to the disease severity.

Aged↗
PubMed1999

Alcohol problems among residents in old age homes in the city of Mannheim, Germany.

OBJECTIVE: This study aims to determine the prevalence of alcohol problems among residents in old age homes, its demographic and clinical features, and its association with the risk of falling. METHOD: All residents (n = 1922) living in 20 randomly selected residential and nursing homes in the city of Mannheim, Germany, were included. Based on routine documentation, details of their sociodemographic features, medical diagnoses made upon admission, and current medication were compiled. The home staff filled out for each resident a standardised assessment sheet on activities of daily living-impairment (Barthel Index), behaviour problems, alcohol consumption, and frequency of falls. RESULTS: According to the diagnoses of the primary care physicians, 7.4% of the residents had mental and behavioural disorders due to alcohol (ICD-10: F10). Rates were particularly high among men, and younger and single or divorced residents. A high percentage of those with a diagnosis of alcohol abuse/dependence (41.1%) were transferred from mental hospitals. Home staff reported current alcohol abuse/dependence among 3.4% of all residents. The risk of falling was significantly elevated (Odds ratio: 2.65; p<0.01) among those with current alcohol problems. CONCLUSION: The results corroborate the findings from other studies wherein residents of old age homes constitute a group at risk of alcohol abuse and dependence. Alcohol problems were more the cause for, rather than the consequence of, home admission.

Accidental Falls↗
PubMed1999

The Even Briefer Assessment Scale for Depression (EBAS DEP): its suitability for the elderly in geriatric care in English- and German-speaking countries.

OBJECTIVES: To determine the psychometric properties of the Even Briefer Assessment Scale for Depression (EBAS DEP) developed by Allen et al. (1994) among samples of the German elderly and compare the results with those from English-speaking countries. DESIGN: Depression scale scores from elderly persons in residential and gerontopsychiatric care were assessed for internal consistency using Cronbach's alpha and validity (Feighner Criteria of Depression and Center for Epidemiologic Studies Depression Scale). SUBJECTS: Eight hundred and fifty-two elderly persons aged 65 years and over, in residential and gerontopsychiatric care. MATERIALS: The eight-item Even Briefer Assessment Scale for Depression (EBAS DEP) derived from the 21-item Brief Assessment Scale (BAS DEP). RESULTS: The analysis of the reliability of the German EBAS DEP yielded, as did that of the English version, a satisfactorily high internal consistency (0. 73 and higher). Based on a subset of 71 subjects, the validity of the scale was tested by independent psychiatric experts using the Feighner Criteria of Depression. The EBAS DEP (cutoff 3/4) had a sensitivity and specificity for a diagnosis of depression of 93.3% and 85.3%, respectively. Similar results were reported by Allen et al., but at a lower cutoff (2/3). In agreement with the English findings, the receiver operating curve (ROC) statistics revealed that the EBAS DEP is a screening instrument which is as efficient as the longer BAS DEP. CONCLUSION: The EBAS DEP is an instrument well suited for use in screening the depressed elderly in different care settings in English- and German-speaking countries.

Aged↗
PubMed1998

[Changes in homes for the aged and nursing homes: functional impairments and behavioral disorders of residents are increasing].

Residents in homes for the elderly and in nursing homes suffer from physical and mental disorders that are prevalent far above average. In the course of the changes that are presently taking place in the German health care system there is now an increase in the number of mentally ill and severely impaired persons residing in old-age homes. Earlier epidemiological studies do not yield any conclusive predictions of changes in residential structures and hence in nursing care requirements. Two cross-sectional studies are presented on the prevalence of physical and mental diseases, daily and behaviour problems among residents of old-age and nursing homes in Mannheim. There was a distinct increase in average age, functional impairment, depression and disoriented behaviour among residents in 12 homes for the elderly in Mannheim conducted in 1988 (n = 542) and 1992 (n = 497). During the period it was noted that disoriented behaviour significantly increased the mortality risk. In another study the by far larger group of nursing home residents was investigated. So far we have data for 1995 and 1996 on results obtained from 1178 residents of Mannheim homes for the elderly and nursing homes. Among the residents of nursing homes there was a much higher prevalence of functional impairment and behaviour problems than among those of homes for the elderly. Despite a very high prevalence of depression or disorientation, only every third resident was diagnosed as suffering from organic brain disease and only every tenth resident had a depressive disorder. Since a growing proportion of residents will be mentally ill or severely impaired, these institutions will be facing increasing medical and nursing demands. Due to limited resources, the homes cannot meet these demands adequately. Hence, health policy changes are mandatory to improve nursing care and to avoid placing an increasing burden on the nursing staff.

Activities of Daily Living↗
PubMed1997

Family climate and expressed emotion in the course of alcoholism.

Family-based predictors of relapse were examined in 100 alcoholics who participated in a 12-week treatment program with 6-month and 18-month followups. "Expressed Emotion" (EE), or attitudes of relatives toward the alcoholic as measured by the Camberwell Family Interview, scales measuring rejection of the alcoholic by relatives, and self-reports of partner interaction were evaluated as possible predictors of abstinence. During therapy, partnership interactions showed a transient deterioration with increased temporary friction. Based on conservative criteria, the abstinence rate was 40% at 6-month followup and 30% at 18-month followup. An association with the relapse at followup could be obtained for the Patient Rejection Scale (PRS) and, using empirically derived classification rules, for the main three variables of the Camberwell Family Interview (CFI) conducted on admission: "Critical Comments," "Emotional Overinvolvement," and "Warmth." A low number of Critical Comments and a high score in Warmth were associated with a lower risk of relapse; however, contrary to expectations, Emotional Overinvolvement of the significant other was associated with more abstinence. In addition, the number of Critical Comments made by relatives about the alcoholic, a major component of high EE as measured by the CFI, had a statistically significant impact on the "survival function" of abstinence, and thus contributed to the prediction of the course of alcoholism in the expected direction.

Adult↗
PubMed1996

[Epidemiology of psychotropic drug utilization in homes for the aged].

Cross-sectional studies conducted in 1988 and 1992 using identical assessment methods also determined the prevalence of psychotropic drug consumption by the residents of homes for the elderly in the city of Mannheim. Another purpose of the studies was to find out the extent of a possible interrelation between treatment with psychotropics on the one hand and sociodemographic sociodemographic characteristics and behaviour problems of the residents on the other. In addition, in all consecutive new admissions to the homes not only the prevalence of consumption of psychotropics was investigated, but also the question to what extent the use of psychotropic drugs increases the mortality rate. In a total of 12 Mannheim old-age homes each in 1988 (n = 542) and 1992 (n = 497) all the residents older than 65 years of age were investigated. Between 1986 and 1988 all consecutive admissions (n = 239) to Mannheim old-age homes were interviewed and the mortality risk determined in a subsequent investigation in 1992. Taking a period of four weeks as reference period, 42.1% of the residents were treated during that period with psychotropics in 1988, of which 13.3% received neuroleptics, 11.7% hypnotics, 8.9% antidepressants and 13.0% tranquilizers. There were considerable variations between the individual homes in respect of the intake of psychotropics (minimum 18.2%, maximum 58.3%). In 1992 the prevalence of the use of psychotropics rose to 47.6%, the increase being mainly due to neuroleptics (23.8%) and, to a lesser extent, to antidepressants (12.9%). Compared with 1988 there was a slight decrease in the consumption of tranquilizers (10.9%) and hypnotics (10.7%). In 1988 there was no statistically significant connection between intake of psychotropics and gender, age, frequency of visits by relatives/friends, duration of residence and behaviour problems (aggression, suspiciousness, wandering, depression, dementia) of the residents. This result was also confirmed for 1992, albeit with two exceptions: a significantly higher consumption of psychotropic drugs by home residents characterised by the "behaviour problems wandering" and "depression". Examination of the consecutively newly admitted inmates revealed that psychotropic drug consumption was already relatively high (38.0%) at the time of admission. The mortality risk, determined after having checked on possibly confounding variables, was not significantly enhanced in residents who had already been treated with psychotropics at the time of admission (odds ratio: 0.52; Cl: 0.25-1.08). Compared with elderly persons in private households the consumption of psychotropics is markedly higher in old-age homes. However, the intake is not due to institutionalisation, but had already been high at the time of admission. Prospective studies of the course with relatively short follow-up intervals would be necessary for a differentiated examination of the determinants and effects of high psychotropics consumption and to establish a sound foundation for an appropriate prescription of psychotropics for home residents.

Aged↗
PubMed1996

[Detection of psychiatric diseases in general practice: results from Germany].

The family physician plays a key role in medical care. In view of the fact that approximately every fourth resident suffers from some mental disorder, the ability of the primary care physician to recognise a disorder as such is of utmost importance. Results of German studies indicate that primary care physicians recognise about half the mental disorders identified on the basis of clinical interviews. The extent to which mental disorders are recognised depends in addition to the psychiatric competence of the primary care physician upon the type and degree of severity of the specific disorder. The rate of recognition is particularly low for mental disorders in childhood and adolescence and among adults who suffer from sleep disorders or neurotic/psychosomatic disorders. On the contrary, over 70% of cases of schizophrenia and affective psychoses and over 90% of all dementia cases are discovered by primary care physicians. Training programmes are valuable aids in improving the skill of primary care physicians at recognising mental disorders. Corresponding programmes, tested for efficacy, are needed in Germany.

Adolescent↗
PubMed1995

Prevalence and course of depression among elderly residential home admissions in Mannheim and Camden, London.

A longitudinal study based on consecutive admissions to all residential homes for the elderly was conducted in the industrial city of Mannheim (Germany) and in the London borough of Camden (England). Inclusion criteria were that the elderly persons (65 years old and older) came directly from their own home or, if transferred from a hospital, had been there for less than 3 months. At each site, 60 home residents were interviewed at admission and 3 months and 8 months later. Depression and dementia were assessed with the aid of the Brief Assessment Scale. The prevalence of depression (Mannheim: 34.6%; Camden: 47.9%) was already high at admission and did not change significantly over time. Residents in Camden were more demented and more impaired in their activities of daily living at the time of admission, and the percentage of those who died or were transferred to a hospital or nursing home within 8 months thereafter was higher in Camden (30%) than in Mannheim (5%). Multiple regression analysis revealed that, in both study areas, depression at baseline was the best predictor for depression 3 months and 8 months later. This relationship was particularly strong in Camden, where a high percentage of the depressed at admission showed a chronic course of illness. Sex, age, home visits, social isolation, activities of daily living, cognitive impairment, and somatic symptoms at the time of admission were not significantly associated with depression 3 months later. Eight months after admission, a similar pattern was found in Mannheim. In Camden, however, in addition to depression, a lack of home visits by relatives and friends, and somatic symptoms at baseline, were significant predictors of depression 8 months after admission.

Aged↗
PubMed1995

Economic factors and the rates of suicide in Germany between 1881 and 1989.

The potential consequence of economic stress most frequently cited in the literature of medical sociology is the increase in the rate of suicide, it probably being the most valid and reliable indicator of collective mental health. To assess the probability of such being the consequence of current economic realignment in the Federal Republic of Germany, we deemed it promising to evaluate the extent to and manner in which economic factors have to date affected the frequency of suicide in Germany. The current study analyzed the effects of four economic variables (growth of the economy, average real income, unemployment and frequency of bankruptcy) on the rates of suicide in Germany from 1881 to 1989. We set the commencement date of the period analyzed as early as possible to include long-term developments as well as the effects of different moderator variables. The annual fluctuations of all four variables, in conformity with our hypothesis, correlated both in the period preceding World War II as well as in the postwar period with those in the rates of suicide. The strongest correlations held for the rate of unemployment and for the frequency of bankruptcy in times of obvious social disintegration coupled with diminished state safeguards against unemployment. Our hypothesis that the effects of economic factors would more strongly influence the rates of suicide by men as opposed to women could not be corroborated.

Cross-Sectional Studies↗
PubMed1994

Testing Durkheim's theory of suicide: additional results from Germany.

In a recent study of 14 European countries, Lester (1993), using inference statistical techniques, confirmed Durkheim's (1897) observation that lower birth rates were associated with higher suicide rates in 1870 and 1980. Due to changes in national boundaries, Germany was excluded from these analyses. Among the federal states of Germany, Bavaria most suitably lends itself to a study of the relationship between suicide and familial integration over time. A long-term analysis of the years between 1865 and 1980 reveals a prominent reciprocal relationship (r = -0.87; P < 0.001) between rates of suicide and birth in Bavaria. Marriage rates, on the other hand, correlate only minimally (r = -0.19 ns) with rates of suicide. Our results accord with Durkheim's view that unlike birth rates, higher marriage rates per se are only slightly associated with suicide rates.

Birth Rate↗
PubMed1994

Prevalence of insomnia in elderly general practice attenders and the current treatment modalities.

This study aimed to assess the prevalence and treatment modalities of elderly practice attenders. A total of 330 patients aged over 65 years were investigated with a questionnaire in general practice. To assess insomnia, operationalized diagnostic criteria according to DSM-III-R were applied. Twenty-three percent of the elderly patients suffered from severe, 17% from moderate and 17% from mild insomnia. More than 80% of the patients reported suffering from insomnia for 1-5 years or longer, which indicates a chronic course. Elderly patients showed unrealistic expectations concerning duration of sleep and spend more time in bed than they realistically can expect to sleep. More than half of the elderly patients reported habitual daytime napping. Sleep-disturbed elderly patients did not differ significantly from good sleepers in their habit of taking daytime naps, but even when taking daytime naps, good sleepers slept significantly longer than the sleep-disturbed patients. A significant association was found between insomnia and mental disorders, i.e., depression and organic brain syndrome according to the diagnosis of the general physician. In about half of the cases the primary care physician was not aware that the elderly patient suffered from severe insomnia. More than half of the elderly severe insomniacs took prescribed hypnotics habitually, mainly benzodiazepines.

Aged↗
PubMed1994

Physical exercise and psychological health.

For individuals who are just beginning to exercise, the very unfit, the elderly and persons suffering from psychiatric disorders, low intensity activity has important potential psychological benefits. Several studies indicate that mental health can be improved by low- or moderate-intensity activity. In 2 studies it could be demonstrated that aerobic exercise plus counselling was more effective in the treatment of depressive disorders than counselling alone. Cross-sectional community studies clearly reveal that after controlling for potential sociodemographic and health-related confounding variables the risk of depression is significantly higher for physically inactive individuals compared with regular exercisers. No final conclusions can be drawn from longitudinal field studies on the predictive value of physical activity on the degree of depressive symptoms. Several biological and psychological hypotheses have been proposed to explain the association between physical activity and mental health, however, there is still a lack of an integrated theoretical model.

Exercise↗
PubMed1994

Social risk factors in schizophrenia.

In analyzing the relationship between social factors and schizophrenia one can distinguish two research strategies. Studies can focus on individual differences or the aggregate level. Several investigations indicate that social factors, e.g., low socioeconomic status, single status, ethnic group, are significantly associated with the prevalence of schizophrenia. To explain this relationship most investigators favor the hypothesis of social selection rather than a social causation. This view is also supported by an ecological study of the incidence of psychiatrically treated schizophrenic disorders in the city of Mannheim.

Cross-Sectional Studies↗
PubMed1994

Sleep onset insomnia, sleep maintaining insomnia and insomnia with early morning awakening--temporal stability of subtypes in a longitudinal study on general practice attenders.

The present study investigated the temporal stability of insomnia patterns during a 4-month study period, classifying insomnia as sleep-onset insomnia, sleep-maintaining insomnia or insomnia with early morning awakening. In a longitudinal study design, 2,512 general practice attenders were investigated at the time of the first inquiry (T1) with a questionnaire. Four months later (T2), all patients complaining of difficulties in initiating and/or maintaining sleep and/or early morning awakening (n = 328) were again contacted by mail and received the same questionnaire as at T1. According to the reported symptoms, patients were assigned to the different subtypes of insomnia. The diagnosis at T1 was then compared with the diagnosis at T2 4 months later. Only about half of all patients who complained of difficulties in initiating sleep at T1 still exclusively reported sleep-onset insomnia 4 months later, whereas the remaining patients were distributed to different subtypes. The stability of sleep-maintaining insomnia and insomnia with early morning awakening was even lower. Comorbidity with a somatic or psychiatric disorder at T1 and change in hypnotic treatment did not account for the instability of the respective subgroup of insomnia. These findings illustrate that cross-sectional studies focusing on subtypes of insomnia, e.g. sleep-onset insomnia, may lead to erroneous results.

Adolescent↗