The subjective side of delirium (SSD)
The explorative single-arm study is multicentre, carried out in co-operation with the Agaplesion Bethesda Hospital Bergedorf in Hamburg and the Bremerhaven Reinkenheide Hospital in Bremerhaven and includes both qualitative and quantitative aspects.
Delirium is a serious, acute state of confusion that often occurs in older people during a hospital stay. Little is known about the subjective side of delirium, i.e. the experiences of the person affected, except for individual case reports. Patients who have overcome delirium report very different perceptions, which have so far only been recorded in small studies. The interviews with patients who have experienced delirium should help to characterise the experience of those affected and help to identify starting points for delirium treatment as well as to analyse the connection between subjective experiences and objectifiable data.
Video-based physiotherapy in older adults in the context of the COVID-19 pandemic- "ConVideo".
Older people were considered as a high-risk group for a severe course of COVID-19 infections, and were therefore encouraged to limit their social life and their daily activities outside their own home as much as possible. However, reducing daily activities increases the risk to lose muscle strength and functional abilities. Although physiotherapy could be used to counteract these losses, many older patients avoid contact with physiotherapists in order to prevent infection.
During the pandemic, the health insurance associations at the national level and the GKV-Spitzenverband decided, to allow the conduction of physiotherapy via video. The possibility and willingness of older people to use this form of therapy and possible barriers are not yet known. The same applies to the technical and organizational framework for this therapy option.
The purpose of this study is to investigate whether and how the provision of video-based physiotherapy has an effect on the maintenance of care for persons aged 60 years and older and how the new form of therapy is subjectively perceived by physiotherapists and patients or which forms of therapy are or are not suitable for video therapy. Another goal is to assess activity, participation, and health-related quality of life before, during, and after the corona crisis or its associated limitations.
Participating physiotherapy practices in the Oldenburg area were supported by the study team in providing video therapy to individuals above the age of 60 years by providing hardware (tablets with mobile data) with appropriate software (video telephone application) and received instructions on how to use the system. At baseline and after completion of the study, sociodemographic and health-related data as well as standardized questionnaires on physical activity, quality of life, and participation were collected by means of telephone interviews to assess the impact of the corona crisis on patients. Therapists briefly document aspects of the connection quality and feasibility of the treatment after each therapy session. Patients were asked about their subjective perception of videotherapy after the end of the study.
Effects of rollator use on posture, gait and balance in old age (RollGa)
The use of rollators is widespread and is intended to support safety when walking, the preservation of walking ability and the associated independence in old age. However, their use also carries risks of falls and an increasing loss of physiological gait. After initial improvements of the gait pattern, a deterioration of gait quality often occurs with continued rollator use. The effects of a rollator on posture in combination with dynamic balance have not yet been investigated.
In this study, the influence of a rollator on posture, physiological gait pattern and dynamic balance in older people aged 70 and over will be investigated. The project will be implemented using qualitative (Phase I) and quantitative methods (Phase II).
In phase I, individual interviews with rollator users and focus group discussions with medical professionals will be conducted. In this way, needs can be identified and an internal view of the prescription processes regarding rollator use can be analysed. In phase II of the project, gait analyses will be carried out on test persons with and without a rollator as well as persons with and without subjective gait insecurity. The measurements will be carried out using a new type of treadmill. Everyday disturbances in the gait pattern (e.g. stumbling or swaying) can thus be simulated under safe conditions and provide new insights into the movement behaviour of the different groups.
The aim is to implement the findings in the care process for people with gait disorders. This includes the development of standardised criteria for the indication of a rollator and the development of intervention programmes to improve the gait pattern and reduce the risk of falls in permanent and transitional rollator use.
Constraints on social life in the context of the COVID-19 pandemic - impact on physical capacity and health-related quality of life of older people (CoNFINE)
The measures taken to flatten the infection rate during the Covid-19 pandemic were accompanied by enormous restrictions on social life, some of which still persist at present. In particular, the at-risk group of older people not only comply with the respective imposed contact bans, but have also been restricting their activities of daily living on their own for quite some time. Especially the two-month interruption of the availability of structured sports activities could have an enormous impact on the physical performance and health-related quality of life of older people and be more pronounced compared to younger people. To assess the impact of these limitations, the study will compare older (≥ 60 years) and younger (45-59 years) people from physiotherapy practices exercising in a milon circuit. The training data recorded via the milon circuit software allow an objective comparison of physical performance before the measures came into effect from mid-March with the training data that can be recorded when training is resumed. These values will be compared between age groups as well as followed up over a period of 6 months after resumption of training. Participants will be asked about their physical activity and quality of life before, during (retrospectively) and after the pandemic-related limitations. On the one hand, this enables the recording of objectively measurable functional changes and, on the other hand, the survey and comparison with possible changes in physical activity and quality of life during and after the limitations of social life and structured training opportunities in the context of the COVID-19 pandemic.
Introduction of a care system for people with dementia
The project "Introduction of patient-centered care for people with dementia" was funded by the Lower Saxony State Office for Social Affairs, Youth and Family. Starting in 2020, a patient-centred care system was set up at the geriatric ward and in the geriatric trauma centre of the Klinikum Oldenburg. Care givers were trained to give individualized care for patients with dementia and or delirium, and worked outside of regular working shifts. The scientific part of the project was designed to observe the improvement of care for patients with dementia by nursing staff, as well as the overall perception of these specialized nursing staff by the team of the respective ward.
In this context, the potential improvement in delirium, depression, cognitive status, frequency of falls, eating behaviour, and length of hospital stay was documented. Functional and cognitive abilities as well as food intake were recorded before, during and at the end of the hospital stay. Family members were also surveyed to rate the patient-centred care system.
In addition, it was assessed how the nursing team in the hospital can be relieved by the specialized nursing staff who, for example, can no longer work in the 3-shift model for, i.e. family reasons.
The Multidimensional Prognostic Index (MPI) for prognostic stratification of older hospitalised patients with Covid-19: a prospective observational cohort Study (MPI_Covid-19).
The study will investigate the applicability of the Multidimensional Prognostic Index (MPI) among hospitalised patients above the age of 65 years who are infected with COVID-19.
This observational, prospective, multicentre study is led by Prof. Priv.-Doz. Dr. Dr. M. Cristina Polidori Nelles of the Clinic II for Internal Medicine at the University of Cologne.
The MPI is a prognostic tool to determe short-term and long-term mortality risk. Multicentre studies have already shown that the MPI had excellent accuracy and calibration in predicting clinical outcomes during hospitalisation and its duration. To date, the MPI has been validated in over 50 international studies involving more than 54,000 older adults suffering from the most common chronic and acute age-related diseases associated with high mortality. Recently, it was demonstrated that the MPI can predict clinical outcome after non-invasive ventilation in patients with respiratory failure. Up to now, there are no studies on the use of the MPI to predict prognosis in older COVID-19 patients.
The MPI is calculated using information derived from a standardised comprehensive geriatric assessment in eight domains: basal and instrumental activities of daily living, cognitive status, risk of decubitus due to immobility, nutrition, multimorbidity, number of medications taken, living situation.
The primary objective of this study is to assess, if the MPI is able to predict 1) the ICU admission, and 2) the mortality in hospitals among older inpatients with a Covid-19 infection. Furthermore, it is assessed, if the MPI after three months can predict a) the duration of stay, b) rehospitalisation, c) admission to long-term care facilities, and/or d) mortality.