@article {11, title = {Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): study protocol for a cluster-randomised controlled trial.}, journal = {Implement Sci}, volume = {10}, year = {2015}, month = {2015 Jun 04}, pages = {82}, abstract = {

BACKGROUND: The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions.

METHODS/DESIGN: The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12~months of follow-up. Secondary outcomes are residents{\textquoteright} quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study.

DISCUSSION: To improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT02295462.

}, keywords = {Accidental Falls, Antipsychotic Agents, Costs and Cost Analysis, Dementia, Drug Utilization, Germany, Homes for the Aged, Humans, Inservice Training, Mental Disorders, Nursing Homes, Patient-Centered Care, Psychomotor Agitation, Quality of Life, Research Design}, issn = {1748-5908}, doi = {10.1186/s13012-015-0268-3}, author = {Richter, Christin and Berg, Almuth and Fleischer, Steffen and K{\"o}pke, Sascha and Balzer, Katrin and Fick, Eva-Maria and S{\"o}nnichsen, Andreas and L{\"o}scher, Susanne and Vollmar, Horst Christian and Haastert, Burkhard and Icks, Andrea and Dintsios, Charalabos-Markos and Mann, Eva and Wolf, Ursula and Meyer, Gabriele} } @article {14, title = {Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review.}, journal = {BMC Geriatr}, volume = {14}, year = {2014}, month = {2014 Jun 22}, pages = {80}, abstract = {

BACKGROUND: Residents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents.

METHOD: Systematic review of the literature of two databases (PubMed and CINAHL{\textregistered}). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data.

RESULTS: Twenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2\% to 77\%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents{\textquoteright} characteristics prior to admission (n = 6), residents{\textquoteright} or families{\textquoteright} wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools.

CONCLUSIONS: Most assessment tools are not comprehensive and do not take into account residents{\textquoteright} individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.

}, keywords = {Emergency Service, Hospital, Humans, Long-Term Care, Patient Admission, Patient Transfer, Residential Facilities}, issn = {1471-2318}, doi = {10.1186/1471-2318-14-80}, author = {Renom-Guiteras, Anna and Uhrenfeldt, Lisbeth and Meyer, Gabriele and Mann, Eva} } @article {13, title = {Compliance with trial registration in five core journals of clinical geriatrics: a survey of original publications on randomised controlled trials from 2008 to 2012.}, journal = {Age Ageing}, volume = {43}, year = {2014}, month = {2014 Nov}, pages = {872-6}, abstract = {

OBJECTIVE: to assess the proportion of registered randomised controlled trials in five core clinical geriatric journals and to analyse whether registered study outcomes correspond with published outcomes.

DESIGN: survey of original papers published 2008 to 2012.

METHODS: two independent reviewers retrieved the sample through search in the web-based archives of Age and Ageing, the Journal of the American Geriatric Society, the American Journal of Geriatric Psychiatry, the Journal of the American Medical Directors Association and International Psychogeriatrics. Data extraction was performed by two independent reviewers using a pre-tested 13-item checklist. Registration status was checked and information provided in registers compared with information presented in the original publication. A third reviewer was consulted if no consensus could be reached.

RESULTS: the sample comprised 220 original publications on randomised controlled trials. A total of 140 (63.6\%) were registered. Registration was in accordance with the ICMJE requirements in 54 out of 140 registered trials (38.6\%). Less than one-third of registered papers (n = 40) reported on all study outcomes listed in the study register. In 74 out of the 80 non-registered trials, the missing registration was not declared in the publication. There was no consistent upward trend towards higher registration compliance throughout journals and years.

CONCLUSION: our survey shows that prospective trial registration and compliance between outcomes declared in the registry and reported in the publication is poor. Concerted action of authors, editors and peer-reviewers is overdue aimed to irreversibly implement the imperative of registration of randomised controlled trials and complete outcome reporting.

}, keywords = {Geriatrics, Guideline Adherence, Guidelines as Topic, Humans, Periodicals as Topic, Publication Bias, Randomized Controlled Trials as Topic, Registries, Research Design}, issn = {1468-2834}, doi = {10.1093/ageing/afu086}, author = {Mann, Eva and Nguyen, Natalie and Fleischer, Steffen and Meyer, Gabriele} } @article {17, title = {Prevalence and associations of potentially inappropriate prescriptions in Austrian nursing home residents: secondary analysis of a cross-sectional study.}, journal = {Wien Klin Wochenschr}, volume = {125}, year = {2013}, month = {2013 Apr}, pages = {180-8}, abstract = {

BACKGROUND: Potentially inappropriate prescriptions (PIP) are an important cause of adverse medication-related events and increases morbidity, hospitalization, and health care costs, especially in nursing home residents. However, little is known about the associations between PIP and residents{\textquoteright} characteristics.

OBJECTIVE: The aim of our study was to analyse the prevalence and associations of PIP with residents{\textquoteright} and facilities{\textquoteright} characteristics.

METHODS: We performed a secondary analysis of a cross-sectional study with 48 out of 50 eligible nursing homes and 1,844 out of 2,005 eligible residents in a defined rural-urban area in Austria. The Austrian list of potentially inappropriate medications was applied for the evaluation of inappropriate prescribing. Cluster-adjusted multiple regression analysis was used to investigate institutional and residents{\textquoteright} characteristics associated with PIP.

RESULTS: Mean cluster-adjusted prevalence of residents with at least one PIP was 70.3 \% (95 \% CI 67.2-73.4). The number of residents with at least one psychotropic PIP was 1.014 (55 \%). The most often prescribed PIP were Prothipendyl (25.9 \% residents), Lorazepam (14.5 \%) and Diclofenac (6.1 \%). Multiple regression analysis showed an inverse association of PIP with cognitive impairment and significant positive associations with permanent restlessness and permanent negative attitude. The associations of PIP with age and male gender were inconsistent. No significant associations were found for PIP and the ratio of staff nurses to residents.

CONCLUSIONS: Our study results confirm that PIP is highly prevalent in the nursing home population. These results urgently call for effective interventions. Initiatives and successful interventions performed in other countries could serve as examples for safer prescribing in residents in Austria.

}, keywords = {Adult, Age Distribution, Aged, Austria, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Diclofenac, Female, Humans, Inappropriate Prescribing, Lorazepam, Male, Middle Aged, Nursing Care, Nursing Homes, Prescriptions, Prevalence, Psychomotor Agitation, Psychotropic Drugs, Risk Assessment}, issn = {1613-7671}, doi = {10.1007/s00508-013-0342-2}, author = {Mann, Eva and Haastert, Burkhard and B{\"o}hmdorfer, Birgit and Fr{\"u}hwald, Thomas and Iglseder, Bernhard and Roller-Wirnsberger, Regina and Meyer, Gabriele} } @article {20, title = {Prevalence of psychotropic medication use among German and Austrian nursing home residents: a comparison of 3 cohorts.}, journal = {J Am Med Dir Assoc}, volume = {13}, year = {2012}, month = {2012 Feb}, pages = {187.e7-187.e13}, abstract = {

BACKGROUND: Despite increasing knowledge about the limited effectiveness and severe adverse effects, the prescription rate of psychotropic medications in frail elderly persons remains high. Prescriptions are mainly made to control behavioral and psychological symptoms of dementia, although factors associated with prescriptions are rarely reported. However, such information is a prerequisite to develop intervention programs aiming to safely reduce psychotropic medication in nursing home residents.

METHODS: We report the comparison of cross-sectional data of psychotropic medication prescription rates from 3 large studies including nursing home residents in Germany and Austria. We aimed to compare the prevalence of (1) psychotropic medication, (2) different classes of psychotropic medication, (3) psychotropic medication administered for bedtime use, and (4) associations between prescription of psychotropics and institutional and residents{\textquoteright} characteristics. Confidence intervals of prevalences and multiple logistic regression analyses were adjusted for cluster correlation.

RESULTS: Data from 5336 residents in 136 long term care facilities were included. In Austria, 74.6\% (95\% CI 72.0-77.2\%) of all residents had a prescription of at least one psychotropic medication compared to Germany with about 51.8\% (95\% CI 48.3-55.2\%) and 52.4\% (95\% CI 48.7-56.1\%). Of all antipsychotics, 66\% (Austria) and 47\% (Germany) were prescribed for bedtime use. Most prescriptions were conventional, low-potency antipsychotics. In all 3 studies, there was no statistically significant association between psychotropic medication prescription and nursing home characteristics. On the level of residents, consistent positive associations were found for higher level of care dependency and permanent restlessness. Consistent negative associations were found for older age and male gender.

CONCLUSION: Frequency of psychotropic and especially antipsychotic medication is substantial in nursing home residents in Germany and Austria. The high number of prescriptions is likely to be an indicator for a perceived or actual lack of strategies to handle behavioral and psychological symptoms of dementia.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Austria, Cluster Analysis, Cross-Sectional Studies, Dementia, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Utilization, Female, Geriatric Assessment, Germany, Homes for the Aged, Humans, Logistic Models, Long-Term Care, Male, Nursing Homes, Prevalence, Psychotropic Drugs, Risk Assessment, Sex Distribution}, issn = {1538-9375}, doi = {10.1016/j.jamda.2011.03.007}, author = {Richter, Tanja and Mann, Eva and Meyer, Gabriele and Haastert, Burkhard and K{\"o}pke, Sascha} } @article {21, title = {Reporting quality of conference abstracts on randomised controlled trials in gerontology and geriatrics: a cross-sectional investigation.}, journal = {Z Evid Fortbild Qual Gesundhwes}, volume = {105}, year = {2011}, month = {2011}, pages = {459-62}, abstract = {

Without transparent reporting of how a randomised controlled trial was designed and conducted and of the methods used, its internal validity cannot be assessed by the reader. A congress abstract is often the only source providing information about a trial. In January 2008, an extended CONSORT statement on abstract reporting was published. Its impact has yet to be evaluated. Using a slightly modified CONSORT checklist comprising 17 items, we thus investigated the reporting quality of randomised controlled trials published in the book of abstracts presented at the World Congress of Geriatrics and Gerontology in Paris in July 2009. A total of n=4,416 abstracts was screened for inclusion; n=129 met the inclusion criteria. The overall quality of the abstracts was remarkably poor. The primary outcome was mentioned in 34/129 abstracts (26\%), none of the abstracts reported on the procedure of random allocation of participants or clusters, 21/129 abstracts (16\%) reported some kind of blinding, and the attrition rate was mentioned in only 12/129 abstracts (9\%). The majority of abstracts fulfilled two items: description of intended intervention for each group (102/129; 79\%) and general interpretation of results (107/129; 83\%). Trial status was reported in all abstracts. Both journal editors and committees organising congresses are requested to define the use of the CONSORT statement as a prerequisite in their guidelines for authors and to instruct reviewers to conduct compliance checks. Medical associations should finally endorse the indispensability of the CONSORT statement and publish it in their journals. Otherwise the intended benefits cannot be fully generated.

}, keywords = {Abstracting and Indexing, Checklist, Congresses as Topic, Cross-Sectional Studies, Geriatrics, Germany, Guidelines as Topic, Humans, Quality Assurance, Health Care, Randomized Controlled Trials as Topic, Research Design, Writing}, issn = {1865-9217}, doi = {10.1016/j.zefq.2010.07.011}, author = {Mann, Eva and Meyer, Gabriele} } @article {24, title = {Comparison of hip fracture incidence and trends between Germany and Austria 1995-2004: an epidemiological study.}, journal = {BMC Public Health}, volume = {10}, year = {2010}, month = {2010 Jan 29}, pages = {46}, abstract = {

BACKGROUND: Several studies evaluated variations in hip fracture incidences, as well as trends of the hip fracture incidences. Comparisons of trends are lacking so far. We compared the incidence rates and, in particular, its trends between Austria and Germany 1995 to 2004 analysing national hospital discharge diagnosis register data.

METHODS: Annual frequencies of hip fractures and corresponding incidences per 100,000 person years were estimated, overall and stratified for sex and age, assuming Poisson distribution. Multiple Poisson regression models including country and calendar year, age and sex were used to analyse differences in incidence and trend. The difference of annual changes between the two countries was explored using an interaction term (calender year * country).

RESULTS: Overall, the increase of hip fracture risk was 1.31 fold higher (95\% CI 1.29-1.34) in Austria compared to Germany, adjusted for age, sex, and calendar year. The risk increase was comparable for both sexes (males: RR 1.35 (1.32-1.37), females: RR 1.31 (1.29-1.33)). Hip fracture trend from 1995 to 2004 indicates an increase in both countries without a statistically significant difference between Austria and Germany (interaction term: p = 0.67).

CONCLUSION: In this study comparing hip fracture incidences and its trend using pooled data, the incidence in Austria was 30\% higher compared to its neighbouring country Germany. For both countries a similar increasing trend of hip fracture incidence over the 10-year study period was calculated. The results need confirmation by other studies.

}, keywords = {Adult, Aged, Aged, 80 and over, Austria, Female, Germany, Hip Fractures, Humans, Incidence, Male, Middle Aged, Poisson Distribution, Young Adult}, issn = {1471-2458}, doi = {10.1186/1471-2458-10-46}, author = {Mann, Eva and Meyer, Gabriele and Haastert, Burkhart and Icks, Andrea} } @article {23, title = {Discrepancies in national incidence trends for hip fracture: why does Austria have such a high incidence?}, journal = {Wien Klin Wochenschr}, volume = {122}, year = {2010}, month = {2010 Mar}, pages = {126-8}, keywords = {Accidental Falls, Age Factors, Aged, Austria, Causality, Cross-Cultural Comparison, Cross-Sectional Studies, Female, Germany, Hip Fractures, Humans, Incidence, Male, Middle Aged, Risk Factors, Sex Factors, Switzerland}, issn = {1613-7671}, doi = {10.1007/s00508-010-1321-5}, author = {Mann, Eva and Icks, Andrea and Meyer, Gabriele} } @article {22, title = {Is it really a true reversal?}, journal = {Wien Klin Wochenschr}, volume = {122}, year = {2010}, month = {2010 Sep}, pages = {545}, keywords = {Age Factors, Aged, Aged, 80 and over, Austria, Cross-Cultural Comparison, Cross-Sectional Studies, Female, Hip Fractures, Humans, Incidence, Male, Middle Aged, Sex Factors}, issn = {1613-7671}, doi = {10.1007/s00508-010-1454-6}, author = {Mann, Eva and Icks, Andrea and Haastert, Bernhard and Meyer, Gabriele} } @article {25, title = {Psychotropic medication use among nursing home residents in Austria: a cross-sectional study.}, journal = {BMC Geriatr}, volume = {9}, year = {2009}, month = {2009 May 21}, pages = {18}, abstract = {

BACKGROUND: The use of psychotropic medications and their adverse effects in frail elderly has been debated extensively. However, recent data from European studies show that these drugs are still frequently prescribed in nursing home residents. In Austria, prevalence data are lacking. We aimed to determine the prevalence of psychotropic medication prescription in Austrian nursing homes and to explore characteristics associated with their prescription.

METHODS: Cross-sectional study and association analysis in forty-eight out of 50 nursing homes with 1844 out of a total of 2005 residents in a defined urban-rural region in Austria. Prescribed medication was retrieved from residents{\textquoteright} charts. Psychotropic medications were coded according to the Anatomical Therapeutic Chemical Classification 2005. Cluster-adjusted multiple logistic regression analysis was performed to investigate institutional and residents{\textquoteright} characteristics associated with prescription.

RESULTS: Residents{\textquoteright} mean age was 81; 73\% of residents were female. Mean cluster-adjusted prevalence of residents with at least one psychotropic medication was 74.6\% (95\% confidence interval, CI, 72.0-77.2). A total of 45.9\% (95\% CI 42.7-49.1) had at least one prescription of an antipsychotic medication. Two third of all antipsychotic medications were prescribed for bedtime use only. Anxiolytics were prescribed in 22.2\% (95\% CI 20.0-24.5), hypnotics in 13.3\% (95\% CI 11.3-15.4), and antidepressants in 36.8\% (95\% CI 34.1-39.6) of residents. None of the institutional characteristics and only few residents{\textquoteright} characteristics were significantly associated with psychotropic medication prescription. Permanent restlessness was positively associated with psychotropic medication prescription (AOR 1.54, 95\% CI 1.32-1.79) whereas cognitive impairment was inversely associated (AOR 0.70, 95\% CI 0.56-0.88).

CONCLUSION: Frequency of psychotropic medication prescription is high in Austrian nursing homes compared to recent published data from other countries. Interventions should aim at reduction and optimisation of prescriptions.

}, keywords = {Adult, Aged, Aged, 80 and over, Austria, Cross-Sectional Studies, Female, Homes for the Aged, Humans, Male, Middle Aged, Nursing Homes, Psychotropic Drugs}, issn = {1471-2318}, doi = {10.1186/1471-2318-9-18}, author = {Mann, Eva and K{\"o}pke, Sascha and Haastert, Burkhard and Pitk{\"a}l{\"a}, Kaisu and Meyer, Gabriele} } @article {29, title = {[Chemical restraints in nursing homes in the federal state Vorarlberg, Austria--an analysis of nursing home documentation according to legal obligation and suggestions for future improvement].}, journal = {Wien Med Wochenschr}, volume = {158}, year = {2008}, month = {2008}, pages = {489-92}, abstract = {

High prevalence of chemical restraints in nursing homes is being criticised as suboptimal care. According to a new legal act, the Austrian "Heimaufenthaltsgesetz" 2005, nursing homes are obliged to report not only physical restraints but also chemical restraints. Using the Beers criteria we analysed all 78 notifications of chemical restraints registered during 18 months. Pronounced deficits concerning the selection of reporting criteria and the quality of doctors{\textquoteright} documentation of prescription were observed. National guidelines defining chemical restraints and providing valid assessment instruments are urgently warranted.

}, keywords = {Austria, Behavior Control, Diazepam, Documentation, Drug Prescriptions, Forecasting, Humans, Hypnotics and Sedatives, Nursing Homes, Tranquilizing Agents}, issn = {0043-5341}, doi = {10.1007/s10354-008-0549-4}, author = {Mann, Eva and Meyer, Gabriele} } @article {27, title = {Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994 to 2006.}, journal = {BMC Geriatr}, volume = {8}, year = {2008}, month = {2008 Dec 23}, pages = {35}, abstract = {

BACKGROUND: Hip fractures in the elderly are a major public health burden. Data concerning secular trends of hip fracture incidence show divergent results for age, sex and regions. In Austria, the hip fracture incidence in the elderly population and trends have not been analysed yet.

METHODS: Hip fractures in the population of 50 years and above were identified from 1994 to 2006 using the national hospital discharge register. Crude incidences (IR) per 100,000 person years and standardised incidences related to the European population 2006 were analysed. Estimate of age-sex-adjusted changes was determined using Poisson regression (incidence rate ratios, IRRs).

RESULTS: The number of hospital admissions due to hip fracture increased from a total number of 11,694 in 1994 to 15,987 in 2006. Crude incidences rates (IR) per 100.000 for men increased from 244.3 (95\% confidence interval (CI) 234.8 to 253.7) in 1994 to IR 330.8 (95\% CI 320.8 to 340.9) in 2006 and for women from 637.3 (95\% CI 624.2 to 650.4) in 1994 to IR 758.7 (95\% CI 745.0 to 772.4) in 2006. After adjustment for age and sex the annual hip fracture incidence increase was only small but statistically significant (IRR per year 1.01, 95\% CI 1.01 to 1.01, p < 0.01). Change of IRR over the 12 years study period was 13\%. It was significantly higher for men (IRR over 12 years 1.21, 95\% CI 1.16 to 1.27) than for women (IRR over 12 years 1.10, 95\% CI 1.06 to 1.14) (interaction: p = 0.03).

CONCLUSION: In contrast to findings in other countries there is no levelling-off or downward trend of hip fracture incidence from 1994 to 2006 in the Austrian elderly population. Further investigations should aim to evaluate the underlying causes in order to plan effective hip fracture reduction programmes.

}, keywords = {Aged, Aged, 80 and over, Austria, Female, Hip Fractures, Humans, Incidence, Male, Middle Aged}, issn = {1471-2318}, doi = {10.1186/1471-2318-8-35}, author = {Mann, Eva and Icks, Andrea and Haastert, Burkhard and Meyer, Gabriele} }