Carolin Donath - Academia.edu (original) (raw)

Papers by Carolin Donath

Health Care Utilization in Germany, 2013

BMC Health Services Research

Dementia and geriatric cognitive disorders extra, 2013

Institutionalization is the most important milestone in the care of dementia patients. This study... more Institutionalization is the most important milestone in the care of dementia patients. This study was aimed at identifying relevant predictors of institutionalization in a broad empirical context and interpreting them on the basis of the predictor model proposed by Luppa et al. [Dement Geriatr Cogn Disord 2008;26:65-78]. At the start of this study, 357 patients with mild to moderate dementia were examined by their general practitioners, and a telephone interview was conducted with their caregivers. Four years later, the outcomes 'institutionalization' and 'death' were determined from health insurance data. Forty-one variables were examined for their predictive influence by univariate and multivariate Cox regression. The risk of institutionalization increased significantly (p ≤ 0.05) with older ages of patients [hazard ratio (HR) = 1.05] and caregivers (HR = 1.03), a higher educational level of the caregiver (HR = 1.83), greater use of community health services (HR = ...

European Journal of Ageing, 2010

Caregiver counselling has proved to be effective in reducing the burden of family caregivers of d... more Caregiver counselling has proved to be effective in reducing the burden of family caregivers of dementia patients. Nevertheless, little is known about the influencing factors for utilization and quality expectations of family caregivers. In this article, we address the following questions on the theoretical base of the Andersen/Newman model: Which variables of the care situation, the caregivers and their attitudes

Value in Health, 2011

Background: Dementia patients are often cared for in institutional arrangements, which are associ... more Background: Dementia patients are often cared for in institutional arrangements, which are associated with substantial spending on professional long-term care services. Nevertheless, there is little evidence on the exact cost differences between community-based and institutional dementia care, especially when it comes to the distinct health care services. Adopting the perspective of the German social security system, which combines Statutory Health Insurance and Compulsory Long-Term Care Insurance (payer perspective), our study aimed to compare community-living and institutionalized dementia patients regarding their health care service utilization profiles and to contrast the respective expenditures. Methods: We analysed 2006 claims data for 2,934 institutionalized and 5,484 community-living individuals stratified by so-called care levels, which reflect different needs for support in activities of daily living. Concordant general linear models adjusting for clinical and demographic differences were run for each stratum separately to estimate mean per capita utilization and expenditures in both settings. Subsequently, spending for the community-living and the institutionalized population as a whole was compared within an extended overall model. Results: Regarding both settings, health and long-term care expenditures rose the higher the care level. Thus, long-term care spending was always increased in nursing homes, but health care spending was comparable. However, the underlying service utilization profiles differed, with nursing home residents receiving more frequent visits from medical specialists but fewer in-hospital services and anti-dementia drug prescriptions. Altogether, institutional care required additional yearly per capita expenses of ca. €200 on health and ca. €11,200 on long-term care. Conclusion: Community-based dementia care is cost saving from the payer perspective due to substantially lower long-term care expenditures. Health care spending is comparable but community-living and institutionalized individuals present characteristic service utilization patterns. This apparently reflects the existence of setting-specific care strategies. However, the bare economic figures do not indicate whether these different concepts affect the quality of care provision and disregard patient preferences and caregiver-related aspects. Hence, additional research combining primary and secondary data seems to be required to foster both, sound allocation of scarce resources and the development of patient-centred dementia care in each setting.

Value in Health, 2012

To compare a complex nondrug intervention including actively approaching counseling and caregiver... more To compare a complex nondrug intervention including actively approaching counseling and caregiver support groups with differing intensity against usual care with respect to time to institutionalization in patients with dementia. Within this three-armed cluster-randomized controlled trial, 390 community-dwelling patients aged 65 years or older with physician-diagnosed mild to moderate dementia and their caregivers were enrolled via 129 general practitioners in Middle Franconia, Germany. The intervention included general practitioners&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; training in dementia care and their recommendation of support groups and actively approaching caregiver counseling. Primary study end point was time to institutionalization over 2 years. In addition, long-term intervention effects were assessed over a time horizon of 4 years. Secondary end points included cognitive functioning, (instrumental) activities of daily living, burden of caregiving, and health-related quality of life after 2 years. Frailty models with strict intention-to-treat approach and mixed linear models were applied to account for cluster randomization. Health care costs were assessed from the societal perspective. After 2 (4) years, 12% (24%) of the patients were institutionalized and another 21% (35%) died before institutionalization. No significant differences between study groups were observed with respect to time to institutionalization after 2 and 4 years (P 0.25 and 0.71, respectively). Secondary end points deteriorated, but differences were not significant between study groups. Almost 80% of the health care costs were due to informal care. Total annual costs amounted to more than €47,000 per patient and did not differ between study arms. The intervention showed no effects on time to institutionalization and secondary outcomes.

Journal of the American Geriatrics Society, 2012

To determine the efficacy of multimodal, nondrug therapy on symptoms of dementia and need for car... more To determine the efficacy of multimodal, nondrug therapy on symptoms of dementia and need for care in institutionalized individuals with degenerative dementia. Randomized, controlled, longitudinal trial. Data were analyzed using multiple linear regression. Five German nursing homes. One hundred thirty-nine nursing home residents with primary degenerative dementia (Mini-Mental State Examination score &amp;amp;amp;amp;amp;lt; 24). The 6-month intervention comprised three components: motor stimulation, activities of daily living, and cognitive stimulation (MAKS). Groups of 10 patients led by two therapists participated in the standardized intervention for 2 hours, 6 days a week. The intervention was described in detail in an intervention manual. Adherence to the manual was high. Controls received treatment as usual. Overall geriatric symptoms were recorded using the Nurses&amp;amp;amp;amp;amp;#39; Observation Scale for Geriatric Patients, functional independence using the Barthel Index, and care time using the Resource Utilization in Dementia-Formal Care. Of 646 individuals screened, 146 were eligible, and 130 were included in the intention-to-treat analysis. At 6 months, results of the per-protocol analysis (n = 119) showed improvement in overall dementia symptoms in the MAKS group and no change in the control group (adjusted mean difference (AMD) = -6.8, 95% confidence interval (CI) = -10.3 to -3.3; P &amp;amp;amp;amp;amp;lt; .001, Cohen d = 0.66). This effect was greatest on the social behavior (AMD = -1.9, 95% CI = -2.9 to -0.8; P &amp;amp;amp;amp;amp;lt; .001; Cohen d = 0.54) and instrumental activity of daily living (IADL) (AMD = -1.4, 95% CI = -2.5 to -0.30; P = .01; Cohen d = 0.43) subscales. No effect was seen on functional independence or total care time. This 6-month nondrug multimodal intervention improved dementia symptoms in nursing home residents, especially in social behavior and IADL capabilities.

Fortschritte der Neurologie · Psychiatrie, 2010

Various studies in industrialised European and non-European countries have expressed concern abou... more Various studies in industrialised European and non-European countries have expressed concern about the link between alcoholic drinks (e. g. alcoholic sodas, so called "alcopops") and binge drinking in adolescents and young adults. Binge drinking has been shown to be associated with considerable social harm and disease burden. Adolescent alcohol abuse including binge drinking is common, but the extent of the problem and the specific risk factors leading to binge drinking behaviour remains unclear. Although the long-term health of adolescent binge drinking has not been studied in detail, first studies report an elevated risk for physical injury, aggression, violent or driving offences while intoxicated and high-risk sexual behaviour. To date, a variety of socio-demographical characteristics associated with binge drinking have been studied. However, knowledge in this area is limited, as most research has been conducted among specific groups (i. e. North American college students, adolescents in Australia etc.). More and intensive research in Germany and other European countries is urgently needed, as results from other cultural backgrounds are not necessarily transferable.

BMC Public Health, 2012

Background: As epidemiological surveys have shown, binge drinking is a constant and wide-spread p... more Background: As epidemiological surveys have shown, binge drinking is a constant and wide-spread problem behavior in adolescents. It is not rare to find that more than half of all adolescents engage in this behavior when assessing only the last 4 weeks of time independent of the urbanity of the region they live in. There have been several reviews on predictors of substance consumption in adolescents in general, but there has been less high quality research on predictors of binge drinking, and most studies have not been theoretically based. The current study aimed to analyze the ultimate and distal factors predicting substance consumption according to Petraitis' theory of triadic influence. We assessed the predictive value of these factors with respect to binge drinking in German adolescents, including the identification of influence direction.

BMC Public Health, 2011

Background: Binge drinking is a constant problem behavior in adolescents across Europe. Epidemiol... more Background: Binge drinking is a constant problem behavior in adolescents across Europe. Epidemiological investigations have been reported. However, epidemiological data on alcohol consumption of adolescents with different migration backgrounds are rare. Furthermore representative data on rural-urban comparison concerning alcohol consumption and binge drinking are lacking. The aims of the study are the investigation of alcohol consumption patterns with respect to a) urban-rural differences and b) differences according to migration background. Methods: In the years 2007/2008, a representative written survey of N = 44,610 students in the 9 th. grade of different school types in Germany was carried out (net sample). The return rate of questionnaires was 88% regarding all students whose teachers respectively school directors had agreed to participate in the study. Weighting factors were specified and used to make up for regional and school-type specific differences in return rates. 27.4% of the adolescents surveyed have a migration background, whereby the Turkish culture is the largest group followed by adolescents who emigrated from former Soviet Union states. The sample includes seven large cities (over 500,000 inhabitants) (12.2%), independent smaller cities ("urban districts") (19.0%) and rural areas ("rural districts") (68.8%).

BMC Pediatrics, 2014

Background: Suicidal ideation and suicide attempts are serious but not rare conditions in adolesc... more Background: Suicidal ideation and suicide attempts are serious but not rare conditions in adolescents. However, there are several research and practical suicide-prevention initiatives that discuss the possibility of preventing serious self-harm. Profound knowledge about risk and protective factors is therefore necessary. The aim of this study is a) to clarify the role of parenting behavior and parenting styles in adolescents' suicide attempts and b) to identify other statistically significant and clinically relevant risk and protective factors for suicide attempts in a representative sample of German adolescents. Methods: In the years 2007/2008, a representative written survey of N = 44,610 students in the 9 th grade of different school types in Germany was conducted. In this survey, the lifetime prevalence of suicide attempts was investigated as well as potential predictors including parenting behavior. A three-step statistical analysis was carried out: I) As basic model, the association between parenting and suicide attempts was explored via binary logistic regression controlled for age and sex. II) The predictive values of 13 additional potential risk/protective factors were analyzed with single binary logistic regression analyses for each predictor alone. Non-significant predictors were excluded in Step III. III) In a multivariate binary logistic regression analysis, all significant predictor variables from Step II and the parenting styles were included after testing for multicollinearity. Results: Three parental variables showed a relevant association with suicide attempts in adolescents -(all protective): mother's warmth and father's warmth in childhood and mother's control in adolescence (Step I). In the full model (Step III), Authoritative parenting (protective: OR: .79) and Rejecting-Neglecting parenting (risk: OR: 1.63) were identified as significant predictors (p < .001) for suicidal attempts. Seven further variables were interpreted to be statistically significant and clinically relevant: ADHD, female sex, smoking, Binge Drinking, absenteeism/truancy, migration background, and parental separation events. Conclusions: Parenting style does matter. While children of Authoritative parents profit, children of Rejecting-Neglecting parents are put at riskas we were able to show for suicide attempts in adolescence. Some of the identified risk factors contribute new knowledge and potential areas of intervention for special groups such as migrants or children diagnosed with ADHD.

BMC Medicine, 2011

Background: Currently available pharmacological and non-pharmacological treatments have shown onl... more Background: Currently available pharmacological and non-pharmacological treatments have shown only modest effects in slowing the progression of dementia. Our objective was to assess the impact of a long-term nonpharmacological group intervention on cognitive function in dementia patients and on their ability to carry out activities of daily living compared to a control group receiving the usual care. Methods: A randomized, controlled, single-blind longitudinal trial was conducted with 98 patients (follow-up: n = 61) with primary degenerative dementia in five nursing homes in Bavaria, Germany. The highly standardized intervention consisted of motor stimulation, practice in activities of daily living, and cognitive stimulation (acronym MAKS). It was conducted in groups of ten patients led by two therapists for 2 hours, 6 days a week for 12 months. Control patients received treatment as usual. Cognitive function was assessed using the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog), and the ability to carry out activities of daily living using the Erlangen Test of Activities of Daily Living (E-ADL test) at baseline and after 12 months. Results: Of the 553 individuals screened, 119 (21.5%) were eligible and 98 (17.7%) were ultimately included in the study. At 12 months, the results of the per protocol analysis (n = 61) showed that cognitive function and the ability to carry out activities of daily living had remained stable in the intervention group but had decreased in the control patients (ADAS-Cog: adjusted mean difference: -7.7, 95% CI -14.0 to -1.4, P = 0.018, Cohen's d = 0.45; E-ADL test: adjusted mean difference: 3.6, 95% CI 0.7 to 6.4, P = 0.015, Cohen's d = 0.50). The effect sizes for the intervention were greater in the subgroup of patients (n = 50) with mild to moderate disease (ADAS-Cog: Cohen's d = 0.67; E-ADL test: Cohen's d = 0.69). Conclusions: A highly standardized, non-pharmacological, multicomponent group intervention conducted in a nursing-home setting was able to postpone a decline in cognitive function in dementia patients and in their ability to carry out activities of daily living for at least 12 months.

BMC Health Services Research, 2011

Background: The investigation of the predictive variables for utilisation of day care and the vie... more Background: The investigation of the predictive variables for utilisation of day care and the views of family caregivers of dementia patients about quality of day care are the goals of this work. Methods: The cross-sectional study was carried out as an anonymous written survey of family caregivers of dementia patients in Germany. Participants were 404 family caregivers of dementia patients, of these 128 were users of day care, 269 were non-users and 7 gave no details about utilisation. Qualitative and quantitative data were analysed using qualitative content analysis and binary logistic regression analysis. Results: The assessment of how helpful day care is for the individual care situation and the age of the family caregiver are significant predictors for utilisation of day care. Caregivers most frequently cited a programme of activities suited to the abilities of the dementia patients as quality criterion. Conclusions: In order to reduce the number of those caregivers who think they don't need day care compared with the number who really don't need it, caregivers should be transparently informed of the relevant advantages and quality principles of using day care. According to caregivers' wishes, the organisation of day care centres must include activities suited for dementia patients.

BMC Health Services Research, 2010

More than 90% of dementia patients are cared for by their general practitioners, who are decisive... more More than 90% of dementia patients are cared for by their general practitioners, who are decisively involved in the diagnosis, therapy and recommendation of support services. To test whether special training of general practitioners alters the care of dementia patients through their systematic recommendation of caregiver counseling and support groups. 129 general practitioners enrolled 390 dementia patients and their informal caregivers in a prospective, three-arm cluster-randomized 2-year study. Arm A constituted usual care, in Arm B and C support groups and caregiver counseling (in Arm B one year after baseline, in Arm C at baseline) were recommended by the general practitioners. The general practitioners received arm-specific training. Diagnostic and therapeutic behavior of physicians was recorded at baseline. Informal caregivers were questioned in follow-up after 2 years about the utilization of support services. The diagnostic behavior of the general practitioners conforms to relevant guidelines. The procedure in newly-diagnosed patients does not differ from previously diagnosed patients with the exception of the rate of referral to a specialist. About one-third of the newly-diagnosed dementia patients are given an anti-dementia drug. The utilization of support groups and counseling increased five- and fourfold, respectively. Utilization of other support services remained low (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 10%), with the exception of home nursing and institutional short-term nursing. Trained general practitioners usually act in conformity with guidelines with respect to diagnosing dementia, and partly in conformity with the guidelines with respect to recommended drug therapy. Recommendations of support services for informal caregivers by the general practitioner are successful. They result in a marked increase in the utilization rate for the recommended services compared to offers which are not recommended by the general practitioner. ISRCTN68329593.

BMC Geriatrics, 2010

Background: Counselling of family members is an established procedure in the support of dementia ... more Background: Counselling of family members is an established procedure in the support of dementia patients' relatives. In absence of widespread specialised dementia care services in most countries, however, counselling services are often not taken up or only very late in the course of the disease.

Archives of Gerontology and Geriatrics, 2011

Alcohol and Alcoholism, 2011