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  1. AU="Michael Denkinger"
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  1. Article ; Online: Use and benefit of information, communication, and assistive technology among community-dwelling older adults – a cross-sectional study

    Marina L. Fotteler / Thomas D. Kocar / Dhayana Dallmeier / Brigitte Kohn / Sarah Mayer / Ann-Kathrin Waibel / Walter Swoboda / Michael Denkinger

    BMC Public Health, Vol 23, Iss 1, Pp 1-

    2023  Volume 11

    Abstract: Abstract Background Technology can support healthy aging and empower older adults to live independently. However, technology adoption by older adults, particularly assistive technology (AT), is limited and little is known about the types of AT used among ...

    Abstract Abstract Background Technology can support healthy aging and empower older adults to live independently. However, technology adoption by older adults, particularly assistive technology (AT), is limited and little is known about the types of AT used among older adults. This study explored the use of key information and communication technologies (ICT) and AT among community-dwelling adults aged ≥ 65. Methods A cross-sectional study was conducted among community-dwelling adults aged ≥ 65 in southern Germany using a paper-based questionnaire. The questionnaire included questions on the three domains sociodemographic aspects, health status, and technology use. Technology use was considered separately for key ICT (smartphone, computer/laptop, and tablet) and a range of 31 different AT. Data were analyzed using descriptive statistics, univariate analyses, and Bernoulli Naïve Bayes modelling. Results The questionnaire was answered by 616 participants (response rate: 24.64%). ICT were used by 497 (80.68%) participants and were associated with lower age, higher level of education, living together with someone, availability of internet connection, higher interest in technology, and better health status (p < .05). No association was found with sex and size of the hometown. The most frequently owned AT were a landline phone, a body scale, and a blood pressure monitor. Several AT related to functionality, (instrumental) activities of daily living- (IADL), and morbidity were used more frequently among non-ICT users compared to ICT-users: senior mobile phone (19.33% vs. 3.22%), in-house emergency call (13.45% vs. 1.01%), hearing aid (26.89% vs. 16.7%), personal lift (7.56% vs. 1.61%), electronic stand-up aid (4.2% vs. 0%). Those with higher interest in technology reported higher levels of benefit from technology use. Conclusions Despite the benefits older adults can gain from technology, its use remains low, especially among those with multimorbidity. Particularly newer, more innovative and (I)ADL-related AT appear ...
    Keywords Information and communication technology ; Assistive technology ; Benefit ; Sociodemographic ; Older adults ; Cross-sectional ; Public aspects of medicine ; RA1-1270
    Subject code 306
    Language English
    Publishing date 2023-10-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Development of an innovative physical examination course involving handheld ultrasound devices [Version 2]

    Achim Jerg / Michael Denkinger / Lucia Jerg-Bretzke

    MedEdPublish, Vol 7, Iss

    2019  Volume 3

    Abstract: Several studies in recent years have shown that the physical examination skills of medical students are inadequate. In response to this deficit, a new teaching intervention has been developed consisting of five physical examination courses and a set of ... ...

    Abstract Several studies in recent years have shown that the physical examination skills of medical students are inadequate. In response to this deficit, a new teaching intervention has been developed consisting of five physical examination courses and a set of corresponding bedside teaching modules. The bedside modules are primarily intended to provide the opportunity for practical application of the examination techniques learned. One particularity of the bedside teaching was the use of handheld ultrasound (HHU) units in order to be able to visualize and verify/falsify diagnostic findings immediately. Since this demonstration of findings was standardized according to the specifications of the Rapid Ultrasound in Shock and Hypotension (RUSH) protocol, it constituted the basis for the communication of basic emergency ultrasound skills. A pilot study, which included an initial evaluation, has demonstrated this concept is feasible and is met with great interest on the part of the students.
    Keywords Clinical Skills ; Handheld Ultrasound ; Physical Examination ; Practical Training ; Special aspects of education ; LC8-6691 ; Medicine ; R
    Subject code 796
    Language English
    Publishing date 2019-01-01T00:00:00Z
    Publisher F1000 Research Ltd
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents

    Maria Beatrice Zazzara / Emanuele Rocco Villani / Katie Palmer / Daniela Fialova / Andrea Corsonello / Luca Soraci / Domenico Fusco / Maria Camilla Cipriani / Michael Denkinger / Graziano Onder / Rosa Liperoti

    Frontiers in Medicine, Vol

    Results from the SHELTER study

    2023  Volume 10

    Abstract: BackgroundFrailty, disability, and polypharmacy are prevalent in nursing home (NH) residents, often co-occurring with multimorbidity. There may be a complex interplay among them in terms of outcomes such as mortality. Aims of the study were to (i) assess ...

    Abstract BackgroundFrailty, disability, and polypharmacy are prevalent in nursing home (NH) residents, often co-occurring with multimorbidity. There may be a complex interplay among them in terms of outcomes such as mortality. Aims of the study were to (i) assess whether nursing home residents with polypharmacy (5–9 medications) or hyperpolypharmacy (≥10 drugs), have an increased risk of death and (ii) whether any association is modified by the co-presence of frailty or disability.MethodsCohort study with longitudinal mortality data including 4,023 residents from 50 European and 7 Israeli NH facilities (mean age = 83.6 years, 73.2% female) in The Services and Health for Elderly in Long Term care (SHELTER) cohort study. Participants were evaluated with the interRAI-LongTerm Care assessment tool. Frailty was evaluated with the FRAIL-NH scale. Hazard ratio (HR) of death over 12 months was assessed with stratified Cox proportional hazards models adjusted for demographics, facilities, and cognitive status.Results1,042 (25.9%) participants were not on polypharmacy, 49.8% (n = 2,002) were on polypharmacy, and 24.3% (n = 979) on hyperpolypharmacy. Frailty and disability mostly increased risk of death in the study population (frailty: HR = 1.85, 95%CI 1.49–2.28; disability: HR = 2.10, 95%CI 1.86–2.47). Among non-frail participants, multimorbidity (HR = 1.34, 95%CI = 1.01–1.82) and hyperpolypharmacy (HR = 1.61, 95%CI = 1.09–2.40) were associated with higher risk of death. Among frail participants, no other factors were associated with mortality. Polypharmacy and multimorbidity were not associated with mortality after stratification for disability.ConclusionsFrailty and disability are the strongest predictors of death in NH residents. Multimorbidity and hyperpolypharmacy increase mortality only in people without frailty. These findings may be relevant to identify patients who could benefit from tailored deprescription.
    Keywords drugs ; hyperpolypharmacy ; frailty ; long-term care facility ; mortality ; Medicine (General) ; R5-920
    Subject code 360
    Language English
    Publishing date 2023-02-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Anticholinergic Drug Exposure Increases the Risk of Delirium in Older Patients Undergoing Elective Surgery

    Matthias L. Herrmann / Cindy Boden / Christoph Maurer / Felix Kentischer / Eva Mennig / Sören Wagner / Lars O. Conzelmann / Bernd R. Förstner / Michael A. Rapp / Christine A. F. von Arnim / Michael Denkinger / Gerhard W. Eschweiler / Christine Thomas

    Frontiers in Medicine, Vol

    2022  Volume 9

    Abstract: IntroductionPostoperative delirium (POD) is a common and serious adverse event of surgery in older people. Because of its great impact on patients' safety and quality of life, identification of modifiable risk factors could be useful. Although ... ...

    Abstract IntroductionPostoperative delirium (POD) is a common and serious adverse event of surgery in older people. Because of its great impact on patients' safety and quality of life, identification of modifiable risk factors could be useful. Although preoperative medication intake is assumed to be an important modifiable risk factor, the impact of anticholinergic drugs on the occurrence of POD seems underestimated in elective surgery. The aim of this study was to investigate the association between preoperative anticholinergic burden and POD. We hypothesized that a high preoperative anticholinergic burden is an independent, potentially modifiable predisposing and precipitating factor of POD in older people.MethodsBetween November 2017 and April 2019, 1,470 patients of 70 years and older undergoing elective orthopedic, general, cardiac, or vascular surgery were recruited in the randomized, prospective, multicenter PAWEL trial. Anticholinergic burden of a sub-cohort of 899 patients, who did not receive a multimodal intervention for preventing POD, was assessed by two different tools at hospital admission: The established Anticholinergic Risk Scale (ARS) and the recently developed Anticholinergic Burden Score (ABS). POD was detected by confusion assessment method (CAM) and a validated post discharge medical record review. Logistic regression analyses were performed to evaluate the association between anticholinergic burden and POD.ResultsPOD was observed in 210 of 899 patients (23.4%). Both ARS and ABS were independently associated with POD. The association persisted after adjustment for relevant confounding factors such as age, sex, comorbidities, preoperative cognitive and physical status, number of prescribed drugs, surgery time, type of surgery and anesthesia, usage of heart-lung-machine, and treatment in intensive care unit. If a patient was taking one of the 56 drugs listed in the ABS, risk for POD was 2.7-fold higher (OR = 2.74, 95% CI = 1.55–4.94) and 1.5-fold higher per additional point on the ARS (OR = 1.54, 95% ...
    Keywords delirium ; acute encephalopathy ; surgery ; anticholinergic ; geriatric ; postoperative ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2022-05-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Supporting SURgery with GEriatric Co-Management and AI (SURGE-Ahead)

    Christoph Leinert / Marina Fotteler / Thomas Derya Kocar / Dhayana Dallmeier / Hans A Kestler / Dennis Wolf / Florian Gebhard / Adriane Uihlein / Florian Steger / Reinhold Kilian / Annabel S Mueller-Stierlin / Christoph W Michalski / André Mihaljevic / Christian Bolenz / Friedemann Zengerling / Elena Leinert / Sabine Schütze / Thomas K Hoffmann / Graziano Onder /
    Karen Andersen-Ranberg / Desmond O'Neill / Martin Wehling / Johannes Schobel / Walter Swoboda / Michael Denkinger / SURGE-Ahead Study Group

    PLoS ONE, Vol 18, Iss 6, p e

    A study protocol for the development of a digital geriatrician.

    2023  Volume 0287230

    Abstract: Introduction Geriatric co-management is known to improve treatment of older adults in various clinical settings, however, widespread application of the concept is limited due to restricted resources. Digitalization may offer options to overcome these ... ...

    Abstract Introduction Geriatric co-management is known to improve treatment of older adults in various clinical settings, however, widespread application of the concept is limited due to restricted resources. Digitalization may offer options to overcome these shortages by providing structured, relevant information and decision support tools for medical professionals. We present the SURGE-Ahead project (Supporting SURgery with GEriatric co-management and Artificial Intelligence) addressing this challenge. Methods A digital application with a dashboard-style user interface will be developed, displaying 1) evidence-based recommendations for geriatric co-management and 2) artificial intelligence-enhanced suggestions for continuity of care (COC) decisions. The development and implementation of the SURGE-Ahead application (SAA) will follow the Medical research council framework for complex medical interventions. In the development phase a minimum geriatric data set (MGDS) will be defined that combines parametrized information from the hospital information system with a concise assessment battery and sensor data. Two literature reviews will be conducted to create an evidence base for co-management and COC suggestions that will be used to display guideline-compliant recommendations. Principles of machine learning will be used for further data processing and COC proposals for the postoperative course. In an observational and AI-development study, data will be collected in three surgical departments of a University Hospital (trauma surgery, general and visceral surgery, urology) for AI-training, feasibility testing of the MGDS and identification of co-management needs. Usability will be tested in a workshop with potential users. During a subsequent project phase, the SAA will be tested and evaluated in clinical routine, allowing its further improvement through an iterative process. Discussion The outline offers insights into a novel and comprehensive project that combines geriatric co-management with digital support tools to ...
    Keywords Medicine ; R ; Science ; Q
    Subject code 650
    Language English
    Publishing date 2023-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Patient safety, cost-effectiveness, and quality of life

    Alba Sánchez / Christine Thomas / Friederike Deeken / Sören Wagner / Stefan Klöppel / Felix Kentischer / Christine A. F. von Arnim / Michael Denkinger / Lars O. Conzelmann / Janine Biermann-Stallwitz / Stefanie Joos / Heidrun Sturm / Brigitte Metz / Ramona Auer / Yoanna Skrobik / Gerhard W. Eschweiler / Michael A. Rapp / PAWEL Study group

    Trials, Vol 20, Iss 1, Pp 1-

    reduction of delirium risk and postoperative cognitive dysfunction after elective procedures in older adults—study protocol for a stepped-wedge cluster randomized trial (PAWEL Study)

    2019  Volume 15

    Abstract: Abstract Background Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare ... ...

    Abstract Abstract Background Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff. In this study, we will investigate whether a cross-sectoral and multimodal intervention for preventing delirium can reduce the prevalence of delirium and postoperative cognitive decline (POCD) in patients older than 70 years undergoing elective surgery. Additionally, we will analyze whether the intervention is cost-effective. Methods The study will be conducted at five medical centers (with two or three surgical departments each) in the southwest of Germany. The study employs a stepped-wedge design with cluster randomization of the medical centers. Measurements are performed at six consecutive points: preadmission, preoperative, and postoperative with daily delirium screening up to day 7 and POCD evaluations at 2, 6, and 12 months after surgery. Recruitment goals are to enroll 1500 patients older than 70 years undergoing elective operative procedures (cardiac, thoracic, vascular, proximal big joints and spine, genitourinary, gastrointestinal, and general elective surgery procedures). Discussion Results of the trial should form the basis of future standards for preventing delirium and POCD in surgical wards. Key aims are the improvement of patient safety and quality of life, as well as the reduction of the long-term risk of conversion to dementia. Furthermore, from an economic perspective, we expect benefits and decreased costs for hospitals, patients, and healthcare insurances. Trial registration German Clinical Trials Register, DRKS00013311. Registered on 10 November 2017.
    Keywords Cross-sectoral care ; Delirium prevention ; Postoperative cognitive dysfunction ; Dementia ; Older patients ; Elective surgery ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2019-01-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: The SITLESS project

    Maria Giné-Garriga / Laura Coll-Planas / Míriam Guerra / Àlex Domingo / Marta Roqué / Paolo Caserotti / Michael Denkinger / Dietrich Rothenbacher / Mark A. Tully / Frank Kee / Emma McIntosh / Carme Martín-Borràs / Guillermo R. Oviedo / Javier Jerez-Roig / Marta Santiago / Oriol Sansano / Guillermo Varela / Mathias Skjødt / Katharina Wirth /
    Dhayana Dallmeier / Jochen Klenk / Jason J. Wilson / Nicole E. Blackburn / Manuela Deidda / Guillaume Lefebvre / Denise González / Antoni Salvà

    Trials, Vol 18, Iss 1, Pp 1-

    exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: study protocol for a randomised controlled trial

    2017  Volume 14

    Abstract: Abstract Background Older adults are the fastest growing segment of the world‘s population. Recent evidence indicates that excessive sitting time is harmful to health, independent of meeting the recommended moderate to vigorous physical activity (PA) ... ...

    Abstract Abstract Background Older adults are the fastest growing segment of the world‘s population. Recent evidence indicates that excessive sitting time is harmful to health, independent of meeting the recommended moderate to vigorous physical activity (PA) guidelines. The SITLESS project aims to determine whether exercise referral schemes (ERS) can be enhanced by self-management strategies (SMSs) to reduce sedentary behaviour (SB), increase PA and improve health, quality of life and function in the long term, as well as psychosocial outcomes in community-dwelling older European citizens from four countries, within a three-armed pragmatic randomised controlled trial, compared with ERS alone and also with general recommendations about PA. Methods A total of 1338 older adults will be included in this study, recruited from four European countries through different existing primary prevention pathways. Participants will be randomly allocated into an ERS of 16 weeks (32 sessions, 45–60 min per session), ERS enhanced by seven sessions of SMSs and four telephone prompts, or a control group. Outcomes will be assessed at baseline, month 4 (end of ERS intervention), month 16 (12 months post intervention) and month 22 (18 months post intervention). Primary outcomes will include measures of SB (time spent sedentary) and PA (counts per minute). Secondary outcomes will include muscle and physical function, health economics’ related outcomes, anthropometry, quality of life, social networks, anxiety and depressive symptoms, disability, fear of falling, executive function and fatigue. A process evaluation will be conducted throughout the trial. The full analysis set will follow an intention-to-treat principle and will include all randomised participants for whom a baseline assessment is conducted. The study hypothesis will be tested with mixed linear models with repeated measures, to assess changes in the main outcomes (SB and PA) over time (baseline to month 22) and between study arms. Discussion The findings of this study may help ...
    Keywords Sedentary behaviour ; Physical activity ; Behaviour change ; Older adults ; Self-management strategies ; Medicine (General) ; R5-920
    Subject code 796
    Language English
    Publishing date 2017-05-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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