Background Outpatient follow-up care for stroke survivors is often inadequate and mostly self-organized by the patients themselves. In the German health care system, there are no standard care programs for patients after they are discharged from the hospital to support them with their multifaceted and heterogeneous health care needs. The objective of this complex intervention study was to evaluate the effectiveness of a post-stroke care coordination program in comparison to standard care in the first year after a stroke. Methods Patients aged 55 and older who had survived a stroke or a transient ischemic attack (TIA) within the last 6 months before enrollment were included. Participants received care coordination either by telephone or face-to-face for up to 1 year. Patients’ health insurance claims data were used to measure outcomes. The control group consisted of stroke survivors receiving standard care and was constructed by exact matching based on six criteria. Outcome measures were health services utilization, rate of recurrent events, readmissions and accompanying costs, and mortality. Outcomes were tested using different multiple models. Results In total, N = 361 patients were included in the analyses. Intervention participants had seen an outpatient neurologist more often (OR = 4.75; 95% CI: 2.71–8.31) and were readmitted to a hospital less frequently (IRR = 0.42; 95% CI: 0.29–0.61), resulting in lower hospital costs (IQR = €0–1910 in the intervention group, IQR = €0–4375 in the control group). There were no substantial group differences in the rate of recurrent events and mortality. Conclusion This study showed the beneficial potential of care coordination for a vulnerable patient population: the utilization rate of important health services was increased, and the rate of hospital readmissions decreased as a result. Future research should focus on the risk of recurrent strokes and the long-term effects of improved care. Trial registration DRKS00017526 on DRKS – German Clinical Trials Register (retrospectively registered: 21 June 2019).

It may be assumed that women have a higher risk of becoming care-dependent after stroke than men because they are older and suffer more often from geriatric conditions such as urinary incontinence at onset of stroke. Preventive strategies should therefore focus on geriatric conditions in order to reduce the post-stroke care dependency risk for women.

The gender effect is attributed to the BKK member structure, and especially the high proportion of women in the older age groups. Discussion of stroke frequency in Germany needs to take structural differences between study types into account. There are two vulnerable groups that tend to be underrepresented: TIA patients with a high risk of recurrent strokes, and high-risk patients who have already had a stroke and are care-dependent, which are often unspecifically coded. In the future, study designs should include the whole range of stroke coding, thus enabling differentiated analyses.

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BackgroundMost studies on food choice have been focussing on the individual level but familial aspects may also play an important role. This paper reports of a novel study that will focus on the familial aspects of the formation of food choice among men and women aged 50–70 years by recruiting spouses and siblings (NutriAct Family Study; NFS).MethodsData is collected prospectively via repeatedly applied web-based questionnaires over the next years. The recruitment for the NFS started in October 2016. Participants are recruited based on an index person who is actively participating in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. This index person was asked to invite the spouse, a sibling or an in-law. If a set of family members agreed to participate, access to individualized web-based questionnaires assessing dietary intake, other health related lifestyle habits, eating behaviour, food responsiveness, personality, self-regulation, socio-economic status and socio-cultural values was provided. In the first phase of the NSF, recruitment rates were monitored in detail and participants’ comments were analysed in order to improve the feasibility of procedures and instruments.DiscussionUntil August 4th 2017, 4783 EPIC-Participants were contacted by mail of which 446 persons recruited 2 to 5 family members (including themselves) resulting in 1032 participants, of whom 82% had started answering or already completed the questionnaires. Of the 4337 remaining EPIC-participants who had been contacted, 1040 (24%) did not respond at all, and 3297 (76%) responded but declined, in 51% of the cases because of the request to recruit at least 2 family members in the respective age range. The developed recruitment procedures and web-based methods of data collection are capable to generate the required study population including the data on individual and inter-personal determinants which will be linkable to food choice. The information on familial links among the study participants will show the role of familial traits in midlife for the adoption of food choices supporting healthy aging.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5814-x) contains supplementary material, which is available to authorized users.

Context Unfavorable diets contribute to the global burden of disease and particularly affect individuals’ health in old age. To promote healthy aging, it is vital to understand the biographical circumstances under which diets manifest and change. Objective This systematic mixed-studies review explored changes in dietary styles of people facing retirement. Data Sources Seven electronic databases were searched systematically, along with reference lists. Data Extraction Five qualitative and five quantitative studies were identified out of n = 974 records screened. Relevant study characteristics were extracted with a piloted form. Data Synthesis A qualitative convergent synthesis design was conducted. Results Study results were inconsistent. The majority of studies identified various dietary-style changes after retirement – some in favorable ways (eg, increased vegetable consumption [n = 4]) and some in rather unfavorable ways (eg, increased snacking [n = 2]). Influencing factors were changes in mealtime structures, available time, and financial situations accompanying retirement. Conclusion More high-quality, longitudinal research is needed to build a sound basis for interventions by utilizing the retirement transition as a window of opportunity for dietary changes. Systematic Review Registration PROSPERO registration no. CRD42018074049.

Background Self-reported health (SRH) and life satisfaction (LS) are patient-reported outcomes (PROs) that independently predict mortality and morbidity in older adults. Emergency department (ED) visits due to serious health problems or accidents might pose critical life events for patients. This study aimed (a) to characterize older patients’ SRH and LS during the distinct event of an ED stay, and (b) to analyze concomitant associations of PROs with ED patients’ sociodemographic, disease-specific and care-related variables. Methods Study personnel recruited mostly older ED patients from three disease groups during a two-year period (2017–2019) in eight EDs in central Berlin, Germany, in the context of the health services research network EMANet. Cross-sectional data from the baseline patient survey and associated secondary data from hospital information systems were analyzed. Multilevel linear regression models with random intercept were applied to assess concomitant associations with SRH (scale: 0 (worst) to 100 (best)) and LS (scale: 0 (not at all satisfied) to 10 (completely satisfied)) as outcomes, including sensitivity analyses. Results The final sample comprised N = 1435 participants. Mean age was 65.18 (SD: 16.72) and 50.9% were male. Mean ratings of SRH were 50.10 (SD: 23.62) while mean LS scores amounted to 7.15 (SD: 2.50). Better SRH and higher LS were found in patients with cardiac symptoms (SRH: β = 4.35, p = .036; LS: β = 0.53, p = .006). Worse SRH and lower LS were associated with being in need of nursing care (SRH: β = − 7.52, p < .001; LS: β = − 0.59, p = .003) and being unemployed (SRH: β = − 8.54, p = .002; LS: β = − 1.27, p < .001). Sex, age, number of close social contacts, and hospital stays in the previous 6 months were additionally related to the outcomes. Sensitivity analyses largely supported results of the main sample. Conclusions SRH and LS were associated with different sociodemographic and disease-related variables in older ED patients. Nursing care dependency and unemployment emerged as significant factors relating to both outcomes. Being able to identify especially vulnerable patients in the ED setting might facilitate patient-centered care and prevent negative health outcomes. However, further longitudinal research needs to analyze trajectories in both outcomes and suitable intervention possibilities in the ED setting. Trial registration EMANet sub-studies were registered separately: German Clinical Trials Register (EMAAge: DRKS00014273, registration date: May 16, 2018; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014273; EMACROSS: DRKS00011930, registration date: April 25, 2017; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011930); ClinicalTrials.gov (EMASPOT: NCT03188861, registration date: June 16, 2017; https://clinicaltrials.gov/ct2/show/NCT03188861?term=NCT03188861&draw=2&rank=1).

BackgroundHip fractures in older people are a common health problem often associated with malnutrition that might affect outcomes. Screening for malnutrition is not a routine examination in emergency departments (ED). This analysis of the EMAAge study, a prospective, multicenter cohort study, aimed to evaluate the nutritional status of older patients (≥ 50 years) with hip fracture, factors associated with malnutrition risk, and the association between malnutrition and the six-months mortality.MethodsRisk of malnutrition was evaluated using the Short Nutritional Assessment Questionnaire. Clinical data as well as data on depression and physical activity were determined. Mortality was captured for the first six months after the event. To assess factors associated with malnutrition risk we used a binary logistic regression. A Cox proportional hazards model was used to assess the association of malnutrition risk with six-month survival adjusted for other relevant risk factors.ResultsThe sample consisted of N = 318 hip fracture patients aged 50 to 98 (68% women). The prevalence of malnutrition risk was 25.3% (n = 76) at the time of injury. There were no differences in triage categories or routine parameters measured in the ED that could point to malnutrition. 89% of the patients (n = 267) survived for six months. The mean survival time was longer in those without malnutrition risk (171.9 (167.1–176.9) days vs. 153.1 (140.0–166.2) days). The Kaplan Meier curves and the unadjusted Cox regression (Hazard Ratio (HR) 3.08 (1.61–5.91)) showed differences between patients with and patients without malnutrition risk. In the adjusted Cox regression model, risk of death was associated with malnutrition risk (HR 2.61, 1.34–5.06), older age (70–76 years: HR 2.5 (0.52–11.99); 77–82 years: HR 4.25 (1.15–15.62); 83–99 years: HR 3.82 (1.05–13.88)) and a high burden of comorbidities (Charlson Comorbidity Index ≥3: HR 5.4 (1.53–19.12)).ConclusionRisk of malnutrition was associated with higher mortality after hip fracture. ED parameters did not differentiate between patients with nutritional deficiencies and those without. Therefore, it is particularly important to pay attention to malnutrition in EDs to detect patients at risk of adverse outcomes and to initiate early interventions.