Kilian Rapp

• Oberarzt at Robert-Bosch Krankenhaus

Background Orthogeriatric co-management (OGCM) has been proposed as care model for geriatric patients with fragility fractures. However, its impact on nursing home (NH) admissions following non-hip fractures is unclear. This study aims to assess the association between OGCM and the probability of NH admissions within 6 months in older patients with...

Background Fear of falling (FoF) is estimated to be prevalent in over 50% of older adults and several studies suggest that it negatively affects health-related quality of life (HrQoL). Unlike previous studies that examined only few mediating variables, this study aimed to develop a more comprehensive path model explaining the association between Fo...

Background Physical activity (PA) plays a vital role in maintaining the functional ability that enables well-being in older age (healthy aging), potentially also saving costs for the healthcare system and society. The aim of this study was to examine the association between PA and healthcare and societal costs in a sample of very mild to moderately...

Background Geriatric rehabilitation aims at increasing physical and social activity and maintaining the functional reserve of older people. However, the continuity of geriatric rehabilitation in the outpatient setting is limited due to a lack of structured aftercare programs. In order to overcome this, a three-month multimodal home-based interventi...

Background Orthogeriatric co-management (OGCM) addresses the special needs of geriatric fracture patients. Most of the research on OGCM focused on hip fractures while results concerning other severe fractures are rare. We conducted a health-economic evaluation of OGCM for pelvic and vertebral fractures. Methods In this retrospective cohort study,...

Background Structured aftercare programs are implemented to facilitate the transition from rehabilitation centers to patients’ home environments. Taking the program GeRas as an example, this paper aims to evaluate the influence of patient-related factors on the implementation of the geriatric aftercare program GeRas from patients' and providers' pe...

Purpose Frailty in older adults is associated with multiple adverse health outcomes, while evidence on its successful prevention has been scarce. Therefore, we analyzed the effectiveness of different interventions for the prevention of frailty onset. Methods In this systematic review, eight databases were searched for randomized controlled trials...

Orthogeriatric co-management (OGCM) describes a collaboration of orthopedic surgeons and geriatricians for the treatment of fragility fractures in geriatric patients. While its cost-effectiveness for hip fractures has been widely investigated, research focusing on fractures of the upper extremities is lacking. Thus, we conducted a health economic e...

Background The “PromeTheus” trial is evaluating a home-based, multifactorial, interdisciplinary prevention program for community-dwelling (pre-)frail older adults. These individuals often suffer from reduced participation, which can complicate the recruitment and enrollment in a clinical trial. Aims The aim of this study was to evaluate different...

Background In Germany, geriatricians deliver acute geriatric care during acute hospital stay and post-acute rehabilitation after transfer to a rehabilitation clinic. The rate patients receive acute geriatric care (AGC) or are transferred to post-acute rehabilitation (TPR) differs between hospitals. This study analyses the association between the tw...

Zusammenfassung Die Bedeutung der Wirbelkörperfrakturen, die zu einer Krankenhauseinweisung führen nimmt zu. Dieser Anstieg ist nicht nur demographisch bedingt. Die Fallzahlen der LWK-, BWK- und HWK Frakturen sind altersadjustiert in den letzten 15 Jahren um weit mehr als 100% angestiegen. Ein ähnlicher Anstieg wird auch für die Beckenfrakturen beo...

Background Geriatric rehabilitation aims to maintain the functional reserves of older adults in order to optimize social participation and prevent disability. After discharge from inpatient geriatric rehabilitation, patients are at high risk for decreased physical capacity, increased vulnerability, and limitations in mobility. As a result, ageing i...

In Germany, different models of orthogeriatric co-management have been implemented in certified geriatric trauma centers. So far, it is not clear how the different models are implemented and what influence the certification has on the structures and processes within the centers. The present study examined the extent of cooperation between surgery a...

Background Around one‐third of older adults aged 65 years or older who live in the community fall each year. Interventions to prevent falls can be designed to target the whole community, rather than selected individuals. These population‐level interventions may be facilitated by different healthcare, social care, and community‐level agencies. They...

Orthogeriatric co-management (OGCM) may provide benefits for geriatric fragility fracture patients in terms of more frequent osteoporosis treatment and fewer re-fractures. Yet, we did not find higher costs in OGCM hospitals for re-fractures or antiosteoporotic medication for most fracture sites within 12 months, although antiosteoporotic medication...

Background There is a need for a comprehensive evaluation of the associations between varieties of weather conditions on the time spent out-of-home (TOH) and on walking duration (WD) among older adults. We aim to investigate the extent to which various weather parameters (temperature, solar radiation, sunshine duration, humidity, windspeed, and rai...

The concept of frailty describes an older at-risk population, which has a higher probability for the occurrence of unfavorable health outcomes. It is in the interest of frail individuals as well as the healthcare system to improve the prognosis of these people by targeted interventions. Several systematic reviews and meta-analyses are now available...

Background Fragility fractures are one of the leading causes of disability in older adults. Yet, evidence for effectiveness and cost-effectiveness of preventive approaches combining bone health and fall prevention is rare. Objective To conduct a health-economic evaluation of the German osteoporotic fracture prevention program in rural areas (OFRA)...

Background In Germany, geriatricians deliver acute geriatric care during an acute hospital stay and subacute rehabilitation after transfer to a rehabilitation clinic. However, the proportion of patients who receive acute geriatric care (AGC) or are transferred to subacute rehabilitation (TSR) differs considerably between hospitals. The aim of this...

IMPORTANCE The predictive value of common performance-based outcome assessments of mobility capacity on incident disability in activities of daily living in community-dwelling older adults remains uncertain. OBJECTIVE To synthesize all available research on the association between mobility capacity and incident disability in non-disabled older adu...

Background Age-related decline in physical capacity can lead to frailty, associated with an increased vulnerability to adverse health outcomes and greater healthcare utilization. In an aging population, effective strategies to prevent physical decline and frailty, and preserve independence are needed. Prevention programs for vulnerable community-dw...

Background Fractures are a major health problem in aging societies. Preventive approaches combining bone health and fall prevention are rare. The osteoporotic fracture prevention program in rural areas (OFRA) is a health care fund-driven program for older people in randomly selected districts in Germany. The components of the program were falls pre...

Background: Heat waves are known to cause increased morbidity and mortality in susceptible populations like old and functionally impaired people. The objective of the study was to assess renal tubular stress, a predictor for development of acute kidney injury, during heat waves in Central Europe. As a marker of renal tubular stress tissue inhibito...

Background A growing number of older adults suffer hip and pelvic fractures leading to hospital admission. They often result in reduced physical activity (PA) and impaired mobility. PA can be objectively measured with body-worn sensors. Usually, global cumulative PA parameters are analysed, such as walking duration, upright-time and number of steps...

This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention a...

Current evidence is insufficient to support different hypertension treatment targets in older adults. We evaluated whether frailty modifies the association between systolic blood pressure (SBP) and 8-year all-cause mortality in community-dwelling older adults. Longitudinal data from the ActiFE Ulm study (Activity and Function in the Elderly in Ulm;...

Background Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence on cost-effectiveness is limited and based on small datasets. The aim of our study was to conduct an economic evaluation of the German OGCM for geriatric hip fracture patients. Methods This retrospective cohort study was based on G...

Der aktuelle Versorgungs-Report geht der Frage nach, welche Auswirkungen der Klimawandel auf unsere Gesundheit hat und welche Konsequenzen sich daraus für die medizinische Versorgung in Deutschland ergeben. Dabei bringt er die unterschiedlichen Perspektiven von Umweltepidemiologie, Medizin und Gesundheitspolitik zusammen. Expertinnen und Experten a...

The ability to effectively increase the base of support is crucial to prevent from falling due to stability disturbances and has been commonly assessed using the forward-directed lean-and-release test. With this multicentre study we examined whether the assessment of stability recovery performance using two different forward lean-and-release test p...

Die Bundesinitiative Sturzprävention (BIS) ist ein Zusammenschluss von Wissenschaftlern und Experten aus dem Bereich der Sturzprävention, von Mitarbeitern der Krankenkassen sowie Sport-, Berufs- und Wohlfahrtsverbänden. Alle beteiligten Verbände oder Einzelpersonen verfügen über vielfältige wissenschaftliche Kenntnisse oder über praktische Erfahrun...

Background A growing number of older people are care dependent and live in nursing homes, which accounts for the majority of long-term-care spending. Specific medical conditions and resident characteristics may serve as risk factors predicting negative health outcomes. We investigated the association between the risk of increasing care need and chr...

Zusammenfassung Aufgrund des demographischen Wandels steigt die Zahl hochbetagter, multimorbider Menschen mit Rehabilitationsbedarf und -potenzial. Dieser Entwicklung wurde bereits in den 90er Jahren durch die Unterstützung der geriatrischen Rehabilitation begegnet. Mit ihren diversen Ausgestaltungen hilft diese, die rehabilitativen Bedarfe älterer...

Background: fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes. To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioural intervention ("Step by Step") and evaluated in a RCT. Methods: one hun...

Reduced lung function is associated with overall and cardiovascular mortality. Chronic low grade systemic inflammation is linked to impaired lung function and cardiovascular outcomes. We assessed the association of lung function with overall 8-year mortality in 867 individuals of the Activity and Function in the Elderly study using confounder-adjus...

BackgroundOFRA is a large health insurance fund-driven program which aims to reduce the risk of falls and fractures in older people living in rural areas. The programme offered specific mobility and falls prevention classes and bone density measurement by a DXA scan free of charge to more than 10,000 people, and was promoted by staff of the health...

Objective Hip fractures are among the most frequently occurring fragility fractures in older adults, associated with a loss of quality of life, high mortality, and high use of healthcare resources. The aim was to apply the superlearner method to predict osteoporotic hip fractures using administrative claims data and to compare its performance to es...

Objective To investigate variation of care dependency after hip fracture across German regions based on the assessment by the German statutory long-term care insurance. Data sources/study setting Patient-level statutory health and long-term care insurance claims data from 2009–2011 and official statistical data from Germany. Study design We perfo...

Background: To meet the special needs of older patients with fragility fractures, models for collaborative orthogeriatric care have been developed. The objective of our study was to analyze the association of orthogeriatric co-management with mortality following hip fracture in older patients in Germany. Methods: This observational study was bas...

To explore the association of incident hip fractures with metabolic syndrome (MetS) and its single components, we designed a prospective cohort study of hip fracture incidence among 117,053 participants of a population-based health surveillance program in Vorarlberg, the westernmost Austrian province. Incident hip fractures were recorded between 5...

This prospective study investigated feasibility and sensitivity of sensor-based physical activity (PA) measures to monitor changes in PA during geriatric rehabilitation and its relation to clinical parameters at admission. PA was routinely measured at day 2 and day 15 after admission in 647 patients (70.2% women, mean age = 82.0 (SD = 7.19) years)...

Background: The aim of this study was to assess the effect of day of the week and wearing a device (reactivity) on objectively measured physical activity (PA) in older people. Methods: Walking duration as a measure for PA was recorded from 1333 German community-dwelling older people (≥65 years, 43.8% women) over 5 days using accelerometers (acti...

[This corrects the article DOI: 10.1186/s11556-019-0226-1.].

Objective: Acute geriatric care (geriatric early rehabilitative treatment) and sub-acute (inpatient) geriatric rehabilitation are delivered to geriatric patients in Germany after hip fracture. The aim of this study was to compare patients' outcomes after hip fracture between 3 German federal states (Hesse, Bavaria, and Baden-Wuerttemberg) that nea...

The aim of this study was to develop a simple visualized approach to classify persons into meaningful gait speed categories. Footprints of 310 instrumented gait analyses of 190 geriatric persons (mean age 79.1 years, 74 women) were used in a retrospective analysis to classify persons´ footprints into a left/right step overlapping, an intermediate o...

Heat waves increase the morbidity and mortality in Germany, particularly of older patients in need of care. Due to climate change the number of heat waves in Germany will increase threefold by the end of the century. In addition, the proportion of patients at risk will grow due to demographic change. Therefore, the Government and the Federal States...

Background: Identifying those people at increased risk of early functional decline in activities of daily living (ADL) is essential for initiating preventive interventions. The aim of this study is to develop and validate a clinical prediction model for onset of functional decline in ADL in three years of follow-up in older people of 65-75 years o...

Selecting relevant indicators is an important step in the development of public health monitoring for older people. Indicators can be used to combine information comprehensively from various data sources and enable recurring, comparable findings to be made about the health of older people. Indicators were systematically compiled from existing inter...

More and longer heatwaves can be expected in Germany as a consequence of climate change. Older persons are predominantly threatened with the associated health-related problems and premature death. So far, heat action plans have failed to prevent excess mortality. Therefore, new approaches of prevention must be found. General practitioner, ambulant...

Previously independent living older people suffering fractures of the hip have a high risk of new admission to a nursing home during the subsequent months. This study shows that older people admitted to hospital for fractures of the pelvis and spine have a similar risk of admission to a nursing home. Introduction Fall-related fractures are a serio...

Beweglichkeit im Alter Stürze und Frakturen gehören zu den häufigsten Ursachen für Mobilitätseinschränkungen und Pflegebedürftigkeit. Erleidet ein Bewohner in einer Pflegeeinrichtung eine Hüftfraktur infolge eines Sturzes, so verdoppelt sich das Risiko, in den ersten drei Monaten nach Fraktur zu versterben. Diese Kaskade kann jedoch durchbrochen we...

Background Considering that mortality rate and deficit accumulation varies considerably in men and women we performed a sex-stratified analysis of the association between an estimated frailty index (eFI) with six-year mortality in the Activity and Function in the Elderly (ActiFE) Study. Methods We constructed an eFI using a score (0 (no deficit) t...

Background: Time spent out-of-home can increase physical activity (PA) levels. However the association between purpose for leaving home and modes of transport (MoT) on time out-of-home and PA are not straightforward. Methods: In a large sample of community-dwelling older adults (≥65 years) daily walking duration was measured prospectively over o...

Zusammenfassung Hintergrund Stürze und sturzbedingte Verletzungen gehören zu den großen Herausforderungen heutiger industrieller Gesellschaften. Die bekanntermaßen effektiven gruppenbasierten Trainingsprogramme sind jedoch gerade in ländlichen Gebieten unzureichend verfügbar. Ziel Nach erfolgreicher Implementation der Trittsicher-Bewegungskurse in...

Background: Physical activity is considered an effective measure to promote health in older people. There is evidence that the number of outdoor trips increases physical activity by increasing walking duration. The objective of this study was to analyse the relationship between daily time out-of-home and walking duration. Furthermore, predictors f...

Objectives: Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assi...

Background: Falls and fractures are extremely frequent in long-term care facilities (LTCFs). Therefore, a fall and fracture prevention program was started in nearly 1000 LTCFs in Bavaria/Germany between 2007 and 2010. The components of the program were exercise classes, the documentation of falls, environmental adaptations, medication reviews, the...

Background: Specific training reduces the risk of falls and fall-related injuries in older persons. The availability of specific exercise programs in Germany, especially in rural areas is scarce. Therefore, a healthcare fund driven program osteoporotic fracture prevention program in rural areas (OFRA) (German name: "Trittsicher durchs Leben") was...

Vorgestellt wurde das Programm "Trittsicher durchs Leben", welches derzeit zu einem der größten Bewegungs- und Sturzpräventionsprogramme für den ländlichen Raum in Deutschland gehört. Darüber hinaus wurde ein Einblick zu den ersten Ergebnissen der Struktur- und Prozessevaluation gegeben.

Background: Hip fractures are regarded as a worldwide epidemic and a major public health concern. Changing risk factors, local differences and temporal trends contribute to the particular epidemiology of hip fractures. This overview gives a comprehensive insight into the epidemiology of hip fractures and reviews where German data have contributed...

Hintergrund: Stürze treten in Pflegeeinrichtungen häufig auf. Aus diesem Grund wurde in den Jahren 2007 – 2010 ein Sturz- und Frakturpräventionsprogramm in nahezu 1000 bayerischen Pflegeeinrichtungen nach den Vorgaben des „Ulmer Modells“ implementiert. Einen zentralen Bestandteil des Programms bildet ein gruppenbasiertes Kraft- und Balancetraining....

Background: In aging societies osteoporotic fractures are a major health problem with high economic costs. Targeting prevention at individuals at high risk is important to reduce the future burden of fractures. Available risk assessment tools (e.g., FRAX®, QFracture, the algorithm provided by the German Osteology Society (DVO-Tool)) rely on self-r...

Background High indoor temperatures require behavioral adaptation, especially among vulnerable older adults. There are uncertainties as to the degree to which people adapt to these challenging conditions. Objective The aim of this study was to describe the degree of adaptation of social participation and other heat-related behavior with respect to...

Falls are a major cause of injury and disability in older people, leading to serious health and social consequences including fractures, poor quality of life, loss of independence, and institutionalization. To design and provide adequate prevention measures, accurate understanding and identification of person's individual fall risk is important. Ho...

Daily activity can be characterized by metrics such as duration, intensity, frequency. Combining these activity metrics into a temporal pattern (barcoding), and calculating its complexity can provide a global view of physical behaviour. We hypothesize that complexity increases following rehabilitation (n=524 inpatients). Using an accelerometer fixe...

The question of how to assess fear of falling (FoF) and falls efficacy in hip fracture patients is still not clearly resolved. While the Fall Efficacy Scale International (FES-I) shows good reliability and structural validity in this population, it appears more related to functional performance than to more general anxiety symptoms (Visschedijk et...

Objective Femoral fractures are frequently consequences of falls in nursing homes and are associated with considerable costs and unfavorable outcomes such as immobility and mortality. The purpose of this study was to examine the long-term effectiveness of a multifactorial fall and fracture prevention program in nursing homes in terms of reducing fe...

Nationale und internationale Studien zeigen, dass Maßnahmen zur Sturzprävention zu einer Reduktion von Stürzen und sturzbedingten Verletzungen führen können. Voraussetzungen hierfür ist die Unterstützung der Mitarbeitenden in den Pflegeeinrichtungen durch das Management aber auch die fachliche Zusammenarbeit im therapeutischen Team. Anhand vorliege...

Indoor temperature is relevant with regard to mortality and heat-related self-perceived health problems. The aim of this study was to describe the association between indoor temperature and physical performance in older adults. Eighty-one older adults (84% women, mean age 80.9 years, standard deviation 6.53) were visited every four weeks from May t...

Background Fragility fractures are one of the leading causes for disability in old people. The main underlying mechanisms are osteoporosis and falls. Evidence-based measures to prevent either falls or fractures are available. However, coordinated preventive approaches combining bone health and fall prevention are rare.The objective of the study is...

Background There is evidence about time-dependent fracture rates in different settings and situations. Lacking are data about underlying time-dependent fall risk patterns. The objective of the study was to analyse fall rates as a function of time after admission to sub-acute hospital units and to evaluate the time-dependent impact of clinical facto...

Objectives: Persons with osteoporotic fracture history are subject to an increased risk for subsequent fractures and mortality. The aim of this retrospective study was to investigate the impact of a previous osteoporotic low-impact (fragility) index fracture (eg, forearm, lower leg) on mortality of a subsequent femoral fracture. Design: Retrospe...

Background and objective: The fall risk assessment tool (FRAT-up) is a tool for predicting falls in community-dwelling older people based on a meta-analysis of fall risk factors. Based on the fall risk factor profile, this tool calculates the individual risk of falling over the next year. The objective of this study is to evaluate the performance...

Introduction: Previous studies suggested that fracture risks in people with developmental disabilities (DD) may be higher than in people in the general population. However, there are no current sufficiently large studies to compare age- and sex-specific fracture rates of single fracture types. Methods: People with DD and incident fractures were...

Objectives Elevated hip fracture incidence is a major public health problem looming to aggravate in industrialized countries due to demographic developments. We report hip fracture incidence and expected future cases from Vorarlberg, the westernmost province of Austria, results potentially representative of Central European populations. Methods Cru...

The construct of sarcopenia is still discussed with regard to best appropriate measures of muscle volume and muscle function. The aim of this post-hoc analysis of a cross-sectional experimental study was to investigate and describe the hierarchy of the association between thigh muscle volume and measurements of functional performance in older women...

contains the complete data set. (XLSX)

Background: Physical activity is an important component of health. Recommendations based on sensor measurements are sparse in older people. The aim of this study was to analyse the effect of objectively measured walking and sedentary duration on four-year mortality in community-dwelling older people. Methods: Between March 2009 and April 2010, p...

Median (Q1-Q3) of biomarkers by quartiles of walking duration and sedentary duration as well as Spearman correlation coefficients adjusted for age and sex. (DOCX)

Secondary multivariable analyses between walking and sedentary duration with all-cause mortality excluding those with poor self-perceived health status at baseline (n = 25, 6 deaths), as well as deaths within the first year of follow-up (n = 17). (DOCX)

Due to the demographic transition with a growing number of old and oldest-old persons the absolute number of fragility fractures is expected to increase in industrialized countries unless effective preventive efforts are intensified. The main causes leading to fractures are osteoporosis and falls. The aim of this study is to develop population base...

Introduction: Hospital admissions due to traumatic brain injuries (TBIs) in older persons are increasing. Falls are the leading mechanism of injury in this age group. TBIs are associated with unfavorable outcomes such as mortality and institutionalization. Objectives: To estimate rates of TBIs in older persons with severe functional limitations,...

Stürze sind die häufigste Ursache für Verletzungen im Alter. Aufgrund des demographischen Wandels wird ihre Bedeutung in Zukunft noch zunehmen. Individuelle Maßnahmen, wie der Besuch von Sturzpräventionskursen, werden aller Voraussicht nach nicht ausreichen, um die Zunahme von Stürzen wirksam einzudämmen. Deshalb stellte sich in der Vergangenheit i...

To analyze the burden of institutionalizations after femoral fracture and compare it with other "catastrophic" disease entities like stroke, myocardial infarction, or pneumonia. Routine data of 414,000 hospitalized German patients aged 66 years and older were used to calculate institutionalization risks after femoral fracture, stroke, myocardial in...

Falls are related to a complex interaction of risk factors. We examined if cardiac biomarkers for hemodynamic stress (N-terminal pro Brain Natriuretic Peptide-NT-proBNP), and for necrosis [high sensitive (hs) cardiac troponins T (cTnT) and I (cTnI)] are associated with falls in older people. Biomarkers were measured at baseline in a cohort of 1506...

To investigate the relationship between physical activity and two measures of fall incidence in an elderly population using person-years as well as hours walked as denominators and to compare these two approaches. Prospective cohort study with one-year follow-up of falls using fall calendars. Physical activity was defined as walking duration and re...