Tijdschrift voor gerontologie en geriatrie最新文献

Dehydration in patients in the final stage of life requires a multidimensional approach.The appropriateness of a particular intervention depends not only on clinical factors and medical-technical possibilities, but also on ethical, spiritual, and psychosocial considerations. These aspects all contribute to the decision whether or not to initiate diagnostic procedures or treatment for an individual patient.This clinical lesson presents a fictional case to illustrate the key considerations involved in decision-making, as outlined in the new guideline Dehydration in the Palliative Phase.

Physical activity is beneficial, yet older adults living in nursing homes often move too little. Compared to the general population of older adults, less is known about nursing home residents regarding their motivation to engage in physical activity. This study focuses on gaining insight into the drivers and barriers to movement among nursing home residents, based on sub-questions addressing the meaning of physical activity, obstacles, motivations, and responsibility. Eight residents from one nursing home participated in semi-structured interviews. The concept of physical activity can be divided into physical exercise, available activity programs, and the ability to lead an independent life. The theme of 'leading an independent life' appears to be a motivation specific to nursing home residents. An important barrier identified is the presence of unhelpful (and sometimes factually incorrect) beliefs, such as the notion that increasing physical activity would no longer have any benefit. Other motivations and obstacles aligned with findings from previous studies on independently living older adults. Residents primarily place the responsibility for physical activity on themselves. Some also see a role for family, the organization, and (local) government. The identified helpful and obstructive factors can serve as input for developing exercise programs.

Moving to a nursing home has a major impact on the lives of residents and their relatives. The relationship with healthcare workers is often intensive and offers plenty of opportunities to pay attention to the spiritual dimension. Until now, it is unclear whether healthcare professionals pay attention to the spiritual dimension and how they apply it in daily contact. To provide insight into how residents and relatives experience attention for spirituality in the nursing home, semi-structured interviews were conducted with four residents and four relatives. Transcripts were analyzed according to the principles of reflexive, inductive thematic analysis. We identified three themes and seven sub-themes that contribute to attention for meaning in life and which we have named 'spiritual skills/meaning in life skills': Alignment (being present with attention and acknowledging individuality), connecting (aligning approach, aligning communication and building a care relationship) and deepening (deepening contact and acknowledging life-questions). Our study shows that healthcare professionals apply skills in their daily contact with residents that help them align and connect. However, it was not apparent from the interviews if they also deepened their contact. A combination of training, intervision-meetings and on-the-job coaching, as was also part of the broader study, is in line with the way care workers learn and what they need to further deepen their spiritual skills in practice.

One in six couples is confronted with intimate partner violence (IPV). Throughout the lifespan the nature of IPV may change, and in late life emotional or financial violence become more prevalent. In this paper we discuss factors that have an impact on IPV in older couples. Changing life circumstances may alter an existing balance. We elaborate on the role of attachment, power and control. Finally, guidelines for the healthcare professional are summarized.

Background: The benefit-harm balance of antihypertensive treatment in older adults with advanced dementia is unclear. This study assesses whether discontinuing antihypertensive treatment reduces neuropsychiatric symptoms (NPS) and maintains quality of life (QoL) in nursing home residents with dementia.

Methods: This outcome-blinded RCT (trial registration: NL7365) randomised Dutch long-term care residents with moderate-to-severe dementia and systolic blood pressure (SBP) ≤160mmHg during antihypertensive treatment (planned sample size n=492) to either antihypertensive treatment discontinuation (n=101) or usual care (n=104). Outcomes were NPS (Neuropsychiatric Inventory-Nursing Home [NPI-NH]) and QoL (Qualidem) at 16 weeks.

Results: 205 participants (median age 86 years [IQR 80-90]; 79.5% female; median SBP 134mmHg [IQR 123-146]) were included. Randomisation ceased prematurely 29 months after start randomisation because of safety concerns, combined with lacking benefits. No significant differences were found between groups for NPI-NH (mean difference 1.6 [95%CI -2.3 to 5.6]) or Qualidem (mean difference -2.5 [95%CI -6.0 to 1.0]). Serious adverse events, such as cardiovascular events or death, occurred in 36% (discontinuation) and 24% (usual care) of the participants (adjusted hazard ratio 1.65 [95%CI 0.98 to 2.79], at a median of 135 (IQR 66-209) days in the discontinuation and 103 (IQR 54-171) days in the usual care group).

Conclusion: Because of lacking benefits and an observed increase in adverse events, proactive discontinuation of antihypertensive treatment is not recommended in older adults with dementia.

Cognitive discrepancy theory defines loneliness as the experienced discrepancy between the desired or needed (quality of) relationships and the achieved ones. This assumes that people have relationship expectations that need to be met in order to avoid loneliness. This study examines quantitative and qualitative relationship expectations of older adults, for which the 'social relationships expectations framework' by Akhter-Kahn et al.1 serves as an important starting point. Semi-structured interviews about loneliness and relationship expectations were conducted among older adults (ages 62-93 years; N=18). Thematic analysis was used to analyse the data. The results show that partners are typically considered to be the most important social relationships, followed by children and grandchildren, friends and brothers and sisters, and other relations. A high contact frequency, availability, closeness, provision of care and support, intimacy, and fun is expected from the most important social relationships. Availability when needed, fun and distraction are expected of less important social relationships. Relationship expectations change over time and as a result of social circumstances. Implications for loneliness interventions are discussed.

In Dutch nursing homes, the number of older adults with complex care needs increases, while at the same time there is a shortage of professionals. This requires changes in the organisation of care in order to provide appropriate care. The aims of this study were to generate knowledge about: 1) how team composition and interprofessional collaboration influence each other and 2) the development and implementation of optimal skill mix in nursing homes. In this participatory action research study five nursing homes organisations participated with seven teams. The focus in this study was on the nursing, psychological and medical disciplines. The teams worked on optimizing their skill mix based on general rules formulated on organisation level and a situation analysis assessed by the action researcher. Data were collected by logbooks of the action researchers and focus groups with participants. Thematic analysis revealed that teams started with creating clarity about everyone's function and qualities optimising everyone's contribution and improving interprofessional collaboration. Therefrom they gained more insight into optimal team composition in order to provide appropriate care. Preconditions for experimenting with skill mix were support, coaching, time and (financial) space.