Tijdschrift voor Gerontologie en Geriatrie最新文献

Background: Pharmacotherapy in older adults with personality disorders (PD) is a new and important area of attention. Nowadays, symptom based pharmacotherapy in older adults with PD is based on multidisciplinary guidelines, which are constructed on research performed in patients up to 50 years of age. There is no specific guideline for older adults with PD.

Goal: Providing a description of patient characteristics: number of comorbid psychiatric disorders, use of medication, including polypharmacy, in older adults (≥ 65 years) with personality disorders.

Method: A retrospective cross-sectional patient file study (n = 50) in a clinical center of excellence for older adults with personality disorders (outpatient setting).

Results: . From the file study, it appears that 1) the unspecified/other specified personality disorder and the borderline personality disorder (BPD) occur most frequently, 2) there is a trend (no significant difference) that older adults with BPS use most medication (somatic medication and psychotropics) and 3) there is a trend (no significant difference) that polypharmacy is the most prevalent amongst older adults with BPD.

Conclusion: The use of medication in certain subgroups of older adults with PD tends to be high. Further research is necessary to optimize pharmacotherapy in older adults with PD.

Late life is a period during which individuals are increasingly confronted with challenges and losses. These challenges can have a negative impact on late life functioning, which is often reflected in poor well-being or an increase in depressive feelings. Current research points out that positive psychological resources might enhance coping with late life stressors. Forgiveness is a variable that has received increasing interest as a positive psychological resource and is linked with several aspects of late life health and well-being. The idea of forgiveness being pivotal in late life can be framed within the life stage theory of Erikson. Erikson's psychosocial crisis in late life consists of finding a balance between feelings of despair and the achievement of ego-integrity and it is considered as a potential explaining process in the association between forgiveness and positive late life functioning.  The results of three quantitative studies in older adults (75+) provide indeed preliminary evidence that forgiveness is a resource in late life. They show that the relationship between forgiveness and late life well-being can be partly explained by the developmental task of finding a balance between integrity and despair.

Introduction: Delirium is a common disorder, affecting many patients in nursing-homes, with large impact on patients. Implementation of good care and treatment can potentially prevent development of a delirium or may reduce the severity or duration. This research was conducted to get an impression of delirium care in Dutch nursing homes, and of the implementation of the recommendations of the national guideline.

Objectives: 1. How many Dutch nursing homes have a local protocol for delirium?2. To what extend do doctors, specialised in care for older people in nursing homes, screen, diagnose and treat delirium according to the Dutch guideline for delirium?

Methods: Between June and December 2016, Dutch nursing homes were approached with an online questionnaire. Data were collected in Survey Monkey and descriptive analyses were performed.

Results: 68 nursing homes were included. 32% of the nursing homes had a local delirium protocol. 48% of the doctors knew about the national guideline delirium, 60% used preventive measures, and screening instruments were used in 98%. 29% used diagnostic criteria. Non-medical interventions were applied by 96%. In 98%, haloperidol was the drug of first choice. Preventive antipsychotics were prescribed by 21%.

Conclusions: Only a third of the organisations developed a local delirium protocol. Standardising delirium care by a local delirium protocol, with special attention for prevention, diagnostics and aftercare of delirium, can be an important step in improving the quality of care in nursing homes.

A qualitative research focused on contributing and obstructing factors for healthcare assistants in district nursing Older people with confused behavior have behavioral problems due to dementia, mental problems or social problems. For the Healthcare Assistant (HA) in district nursing, it is a daily challenge to care for older people with confused behavior. Aim of this research is to achieve an insight in the strategies the HA uses to deal with the daily care for older people with confused behavior. It is also the aim to have insight in factors which contribute to the daily care in a positive or negative way. Method: a qualitative explorative research. 17 HA's in district nursing participated in semi-structured interviews. All respondents had experience with caring for older people with confused behavior. The most important influencing factors are the experienced relationship between HA and the client and the experienced support by the team. Particularly behavioral problems due to mental problems can impede a relationship with the client. Further research is recommended to study the level of knowledge and competences of all levels of employees in district nursing.

A major event in the human life course is the move to a care center. In order for this transition to be successful, it is important that a care center creates the right conditions to achieve that residents feel at home and satisfied. The aim of this study is to investigate which characteristics are important for this,  according to the employees of care centers in the Netherlands. First a limited list of 15 characteristics has been constructed on the basis of literature research. With the help of the Delphi method, in three rounds, employees of Dutch care institutions were then asked about the importance of these characteristics for a successful adaptation of residents to the new living environment and they were asked to provide additional comments. Based on this, characteristics have been reformulated, added or removed. The result after the third round was a high degree of agreement on the characteristics that were considered (very) important. The attribute 'respect', scored in all three rounds the highest, followed directly by the characteristics 'approach' and 'safety'. There was a high degree of agreement about the most important characteristics between the different job levels (such as employee care or supervisor).

Psychotic depression is a frequent, severe psychiatric condition in older depressive inpatients aged 60 years and older. Older adults with a psychotic depression exhibit specific symptoms that are different from those in younger adults with psychotic depression. Moreover, the symptoms are also different from those in older adults  with a major depression without psychotic features. The recommended treatment consists of a tricyclic antidepressant, with or without addition of an antipsychotic, or electroconvulsive therapy. These treatments may however produce significant side effects that require intensive monitoring. In this article we present an overview of clinical topics regarding the diagnosis and treatment of older people with a psychotic depression.

In the Netherlands geriatric rehabilitation is possible (among others) for patients who are selected by a geriatrician at the emergency department of a hospital. The aim of this study was to investigate the rehabilitation trajectory of patients who were selected for geriatric rehabilitation at the emergency department after a single contact with the geriatrician and to identify patient factors related to rehabilitation outcome. Successful rehabilitation was defined as discharge to home or a residential care facility after a maximum of 6 months. All patients who in 2016 were selected for geriatric rehabilitation were included. Data were collected retrospectively from electronic patient files. 74 patients were included (mean age 84.7 years). 84% were successfully discharged home or to a residential care facility within six months. The presentation with a fall and the absence of a partner at home was higher in the unsuccessful group. In the successful group more patients lived independent and without professional help prior to rehabilitation. Noteworthy is that the analysed patient group is a frail group, considering the high one-year mortality (21,6%) and overall functional decline despite geriatric rehabilitation.