Tijdschrift voor Gerontologie en Geriatrie最新文献

An increasing group of older adults living at home in the Netherlands requires proper support through the use of services. Determining important outcomes is crucial in this respect. For this specific group, broad outcomes in terms of quality of life (QoL) are relevant, focusing on the influence of services on capabilities. This article describes the development and content of the ASCOT-NL (Adult Social Care Outcomes Toolkit, Dutch version) and the EQLT (Extended Quality of Life Tool), and highlights application possibilities in the evaluation of care. Both instruments aim to measure effects of care on QoL of elderly people living at home in multiple relevant domains. The ASCOT-NL has eight domains, the EQLT includes these eight domains and adds six domains, resulting in a total of fourteen domains. The domains of the ASCOT-NL are based on the goals of social support and care; the additional domains of the EQLT are based on empirical research on QoL from the perspective of older people living at home and how care can contribute to QoL.

The increasing number of elderly people living at home demands a strengthening of primary care for (vulnerable) older adults. Therefore, in 2015 the VU University Medical Centre in Amsterdam founded the Universitaire Praktijk Ouderengeneeskunde (UPO) (University Practice for Elderly Care). This practice makes the expertise of the Elderly Care physician (SO) available in primary care through a close and easy accessible collaboration between the SO and the General Practitioner. The aim of this research is an evaluation of the UPO, in order to determine the added value of this care innovation and to identify areas for improvement. This research consists of a quantitative part in which the characteristics of the 190 treated UPO patients have been assessed. Also, costs have been estimated of UPO care compared to expected usual care. The qualitative part of this study consists of 22 interviews with the most important UPO stakeholders. The results of this study show  that 1) the UPO seems to meet a demand from general practitioners to support them in the care of vulnerable elderly people with mostly cognitive disorders, 2) this care seems to save costs and 3) the UPO was appreciated by most of those involved. The current results call for applying this care innovation in other regions and to evaluate it on a larger scale.

The prevalence of multimorbidity increases with age, with over 70% of people aged 75 years and over having three or more chronic conditions, often combined with frailty. In current medical practice, evidence-based medicine with evidence-based guidelines forms the basis for treatment. The aim of this study is to determine the practical applicability of the current medical specialist guidelines for the treatment of the heterogeneous group of older patients. All guidelines from the Dutch guidelines database were examined. Twelve guidelines identified as elderly-specific were compared with the recommendations from the 'methodology for the development of guidelines tailored to the elderly'. In 117 guidelines (54%) general terms such as 'older' or 'elderly' were found. An age limit was mentioned in 26 guidelines (12%). The term 'frailty' was mentioned in 38 guidelines (18%), the term 'comorbidity' in 107 (50%) and cognitive problems in eight (4%). Five age-specific guidelines distinguished frail from non-frail older people. Three guidelines discussed relevant outcome measures for the elderly. The results show that the practical applicability of current guidelines is not optimal for the various groups of older people. In our opinion, the improvement of the guidelines preferably by implementation of the Dutch methodology for senior-proof guidelines is a necessary first step in making the current second-line evidence-based guidelines in the Netherlands usable for the growing group of frail and multimorbid elderly.

To anticipate future suffering due to dementia a growing number of people draft written advance euthanasia directives (AED). In actual practice the number of cases of euthanasia in advanced dementia is very limited. Dementia case managers are often closely involved since an early stage of the disease in the support and guidance of people with dementia and are well positioned to talk about the AED. This study aims to acquire insights into the way case managers deal with AEDs of people suffering from dementia. This qualitative study consists of two focus groups of ten case managers in total. Involvement of case managers was found to extend beyond discussing merely AEDs, to also the broader discussion of euthanasia and 'future euthanasia wishes' of patients with dementia. A thematic analysis of how case managers proceed with future euthanasia wishes yielded five themes: 1) Scenarios in practice; 2) Introduction of a written euthanasia directive as a conversation topic; 3) Guidance and support of the client and caregiver; 4) Cooperation with other health care workers; 5) Experienced dilemmas. The insights, provided by this study, into the role of case managers regarding the guidance of people with dementia and a future euthanasia wish contributes to a further optimization of the multidisciplinary collaboration between general practitioners and dementia case managers. Further research into the added value of this collaboration in dealing with these complicated issues around euthanasia in dementia care, is recommended.

This study evaluates a public health campaign initiated by the Alzheimer Center Limburg of Maastricht University. The aim was to increase awareness of the influence of a healthy lifestyle on lowering the risk of dementia in community-dwelling inhabitants of the Province of Limburg (aged 40 - 75 years). The campaign used mass media and public events, supported by a campaign website and mobile application (MijnBreincoach app).  An additional district-oriented approach was chosen in the municipalities of Roermond, Landgraaf and Brunssum, in which local stakeholders were involved in the design and execution of campaign-related events. Population-level difference in awareness before and after the campaign was assessed in two independent samples. No pre-post difference was observed in the level of awareness of dementia risk reduction. An additional analyses in the post-campaign sample revealed that the group that reported to have heard of the campaign, was more often aware of dementia risk reduction and reported higher motivation for behavioural change than the group that had not heard of the campaign. The district-oriented approach resulted in better recognition of campaign-material and the mobile application. With regard to the individual lifestyle factors, healthy diet and physical activity were identified more often post-campaign. Cognitive activity was identified most often at both pre- and post-assessment, but there was no increase in awareness after the campaign.

Many older adults who live at home face memory problems, which creates challenges for their participation in society. This may lead to social isolation and a lower wellbeing. In this qualitative study, we studied the physical and social participation of seven older adults with memory problems who live at home, to identify obstacles and coping strategies. Different research methods were adopted: 1) walking interviews, 2) travel diaries, and 3) in-depth interviews. Physical and social participation take place independently and in the immediate living environment. Participants experience several obstacles, which are highly impacted by the mode of transportation that they use: walking versus cycling. The results provide new insights on the strategies that participants develop to continue to participate. Fixed routes help them navigate, orientate and anticipate to traffic situations. Participating in activities for a short period of time is a strategy to make social participation less demanding. It is not the duration, but the experience of the activity that is important. The article concludes that older adults with memory problems exercise control in shaping their activities according to their personal needs, possibilities and surroundings. It is important that they are not only supported in avoiding risks, but also in developing suitable coping strategies.

The COVID-19 pandemic and its impact on older and frail people underlines the importance of advance care planning (ACP). ACP is a dynamic communication process involving patients, families and healthcare providers, which serves to discuss and document wishes and goals for future care. Currently, ACP practice is often suboptimal. This implies that important decisions about care and treatment may need to be made acutely in crises. Many factors contribute to suboptimal ACP practice. One such factor is ambiguity regarding roles and responsibilities of different disciplines in the ACP-process. The perception that having ACP conversations is primarily a physician's task is a misconception. Specific skills that could contribute to a holistic and person-centered ACP-process are largely lacking in nursing curricula and therefore, may be insufficient and under-utilized. For instance, nursing staff could involve persons in conversations about meaning, quality of life, loss and grief as a part of ACP. Moreover, they may communicate a patient's wishes to other healthcare providers including physicians. Acknowledgement of this potential role, by physicians as well as by nursing staff themselves, is needed for ACP to become a truly interprofessional process.

Despite compliance with national (RIVM) guidelines, nursing home Mariënburght (the Netherlands) was severely affected during the first COVID-19 wave: 68 (68%) of the residents were infected. This resulted in a large emotional impact on the (nursing) staff. This study aims to describe the experiences of (nursing) staff, as well as the results of serological tests on COVID-19 that have been administered to professionals. All professionals (n=281) were invited for group interviews to share their experiences concerning the COVID-19 outbreak and for a serological test for COVID-19. The 29 professionals participating in the group interviews mentioned negative and positive experiences about their fear and anxiety, the changed care for residents, the team spirit, the use of personal protective equipment and the testing policy. Out of 240 professionals who underwent the serological test and completed a questionnaire, 94 professionals (39%) had COVID-19 antibodies. In this group, 18 professionals (19%) indicated not having experienced any (physical) complaints related to COVID. Insight into the experiences of professionals resulted in essential learning points, in particular the importance of clear communication with and emotional support for staff. This study also reveals that many professionals of nursing home Mariënburght were affected by COVID-19. An important finding is the high percentage of asymptomatic employees (19% of 94 infected). Our results contributed to changed national testing policies and adapted recommendations in the use of personal protective equipment in nursing homes.