Objective: To predict mortality by disability in a sample of 479 Dutch community-dwelling people aged 75 years or older. Methods: A longitudinal study was carried out using a follow-up of seven years. The Groningen Activity Restriction Scale (GARS), a self-reported questionnaire with good psychometric properties, was used for data collection about total disability, disability in activities in daily living (ADL) and disability in instrumental activities in daily living (IADL). The mortality dates were provided by the municipality of Roosendaal (a city in the Netherlands). For analyses of survival, we used Kaplan–Meier analyses and Cox regression analyses to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results: All three disability variables (total, ADL and IADL) predicted mortality, unadjusted and adjusted for age and gender. The unadjusted HRs for total, ADL and IADL disability were 1.054 (95%-CI: [1.039;1.069]), 1.091 (95%-CI: [1.062;1.121]) and 1.106 (95%-CI: [1.077;1.135]) with p-values <0.001, respectively. The AUCs were <0.7, ranging from 0.630 (ADL) to 0.668 (IADL). Multivariate analyses including all 18 disability items revealed that only “Do the shopping” predicted mortality. In addition, multivariate analyses focusing on 11 ADL items and 7 IADL items separately showed that only the ADL item “Get around in the house” and the IADL item “Do the shopping” significantly predicted mortality. Conclusion: Disability predicted mortality in a seven years follow-up among Dutch community-dwelling older people. It is important that healthcare professionals are aware of disability at early stages, so they can intervene swiftly, efficiently and effectively, to maintain or enhance the quality of life of older people.
MULTIFILE
Background: The concept of Functional Independence (FI), defined as ‘functioning physically safe and independent from other persons, within one’s context”, plays an important role in maintaining the functional ability to enable well-being in older age. FI is a dynamic and complex concept covering four clinical outcomes: physical capacity, empowerment, coping flexibility, and health literacy. As the level of FI differs widely between older adults, healthcare professionals must gain insight into how to best support older people in maintaining their level of FI in a personalized manner. Insight into subgroups of FI could be a first step in providing personalized support This study aims to identify clinically relevant, distinct subgroups of FI in Dutch community-dwelling older people and subsequently describe them according to individual characteristics. Results: One hundred fifty-three community-dwelling older persons were included for participation. Cluster analysis identified four distinctive clusters: (1) Performers – Well-informed; this subgroup is physically strong, well-informed and educated, independent, non-falling, with limited reflective coping style. (2) Performers – Achievers: physically strong people with a limited coping style and health literacy level. (3) The reliant- Good Coper representing physically somewhat limited people with sufficient coping styles who receive professional help. (4) The reliant – Receivers: physically limited people with insufficient coping styles who receive professional help. These subgroups showed significant differences in demographic characteristics and clinical FI outcomes. Conclusions: Community-dwelling older persons can be allocated to four distinct and clinically relevant subgroups based on their level of FI. This subgrouping provides insight into the complex holistic concept of FI by pointing out for each subgroup which FI domain is affected. This way, it helps to better target interventions to prevent the decline of FI in the community-dwelling older population.
DOCUMENT
Purpose: To investigate the prevalence of multidimensional frailty in older people with hypertension and to examine a possible relationship of general obesity and abdominal obesity to frailty in older people with hypertension. Patients and Methods: A sample of 995 community-dwelling older people with hypertension, aged 65 years and older and living in Zhengzhou (China), completed the Tilburg Frailty Indicator (TFI), a validated self-report questionnaire for assessing multidimensional frailty. In addition, socio-demographic and lifestyle characteristics were assessed by self-report, and obesity was determined by measuring waist circumference and calculating the body mass index. Results: The prevalence of multidimensional frailty in this older population with hypertension was 46.5%. Using multiple linear regression analysis, body mass index was significantly associated with physical frailty (p = 0.001), and waist circumference was significantly positively associated with multidimensional frailty and all three frailty domains. Older age was positively associated with multidimensional frailty, physical frailty, and psychological frailty, while gender (woman) was positively associated with multidimensional, psychological, and social frailty. Furthermore, comorbid diseases and being without a partner were positively associated with multidimensional, physical, psychological, and social frailty. Of the lifestyle characteristics, drinking alcohol was positively associated with frailty domains. Conclusion: Multidimensional frailty was highly prevalent among Chinese community-dwelling older people with hypertension. Abdominal obesity could be a concern in physical frailty, psychological frailty, and social frailty, while general obesity was concerning in relation to physical frailty.
DOCUMENT
The aim of this systematic review was to examine the association between malnutrition and oral health in older people (≥ 60 years of age). A comprehensive systematic literature search was performed in four databases (PubMed, CINAHL, Dentistry and Oral Sciences Source, and Embase) for literature from January 2000 to May 2020. Both observational and intervention studies were screened for eligibility. Two reviewers independently screened the search results to identify potential eligible studies, and assessed the methodological quality of the full-text studies. A total of 3240 potential studies were identified. After judgement for relevance, 10 studies (cross-sectional (n = 9), prospective cohort (n = 1)) met the inclusion criteria. Three studies described malnourished participants as having fewer teeth, or functional (tooth) units (FTUs), compared to well-nourished participants. Four studies reported soft tissue problems in malnourished participants, including red tongue with blisters, and dry or cracked lips. Subjective oral health was the topic in six studies, with poorer oral health and negative self-perception of oral health in malnourished elderly participants. There are associations between (at risk of) malnutrition and oral health in older people, categorized in hard and soft tissue conditions of the mouth, and subjective oral health. Future research should be focused on longitudinal cohort studies with proper determination of malnutrition and oral health assessments, in order to evaluate the actual association between malnutrition and oral health in older people.
DOCUMENT
Given the increasing importance of sustainability as a part of one’s daily routine and life in countries in the European Union, there is a need to establish a basic understanding of the attitudes, behaviours and culture among older people. This, in turn, should lead to better policies which help alleviate the effects of the current cost-of-living and energy crises and make our societies more sustainable and resilient. Despite the growing awareness of sustainability amongst the general public, a conceptual model of a sustainable lifestyle among older people is missing. The existing reports from the WHOprovide some guidance on how to move along, as they touch upon items that are related to sustainability such as walkability, proximity to transportation stops and emergency preparedness, and highlight the need to improve the fit between people’s needs and the environments in which they live. Any effort to come up with such a conceptual model would have to acknowledge that energy conservation and sustainable behaviours among our older population, as was shown by Bennetts et al., are not an integral part of all older people’s lifestyles and day-to-day choices. Also, following Dikken et al.,many seemingly sustainable choices may be made purely out of financial necessity. New models and policies would have to acknowledge that in times of declining purchase power, the majority of older people living on the edge make sacrifices in terms of energy use in the broadest sense of the word due to financial constraints and not out of concern for the environment.
MULTIFILE
By having a healthy and happy social life, social needs are fulfilled. When social needs are not fulfilled, loneliness and social isolation can occur, which have negative consequences for one’s physical and mental health. Social technology, technology that enables social interaction, can be a resource to fulfil the social needs of older people. In this study, we aimed to learn what role social technology plays in the social life of older people. We held 15 interviews with people aged over 70 who regularly use some form of social technology. Our results indicate that social technology plays different roles in the lives of older people. It strengthens the existing social relationships and social structures. It also brings depth and fun to the social contacts of older people and in this way, enriches their social lives. Social technology also gives a sense of safety and peace of mind to the older people themselves but also to their network members. However, there are barriers in the use of social technology. The older people struggled with using social technology and feel that social technology sometimes stands in the way of real human contact. In supporting and facilitating people’s relationship with others, a community and society, technology helps fulfil older people’s need for connectedness, meaningfulness and independence. However, the relationship with independence is ambiguous. Their life experience gives older people a thoughtful way of looking at social technology and the role it plays in their lives
DOCUMENT
The global agenda to move societies towards a more sustainable course of development also affects the lives of older people in our ageing populations. Therefore, it is important to understand the drivers, intentions and behaviours concerning sustainability among older adults. The aim of this study is to translate and cross-culturally validate an existing instrument (SustainABLE-16 Questionnaire), developed in the Netherlands, which measures how older people view the theme of environmental sustainability in their daily lives, for use in Romania, Poland, North Macedonia and Israel. The SustainABLE-16 covers three domains: 1) Pro-environmental behaviours; 2) Financial position; and 3) Beliefs. The scale was translated in Romanian, Polish, Macedonian, Albanian and Hebrew. Its 16 items were appraised for relevance by older people and experts in the field. A total of 2299 older people, including the original Dutch respondents, were included for the assessment of the level of measurement invariance across six languages, spoken in five countries. As the initial validation of the SustainABLE-16 did not meet internationally-recognised fit requirements, the shorter SustainABLE-8 was validated instead. This instrument proved valid for use in all participating countries (configural validity). Subsequently, increasingly constrained structural equation models were applied to test their fit with the data, ensuring that the fit did not deteriorate. The test results of measurement invariance across the countries indicated that items were stable, achieving partial scalar invariance, with five items demonstrating full scalar invariance. The shorter SustainABLE-8 functions uniformly across all language groups and can, therefore, be used to evaluate sustainable practices among older people. A better understanding of the drivers and practices among older citizens across Europe could, in turn, feed into more fitting public policies on sustainability in the built environment.
MULTIFILE
As the population ages, the proportion of frail older people is also increasing. While attention to frailty experiences has increased, how these account to a comprehensive understanding of frailty and its impact on behavior and functioning remains understudied. Therefore, in this study, we aimed to understand how frailty is experienced, and how frailty and frailty experiences affect behavior and functioning from the perspectives of Dutch community-dwelling older people. In this phenomenological qualitative study, we conducted semi-structured interviews with 36 community-dwelling older people (≥65 years). The ‘Tilburg Frailty Indicator’ was administered to measure frailty, 15 of the participants were considered frail. Thematic analysis revealed the following themes and subthemes: 1) frailty experiences: situation related, initiated internally, initiated externally, and being and feeling frail; 2) coping: cognitive efforts, behavioral efforts, and emotional aspects. The distinction between being frail and feeling frail was, among other things, reflected in the temporality of frailty experiences, such as short periods of moments in time experiencing frailty. Personal factors and contexts strongly influence an individual's experiences and multiple coping strategies were discovered, with mindset shaping individual coping strategies. We recommend a personalized approach in which the experiences and capabilities of older people are considered to support them in maintaining or enhancing their well-being.
DOCUMENT
Objective: To predict mortality by disability in a sample of 479 Dutch community-dwelling people aged 75 years or older. Methods: A longitudinal study was carried out using a follow-up of seven years. The Groningen Activity Restriction Scale (GARS), a self-reported questionnaire with good psychometric properties, was used for data collection about total disability, disability in activities in daily living (ADL) and disability in instrumental activities in daily living (IADL). The mortality dates were provided by the municipality of Roosendaal (a city in the Netherlands). For analyses of survival, we used Kaplan–Meier analyses and Cox regression analyses to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results: All three disability variables (total, ADL and IADL) predicted mortality, unadjusted and adjusted for age and gender. The unadjusted HRs for total, ADL and IADL disability were 1.054 (95%-CI: [1.039;1.069]), 1.091 (95%-CI: [1.062;1.121]) and 1.106 (95%-CI: [1.077;1.135]) with p-values <0.001, respectively. The AUCs were <0.7, ranging from 0.630 (ADL) to 0.668 (IADL). Multivariate analyses including all 18 disability items revealed that only “Do the shopping” predicted mortality. In addition, multivariate analyses focusing on 11 ADL items and 7 IADL items separately showed that only the ADL item “Get around in the house” and the IADL item “Do the shopping” significantly predicted mortality. Conclusion: Disability predicted mortality in a seven years follow-up among Dutch community-dwelling older people. It is important that healthcare professionals are aware of disability at early stages, so they can intervene swiftly, efficiently and effectively, to maintain or enhance the quality of life of older people.
DOCUMENT
Background: The aging population is increasingly faced with daily life limitations, threatening their Functional Independence (FI). These limitations extend different life domains and require a broad range of community-care professionals to be addressed. The Decision Support Tool for Functional Independence (DST-FI) facilitates community-care professionals in providing uncontradictory recommendations regarding the maintenance of FI in community-dwelling older people. The current study aims to determine the validity and reliability of the DST-FI. Methods: Sixty community-care professionals completed a twofold assessment. To assess construct validity, participants were asked to assign predefined recommendations to fifty cases of older people to maintain their level of FI. Hypotheses were tested regarding the expected recommendations per case. Content validity was assessed by questions on relevance, comprehensiveness, and comprehensibility of the current set of recommendations. Twelve participants repeated the assessment after two weeks to enable both within- and between rater reliability properties, expressed by an Intraclass Correlation Coefficient. Results: Seven out of eight predefined hypotheses confirmed expectations, indicating high construct validity. As the recommendations were indicated 'relevant' and 'complete', content validity was high as well. Agreement between raters was poor to moderate while agreement within raters was moderate to excellent, resulting in moderate overall reliability. Conclusion: The DST-FI suggests high validity and moderate reliability properties when used in a population of community-dwelling older people. The tool could facilitate community-care professionals in their task to preserve FI in older people. Future research should focus on psychometric properties like feasibility, acceptability, and developing and piloting strategies for implementation in community-care.
LINK
