Ageing of the population in European cities creates fundamental challenges with regard to employment, pensions, health care and other age-related services. Many older people want to live independent lives as long as possible. This aspiration is currently strongly supported by many local governments. A precondition for 'ageing in place' is that older people perceive their neighbourhoods as familiar and safe places. In the Netherlands, many neighbourhoods with an ageing population have been subject to urban restructuring policies. An important question is to what extent such policies affect the housing situation, socioeconomic position and social support networks of older people, as these factors strongly assist their ability to 'age in place'. The paper answers this question through an exploratory analysis of a small but unique panel data set from Hoogvliet, a large urban restructuring area in the city of Rotterdam. The partly counter-intuitive results show that restructuring has enabled 'ageing in place'. Compared to stayers, movers within Hoogvliet often report improved housing quality and positive neighbourhood change. The exploratory analyses did not provide evidence of decreased social support or increased loneliness through restructuring-induced disruptions of social ties. Various 'buffer measures' have been effective in preventing negative restructuring impacts on older residents.
BackgroundTo reduce homelessness, it is important to gain a better understanding of the differences between homeless people who remain in institutions and those who gain and can sustain independent housing. This longitudinal study explores differences in housing transitions and differences in changes in health and self-determination between formerly homeless people still living in institutions 2.5 years later and those now living in independent housing in the Netherlands.MethodsThis study mapped the housing transitions of 263 participants from when they entered the social relief system (SRS) to 2.5 years later when they were in independent housing or institutions. These individuals were compared at the 2.5-year mark in terms of gender, age and retrospectively in terms of duration of homelessness. They were also compared with regard to changes in psychological distress, perceived health, substance use and self-determination.ResultsTwo and a half years after entering the SRS, 81% of participants were independently housed and 19% still lived in institutions. People in institutions had a longer lifetime duration of homelessness, were more often men, and their number of days of alcohol use had decreased significantly more, whereas independently housed people had shown a significant increase in their sense of autonomy and relatedness.ConclusionFormerly homeless people living in independent housing and in institutions show few health-related differences 2.5 years after entering the SRS, but changes in autonomy and relatedness are distinctly more prevalent, after the same period of time, in those who are independently housed.
Abstract: Teledentistry offers possibilities for improving efficiency and quality of care and supporting cost-effective healthcare systems. This umbrella review aims to synthesize existing systematic reviews on teledentistry and provide a summary of evidence of its clinical- and cost-effectiveness. A comprehensive search strategy involving various teledentistry-related terms, across seven databases, was conducted. Articles published until 24 April 2023 were considered. Two researchers independently reviewed titles, abstracts and full-text articles. The quality of the included reviews was critically appraised with the AMSTAR-2 checklist. Out of 749 studies identified, 10 were included in this umbrella review. Two reviews focusing on oral-health outcomes revealed that, despite positive findings, there is not yet enough evidence for the long-term clinical effectiveness of teledentistry. Ten reviews reported on economic evaluations or costs, indicating that teledentistry is cost-saving. However, these conclusions were based on assumptions due to insufficient evidence on cost-effectiveness. The main limitation of our umbrella review was the critically low quality of the included reviews according to AMSTAR-2 criteria, with many of these reviews basing their conclusions on low-quality studies. This highlights the need for high-quality experimental studies (e.g., RCTs, factorial designs, stepped-wedge designs, SMARTs and MRTs) to assess teledentistry’s clinical- and cost-effectiveness.