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Care and decision-making at the end of life for migrants living in the Netherlands

As migrant populations age, the care system is confronted with the question how to respond to care needs of an increasingly diverse population of older adults. We used qualitative intersectional analysis to examine differential preferences and experiences with care at the end of life of twenty-five patients and their relatives from Suriname, Morocco and Turkey living in The Netherlands. Our analysis focused on the question how–in light of impairment–ethnicity, religion and gender intersect to create differences in social position that shape preferences and experiences related to three main themes: place of care at the end of life; discussing prognosis, advance care, and end-of-life care; and, end-of-life decision-making. Our findings show that belonging to an ethnic or religious minority brings forth concerns about responsive care. In the nursing home, patients’ minority position and the interplay thereof with gender make it difficult for female patients to request and receive responsive care. Patients with a strong religious affiliation prefer to discuss diagnosis but not prognosis. These preferences are at interplay with factors related to socioeconomic status. The oversight of this variance hampers responsive care for patients and relatives. Preferences for discussion of medical aspects of care are subject to functional impairment and faith. Personal values and goals often remain unexpressed. Lastly, preferences regarding medical end-of-life decisions are foremost subject to religious affiliation and associated moral values. Respondents’ impairment and limited Dutch language proficiency requires their children to be involved in decision-making. Intersecting gendered care roles determine that mostly daughters are involved. Considering the interplay of aspects of social identity and their effect on social positioning, and pro-active enquiry into values, goals and preferences for end-of-life care of patients and their relatives are paramount to achieve person centred and family-oriented care responsive to the needs of diverse communities.

A Case Report for Diagnosing Anxiety in People With Intellectual Disability: The Role of Nurses in the Application of a Multidimensional Diagnostic Guideline

The purpose of this article is the presentation of a multidimensional guideline for the diagnosis of anxiety and anxiety-related behavior problems in people with intellectual disability (ID), with a substantial role for the nurse in this diagnostic process. DESIGN AND METHODS:  The guideline is illustrated by a case report of a woman with ID with severe problems. FINDINGS:  It appears that a multidimensional diagnostic approach involving multidisciplinary team efforts can result in a more accurate diagnosis and improved subsequent treatment. PRACTICE IMPLICATIONS:  Nurses should be engaged in the diagnostic process because of their ability to make direct observations and to actively participate in carrying out all parts of the guideline.

Idiopathic toe-walking in children, adolescents and young adults: a matter of local or generalised stiffness?

BackgroundIdiopathic Toe Walking (ITW) is present in children older than 3 years of age still walking on their toes without signs of neurological, orthopaedic or psychiatric diseases. ITW has been estimated to occur in 7% to 24% of the childhood population. To study associations between Idiopathic Toe Walking (ITW) and decrease in range of joint motion of the ankle joint. To study associations between ITW (with stiff ankles) and stiffness in other joints, muscle strength and bone density.MethodsIn a cross-sectional study, 362 healthy children, adolescents and young adults (mean age (sd): 14.2 (3.9) years) participated. Range of joint motion (ROM), muscle strength, anthropometrics sport activities and bone density were measured.ResultsA prevalence of 12% of ITW was found. Nine percent had ITW and severely restricted ROM of the ankle joint. Children with ITW had three times higher chance of severe ROM restriction of the ankle joint. Participants with ITW and stiff ankle joints had a decreased ROM in other joints, whereas bone density and muscle strength were comparable.ConclusionITW and a decrease in ankle joint ROM might be due to local stiffness. Differential etiological diagnosis should be considered.

Differential diagnostics in cluttering and stuttering A test of speech motor control on word level productions: The SPA Test (Dutch: Screening Pittige Articulatie)

Tot op heden bestond er geen onderzoeksinstrument dat betrouwbaar differentieert tussen broddelende en stotterende clienten. Een door de eerste auteur ontwikkelde test voor spraakmotorische controle op woordniveau is genormeerd en gevalideerd voor broddelende, stotterende sprekers en controles. Dit unieke instrument heeft een differentiaal diagnostische waarde binnen de vloeiendheidsstoornissen.

Cluttering Assessment

In dit document is het logopedisch onderzoek bij broddelen beschreven waarover internationaal consensus bestaat. Dit document is gepresenteerd op de website van de International Cluttering Association

Cluttering identified: differential diagnostics between cluttering, stuttering and speech impairment related to learning difficulties