Veel medewerkers geven de voorkeur aan informele vormen van leren en ontwikkelen op de werkplek, terwijl formele leeractiviteiten gangbaarder zijn in organisaties. Deze activiteiten lijken vaak geïnitieerd door managers en HR-functionarissen en vinden veelal buiten de werkplek plaats. Dit terwijl arbeidsmarkttekorten noodzaken om leren en ontwikkelen in het dagelijkse werk vorm te geven. Dit artikel gaat in op het potentieel van participatief actieonderzoek om te leren en te ontwikkelen op de werkplek. Er wordt verslag gedaan van een actieonderzoeksproject binnen de verpleeghuiscontext. Onderzocht is hoe leren en ontwikkelen plaatsvonden en welke werkzame elementen binnen het actieonderzoeksproject hieraan bijdroegen. Resultaten laten zien dat leren en ontwikkelen in en van werk plaatsvinden op het moment dat authentieke situaties, direct beleefd worden. Ook helpt het als de authentieke situaties verkend worden vanuit verschillende perspectieven en als er mogelijkheden gezien worden voor nieuw of anders handelen. Regels en routines kunnen de integratie van leren en ontwikkelen in het werk beperken. Op basis van opgedane ervaringen en geleerde lessen worden aanbevelingen gegeven.
MULTIFILE
The aim of this study was to explore the association between oral health and frailty in community-dwelling Dutch adults aged 55 years and older. Included were 170 participants (n = 95 female [56%]; median age 64 years [IQR: 59–69 years]). Frailty was assessed by the Groningen Frailty Indicator. Oral health was assessed by the Oral Health Impact Profile-14-NL (OHIP-NL14). OHIP-NL14 item scores were analyzed for differences between frail and non-frail participants. Univariate and multivariate logistic regression analyses were performed to assess the association between oral health and presence of frailty. The multivariate analysis included age, gender, and depressive symptoms as co-variables. After adjustment, 1 point increase on the OHIP-NL14 scale was associated with 21% higher odds of being frail (p = 0.000). In addition, significantly more frail participants reported presence of problems on each OHIP-NL14 item, compared to non-frail participants (p < 0.003). Contrast in prevalence of different oral health problems between frail and non-frail was most prominent in ‘younger’ older adults aged 55–64 years. In conclusion: decreased oral health was associated with frailty in older adults aged 55 years. Since oral health problems are not included in most frailty assessments, tackling oral health problems may not be sufficiently emphasized in frailty policies.
BACKGROUND: Frailty is a predictor of adverse outcomes in elderly patients. The Canadian Study of Health and Aging Clinical Frailty Scale (CFS) is an often-used frailty assessment instrument. However, the CFS's reliability and validity in patients with burn injuries are unknown. This study aimed to assess the CFS's inter-rater reliability and validity (predictive validity, known group validity and convergent validity) in patients with burn injuries treated to specialized burn care.METHODS: A retrospective multicentre cohort study was conducted in all three Dutch burn centres. Patients aged ≥ 50 years with burn injuries, with a primary admission in 2015-2018, were included. Based on information in the electronic patient files, a research team member scored the CFS retrospectively. Inter-rater reliability was calculated using Krippendorff's α. Validity was assessed using logistic regression analysis. Patients with a CFS ≥ 5 were considered frail.RESULTS: In total, 540 patients were included, with a mean age of 65.8 years (SD 11.5) and a Total Body Surface Area (TBSA) burned of 8.5%. The CFS was used to assess frailty in 540 patients and the reliability of the CFS was scored for 212 patients. Mean CFS was 3.4(SD 2.0). Inter-rater reliability was adequate, Krippendorff's α 0.69 (95%CI 0.62-0.74). A positive frailty screening was predictive of a non-home discharge location (OR 3.57, 95%CI 2.16-5.93), a higher in-hospital mortality rate (OR 1.06-8.77), and a higher mortality rate within 12 months after discharge (OR 4.61, 95%CI 1.99-10.65) after adjustment for age, TBSA, and inhalation injury. Frail patients were more likely to be older (for<70 vs. ≥70 years odds ratio 2.88, 95%CI 1.95-4.25) and their comorbidities were more severe (ASA ≥3 vs 1-2 OR 6.43, 95%CI 4.26-9.70) (known group validity). The CFS was significantly related (rSpearman=0.55) to the Dutch Safety Management System (DSMS) frailty screening, reflecting a fair-good correlation between the CFS and DSMS frailty screening outcomes.CONCLUSION: The Clinical Frailty scale is reliable and has shown its validity, including its association with adverse outcomes in patients with burn injury admitted to specialized burn care. Early frailty assessment with the CFS must be considered, to optimize early recognition and treatment of frailty.
