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Is het proactieve zorgprogramma voor kwetsbare ouderen uitgevoerd zoals gepland? Een analyse van interventiegetrouwheid

Full text beschikbaar met HU-account. Het evalueren van de effectiviteit van een complexe interventie in een gerandomiseerde klinische trial is niet eenvoudig.1,2) In de literatuur wordt een interventie als effectief beschouwd wanneer er een positief resultaat op de primaire uitkomst is gevonden. Echter, om de validiteit en betrouwbaarheid van een interventie te beoordelen is kennis nodig over de mate waarin de interventie is uitgevoerd als gepland, ofwel de interventiegetrouwheid.3) Daarnaast geeft kennis over interventiegetrouwheid inzicht in hoeverre de implementatie succesvol was en daadwerkelijk een bijdrage heeft kunnen leveren aan de geobserveerde uitkomsten.

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Is het proactieve zorgprogramma voor kwetsbare ouderen uitgevoerd zoals gepland? Een analyse van interventiegetrouwheid

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Caring for Confused Community Dwelling Seniors:

Older people with confused behavior, have behavioral problems due to dementia, mental problems or social problems. For the Healthcare Assistant (HA) in district nursing, it is a daily challenge to care for older people with confused behavior. Aim of this research is to achieve an insight in the strategies the HA uses to deal with the daily care for older people with confused behavior. It is also the aim to have insight in factors which contribute to the daily care in a positive or negative way. Method: a qualitative explorative research. 17 HA’s in district nursing participated in semi-structured interviews. All respondents had experience with caring for older people with confused behavior. The most important influencing factors are the experienced relationship between HA and the client and the experienced support by the team. Particularly behavioral problems due to mental problems can impede a relationship with the client. Further research is recommended to study the level of knowledge and competences of all levels of employees in district nursing.

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Caring for Confused Community Dwelling Seniors:

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Haastige spoed is zelden goed

Het lectoraat Transmurale Ouderenzorg is onderdeel van het kenniscentrum ACHIEVE van de faculteit Gezondheid. ACHIEVE heeft ‘Complex Care’ als focus. De complexiteit van de acute zorg voor oudere patiënten, waarin samenwerking en coördinatie van essentieel belang zijn, sluit hier naadloos op aan.

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The quality of geriatric rehabilitation from the patients’ perspective: a scoping review

Backgroundthe efficacy and outcomes of geriatric rehabilitation (GR) have previously been investigated. However, a systematic synthesis of the aspects that are important to patients regarding the quality of GR does not exist.Objectivethe aim of this scoping review was to systematically synthesise the patients’ perspective on the quality of GR.Methodswe followed the Scoping Review framework and gathered literature including a qualitative study design from multiple databases. The inclusion criteria were: a qualitative study design; a geriatric population; that patients had participated in a geriatric rehabilitation programme and that geriatric rehabilitation was assessed by the patient. The results sections of the included studies were analysed using a thematic analysis approach.Resultstwenty articles were included in this review. The main themes identified were: (i) the need for information about the rehabilitation process, (ii) the need for telling one’s story, (iii) the need for support (physical, psychological, social and how to cope with limitations), (iv) the need for shared decision-making and autonomy, (v) the need for a stimulating rehabilitation environment and (vi) the need for rehabilitation at home.Conclusionin this study, we identified the aspects that determine the quality of rehabilitation from the patient’s perspective, which may lead to a more holistic perspective on the quality of GR.

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The quality of geriatric rehabilitation from the patients’ perspective: a scoping review

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Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis

BACKGROUND: Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increase.OBJECTIVE: To assess the effects of OGR on the primary outcome functional performance (FP) and secondary outcomes: length of in-patient stay, re-admission rate, patients' and caregivers' quality of life, mortality and cost-effectiveness. We also aim to describe the organisation and content of OGR.METHODS: Systematic review and meta-analysis. Five databases were queried from inception to July 2022. We selected randomised controlled trials written in English, focusing on multidisciplinary interventions related to OGR, included participants aged ≥65 and reported one of the main outcomes. A meta-analysis was performed on FP, patients' quality of life, length of stay and re-admissions. The structural, procedural and environmental aspects of OGR were systematically mapped.RESULTS: We selected 24 studies involving 3,405 participants. The meta-analysis showed no significant effect on the primary outcome FP (activity). It demonstrated a significant effect of OGR on shortening length of in-patient stay (P = 0.03, MD = -2.41 days, 95%CI: [-4.61-0.22]). Frequently used elements of OGR are: inpatient start of OGR with an interdisciplinary rehabilitation team, close cooperation with primary care, an OGR coordinator, individual goal setting and education for both patient and caregiver.CONCLUSION: This review showed that OGR is as effective as usual care on FP activity. It shows low certainty of evidence for OGR being effective in reducing the length of inpatient stay. Further research is needed on the various frequently used elements of OGR.

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Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis

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How do ageism, death anxiety and ageing anxiety among medical students and residents affect their attitude towards medical care for older patients

Background: Although the number of older patients requiring medical care is increasing, caring for older patients is often seen as unattractive by medical trainees (i.e., medical students, residents, interns, and fellows). Terror Management Theory states that people have a negative attitude towards older people, because they remind people of their own mortality. We hypothesize that ageism, death anxiety, and ageing anxiety among medical trainees negatively affect their attitude towards medical care for older patients. This review aimed to examine and generate an overview of available literature on the relationship between ageism, death anxiety, and ageing anxiety among medical trainees and their attitude towards medical care for older patients. Methods: A systematic review was performed with a review protocol based on the PRISMA Statement. PubMed, Ebsco/PsycInfo, Ebsco/ERIC and Embase were searched from inception to August 2022, using the following search terms, including their synonyms and closely related words: “medical trainees” AND “ageism” OR “death anxiety” OR “ageing anxiety” AND “(attitude AND older patient)”. Results: The search yielded 4072 different studies; 12 eligible studies (10 quantitative and 2 qualitative) were identified and synthesized using narrative synthesis. Findings suggest that a positive attitude towards older people was related to a positive attitude towards medical care for older patients among medical students. The available literature on the relationship between death anxiety and/or ageing anxiety and attitude towards medical care for older patients among medical trainees was limited and had a heterogeneity in focus, which hindered comparison of results. Conclusion: Our findings suggest that a positive attitude towards older people in general is related to a positive attitude towards medical care for older patients among medical students. Future research should focus on further exploring underlying mechanisms affecting the attitude towards medical care for older patients among medical trainees.

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How do ageism, death anxiety and ageing anxiety among medical students and residents affect their attitude towards medical care for older patients

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Older patients’ motives of whether or not to perform self-management during a hospital stay and influencing factors

Semi-structured in-depth interviews (n = 12) were held to explore older patients’ motives of whether or not toperform self-management while hospitalized and to identify factors influencing self-management during hospitalization. These interviews were analyzed using the Quacol method. Self-management during hospitalization is operationalized as: collaboration with the nursing staff, having a proactive role, and having control over personal care. Three main themes, i.e., patients’ abilities, expectations and opinions, as well as their perceived behavior of nurses were identified along with eight influencing factors. Results indicate that older inpatients perform selfmanagement when they know that it impacts their recovery, when they perceive that a mistake is impending, when their own personal limits are exceeded, or when they are invited to self-manage by nurses.This study provides several suggestions for developing interventions to support patients’ self-management during hospitalization.

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De mens zien bij dementie

Voor mensen met dementie en hun (in)formele zorgverleners is er een enorme keuze aan producten, services en diensten om zo lang mogelijk zelfstandig te blijven, dat aanbod groeit met de dag. Echter, in praktijk sluiten vraag en aanbod niet naadloos op elkaar aan. Komt dat omdat het aanbod moeilijk te vinden is? Of is de juiste oplossing er (nog) niet? En wat is precies de behoefte van de doelgroep? Deze vragen staan centraal binnen het project FIT. Inzichten eerste fase FIT Het project FIT bestaat uit verschillende fasen. In de eerste fase is zowel de dieperliggende behoeften (de vraag achter de vraag) van de doelgroep in kaart gebracht, samen met mensen die leven met dementie en hun mantelzorgers, als een theoretisch model voor het proces van vraagverheldering.

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Frailty among older people in a community setting in China

Frailty is the most common manifestation of serious health issues in the world, and it is becoming more prevalent worldwide as the aging population grows. Changes that occur in an individual during the aging process have physical, psychological, social, and environmental aspects that make an individual more frail. In China, older people may live in communities for aging individuals. This study aimed to describe the presence and severity of frailty and to analyze influencing factors among this population in China. The Frailty Index 35 (FI-35) scale, which includes 35 items in physical, psychological, social, and environmental domains, was used to investigate frailty. The FI-35 score ranges from zero to one, with a score closer to one indicating greater frailty. Biographical, socioeconomic, and lifestyle factors were measured as potential determinants of frailty. We relied on the November 2017-February 2018 waves of the Chinese cross-sectional study survey that comprised a sample of 513 adults, aged 60 or older, who were living in China. Linear regression was performed to identify factors associated with FI-35 scores. We categorized the determinants of frailty into three models: Model 1: biographical variables; Model 2: biographical and socioeconomic variables; and Model 3: biographical, economic, and lifestyle variables. Frailty scores ranged from 0.00 to 0.89, with a median of 0.31, and the prevalence of frailty was 67.6%. The final model obtained after variable selection included age, minority status, marriage status, income, diet, and exercise. The adjusted R-squared indicated that the analysis explained 13.8% of the variance in frailty scores. Adding household, marriage status, education level, medical insurance, and income as elements in Model 2 explained 25.7%. Adding diet, smoking, drinking, exercise, and hobbies in Model 3 explained 27.9%. The degree of frailty varies considerably among Chinese community-dwelling older people and is partly determined by biographical, socioeconomic, and lifestyle factors.

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Is het proactieve zorgprogramma voor kwetsbare ouderen uitgevoerd zoals gepland? Een analyse van interventiegetrouwheid

Caring for Confused Community Dwelling Seniors:

Haastige spoed is zelden goed

The quality of geriatric rehabilitation from the patients’ perspective: a scoping review

Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis

How do ageism, death anxiety and ageing anxiety among medical students and residents affect their attitude towards medical care for older patients

Older patients’ motives of whether or not to perform self-management during a hospital stay and influencing factors

De mens zien bij dementie

Frailty among older people in a community setting in China

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Is het proactieve zorgprogramma voor kwetsbare ouderen uitgevoerd zoals gepland? Een analyse van interventiegetrouwheid

Caring for Confused Community Dwelling Seniors:

Haastige spoed is zelden goed

The quality of geriatric rehabilitation from the patients’ perspective: a scoping review

Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis

How do ageism, death anxiety and ageing anxiety among medical students and residents affect their attitude towards medical care for older patients

Older patients’ motives of whether or not to perform self-management during a hospital stay and influencing factors

De mens zien bij dementie

Frailty among older people in a community setting in China