Abstract: Hypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease. Considering the physiological changes resulting from ageing alongside multiple comorbidities, treatment of hypertension in elderly patients poses a significant challenge to treatment teams. Progressive disability with regard to the activities of daily life, more frequent hospitalisations and low quality of life are often seen in elderly patients. There is discussion in the literature regarding frailty syndrome associated with old age. Frailty is understood to involve decreased resistance to stressors, depleted adaptive and physiological reserves of a number of organs, endocrine dysregulation and immune dysfunction. The primary dilemma concerning frailty is whether it should only be defined on the basis of physical factors, or whether psychological and social factors should also be included. Proper nutrition and motor rehabilitation should be prioritised in care for frail patients. The risk of orthostatic hypotension is a significant issue in elderly patients. It results from an autonomic nervous system dysfunction and involves maladjustment of the cardiovascular system to sudden changes in the position of the body. Other significant issues in elderly patients include polypharmacy, increased risk of falls and cognitive impairment. Chronic diseases, including hypertension, deteriorate baroreceptor function and result in irreversible changes in cerebral and coronary circulation. Concurrent frailty or other components of geriatric syndrome in elderly patients are associated with a worse perception of health, an increased number of comorbidities and social isolation of the patient. It may also interfere with treatment adherence. Identifying causes of non-adherence to pharmaceutical treatment is a key factor in planning therapeutic interventions aimed at increasing control, preventing complications, and improving long-term outcomes and any adverse effects of treatment. Diagnosis of frailty and awareness of the associated difficulties in adhering to treatment may allow targeting of those elderly patients who have a poorer prognosis or may be at risk of complications from untreated or undertreated hypertension, and for the planning of interventions to improve hypertension control.
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The aim of this report is to give an overview of current state of the art in the occurrence and policies regarding affordable age-friendly and eco-friendly solutions in the partner countries. The report consists of the findings from the literature review, the comparative analysis and the reporting of good practices. It aims for the consortium as a whole to gain an understanding of the state of the art and on affordable age and eco-friendly solutions in partner countries and particularly the home and community fields, and to present that knowledge in the form of a written report. The literature review, the analysis of barriers and facilitators, and the survey on existing or even planning good practices in the project countries, will help the partners to build and update a strong knowledge base in these fields. To be closer to the practical issues that define the adaptability of eco and age-friendly solutions in community, the consortium decided to use mostly grey literature and websites for tools and advice, such as governmental pages. Common grey literature publication types include reports (annual, research, technical, project, etc.), working papers, government documents, white papers and evaluations, which will help all partners to reach conclusions around the common field between age and eco-friendly developments. Barriers and facilitators found in each project country will be used for stipulating the right consequence of actions needed, to propose a sound methodology that could – in combination with other actions and stakeholders – promote the implementation of age and eco-friendly principles into the public and private sphere of care for older people. Finally, the selection of good representative practices by each project country can be the basis for a report, and a publication, that depicts the level of maturity and progress of the notions of age-friendliness and eco-friendliness, as well as their impact on the care of older people.
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The gradual aging of western society during the twentieth century, including its causes and consequences, has become one of the dominant themes of demography and sociology. This study tries to shed more light on the recent past of older individuals emphasizing the socio-economic strategies they employed in order to maintain their standard of living after reaching the age of 60. Theories concerning different elements within these strategies (work, savings, the family and the collectivity) are discussed. The last part of this study considers the impact of these strategies in the context of a case study using a variety of sources on the lives of a selected group of elderly people living in the civil parish of Winterswijk over the periode 1880-1938.
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Objective: The effects of sociodemographic factors on quality of life in older people differ strongly, possibly due to the fact that different measurement instruments have been used. The main aim of this cross-sectional study is to compare the associations of sex, age, marital status, education, and income with quality of life assessed with the Short-Form Health Survey (SF-12), the World Health Organization Quality of Life Questionnaire-BREF (WHOQOL-BREF), and the World Health Organization Quality of Life Questionnaire-Older Adults Module (WHOQOL-OLD). Methods: The associations between sociodemographic factors and eleven quality of life domains were examined using a sample of 1,492 Dutch people aged $50 years. Participants completed the “Senioren Barometer”, a web-based questionnaire including sociodemographic factors, the SF-12, the WHOQOL-BREF, and the WHOQOL-OLD. Results: All the sociodemographic factors together explained a significant part of the variance of all the quality of life domains’ scores, ranging from 5% to 17% for the WHOQOL-BREF, 5.8% to 6.7% for the SF-12, and 1.4% to 26% for the WHOQOL-OLD. Being a woman and being older were negatively associated with two and four quality of life domains, respectively. Being a woman, being married or cohabiting, and having higher education and a higher income were positively associated with six, six, one, and eleven quality of life domains, respectively. Conclusion: Our study showed that the associations of sociodemographic factors and quality of life in middle-aged and older people depend on the instruments used to assess quality of life. We recommend that health care and welfare professionals focus particularly on people with a low income and carry out interventions aimed at improving their quality of life.
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A comparison between arrangements for income and care in old age in Britain and the Netherlands before and after the welfare state.
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Abstract Background: To assess the internal consistency reliability and construct validity of the Dutch version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD). Methods: The psychometric properties of the Dutch WHOQOL-OLD were examined in a cross-sectional study using a sample of 1,340 people aged 60 years or older. Participants completed a Web-based questionnaire, the ‘Senioren Barometer’. Reliability was evaluated using Cronbach’s alpha and corrected item-total correlations. Construct validity of the Dutch WHOQOL-OLD was evaluated with confirmatory factor analyses, and correlations within and between scales, using scales WHOQOL-BREF, Short Form Health Survey (SF-12), Tilburg Frailty Indicator (TFI), and the Emotional and Social Loneliness Scale (ESLS).
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Urban ageing is an emerging domain that deals with the population of older people living in cities. The ageing of society is a positive yet challenging phenomenon, as population ageing and urbanisation are the culmination of successful human development. One could argue whether the city environment is an ideal place for people to grow old and live at an old age compared to rural areas. This viewpoint article explores and describes the challenges that are encountered when making cities age-friendly in Europe. Such challenges include the creation of inclusive neighbourhoods and the implementation of technology for ageing-in-place. Examples from projects in two age-friendly cities in The Netherlands (The Hague) and Poland (Cracow) are shown to illustrate the potential of making cities more tuned to the needs of older people and identify important challenges for the next couple of years. Overall, the global ageing of urban populations calls for more age-friendly approaches to be implemented in our cities. It is a challenge to prepare for these developments in such a way that both current and future generations of older people can benefit from age-friendly strategies. CC-BY Original article: https://doi.org/10.3390/ijerph15112473 https://www.dehaagsehogeschool.nl/onderzoek/lectoraten/details/urban-ageing#over-het-lectoraat
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Current global trends show that different regions of the globe face an increased level of urbanization, and there is a swift aging process from the Western to the Eastern European countries. Romania is a typical country expecting to triple the percentage of the older population aged 65 and over in the next 30 years. Urban policies often neglect such demographic perspectives. The World Health Organization launched the age-friendly city and communities' movement that proposes solutions for older people to age actively by improving their welfare and social participation. The concept of an age-friendly city comprised eight dimensions: (1) outdoor spaces and buildings; (2) transportation; (3) housing; (4) social participation; (5) respect and social inclusion; (6) civic participation and employment; (7) communication and information; and (8) community support and health services. It raises some important questions about how to measure and evaluate urban policies in this framework. Current work presents the process of adaptation and validation for the Romanian older population of a standardized tool - the Age-Friendly Cities and Communities Questionnaire (AFCCQ). The validation study was conducted in Bucharest (n = 424) on a representative sample of older people, who were asked to rate their life in the city, following the eight dimensions and an additional one regarding their financial situation. Four clusters were differentiated in the analysis, resulting in different views of older adults on their experience of living in the city, showing that people's socio-economic status, their living arrangements and health situation play a role in shaping their views on city life. The results highlight the importance of standardized tools to design urban policies following an age-friendly agenda.
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The World Health Organization engages cities and communities all over the world in becoming age-friendly. There is a need for assessing the age-friendliness of cities and communities by means of a transparently constructed and validated tool which measures the construct as a whole. The aim of this study was to develop a questionnaire measuring age-friendliness, providing full transparency and reproducibility. The development and validation of the Age Friendly Cities and Communities Questionnaire (AFCCQ) followed the criteria of the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN). Four phases were followed: (1) development of the conceptual model, themes and items; (2) initial (qualitative) validation; (3) psychometric validation, and (4) translating the instrument using the forward-backward translation method. This rigorous process of development and validation resulted in a valid, psychometrically sound, comprehensive 23-item questionnaire. This questionnaire can be used to measure older people’s experiences regarding the eight domains of the WHO Age-Friendly Cities model, and an additional financial domain. The AFCCQ allows practitioners and researchers to capture the age-friendliness of a city or community in a numerical fashion, which helps monitor the age-friendliness and the potential impact of policies or social programmes. The AFCCQ was created in Dutch and translated into British-English. CC-BY Original article: https://doi.org/10.3390/ijerph17186867 (This article belongs to the Special Issue Feature Papers "Age-Friendly Cities & Communities: State of the Art and Future Perspectives") https://www.dehaagsehogeschool.nl/onderzoek/lectoraten/details/urban-ageing#over-het-lectoraat Extra: Vragenlijst bijlage / Questionnaire attachement
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Purpose: To establish age-related, normal limits of monocular and binocular spatial vision under photopic and mesopic conditions. Methods: Photopic and mesopic visual acuity (VA) and contrast thresholds (CTs) were measured with both positive and negative contrast optotypes under binocular and monocular viewing conditions using the Acuity-Plus (AP) test. The experiments were carried out on participants (age range from 10 to 86 years), who met pre-established, normal sight criteria. Mean and ± 2.5σ limits were calculated within each 5-year subgroup. A biologically meaningful model was then fitted to predict mean values and upper and lower threshold limits for VA and CT as a function of age. The best-fit model parameters describe normal aging of spatial vision for each of the 16 experimental conditions investigated. Results: Out of the 382 participants recruited for this study, 285 participants passed the selection criteria for normal aging. Log transforms were applied to ensure approximate normal distributions. Outliers were also removed for each of the 16 stimulus conditions investigated based on the ±2.5σ limit criterion. VA, CTs and the overall variability were found to be age-invariant up to ~50 years in the photopic condition. A lower, age-invariant limit of ~30 years was more appropriate for the mesopic range with a gradual, but accelerating increase in both mean thresholds and intersubject variability above this age. Binocular thresholds were smaller and much less variable when compared to the thresholds measured in either eye. Results with negative contrast optotypes were significantly better than the corresponding results measured with positive contrast (p < 0.004). Conclusions: This project has established the expected age limits of spatial vision for monocular and binocular viewing under photopic and high mesopic lighting with both positive and negative contrast optotypes using a single test, which can be implemented either in the clinic or in an occupational setting.
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