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Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people

Effectiveness of a reablement training program for homecare staff on older adults' sedentary behavior

Background/Objectives: Homecare staff often take over activities instead of “doing activities with” clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the “Stay Active at Home” (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior. Design: Cluster randomized controlled trial (c-RCT). Setting: Dutch homecare (10 nursing teams comprising a total of 313 staff members). Participants: 264 clients (aged ≥65 years). Intervention: SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual. Measurements: Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed. Results: We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI]
22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI 1.5, 2.6], p = 0.589) or for most secondary outcomes. Conclusion: Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.

SynergyS: Multi-commodity energy systems

The increasing share of renewable production like wind and PV poses new challenges to our energy system. The intermittent behavior and lack of controllability on these sources requires flexibility measures like storage and conversion. Production, consumption, transportation, storage and conversion systems become more intertwined. The increasing complexity of the system requires new control strategies to fulfill existing requirements.The SynergyS project addresses the main question how to operate increasingly complex energy systems in a controllable, robust, safe, affordable, and reliable way. Goal of the project is to develop and test a smart control system for a multi-commodity energy system (MCES), with electricity, hydrogen and heat. In scope are an industrial cluster (Chemistry Park Delfzijl) and a residential cluster (Leeuwarden) and their mutual interaction. Results are experimentally tested in two real-life demo-sites scale models: Centre of Expertise Energy (EnTranCe) and The Green Village (TU Delft) represent respectively the industrial and residential cluster.The result will be a market-driven control system to operate a multi-commodity energy system, integrating the industrial and residential cluster. The experimental setup is a combination of physical demo-site assets complemented with (digital) asset models. Experimental validation is based on a demo-scenario including real time data, simulated data and several stress tests.In this session we’ll elaborate more on the project and present (preliminary) results on the testing criteria, scenarios and experimental setup.

Cluster analysis of functional independence in community‑dwelling older people

Background: The concept of Functional Independence (FI), defined as ‘functioning physically safe and independent from other persons, within one’s context”, plays an important role in maintaining the functional ability to enable well-being in older age. FI is a dynamic and complex concept covering four clinical outcomes: physical capacity, empowerment, coping flexibility, and health literacy. As the level of FI differs widely between older adults, healthcare professionals must gain insight into how to best support older people in maintaining their level of FI in a personalized manner. Insight into subgroups of FI could be a first step in providing personalized support This study aims to identify clinically relevant, distinct subgroups of FI in Dutch community-dwelling older people and subsequently describe them according to individual characteristics. Results: One hundred fifty-three community-dwelling older persons were included for participation. Cluster analysis identified four distinctive clusters: (1) Performers – Well-informed; this subgroup is physically strong, well-informed and educated, independent, non-falling, with limited reflective coping style. (2) Performers – Achievers: physically strong people with a limited coping style and health literacy level. (3) The reliant- Good Coper representing physically somewhat limited people with sufficient coping styles who receive professional help. (4) The reliant – Receivers: physically limited people with insufficient coping styles who receive professional help. These subgroups showed significant differences in demographic characteristics and clinical FI outcomes. Conclusions: Community-dwelling older persons can be allocated to four distinct and clinically relevant subgroups based on their level of FI. This subgrouping provides insight into the complex holistic concept of FI by pointing out for each subgroup which FI domain is affected. This way, it helps to better target interventions to prevent the decline of FI in the community-dwelling older population.

That which goes unsaid: Experiences of everyday life in residential care for residents with limited communication ability. A collective case study.

Background The experiences of residents who have communication difficulties such as dysphasia are largely absent from the literature. Aim To illuminate the everyday experiences of four residents with severe communication difficulties living in a residential care setting in the Netherlands. Methodology & Methods A collective case study methodology was used. Seventy-five hours of observation, interview and documentary data was gathered over six weeks. Alternative strategies of communication were developed to enable the co-creation of dialogue between participants and researcher. For example, a participant who could not talk used intentionally created artwork to share her ideas with the researcher. Findings Participants' daily experiences were characterised by struggling against the constraints of the residential setting: having to wait, having unmet needs, experiencing vulnerability and uncertainty. Participants' communication difficulties exacerbated these constraints. Their experiences of struggling were sometimes ameliorated by significant social contact with family or particular staff members, and engaging in enjoyable activities. Occasionally the experiences of enjoying the here-and-now, and being 'seen' as a person by the other, would create beautiful moments in which truly person centred engagement would occur. These moments were neither articulated nor recorded, and were thus invisible after they had occurred. Similarly, the experiences of struggling against the constraints were neither acknowledged nor recorded. Significant experiences in the lives of these four residents were therefore invisible to others. The unifying theme representing the participants' daily experiences was: That which goes unsaid. Discussion It was necessary to develop communication strategies which would by-pass the researcher's assumptions and enable participants to introduce their own ideas and opinions. This ongoing process of co-creation of dialogue required work from, and trust between, participants and researcher. What is new? • Expressly seeking the views of residents with communication difficulties • Successfully using process consent with participants in this situation • Using intentionally created artwork during data gathering in this context What has regional, national or international relevance? The findings indicate that people with communication difficulties may not receive optimal care in residential settings in the Netherlands. Methods are described which could be used by practitioners in their everyday work, and which show facilitators or practice developers how they can help carers to engage in more effective communication with this kind of resident. Additionally, this research contributes to the international discussion about ethical participation of vulnerable people in research.

Longitudinal residential ambient monitoring

Wireless sensor networks are becoming popular in the field of ambient assisted living. In this paper we report our study on the relationship between a functional health metric and features derived from the sensor data. Sensor systems are installed in the houses of nine people who are also quarterly visited by an occupational therapist for functional health assessments. Different features are extracted and these are correlated with a metric of functional health (the AMPS). Though the sample is small, the results indicate that some features are better in describing the functional health in the population, but individual differences should also be taken into account when developing a sensor system for functional health assessment.