In dit abstract wordt de ontwikkeling van een online onderwijsmodule beschreven gericht op eHealth voor leefstijlverbetering
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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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Abstract: Existing frailty models have enhanced research and practice; however, none of the models accounts for the perspective of older adults upon defining and operationalizing frailty. We aim to propose a mixed conceptual model that builds on the integral model while accounting for older adults’ perceptions and lived experiences of frailty. We conducted a traditional literature review to address frailty attributes, risk factors, consequences, perceptions, and lived experiences of older adults with frailty. Frailty attributes are vulnerability/susceptibility, aging, dynamic, complex, physical, psychological, and social. Frailty perceptions and lived experience themes/subthemes are refusing frailty labeling, being labeled “by others” as compared to “self-labeling”, from the perception of being frail towards acting as being frail, positive self-image, skepticism about frailty screening, communicating the term “frail”, and negative and positive impacts and experiences of frailty. Frailty risk factors are classified into socio-demographic, biological, physical, psychological/cognitive, behavioral, and situational/environmental factors. The consequences of frailty affect the individual, the caregiver/family, the healthcare sector, and society. The mixed conceptual model of frailty consists of interacting risk factors, interacting attributes surrounded by the older adult’s perception and lived experience, and interacting consequences at multiple levels. The mixed conceptual model provides a lens to qualify frailty in addition to quantifying it.
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The transition from home to a nursing home can be stressful and traumatic for both older persons and informal caregivers and is often associated with negative outcomes. Additionally, transitional care interventions often lack a comprehensive approach, possibly leading to fragmented care. To avoid this fragmentation and to optimize transitional care, a comprehensive and theory-based model is fundamental. It should include the needs of both older persons and informal caregivers. Therefore, this study, conducted within the European TRANS-SENIOR research consortium, proposes a model to optimize the transition from home to a nursing home, based on the experiences of older persons and informal caregivers. These experiences were captured by conducting a literature review with relevant literature retrieved from the databases CINAHL and PubMed. Studies were included if older persons and/or informal caregivers identified the experiences, needs, barriers, or facilitators during the transition from home to a nursing home. Subsequently, the data extracted from the included studies were mapped to the different stages of transition (pre-transition, mid-transition, and post-transition), creating the TRANSCITmodel. Finally, results were discussed with an expert panel, leading to a final proposed TRANSCIT model. The TRANSCIT model identified that older people and informal caregivers expressed an overall need for partnership during the transition from home to a nursing home. Moreover, it identified 4 key components throughout the transition trajectory (ie, pre-, mid-, and post-transition): (1) support, (2) communication, (3) information, and (4) time. The TRANSCIT model could advise policy makers, practitioners, and researchers on the development and evaluation of (future) transitional care interventions. It can be a guideline reckoning the needs of older people and their informal caregivers, emphasizing the need for a partnership, consequently reducing fragmentation in transitional care and optimizing the transition from home to a nursing home.
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Er lijkt een duidelijke mate van evidentie te bestaan betreffende de relatie fysieke activiteit, respectievelijk fitheid en gezondheid in de algemene populatie en bij bepaalde pathologieën. Er is evenwel nog behoefte aan verder wetenschappelijk onderzoek naar mogelijke determinanten en onderliggende mechanismen, als ook naar evidentie bij bepaalde, specifieke aandoeningen. Tevens mag duidelijk zijn dat ondanks de bestaande evidentie fysieke activiteit/oefening te weinig toegepast wordt in de gezondheidszorg. Het onderzoek naar de effectiviteit van gezondheidskundige interventies is dan ook uitermate belangrijk. Dit lectoraat hoopt dan ook een bescheiden bijdrage hieraan te kunnen leveren. Hiervoor heeft zij reeds afspraken tot samenwerking met de academische en medische wereld (in Utrecht, Amsterdam, Maastricht en Leuven), met de gezondheidszorg (RIVM Bilthoven en GG&GD Utrecht) en met de beroepen- of bedrijfswereld (Politie regio Utrecht; Enraf Nonius, Delft). De beoogde doelstellingen zullen echter naar alle waarschijnlijkheid beduidend meer tijd in beslag nemen dan de periode van 4 jaar die de Stichting Kennis Ontwikkeling voorzien heeft met betrekking tot het oprichten en financieren van de lectoraten.
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Real-time location systems (RTLS) can be implemented in aged care for monitoring persons with wandering behaviour and asset management. RTLS can help retrieve personal items and assistive technologies that when lost or misplaced may have serious financial, economic and practical implications. Various ethical questions arise during the design and implementation phases of RTLS. This study investigates the perspectives of various stakeholders on ethical questions regarding the use of RTLS for asset management in nursing homes. Three focus group sessions were conducted concerning the needs and wishes of (1) care professionals; (2) residents and their relatives; and (3) researchers and representatives of small and medium-sized enterprises (SMEs). The sessions were transcribed and analysed through a process of open, axial and selective coding. Ethical perspectives concerned the design of the system, the possibilities and functionalities of tracking, monitoring in general and the user-friendliness of the system. In addition, ethical concerns were expressed about security and responsibilities. The ethical perspectives differed per focus group. Aspects of privacy, the benefit of reduced search times, trust, responsibility, security and well-being were raised. The main focus of the carers and residents was on a reduced burden and privacy, whereas the SMEs stressed the potential for improving products and services. Original article at MDPI: https://doi.org/10.3390/info9040080
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Key summary points Aim To describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation. Findings This guidance addresses general requirements for post-acute COVID-19 geriatric rehabilitation and critical aspects for quality assurance during the COVID-19 pandemic. Furthermore, the guidance describes relevant care processes and procedures divided in five topics: patient selection; admission; treatment; discharge; and follow-up and monitoring. Message This guidance is designed to provide support to care professionals involved in the geriatric rehabilitation treatment of post-acute COVID-19 patients.
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(‘Co’-)Designing for healthy behaviour greatly benefits from integrating insights about individual behaviour and systemic influences. This study reports our experiences in using insights about individual and systemic determinants of behaviour to inform a large co-design project. To do so, we used two design tools that encourage focusing on individual determinants (Behavioural Lenses Approach) and social / systemic aspects of behaviour (Socionas). We performed a qualitative analysis to identify 1) when and how the team applied the design tools, and 2) how the tools supported or obstructed the design process. The results show that both tools had their distinctive uses during the process. Both tools improved the co-design process by deepening the conversations and underpinnings of the prototypes. Using the Behavioural Lenses under the guidance of a behavioural expert proved most beneficial. Furthermore, the Socionas showed the most potential when interacting with stakeholders, i.c. parents and PPTs.
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Studie naar problemen en behoeften op het gebied van mondgezondheid en -verzorging onder een groep van 97 ouderen in een instelling voor ouderenzorg. Vanwege complexe gebitsprothesen en een afname in de mondhygiëne ontstaan diverse problemen.
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Buildings with innovative technologies and architectural solutions are needed as a means of support for future nursing homes alongside adequate care services. This study investigated how various groups of stakeholders from healthcare and technology envision the nursing home of the future in the presumed perspective of residents, care professionals and technical staff. This qualitative study gathered data via ten simultaneous monodisciplinary focus group sessions with 95 professional stakeholders. The sessions yielded eight main themes: person and well-being; relatives and interaction; care technology; safety and security; interior design, architecture and the built environment; vision and knowledge; communication; and maintenance and operation. These themes can be used for programming future nursing homes, and for prioritising design and technological solutions. The views between the groups of stakeholders are to a large extent similar, and the personal needs of the residents are the most prominent factor for practice.
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