A growing number of older patients undergo cardiac surgery. Some of these patients are at increased risk of post-operative functional decline, potentially leading to reduced quality of life and autonomy, and other negative health outcomes. First step in prevention is to identify patients at risk of functional decline. There are no current published tools available to predict functional decline following cardiac surgery. The objective was to validate the identification of seniors at risk—hospitalised patients (ISAR-HP), in older patients undergoing cardiac surgery. A multicenter cohort study was performed in cardiac surgery wards of two university hospitals with follow-up 3 months after hospital admission. Inclusion criteria: consecutive cardiac surgery patients, aged ≥65. Functional decline was defined as a decline of at least one point on the Katz ADL Index at follow-up compared with preadmission status.
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Population decline, welfare state reforms and austerity measures pressurise the liveability of rural areas in the Netherlands and call upon local governments and communities to adapt and renew their mode of governance. This paper reports on three Dutch experimental governance arrangements which are analysed through the lens of Evolutionary Governance Theory. The study focuses on how decision-making roles change while these arrangements unfold and how the three municipalities institutionalise these changes in the course of time. The study produces three main conclusions. First, the readiness and preparedness of local governments to shift decision-making roles with citizens proved to be of main influence on governance change. Second, local residents’ commitment importantly affected the progress of the experiments, while social cohesion and tangible outputs strongly influenced the extent and continuity of such commitment. Third, although the arrangements took place in the same period of time and abovementioned context, the level of institutionalisation of shifting roles between government and residents differed among the cases. Certain pathways of evolving decision-making roles seem to be more stable than others. It is in this area that the extent of both formal and informal institutionalisation seems to play an important role.
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Purpose: Intellectual capital theory and practice predominantly focus on measuring and managing intangible assets. However, if we want to balance the intellectual capital books (Harvey and Lusch, 1999), we should recognize both intellectual assets and intellectual liabilities (Caddy, 2000). Therefore, the purpose of this article is to present a theoretical framework for measuring intellectual liabilities. Design: Identifying intangible liabilities is identifying the risk of decline and fall of organizations. One of the first extensive studies related to causes of decline and fall is Gibbon‟s Decline and Fall of the Roman Empire (Gibbon, 2003 [original publication 1776]). It seems as if the main lessons that were drawn from this study are also applicable to today‟s business environment. Therefore, the framework that is developed in this article is not only based on intellectual capital literature, but also on Gibbon‟s study into the causes of decline and fall of the Roman Empire. Findings: The findings are combined in a framework for measuring intellectual liabilities. The main distinction within the proposed framework is the distinction between internal and external liabilities. Internal liabilities refer to the causes of deterioration that arise from the sources of value creation within the organization. External liabilities refer to the causes of deterioration that come from outside and are beyond control of the organization. Originality: This article explores a relatively new topic (intellectual liabilities) from a perspective (historical sciences) that is hardly used in management science.
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Against the backdrop of depopulation and Big Society, citizen initiatives in rural areas are believed to be able to mitigate service-provision inequalities between urban and peripheral regions. Factors influencing the success and failure of such citizen initiatives and their potential in providing solutions to perceived problems have thus far hardly been explored. Our previous work on potential aspects of success and failure indicates that the durability of an initiative does not necessarily define the success of the initiative. Studies have neglected the question of continuity and what will happen when the initiators put down their efforts. In what way do initiators transfer their responsibility and is there a sense of problem ownership?This paper aims to conceptualize factors influencing the continuity of citizen initiatives and provide insight in the processes that take place when initiators stop their activities. Further, the study aims to identify who claims ownership of the issue the initiative focuses on. An inventory of citizen initiatives was made in the three northern provinces of the Netherlands, where rural areas experience depopulation. Questionnaires focusing on how initiatives think about their future, especially when the initiators stop, were sent to around 600 initiatives. The results will add to future research on success and failure of citizen initiatives, but also provide insights for citizen initiatives and ways local governments try to facilitate them.
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Contribution and presentation at the International Conference on Population Geographies - Groningen, June 2013.
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The structure and financing of collective long-term care and support in the Netherlands changed dramatically with the introduction of the Social Support Act (WMO) the 1st of January 2015. This act arranged that municipalities assist people to live in their homes for as long as possible by providing various forms of aid and support. This aid and support however, is in addition to the help that people arrange for themselves and / or receive in the form of volunteer aid (mantelzorg) by family, friends and neighbours. Furthermore under this Act people only become eligible for state financed sheltered accommodation in the exceptional case of severe physical or mental illness. The fact that under the new regime of the Social Support Act municipal support is made additional to volunteer aid, it is important to understand what role family, friends and neighbours potentially can play and in fact do play. This is especially important in regions were unbalanced population decline through out-migration of young people, effectively changes social structures and accelerates the ageing of the population. For this reason we designed a limited pilot-study to test the possibilities and the necessity of a broader study focussing on potential and every day practice concerning volunteer aid for elderly in regions characterized by unbalanced population decline. In this pilot study we will focus on a rural municipality in the north of the Netherlands: Oldambt.Within the framework of this pilot-study we focussed on living arrangements and social network of two groups of senior citizens; one group of men and women aged 65-79 and one group aged 80 years and over. Based on demographic data kindly made available by the municipal office of Oldambt, in this paper we will draw a picture of these citizens living in the municipality. Going deeper into the material and the municipality’s structure we will than focus on one of the municipality’s communities, Finsterwolde, with its village, hamlets and surrounding rural area. For the purpose of this pilot-study we constructed a sample of 30 men and women aged 80+-elderly and asked them to fill in a questionnaire. Based on the outcomes of these questionnaires we than had five in-depth interviews with some of them. Finally, on the basis of the gathered material, we will draw some general conclusions while presenting some new questions for further research into the living conditions and social support systems for elderly in a region with unbalanced population decline and accelerated ageing.
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OBJECTIVES: The aim of the present study was to disentangle the impact of age and that of cancer diagnosis and treatment on functional status (FS) decline in older patients with cancer.MATERIALS AND METHODS: Patients with breast and colorectal cancer aged 50-69years and aged ≥70years who had undergone surgery, and older patients without cancer aged ≥70years were included. FS was assessed at baseline and after 12months follow-up, using the Katz index for activities of daily living (ADL) and the Lawton scale for instrumental activities of daily living (IADL). FS decline was defined as ≥1 point decrease on the ADL or IADL scale from baseline to 12months follow-up.RESULTS: In total, 179 older patients with cancer (≥ 70years), 341 younger patients with cancer (50-69years) and 317 older patients without cancer (≥ 70years) were included. FS decline was found in 43.6%, 24.6% and 28.1% of the groups, respectively. FS decline was significantly worse in older compared to younger patients with cancer receiving no chemotherapy (44.5% versus 17.6%, p<0.001), but not for those who did receive chemotherapy (39.4% versus 30.8%, p=0.33). Among the patients with cancer, FS decline was significantly associated with older age (OR 2.63), female sex (OR 3.72), colorectal cancer (OR 2.81), polypharmacy (OR 2.10) and, inversely, with baseline ADL dependency (OR 0.44).CONCLUSION: Cancer treatment, and older age are important predictors of FS decline. The relation of baseline ADL dependency and chemotherapy with FS decline suggest that the fittest of the older patients with cancer were selected for chemotherapy.
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The Northern region of the Netherlands has beautiful landscapes, a nice diversity of green and blue areas, and dispersed settlements. However, some recent population changes can become threats to health and wellbeing in these areas.The rural areas in the three northern provinces - Groningen, Friesland and Drenthe, see youngsters leave the region for which reason they are aging faster than other regions in the Netherlands. As a result, some villages have faced major population decline that is leading to lose of facilities/amenities and decrease in accessibility and social cohesion. Those who still live in these villages; are relatively old, low educated and have low-income. To develop a deeper understanding of the health status of the people living in these areas, and help them to improve their living environment, the GO!-Method is being applied in this study. This method has been developed by the National Institute for Public Health and the Environment (RIVM) of the Netherlands and is inspired by the broad definition of health by Machteld Huber: the ability to adapt and direct control, in terms of the physical, emotional and social challenges of life, while paying extra attention to vulnerable groups. A healthy living environment is defined as an environment that residents find it pleasant, and encourages and supports healthy behavior. The GO!-method integrates six domains that constitutes a healthy living environment: Health and lifestyle, facilities and development, Safety and hygiene, Social cohesion and active citizens, Green areas, and Air and noise pollution.First of all this method will identify opportunities for a healthier living environment using existing information and perceptions of residents and other local stakeholders in order to strengthen social participation and quality of life in these rural areas. Second this approach will connect identified opportunities with available and effective evidence based interventions in order to develop an action plan from the residents and local authorities perspective which will help them to design their municipalities healthier and more resilient. This method is being used for the first time in rural areas to our best knowledge, in close collaboration with the residents and local authorities of the three provinces to create a sustainable process and stimulate social participation.Our paper will present the outcomes of the first phase of this project in collaboration with the municipality of Westerkwartier, located in the northwest of the province of Groningen. And will describe the current situation, and identify local assets, opportunities, and policies relating to healthier environment; as well as needs and challenges to achieve goals. The preliminary results show that rural demographic changes in the northern Netherlands have negative impacts on service provisions and social cohesion, and there is a need to understand this complicated situation and improve the quality of life in those areas.
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This paper relies on knowledge gained from ITRACT (Improving Transport and Accessibility through new Communication Technologies), an Interreg IVB project in the North Sea Region. We will show how digital innovation to promote mobility and accessibility in rural areas is limited by poor data infrastructure and a lack of digital engagement. It is argued that these limitations perpetuate the remoteness of these areas.
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After being hospitalised, 30–60% of older patients experience a decline in functioning, resulting in a decreased quality of life and autonomy. The objective of this study was to establish a screening instrument for identifying older hospitalised patients at risk for functional decline by comparing the predictive values of three screening instruments: identification of seniors at risk, care complexity prediction instrument and hospital admission risk profile.
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