Aims and objectives: To determine a valid, reliable and clinical userfriendly instrument, based on predictors of functional decline, to identify older patients at risk for functional decline. The predictors of functional decline are initially considered and, subsequently, the characteristics and psychometric qualities of existing screening instruments are investigated. Background: Functional decline is a common and serious problem in older hospitalized patients, resulting in a change in quality of life and lifestyle. Studies have shown that 3060% of older people develop new dependencies in activities of daily living (ADL) during their hospital stay. Adverse health outcomes such as mortality, a prolonged hospital stay, nursing home placement and increased dependency of older people at home are the results. Not only are the personal costs high but also, in a rapidly growing older population, the impact on health-care costs is also high. Results: Age, lower functional status, cognitive impairment, preadmission disability in instrumental activities of daily life (IADL), depression and length of hospital stay were identified as predictors of functional decline. Three screening instruments to identify hospitalized patients at risk for functional decline were found in the literature: the Hospital Admission Risk Profile, the Identification of Seniors at Risk and the Care Complexity Prediction Instrument. The reported validity was moderate. Reliability and the ease of use in the clinical setting were not well described. Conclusion.: These three instruments should be further tested in a hospitalized older population. Relevance to clinical practice. Screening is a first step to identify patients at risk for functional decline and this will make it possible to treat patients who are identified so as to prevent functional decline. Because of their ability to observe and to guide the patients and the overall view they have, nurses play a key role in this process.
Maintaining independence is the most important goal of the majority of older people. The onset of disability in activities of daily living is one of the greatest threats to the ability of older people to live independently. Older people with a low socioeconomic status (SES) are at high risk of functional decline. It is unclear what predicts functional decline in older people with a low SES. The aim of this study was to determine predictors of 12-month functional decline in community-living older people with low SES in the Netherlands. Functional decline was defined as the inability to perform (instrumental) activities of daily living. A prognostic multicentre study was conducted, using data from The Dutch Older Persons and Informal Caregivers Survey Minimum DataSet. A multivariable logistic regression model was fitted, using a stepwise backward selection process. Performance of the model was expressed by discrimination, calibration and accuracy. A total of 4.370 participants were included. The mean age of the participants was 80 years and 58.9% were female. Functional decline was present in 1486 participants (34.0%). Ten predictors were independently associated with the outcome. Dementia was the strongest predictor (OR 1.83, 95% CI 1.04–3.23). Other predictors were age, education, poor health, quality of life rate, arthrosis/arthritis, hearing problems, anxiety/panic disorder, pain and less social activities. The final model showed an acceptable discrimination (C-statistic 0.69, 95% CI 0.67–0.70), calibration (Hosmer-Lemeshow p-value 0.33) and accuracy (Brier score 0.20). Further research is needed to examine how functional decline can be ameliorated in this population.
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There is increasing evidence that humans are not living sustainably. There are three major drivers of the unsustainable approach: population, consumption and the growth economy. There is widespread denial about these issues, but they clearly need to be addressed if we are to achieve any of the possible sustainable futures. The first and second versions of the ‘World Scientists Warning to Humanity’ both highlight the problem of increasing human population, as do the IPCC and IPBES reports. However, all have been largely ignored. The size of an ecologically sustainable global population is considered, taking into account the implications of increasing per capita consumption. The paper then discusses the reasons why society and academia largely ignore overpopulation. The claim that discussing overpopulation is ‘anti-human’ is refuted. Causal Layered Analysis is used to examine why society ignores data that do not fit with its myths and metaphors, and how such denial is leading society towards collapse. Non-coercive solutions are then considered to reach an ecologically-sustainable human population. LinkedIn: https://www.linkedin.com/in/helenkopnina/
MULTIFILE
Circular BIOmass CAScade to 100% North Sea Region (NSR) economic activity and growth are mostly found in urban areas. Rural NSR regions experience population decline and negative economic growth. The BIOCAS project expects revitalizing and greening of rural areas go hand in hand. BIOCAS will develop rural areas of the NSR into smart specialized regions for integrated and local valorization of biomass. 13 Commercial running Bio-Cascade-Alliances (BCA’s) will be piloted, evaluated and actively shared in the involved regions. These proven concepts will accelerate adoption of high to low value bio-cascading technologies and businesses in rural regions. The project connects 18 regional initiatives around technologies, processes, businesses for the conversion of biomass streams. The initiatives collaborate in a thematic approach: Through engineering, value chain assessments, BCA’s building, partners tackle challenges that are shared by rural areas. I.e. unsustainable biomass use, a mineral surplus and soil degradation, deprivation of potentially valuable resources, and limited involvement of regional businesses and SMEs in existing bio-economy developments. The 18 partners are strongly embedded in regional settings, connected to many local partners. They will align stakeholders in BCA’s that would not have cooperated without BIOCAS interventions. Triple helix, science, business and governmental input will realize inclusive lasting bio cascade businesses, transforming costly waste to resources and viable business.Interreg IVB North Sea Region Programme: €378,520.00, fEC % 50.00%1/07/17 → 30/06/21
For the general public harbour and grey seals are the symbol of the Wadden Sea. The Wadden Sea is an ideal environment for seals: sandbanks that fall dry at low tide are important for rest and for suckle pups. However, the total population of harbour seals has first stabilized and later decreased in recent years, while the annual number of pups born has increased, but the mechanisms underlying this mismatch remain unclear. Furthermore, the harbour seal population has declined since 2022, but the cause of this decline is also unknown. The objective of the proposed study is to increase our understanding of the mechanisms underlying the population trends of harbour seals currently observed in the Dutch Wadden Sea. The study will be carried out by a consortium, involving key players involved in seal conservation and research in the Netherlands. Furthermore, to ensure that the research is embedded in the international context, the Common Wadden Sea Secretariat is a partner in the consortium. The consortium partners have concluded that essential monitoring data on harbour seals is missing and therefore we propose to investigate and report on four themes: (1) mapping of governance, stakeholders and data landscape, (2) identifying mechanisms underlying the observed population numbers, by reviewing available evidence and exploring possible mechanisms, (3) evaluation and improvement of harbour seal monitoring and (4) communication and advice for governance. We will share our findings through reports, scientific papers, infographics, conference presentations, workshops, and proposed monitoring protocols. We will synthesize and communicate our findings targeting four specific groups: (1) the general public (2) the scientific community, (3) educational institutions, and finally (4) the ministry of Agriculture, Nature and Food Quality (LNV), providing them with advice on how to advance research, conservation and management of the harbour seal population in the Dutch Wadden Sea.
