Onderwijs in het Nationaal Programma Ouderenzorg

The Netherlands Organisation of Health Research and Development started in 2008 the Dutch National Care for the Elderly Programme (in Dutch abbreviated as NPO) with the aim to improve the quality of life for the frail older people through better quality of care (health, social, community) which is tailored to the needs and wants of older people. The delivery of good care is related with competent professional behaviour which is inextricably linked to the education of professionals. This article presents an overview of 32 educational programmes developed within the NPO. Within the NPO different educational programmes were developed on relevant themes to improve elderly care. However, the programmes focused mainly on professionals in health care, especially those working in primary care. For nurses and nursing assistants and more or less for physicians also different educational programmes were developed. Educational programmes for paramedics or professionals working in social care, housing or in the municipalities were scarce. This is also the case for specific themes in elderly care like loneliness or (domestic) violence. Moreover, none of the experiments focused on older people or informal care givers. Although 22 of the 32 projects developed educational programmes for different groups, multi – or interdisciplinary education is rare in these programmes. Based on the overview we advise the development of more educational programmes on: target groups which were less or not addressed in the NPO, like professionals in social care and paramedics; multi- or interdisciplinary collaboration; and themes, like loneliness in older people and elder abuse.     

Implementatie van een proactief zorgprogramma voor kwetsbare ouderen in de huisartsenpraktijk: van onderzoek naar praktijk

Background

Multimorbidity, functional impairment and frailty among community-dwelling older people are causing increasing complexity in primary care. A proactive integrated primary care approach is therefore essential. Between October 2014–2015, an evidence-based proactive care program for frail older people was implemented in the region Noord-West Veluwe en Zeewolde, the Netherlands. This study evaluated the feasibility of the implementation, having a strong focus on the collaboration between the medical and social domain.

Methods

Using a mixed-methods design we evaluated several process indicators. Data were obtained from electronic routine medical record data within primary care, questionnaires, and interviews with older adults. The questionnaires provided information regarding the expectations and experiences towards the program and were sent to health care professionals at baseline and six months follow-up. Stakeholders from various domains were asked to fill in the questionnaire at baseline and twelve months follow-up. Interviews were conducted to explore the experiences of older adults with the program. Regional work groups were set up in each municipality to enhance the interdisciplinary and domain transcending collaboration.

Results

The proactive primary care program was implemented in 42 general practices who provided care to 7904 older adults aged 75 years or older. A total of 101 health care professionals and 44 stakeholders filled in the questionnaires. The need for better structure and interdisciplinary cooperation seemed widespread among the participants. The implementation resulted in a positive significant change in the demand for a better regional healthcare-framework (34% p ≤ .001) among health care professionals, and the needs for transparency regarding the possibilities for referral improved (27% , p = .009). Half of the participants reported that the regional collaboration has been improved after the implementation. Health care professionals and stakeholders gained increased attention and awareness of frail elderly in their area compared to before the implementation. Older people and their caregivers were positive about the proactive approach. The nurses reported that the screenings questionnaire was too lengthy and therefore time consuming.

Conclusions

The implementation of the proactive primary care approach in daily practice was feasible. A strong interdisciplinary collaboration was realized. The program was easily adapted to the local context.

     

Er is disciplinebreed sprake van relatieve onbevoegdheid en onbekwaamheid op het gebied van kwetsbare ouderen

There is much negative publicity about the health care for the frail elderly especially in nursing homes. However, inscientific research programs the results are also quite disappointing. We see a low percentage (< 50 %) of treatment fidelity in the intervention programs at stake. Research on the education content with respect to the frail elderly showed that this is very poor for every profession.From the perspective of formal education the professionals who provide treatment and care the frail elderly are relatively unqualified and incompetent. Government, health inspection and umbrella organizations should focus on solving this issue instead of enforcing their control mechanisms. Formal education is the hallmark of quality treatment and care especially in case of complex and unpredictable health problems of the frail elderly. If we don’t change our policy and don’t invest in the solution of fundamental educational shortcomings we continue to build on quicksand.     

Palliatieve zorg bij dementie en de ontmanteling van de behandelfunctie van het verpleeghuis

Palliative care in dementia and the dismantlement of nursing home medicinePalliative care is mostly restricted to the terminal phase of incurable illness. According to the WHO revised definition palliative care is specifically directed towards patients and families facing life-threatening illness. This definition is not adequate to orient and direct palliative care policies in non-cancer diseases such as dementia. Although dementia is incurable from the outset, its course is often protracted, resulting in a terminal stage only after several years. This disease trajectory necessitates an alternative palliative approach, implying a proactive attitude of nursing home physicians in facilitating early and timely discussions with patients and their proxies on advance care planning and treatment of complications and concomitant diseases. This, together with their specific training in the treatment of the long term sequelae of chronic diseases, defines the success of Dutch nursing home medicine in foregoing inappropriate hospital admissions and providing adequate medical care in the nursing home. However, recent reorganisations of nursing home care and its funding threaten to downgrade the quality of medical care for patients with dementia in Dutch nursing homes by focusing unilaterally on welfare ideology and ‘marketization’ of long term care, thus underestimating the importance of a palliative care policy in dementia.     

De impact van het wijkgerichte werken voor de toeleiding naar zorg van oudere migranten

This article studies how older migrants gain access to care through neighbourhood-based forms of working. In the Netherlands, the neighbourhood is increasingly viewed as an ideal place to organize care and social services, close to citizens. To this end, municipalities are developing neighbourhood structures and facilities in which local providers cooperate. In our qualitative research we studied the developments in crafting practices relevant to access to care of older migrants in the city of Nijmegen, the Netherlands. In Nijmegen the new neighbourhood structures are only partly successful in helping older migrants gain access to care. Older migrants visit neighbourhood facilities not for the services these facilities provide, but because of the presence of care professionals who speak the same language, or share the same cultural background as do these older migrants. These caregivers are able to bridge the mental distance between the health care system and the lifeworld of older migrants. Relations also arise outside the neighbourhood structures, for instance at culture-specific day care facilities. To prevent too great a claim on professionals with a migration background, agreements between the city of Nijmegen and local providers to enhance cultural sensitivity should be better monitored.     

Advies Onderzoek medische zorg aan ouderen. In het bijzonder ouderen met multiple en complexe problematiek

Recent heeft de Raad voor Gezondheidsonderzoek (RGO) het advies “Medisch Onderzoek voor Ouderen” Het Advies Onderzoek medische zorg voor Ouderen. Den Haag: Raad voor Gezondheidsonderzoek, 2006; Publicatienummer 54 is te bestellen bij mw. A.J.H. Bakker, management assistente; 070-3407521, bureau@rgo.nl Het rapport is ook te downloaden via de website van de RGO (www.rgo.nl) uitgebracht.