Veranderingen in de kwaliteit van leven van thuiswonende ouderen: speelt de vorm van zorg een rol?

Changes in the quality of life of older people living at home: does type of care play a role? Purpose: To determine whether a change in physical, psychological and social dimensions of quality of life of older people living at home is associated with receiving formal care, compared to informal care and no care. Method: Data from the observation cycles in 1998 and 2001 of the Longitudinal Aging Study Amsterdam (LASA) were used. Older people receiving formal homecare in 1998 were compared to older people receiving informal care and to older people receiving no care at all in 1998 on subjective scores on 3-year changes in self-perceived health, loneliness, positive affect and satisfaction with life. The data were analysed using linear regression analysis and ANOVA. Results: In all groups there is a change for the worse between 1998 and 2001 in the four aspects of quality of life. Self-perceived health declines significantly more in the group receiving formal care compared to the group without care, but this is explained by a higher score on functional limitations in 1998. Loneliness increases significantly more in the group receiving formal care, even after correction for confounders. In the group receiving formal care the satisfaction with life decreases significantly more compared to the group receiving no care and the group with informal care. An interaction effect with gender was found, showing that after correction for confounders this difference is maintained for the women but not for the men. There is no significant difference between the three care groups regarding changes in positive affect. Conclusion: Older men and women who receive formal home care experience an increase in loneliness, and older women who receive formal care experience less satisfaction with life, compared to women who receive informal care or no care. Future research should confirm these results and investigate the mechanisms underlying these changes. Tijdschr Gerontol Geriatr 2011; 42: 170-183     

Factoren die van invloed zijn op het verwijzen van patiënten van het verpleeghuis naar het ziekenhuis

Introduction

Hospitalisation may cause negative effects on elderly patients. Therefore, it is important that referral and admission of older nursing home patients is well-considered. The aim of this study is to investigate the factors that affect the decision making process.

Method

Questionnaire survey among elderly care physicians and physicians following the elderly care physician training program.

Results

Of the 1,540 surveys, 200 were returned (response rate of 13%). Over 60% of the respondents had referred a nursing home patient to the hospital in the previous month. A stay at a geriatric rehabilitation ward, suspicion of a fracture, a good quality of life, a patient’s or family’s wish for referral, no treatment restrictions, and follow-up appointments in the hospital were factors which made referral to the hospital more likely according to the respondents. Medical specialist consultation and the in hospital presence of a physician specialised in geriatric care were considered to be important. Referral was less likely if a patient was diagnosed with dementia, had a low quality of life or had treatment restrictions.

Conclusion

Both patient-related and non-patient-related factors influence hospital referral of nursing home patients. Further research is needed to determine whether these different factors contribute to the different outcomes of a hospital admission, to facilitate proper decision-making for elderly care physicians.

     

Het verklaren van verschillen in ervaren kwaliteit van leven van kwetsbare ouderen: een ‘mixed-method’ onderzoek

Most research on (multidimensional) frailty focuses on deficits and risks of adverse outcomes. However, frail older people can still report positive outcomes, such as a relatively high QoL. In order to develop more positively oriented prevention strategies, this exploratory study aimed (a) to identify characteristics related to QoL among frail older people; and (b) to explain discrepancies between higher and lower levels of QoL, with a specific focus on strengths frail older people with a higher QoL still may have. Quantitative and qualitative data was gathered by means of semi-structured interviews with Flemish community-dwelling, frail older people with higher (n?=?16) and lower QoL levels (n?=?18). Quantitative analyses showed that frail older people with a higher QoL were older, had lower levels of psychological frailty, and reported higher meaning in life compared to those with a lower QoL. Outcomes of qualitative analysis showed that participants in the high QoL subgroup adapted more effectively to difficulties, had more things in prospect, performed more activities, and were more satisfied with their social network compared to the low QoL subgroup. To conclude, this exploratory study suggests possibilities to promote and improve QoL by strengthening specific resources among frail older people.Please note that an English version of this article has been published in BMC Geriatrics: van der Vorst A, Zijlstra GAR, De Witte N, Vogel RGM, Schols JMGA, Kempen GIJM, D?SCOPE Consortium. Explaining discrepancies in self-reported quality of life in frail older people: a mixed-methods study. BMC Geriatr. 2017;17(1): 251.  https://doi.org/10.1186/s12877-017-0641-y.     

Effecten van een integrale wijkaanpak genaamd ‘Even Buurten’ op de (gezondheidsgerelateerde) kwaliteit van leven en welzijn van ouderen

Integrated neighborhood approaches (INAs) are increasingly advocated to support community-dwelling older people; their effectiveness however remains unknown. We evaluated INA effects on older people’s (health-related) quality of life (HRQoL) and well-being in Rotterdam. We used a matched quasi-experimental design comparing INA with “usual” care and support. Community-dwelling people (aged ≥70) and control subjects (n?=?186 each) were followed over a one-year period (measurements at baseline, 6 and 12 months). Primary outcomes were HRQoL (EQ-5D-3L, SF-20) and well-being (SPF-IL). The effect of INA was analysed with generalized linear mixed modeling of repeated measurements, using both an “intention to treat” and “as treated” approach. The results indicated that pre-intervention participants were significantly older, more often single, less educated, had lower incomes and more likely to have ≥1 disease than control subjects; they had lower well-being, physical functioning, role functioning, and mental health. No substantial difference in well-being or HRQoL was observed between the intervention and control group after 1 year. The lack of effects of INA highlights the complexity of integrated care and support initiatives.     

Sarcopenie als component van “frailty”

Met de term “sarcopenie” bedoelt men het verlies aan spiermassa en de daarmee gepaard gaande vermindering van spierkracht als rechtstreeks gevolg van het ouder worden. 1 Hierin verschilt sarcopenie van andere vormen van spierverlies zoals wij dat terugvinden in de cachexie die voorkomt bij inflammatoire aandoeningen of bij tumorale processen. Als een echt leeftijdsgebonden fenomeen doet het zich dus ook voor bij de “gezonde” oudere. Natuurlijk zullen optredende ziekteprocessen de evolutie van sarcopenie kunnen versnellen. Op een bepaald moment zal de sarcopenie interfereren met de mobiliteit van de persoon. Hierdoor stijgt het risico voor het optreden van kwetsbaarheid (frailty) en verlies aan autonomie.     

Bespreken van het reanimatiebeleid op een afdeling geriatrie: de ervaring van patiënt en familie

Discussing the resuscitation policy at a geriatric ward: the experience of patients or their representatives Aim To identify geriatric patients’ and their surrogate decision makers’ experience with regard to discussing cardio pulmonary resuscitation (CPR) policy.Methods This is a prospective, observational, explorative survey. During 10 weeks, all patients admitted to a geriatric ward of a general Dutch hospital or their representatives were asked for their experience regarding discussion of the resuscitation policy with the physician in attendance. Discussing this policy is a standard procedure at the first day of admission. We also asked on several factors which could influence their experience and on factors to improve discussing resuscitation policies. The primary outcome was the participant’s satisfaction expressed on a scale of 1 to 10 regarding satisfaction with the CPR discussion.Results Seventy-six participants were included, of which 29 patients and 47 surrogate decision makers . Discussing the resuscitation policy took an average of 4,5 minutes (SD 3.2) to complete. In 70% (n=53) of cases a do-not-resuscitate decision was made. Discussing the resuscitation policy was experienced positive, with an average rate of 7,8 (SD 1.5). A total of 121 positive comments were made, as opposed to 70 negative comments. When they talked about their resuscitation policy, most patients expressed positive emotional responses. As most important improvements were mentioned: a better introduction to discussing this subject (17%), a better explanation of resuscitation and chances of survival (17%) and providing information prior to admission to the ward, so that patient and surrogate decision maker have been informed that the resuscitation policy will be discussed (12%).Conclusion Most patients and relatives in this study wished to discuss their resuscitation policy with physicians. Still, there is room for improvement in several respects. Patients and surrogate decision makers are in favour of discussing the standard resuscitation policy with the doctor, and evaluate this conversation with a 7.8 / 10. In order to improve both discussing the CPR policy preparing the patient and his representatives and communicating more extensively during the interview are recommended. Tijdschr Gerontol Geriatr 2011; 42: 256-262     

Toegankelijke gezondheidsinformatie: een kwestie van leeftijd?

Aging and digitalisation are important trends which have their impact on information accessibility. Accessible information about products and services is of crucial importance to ensure that all citizens can participate fully as active members of society. Senior citizens who have difficulties using new media run the risk of exclusion in today's information society. Not all senior citizens, however, encounter problems with new media. Not by a long shot. There is much to be said for 'aged heterogeneity', the concept that individual differences increase as people age. In two explorative qualitative case studies related to accessible health information--an important issue for senior citizens--that were conducted in the Netherlands, variables such as gender, education level and frequency of internet use were therefore included in the research design. In this paper, the most important results of these case studies will be discussed. Attention will be also paid to complementary theories (socialisation, life stages) which could explain differences in information search behaviour when using old or new media.     

Indicatoren voor kwaliteit van zorg. Wie worden er wijzer van, de patiënten of de managers?

In the Netherlands and abroad detailed indicators are developed to measure quality of care for a variety of treatments and care systems. These days the development of quality indicators is a profession and business in itself. The significance of these indicators is often not related to the primary care process, but based on (administrative) data for 'quality management'. The consequence is a gap between 'real' and 'measured' quality of care. Improvement in quality of care is therefore problematic. There is a need to return to the essence of care, i.e. the patient and the care professional, to develop appropriate indicators for quality of care.     

Nico M. van Gelder (1933–2005)

IN MEMORIAM

Nico M. van Gelder (1933–2005)     

Behandeling van osteoporose bij ouderen: wat is de evidence?

Many older people, especially women, and their doctors still see osteoporosis as part of the natural course of ageing instead of as a preventable or treatable disorder. Height loss, hyperkyphosis, back pain, and fractures are accepted as consequences of ageing. The notion that it is too late to start treatment in a late stage of the disease forms another barrier to treatment. Although most studies of fracture reduction with medical treatment were not designed for the "geriatric" population, the average age of participants in most clinical trials was about 70 years. In all major studies patients also received calcium and vitamin D supplements. Nowadays, clinicians can choose from several effective treatments for the prevention of osteoporotic fractures in high-risk postmenopausal women. Data on the anti-fracture potential of calcium/vitamin D, raloxifene, bisphosphonates, strontium ralenate, and parathyroid hormone are now available. Bisphosphonates and strontium ralenate are good choices for first- or second-line treatment, while for the time being parathyroid hormone should only be used for the second-line treatment of osteoporosis in the elderly.     

Lichte Cognitieve Stoornissen (MCI): Prodromen van dementie?

Mild cognitive impairment: a prodromal phase of dementia? Cognitive decline without dementia is common among older persons. A variety of clinical concepts have been introduced in the past 30 years, in order to describe these cognitive deficits arising in older persons. The most frequently used concept is Mild Cognitive Impairment (MCI). MCI is generally seen as a prodromal phase of Alzheimer disease (AD). Several concepts are described, with the neuropsychiatric features and predictors of conversion to dementia c.q. AD. Finally, consequences of preclinically diagnoses for health care are clarified. Tijdschr Gerontol Geriatr 2007; 38:115-121     

Cognitieve problematiek bij revalidatie van CVA-patiënten in het verpleeghuis

In many regions in the Netherlands the care for stroke patients is organised in a coordinated stroke service. Within these stroke services, each year more patients are referred to nursing homes for a period of rehabilitation. A stroke leads to lasting cognitive and emotional consequences in more than half of the stroke patients. These consequences interfere with the daily life of the patients and their caregivers. Due to the nature and severity of these problems specific care is needed in the nursing home. In the present article a procedure for cognitive screening in a nursing home is described and data of a large group of patients are presented. These data clearly show the magnitude of the cognitive problems: high percentages of impairments are found in many cognitive domains. In the discussion therefore arguments are given for specialised care – assessment as well as treatment - in the nursing home for stroke patients with cognitive deficits.Tijdschr Gerontol Geriatr 2007; 38: 174-185