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.

     

Een methode voor het tellen van levende bacteriën,vervanging voor de plaatmethode

Ohne Zusammenfassung     

De erfelikheid van het al of niet bezit van „draad” bij rassen van Phaseolus vulgarisl

Ohne Zusammenfassung

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Laboratorium voor Tuinbouwplantenteelt.     

Over den invloed van Röntgenstralen op het ontstaan van tuberculose na inspuiting van filtreerbaar tuberculose-virus

Samenvatting Medegedeeld wordt het resultaat van eenige proeven, welke ten doel hadden na te gaan of bestraling met röntgenstralen van caviae, ingespoten met filtraten van culturen van tuberkelbacillen en tuberculeus materiaal, van invloed is op het ontstaan van tuberculose bij deze dieren. Bij één cavia konden gelocaliseerde veranderingen in milt, mesenteriale klier en longen worden aangetoond, waarin tuberkelbacillen gevonden werden. Na inspuiting van miltbrij van een andere cavia van dezelfde proefreeks bij 4 caviae, ontstond bij allen een progressieve cachexie.In een andere proef (IV), stierven de twee caviae, welke 2×bestraald waren, ±1 maand na inspuiting van filtraat, met een tusschenruimte van 10 dagen, na 113 en 185 dagen aan verkazende tuberculose.     

In hoeverre kan de duurzaamheid van koelhuisboter worden beïnvloed door verschillende wijzen van het zuren van de room en door het al of niet zouten van de boter?

Conclusie Aan de hand van de keuringsuitslagen zou men mogen besluiten om voor het bereiden van koelhuisboter van goede kwaliteit uit te gaan van ongezuurde room, waarbij men, ten einde zich van een uiteindelijke goede botersmaak te verzekeren, verstandig doet om aan het laatste waschwater een zekere hoeveelheid zuursel toe te voegen. Wanneer men zich verder zoo goed mogelijk wil vrijwaren tegen schimmelontwikkeling verdient het aanbeveling om de boter te zouten (vgl. tabel XX).      

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     

Over het gebruik van glutaminezuur in een synthetische voedingsbodem bij het biochemisch onderzoek van pathogene darmbacteriën en over phenolrood als indicator in de lactose-agarplaat

Ohne Zusammenfassung     

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     

Langer leven, langer werken?De rol van gepercipieerde levensverwachting in het uittredeproces

Virtually all Western countries are seeking to bring retirement ages more in line with increases in longevity. The central question in this paper is whether individuals choose a retirement age that fits their life expectancy. This would be ideal from a public policy perspective. The present study aims to test empirically whether retirement planning varies with expectations of survival among a sample of older employees in the Netherlands. Two questions are addressed: (1) What are older employees' expectations of their remaining lifetime, and what factors influence this subjective life expectancy? (2) Are individuals who perceive longer life horizons (high subjective life expectancy) more inclined to retire later than people who expect to live shorter? Using data from a panel study on retirement behaviour in the Netherlands (N=1621 older employees aged 50-60), regression and survival models are estimated to examine the effect of subjective life expectancy on retirement planning and behaviour. The results indicate that subjective life expectancy is a factor that is taken into account in retirement decision making, at least as far as retirement intentions are concerned. Older employees with longer time horizons have a preference for later retirement. When it comes to actual behaviour, however, time horizon does not appear to play a role. The results suggest that particularly employees with a high perceived life expectancy and an intention to work longer do not succeed in carrying their intentions into effect.     

Het krimpende brein: normale veroudering of een gevolg van selectiebias in het onderzoek?

The volume of our brain decreases as we age. This has been demonstrated by several large studies on normal aging. A recent study indicates, however, that the extent of this decline in normal aging probably has been overestimated because these studies have included subjects with preclinical disorders. In this article, an example from science is used to describe what effect selection bias may have on our model of the aging brain.     

Pilot study naar het persoonsgericht gebruik van foto’s in de communicatie met mensen met dementie

Social contact is important for the wellbeing of people. Dementia can complicate social interaction. In two randomized controlled pilot studies, it was investigated whether viewing different types of images together affects the mood and social interaction of people with moderately severe to severe Alzheimer’s dementia residing in nursing homes. At the first intervention participants in the experimental group (n?=?10) were shown portraits with positive facial expressions, and the participants in the control group (n?=?10) were shown portraits with a neutral facial expression. During the second intervention, the experimental group (n?=?10) were shown personalized photos and the control group (n?=?10) non-personalized photos. There were no statistically significant differences in mood and the degree of social interaction between the groups. However, calculation of the effect sizes showed that there was a tendency for more positive behavior in viewing neutral portraits and that personalized images had a more positive impact on social interaction, negative behavior, speech and mood.     

Eenige opmerkingen betreffende S.enteritidis var.essen. (Naar aanleiding van “essen” infectie bij den mensch na het eten van snoek)

Ohne Zusammenfassung Voordracht gehouden 2 April 1938 te's Gravenhage voor de Nederlandsche Vereeniging voor Microbiologie.     

Gaat zorggebruik in het land van herkomst onder oudere Turkse en Marokkaanse migranten gepaard met minder zorggebruik in Nederland? Een combinatie van HELIUS-data met Achmea registratiedata

A substantial part of all Dutch people of Turkish and Moroccan origin use healthcare in the country of origin when travelling to their country of origin for a shorter or longer period of time (21% and 10%, respectively). If using care in the country of origin leads to avoidance of care in the Netherlands, this could threaten the continuity of care. We linked data of the HELIUS study to health insurance data. We examined the relationship between healthcare utilisation in the country of origin and the Netherlands, in the period of 2010–2015, adjusting for health status as an indicator of need. Contrary to our expectations, Dutch people of Turkish or Moroccan origin using healthcare consumption in the country of origin utilise more care in the Netherlands than individuals that do not utilize healthcare in the country of origin. Thus, our results do not provide any indication for avoidance of healthcare in the Netherlands among this group of older migrants in the Netherlands.     

Weitere untersuchungen über die methode der zeitfange

Ohne ZusammenfassungAbkürzung der Artnamen A.o. Armadillidium opacum (C. L. Koch) - A.pu. Armadillidium pulchellum B.-L. - L. Ligidium hypnorum (Cuv.). - O. Oniscus asellus L. - P.c. Porcellium conspersum (C. L. Koch) - Ph. Philoscia muscorum Scop. var. sylvestris (Dahl) - P.r. Porcellio (Tracheoniscus) rathkei Br - P.sc. Porcellio (Euporcellio) scaber Latr - Tr. Trichoniscus caelebs (Verhoeff) und Trichoniscus elisabethae Herold     

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     

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.