Active ageing and quality of life:Community-dwelling older adults in deprived neighbourhoods

Socioeconomic factors may influence health and quality of life. Older adults residing in deprived neighbourhoods are at risk to develop negative health outcomes with adverse consequences for a person’s quality of life. Therefore, it is crucial to determine feasible and effective ways to maintain or improve quality of life for elderly people living in deprived neighborhoods. The results of the studies presented in this thesis contribute to the knowledge about enhancing active ageing and improving the quality of life for older adults. Insight into ageing-related issues such as frailty, resilience, and quality of life are relevant for developing an appropriate approach to optimize quality of life for older adults, in general, and those living in deprived neighbourhoods. This thesis shows that, even in deprived neighbourhoods, it is possible to recruit sedentary, community-dwelling, older adults and engage them in physical exercise. A community-based approach with attention for group building aspects and community ownership of the project, seem to be essential factors. For these older adults, a group program with weekly exercise sessions on moderate intensity is suitable to improve physical fitness (muscle strength and endurance). This improvement in physical fitness does not directly translate into an improvement in global quality of life, nor did physical fitness have a direct or indirect effect on quality of life. Therefore, a multifactorial approach is recommended to influence the quality of life in older adults

Agreement between PG-SGA Short Form, MUST and SNAQ in hospital patients

Rationale: The Patient-Generated Subjective Global Assessment (PG-SGA) is a validated instrument to assess malnutrition and its risk factors in clinical populations. Its patient component, PG-SGA Short Form (SF), can be used as screening instrument. In this cross-sectional study we aimed to assess agreement between the PG-SGA SF, Malnutrition Universal Screening Tool (MUST), and Short Nutritional Assessment Questionnaire (SNAQ) in patients at the University Medical Center Groningen, The Netherlands. Methods: Malnutrition risk was assessed by PG-SGA SF, MUST, and SNAQ in 81 patients from the Departments Ear Nose Throat (ENT), Oral and Maxillofacial Surgery (OMS) and Orthopedics. Point scores of PG-SGA SF=4-8, MUST=1, and SNAQ=2 were classified as ‘medium malnutrition risk’, and PG-SGA SF≥9, MUST ≥2, and SNAQ ≥3 as ‘high malnutrition risk’. Agreement in classification for malnutrition risk was assessed by weighted kappa (κ) and intra-class correlation coefficient (ICC). A p-value of <0.05 was considered statistically significant. Results: According to the PG-SGA SF, MUST and SNAQ, respectively 65%, 81%, and 80% of all patients were classified as ‘low malnutrition risk’; 24%, 8% and 6% as ‘medium malnutrition risk’; 11%, 10% and 14% as ‘high malnutrition risk’.Agreement between PG-SGA SF and MUST (κ=0.452, ICC=0.448; p<0.001), and between PG-SGA SF and SNAQ (κ=0.395, ICC=0.395; p<0.001) were both fair. In patients from the Departments ENT and OMS, PG-SGA SF classified more patients at medium/high malnutrition risk (n=26) as compared to the MUST (n=12) or SNAQ (n=14). Conclusion: We found only fair agreement between the PG-SGA SF and MUST and SNAQ, respectively. The PG-SGA SF classified three and four times more patients at medium malnutrition risk, compared to MUST and SNAQ respectively, due to its scoring on symptoms and activities/functioning. Hence, the PG-SGA SF may help facilitate proactive prevention of malnutrition

Reopening the doors of Dutch nursing homes during the COVID-19 crisis: results of an in-depth monitoring

Objectives: On May 11, the Dutch Government allowed 26 nursing homes to welcome 1 visitor per resident, after 2 months of lockdown. The study aimed to monitor in-depth the feasibility of the regulations and their impact on the well-being of residents, their visitors, and healthcare staff. Design: Mixed-methods study in 5 of the 26 facilities; the facilities were affiliated to an academic network of nursing homes. Participants: Visitors and healthcare professionals. Intervention: Allowing visitors using local regulations based on national guidelines. Measurements: Digital questionnaire, analyzing documentation such as infection prevention control protocols, attending meetings of COVID-19 crisis teams, in-depth telephone or in-person interviews with visitors and healthcare professionals, and on-site observations. Results: National guidelines were translated with great variety into local care practice. Healthcare professionals agreed that reopening would increase the well-being of the residents and their loved ones. However, there were also great worries for increasing workload, increasing the risk of emotional exhaustion, and the risk of COVID-19 infections. Compliance with local regulations was generally satisfactory, but maintaining social distance and correctly wearing face masks appeared to be difficult. Care staff remained ambivalent for fear of infections. In general, allowing visitors was experienced as having a positive impact on the well-being of all stakeholders. Nevertheless, some residents with dementia showed negative effects. Conclusion: The complete lockdown of Dutch nursing homes had a substantial impact on the well-being of the residents. The reopening was welcomed by all stakeholders, but provided a high organizational workload as well as feelings of ambivalence among care staff. In the second wave, a more tailored approach is being implemented. However, facilities are sometimes still struggling to find the right balance between infection control and well-being

Family caregivers’ perspectives on their interaction and relationship with people living with dementia in a nursing home:A qualitative study

BACKGROUND: Social interactions are important for people living with dementia in a nursing home. However, not much is known about interactions and relationships between residents and family caregivers and related experiences of family caregivers. We aim to advance the knowledge on how family caregivers interact with people living with dementia in a nursing home and how they maintain or redesign a meaningful connection. METHODS: Qualitative research using interviews with family caregivers (n = 31) to explore perspectives on their interaction and relationship with the person living with dementia. Interviews were held during the reopening of nursing homes after the first COVID-19 lockdown in the Netherlands. In this situation, family caregivers became more aware of their interaction and relationship with the resident, which provided a unique opportunity to reflect on this. The interviews explored the interaction and relationship in a broad sense, not specifically for the COVID-19 situation. Thematic analysis was performed to analyze the data. RESULTS: We were able to identify three key themes reflecting the experiences of family caregivers: (1) changes in the interaction and relationship, (2) strategies to promote connection, and (3) appreciation of the interaction and relationship. From the viewpoint of family caregivers, the interaction and relationship are important for both the resident living with dementia and for themselves, and family caregivers have different strategies for establishing a meaningful connection. Nevertheless, some appear to experience difficulties with constructing such a connection with the resident. CONCLUSIONS: Our results provide a basis for supporting family caregivers in perceiving and establishing mutuality and reciprocity so that they can experience togetherness. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-02922-x