Prevention of clinical urinary tract infections in vulnerable very old persons

Urinary tract infections (UTI) are among the most frequently reported infections among older persons. UTI not only causes several days of illness but may have more severe consequences, such as a decline in functioning, as well as delirium, dehydration, urosepsis, hospitalization, or even death. Annually, 20% of all older persons visit their general practitioner for a UTI and about 50% of the residents in long-term care facilities (LTCF) get a UTI. This thesis describes the possibilities for and the effects of the prevention of UTI in vulnerable very old persons. The first part of this thesis investigates the effect of infections on functioning and explores which vulnerable very old persons would benefit most from UTI prevention. The second part of this thesis describes the results of the CRANBERRY study. A double-blind randomized placebo-controlled multicentre trial in LTCF. This study investigates the effectiveness and costs of cranberry capsule use in the prevention of clinical UTI.UBL - phd migration 201

GYNOTEL: telephone advice to gynaecological surgical patients after discharge

Aims and objectives. To investigate in surgical gynaecological patients the types of health problems arising or persisting up to six weeks after discharge and the effectiveness of telephone advice. Background. The decreasing length of hospital stay has increased the need for specific instructions about the postdischarge period. Telephone advice could be a valuable tool to address this problem. To our knowledge, postdischarge health problems and the value of telephone advice have not been investigated among gynaecological patients. Design. Randomised controlled trial. Methods. Gynaecological patients expected to stay in the ward longer than 24 hour were invited to participate. A pilot study showed that wound healing, pain, mobility, urination, defecation and vaginal bleeding were the most common health problems postdischarge. Based on that information, guidelines were formulated that were used by trained nurses to give telephone advice to the intervention group (n = 235), in addition to the usual care. The control group of gynaecological patients (n = 233) received usual care only. Results. Of all 468 participants, about 50% were operated for general gynaecology. At discharge, wound pain (56%), mobility problems (54%) and constipation (27%) were the most frequently mentioned problems in both groups. Participants who completely followed the advice with regard to wound healing (p = 0.02), pain (p = 0.01), vaginal bleeding (p = 0.03) and mobility (p = 0.04) experienced greater improvement than participants who did not follow, or only partly followed, the advice. Conclusions. The telephone advice appears to make a significant contribution to help gynaecological surgical patients to solve or reduce their postdischarge health problems. Relevance to clinical practice. The positive effect of such advice can be interpreted as an improvement in the quality of life of the postoperative gynaecological patient.Public Health and primary car

Natural course of care dependency in residents of long-term care facilities: prospective follow-up study

Geriatrics in primary car

Strategies to increase willingness to receive a COVID-19 vaccine among nursing home staff

Background: Nursing home (NH) staff and residents have been prioritized to receive COVID-19 vaccinations. However, NH staff have been hesitant. This study explored what strategies were used to overcome this hesitancy and which of these were found to be important by NH staff to increase their willingness to take a COVID-19 vaccine. Methods: This study employed a sequential exploratory qualitative design. The COVID-19 MINUTES study aimed to describe the challenges presented by, responses to, and impact of the COVID-19 pandemic in NHs. The minutes of COVID-19 outbreak teams (COTs) in Dutch long-term care organizations (n = 41) were collected and coded using content analysis. Textual units from December 2020 to April 2021 that regarded strategies to increase staff's vaccination willingness (n = 67) were selected. Subsequently, to validate these data, two panels of NH healthcare workers (HCWs) and policy workers (PWs) (n = 8) selected, discussed, and ranked the strategies that they found to be important using a modified nominal group technique. Results: The strategies described in the minutes included financial reimbursements, personal contact, story sharing, logistics support, role models, visual information, and written information. Except for financial reimbursement, all these strategies were considered important or very important by the panel participants. Some organizations combined multiple strategies. Conclusion: The strategies that were found important in combination may be used more broadly and should be developed further with the involvement of HCWs

Changes in geriatric rehabilitation: a national programme to improve quality of care. The synergy and innovation in geriatric rehabilitation study

Geriatrics in primary car

Characteristics Associated with Quality of Life in Long-Term Care Residents with Dementia: A Cross-Sectional Study

Geriatrics in primary car

Cost-Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infection in Long-Term Care Facilities: Economic Evaluation with a Randomized Controlled Trial

Analysis and support of clinical decision makin

Structured scoring of supporting nursing tasks to enhance early discharge in geriatric rehabilitation: The BACK-HOME quasi-experimental study

Pathophysiology, epidemiology and therapy of agein

Clinically diagnosed infections predict disability in activities of daily living among the oldest-old in the general population: the Leiden 85-plus Study

BACKGROUND: ageing is frequently accompanied by a higher incidence of infections and an increase in disability in activities of daily living (ADL). OBJECTIVE: this study examines whether clinical infections [urinary tract infections (UTI) and lower respiratory tract infections (LRTI)] predict an increase in ADL disability, stratified for the presence of ADL disability at baseline (age 86 years). DESIGN: the Leiden 85-plus Study. A population-based prospective follow-up study. SETTING: general population.Participants: a total of 154 men and 319 women aged 86 years. METHODS: information on clinical infections was obtained from the medical records. ADL disability was determined at baseline and annually thereafter during 4 years of follow-up, using the 9 ADL items of the Groningen Activity Restriction Scale. RESULTS: in 86-year-old participants with ADL disability, there were no differences in ADL increase between participants with and without an infection (-0.32 points extra per year; P = 0.230). However, participants without ADL disability at age 86 years (n = 194; 41%) had an accelerated increase in ADL disability of 1.07 point extra per year (P < 0.001). For UTIs, this was 1.25 points per year (P < 0.001) and for LRTIs 0.70 points per year (P = 0.041). In this group, an infection between age 85 and 86 years was associated with a higher risk to develop ADL disability from age 86 onwards [HR: 1.63 (95% CI: 1.04-2.55)]. CONCLUSIONS: among the oldest-old in the general population, clinically diagnosed infections are predictive for the development of ADL disability in persons without ADL disability. No such association was found for persons with ADL disability.Geriatrics in primary car

Health care usage in Dutch systemic lupus erythematosus patients

Public Health and primary car