Natasja Essed: Flavor enhancement of food as a stimulant for food intake in elderly people

bespreking proefschrift Natasja Essed: Flavor enhancement of food as a stimulant for food intake in elderly people Met het stijgen van de leeftijd gaan mensen vaak minder eten. Dat geldt zowel voor ouderen die zelfstandig wonen als voor bewoners van een verzorgings- of verpleeghuis. Het hiermee gepaarde gewichtsverlies is een bron van zorg omdat het bijdraagt aan een slechte gezondheid en een lagere levensverwachting

The effectiveness of assertive community treatment for elderly patients with severe mental illness: A randomized controlled trial

Background: Due to fragmented mental, somatic, and social healthcare services, it can be hard to engage into care older patients with severe mental illness (SMI). In adult mental health care, assertive community treatment (ACT) is an organizational model of care for treating patients with SMI who are difficult to engage. So far all outcome studies of assertive community treatment have been conducted in adults.Methods: In a randomized controlled trial design we compared the effectiveness of ACT for elderly patients with that of treatment as usual (TAU). Sixty-two outpatients (60 years and older) with SMI who were difficult to engage in psychiatric treatment were randomly assigned to the intervention or control group (32 to ACT for elderly patients and 30 to TAU). Primary outcomes included number of patients who had a first treatment contact within 3 months, the number of dropouts (i.e. those discharged from care due to refusing care or those who unintentionally lost contact with the service over a period of at least 3 months); and patients' psychosocial functioning (HoNOS65+ scores) during 18 months follow-up. Secondary outcomes included the number of unmet needs and mental health care use. Analyses were based on intention-to-treat.Results: Of the 62 patients who were randomized, 26 were lost to follow-up (10 patients in ACT for elderly patients and 16 in TAU). Relative to patients with TAU, more patients allocated to ACT had a first contact within three months (96.9 versus 66.7%; X2 (df = 1) = 9.68, p = 0.002). ACT for elderly patients also had fewer dropouts from treatment (18.8% of assertive community treatment for elderly patients versus 50% of TAU patients; X2 (df = 1) = 6.75, p = 0.009). There were no differences in the other primary and secondary outcome variables.Conclusions: These findings suggest that ACT for elderly patients with SMI engaged patients in treatment more successfully.Trial registration: NTR1620

Haalbaarheid van een poliklinisch geriatrisch Revalidatieprogramma – lessen uit een pilotproject

Doel Beschrijven van de haalbaarheid van een poliklinisch geriatrisch behandelprogramma, als pilotproject ontwikkeld in Vivium Naarderheem. Methoden De uitkomsten werden onderzocht in een pretest-posttest design met één groep. Haalbaarheid werd onderzocht door mondelinge afname van een patiënttevredenheidsvragenlijst en door gestructureerde interviews met behandelaars en management. Het effect werd onderzocht door bij start (T0) en bij ontslag (T1) van het behandelprogramma schriftelijke vragenlijsten af te nemen: bij de patiënten over het participatieniveau en de gezondheidsgerelateerde kwaliteit van leven en bij hun mantelzorgers over de ervaren belasting. Resultaten Er werden 18 patiënten geïncludeerd. Vijftien daarvan revalideerden na een CVA. Behandelaars en managers vonden het programma uitvoerbaar, op voorwaarde dat het vervoer van de patiënten, de roosterplanning en de financiering goed geregeld zijn. Het behandelprogramma werd door de patiënten met een gemiddeld rapportcijfer van 8,1 gewaardeerd. Er zijn geen statistisch significante verschillen gevonden in het participatieniveau van de patiënten en in de zorgbelasting van de mantelzorgers bij de start en het einde van de poliklinische behandeling. De algemene gezondheidsbeleving, gemeten met de RAND-36, was na poliklinische revalidatie achteruit gegaan. Conclusie Uit deze pilotstudie blijkt dat vijftien van de achttien patiënten die gebruik maken van de polikliniek, revalideert vanwege CVA. Poliklinische geriatrische revalidatie is een door de bevraagde patiënten gewaardeerde aanvulling op de klinische revalidatieperiode, en de uitvoering ervan lijkt haalbaar. Een verbetering van de gezondheidstoestand of van het participatieniveau kon niet worden aangetoond

Working in group living homes for older people with dementia: the effects on job satisfaction and burnout and the role of job characteristics

ABSTRACT Background: Group living homes are a fast-growing form of nursing home care for older people with dementia. This study seeks to determine the differences in job characteristics of nursing staff in group living homes and their influence on well-being. Methods: We examined the Job Demand Control Support (JDCS) model in relation to 183 professional caregivers in group living homes and 197 professional caregivers in traditional nursing homes. Multilevel linear regression analysis was used to study the mediator effect of the three job characteristics of the JDCS-model (demands, control and social support) on job satisfaction and three components of burnout (emotional exhaustion, depersonalization and decreased personal accomplishment). Results: Demands were lower in group living homes, while control and social support from co-workers were higher in this setting. Likewise, job satisfaction was higher and burnout was lower in group living homes. Analysis of the mediator effects showed that job satisfaction was fully mediated by all three psychosocial job characteristics, as was emotional exhaustion. Depersonalization was also fully mediated, but only by control and social support. Decreased personal accomplishment was partially mediated, again only by job characteristics, control and support. Conclusion: This study indicates that working in a group living home instead of a traditional nursing home has a beneficial effect on the well-being of nursing staff, largely because of a positive difference in psychosocial job characteristic

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

Assertive community treatment for elderly people with severe mental illness

Background: Adults aged 65 and older with severe mental illnesses are a growing segment of the Dutch population. Some of them have a range of serious problems and are also difficult to engage. While assertive community treatment is a common model for treating difficult to engage severe mental illnesses patients, no special form of it is available for the elderly. A special assertive community treatment team for the elderly is developed in Rotterdam, the Netherlands and tested for its effectiveness.Methods: We will use a randomized controlled trial design to compare the effects of assertive community treatment for the elderly with those of care as usual. Primary outcome measures will be the number of dropouts, the number of patients engaged in care and patient's psychiatric symptoms, somatic symptoms, and social functioning. Secondary outcome measures are the number of unmet needs, the subjective quality of life and patients' satisfaction. Other secondary outcomes include the number of crisis contacts, rates of voluntary and involuntary admission, and length of stay. Inclusion criteria are aged 65 plus, the presence of a mental disorder, a lack of motivation for treatment and at least four suspected problems with functioning (addiction, somatic problems, daily living activities, housing etc.). If patients meet the inclusion criteria, they will be randomly allocated to either assertive community treatment for the elderly or care as usual. Trained assessors will use mainly observational instruments at the following time points: at baseline, after 9 and 18 months.Discussion: This study will help establish whether assertive community treatment for the elderly produces better results than care as usual in elderly people with severe mental illnesses who are difficult to engage. When assertive community treatment for the elderly proves valuable in these respects, it can be tested and implemented more widely, and mechanisms for its effects investigated

Database 'Decision-making on palliative care after a severe CVA'

Aim: To gain insight in decision making on treatment options after a severe stroke. Design: ethnographic field research on 16 patients in three hospitals. Data: For each case there are verbatim written interviews and verbatim written family conversations. Restricted access: The data can only be reused if the legal representative of the patients grants permission to do so.Doel: Inzicht verwerven in de besluitvorming over het behandelbeleid in de post-acute fase van een ernstige beroerte. Design: etnografisch veldonderzoek naar 16 patiënten in drie ziekenhuizen. Data: Van elke casus bestaan verbatim uitgeschreven interviews en verbatim uitgeschreven familiegesprekken. Restricted access: De data komen alleen in aanmerking voor hergebruik als de wettelijk vertegenwoordiger van de patiënten daarvoor toestemming verleent

Beliefs on coping with illness: A consumer's perspective

This article discusses the results of a study on beliefs on coping with illness and coping with the health care system. Using the concept mapping method, members of patient organizations (n = 172) sorted their beliefs on coping with illness and coping with the health care system into two dimensions (priority and content). Statistical analysis reveals eight beliefs on coping with illness, with "autonomy" and "acceptance of illness" as the most important. It also reveals eight beliefs on coping with the health care system, of which the most important is a professional relationship with the physician based on mutual trust and respect between two equal partners. It is argued that these beliefs represent idealized images of coping with illness and coping with the health care system. In relation to the political debate on responsible use of the health care system in Western countries, these findings show many patients are willing to act as responsible consumers of health care, that is, if providers of health care create an environment in which patients receive guidance in determining alternatives.health beliefs coping with illness patient organizations chronic disease concept mapping

Experiences of patients with stroke and their caregivers with caregiver-mediated exercises during the CARE4STROKE trial

PURPOSE: Caregiver-mediated exercises are a novel way of delivering augmented exercise therapy for patients with stroke, in which patients do additional therapeutic exercises together with a caregiver. This explorative qualitative study is part of the CARE4STROKE trial and focused on how participants manage these exercises together. The research questions were: (1) how do the patient-caregiver couples exercise together? and (2) what does exercising together bring about, besides more hours of practice? METHODS: Semi-structured interviews were conducted with patients and caregivers who participated in the CARE4STROKE intervention. Inductive thematic data analysis was applied. RESULTS: Seven patients and seven caregivers were interviewed. Three different role-dynamics were found during caregiver-mediated exercises: (1) patient in control, (2) in concert, and (3) the caregiver as informal carer. In addition, three themes were identified about what exercising together brings about: (a) tailor-made exercises through active involvement, (b) preparation for the home situation, and (c) opportunity to be involved. CONCLUSION: Different role-dynamics are at play in caregiver-mediated exercises, and it is important for participating staff to be aware of their possible effects on the strain of patient or caregiver. Caregiver-mediated exercises were found to enhance individualization of the treatment plan and preparation for home discharge. Implications for rehabilitation Caregiver-mediated exercises, in which a caregiver does exercises with a patient, are currently under investigation as a new form of augmented exercise delivery after stroke Doing exercises together seems to make patient and caregivers actively involved in rehabilitation, which they appreciate, and which seems to help them prepare for the home situation Caregiver selection and monitoring role-dynamics during exercising is an important task of the rehabilitation team