Psychosociale aspecten van gezondheid en zelfredzaamheid bij ouderen: van determinanten naar interventie

Een centrale vraag binnen de sociale gerontologie betreft hoe het is te verklaren dat sommige ouderen tot op hoge leeftijd – ongeacht de aanwezigheid van ziekte – op een redelijk niveau blijven functioneren, terwijl dit voor andere ouderen niet het geval is. Dit artikel schetst een conceptueel model dat inzicht geeft in de individuele uitwerking van (voornamelijk) chronische gezondheidsproblemen en daardoor aanknopingspunten biedt voor gerichte interventies voor het bevorderen van zelfredzaamheid bij ouderen. Meer specifiek wordt ingegaan op de rol die gevoelens van competentie en controle hierbij spelen. Uit het beschreven onderzoek blijkt dat gevoelens van competentie en controle weliswaar niet overheersend maar wel consistent in positieve zin bijdragen aan zelfredzaamheid en het functioneren van ouderen. Daarmee is een basis gelegd voor de ontwikkeling en evaluatie van psychosociale interventies die beide concepten en zelfredzaamheid in positieve zin kunnen beïnvloeden. Twee van dergelijke interventies worden gepresenteerd: vermindering van angst om te vallen en zelfmanagement bij chronisch hartfalen. Geconcludeerd wordt dat de ontwikkeling en de bewijskracht van dergelijke interventies pas in de kinderschoenen staan maar potentie hebben. Een verdere stimulans ervan kan bijdragen aan een meer adequate ouderenzorg omdat deze aansluit bij ouderen zelf en mogelijk de zorgvraag zal verminderen

A.A.G.C. Jonker. Health decline and well-being in old age: the need of coping

bespreking proefschrift A.A.G.C. Jonker. Health decline and well-being in old age: the need of coping

Socioeconomic Status and the Course of Quality of Life in Older Patients with Coronary Heart Disease

BACKGROUND: Previous research suggests that socioeconomic status (SES) might be related to the course of quality of life (QoL) in coronary heart disease (CHD) patients. The authors sought to determine whether there are differences in the course of QoL before and after the incidence of CHD among older persons of differing SES. METHOD: Two hundred two CHD patients were followed up longitudinally using a community-based survey. Data on patients' QoL were collected before the diagnosis and at three follow-up assessments. RESULTS: High SES patients reported better outcomes at the premorbid assessment with fewer depressive feelings and better physical functioning. In physical functioning, similar results were repeated 6 and 12 months after the diagnosis. Additionally, high SES patients showed better role and social functioning 1 year after CHD. A multivariate analysis of variance revealed differential longitudinal pathways in relation to SES in role, social, and physical functioning. CONCLUSION: CHD modulates premorbid differences in depressive feelings. Conversely, high SES leads to better outcomes in all functional domains in the long-term after diagnosis. Postmorbid differences in physical functioning are not directly related to CHD, but rather the reestablishment of a premorbid situation. In contrast, socioeconomic inequalities in social and role functioning are a direct response to the impact of the disease

Innovaties in de zorg voor ouderen

In deze 43-ste jaargang van het Tijdschrift voor Gerontologie en Geriatrie opent de redactie de nieuwe rubriek Recent onderzoek. Onderzoekers en programmaleiders van universitaire en niet-universitaire onderzoekscentra op het gebied van de gerontologie en geriatrie in België en Nederland zijn uitgenodigd om samenvattingen in te sturen van onderzoek dat onlangs door hen zelf of in hun vakgroepen of organisaties is afgerond. Met deze rubriek wil de redactie de lezers van het Tijdschrift blijven informeren over onderzoek naar veroudering en de maatschappelijke consequenties daarvan in brede zin: medisch, psychologisch en sociaal.  Het onderzoeksprogramma “Innovaties in de zorg voor ouderen” van de CAPHRI School for Public Health and Primary Care van de Universiteit Maastricht richt zich op drie samenhangende thema’s: (1) onderzoek naar prevalentie en determinanten van relevante zorgproblemen bij ouderen; (2) ontwikkeling en evaluatie van interventies en zorgvernieuwingen die zelfredzaamheid en kwaliteit van leven van ouderen (kunnen) bevorderen en (3) de implementatie van dergelijke interventies en zorgvernieuwingen in de zorgpraktijk. Hieronder volgen enkele voorbeelden van projecten die de afgelopen jaren binnen het programma zijn uitgevoerd

Effectiveness of a self-management program for dual sensory impaired seniors in aged care settings:study protocol for a cluster randomized controlled trial

<p>Background: Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study is to evaluate the effectiveness of a self-management program for seniors who acquired dual sensory impairment at old age.</p><p>Methods/Design: In a cluster randomized, single-blind controlled trial, with aged care settings as the unit of randomization, the effectiveness of a self-management program will be compared to usual care. A minimum of 14 and maximum of 20 settings will be randomized to either the intervention cluster or the control cluster, aiming to include a total of 132 seniors with dual sensory impairment. Each senior will be linked to a licensed practical nurse working at the setting. During a five to six month intervention period, nurses at the intervention clusters will be trained in a self-management program to support and empower seniors to use self-management strategies. In two separate diaries, nurses keep track of the interviews with the seniors and their reflections on their own learning process. Nurses of the control clusters offer care as usual. At senior level, the primary outcome is the social participation of the seniors measured using the Hearing Handicap Questionnaire and the Activity Card Sort, and secondary outcomes are mood, autonomy and quality of life. At nurse level, the outcome is job satisfaction. Effectiveness will be evaluated using linear mixed model analysis.</p><p>Discussion: The results of this study will provide evidence for the effectiveness of the Self-Management Program for seniors with dual sensory impairment living in aged care settings. The findings are expected to contribute to the knowledge on the program's potential to enhance social participation and autonomy of the seniors, as well as increasing the job satisfaction of the licensed practical nurses. Furthermore, an extensive process evaluation will take place which will offer insight in the quality and feasibility of the sampling and intervention process. If it is shown to be effective and feasible, this Self-Management Program could be widely disseminated.</p>

Gender-specific risk factors for mortality associated with incident coronary heart disease - A prospective community-based study

Background. Risk factors for mortality in community-residing persons developing congestive heart failure (CHF) and acute myocardial infarction (AMI) may differ for males and females. Method. Persons from the Groningen Longitudinal Aging Study with incident CHF (N=274) or AMI (N=198) were identified between 1993 and 1998 and their survival status was collected in 2001. Risk factors are assessed prior to the cardiac diagnosis. Results. The 1-, 5-, 7-year survival rates were 65, 53, 50% for AMI and 74, 45, 32% for CHF. Multivariate analyses showed that male gender, high age, smoking, diabetes and low physical function were risk factors for mortality among persons with CHE For AMI, 1 month mortality was related to high age and baseline low body mass index, while longer term mortality was related to male gender and high age. In addition, diabetes increased longer term mortality among females but not among males with AMI. Depression was not a risk factor for mortality for either condition in either gender. Conclusion. Males with CHF or AMI have worse survival rates compared to females. Risk factors for mortality are predominantly similar for males and females, except for diabetes which is a risk factor among females, but not males with AMI. (c) 2006 Elsevier Inc. All rights reserved

Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial

Background: Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community. Methods: In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control (n = 195) or intervention group (n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls. Results: At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups. Conclusions: The home-based, cognitive behavioral program significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs

Effectiveness of a nurse-supported self-management programme for dual sensory impaired older adults in long-term care:A cluster randomised controlled trial

Objective To evaluate the effectiveness of a nurse supported self-management programme to improve social participation of dual sensory impaired older adults in long-term care homes. Design Cluster randomised controlled trial. Setting Thirty long-term care homes across the Netherlands. Participants Long-term care homes were randomised into intervention clusters (n=17) and control clusters (n=13), involving 89 dual sensory impaired older adults and 56 licensed practical nurses. Intervention Nurse-supported self-management programme. Measurements Effectiveness was evaluated by the primary outcome social participation using a participation scale adapted for visually impaired older adults distinguishing four domains: instrumental activities of daily living, social-cultural activities, high physical-demand and low-physical-demand leisure activities. A questionnaire assessing hearing-related participation problems was added as supportive outcome. Secondary outcomes were autonomy, control, mood and quality of life and nurses' job satisfaction. For effectiveness analyses, linear mixed models were used. Sampling and intervention quality were analysed using descriptive statistics. Results Self-management did not affect all four domains of social participation; however. the domain 'instrumental activities of daily living' had a significant effect in favour of the intervention group (P=0.04; 95% CI 0.12 to 8.5). Sampling and intervention quality was adequate. Conclusions A nurse-supported self-management programme was effective in empowering the dual sensory impaired older adults to address the domain 'instrumental activities of daily living', but no differences were found in addressing the other three participation domains. Self-management showed to be beneficial for managing practical problems, but not for those problems requiring behavioural adaptations of other persons