Community-dwelling and recently widowed older adults:Effects of spousal loss on psychological well-being, perceived quality of life, and health-care costs

This study is on the effects of spousal loss among older adults who continue to live independently after bereavement. Little longitudinal studies focus on this group, which is of special interest, since in many countries, care policy and system reform are aimed at increasing independent living among older adults. Using longitudinal data from a Dutch public data repository, we investigate the effects of spousal loss on psychological well-being, perceived quality of life, and (indication of) yearly health-care costs. Of the respondents who had a spouse and were living independently (N = 9,400) at baseline, the majority had not lost their spouse after 12 months (T12, n = 9,150), but 2.7% (n = 250) had lost their spouse and still lived independently. We compared both groups using multivariate regression (ordinary least squares) analyses. The results show that spousal loss significantly lowers scores on psychological well-being and perceived quality of life, but we found no effect on health-care costs

Developing a person-centred care environment aiming to enhance the autonomy of nursing home residents with physical impairments, a descriptive study

BackgroundEnhancing autonomy is important within the context of the care environment in nursing homes. A nursing home is a place for older adults with physical impairments, who need assistance, to live and where staff work who help them to exercise autonomy. Previous research shows that older adults and staff are influenced by the care environment to apply autonomy-enhancing activities. Therefore, organisational policies regarding the care environment seem promising for enhancing autonomy. The aim is to gain a deeper insight into the development and implementation of organisational policies aimed to enhance the autonomy of older adults with physical impairments.MethodsA qualitative descriptive design was chosen, using two methods. A document study was conducted on the policies, plans and proceedings in two care organisations. Moreover, interviews were conducted with 17 stakeholders involved in the policies, such as managers and members of the client council. The fragments of the 137 documents and 17 verbatim transcripts were coded and deductively categorised into the seven aspects (i.e., power-sharing, supportive organisational systems, appropriate skill mix, potential for innovation and risk-taking, the physical environment, effective staff relationships and shared decision-making systems) of the key domain care environment, as defined in the person-centred practice (PCP) framework developed by McCormack and McCance.ResultsThe aspect of power-sharing was used the most in the policies of the two participating organisations. The organisations expected much from the implementation of indirect interventions, such as access to the electronic care plan for residents and the development of staff towards self-managing teams. Less attention was paid to interventions in the physical environment, such as the interior of the building and privacy, and the collaboration processes between staff.ConclusionsThe PCP framework poses that all aspects of the key domain care environment are important to develop a person-centred practice. This is not yet the case in practice and the authors therefore recommend using all seven aspects of the care environment in a balanced combination with the other key domains of the PCP framework to achieve person-centred practice and as a result the enhancement of the autonomy of nursing home residents with physical impairments

The Academic Collaborative Center Older Adults:A description of co-creation between science, care practice and education with the aim to contribute to person-centered care for older adult

Long-term care for older adults is in transition. Organizations offering long-term care for older adults are expected to provide person-centered care (PCC) in a complex context, with older adults aging in place and participating in society for as long as possible, staff shortages and the slow adoption of technological solutions. To address these challenges, these organizations increasingly use scientific knowledge to evaluate and innovate long-term care. This paper describes how co-creation, in the sense of close, intensive, and equivalent collaboration between science, care practice, and education, is a key factor in the success of improving long-term care for older adults. Such co-creation is central in the Academic Collaborative Center (ACC) Older Adults of Tilburg University. In this ACC, Tilburg University has joined forces with ten organizations that provide care for older adults and CZ zorgkantoor to create both scientific knowledge and societal impact in order to improve the quality of person-centered care for older adults. In the Netherlands, a “zorgkantoor” arranges long-term (residential) care on behalf of the national government. A zorgkantoor makes agreements on cost and quality with care providers and helps people that are in need of care to decide what the best possible option in their situation is. The CZ zorgkantoor arranges the long-term (residential) care in the south and southwest of the Netherlands. This paper describes how we create scientific knowledge to contribute to the knowledge base of PCC for older adults by conducting social scientific research in which the perspectives of older adults are central. Subsequently, we show how we create societal impact by facilitating and stimulating the use of our scientific knowledge in daily care practice. In the closing section, our ambitions for the future are discussed

Exploring the impact of social network change:Experiences of older adults ageing in place

Social networks are sources of support and contribute to the well-being of older adults who are ageing in place. As social networks change, especially when accompanied by health decline, older adults' sources of support change and their well-being is challenged. Previous studies predominantly used quantitative measures to examine how older adults' social networks change. Alternatively, this study explores the impact of changing social networks on older adults' lives by examining their personal experiences. We held four focus groups, two with a total of 14 older adults who are ageing in place and receiving home care and two with a total of 20 home-care nurses from different regions and organisations in the Netherlands. Subsequently, an expert team of home-care professionals and managers discussed and verified the results. Procedures for grounded theory building were used for analysis. We revealed four themes of high-impact experiences: (a) struggling with illness/death of the spouse; (b) working out a changing relationship with (grand)children; (c) regretting the loss of people they have known for so long and (d) feeling dependent and stressed when helpers enter the network. Also, network dynamics were found to follow three consecutive stages: (a) awareness of social network change; (b) surprise when social network change actually occurs and (c) acceptance and adjusting to new circumstances. Together, the four themes of experiences and three stages of network change form an integrative model of the role of social network dynamics for older adults' lives when ageing in place

Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography:inter-observer agreement

To evaluate and improve the interobserver agreement for the CT-based diagnosis of diffuse idiopathic skeletal hyperostosis (DISH). Six hundred participants of the CT arm of a lung cancer screening trial were randomly divided into two groups. The first 300 CTs were scored by five observers for the presence of DISH based on the original Resnick criteria for radiographs. After analysis of the data a consensus meeting was organised and the criteria were slightly modified regarding the definition of 'contiguous', the definition of 'flowing ossifications' and the viewing plane and window level. Subsequently, the second set of 300 CTs was scored by the same observers. kappa >= 0.61 was considered good agreement. The 600 male participants were on average 63.5 (SD 5.3) years old and had smoked on average 38.0 pack-years. In the first round kappa values ranged from 0.32 to 0.74 and 7 out of 10 values were below 0.61. After the consensus meeting the interobserver agreement ranged from 0.51 to 0.86 and 3 out of 10 values were below 0.61. The agreement improved significantly. This is the first study that reports interobserver agreement for the diagnosis of DISH on chest CT, showing mostly good agreement for modified Resnick criteria. . DISH is diagnosed on fluoroscopic and radiographic examinations using Resnick criteria . Evaluation of DISH on chest CT was modestly reproducible with the Resnick criteria . A consensus meeting and Resnick criteria modification improved inter-rater reliability for DISH . Reproducible CT criteria for DISH aids research into this poorly understood entity

Diurnal variability of atmospheric O-2, CO2, and their exchange ratio above a boreal forest in southern Finland

The exchange ratio (ER) between atmospheric O(2 )and CO2 is a useful tracer for better understanding the carbon budget on global and local scales. The variability of ER (in mol O(2 )per mol CO2) between terrestrial ecosystems is not well known, and there is no consensus on how to derive the ER signal of an ecosystem, as there are different approaches available, either based on concentration (ERatmos) or flux measurements (ERforest). In this study we measured atmospheric O-2 and CO2 concentrations at two heights (23 and 125 m) above the boreal forest in Hyytiala, Finland. Such measurements of O-2 are unique and enable us to potentially identify which forest carbon loss and production mechanisms dominate over various hours of the day. We found that the ERatmos signal at 23 m not only represents the diurnal cycle of the forest exchange but also includes other factors, including entrainment of air masses in the atmospheric boundary layer before midday, with different thermodynamic and atmospheric composition characteristics. To derive ERforest, we infer O(2 )fluxes using multiple theoretical and observation-based micro-meteorological formulations to determine the most suitable approach. Our resulting ERforest shows a distinct difference in behaviour between daytime (0.92 +/- 0.17 mol mol(-1)) and nighttime (1.03 +/- 0.05 mol mol(-1)). These insights demonstrate the diurnal variability of different ER signals above a boreal forest, and we also confirmed that the signals of ERatmos and ERforest cannot be used interchangeably. Therefore, we recommend measurements on multiple vertical levels to derive O-2 and CO2 fluxes for the ERforest signal instead of a single level time series of the concentrations for the ERatmos signal. We show that ERforest can be further split into specific signals for respiration (1.03 +/-; 0.05 mol mol-1) and photosynthesis (0.96 +/- 0.12 molmol(-1)). This estimation allows us to separate the net ecosystem exchange (NEE) into gross primary production (GPP) and total ecosystem respiration (TER), giving comparable results to the more commonly used eddy covariance approach. Our study shows the potential of using atmospheric O-2 as an alternative and complementary method to gain new insights into the different CO2 signals that contribute to the forest carbon budget.Peer reviewe

Top-down assessment of the Asian carbon budget since the mid 1990s

Increasing atmospheric carbon dioxide (CO2) is the principal driver of anthropogenic climate change. Asia is an important region for the global carbon budget, with 4 of the world’s 10 largest national emitters of CO2. Using an ensemble of seven atmospheric inverse systems, we estimated land biosphere fluxes (natural, land-use change and fires) based on atmospheric observations of CO2 concentration. The Asian land biosphere was a net sink of −0.46 (−0.70–0.24) PgC per year (median and range) for 1996–2012 and was mostly located in East Asia, while in South and Southeast Asia the land biosphere was close to carbon neutral. In East Asia, the annual CO2 sink increased between 1996–2001 and 2008–2012 by 0.56 (0.30–0.81) PgC, accounting for ∼35% of the increase in the global land biosphere sink. Uncertainty in the fossil fuel emissions contributes significantly (32%) to the uncertainty in land biosphere sink change

Sources of Uncertainty in Regional and Global Terrestrial CO2 Exchange Estimates

The Global Carbon Budget 2018 (GCB2018) estimated by the atmospheric CO2 growth rate, fossil fuel emissions, and modeled (bottom-up) land and ocean fluxes cannot be fully closed, leading to a “budget imbalance,” highlighting uncertainties in GCB components. However, no systematic analysis has been performed on which regions or processes contribute to this term. To obtain deeper insight on the sources of uncertainty in global and regional carbon budgets, we analyzed differences in Net Biome Productivity (NBP) for all possible combinations of bottom-up and top-down data sets in GCB2018: (i) 16 dynamic global vegetation models (DGVMs), and (ii) 5 atmospheric inversions that match the atmospheric CO2 growth rate. We find that the global mismatch between the two ensembles matches well the GCB2018 budget imbalance, with Brazil, Southeast Asia, and Oceania as the largest contributors. Differences between DGVMs dominate global mismatches, while at regional scale differences between inversions contribute the most to uncertainty. At both global and regional scales, disagreement on NBP interannual variability between the two approaches explains a large fraction of differences. We attribute this mismatch to distinct responses to El Niño–Southern Oscillation variability between DGVMs and inversions and to uncertainties in land use change emissions, especially in South America and Southeast Asia. We identify key needs to reduce uncertainty in carbon budgets: reducing uncertainty in atmospheric inversions (e.g., through more observations in the tropics) and in land use change fluxes, including more land use processes and evaluating land use transitions (e.g., using high-resolution remote-sensing), and, finally, improving tropical hydroecological processes and fire representation within DGVMs.</p