A promising approach in comparative research on care for the elderly

Long-term care (LTC) in the form of care provided in nursing homes, homes for the aged and home care is considered an appropriate answer to the growing needs of the aging populations of the industrialized world. However, the provision of and expenditures on LTC vary considerably between these industrialized countries. Although one would expect LTC to be subject to many internationally comparative studies, including all European countries, this is not the case. A paper presented by Damiani et al. in BMC Health Services Research contains an internationally comparative model regarding the development of LTC in Europe (2003 to 2007). They achieve an intriguing compromise between depth and width in the sparsely populated domain of internationally comparative research on LTC by characterizing countries' LTC and interpreting the large north/south differences found. Their results also show that 'cash for care' schemes form a substantial alternative to traditional LTC provision. An additional time series analysis showed that many countries seem to be engaged in reorganizing the LTC sector. This study widens knowledge in a neglected area of health services research and should serve as a source of inspiration for further studies

Transitions across cognitive states and death among older adults in relation to education:A multistate survival model using data from six longitudinal studies

INTRODUCTION: This study examines the role of educational attainment, an indicator of cognitive reserve, on transitions in later life between cognitive states (normal Mini-Mental State Examination (MMSE), mild MMSE impairment, and severe MMSE impairment) and death. METHODS: Analysis of six international longitudinal studies was performed using a coordinated approach. Multistate survival models were used to estimate the transition patterns via different cognitive states. Life expectancies were estimated. RESULTS: Across most studies, a higher level of education was associated with a lower risk of transitioning from normal MMSE to mild MMSE impairment but was not associated with other transitions. Those with higher levels of education and socioeconomic status had longer nonimpaired life expectancies. DISCUSSION: This study highlights the importance of education in later life and that early life experiences can delay later compromised cognitive health. This study also demonstrates the feasibility and benefit in conducting coordinated analysis across multiple studies to validate findings

Mental health of healthcare workers during the first year of the COVID-19 pandemic in the Netherlands: a longitudinal study

PurposeIn March 2020, the WHO declared COVID-19 a pandemic. Previous virus outbreaks, such as the SARS outbreak in 2003, appeared to have a great impact on the mental health of healthcare workers. The aim of this study is to examine to what extent mental health of healthcare workers differed from non-healthcare workers during the first year of the COVID-19 pandemic.MethodsWe used data from a large-scale longitudinal online survey conducted by the Corona Behavioral Unit in the Netherlands. Eleven measurement rounds were analyzed, from April 2020 to March 2021 (N = 16,615; number of observations = 64,206). Mental health, as measured by the 5-item Mental Health Inventory, was compared between healthcare workers and non-healthcare workers over time, by performing linear GEE-analyses.ResultsMental health scores were higher among healthcare workers compared to non-healthcare workers during the first year of the pandemic (1.29 on a 0–100 scale, 95%-CI = 0.75–1.84). During peak periods of the pandemic, with over 100 hospital admissions or over 25 ICU admissions per day and subsequently more restrictive measures, mental health scores were observed to be lower in both healthcare workers and non-healthcare workers.ConclusionDuring the first year of the COVID-19 pandemic, we observed no relevant difference in mental health between healthcare workers and non-healthcare workers in the Netherlands. To be better prepared for another pandemic, future research should investigate which factors hinder and which factors support healthcare workers to maintain a good mental health

Impact of improved recording of work-relatedness in primary care visits at occupational health services on sickness absences: study protocol for a randomised controlled trial

Abstract Background Employment protects and fosters health. Occupational health services, particularly in Finland, have a central role in protecting employee health and preventing work ability problems. However, primary care within occupational health services is currently underused in informing preventive activities. This study was designed to assess whether the recording of work ability problems and improvement of follow-up of work-related primary care visits can reduce sickness absences and work disability pensions after 1 year. Methods/design A pragmatic trial will be conducted using patient electronic registers and registers of the central pensions agency in Finland. Twenty-two occupational health centres will be randomised to intervention and control groups. Intervention units will receive training to improve recording of work ability illnesses in the primary care setting and improved follow-up procedures. The intervention impact will be assessed through examining rates of sickness absence across intervention and control clinics as well as before and after the intervention. Discussion The trial will develop knowledge of the intervention potential of primary care for preventing work disability pensions and sickness absence. The use of routine patient registers and pensions registers to assess the outcomes of a randomised controlled trial will bring forward trial methodology, particularly when using register-based data. If successful, the intervention will improve the quality of occupational health care primary care and contribute to reducing work disability. Trial registration ISRCTN Registry reference number ISRCTN45728263 . Registered on 18 April 2016

Health of the Dutch working population. Developments between 2012 and 2020

Tussen 2012 en 2020 nam in Nederland het aantal mensen met betaald werk toe: van 8,3 naar 9 miljoen. Dat komt voor een groot deel doordat werkenden later met pensioen zijn gegaan. Ook zijn er meer vrouwen gaan werken. De meeste mensen met een betaalde baan (88 procent) voelden zich gezond. Mensen die werken zijn over het algemeen gezonder dan mensen die niet werken. Tussen 2012 en 2020 veranderde de lichamelijke gezondheid van werkenden nauwelijks. Zo bleef het percentage werkenden met een lichamelijke beperking of een langdurige aandoening bijna hetzelfde. In bepaalde leeftijdsgroepen, waaronder 45- tot 65-jarigen, was het aantal mensen dat zich gezond voelde in 2020 iets hoger dan in 2016. Wel verslechterde de mentale gezondheid onder werkenden in de onderzochte periode, vooral onder jongvolwassenen tot 35 jaar. Steeds meer jonge werkenden hadden een kans een angststoornis of depressie te krijgen. Zij gaven aan vaker vermoeid, zenuwachtig of somber te zijn. Of voelden zich vaker rusteloos, minderwaardig of depressief. Deze verslechtering was al vóór de coronajaren te zien, dus kan niet alleen door de epidemie komen. Oudere werkenden zijn lichamelijk minder gezond dan jongere werkenden. Nu mensen steeds langer doorwerken, is het belangrijk om de gezondheid van oudere werkenden in de gaten te houden. Tussen 2012 en 2020 had ongeveer 10 procent van de 60- tot 67-jarigen een lichamelijke beperking. Dit percentage bleef deze jaren hetzelfde. Maar het aantal mensen in deze leeftijdsgroep met een lichamelijke beperking, steeg in deze periode met 36.000. Dat komt omdat de pensioengerechtigde leeftijd omhoog is gegaan naar 67 jaar en meer mensen in deze leeftijd bleven werken. Dit blijkt uit onderzoek van het RIVM naar de gezondheid van de beroepsbevolking in Nederland. Het RIVM deed dat voor de eerste keer en onderzocht hun gezondheid in 2012, 2016 en 2020. Het RIVM heeft deze gegevens gehaald uit de Gezondheidsmonitor Volwassenen en Ouderen (van de GGD(Gemeentelijke Gezondheidsdienst)’en, het Centraal Bureau voor de Statistiek (CBS(Centraal Bureau voor de Statistiek)) en het RIVM).Between 2012 and 2020, the number of people in the Netherlands who were in paid work increased from 8.3 million to 9 million. This was due to a large extent to working people putting off their retirement. In addition, more women entered work. Most people in paid work (88 per cent) felt healthy. People who are in work are generally healthier than people who are out of work. The physical health of the working population changed little between 2012 and 2020. As an example, the percentage of the working population with a physical disability or long-term condition remained almost stable. In some age categories, including 45–65-year-olds, the number of people who felt healthy was slightly higher in 2020 than in 2016. On the other hand, the mental health of the working population declined in the period under review, with young adults under the age of 35 particularly affected. Increasing numbers of young working people were at risk of developing an anxiety disorder or depression. They indicated they were tired, nervous or depressed more often, or that they felt restless, inferior or gloomy more often. As this decline was already noticeable before the coronavirus pandemic, the pandemic cannot be the only reason for this. Older working people are physically less healthy than younger working people. Now that people are remaining in work for longer, it is important to monitor the health of older working people. Between 2012 and 2020, around 10 per cent of those aged between 60 and 67 had a physical disability. This percentage remained stable throughout the period under review. In absolute terms, however, the number of people in this age category with a physical disability increased by 36,000. This seeming paradox was due to the increase in the state pension age to 67 and more people in this age category remaining in work. These are the findings of an RIVM study into the health of the Dutch working population. For this inaugural study, RIVM investigated the health of the Dutch working population in 2012, 2016 and 2020. It did so on the basis of data from the Health Monitor for Adults and the Elderly (conducted by the Municipal Public Health Services, Statistics Netherlands and RIVM)

Regional variation in hospital admission rates in the Netherlands, Belgium, Northern France and Nordrhein-Westfalen.

For the analysis of regional variations in hospital admission rates a model was set up, including both supply and demand indicators. Data were gathered for regions in four health care systems (the Dutch, Belgian, French and German), for 1982, 1979, 1974 (France 1982 only). Hospital bed supply proved to be the key factor in the explanation of the variation. The French health care system and, to a lesser extent, the German, turned out to be the strongest supply-dominated health care systems of the four. However, supply dominnance in the German health care system seems to decrease over time. We concluded that the empirical generalisation, contained in Roemer's law, a bed built is a bed filled, is conditioned by time and place. Hypotheses on the conditional character of Roemer's law require further testing. (aut.ref.

Health effects of employment: a systematic review of prospective studies

Objectives The purpose of this review was to systematically summarise the literature on the health effects of employment

Trends in working conditions and health across three cohorts of older workers in 1993, 2003 and 2013: a cross-sequential study

Background Over the past decades, the number of older workers has increased tremendously. This study examines trends from 1993 to 2013 in physical, cognitive and psychological functioning among three successive cohorts of Dutch older workers. The contribution of the changes in physical and psychosocial work demands and psychosocial work resources to change in functioning is examined. Insight in health of the older working population, and in potential explanatory variables, is relevant in order to reach sustainable employability. Methods Data from three cohorts (observations in 1993, 2003 and 2013) of the Longitudinal Aging Study Amsterdam (LASA) were used. Individuals aged 55–65 with a paid job were included (N = 1307). Physical functioning was measured using the Timed Chair Stand Test, cognitive functioning by a Coding Task and psychological functioning by the positive affect scale from the CES-D. Working conditions were deduced from a general population job exposure matrix. Linear and logistic regression analyses were performed. Results From 1993 to 2013, time needed to perform the Timed Chair Stand Test increased with 1.3 s (95%CI = 0.89–1.71), to a mean of 11.5 s. Coding Task scores increased with 1.7 points (95%CI = 0.81–2.59), to a mean of 31 points. The proportion of workers with low positive affect increased non-significantly from 15 to 20% (p = 0.088). Only the improvement in cognitive functioning was associated with the change in working conditions. The observed decrease of physically demanding jobs and increase of jobs with higher psychosocial resources explained 8% of the improvement

Gezondheid en arbeidsparticipatie rond de AOW-leeftijd : Verwachte ontwikkelingen tot 2040

De leeftijd waarop mensen in Nederland gebruik mogen maken van de Algemene Ouderdomswet (AOW) zal in 2040 gestegen zijn naar 68 jaar. De regering heeft dit besloten vanwege de stijgende levensverwachting. Uit onderzoek van het RIVM blijkt dat mensen de afgelopen twintig jaar langer gezond blijven. De komende jaren zal deze 'gezonde levensverwachting' blijven stijgen. Gezondheid is in die zin geen belemmering om de AOW-leeftijd te verhogen. De gezondheid van één leeftijdsgroep, de 60-65-jarigen, is echter niet verbeterd maar hetzelfde gebleven. Waarom hun gezondheid is achtergebleven bij de rest van de Nederlandse bevolking, is niet helemaal duidelijk. Het zou te maken kunnen hebben met de plotseling weggevallen mogelijkheden om vervroegd met pensioen te gaan. Hierdoor hebben mensen het misschien als belastend ervaren om langer door te werken. Als mensen zich daar de komende jaren beter op kunnen voorbereiden, blijft hun gezondheid mogelijk niet achter. Het zou ook kunnen komen doordat ze langer blijven werken. In dat geval zal de gezondheid van 60-65-jarigen ook in de toekomst achter kunnen blijven. Met 'gezondheid' wordt de manier waarop mensen zelf hun gezondheid en de mate van lichamelijke beperkingen ervaren bedoeld. Hoe de ontwikkelingen ook uitpakken, zeker is dat er de komende jaren meer zestigplussers zullen zijn met een minder goede gezondheid die in principe langer doorwerken. Dit komt doordat een grotere groep Nederlanders de leeftijd van zestig jaar en ouder zal bereiken en langer zal doorwerken. Deze mensen lopen het risico om eerder uit het arbeidsproces te vallen of arbeidsongeschikt te worden. Het is daarom belangrijk ervoor te zorgen dat mensen gezond zijn in de periode dat ze langer werken. Er is nog weinig bewijs welke maatregel daarvoor effectief is. De meeste kans lijkt een 'levensloopbenadering' te hebben: zorg ervoor dat mensen gedurende hun hele werkende leven gezond en inzetbaar blijven. Ook een 'integrale' aanpak lijkt effectief, met aandacht voor meerdere zaken, zoals een gezonde leefstijl en goede werkomstandigheden