Positive and negative outcomes of informal caregiving at home and in institutionalised long-term care: A cross-sectional study

Background: Our ageing society is putting tremendous strain on public health and welfare programs to meet the needs of ageing individuals. Promoting informal caregiving is one way for policymakers to reduce this burden. However, caregiving may be experienced as stressful and is associated with adverse health consequences. While quite a lot of research focuses on caregiving for community-dwelling older adults, little is known about informal care in institutionalised long-term care (ILTC). Therefore, the objectives of this study were: 1) to compare characteristics of informal caregivers and care receivers and caregiver outcomes - at home and in ILTC; 2) to study the association between these characteristics and positive and negative caregiver outcomes; 3) to investigate the moderating effect of the setting (at home vs. ILTC) on these associations. Methods: A cross-sectional study was conducted using the TOPICS-MDS DataSet. A total of 5197 Dutch dyads were included. The average age of the care receivers and caregivers was respectively 80.7 years and 63.2 years. Several sociodemographic, health-related and caregiving-related characteristics of care receiver and caregiver and two caregiver outcomes (i.e., subjective burden and care-related quality of life) were included in the analyses. Results: Caregivers in both settings experienced comparable levels of subjective burden. Caregivers at home had slightly lower care-related quality of life than caregivers in ILTC. Several care receiver characteristics (i.e., male sex, married/cohabiting, more morbidities/disability, and less self-perceived health/psychological wellbeing) and several caregiver characteristics (i.e., female sex, being younger, living together with the care receiver, more objective burden, less self-perceived health, and more support) were associated with an increase in burden and/or a decrease in care-related quality of life. Some of these associations were stronger for dyads at home compared to dyads in ILTC. Conclusions: Informal caregiving does not stop with admission to an ILTC facility. Both settings need an informal caregiving policy, which is (1) tailored to the individual characteristics of care receivers and caregivers; (2) pays attention to the identified risk groups; and (3) reduces the negative caregiver outcomes and emphasizes the positive outcomes at the same time

Portuguese version of the Tilburg Frailty Indicator: Transcultural adaptation and psychometric validation

Artigo científico disponível actualmente em Early View (Online Version of Record published before inclusion in an issue)Aim To present the translation and validation process of the Portuguese version of the Tilburg Frailty Indicator (TFI). Methods A cross-sectional study was designed using a non-probability sample of 252 community-dwelling older adults. Preliminary studies were carried out for face and content validity assessment. Internal consistency, test–retest reliability, construct (convergent/divergent) and criterion validity were subsequently analyzed. Results The sample was mainly women (75.8%), with a mean age of 79.2 ± 7.3 years. TFI internal consistency was good (KR-20 = 0.78). Test–retest reliability for the total was also good (r = 0.91), with kappa coefficients showing substantial agreement for most items. TFI physical and social domains correlated as expected with concurrent measures, whereas the TFI psychological domain showed similar correlations with other psychological and physical measures. The TFI showed a good to excellent discrimination ability in regard to frailty criteria, and fair to good ability to predict adverse outcomes. Conclusions The psychometric properties of the TFI seem to be consistently good. These findings provide initial evidence that the Portuguese version is a valid and reliable measure for assessing frailty in the elderly

De complexiteit van de eerstelijnszorg voor ouderen in een kwetsbare positie

Op woensdag 26 maart 2014 werd in Maastricht een symposium gehouden met als titel: ‘De complexiteit van de eerstelijnszorg voor ouderen in een kwetsbare positie’. In onze vergrijzende samenleving is het waarborgen van goede zorg voor ouderen in een kwetsbare positie één van de grootste uitdagingen. Er zijn aanwijzingen dat extramurale zorg in vergelijking met intramurale zorg betere resultaten oplevert bij minder kosten. De meeste ouderen willen ook graag zo lang mogelijk thuis blijven wonen. Dit heeft tot gevolg dat er een sterke behoefte is aan (kosten-) effectieve en praktisch goed toepasbare zorginterventies, zodat ouderen in een kwetsbare positie zo lang mogelijk thuis kunnen blijven wonen. In de laatste decennia is al veel onderzoek uitgevoerd naar het verbeteren van de extramurale zorg voor ouderen in een kwetsbare positie. Echter, de meeste studies hebben geen of slechts kleine en/of korte termijn effecten laten zien

Responses of water mite assemblages (Acari) to environmental parameters at irrigated rice cultivation fields and native lakes

Many studies have revealed that water mite communities can be affected by the physical and chemical parameters of the water. The similarity between the water ‘mite assemblages in local water bodies and in irrigated rice areas can be a way to measure the water conditions, enabling an assessment of the anthropic impact in the environment. The aim of this study was to evaluate the distribution of water mites in lakes and irrigated rice fields in south Brazil. To accomplish that we characterized the distinctive environments using physical and chemical variables such as pH, turbidity (NTU), water temperature (°C) and dissolved oxygen (mg/L), in order to verify the influence of these abiotic factors on the species composition of water mite communities; and to compare water mite abundance, richness and composition among different habitats. We assessed three native lakes and four sites with irrigated rice cultivation. Our results showed, for the first time in Brazil, strong correlations between the water mite fauna and turbidity. In addition, native lakes were richer and had greater mite abundance when compared with the irrigated rice areas

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT.

BACKGROUND: Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. OBJECTIVES: (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). DESIGN: Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. INTERVENTION DEVELOPMENT: Two systematic reviews (including systematic searches of 14 databases and registries, 1990-2016 and 1980-2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65-94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the 'HomeHealth' intervention in collaboration with older people and multidisciplinary stakeholders. 'HomeHealth' comprised 3-6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. FEASIBILITY RCT: Single-blind RCT, individually randomised to 'HomeHealth' or treatment as usual (TAU). SETTING: Community settings in London and Hertfordshire, UK. PARTICIPANTS: A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. MAIN OUTCOME MEASURES: Feasibility - recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. RESULTS: We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire -3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. CONCLUSIONS: Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. FUTURE WORK: A large, definitive RCT of the HomeHealth service is warranted. STUDY REGISTRATION: This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information

Gender Imbalance in Physics Education and Employment in Germany: Trends and Challenges

Gender imbalance among German physicists persists, with fewer women in advanced degrees and research leadership roles. Although female enrollment in Physics programs increased slightly until 2022, potentially influenced by COVID-19 the long-term trend remains uncertain. Despite the rise in female Ph.D. students and foreign representation, female professors in Physics and Astronomy stagnated below 14 %, indicating significant underrepresentation. Anticipated revisions to the WissZeitVG law may impact female mainstreaming efforts, potentially leading to greater precarization of research staff. Women make up only around 20 % of employed physicists, with low visibility in the community, as seen in the representation of female physicists in prestigious awards. Addressing this imbalance requires structural interventions beyond mere encouragement and empowerment