Research Centre for Healthy and Sustainable Living

[EN] The Research Centre for Healthy and Sustainable Living of the University of Applied Sciences Utrecht aims to enable healthy urban living. According to the latest concept, health entails the capacity to respond resiliently to stressors that disturb homeostasis. In addition, an individual’s health benefits from the ability to self-manage and is determined by personalized conditions. One of the derived research challenges is to obtain know-how (biomarkers) and tools (e.g. point-of-care, wearables) to monitor an individual’s health condition in daily life. The well-known quotes “you are what you eat” and “sitting is the new smoking” indicate that condition of the oro-gastrointestinal tract and physical activity are pivotal to health. With this popular knowledge, we set out to identify biomarkers to monitor health benefits from nutrition and physical activity. Our first studies with human volunteers indicated that immune and intestinal parameters are responsive to physical stress (performed on a bicycle ergometer) in a clear kinetic manner, related to extent of physical activity and influenced by an unhealthy condition (deprivation of water intake during exercise). Our next research goals are to: -evaluate the initial selection of biomarkers in specific patient-groups and; -how these biomarkers are influenced by the condition of the oro-gastrointestinal tract, e.g. via nutrition.Pieters, R.; Bleijenberg, N.; Jerkovic, K.; Krul, C.; Veenhof, C.; Wittink, H. (2020). Research Centre for Healthy and Sustainable Living. Editorial Universitat Politècnica de València. http://hdl.handle.net/10251/156433OC

The Methodological Development of an Interprofessional Educational Program to Provide Proactive Integrated Care for Elders

Background: Interprofessional collaboration in practice (IPCP) between professionals from the medical and social domain within primary care is desirable; however, it is also challenging due to fragmented healthcare. Little is known about the development of IPCP in primary care to fit the implementation context. This article describes the methodological development and the final content of an IPCP program.Methods and findings: The development process started with the identification of IPCP competencies in a literature review and a qualitative needs analysis with semi-structured interviews among eight elders and four health care professionals. The results were discussed during a first consultation with an expert team, which consisted of ten health care professionals. Consensus was reached on the themes role identity, communication, and shared vision development to form the basis of the program. A second consultation with the experts discussed the first version of the program. Then, consensus was reached on the final version of the program, which included a blended learning approach consisting of two face-to-face meetings, online learning, and on-the-job learning with a sixteen-hour time investment over a six-week period.Conclusions: The IPCP program was developed based on educational strategies and evidence, and with the support and knowledge of practice experts to fit the implementation context.

Everyday experiences of people living with MCI or dementia:A scoping review

Background Increasing attention has been paid to the ‘voice’ of people living with MCI or dementia, but there is a lack of clarity about how everyday life is exercised, lived, and understood from this insider’s perspective. The current study aimed to explore and identify the everyday life experiences, challenges and facilitators, of home living individuals with MCI and dementia. Method Our study adopted a scoping review methodology, guided by the Joanna Briggs Institute Reviewers Manual. Eight databases were searched, resulting in 6345 records, of which 58 papers were included in the review. Only qualitative studies were included, published between 2011 and 2021. Analysis was done by descriptive content analysis. Result Included study characteristics are summarized in Table 1. Our findings were categorized into seven spheres of everyday life: experiences related to the condition, the self, relationships, activities, environment, health and social care, and public opinions [Figure 1, Table 2]. Results show the many disruptions and losses in everyday life and the ways people try to adapt to these changes. Highlighted in every area is the importance of reciprocal relationships and being engaged as citizens in the community in a meaningful way. Included studies showed no differences between groups in the impact on the experience of everyday life, such as between MCI and dementia. Conclusion This review shows that the change of focus from healthcare to all aspects of everyday life provides insight into the insider’s perspective of people living with dementia. The majority of included studies emphasize the social needs of people living with MCI or dementia. All areas of everyday life seem to be closely intertwined and reflect an socioecological model [1], [2], [3]. Furthermore, perhaps one of the defining aspects of MCI according to the current definition, that symptoms do not interfere with daily life, requires more nuance. More research is needed on factors that promote and impede the sense of reciprocity and belonging, as experienced by people living with MCI and dementia

Educational intervention to increase nurses' knowledge, self-efficacy and usage of telehealth:A multi-setting pretest-posttest study

The widespread use of telehealth, providing healthcare remotely, is hampered by various barriers. Dutch nurses currently working in practice never received education in this new way of healthcare delivery. Education is frequently suggested as a strategy to overcome barriers in telehealth use. However, the nature and effectiveness of such education has not yet been specified and tested in practice. In a previous study, we identified 14 nursing telehealth activities and accompanying competencies. In the current study, we established the effectiveness of training in these competencies on nurses' subjective knowledge, self-efficacy and usage of telehealth. A two-day tailored training program in nursing telehealth activities was evaluated in a Dutch context among 37 participants across three settings: (a) twelve primary care (PC), (b) fourteen homecare (HC) and (c) eleven hospital (H) nurses. In each team, telehealth knowledge significantly increased during the training sessions. In each team, nurses' telehealth self-efficacy also significantly increased 6-10 weeks after the training. After the training, the number of remote consultations increased from 2 to 12 in primary care, 12 to 35 in homecare and decreased from 28 to 17 in the hospital setting. We conclude that training nurses in telehealth activities contributes to their knowledge and self-efficacy.</p

What matters most: Exploring the everyday lives of people with dementia

OBJECTIVES: Research on what matters most to people with dementia is crucial for developing tailored interventions and support. This study explored how people with dementia experience their everyday lives, providing insight into what is important to them to live the best they can at home. METHODS: Inspired by a phenomenological approach, open interviews were conducted with 15 people with dementia, supplemented by home tours and walking interviews. Data collection included one to three sessions per participant. Data were analysed using descriptive content analysis and followed the phases of open, axial, and selective coding. A co-researcher group of seven people with dementia was consulted during the analysis to help interpret the emergent findings. FINDINGS: Six dimensions of what matters most in everyday life were identified: 1) Engaging in meaningful activities, which included routines, household chores, leisure, day activities, and volunteering or work; 2) Keeping a sense of connection, in relationships within the home, with family, friends, groups, and the neighbourhood; 3) Having a sense of belonging, which included attachments inside and outside the home, and to cherished objects; 4) Connecting to self, which included the ability to reflect on past experiences, live in the present moment and anticipate the future; 5) Adjusting to ongoing changes, which included alterations in sensory perceptions, perceptions of the physical environment, and navigating shifts in interpersonal dynamics; 6) Being open to help and support, from professionals, community and society. CONCLUSIONS: For people with dementia, everyday life is a continuous balancing act between what matters most and what can be achieved daily. This is not only related to dementia but is also embedded in the wider perspective of life history, relational networks, and the physical environment. This study highlights the importance of identifying what matters most to people with dementia to provide person-centred support

Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study

BACKGROUND: The effectiveness of health care interventions is co-determined by contextual factors. Unknown is the extent of this impact on patient outcomes. Therefore, the aim of this study is to explore which characteristics of general practices are associated with patient outcomes in a proactive primary care program, the U-PROFIT 2.0. METHODS: A longitudinal observational study was conducted from January 2016 till October 2017. Two questionnaires were send out, one to collect characteristics of general practices such as practice neighbourhood socio-economic status, general practice versus healthcare centre (involving multiple primary care professionals), and professional- frail older patient ratio per practice of general practitioners and practice nurses. Regarding delivering the program, the practice or district nurse who delivered the program, number of years since the start of the implementation, and choice of age threshold for frailty screening were collected. Patient outcomes collected by the second questionnaire and send to frail patients were daily functioning, hospital admissions, emergency department visits, and general practice out-of-hours consultations. Linear and generalized linear mixed models were used. RESULTS: A total of 827 frail older people were included at baseline. Delivery of the program by a district nurse compared to a practice nurse was significantly associated with a decrease in daily functioning on patient-level (β = 2.19; P = < 0.001). Duration since implementation of 3 years compared to 9 years was significantly associated with less out-of-hours consultations to a general practice (OR 0.11; P = 0.001). Applying frailty screening from the age of 75 compared to those targeted from the age of 60 showed a significant increase in emergency visits (OR 5.26; P = 0.03). CONCLUSION: Three associations regarding the organizational context 1) the nurse who delivered the program, 2) the number of years the program was implemented and 3) the age threshold for defining a frail patient are significant and clinically relevant for frail patients that receive a proactive primary care program. In general, contextual factors need more attention when implementing complex primary care programs which can result in better balanced choices to enhance effective proactive care for older people living in the community

Measurement properties of oral health assessments for non-dental healthcare professionals in older people:a systematic review

Background: Regular inspection of the oral cavity is required for prevention, early diagnosis and risk reduction of oral-and general health-related problems. Assessments to inspect the oral cavity have been designed for non-dental healthcare professionals, like nurses. The purpose of this systematic review was to evaluate the content and the measurement properties of oral health assessments for use by non-dental healthcare professionals in assessing older peoples' oral health, in order to provide recommendations for practice, policy, and research. Methods: A systematic search in PubMed, EMBASE.com, and Cinahl (via Ebsco) has been performed. Search terms referring to 'oral health assessments', 'non-dental healthcare professionals' and 'older people (60+)' were used. Two reviewers individually performed title/abstract, and full-text screening for eligibility. The included studies have investigated at least one measurement property (validity/reliability) and were evaluated on their methodological quality using "The Consensus-based Standards for the selection of health Measurement Instruments"(COSMIN) checklist. The measurement properties were then scored using quality criteria (positive/negative/indeterminate). Results: Out of 879 hits, 18 studies were included in this review. Five studies showed good methodological quality on at least one measurement property and 14 studies showed poor methodological quality on some of their measurement properties. None of the studies assessed all measurement properties of the COSMIN. In total eight oral health assessments were found: the Revised Oral Assessment Guide (ROAG); the Minimum Data Set (MDS), with oral health component; the Oral Health Assessment Tool (OHAT); The Holistic Reliable Oral Assessment Tool (THROAT); Dental Hygiene Registration (DHR); Mucosal Plaque Score (MPS); The Brief Oral Health Screening Examination (BOHSE) and the Oral Assessment Sheet (OAS). Most frequently assessed items were: lips, mucosa membrane, tongue, gums, teeth, denture, saliva, and oral hygiene. Conclusion: Taken into account the scarce evidence of the proposed assessments, the OHAT and ROAG are most complete in their included oral health items and are of best methodological quality in combination with positive quality criteria on their measurement properties. Non-dental healthcare professionals, policymakers and researchers should be aware of the methodological limitations of the available oral health assessments and realize that the quality of the measurement properties remains uncertain

Factors That Influence the Use of eHealth in Home Care: Scoping Review and Cross-sectional Survey

BACKGROUND: In home care, eHealth implementation requires health care professionals and home care clients to change their behavior because they have to incorporate the use of eHealth into their daily routines. Knowledge of factors that influence the use of eHealth in home care is needed to optimize implementation strategies. However, a comprehensive overview of such factors is lacking. OBJECTIVE: The aims of this study were to (1) provide insight into the types of eHealth that are used and preferred in home care and (2) identify factors that influence the use of eHealth in home care according to health care professionals and home care clients. METHODS: A scoping review and online, cross-sectional survey were conducted sequentially. The survey was conducted among Dutch health care professionals with a nursing background who were working for a home care organization at the time. The capability, opportunity, motivation, behavior (COM-B) model, which posits that for any behavior (B) to occur, a person must have the capability (C), opportunity (O), and motivation (M) to perform the behavior, was used to identify influencing factors. The use of a theoretical model may contribute to a better understanding of how to achieve and sustain behavior change in clinical practice. RESULTS: We included 30 studies in the scoping review. The most frequently studied type of eHealth was a telecommunication/telemonitoring system. The survey was completed by 102 participants. The most frequently used types of eHealth were electronic health records, social alarms, and online client portals. A health app was the most frequently preferred type of eHealth. We identified 22 factors that influence the use of eHealth in home care according to health care professionals and home care clients. Influencing factors were organized into the components of the COM-B model, namely capability (n=6), opportunity (n=10), and motivation (n=6). We found that there is no single influencing factor that is key to the complexity of eHealth implementation. CONCLUSIONS: Different types of eHealth are used, and many types of eHealth are preferred by health care professionals. The identified factors that influence the use of eHealth in home care relate to all components of the COM-B model. These factors need to be addressed and embedded in implementation strategies of eHealth to optimize the use of eHealth in home care

Proactieve en gestructureerde zorg voor kwetsbare oudere patiënten in de eerstelijn: Achtergrond, opzet en uitvoering van een screenings- en zorgprogramma

De huidige zorg voor de oudere, kwetsbare patiënt is reactief, gefragmenteerd en voldoet niet aan de behoefte van de patiënt. Gezien de verwachte sterke toename van de groep thuiswonende, kwetsbare oudere patiënten is een transitie nodig naar proactieve en geïntegreerde zorg. In de hier beschreven studie onderzoeken we twee innovatieve interventies in deze zorg: een screenings- en monitoringsprogramma voor kwetsbare ouderen op basis van routine zorggegevens en een multidisciplinair interventie programma door een verpleegkundige ouderenzorg in de huisartsenpraktijk. De effectiviteit van de interventies wordt onderzocht in een drie-armige, cluster gerandomiseerde trial, die plaats vindt binnen 58 huisartsenpraktijken in Utrecht, de Bilt en Maarssenbroek. 3008 patiënten zijn geïncludeerd. Primaire uitkomstmaat is het effect van de interventies op de dagelijkse bezigheden, gemeten met de Katz vragenlijst. Secundaire uitkomstmaten zijn kwaliteit van leven, mortaliteit, opname in een verzorgings- of verpleeghuis, bezoek aan een spoedeisende hulp of huisartsenpost, opnames in het ziekenhuis en mantelzorgbelasting. In dit artikel beschrijven we de achtergrond, opzet en uitvoering van een proactief en gestructureerd screenings- en zorgprogramma voor kwetsbare thuiswonende ouderen. De resultaten van de interventies worden elders beschreven

Cluster analysis of functional independence in community-dwelling older people

Background: The concept of Functional Independence (FI), defined as ‘functioning physically safe and independent from other persons, within one’s context”, plays an important role in maintaining the functional ability to enable well-being in older age. FI is a dynamic and complex concept covering four clinical outcomes: physical capacity, empowerment, coping flexibility, and health literacy. As the level of FI differs widely between older adults, healthcare professionals must gain insight into how to best support older people in maintaining their level of FI in a personalized manner. Insight into subgroups of FI could be a first step in providing personalized support This study aims to identify clinically relevant, distinct subgroups of FI in Dutch community-dwelling older people and subsequently describe them according to individual characteristics. Results: One hundred fifty-three community-dwelling older persons were included for participation. Cluster analysis identified four distinctive clusters: (1) Performers – Well-informed; this subgroup is physically strong, well-informed and educated, independent, non-falling, with limited reflective coping style. (2) Performers – Achievers: physically strong people with a limited coping style and health literacy level. (3) The reliant- Good Coper representing physically somewhat limited people with sufficient coping styles who receive professional help. (4) The reliant – Receivers: physically limited people with insufficient coping styles who receive professional help. These subgroups showed significant differences in demographic characteristics and clinical FI outcomes. Conclusions: Community-dwelling older persons can be allocated to four distinct and clinically relevant subgroups based on their level of FI. This subgrouping provides insight into the complex holistic concept of FI by pointing out for each subgroup which FI domain is affected. This way, it helps to better target interventions to prevent the decline of FI in the community-dwelling older population