Onnodige slechtziendheid onder ouderen in zorginstellingen: lessen uit een interventieproject in de regio Den Bosch

Introductie Veel ouderen in zorginstellingen in Nederland zijn onnodig blind of slechtziend (visus <0,3). Zij vallen vaker, zijn vaker depressief en hebben meer zorg nodig. In dit interventieproject werden slechtziende bewoners geïdentificeerd en doorverwezen voor adequate oogzorg. Het doel van het onderzoek is evaluatie van de interventie, waaronder validatie van de screening, bepalen van prevalentie en oorzaken van visuele beperkingen en bepalen van resultaten van de behandeling. Daarnaast wordt ook de effectiviteit van de zorgketen geëvalueerd. Materiaal en methode Aan 640 bewoners werd een eenvoudige oogscreening aangeboden en 210 van hen werden verwezen, via hun huisarts, naar de optiek (10), oogarts (98) of revalidatie-instelling (1). Resultaten De uitval in dit onderzoek was fors. De prevalentie van slechtziendheid (24%) was lager dan in vergelijkbare studies. Van de onderzochte bewoners had 51% cataract. Uiteindelijk zijn 17 (8,1%) van de 210 verwezen bewoners behandeld door de oogarts en negen (4,3%) naar een optiekzaak verwezen. Knelpunten in de effectiviteit van de zorgketen werden geïdentificeerd. Discussie Visusscreening in zorginstellingen voor ouderen is goed uitvoerbaar en zinvol. De organisatie van de zorgketen dient korter en eenvoudiger te worden. Daarmee zal de effectiviteit van deze interventie, en daarmee de kwaliteit van leven van veel bewoners, verbeteren

Measurement of overall quality of life in nursing homes through self-report: the role of cognitive impairment

Measuring quality of life is a necessity for adequate interventions. This paper concerns the usefulness of six self-report measures for overall quality of life for nursing home residents with various levels of cognitive impairment. It was investigated which proportion of residents from four cognition groups could complete a scale, and internal consistency and construct validity of the scales were studied. Data collection took place in ten Dutch nursing homes (N = 227). The proportion of residents that could complete each scale varied. The Depression List could be administered most often to the cognitively most impaired group (43%; Mini Mental State Examination-scores 0–4). In the three cognition groups with MMSE-score >5, internal consistency of the Depression List, Geriatric Depression Scale and Negative Affect Scale was adequate in all three groups (alpha ≥.68). Intercorrelation was highest for the Philadelphia Geriatric Center Morale Scale, the Depression List, and the Geriatric Depression Scale (rho ≥.65). Nonetheless, self-report scales were not strongly correlated with two observational scales for depression, especially in cognitively severely impaired residents (rho ≤.30). In conclusion, it may not be possible to measure overall quality of life through self-report, and possibly also through observation, in many nursing home residents

Effects and feasibility of a standardised orientation and mobility training in using an identification cane for older adults with low vision: design of a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Orientation and mobility training (O&M-training) in using an identification cane, also called symbol cane, is provided to people with low vision to facilitate independent participation in the community. In The Netherlands this training is mainly practice-based because a standardised and validly evaluated O&M-training in using the identification cane is lacking. Recently a standardised O&M-training in using the identification cane was developed. This training consists of two face-to-face sessions and one telephone session during which, in addition to usual care, the client's needs regarding mobility are prioritised, and cognitive restructuring techniques, action planning and contracting are applied to facilitate the use of the cane. This paper presents the design of a randomised controlled trial aimed to evaluate this standardised O&M-training in using the identification cane in older adults with low vision.</p> <p>Methods/design</p> <p>A parallel group randomised controlled trial was designed to compare the standardised O&M-training with usual care, i.e. the O&M-training commonly provided by the mobility trainer. Community-dwelling older people who ask for support at a rehabilitation centre for people with visual impairment and who are likely to receive an O&M-training in using the identification cane are included in the trial (N = 190). The primary outcomes of the effect evaluation are ADL self care and visual functioning with respect to distance activities and mobility. Secondary outcomes include quality of life, feelings of anxiety, symptoms of depression, fear of falling, and falls history. Data for the effect evaluation are collected by means of telephone interviews at baseline, and at 5 and 17 weeks after the start of the O&M-training. In addition to an effect evaluation, a process evaluation to study the feasibility of the O&M-training is carried out.</p> <p>Discussion</p> <p>The screening procedure for eligible participants started in November 2007 and will continue until October 2009. Preliminary findings regarding the evaluation are expected in the course of 2010. If the standardised O&M-training is more effective than the current O&M-training or, in case of equal effectiveness, is considered more feasible, the training will be embedded in the Dutch national instruction for mobility trainers.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00946062</p

Slow and fast visual motion channels have independent binocular-rivalry stages.

We have previously reported a transparent motion after-effect indicating that the human visual system comprises separate slow and fast motion channels. Here, we report that the presentation of a fast motion in one eye and a slow motion in the other eye does not result in binocular rivalry but in a clear percept of transparent motion. We call this new visual phenomenon 'dichoptic motion transparency' (DMT). So far only the DMT phenomenon and the two motion after-effects (the 'classical' motion after-effect, seen after motion adaptation on a static test pattern, and the dynamic motion after-effect, seen on a dynamic-noise test pattern) appear to isolate the channels completely. The speed ranges of the slow and fast channels overlap strongly and are observer dependent. A model is presented that links after-effect durations of an observer to the probability of rivalry or DMT as a function of dichoptic velocity combinations. Model results support the assumption of two highly independent channels showing only within-channel rivalry, and no rivalry or after-effect interactions between the channels. The finding of two independent motion vision channels, each with a separate rivalry stage and a private line to conscious perception, might be helpful in visualizing or analysing pathways to consciousness

Health problems and care needs in patients with Korsakoff’s syndrome: A systematic review

What is known on the subject?: Patients with Korsakoff's syndrome suffer from a broad range of comorbid somatic and/or psychiatric conditions. The various health problems in patients with Korsakoff's syndrome limit their ability to perform daily activities and also negatively affect their social functioning. What the paper adds to existing knowledge?: Patients with Korsakoff's syndrome have complex somatic and psychiatric comorbid conditions co-occurring with behavioural and functional problems. They are compounded by patients’ poor self-awareness regarding their health status and functioning. What are the implications for practice?: This review demonstrates that patients with Korsakoff's syndrome should receive integrated care. Integrated care for patients with Korsakoff's syndrome should be based on accurate multidimensional and multidisciplinary diagnostics in which nurses and nurse assistants have a prominent role due to their central position in the care process patients with Korsakoff's syndrome. Abstract: Introduction The literature shows that Korsakoff's syndrome is associated with a wide range of severe comorbid somatic and psychiatric health problems that lead to care needs in several domains of functioning. Aim To provide a comprehensive overview of Korsakoff patients’ health conditions and related care needs. Method Following the PRISMA guidelines, we searched MEDLINE, PsycInfo, Cochrane Library and CINAHL up to January 2019. After applying our inclusion criteria, two reviewers independently selected the studies, extracted the data and assessed methodological quality. Results Twelve articles were included. The commonest somatic comorbid conditions were liver disease, cardiovascular disease, COPD and diabetes mellitus. The commonest psychiatric comorbid conditions were mood disorder, personality disorder and psychotic disorder. Anxiety, aggressive/agitated behaviour, depressive symptoms and care needs in social functioning and (instrumental) activities of daily living were also very commonly reported. Discussion In patients with Korsakoff's syndrome, somatic and psychiatric comorbid conditions co-occur with behavioural and functional problems. They are compounded by patients’ poor self-awareness regarding their health status and functioning. Adequate responses to their care needs require high-quality integrated care. Implications for practice Patients with Korsakoff's syndrome should receive integrated care based on accurate multidimensional and multidisciplinary diagnostics in which nurses have a prominent role