Time trends in preventive drug treatment after myocardial infarction in older patients

Secondary preventive drug treatment in patients aged >= 60 years with a history of myocardial infarction was investigated for age-dependent differences in time trends. Sixteen general practices in the Netherlands participated. Preventive treatment with at least three of four drugs (antithrombotics, statins, beta-blockers, and/or angiotensin-converting enzyme inhibitors) increased significantly over time in all three age strata of older patients. Although the greatest relative increase (2.2 times greater) took place in patients aged >= 80 years, these patients consistently had most room for improvement.Public Health and primary careGeriatrics in primary car

A Postal Screener for Pain and Need for Treatment in Older Persons in Primary Care

Geriatrics in primary car

Implementation of the multidisciplinary guideline on chronic pain in vulnerable nursing home residents to improve recognition and treatment: a qualitative process evaluation

The recognition and treatment of pain in nursing home residents presents challenges best addressed by a multidisciplinary approach. This approach is also recommended in the applicable Dutch guideline; however, translating guidelines into practical strategies is often difficult in nursing homes. Nevertheless, a better understanding of guideline implementation is key to improving the quality of care. Here we describe and qualitatively evaluate the implementation process of the multidisciplinary guideline 'Recognition and treatment of chronic pain in vulnerable elderly' in a Dutch nursing home. The researchers used interviews and document analyses to study the nursing home's implementation of the guideline. The project team of the nursing home first filled out an implementation matrix to formulate goals based on preferred knowledge, attitudes, and behaviors for the defined target groups. Together with experts and organizations, pharmacotherapy audit meetings were organized, an expert pain team was appointed, a policy document and policy flowchart were prepared, and 'anchor personnel' were assigned to disseminate knowledge amongst professionals. Implementation was partially successful and resulted in a functioning pain team, a pain policy, the selection of preferred measurement instruments, and pain becoming a fixed topic during multidisciplinary meetings. Nevertheless, relatively few professionals were aware of the implementation process.Geriatrics in primary carePublic Health and primary car

Probable pain on the pain assessment in impaired cognition (PAIC15) instrument: assessing sensitivity and specificity of cut-offs against three standards

Observational pain scales can help to identify pain in persons with dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) covers 15 items that indicate pain, but it is unclear how probable pain is, for each summed score (range 0-45). We aimed to determine sensitivity and specificity of cut-offs for probable pain on the PAIC15 against three standards: (1) self-report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut-off of 2, and (3) observer's overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with re-assessment after 2 months in 137 residents. The area under the ROC curve was excellent against the PAINAD cut-off (>= 0.8) but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, PAIC15 scores of 3 and higher represent possible pain for screening in practice, with sensitivity and specificity against self-report in the 0.5 to 0.7 range. While sensitivity for screening in practice may be too low, a cut-off of 4 is reasonable to indicate probable pain in research.Geriatrics in primary carePublic Health and primary car

Psychometrics of the observational scales of the Utrecht Scale for Evaluation of Rehabilitation (USER): Content and structural validity, internal consistency and reliability: A study on psychometric properties of the USER.

Introduction: : Establish content and structural validity, internal consistency, inter-rater reliability, and measurement error of the physical and cognitive scales of the Utrecht Scale for Evaluation clinical Rehabilitation (USER) in geriatric rehabilitation. Material and methods: : First, an expert consensus-meeting (N=7) was organised for content validity wherein scale content validity index (CVI) was measured. Second, in a sample of geriatric rehabilitation patient structural validity (N=616) was assessed by confirmatory factor analyses for exploring unidimensionality. Cut-off criteria were: Root Mean Square Error of Approximation (RMSEA) 0.95. Local independence (residual correlation0.30 and Hs-coefficient >0.50) were also calculated. Cronbach alphas were calculated for internal consistency. Alpha's > 0.7 was considered adequate. T hird, two nurses independently administered the USER to 37 patients. Intraclass-correlation coefficients (ICC) were calculated for inter-rater reliability (IRR), standard error of measurement (SEM) and Smallest Detectable Change (SDC). Results: : The CVI for physical functioning was moderate (0.73) and excellent for cognitive functioning (0.97). Structural validity physical scale was acceptable (CFI;0.95, TLI;0.93, RMSEA;0.07, ECV;0.78, OmegaH;0.87; Monotonicity;(Hi;0.52-0.75 and Hs;0.63)). Cognitive scale was good (CFI;0.98, TLI;0.96, RMSEA;0.05, ECV;0.66 and OmegaH;0.90. Monotonicity;(Hi;0.30 -0.70 and Hs;0.61)). Cronbach's alpha were high: physical scale;0.92 and cognitive scale;0.94. Reliability physical scale ICC;0.94, SEM;5 and SDC;14 and cognitive scale ICC;0.88, SEM;5 and SDC;13. Conclusion: : The observational scales of the USER have shown sufficient content and structural validity, internal consistency, and interrater reliability for measuring physical and cognitive function in geriatric rehabilitation. Trial registration: : N/AGeriatrics in primary carePublic Health and primary car

Blended acceptance and commitment therapy versus face-to-face cognitive behavioral therapy for older adults with anxiety symptoms in primary care: pragmatic single-blind cluster randomized trial

Background: Anxiety symptoms in older adults are prevalent and disabling but often go untreated. Most trials on psychological interventions for anxiety in later life have examined the effectiveness of face-to-face cognitive behavioral therapy (CBT). To bridge the current treatment gap, other treatment approaches and delivery formats should also be evaluated.Objective: This study is the first to examine the effectiveness of a brief blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, compared with a face-to-face CBT intervention. Methods: Adults aged between 55-75 years (n=314) with mild to moderately severe anxiety symptoms were recruited from general practices and cluster randomized to either blended ACT or face-to-face CBT. Assessments were performed at baseline (T0), posttreatment (T1), and at 6- and 12-month follow-ups (T2 and T3, respectively). The primary outcome was anxiety symptom severity (Generalized Anxiety Disorder-7). Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of Diagnostic and Statistical Manual of Mental Disorders V anxiety disorders, and treatment satisfaction. Results: Conditions did not differ significantly regarding changes in anxiety symptom severity during the study period (T0-T1: B=.18, P=.73; T1-T2: B=-.63, P=.26; T1-T3: B=-.33, P=.59). Large reductions in anxiety symptom severity (Cohen d >= 0.96) were found in both conditions post treatment, and these were maintained at the 12-month follow-up. The rates of clinically significant changes in anxiety symptoms were also not different for the blended ACT group and CBT group (chi(2)(1)=0.2, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT group (B=.27, P=.03, Cohen d=0.29), and treatment satisfaction was significantly higher for blended ACT than CBT (B=3.19, PStress and Psychopatholog

Yield and costs of direct and stepped screening for depressive symptoms in subjects aged 75 years and over in general practice

OBJECTIVE To examine yield and costs of two screening methods for depressive symptoms in subjects ≥75 years in general practice. METHODS In 73 general practices of 12.144 registered subjects ≥75 years 10.681 could be invited for screening. In the first 31 practices we invited 3797 subjects for direct screening which implied an invitation by letter followed by a home visit to administer the 15-item Geriatric Depression Scale (GDS-15). In the remaining 42 practices 6884 subjects were invited for stepped screening which implied that the GDS-15 was sent by post, followed by a home visit only if the self-administered GDS-15-score was ≥ 4 points. Being screen-positive for depressive symptoms was defined as an interviewer-administered GDS-15-score ≥5 points. Screening costs were estimated based on results in this study. RESULTS Of all registered subjects 707 (5.8%) were already being treated for depression. The yield of direct screening was higher than of stepped screening (2.6% versus 1.9%, p = 0.009), with similar yields for subjects aged 75-79 years and for subjects aged ≥80 years. In a standard GP-practice with 160 subjects ≥75 years estimated total screening costs are about twice as high for direct screening than for stepped screening. Estimated costs per screen positive subject are €350 for direct screening and €250 for stepped screening. CONCLUSION Direct screening has a higher yield, but is also more time consuming and more expensive. Whether the extra yield is clinically relevant and worth the extra costs, will depend on the subsequent treatment effect. Trial registration: www.controlled-trials.com/ISRCTN 71142851 Copyright © 2010 John Wiley & Sons, Ltd.Medical Decision Makin

COVID-19 management in nursing homes by outbreak teams (MINUTES) - study description and data characteristics: a qualitative study

Objectives Nursing homes are hit relatively hard by the COVID-19 pandemic. Dutch long-term care (LTC) organisations installed outbreak teams (OTs) to coordinate COVID-19 infection prevention and control. LTC organisations and relevant national policy organisations expressed the need to share experiences from these OTs that can be applied directly in COVID-19 policy. The aim of the 'COVID-19 management in nursing homes by outbreak teams' (MINUTES) study is to describe the challenges, responses and the impact of the COVID-19 pandemic in Dutch nursing homes. In this first article, we describe the MINUTES Study and present data characteristics. Design This large-scale multicentre study has a qualitative design using manifest content analysis. The participating organisations shared their OT minutes and other meeting documents on a weekly basis. Data from week 16 (April) to week 53 (December) 2020 included the first two waves of COVID-19. Setting National study with 41 large Dutch LTC organisations. Participants The LTC organisations represented 563 nursing home locations and almost 43 000 residents. Results At least 36 of the 41 organisations had one or more SARS-CoV-2 infections among their residents. Most OTs were composed of management, medical staff, support services staff, policy advisors and communication specialists. Topics that emerged from the documents were: crisis management, isolation of residents, personal protective equipment and hygiene, staff, residents' well-being, visitor policies, testing and vaccination. Conclusions OT meeting minutes are a valuable data source to monitor the impact of and responses to COVID-19 in nursing homes. Depending on the course of the COVID-19 pandemic, data collection and analysis will continue until November 2021. The results are used directly in national and organisational COVID-19 policy.Public Health and primary careGeriatrics in primary car

The Association of Depression and Anxiety with Pain: A Study from NESDA

Prevention, Population and Disease management (PrePoD