SamenOud:Anders denken, anders doen

Het doel van SamenOud is dat ouderen (75+) zo lang als mogelijk én wenselijk is thuis kunnen blijven wonen. Hierbij wordt gebruik gemaakt van twee benaderingen: 1) het vaststellen van het risicoprofiel van de ouderen; en 2) preventieve, proactieve en samenhangende zorg en begeleiding met een passende zorgintensiteit aan de ouderen in de drie profielen door een multidisciplinair Ouderenzorg Team. Alleouderen wordt een programma aangeboden gericht op zelfredzaamheid, eigen regie en gezond blijven dat bestaat uit drie pijlers: sociale contacten, bewegen en voeding. Kwetsbare ouderen ontvangen bovendien casemanagement van de sociaal werker en ouderen met het risicoprofiel Complexe zorgbehoeften ontvangen intensief casemanagement van de wijkverpleegkundige. Onderzoek heeft aangetoond dat door deze benadering zowel de prevalentie als de ernstvan gezondheid gerelateerde problemen bij ouderen met de risicoprofielen ‘Kwetsbaar’ en ‘Complexe zorgbehoeften’ duurzaam afneemt. Zo kunnen ouderen erop vertrouwen dat de maatschappij hun goede zorg biedt in eigen omgeving

Ageing Better in the Netherlands

The Dutch National Care for the Elderly Programme was an initiative organized by the Netherlands Organisation for Health Research and Development (ZonMw) between 2008 and 2016. The aim of the programme was to collect knowledge about frail elderly, to assess their needs and to provide person-centred and integrated care better suited to their needs. The budget of EUR 88 million was provided by the Dutch Ministry of Health, Welfare and Sports. Putting the needs of elderly people at the heart of the programme and ensuring their active participation were key to the programme’s success. The programme outcomes included the establishment of eight geriatric networks around the medical universities with 650 organisations and the completion of 218 projects. These projects, involving 43,000 elderly people and 8500 central caregivers, resulted in the completion of 45 PhD theses and the publication of more than 400 articles and the development of 300 practice toolkits, one database and a website, www.beteroud.nl. The Dutch National Care for the Elderly Programme has since developed into a movement and continues under the consortium Ageing Better, made up of eight organisations. Through the use of ambassadors, Ageing Better promotes the message that ageing is not a disease but a new phase of life

Integrated Care for Older Adults:A Struggle for Sustained Implementation in Northern Netherlands

Introduction: Integrated care has been suggested as a promising solution to the disparities in access and sustained high quality long-term care emerging in Europe's ageing population. We aim to gain a better understanding of context-specific barriers to and facilitators of implementation of integrated care by doing a retrospective assessment of seven years of Embrace. This Dutch integrated person-centred health service for older adults was based on two evidence-based models (the Chronic Care Model and the Kaiser Permanente Triangle). Despite successful deployment the programme ended in 2018. In this case study we assess the impact of the programme based on past evaluations, reflect on why it ended, lessons learned and ideas to take forward. Discussion: The majority of health outcomes were positive and the perceived quality of care improved, albeit no clear-cut savings were observed, and the costs were not balanced across stakeholders. The Embrace payment model did not support the integration of health services, despite reforms in long-term care in 2015. Key lessons: Enabling policy and funding are crucial to the sustained implementation of integrated person-centred health services. The payment model should incentivize the integration of care before the necessary changes can be made at organizational and clinical levels towards providing proactive and preventive health services

Development and testing psychometric properties of an ICF-based health measure:The Neuromuscular Disease Impact Profile

Objectives: To develop a measure that is based on the International Classification of Functioning, Disability and Health (ICF) and reflects the prevalence and severity of disabilities related to neuromuscular disorders, and to evaluate the psychometric properties of this measure. Methods: A preliminary questionnaire was developed, based on the categories of the ICF Core Set for Neuromuscular Diseases. Next a cross-sectional postal survey was carried out among 702 patients (70% response rate) diagnosed with a neuromuscular disease. Finally, psychometric properties were examined. Results: The preliminary Neuromuscular Disease Impact Profile (NMDIP) consisted of 45 items. Factor analysis showed that the NMDIP comprised domains representing 3 ICF-components: 5 factors in the Body Functions component, 2 factors in the Activities component, and 1 factor in the Participation component. Scales showed moderate to good internal consistency (alpha=0.63-0.92) and mean inter-item correlation coefficients (0.38-0.77). Convergent and discriminant validity analysis indicated that the NMDIP measures the impact of neuromuscular disease on physical, mental, and social functioning. The NMDIP discriminates between groups who differ in extent of limitations. Conclusion: The NMDIP is an ICF-based measure that reflects neuromuscular disease-related disabilities. It consists of 36 items divided over 8 scales with satisfactory psychometric properties and 4 single items

Are edentulousness, oral health problems and poor health-related quality of life associated with malnutrition in community-dwelling elderly (aged 75 years and over)?:a cross-sectional study

As the population ages, the risk of becoming malnourished increases. Research has shown that poor oral health can be a risk factor for malnutrition in institutionalized elderly. However, it remains unclear whether oral health problems, edentulousness and health-related quality of life also pose a risk for malnutrition in community-dwelling older adults. In this cross-sectional observational study, 1325 community-living elderly (75 years) were asked to complete questionnaires regarding nutritional status, oral status (edentulous, remaining teeth, or implant-supported overdentures), oral health problems, health-related quality of life (HRQoL), frailty, activities of daily living (ADL) and complexity of care needs. Univariate and multivariate logistic regression analyses were performed with nutritional status as dependent variable. Of the respondents, 51% (n = 521) were edentulous, 38.8% (n = 397) had remaining teeth and 10.2% (n = 104) had an implant-supported overdenture. Elderly with complex care needs were malnourished most frequently, followed by frail and robust elderly (10%, 4.5% and 2.9%, respectively). Malnourished elderly reported more frequent problems with chewing and speech when compared with well-nourished elderly (univariate analysis). However, multivariate analysis did not show an association between malnutrition and oral health problems and edentulousness, although HRQoL was associated with malnutrition (odds ratio (OR) 0.972, confidence interval (CI) 0.951-0.955). Based on the results of this cross-sectional study, it can be concluded that poor HRQoL is significantly associated with malnutrition; however, edentulousness and oral health problems are not

Quality standard for Person-centred and Integrated Care for Older adults

Background: Current healthcare systems are challenged to cope with changing demands of the growing population of older adults, while maintaining quality of care at lower costs. Between 2008 and 2016, the Dutch National Care for the Elderly Program was organized by the ‘Netherlands Organization for Health Research and Development’ ZonMw and financially supported by the Dutch ministry of Health. Aim of the program was to contribute to a solution to these challenges. One of the projects was Embrace1, a person-centered and integrated care service for community-living older adults. Aims of this service are to improve quality of care by reducing the fragmentation in health services, to improve patient outcomes, and to increase sustainability of the healthcare system. Embrace combines two globally recognized models, the Chronic Care Model and a population health management model. Both models were translated to the Dutch situation and specified for older adults. Embrace has been implemented in the Netherlands since 2012. Short- and long-term evaluations, using mixed methods, showed positive results regarding patient outcomes, quality of care, and costs. Before final closing of the national programme, the program committee, with support from the Dutch Care institute and the Dutch ministry of Health, decided to develop a ‘Quality standard Person-centred and Integrated Care for older adults’ based on the characteristics and positive results of Embrace. Aim of this quality standard is to support the transformation in the Dutch health system towards person-centred and integrated care by reaching consensus on values and standards of care for older adults, creating clarity for older adults and professionals, and providing tools for administrative accountability. This network discussion is part of the preparation phase before the actual development of the quality standard. Aim of this phase is to explore the support, scope, and potential bottlenecks for the new standard with future owners of this standard. These owners may include older adults’ representatives, professional organizations and funders for care and welfare. Aims and Objectives: Aim of this network discussion is to use the available expertise among participants of this conference to further explore the support, scope, and potential bottlenecks for the new standard. We have the intention to invite Dutch participants and share the results of the explorations until then, and ask for feedback. Format: The meeting is planned at the end of the six months preparation phase starting January 2018. The preliminary results will be shared with participants, and their reflections and advises will be collected and discussed. Target audience: Dutch experts on person-centred and integrated care. Take away: Results will be included in the final report for the committee of the Dutch National Care for the Elderly Program