‘Zicht op Evenwicht’: een effectieve interventie om bezorgdheid om te vallen en gerelateerd vermijdingsgedrag bij ouderen te verminderen

Valangst en gerelateerd vermijdingsgedrag komen veel voor bij ouderen en kunnen leiden tot een verminderde kwaliteit van leven, verminderd fysiek en psychosociaal functioneren en vervroegde opname in een verpleeghuis. In een gerandomiseerd onderzoek onder 540 zelfstandig wonende ouderen met valangst en gerelateerd vermijdingsgedrag zijn de uitvoerbaarheid en effecten van een cognitief gedragsmatige groepscursus geëvalueerd. De procesgegevens van de interventiegroep (n= 280) en de cursusleiders (n= 6) wees uit dat de cursus goed uitvoerbaar is, positief beoordeeld wordt en dat deelnemers baat hebben bij de cursus (61% rapporteert deze baat tot een jaar na de cursus). Wel meldde 26% van de interventiegroep zich voor de start van de cursus af voor deelname, maar deelnemers die met de cursus begonnen maakten deze doorgaans af (84%). De effectevaluatie liet positieve uitkomsten zien voor de interventiegroep vergeleken met de controle groep (n= 260); na de cursus werd minder bezorgdheid om te vallen en gerelateerd vermijdingsgedrag gerapporteerd en meer dagelijkse activiteit. Ook op de lange termijn waren positieve effecten zichtbaar, onder andere voor bezorgdheid om te vallen en herhaalde valincidenten. Op basis van deze succesvolle resultaten is de implementatie van de cognitief gedragsmatige groepscursus “Zicht op Evenwicht” in de Nederlandse gezondheidszorg gestart

Effectiveness of a self-management program for dual sensory impaired seniors in aged care settings:study protocol for a cluster randomized controlled trial

<p>Background: Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study is to evaluate the effectiveness of a self-management program for seniors who acquired dual sensory impairment at old age.</p><p>Methods/Design: In a cluster randomized, single-blind controlled trial, with aged care settings as the unit of randomization, the effectiveness of a self-management program will be compared to usual care. A minimum of 14 and maximum of 20 settings will be randomized to either the intervention cluster or the control cluster, aiming to include a total of 132 seniors with dual sensory impairment. Each senior will be linked to a licensed practical nurse working at the setting. During a five to six month intervention period, nurses at the intervention clusters will be trained in a self-management program to support and empower seniors to use self-management strategies. In two separate diaries, nurses keep track of the interviews with the seniors and their reflections on their own learning process. Nurses of the control clusters offer care as usual. At senior level, the primary outcome is the social participation of the seniors measured using the Hearing Handicap Questionnaire and the Activity Card Sort, and secondary outcomes are mood, autonomy and quality of life. At nurse level, the outcome is job satisfaction. Effectiveness will be evaluated using linear mixed model analysis.</p><p>Discussion: The results of this study will provide evidence for the effectiveness of the Self-Management Program for seniors with dual sensory impairment living in aged care settings. The findings are expected to contribute to the knowledge on the program's potential to enhance social participation and autonomy of the seniors, as well as increasing the job satisfaction of the licensed practical nurses. Furthermore, an extensive process evaluation will take place which will offer insight in the quality and feasibility of the sampling and intervention process. If it is shown to be effective and feasible, this Self-Management Program could be widely disseminated.</p>

Kleinschalig wonen voor ouderen met dementie: de invloed op bewoners, mantelzorgers en medewerkers

De verpleeghuiszorg voor ouderen met dementie zet sterk in op een ontwikkeling naar kleinschalige woonvormen, zowel nationaal als internationaal. In kleinschalige woonvormen woont een beperkt aantal ouderen, in Nederland doorgaans zes tot acht personen, samen en wordt er zoveel mogelijk gestreefd naar een situatie zoals thuis. In een quasi-experimentele studie zijn de effecten van kleinschalige woonvormen onderzocht op bewoners (n = 259), mantelzorgers (n = 206) en verzorgenden (n = 305). Gedurende één jaar (nulmeting en vervolgmetingen na zes en 12 maanden) zijn hierbij twee typen verpleeghuiszorg met elkaar vergeleken: 28 kleinschalige woonvormen en 21 psychogeriatrische afdelingen in gewone verpleeghuizen. Matching werd toegepast om de vergelijkbaarheid van bewoners wat betreft cognitie en functionele status bij aanvang van de studie te vergroten. Het huidige onderzoek toont een genuanceerd beeld van kleinschalige woonvormen. Op de belangrijkste uitkomstmaten, zoals kwaliteit van leven en gedrag van bewoners en arbeidstevredenheid en –motivatie van verzorgenden, werden geen significante verschillen gevonden in vergelijking met gewone verpleegafdelingen. Deze uitkomsten geven aan dat kleinschalige woonvormen niet automatisch betere voorzieningen zijn dan gewone verpleeghuiszorg. Een volledige overgang naar kleinschalige woonvormen is daarom niet vanzelfsprekend. Gezien de heterogeniteit van de doelgroep is aanbevolen door middel van diversiteit keuzemogelijkheden te bieden voor mensen met dementie en hun naasten

Connective neck evolution and conductance steps in hot point contacts

Dynamic evolution of the connective neck in Al and Pb mechanically controllable break junctions was studied during continuous approach of electrodes at bias voltages V_b up to a few hundred mV. A high level of power dissipation (10^-4 - 10^-3 W) and high current density (j > 10^10 A/cm^2) in the constriction lead to overheating of the contact area, electromigration and current-enhanced diffusion of atoms out of the "hot spot". At a low electrode approach rate (10 - 50 pm/s) the transverse dimension of the neck and the conductance of the junction depend on V_b and remain nearly constant over the approach distance of 10 - 30 nm. For V_b > 300 mV the connective neck consists of a few atoms only and the quantum nature of conductance manifests itself in abrupt steps and reversible jumps between two or more levels. These features are related to an ever changing number of individual conductance channels due to the continuous rearrangement in atomic configuration of the neck, the recurring motion of atoms between metastable states, the formation and breaking of isolated one-atom contacts and the switching between energetically preferable neck geometries.Comment: 21 pages 10 figure

Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial

Background: Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community. Methods: In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control (n = 195) or intervention group (n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls. Results: At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups. Conclusions: The home-based, cognitive behavioral program significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs

The decline and rise of neighbourhoods: the importance of neighbourhood governance

There is a substantial literature on the explanation of neighbourhood change. Most of this literature concentrates on identifying factors and developments behind processes of decline. This paper reviews the literature, focusing on the identification of patterns of neighbourhood change, and argues that the concept of neighbourhood governance is a missing link in attempts to explain these patterns. Including neighbourhood governance in the explanations of neighbourhood change and decline will produce better explanatory models and, finally, a better view about what is actually steering neighbourhood change

Telefonisch Interview Cognitieve Status (TICS): psychometrische aspecten

Het Telefonisch Interview Cognitieve Status (TICS) is een telefonisch screeningsinstrument voor dementie bij ouderen. Hoewel in buitenlands onderzoek de psychometrische kwaliteiten zijn beschreven, zijn deze voor de Nederlandse versie onbekend. In deze studie wordt de Nederlandse versie van de TICS gepresenteerd en worden de betrouwbaarheid en de validiteit beschreven bij 51 patiënten die afkomstig zijn van het Diagnostisch Onderzoekscentrum voor Psychogeriatrische patiënten (N=24) en de Geheugenpoli (N=27) van het Academisch Ziekenhuis Maastricht. De Pearson correlatie en de intraclass correlatie voor de test-hertestbetrouwbaarheid bedroegen respectievelijk 0,93 en 0,92. De Pearson correlatie en de intraclass correlatie voor de interbeoordelaarsbetrouwbaarheid bedroegen respectievelijk 0,91 en 0,90. De sensitiviteit en de specificiteit zijn onderzocht door de verschillende afkappunten op de TICS te vergelijken met het afkappunt 23/24 op de Mini Mental State Examination (MMSE) en de diagnose dementie volgens de DSM-IV. Bij het afkappunt 26/27 op de TICS bedroegen de sensitiviteit en de specificiteit in alle gevallen 0,80 of meer. Het percentage onder de ROC bedroeg 90% en 93% met de MMSE, respectievelijk de diagnose dementie als criterium. Conclusie: de TICS is acceptabel voor het screenen op dementie bij ouderen. De TICS kan vooral efficiënt of bruikbaar zijn in onderzoekssituaties waar een persoonlijk contact niet mogelijk is

Spin-dependent transport in metal/semiconductor tunnel junctions

This paper describes a model as well as experiments on spin-polarized tunnelling with the aid of optical spin orientation. This involves tunnel junctions between a magnetic material and gallium arsenide (GaAs), where the latter is optically excited with circularly polarized light in order to generate spin-polarized carriers. A transport model is presented that takes account of carrier capture in the semiconductor surface states, and describes the semiconductor surface in terms of a spin-dependent energy distribution function. The so-called surface spin-splitting can be calculated from the balance of the polarized electron and hole flow in the semiconductor subsurface region, the polarized tunnelling current across the tunnel barrier between the magnetic material and the semiconductor surface, and the spin relaxation at the semiconductor surface. Measurements are presented of the circular-polarization-dependent photocurrent (the so-called helicity asymmetry) in thin-film tunnel junctions of Co/Al2O3/GaAs. In the absence of a tunnel barrier, the helicity asymmetry is caused by magneto-optical effects (magnetic circular dichroism). In the case where a tunnel barrier is present, the data cannot be explained by magneto-optical effects alone; the deviations provide evidence that spin-polarized tunnelling due to optical spin orientation occurs. In Co/τ-MnAl/AlAs/GaAs junctions no deviations from the magneto-optical effects are observed, most probably due to the weak spin polarization of τ-MnAl along the tunnelling direction; the latter is corroborated by bandstructure calculations. Finally, the application of photoexcited GaAs for spin-polarized tunnelling in a scanning tunnelling microscope is discussed.

Transition from tunneling to direct contact in tungsten nanojunctions

We apply the mechanically controllable break junctions technique to investigate the transition from tunneling to direct contact in tungsten. This transition is quite different from that of other metals and is determined by the local electronic properties of the tungsten surface and the relief of the electrodes at the point of their closest proximity. The conductance traces show a rich variety of patterns from the avalanche-like jump to a mesoscopic contact to the completely smooth transition between direct contact and tunneling. Due to the occasional absence of an adhesive jump the conductance of the contact can be continuously monitored at ultra-small electrode separations. The conductance histograms of tungsten are either featureless or show two distinct peaks related to the sequential opening of spatially separated groups of conductance channels. The role of surface states of tungsten and their contribution to the junction conductance at sub-Angstrom electrode separations are discussed.Comment: 6 pages, 6 figure