De complexiteit van de eerstelijnszorg voor ouderen in een kwetsbare positie

Op woensdag 26 maart 2014 werd in Maastricht een symposium gehouden met als titel: ‘De complexiteit van de eerstelijnszorg voor ouderen in een kwetsbare positie’. In onze vergrijzende samenleving is het waarborgen van goede zorg voor ouderen in een kwetsbare positie één van de grootste uitdagingen. Er zijn aanwijzingen dat extramurale zorg in vergelijking met intramurale zorg betere resultaten oplevert bij minder kosten. De meeste ouderen willen ook graag zo lang mogelijk thuis blijven wonen. Dit heeft tot gevolg dat er een sterke behoefte is aan (kosten-) effectieve en praktisch goed toepasbare zorginterventies, zodat ouderen in een kwetsbare positie zo lang mogelijk thuis kunnen blijven wonen. In de laatste decennia is al veel onderzoek uitgevoerd naar het verbeteren van de extramurale zorg voor ouderen in een kwetsbare positie. Echter, de meeste studies hebben geen of slechts kleine en/of korte termijn effecten laten zien

Positive and negative outcomes of informal caregiving at home and in institutionalised long-term care: A cross-sectional study

Background: Our ageing society is putting tremendous strain on public health and welfare programs to meet the needs of ageing individuals. Promoting informal caregiving is one way for policymakers to reduce this burden. However, caregiving may be experienced as stressful and is associated with adverse health consequences. While quite a lot of research focuses on caregiving for community-dwelling older adults, little is known about informal care in institutionalised long-term care (ILTC). Therefore, the objectives of this study were: 1) to compare characteristics of informal caregivers and care receivers and caregiver outcomes - at home and in ILTC; 2) to study the association between these characteristics and positive and negative caregiver outcomes; 3) to investigate the moderating effect of the setting (at home vs. ILTC) on these associations. Methods: A cross-sectional study was conducted using the TOPICS-MDS DataSet. A total of 5197 Dutch dyads were included. The average age of the care receivers and caregivers was respectively 80.7 years and 63.2 years. Several sociodemographic, health-related and caregiving-related characteristics of care receiver and caregiver and two caregiver outcomes (i.e., subjective burden and care-related quality of life) were included in the analyses. Results: Caregivers in both settings experienced comparable levels of subjective burden. Caregivers at home had slightly lower care-related quality of life than caregivers in ILTC. Several care receiver characteristics (i.e., male sex, married/cohabiting, more morbidities/disability, and less self-perceived health/psychological wellbeing) and several caregiver characteristics (i.e., female sex, being younger, living together with the care receiver, more objective burden, less self-perceived health, and more support) were associated with an increase in burden and/or a decrease in care-related quality of life. Some of these associations were stronger for dyads at home compared to dyads in ILTC. Conclusions: Informal caregiving does not stop with admission to an ILTC facility. Both settings need an informal caregiving policy, which is (1) tailored to the individual characteristics of care receivers and caregivers; (2) pays attention to the identified risk groups; and (3) reduces the negative caregiver outcomes and emphasizes the positive outcomes at the same time

Case management for integrated care of frail older people in community settings

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of case management for integrated care of frail older people compared to usual care

Responses of water mite assemblages (Acari) to environmental parameters at irrigated rice cultivation fields and native lakes

Many studies have revealed that water mite communities can be affected by the physical and chemical parameters of the water. The similarity between the water ‘mite assemblages in local water bodies and in irrigated rice areas can be a way to measure the water conditions, enabling an assessment of the anthropic impact in the environment. The aim of this study was to evaluate the distribution of water mites in lakes and irrigated rice fields in south Brazil. To accomplish that we characterized the distinctive environments using physical and chemical variables such as pH, turbidity (NTU), water temperature (°C) and dissolved oxygen (mg/L), in order to verify the influence of these abiotic factors on the species composition of water mite communities; and to compare water mite abundance, richness and composition among different habitats. We assessed three native lakes and four sites with irrigated rice cultivation. Our results showed, for the first time in Brazil, strong correlations between the water mite fauna and turbidity. In addition, native lakes were richer and had greater mite abundance when compared with the irrigated rice areas

The predictive validity of three self-report screening instruments for identifying frail older people in the community

Background: If brief and easy to use self report screening tools are available to identify frail elderly, this may avoid costs and unnecessary assessment of healthy people. This study investigates the predictive validity of three self-report instruments for identifying community-dwelling frail elderly. Methods: This is a prospective study with 1-year follow-up among community-dwelling elderly aged 70 or older (n = 430) to test sensitivity, specificity, and positive and negative predicted values of the Groningen Frailty Indicator, Tilburg Frailty Indicator and Sherbrooke Postal Questionnaire on development of disabilities, hospital admission and mortality. Odds ratios were calculated to compare frail versus non-frail groups for their risk for the adverse outcomes. Results: Adjusted odds ratios show that those identified as frail have more than twice the risk (GFI, 2.62; TFI, 2.00; SPQ, 2,49) for developing disabilities compared to the non-frail group; those identified as frail by the TFI and SPQ have more than twice the risk of being admitted to a hospital. Sensitivity and specificity for development of disabilities are 71% and 63% (GFI), 62% and 71% (TFI) and 83% and 48% (SPQ). Regarding mortality, sensitivity for all tools are about 70% and specificity between 41% and 61%. For hospital admission, SPQ scores the highest for sensitivity (76%). Conclusion: All three instruments do have potential to identify older persons at risk, but their predictive power is not sufficient yet. Further research on these and other instruments is needed to improve targeting frail elderly

Psychometrische eigenschappen van drie screeningsinstrumenten voor kwetsbaarheid bij thuiswonende ouderen

Achtergrond Kwetsbaarheid kan leiden tot negatieve gezondheidsuitkomsten zoals beperkingen. Om deze te voorkomen zijn valide screeningsinstrumenten nodig om kwetsbare ouderen op te sporen. Doel van deze studie was de evaluatie en vergelijking van drie instrumenten: de Groningen Frailty Indicator (GFI), de Tilburg Frailty Indicator (TFI) en de Sherbrooke Postal Questionnaire (SPQ). Voor constructvalidering was de Groningen Activiteiten Restrictie Schaal (GARS) toegevoegd. Methode Een vragenlijst werd naar 687 ouderen (≥70 jaar) gestuurd. Geëvalueerd werden (1) de prevalentie van kwetsbaarheid, (2) de betrouwbaarheid, (3) de cumulatieve schaalbaarheid volgens het schaalmodel van Mokken, en (4) de constructvaliditeit. Resultaten De respons bedroeg 77%. Prevalentieschattingen varieerden van 40% tot 59%. De grootste overeenstemming in kwetsbaarheid bestond tussen de GFI en TFI (Cohens kappa=0,74). Cronbachs alpha voor de GFI, TFI en SPQ bedroeg respectievelijk 0,73, 0,79 en 0,26. Geen van de ‘frailty’-instrumenten vormt een monotoon homogene set van items met een hiërarchie in de moeilijkheidsgraad van de items (Loevingers H-coëfficiënten voor GFI, TFI en SPQ: 0,28, 0,30 en 0,09). Er werden significante correlaties gevonden tussen de scores voor kwetsbaarheid onderling en tussen deze scores en die op de GARS. Conclusie Vooral de GFI en TFI lijken bruikbaar voor het opsporen van kwetsbare ouderen. Aanvullend onderzoek naar het voorspellend vermogen van deze ‘frailty’-instrumenten voor beperkingen in het dagelijks leven is echter nog nodig. De oorspronkelijke versie van dit vertaalde en bewerkte artikel van deze auteurs is verschenen in BMC Public Health, 2010;10:176

Portuguese version of the Tilburg Frailty Indicator: Transcultural adaptation and psychometric validation

Artigo científico disponível actualmente em Early View (Online Version of Record published before inclusion in an issue)Aim To present the translation and validation process of the Portuguese version of the Tilburg Frailty Indicator (TFI). Methods A cross-sectional study was designed using a non-probability sample of 252 community-dwelling older adults. Preliminary studies were carried out for face and content validity assessment. Internal consistency, test–retest reliability, construct (convergent/divergent) and criterion validity were subsequently analyzed. Results The sample was mainly women (75.8%), with a mean age of 79.2 ± 7.3 years. TFI internal consistency was good (KR-20 = 0.78). Test–retest reliability for the total was also good (r = 0.91), with kappa coefficients showing substantial agreement for most items. TFI physical and social domains correlated as expected with concurrent measures, whereas the TFI psychological domain showed similar correlations with other psychological and physical measures. The TFI showed a good to excellent discrimination ability in regard to frailty criteria, and fair to good ability to predict adverse outcomes. Conclusions The psychometric properties of the TFI seem to be consistently good. These findings provide initial evidence that the Portuguese version is a valid and reliable measure for assessing frailty in the elderly

The reduction of disability in community-dwelling frail older people: design of a two-arm cluster randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Frailty among older people is related to an increased risk of adverse health outcomes such as acute and chronic diseases, disability and mortality. Although many intervention studies for frail older people have been reported, only a few have shown positive effects regarding disability prevention. This article presents the design of a two-arm cluster randomized controlled trial on the effectiveness, cost-effectiveness and feasibility of a primary care intervention that combines the most promising elements of disability prevention in community-dwelling frail older people.</p> <p>Methods/design</p> <p>In this study twelve general practitioner practices were randomly allocated to the intervention group (6 practices) or to the control group (6 practices). Three thousand four hundred ninety-eight screening questionnaires including the Groningen Frailty Indicator (GFI) were sent out to identify frail older people. Based on their GFI score (≥5), 360 participants will be included in the study. The intervention will receive an interdisciplinary primary care intervention. After a comprehensive assessment by a practice nurse and additional assessments by other professionals, if needed, an individual action plan will be defined. The action plan is related to a flexible toolbox of interventions, which will be conducted by an interdisciplinary team. Effects of the intervention, both for the frail older people and their informal caregivers, will be measured after 6, 12 and 24 months using postal questionnaires and telephone interviews. Data for the process evaluation and economic evaluation will be gathered continuously over a 24-month period.</p> <p>Discussion</p> <p>The proposed study will provide information about the usefulness of an interdisciplinary primary care intervention. The postal screening procedure was conducted in two cycles between December 2009 and April 2010 and turned out to be a feasible method. The response rate was 79.7%. According to GFI scores 29.3% of the respondents can be considered as frail (GFI ≥ 5). Nearly half of them (48.1%) were willing to participate. The baseline measurements started in January 2010. In February 2010 the first older people were approached by the practice nurse for a comprehensive assessment. Data on the effect, process, and economic evaluation will be available in 2012.</p> <p>Trial Registration</p> <p>ISRCTN31954692</p

The psychometric properties of three self-report screening instruments for identifying frail older people in the community

Background: Frailty is highly prevalent in older people. Its serious adverse consequences, such as disability, are considered to be a public health problem. Therefore, disability prevention in community-dwelling frail older people is considered to be a priority for research and clinical practice in geriatric care. With regard to disability prevention, valid screening instruments are needed to identify frail older people in time. The aim of this study was to evaluate and compare the psychometric properties of three screening instruments: the Groningen Frailty Indicator (GFI), the Tilburg Frailty Indicator (TFI) and the Sherbrooke Postal Questionnaire (SPQ). For validation purposes the Groningen Activity Restriction Scale (GARS) was added. Methods: A questionnaire was sent to 687 community-dwelling older people (>= 70 years). Agreement between instruments, internal consistency, and construct validity of instruments were evaluated and compared. Results: The response rate was 77%. Prevalence estimates of frailty ranged from 40% to 59%. The highest agreement was found between the GFI and the TFI (Cohen's kappa = 0.74). Cronbach's alpha for the GFI, the TFI and the SPQ was 0.73, 0.79 and 0.26, respectively. Scores on the three instruments correlated significantly with each other (GFI - TFI, r = 0.87; GFI - SPQ, r = 0.47; TFI - SPQ, r = 0.42) and with the GARS (GFI - GARS, r = 0.57; TFI - GARS, r = 0.61; SPQ - GARS, r = 0.46). The GFI and the TFI scores were, as expected, significantly related to age, sex, education and income. Conclusions: The GFI and the TFI showed high internal consistency and construct validity in contrast to the SPQ. Based on these findings it is not yet possible to conclude whether the GFI or the TFI should be preferred; data on the predictive values of both instruments are needed. The SPQ seems less appropriate for postal screening of frailty among community-dwelling older peopl