Vrijwillige maatjes voor eenzame ouderen. Grenzen en mogelijkheden van vrijwillige inzet bij een kwetsbare doelgroep

Vrijwillige maatjes voor eenzame ouderen. Grenzen en mogelijkheden van vrijwillige inzet bij een kwetsbare doelgroepIn de Nederlandse beleidscontext wordt een grote rol toegedacht aan vrijwilligersorganisaties bij het ondersteunen van kwetsbare medeburgers. Het accent ligt daarbij op ondersteuning bij zelfredzaamheid en participatie. Het omgaan met kwetsbare burgers stelt echter hoge eisen aan vrijwilligers. Om inzicht te krijgen in de grenzen van vrijwillige inzet is onderzoek uitgevoerd naar een maatjesproject voor eenzame ouderen die hun zelfstandigheid dreigen te verliezen. Doel van de interventie is de ouderen meer zelfredzaam te maken door het stimuleren van sociale activiteiten en sociale contacten. De interventie is onderzocht door middel van een “monitorende evaluatie”, waarbij ouderen, vrijwilligers en beroepskrachten zijn betrokken. Het onderzoek laat zien dat de activeringsdoelstelling voor de meeste ouderen niet realistisch is omdat hun verandermogelijkheden gering zijn en hun kwetsbaarheid eerder toe- dan afneemt. Ze hebben vooral behoefte aan persoonlijke aandacht en emotionele steun. Koppelingen zijn alleen succesvol als de wederzijdse verwachtingen van de ouderen en de vrijwilligers op elkaar aansluiten. Dit vraagt scherpe keuzes omtrent de doelgroep en het soort vrijwilligers dat wordt ingezet. De belangrijkste eisen aan de vrijwilligers zijn goede relationele vaardigheden en de bereidheid een langdurige verbinding met een oudere aan te gaan. Ook moet de professionele back-up van de vrijwilligers goed zijn geregeld. A mentor project for lonely older adults. The opportunities and limitations of volunteering for a vulnerable target group Background: Many European welfare states are increasingly emphasizing informal care in order to meet the needs of a growing population of older adults. Governments are scaling back their provision of care, encouraging citizens to fill this gap by actively taking care of each other. In the Netherlands, the Social Support Act (WMO) is based on the premise that citizens should be able to solve their problems themselves, possibly with help from their own social network. In this policy context, volunteering organizations play a significant role in supporting vulnerable citizens. Welfare organizations are expected to mobilize informal support and create the right conditions for the deployment of volunteers. This includes the area of outreach to very vulnerable people, such as lonely older adults with multiple problems. The focus of such projects is on promoting self-reliance and social participation, which are dominant norms in this policy context. This article offers an insight into the opportunities and limitations of volunteering for a vulnerable target group. It reports on a study into a mentoring project for lonely and socially isolated older adults who are at risk of losing their self-reliance.Problem statement: As people grow older, the chance of physical decline increases, and often results in reduced self-reliance and limitations in daily functioning, such as taking care of oneself, going shopping for groceries and maintaining social contacts. Supportive relationships can ensure that people can remain independent. However, the chance of loneliness increases as people age. Important risk factors for loneliness arise particularly among people over the age of 75. With this in mind, combatting loneliness is an important policy goal. A broad palette of interventions has been developed in recent years to push back against the negative consequences of loneliness. Many interventions focusing on loneliness are carried out by volunteer organizations. A form of voluntary commitment that we often see is the “mentoring project”, where a trained volunteer (the “mentor”) is paired with someone in a vulnerable situation, one-on-one, for a longer period of time. In this study, a mentoring project for lonely and socially isolated older adults in the Netherlands was evaluated. The aim of the intervention was to make the older adults more self-reliant by stimulating social activities and social contact. The aim of the study was to provide an insight into the functioning of this mentoring project and the opportunities that it creates for increasing the self-reliance of these vulnerable older adults through the work of volunteers. Knowledge on the subject is important in relation to the societal debate concerning the opportunities and limitations of voluntary projects that aim to help vulnerable citizens.Methods: The evaluation of this mentoring project for lonely and socially isolated older adults was conducted through a “monitoring evaluation”, a form of evaluation that is suitable for evaluating the processes and results of an intervention that has already been underway for some time. The research shows to what extent the intervention corresponds with the goals of the project and which points need revision or improvement in order to achieve those goals better. In this case, the goal was to increase the self-reliance of lonely and socially isolated older adults. All stakeholders were involved in the study: the client group of older adults, the volunteers and the professionals who organize the project. Using two rounds of individual in-depth interviews with the older adults, in-depth interviews with the volunteers and the professionals, a group interview with the volunteers and informal conversations with all stakeholders, we explored which older adults are supported effectively by the intervention, how the intervention works and what can be expected from volunteers in a mentoring project for vulnerable older adults. Conclusion: The mentoring project involves a complex and demanding target group. For most older adults in the project, the goal of social activation was unrealistic because their vulnerability is increasing and their options for change are restricted. Above all else, they need personal attention and emotional support.Mentoring can only be successful when the mutual expectations of the elderly and the volunteers are aligned. This requires accurate decision-making regarding both the target group and the volunteers in the project. The support that can be provided must be aligned with the needs of the older adults that have agreed to participate. This means that volunteers need to be willing to engage in a long-term relationship in which personal attention, support and companionship are the most important goals. The professional support provided for the volunteers must also be well-organized

Wooncomplexen voor ouderen: Sociale kwaliteit ontstaat niet vanzelf.

Wooncomplexen voor ouderen: sociale kwaliteit ontstaat niet vanzelfDe Nederlandse overheid stimuleert dat ouderen zo lang mogelijk zelfstandig blijven wonen. De meeste ouderen willen dit ook, mits aan bepaalde voorwaarden is voldaan. Ze hebben vooral behoefte aan een levendige woonomgeving waarin ze gemakkelijk kunnen participeren en contacten kunnen leggen. Dit sociale aspect is voor veel mensen een belangrijke reden om naar een wooncomplex voor ouderen te verhuizen. Corporaties concentreren zich echter op fysieke en materiële aspecten van het wonen; versterking van de sociale kwaliteit wordt aan de bewoners zelf overgelaten.Om inzicht te krijgen in de mogelijkheden van ouderen om de sociale kwaliteit van hun wooncomplex te vergroten, is het experiment “Vitale woongemeenschappen” uitgevoerd in tien wooncomplexen voor ouderen, verspreid over Nederland. Het experiment is geëvalueerd middels een (kwantitatieve) nul- en nameting en een kwalitatief onderzoek. Het onderzoek maakt duidelijk dat sociale kwaliteit in een wooncomplex niet vanzelf ontstaat en dat er grenzen zijn aan het zelforganiserende vermogen van bewoners. Hoewel veel bewoners behoefte hebben aan activiteiten en sociale contacten in hun complex, voelen de meesten zich niet in staat om zelf activiteiten te organiseren of bewoners te activeren. Beroepskrachten zijn noodzakelijk om het vitaliseringsproces op gang te brengen en continuïteit te garanderen.  Residential complexes for seniors: social quality does not occur spontaneouslyBackgroundThe Dutch government encourages older people to live independently for as long as possible. Most seniors also prefer to remain self-reliant, provided that certain conditions are met. In particular, they need a lively environment in which they can easily participate in social activities and make social contact. This social aspect is an important incentive for people to move to housing complexes for seniors. Contact with fellow residents and social participation within the housing complex are important determinants for their well-being. However, housing corporations concentrate on the physical and material aspects of housing, while welfare projects and activity guidance are being phased out. Problem statementResidents of housing complexes for seniors are assumed to be capable of developing and maintaining social relations, and social activities are helpful in this regard. Various studies show, however, that opportunities for organizing activities are not evenly distributed among groups of citizens. The self-organizing capacity of residents in complexes with a low socio-economic status remains underdeveloped. Even among individuals with good organizational abilities, these skills decrease as they age or require more care. To gain an insight into the opportunities for older people themselves to increase the social quality of their residential complexes, the “Vital Living Communities” experiment was carried out in ten housing complexes for seniors, spread across the Netherlands. In the experiment, residents and professionals from housing corporations worked together to strengthen their communities using a particular method, named Studio BRUIS. The goal of this intervention was to improve the quality of social interaction in the residential complexes concerned. The research aimed to provide insight into the contribution of older people to improving the quality of social interaction in housing complexes for seniors. Two indicators for the quality of social interaction were defined: 1) social participation (do residents actively participate in social activities?); 2) social solidarity (do residents know each other and feel connected to each other?). MethodsAn evaluation of this experiment was conducted through baseline and follow-up measurements using a questionnaire in combination with qualitative fieldwork. For the purposes of the baseline and follow-up measurements in this research, a standardized questionnaire was developed focusing on the main themes of the experiment. These quantitative measurements provide an overall insight into the quality of social interaction in the ten residential complexes, as well as insight into any changes in the social atmosphere during the experiment. The measurements also reveal the background to the qualitative aspect of the research, in which the researchers had a more intense contact with the residents involved to find out their perspectives on and experiences with the experiment. The combination of in-depth interviews and participant observations provided knowledge about the existing dynamics in the complexes and the extent to which the experiment was aligned with the activity setting. The qualitative study was carried out in four of the ten participating residential complexes and, in addition to participant observations and individual in-depth interviews, documents were analysed and group interviews were carried out.The analysis of the quantitative material focused primarily on those respondents who participated in both the baseline measurement and the post-test. The qualitative material (interview transcripts, “thick descriptions”, reports of group interviews and informal conversations) was encoded and analysed using MaxQda12. The findings were discussed in the focus groups in which residents and professionals from all participating residential complexes took part (“member check”). ConclusionThe research provides insight into the possibilities and limitations of the self-organizing capacity of residents of housing complexes for seniors. The baseline measurement showed that two-thirds of the residents participated in activities in their complex, but that only a few residents were motivated to participate in organizing and managing these activities. This was confirmed by the findings of the qualitative research. The main reasons for residents not becoming active as organizers was their lack of knowledge and organizational skills, thinking of themselves as too old, limitations caused by health problems, and lack of interest in organizing activities for others. Residents who were willing to actively engage in social activities in their residential complex appeared to depend on a facilitating professional to provide ideas, think about implementation and ensure continuity. The professional helped initiate the process, set goals, make plans and implement these, and motivate other residents. But even once activities were up and running, professional support remained necessary because plans often worked out differently in practice. Residents wanted to be able to exchange ideas with someone who could steer the process to some extent and lead them in the right direction. The assistance of professionals was also indispensable when dealing with the resistance or conflicts that inevitably occur during a process of change.The research revealed that social vitalization requires motivated residents who want to act according to the pace and needs of other residents and who appreciate small successes. Strengthening the quality of social interaction also requires harmonization with the cultural context (“activity setting”) of the residential complex. Goals that do not fit the existing situation, or unrealistic plans that never get off the ground, are demotivating. Social vitalization in residential complexes for older adults is a gradual process of change that requires permanent support from active residents and professionals. The self-confidence of the active residents increases when their plans are a success, but this happens in small steps. Professional support is needed to start the vitalization process, to guide and make it sustainable

Presence of HIF-1 and related genes in normal mucosa, adenomas and carcinomas of the colorectum

Expression of the transcription factor hypoxia-inducible factor 1 (HIF-1), which plays a key role in cellular adaptation to hypoxia, was investigated in normal colorectal mucosa (ten), adenomas (61), and carcinomas (23). Tissue samples were analyzed for HIF-1α, its upstream regulators, von Hippel–Lindau factor, AKT, and mammalian target of rapamycin (mTOR) and its downstream targets glucose transporter 1 (GLUT1), carbonic anhydrase IX, stromal-cell-derived factor 1 (SDF-1) by immunohistochemistry. In normal colorectal mucosa, HIF-1α was observed in almost all nuclei of surface epithelial cells, probably secondary to a gradient of oxygenation, as indicated by pimonidazole staining. The same staining pattern was present in 87% of adenomas. In carcinomas, HIF-1α was present predominantly around areas of necrosis (78%). Active AKT and mTOR, were present in all adenomas, carcinomas, and in normal colorectal mucosa. GLUT1 and SDF-1 were present in the normal surface epithelium of all adenoma cases, whereas in the carcinoma GLUT1 was located around necrotic regions and SDF-1 was present in all epithelial cells. In conclusion, HIF-1α appears to be physiologically expressed in the upper part of the colorectal mucosa. The present observations support that upregulation of HIF-1α and its downstream targets GLUT1 and SDF-1 in colorectal adenomas and carcinomas may be due to hypoxia, in close interaction with an active phosphatidylinositol 3-kinases–AKT–mTOR pathway