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Ibsen TL, Strand BH, Bergh S, Livingston G, Lurås H, Mamelund SE, Voshaar RO, Rokstad AMM, Thingstad P, Gerritsen D, Selbæk G. A longitudinal cohort study on the use of health and care services by older adults living at home with/without dementia before and during the COVID-19 pandemic: the HUNT study. BMC Health Serv Res 2024; 24:485. [PMID: 38641570 PMCID: PMC11027287 DOI: 10.1186/s12913-024-10846-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/11/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Older adults and people with dementia were anticipated to be particularly unable to use health and care services during the lockdown period following the COVID-19 pandemic. To better prepare for future pandemics, we aimed to investigate whether the use of health and care services changed during the pandemic and whether those at older ages and/or dementia experienced a higher degree of change than that observed by their counterparts. METHODS Data from the Norwegian Trøndelag Health Study (HUNT4 70 + , 2017-2019) were linked to two national health registries that have individual-level data on the use of primary and specialist health and care services. A multilevel mixed-effects linear regression model was used to calculate changes in the use of services from 18 months before the lockdown, (12 March 2020) to 18 months after the lockdown. RESULTS The study sample included 10,607 participants, 54% were women and 11% had dementia. The mean age was 76 years (SD: 5.7, range: 68-102 years). A decrease in primary health and care service use, except for contact with general practitioners (GPs), was observed during the lockdown period for people with dementia (p < 0.001) and those aged ≥ 80 years without dementia (p = 0.006), compared to the 6-month period before the lockdown. The use of specialist health services decreased during the lockdown period for all groups (p ≤ 0.011), except for those aged < 80 years with dementia. Service use reached levels comparable to pre-pandemic data within one year after the lockdown. CONCLUSION Older adults experienced an immediate reduction in the use of health and care services, other than GP contacts, during the first wave of the COVID-19 pandemic. Within primary care services, people with dementia demonstrated a more pronounced reduction than that observed in people without dementia; otherwise, the variations related to age and dementia status were small. Both groups returned to services levels similar to those during the pre-pandemic period within one year after the lockdown. The increase in GP contacts may indicate a need to reallocate resources to primary health services during future pandemics. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov, with the identification number NCT04792086.
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Affiliation(s)
- Tanja Louise Ibsen
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway.
| | - Bjørn Heine Strand
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Sverre Bergh
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease (AFS), Innlandet Hospital Trust, Ottestad, Norway
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Hilde Lurås
- Health Services Research Unit, Akershus University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Svenn-Erik Mamelund
- Centre for Research On Pandemics & Society (PANSOC), at Oslo Metropolitan University, Oslo, Norway
| | - Richard Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne Marie Mork Rokstad
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health and Social Services, Trondheim Municipality, Trondheim, Norway
| | - Debby Gerritsen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, Netherlands
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Cummings J, Sano M, Auer S, Bergh S, Fischer CE, Gerritsen D, Grossberg G, Ismail Z, Lanctôt K, Lapid MI, Mintzer J, Palm R, Rosenberg PB, Splaine M, Zhong K, Zhu CW. Reduction and prevention of agitation in persons with neurocognitive disorders: an international psychogeriatric association consensus algorithm. Int Psychogeriatr 2024; 36:251-262. [PMID: 36876335 PMCID: PMC10480345 DOI: 10.1017/s104161022200103x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To develop an agitation reduction and prevention algorithm is intended to guide implementation of the definition of agitation developed by the International Psychogeriatric Association (IPA). DESIGN Review of literature on treatment guidelines and recommended algorithms; algorithm development through reiterative integration of research information and expert opinion. SETTING IPA Agitation Workgroup. PARTICIPANTS IPA panel of international experts on agitation. INTERVENTION Integration of available information into a comprehensive algorithm. MEASUREMENTS None. RESULTS The IPA Agitation Work Group recommends the Investigate, Plan, and Act (IPA) approach to agitation reduction and prevention. A thorough investigation of the behavior is followed by planning and acting with an emphasis on shared decision-making; the success of the plan is evaluated and adjusted as needed. The process is repeated until agitation is reduced to an acceptable level and prevention of recurrence is optimized. Psychosocial interventions are part of every plan and are continued throughout the process. Pharmacologic interventions are organized into panels of choices for nocturnal/circadian agitation; mild-moderate agitation or agitation with prominent mood features; moderate-severe agitation; and severe agitation with threatened harm to the patient or others. Therapeutic alternatives are presented for each panel. The occurrence of agitation in a variety of venues-home, nursing home, emergency department, hospice-and adjustments to the therapeutic approach are presented. CONCLUSIONS The IPA definition of agitation is operationalized into an agitation management algorithm that emphasizes the integration of psychosocial and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision-making.
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Affiliation(s)
- Jeffrey Cummings
- Joy Chambers-Grundy Professor of Brain Science, Director, Chambers-Grundy Center for Transformative Neuroscience, Co-Director, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences. University of Nevada Las Vegas (UNLV)
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NYC NY and James J. Peters VAMC, Bronx NY
| | - Stefanie Auer
- Centre for Dementia Studies, University for Continuing Education Krems, Austria
| | - Sverre Bergh
- The research centre for age-related functional decline and disease, Innlandet hospital trust, Ottestad, Norway
| | - Corinne E. Fischer
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada
| | - Debby Gerritsen
- Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Radboud Alzheimer Center, Nijmegen, the Netherlands
| | - George Grossberg
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry St Louis University School of Medicine
| | - Zahinoor Ismail
- Departments Psychiatry, Neurology, Epidemiology, and Pathology, Hotchkiss Brain Institute & O’Brien Institute for Public Health University of Calgary
| | - Krista Lanctôt
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; and Departments of Psychiatry and Pharmacology/Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maria I Lapid
- Mayo Clinic Department of Psychiatry and Psychology, Rochester, MN, USA
| | - Jacobo Mintzer
- Psychiatrist, Ralph. H. Johnson VA Medical Center, Charleston, SC and Professor, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Rebecca Palm
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Michael Splaine
- Owner Splaine Consulting, Managing Partner, Recruitment Partners LLC
| | - Kate Zhong
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas
| | - Carolyn W. Zhu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, NYC, NY and James J. Peters VAMC, Bronx NY
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Sano M, Cummings J, Auer S, Bergh S, Fischer CE, Gerritsen D, Grossberg G, Ismail Z, Lanctôt K, Lapid MI, Mintzer J, Palm R, Rosenberg PB, Splaine M, Zhong K, Zhu CW. Agitation in cognitive disorders: Progress in the International Psychogeriatric Association consensus clinical and research definition. Int Psychogeriatr 2024; 36:238-250. [PMID: 36880250 PMCID: PMC10684256 DOI: 10.1017/s1041610222001041] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND The International Psychogeriatric Association (IPA) published a provisional consensus definition of agitation in cognitive disorders in 2015. As proposed by the original work group, we summarize the use and validation of criteria in order to remove "provisional" from the definition. METHODS This report summarizes information from the academic literature, research resources, clinical guidelines, expert surveys, and patient and family advocates on the experience of use of the IPA definition. The information was reviewed by a working group of topic experts to create a finalized definition. RESULTS We present a final definition which closely resembles the provisional definition with modifications to address special circumstances. We also summarize the development of tools for diagnosis and assessment of agitation and propose strategies for dissemination and integration into precision diagnosis and agitation interventions. CONCLUSION The IPA definition of agitation captures a common and important entity that is recognized by many stakeholders. Dissemination of the definition will permit broader detection and can advance research and best practices for care of patients with agitation.
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Affiliation(s)
- Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NYC NY and James J. Peters VAMC, Bronx NY
| | - Jeffrey Cummings
- Joy Chambers-Grundy Professor of Brain Science, Director, Chambers-Grundy Center for Transformative Neuroscience, Co-Director, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences. University of Nevada Las Vegas (UNLV)
| | - Stefanie Auer
- Centre for Dementia Studies, University for Continuing Education Krems, Austria
| | - Sverre Bergh
- The research centre for age-related functional decline and disease, Innlandet hospital trust, Ottestad, Norway
| | - Corinne E. Fischer
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada
| | - Debby Gerritsen
- Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Radboud Alzheimer Center, Nijmegen, the Netherlands
| | - George Grossberg
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry St Louis University School of Medicine
| | - Zahinoor Ismail
- Departments Psychiatry, Neurology, Epidemiology, and Pathology, Hotchkiss Brain Institute & O’Brien Institute for Public Health University of Calgary
| | - Krista Lanctôt
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; and Departments of Psychiatry and Pharmacology/Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maria I Lapid
- Mayo Clinic Department of Psychiatry and Psychology, Rochester, MN, USA
| | - Jacobo Mintzer
- Psychiatrist, Ralph. H. Johnson VA Medical Center, Charleston, SC and Professor, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Rebecca Palm
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Michael Splaine
- Owner Splaine Consulting, Managing Partner, Recruitment Partners LLC
| | - Kate Zhong
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas
| | - Carolyn W. Zhu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, NYC, NY and James J. Peters VAMC, Bronx NY
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Knippenberg I, Leontjevas R, Declercq I, van Lankveld J, De Vriendt P, Gerritsen D. Agreement between nursing home caregivers' observations of residents' depression, well-being, and quality of life. Int Psychogeriatr 2023:1-3. [PMID: 37731256 DOI: 10.1017/s1041610223000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Inge Knippenberg
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Medical Innovation, Radboudumc Alzheimer Center, Nijmegen, Netherlands
- Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
| | - Ruslan Leontjevas
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Medical Innovation, Radboudumc Alzheimer Center, Nijmegen, Netherlands
- Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
| | - Ine Declercq
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Medical Innovation, Radboudumc Alzheimer Center, Nijmegen, Netherlands
- Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
- Department of Gerontology and Frailty in Ageing (FRIA) Research Group, Mental Health and Wellbeing (MENT) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Patricia De Vriendt
- Department of Gerontology and Frailty in Ageing (FRIA) Research Group, Mental Health and Wellbeing (MENT) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Research Group Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Debby Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Medical Innovation, Radboudumc Alzheimer Center, Nijmegen, Netherlands
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Postma S, Schers H, van de Belt T, van Boven K, Ten Napel H, Stappers H, Gerritsen D, Olde Hartman T. Assessment of functioning in Dutch primary care: Development study of a consultation tool for patients with chronic conditions and multimorbidity. Health Expect 2022; 25:1363-1373. [PMID: 35607998 PMCID: PMC9327861 DOI: 10.1111/hex.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/17/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In primary care, a shift from a disease-oriented approach for patients with multimorbidity towards a more person-centred approach is needed. AIM To transform a self-report questionnaire for patients with chronic conditions in primary care, the Primary Care Functioning Scale (PCFS), into an understandable, visually attractive and feasible consultation tool for patients and health care providers. The consultation tool consists of a web-based version of the PCFS, which is filled in by the patient and is processed to a feedback report that summarizes and visualizes the main findings. The feedback report can be discussed with the patient to facilitate a more person-centred conversation for patients with chronic conditions and multimorbidity in general practice. DESIGN AND SETTING In this qualitative study, we developed the consultation tool by using design thinking in a participatory developmental process. METHODS In the first phase, we constructed five different feedback report templates to summarize and display the results of a completed PCFS questionnaire in a series of two expert meetings with patients and general practitioners (GPs). In the second phase, we performed an exploratory qualitative interview study involving dyads of patients with chronic conditions and their practice nurses. In an iterative process, we explored their experiences with the consultation tool. RESULTS Patients, as well as GPs, preferred a clear manner of presenting the results of the questionnaire in a feedback report. In 18 interviews with patients and practice nurses during three different interview rounds, we adjusted the feedback report and consultation tool based on the input from patients and practice nurses. After the final interview round, patients and practice nurses consented that the consultation tool was useful for having a more in-depth consultation about functioning and patients' preferences when integrated into the regularly scheduled consultations. CONCLUSION We were able to develop an understandable and feasible consultation tool that is applicable in already existing chronic disease management programmes in general practice in the Netherlands. PATIENT OR PUBLIC CONTRIBUTION To increase the understandability and feasibility of the consultation tool, we collaborated with end-users and actively involved patients, GPs and practice nurses in a participatory development process.
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Affiliation(s)
- Simone Postma
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk Schers
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom van de Belt
- Radboud REshape Innovation Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kees van Boven
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Huib Ten Napel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,WHO Collaborating Centre for Family of International Classifications, Nijmegen, The Netherlands
| | - Hugo Stappers
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Debby Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Du J, Janus S, Voorthuis B, van Manen J, Achterberg W, Smalbrugge M, Zwijsen S, Gerritsen D, Koopmans R, Zuidema S. Time trends in psychotropic drug prescriptions in Dutch nursing home residents with dementia between 2003 and 2018. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5697. [PMID: 35297551 PMCID: PMC9311063 DOI: 10.1002/gps.5697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Several European studies investigated the trends in psychotropic drug prescriptions (PDPs) among nursing home (NH) residents and reported a decline in antipsychotics prescriptions. Since the Dutch long-term care system differs from other European systems (e.g. higher threshold for NH admission and trained elderly care physicians), this study explores the trends in PDPs in Dutch NH residents with dementia. METHODS The study used data from nine studies, comprising two cross-sectional studies, one cohort study, and six cluster-randomized controlled trials, collected in Dutch NHs between 2003 and 2018. With multilevel logistic regression analysis, NHs as a random effect, we estimated the trends in PDPs overall and for five specific psychotropic drug groups (antipsychotics, antidepressants, anxiolytics, hypnotics, and anti-dementia drugs), adjusting for confounders: age, gender, severity of dementia, severity of neuropsychiatric symptoms, and length of stay in NHs. RESULTS The absolute prescription rate of antipsychotics was 37.5% in 2003 and decreased (OR = 0.947, 95% CI [0.926, 0.970]) every year. The absolute prescription rate of anti-dementia drugs was 0.8% in 2003 and increased (OR = 1.162, 95% CI [1.105, 1.223]) per year. The absolute rate of overall PDPs declined from 62.7% in 2003 to 40.4% in 2018. CONCLUSIONS Among Dutch NH residents with dementia, the odds of antipsychotics prescriptions decreased by 5.3% per year while the odds of anti-dementia drug prescriptions increased by 16.2%. There were no distinct trends in antidepressants, anxiolytics, and hypnotics prescriptions. However, overall PDPs were still high. The PDPs in NH residents remain an issue of concern.
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Affiliation(s)
- Jiamin Du
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Sarah Janus
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Brenda Voorthuis
- Health Technology and Services Research DepartmentTechnical Medical CentreUniversity of TwenteEnschedeThe Netherlands
| | | | - Wilco Achterberg
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older PeopleAmsterdam Public Health Research InstituteAmsterdam UMC ‐ Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Sandra Zwijsen
- Quality DepartmentKorian Zorg, Korian GroupArnhemThe Netherlands
| | - Debby Gerritsen
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - Raymond Koopmans
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
- Joachim en AnnaCenter for Specialized Geriatric CareNijmegenThe Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
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Gerritsen D, Backhaus R, de Boer B, Urlings J, Koopmans R, Hamers J, Verbeek H. The Impact of Visitation Guidelines During COVID-19 on Well-Being and Daily Life in Nursing Homes. Innov Aging 2021. [PMCID: PMC8755095 DOI: 10.1093/geroni/igab046.1575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Nursing homes across the world have taken very restrictive measures, including a ban for visitors, to prevent and control COVID-19 infections. This study reports on findings of a study investigating guidelines on allowing visitors in nursing homes and the impact on residents’ well-being, family caregivers and staff. In total, 76 nursing homes in the Netherlands were followed using a survey study, including three waves of data collection in (May 2020, September 2020, March 2021. Results indicated a negative impact of a visitation ban for residents’ overall well-being. There was a variety in guidelines of allowing visitors in nursing homes, and showed that safe visiting was possible during the COVID-19 pandemic. Staff perceived a fragile balance between infection prevention and the impact of restriction on residents. In conclusion, a general ban for visitors is not necessary and may do more harm than good for residents living in nursing homes.
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Affiliation(s)
- Debby Gerritsen
- Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
| | | | - Bram de Boer
- Maastricht University, Maastricht, Limburg, Netherlands
| | - Judith Urlings
- Living Lab in Ageing and Long-Term Care, Maastricht, Limburg, Netherlands
| | - Raymond Koopmans
- Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
| | - Jan Hamers
- Maastricht University, Maastricht, Limburg, Netherlands
| | - Hilde Verbeek
- Maastricht University, Maastricht, Limburg, Netherlands
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8
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Kohnen RF, Lavrijsen J, Akkermans R, Gerritsen D, Koopmans R. The prevalence and determinants of inappropriate sexual behaviour in people with acquired brain injury in nursing homes. J Adv Nurs 2021; 77:3058-3072. [PMID: 33634494 PMCID: PMC8248184 DOI: 10.1111/jan.14817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/18/2021] [Accepted: 02/05/2021] [Indexed: 11/29/2022]
Abstract
AIMS Establishing the prevalence of inappropriate sexual behaviour, concurrent challenging behaviours and the determinants of inappropriate sexual behaviour among patients with acquired brain injury ≤65 years of age in Dutch nursing homes. DESIGN Cross-sectional, observational study in acquired brain injury special care units spreads throughout the country. METHODS Nursing homes were recruited through the national expertise network for patients with severe acquired brain injury, regional brain injury teams and by searching the Internet. Patient characteristics were collected through digital questionnaires. Inappropriate sexual behaviour was assessed with the St. Andrews Sexual Behaviour Assessment, concurrent challenging behaviours with the NeuroPsychiatric Inventory-Nursing Home Version and the Cohen-Mansfield Agitation Inventory, cognition with the Mini-Mental State Examination and activities of daily living with the Disability Rating Scale. Psychotropic drug use was retrieved from the electronic prescription system. Associations between determinants and inappropriate sexual behaviour were examined using multilevel multivariate linear regression model analyses. Data collection started in June 2017 and ended in April 2019. RESULTS Of the 118 included patients, 38.1% had one or more inappropriate sexual behaviours. Verbal comments (30.1%) and non-contact behaviour (24.8%) were the most prevalent types of inappropriate sexual behaviour. Less severe behaviours were more common than more severe behaviours. The most frequent concurrent challenging behaviours were agitation, aggression and hyperactivity. Physical aggression was associated with more inappropriate sexual behaviour. Being married and pain were associated with less inappropriate sexual behaviour. CONCLUSION Inappropriate sexual behaviour is prevalent in patients with acquired brain injury ≤65 years of age residing in nursing homes. IMPACT Inappropriate sexual behaviour may have impact not only on the patients themselves but also on nursing staff. Insight into the magnitude, severity, course and concurrent challenging behaviours, sexuality and quality of life could give direction to the kind of interventions and education that is needed. The ultimate goal is to develop appropriate care for this vulnerable group of patients, specifically psychosocial interventions and appropriate use of psychotropic drugs.
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Affiliation(s)
- Roy F. Kohnen
- Vivent, Rosmalen and LivioEnschedethe Netherlands
- Department of Primary and Community CareRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Jan Lavrijsen
- Department of Primary and Community CareRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Reinier Akkermans
- Radboud University Medical CenterRadboud Institute for Health SciencesScientific Institute for Quality of CareNijmegenthe Netherlands
| | - Debby Gerritsen
- Department of Primary and Community CareRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Raymond Koopmans
- Department of Primary and Community CareRadboud University Medical CenterDe Waalboog“Joachim and Anna”Centre for Specialized Geriatric CareNijmegenthe Netherlands
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9
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Botter L, Ten Have M, Gerritsen D, de Graaf R, van Dijk SDM, van den Brink RHS, Oude Voshaar RC. Impact of borderline personality disorder traits on the association between age and health-related quality of life: A cohort study in the general population. Eur Psychiatry 2021; 64:e33. [PMID: 33896434 PMCID: PMC8135108 DOI: 10.1192/j.eurpsy.2021.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Increasing age as well as borderline personality pathology are associated with a lower level of health-related quality of life (HR-QoL). Our objective was to investigate whether the presence of borderline personality traits modifies the association between age and HR-QoL in the general population. Methods Cross-sectional data from 5,303 respondents (aged 21–72 years) of the Netherlands Mental Health Survey and Incidence Study-2 were analyzed. Borderline personality traits were assessed with the International Personality Disorder Examination questionnaire. Mental and physical HR-QoL were measured with the Medical Outcomes Study Short Form Health Survey. Multiple linear regression analysis was used to examine the association of borderline personality traits, age and their interaction on mental as well as physical HR-QoL, adjusted for demographic variables as well as somatic and mental disorders. Results A total of 1,520 (28.7%) respondents reported one or more borderline personality traits of which 58 (1.1%) reported five or more indicative of a borderline personality disorder. A higher age was associated with lower physical HR-QoL. This negative association became significantly stronger in the presence of borderline personality traits. The association between increasing age and mental HR-QoL was positive in the absence of borderline personality traits and negative in the presence of borderline personality traits. Conclusion Borderline personality traits negatively interfere with the association between age and HR-QoL irrespective of somatic and mental disorders. Attention of clinicians and researchers for subthreshold borderline personality pathology is needed in middle-aged and older persons.
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Affiliation(s)
- L Botter
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Atlant, Markenhaven, Center for Specialized Chronic Psychiatric Nursing Home Care, Beekbergen, The Netherlands
| | - M Ten Have
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - D Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - R de Graaf
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - S D M van Dijk
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R H S van den Brink
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Kohnen R, Lavrijsen J, Smals O, Gerritsen D, Koopmans R. Prevalence and characteristics of neuropsychiatric symptoms, quality of life and psychotropics in people with acquired brain injury in long-term care. J Adv Nurs 2019; 75:3715-3725. [PMID: 31318085 PMCID: PMC6900174 DOI: 10.1111/jan.14156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 12/19/2022]
Abstract
Aim Establishing the prevalence of neuropsychiatric symptoms (NPS), quality of life and psychotropic drug use in people aged ≤65 years with acquired brain injury in nursing homes. Design Cross‐sectional, observational study among patients aged 18–≤65 years with acquired brain injury admitted to special care units in Dutch nursing homes. Methods According to the Committee on Research Involving Human Subjects in January 2017 this study did not require ethics approval. Nursing homes will be recruited through the national acquired brain injury expertise network for patients with severe brain injury, the regional brain injury teams and by searching the internet. Patient characteristics will be collected through digital questionnaires. Neuropsychiatric symptoms will be assessed with the NeuroPsychiatric Inventory‐Nursing Home version, the Cohen–Mansfield Agitation Inventory and the St. Andrews Sexual Behaviour Assessment; cognition with the Mini‐Mental State Examination, quality of life with the Quality of Life after Brain Injury Overall Scale and activities of daily living with the Disability Rating Scale. Medication will be retrieved from the electronic prescription system. Data collection commenced in 2017 and will be followed by data analysis in 2019. Reporting will be completed in 2020. Discussion Little is known about NPS among patients with acquired brain injury in nursing homes. In patients up to the age of 65 years, only six studies were found on prevalence rates of NPS. Impact Patients with severe acquired brain injury experience lifelong consequences, that have a high impact on them and their environment. Although there is increasing attention for the survival of this vulnerable group of patients, it is also important to enlarge awareness on long‐term consequences, specifically the NPS, quality of life and psychotropic drug use in acquired brain injury. Insight into the magnitude of these issues is necessary to achieve appropriate care for these patients.
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Affiliation(s)
- Roy Kohnen
- Vivent, Rosmalen and Livio, Enschede, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jan Lavrijsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Odile Smals
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Vivent, Rosmalen, The Netherlands
| | - Debby Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, De Waalboog, "Joachim and Anna", Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
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11
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Abstract
BACKGROUND Although using professional interpreters is known to improve health outcomes for patients when language barriers are present, care providers often hesitate to use them. Training in how to use interpreters has been effective in increasing students' knowledge and self-efficacy, but little is known about how students apply the competencies gained. We explored students' perspectives on how they dealt with language barriers during their clerkships. METHOD Students in the Netherlands who received training (n = 8) and who did not receive training (n = 8) were interviewed about their experiences during their clerkships with regards to language barriers and the use of professional interpreters. RESULTS Students do not report using interpretation services during clerkships, even when they have been trained. Students report that their supervisors and other staff members provide barriers to the use of interpretation services. CONCLUSIONS Not only students but also staff need training in the use of professional interpretation services, because staff serve as role models for the students. Care providers often hesitate to use [professional interpreters].
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Affiliation(s)
- Laura Lijbers
- Fontys University of Applied Sciences, Tilburg, the Netherlands
| | - Debby Gerritsen
- Department of Interdisciplinary Social Sciences, Faculty of Social and Behavioural Sciences, University of Amsterdam, the Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Academic Medical Centre/University of Amsterdam, the Netherlands
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12
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Gerritsen D. [The construction of a dementia-specific quality of life instrument rated by professional caregivers: the QUALIDEM]. Tijdschr Gerontol Geriatr 2009; 40:34-36. [PMID: 19326701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
We investigated whether adults with a parent with dementia experience their personal aging differently than adults whose parents do not have dementia. Semi-structured interviews were conducted with 25 adults who had a parent with dementia and 25 controls. We found that, although in a general sense the two groups were quite similar in their personal experiences of aging, there were specific differences. The children of parents with dementia had a health-concept in which there was substantial emphasis on mental health. Moreover, they linked the dementia of their parent to their own aging and worried about developing a dementia syndrome themselves. They also held different attitudes with regard to end-of-life decisions. Finally, participants having a parent with dementia gave more extensive answers to simple questions. This overall response suggests more involvement with growing older and finitude in the children of parents with dementia.
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Affiliation(s)
- Debby Gerritsen
- VU University Medical Center, EMGO Institute, Dept of Nursing Home Medicine, Amsterdam, The Netherlands.
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14
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Gerritsen D, Ooms M, Steverink N, Frijters D, Bezemer D, Ribbe M. [Three new observational scales for use in Dutch nursing homes: scales from the Resident Assessment Instrument for Activities of Daily Living, cognition and depression]. Tijdschr Gerontol Geriatr 2004; 35:55-64. [PMID: 15230054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The reliability and validity of three MDS scales for ADL, cognition and depression are described. The scales consist of items of the Minimum Data Set of the Resident Assessment Instrument and are available just after an MDS assessment. Data collection took place in nine Dutch nursing homes (N = 227) and consisted of three MDS assessments within one month to determine reliability. Several criterion measures were assessed in order to determine convergent validity. Intra- and inter-rater reliability and internal consistency were determined as well as correlation coefficients of the criterion measures and the MDS scales. All three MDS scales appear reliable, especially the ADL-Hierarchy has very good psychometric properties (intra- and inter-rater Intra Class Correlation were 0.81 and 0.83, respectively). Convergent validity of the ADL-Hierarchy and the Cognitive Performance Scale is good, the Depression Rating Scale appears valid in residents with moderate cognitive disorders at the most, but the results are more difficult to interpret in residents with severe cognitive disorders. The MDS scales appear useful in clinical practice and for research purposes in the Dutch nursing homes.
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Affiliation(s)
- Debby Gerritsen
- VU medisch centrum Amsterdam, Instituut voor Extramuraal Geneeskundig Onderzoek, afdeling Verpleeghuisgeneeskunde.
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Frijters D, Gerritsen D, Steverink N. [Care quality: reliability and usefulness of observation data in bench marking nursing homes and homes for the aged in the Netherlands]. Tijdschr Gerontol Geriatr 2003; 34:21-9. [PMID: 12629907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Before including quality of care indicators in the Benchmark of Nursing Homes and Homes for the Aged in the Netherlands the reliability of the patient data collection, and usefulness had to be established. The patient data items were derived from the Resident Assessment Instruments (RAI) and a questionnaire on social interaction in elderly people. Three nursing homes and three homes for the aged participated in the test with 550 patients. 279 x 2 assessments were collected by independent raters for an inter rater reliability test; 259 x 2 by the same rater for a reliability test-retest; and 24 by a single rater. The scores on paired assessment forms were compared with the weighted Kappa agreement test. The test results allowed 10 of the 13 quality indicators from RAI to be retained. In addition new quality indicators could be defined on 'giving attention' and 'unrespectful addressing'. We estimate on the basis of a questionnaire for the raters that on average 9 to 12 minutes per patient are needed to collect and enter data for the resulting 12 quality indicators.
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Affiliation(s)
- Dinnus Frijters
- Afd. Verpleeghuis-en Sociale Geneeskunde, Vrije Universiteit Medisch Centrum, Amsterdam, Van der Boechorststraat 7, 1081 BT.
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