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Szczepanowski R, Uchmanowicz I, Pasieczna-Dixit AH, Sobecki J, Katarzyniak R, Kołaczek G, Lorkiewicz W, Kędras M, Dixit A, Biegus J, Wleklik M, Gobbens RJJ, Hill L, Jaarsma T, Hussain A, Barbagallo M, Veronese N, Morabito FC, Kahsin A. Application of machine learning in predicting frailty syndrome in patients with heart failure. ADV CLIN EXP MED 2024; 33:309-315. [PMID: 38530317 DOI: 10.17219/acem/184040] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/13/2024] [Indexed: 03/27/2024]
Abstract
Prevention and diagnosis of frailty syndrome (FS) in patients with heart failure (HF) require innovative systems to help medical personnel tailor and optimize their treatment and care. Traditional methods of diagnosing FS in patients could be more satisfactory. Healthcare personnel in clinical settings use a combination of tests and self-reporting to diagnose patients and those at risk of frailty, which is time-consuming and costly. Modern medicine uses artificial intelligence (AI) to study the physical and psychosocial domains of frailty in cardiac patients with HF. This paper aims to present the potential of using the AI approach, emphasizing machine learning (ML) in predicting frailty in patients with HF. Our team reviewed the literature on ML applications for FS and reviewed frailty measurements applied to modern clinical practice. Our approach analysis resulted in recommendations of ML algorithms for predicting frailty in patients. We also present the exemplary application of ML for FS in patients with HF based on the Tilburg Frailty Indicator (TFI) questionnaire, taking into account psychosocial variables.
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Affiliation(s)
- Remigiusz Szczepanowski
- Department of Computer Science and Systems Engineering, Wroclaw University of Science and Technology, Poland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Poland
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
| | | | - Janusz Sobecki
- Department of Computer Science and Systems Engineering, Wroclaw University of Science and Technology, Poland
| | - Radosław Katarzyniak
- Department of Computer Science and Systems Engineering, Wroclaw University of Science and Technology, Poland
| | - Grzegorz Kołaczek
- Department of Computer Science and Systems Engineering, Wroclaw University of Science and Technology, Poland
| | - Wojciech Lorkiewicz
- Department of Computer Science and Systems Engineering, Wroclaw University of Science and Technology, Poland
| | - Maja Kędras
- Department of Computer Science and Systems Engineering, Wroclaw University of Science and Technology, Poland
| | - Anant Dixit
- Department of Computer Science and Systems Engineering, Wroclaw University of Science and Technology, Poland
| | - Jan Biegus
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
- Institute for Heart Diseases, Wroclaw Medical University, Poland
| | - Marta Wleklik
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Poland
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
| | - Loreena Hill
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | | | - Amir Hussain
- School of Computing, Edinburgh Napier University, UK
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Italy
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Parisius KGH, Verhoeff MC, Lobbezoo F, Avivi-Arber L, Duyck J, Hirano H, Iijima K, Janssens B, Kossioni A, Lin CS, McKenna G, Müller F, Schimmel M, Visser A, Watanabe Y, Gobbens RJJ. Towards an operational definition of oral frailty: A e-Delphi study. Arch Gerontol Geriatr 2024; 117:105181. [PMID: 37713933 DOI: 10.1016/j.archger.2023.105181] [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: 07/29/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES Building upon our recently developed conceptual definition of oral frailty (the age-related functional decline of orofacial structures), this e-Delphi study aims to develop an operational definition of oral frailty by identifying its components. METHODS We used a modified e-Delphi study to reach a consensus among international experts on the components of oral frailty. Twelve out of fifteen invited experts in the field of gerodontology participated. Experts responded to three rounds of an online 5-point scale questionnaire of components to be included or excluded from the operational definition of oral frailty. After each round, scores and rationales were shared with all experts, after which they could revise their position. A consensus was reached when at least 70% of the experts agreed on whether or not a component should be included in the operational definition of oral frailty. RESULTS The experts achieved a high level of agreement (80 - 100%) on including eight components of oral frailty and excluding nineteen. The operational definition of oral frailty should include the following components: 1) difficulty eating hard or tough foods, 2) inability to chew all types of foods, 3) decreased ability to swallow solid foods, 4) decreased ability to swallow liquids, 5) overall poor swallowing function, 6) impaired tongue movement, 7) speech or phonatory disorders, and 8) hyposalivation or xerostomia. CONCLUSION This e-Delphi study provided eight components that make up the operational definition of oral frailty. These components are the foundation for the next stage, which involves developing an oral frailty assessment tool.
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Affiliation(s)
- Karl G H Parisius
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, ACTA, University of Amsterdam, The Netherlands; Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, The Netherlands.
| | - Merel C Verhoeff
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, ACTA, University of Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, ACTA, University of Amsterdam, The Netherlands
| | | | - Joke Duyck
- Department of Oral Health Sciences, KU Leuven, Belgium
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Japan
| | - Katsuya Iijima
- Institute for Future Initiatives, Institute of Gerontology, The University of Tokyo, Japan
| | - Barbara Janssens
- Department of Oral Health Sciences, Gerodontology, ELOHA (Equal Lifelong Oral Health for All) research group, Ghent University, Belgium
| | - Anastassia Kossioni
- Division of Gerodontology, Department of Prosthodontics, Dental School, National and Kapodistrian University of Athens, Greece
| | - Chia-Shu Lin
- Department of Dentistry, National Yang Ming Chiao Tung University, Taiwan
| | - Gerald McKenna
- Centre for Public Health, Queen's University Belfast, Northern Ireland United Kingdom
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthdontics, University Clinics of Dental Medicine, University of Geneva, Switzerland
| | - Martin Schimmel
- Division of Gerodontology and Removable Prosthdontics, University Clinics of Dental Medicine, University of Geneva, Switzerland; Department of Reconstructive Dentistry and Gerodontology, school of Dental Medicine, University of Bern, Switzerland
| | - Anita Visser
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University of Groningen, The Netherlands; University Medical Center Groningen, The Netherlands; Department for Gerodontology, College of Dental Sciences, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, The Netherlands; Zonnehuisgroep Amstelland, The Netherlands; Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Tranzo Academic Centre for Transformation in Care and Welfare, Faculty of Behavioural and Social Sciences, Tilburg University, The Netherlands
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Gobbens RJJ, Kuiper S, Dijkshoorn H, van Assen MALM. Associations of individual chronic diseases and multimorbidity with multidimensional frailty. Arch Gerontol Geriatr 2024; 117:105259. [PMID: 37952423 DOI: 10.1016/j.archger.2023.105259] [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: 09/08/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To examine the associations between individual chronic diseases and multidimensional frailty comprising physical, psychological, and social frailty. METHODS Dutch individuals (N = 47,768) age ≥ 65 years completed a general health questionnaire sent by the Public Health Services (response rate of 58.5 %), including data concerning self-reported chronic diseases, multidimensional frailty, and sociodemographic characteristics. Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Total frailty and each frailty domain were regressed onto background characteristics and the six most prevalent chronic diseases: diabetes mellitus, cancer, hypertension, arthrosis, urinary incontinence, and severe back disorder. Multimorbidity was defined as the presence of combinations of these six diseases. RESULTS The six chronic diseases had medium and strong associations with total ((f2 = 0.122) and physical frailty (f2 = 0.170), respectively, and weak associations with psychological (f2 = 0.023) and social frailty (f2 = 0.008). The effects of the six diseases on the frailty variables differed strongly across diseases, with urinary incontinence and severe back disorder impairing frailty most. No synergetic effects were found; the effects of a disease on frailty did not get noteworthy stronger in the presence of another disease. CONCLUSIONS Chronic diseases, in particular urinary incontinence and severe back disorder, were associated with frailty. We thus recommend assigning different weights to individual chronic diseases in a measure of multimorbidity that aims to examine effects of multimorbidity on multidimensional frailty. Because there were no synergetic effects of chronic diseases, the measure does not need to include interactions between diseases.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, the Netherlands.
| | - Sandra Kuiper
- Tranzo, Tilburg University, Tilburg, the Netherlands; Department of Research, Public Health Service of West-Brabant, Breda, the Netherlands
| | - Henriëtte Dijkshoorn
- Department of Healthy Living, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Marcel A L M van Assen
- Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
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van der Ploeg T, Gobbens RJJ. Disability transitions in Dutch community-dwelling older people aged 75 years or older. Arch Gerontol Geriatr 2024; 116:105165. [PMID: 37639841 DOI: 10.1016/j.archger.2023.105165] [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: 03/03/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Recent world population predictions show that the world population aged >=65 years will increase from 10% in 2022 to 16% in 2050. Population aging is accompanied by an increase in people with disability. It is important to pay special attention to people with disability, as these people are at high risk of adverse outcomes. Our study aimed to investigate the transitions of disability among Dutch community-dwelling older people aged 75 years or older, using a follow-up of nine years. We used socio-demographic factors gender, age, marital status, education, and income, but also lifestyle, diseases, and life events to predict the disability transitions over time. METHODS We used a sample of 484 people that was randomly drawn from the municipality of Roosendaal (the Netherlands), a municipality with 78,000 inhabitants. A subset of people who completed part A of the Tilburg Frailty Indicator (TFI) at baseline and the Groningen Activity Restriction Scale (GARS) questionnaires was used with a nine-year follow-up. Paired Wilcoxon tests were used to compare the consecutive measurements. Socio-demographic factors gender, age, marital status, education, and income, but also lifestyle, diseases, and life events were included to predict the disability transitions over time. For the univariable and multivariable analysis of the measurements over time with the predictor variables, we used generalized estimation equations (GEE). A p-value <0.05 was considered significant. R version 3.4.4 was used for all analyses. RESULTS Of the participants, 65% were younger than 80 years, 50% were married or cohabiting, 87% reported a healthy lifestyle, and 63% had no diseases or chronic disorders. Each year, more participants changed from status not disabled to disabled than vice versa. The GEE analyses showed that lifestyle ('not healthy') and diseases or chronic disorders ('two or more') were significant in the multivariable analysis for the disability score and only diseases or chronic disorders ('two or more') was significant in the multivariable analysis for the dichotomous disability score. CONCLUSIONS The transition of the disability score is strongly influenced by lifestyle and diseases or disorders. This applies to a lesser extent to the dichotomous disability score. There, only diseases or disorders are an important predictor. For health care professionals our study provides starting points for interventions focused on the prevention of worsening disability and for community-dwelling older people >= 75, the most important recommendation is: live healthy!
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Affiliation(s)
- Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Amstelveen, The Netherlands; Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, The Netherlands
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Khalil AH, Gobbens RJJ. What If the Clinical and Older Adults' Perspectives about Frailty Converge? A Call for a Mixed Conceptual Model of Frailty: A Traditional Literature Review. Healthcare (Basel) 2023; 11:3174. [PMID: 38132064 PMCID: PMC10742490 DOI: 10.3390/healthcare11243174] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/01/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
Existing frailty models have enhanced research and practice; however, none of the models accounts for the perspective of older adults upon defining and operationalizing frailty. We aim to propose a mixed conceptual model that builds on the integral model while accounting for older adults' perceptions and lived experiences of frailty. We conducted a traditional literature review to address frailty attributes, risk factors, consequences, perceptions, and lived experiences of older adults with frailty. Frailty attributes are vulnerability/susceptibility, aging, dynamic, complex, physical, psychological, and social. Frailty perceptions and lived experience themes/subthemes are refusing frailty labeling, being labeled "by others" as compared to "self-labeling", from the perception of being frail towards acting as being frail, positive self-image, skepticism about frailty screening, communicating the term "frail", and negative and positive impacts and experiences of frailty. Frailty risk factors are classified into socio-demographic, biological, physical, psychological/cognitive, behavioral, and situational/environmental factors. The consequences of frailty affect the individual, the caregiver/family, the healthcare sector, and society. The mixed conceptual model of frailty consists of interacting risk factors, interacting attributes surrounded by the older adult's perception and lived experience, and interacting consequences at multiple levels. The mixed conceptual model provides a lens to qualify frailty in addition to quantifying it.
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Affiliation(s)
- Asya Hani Khalil
- Hariri School of Nursing, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
- Tranzo, Tilburg University, 5037 DB Tilburg, The Netherlands
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van Wieringen M, Wendelgelst R, Gobbens RJJ. 'They're not doing too much are they?' How the socialization of registered nurses perpetuates status differences with certified nursing assistants: A qualitative study. Nurse Educ Today 2023; 131:105984. [PMID: 37839141 DOI: 10.1016/j.nedt.2023.105984] [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] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/13/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Limited knowledge exists about how the socialization of vocationally trained registered nurses both at school and during internships in the community of practice influences their perception of, and working relationship with certified nursing assistants. OBJECTIVES This paper studies, first, how registered nurse students internalize the perceptions and discourses about certified nursing assistants conveyed by teachers, mentors and other students during their socialization at school and in the community of practice. Second, it examines how this socialization forms student's perception of, and actual working relationship with certified nursing assistants. DESIGN Qualitative descriptive and exploratory study using an interpretative framework. METHODS Individual in-depth interviews were conducted with 15 registered nurse students that were in their third or fourth year of training. RESULTS The findings reveal that at school the division of tasks and working relationship between registered nurse students and certified nursing assistants was very rarely discussed explicitly. However, teachers and students implicitly and explicitly conveyed that certified nursing assistants have lower status, describing the latter's role as inferior and as assisting to the role of registered nurses. During internships in the community of practice, some students initially adjust this perception when directly working with certified nursing assistants, who generally are their mentor in the first years of training, consider certified nursing assistants as equal and highlight the interdependence of the two occupational groups. Yet, further in their training, registered nurse students start to relate more to graduated registered nurses and reproduce the dominant perception and discourse that certified nursing assistants are inferior and supposed to support registered nurses, thereby perpetuating pervasive status differences and inequality. CONCLUSION Findings will assist nurse educators both in training centers and in the community of practice to understand how education can be used to end pervasive status differences and foster mutual respect and equity between different designations in nursing.
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Affiliation(s)
| | | | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, the Netherlands; Tranzo, Tilburg University, the Netherlands; Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Professor, Zonnehuisgroep Amstelland, the Netherlands
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van der Ploeg T, Schalk R, Gobbens RJJ. External Validation of Models for Predicting Disability in Community-Dwelling Older People in the Netherlands: A Comparative Study. Clin Interv Aging 2023; 18:1873-1882. [PMID: 38020449 PMCID: PMC10654350 DOI: 10.2147/cia.s428036] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Background Advanced statistical modeling techniques may help predict health outcomes. However, it is not the case that these modeling techniques always outperform traditional techniques such as regression techniques. In this study, external validation was carried out for five modeling strategies for the prediction of the disability of community-dwelling older people in the Netherlands. Methods We analyzed data from five studies consisting of community-dwelling older people in the Netherlands. For the prediction of the total disability score as measured with the Groningen Activity Restriction Scale (GARS), we used fourteen predictors as measured with the Tilburg Frailty Indicator (TFI). Both the TFI and the GARS are self-report questionnaires. For the modeling, five statistical modeling techniques were evaluated: general linear model (GLM), support vector machine (SVM), neural net (NN), recursive partitioning (RP), and random forest (RF). Each model was developed on one of the five data sets and then applied to each of the four remaining data sets. We assessed the performance of the models with calibration characteristics, the correlation coefficient, and the root of the mean squared error. Results The models GLM, SVM, RP, and RF showed satisfactory performance characteristics when validated on the validation data sets. All models showed poor performance characteristics for the deviating data set both for development and validation due to the deviating baseline characteristics compared to those of the other data sets. Conclusion The performance of four models (GLM, SVM, RP, RF) on the development data sets was satisfactory. This was also the case for the validation data sets, except when these models were developed on the deviating data set. The NN models showed a much worse performance on the validation data sets than on the development data sets.
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Affiliation(s)
- Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
| | - René Schalk
- Tranzo, Tilburg University, Tilburg, the Netherlands
- Human Resource Studies, Tilburg University, Tilburg, the Netherlands
- Economic and Management Science, North West University, Potchefstroom, South Africa
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Tranzo, Tilburg University, Tilburg, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Tan JRO, Boersma P, Ettema TP, Planting CHM, Clark S, Gobbens RJJ, Dröes RM. The effects of psychosocial interventions using generic photos on social interaction, mood and quality of life of persons with dementia: a systematic review. BMC Geriatr 2023; 23:560. [PMID: 37710147 PMCID: PMC10500875 DOI: 10.1186/s12877-023-04270-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Although family photos are often used in the psychosocial care for people with dementia, little is known about the use and effectiveness of generic photos. This systematic literature review explored psychosocial interventions using generic photos for people with dementia, and the effects they have on their social interaction and/or mood and/or quality of life. In addition, it was investigated whether these interventions made use of technology in its implementation. METHODS A systematic search on the following databases was performed: PubMed, Embase, APA PsychInfo, Cinahl, Web of Science, Scopus and Cochrane Central. Inclusion and exclusion criteria were based on the PICO model (Population, Intervention, Comparison, Outcome), and quality assessment was undertaken using the Weight of Evidence Framework. Narrative synthesis was undertaken to summarize study characteristics- settings and designs, type of psychosocial interventions identified, type of photos and technology used, outcome measures, and results. RESULTS A total of 2,035 results were found, however after title, abstract and full-text screening, a total of 8 studies were included. The most common psychosocial intervention using generic photos was found to be reminiscence therapy, followed by art-viewing activities. In studies that used technology, it was reported that viewing digitalized photos were either similar or better to conventional printed photos. Despite photos being generic, it was found that generic photos could still hold personal significance to the person with dementia. Some positive and significant effects were found for the outcomes social interaction, mood and quality of life, though no study evaluated all three outcomes. Two studies were rated as having high overall quality, 4 were rated as fair, and 2 studies had a low quality assessment rating. CONCLUSION Studies found using generic photos were limited, showing varying outcomes and methodological quality. Firm conclusions on the effectiveness of interventions using generic photos are not possible. However, the use of generic photos in psychosocial interventions is a promising area for future research. Researchers should consider studies with better methodological quality and larger samples; and qualitative studies where the intention is to get better insight into successful implementation and impact mechanisms of such psychosocial interventions. TRIAL REGISTRATION n/a.
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Affiliation(s)
- Josephine Rose Orejana Tan
- Department of Psychiatry, Amsterdam University Medical Centers, Location VUmc / Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Petra Boersma
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Ben Sajet Centrum, Amsterdam, the Netherlands
| | - Teake P Ettema
- Department of Psychiatry, Amsterdam University Medical Centers, Location VUmc / Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Soraya Clark
- Department of Psychiatry, Amsterdam University Medical Centers, Location VUmc / Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Tranzo, Tilburg University, Tilburg, the Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centers, Location VUmc / Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
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Vaalburg AM, Wattel EM, Boersma P, Hertogh CMPM, Gobbens RJJ. The Role of Nursing Staff Regarding Goal Setting and Achieving in Geriatric Rehabilitation: A Focus Group Study. Rehabil Nurs 2023; 48:148-159. [PMID: 37669324 PMCID: PMC10487360 DOI: 10.1097/rnj.0000000000000429] [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] [Indexed: 08/20/2023]
Abstract
PURPOSE The aim of this study was to explore and clarify the role of nursing staff in geriatric rehabilitation on supporting patients in goal setting and achieving, through reflecting on rehabilitation interventions. DESIGN A descriptive qualitative study was conducted. METHODS We conducted four online focus group interviews with 23 members of the nursing staff working in geriatric rehabilitation. They reflected on six interventions, preclassified into three types: setting goals in the admission phase, increasing patient participation in order to personalize the rehabilitation trajectory, and supporting patients in working on short-term goals. Data were analyzed using thematic content analysis. RESULTS Setting goals in the admission phase is primarily the task of the multidisciplinary team rather than the nursing staff. Interventions to increase patient participation align with the coordinating role of nursing staff in the rehabilitation team. Working on short-term goals is of great value to patients. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING The connection between the patient's personal goals and professional treatment aimed at functional recovery can be enhanced by strengthening the position of nursing staff working in geriatric rehabilitation. CONCLUSION Members of nursing staff in geriatric rehabilitation see themselves playing a coordinating role in the multidisciplinary team, supporting the patient in goal work. Interventions aimed at advancing patient participation and providing support for short-term goals reinforce this role.
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Affiliation(s)
- Anne Marie Vaalburg
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
| | - Elizabeth M. Wattel
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- University Network of Organizations for Care for the Elderly of VU University Medical Centre, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Petra Boersma
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Ben Sajet Center for Long-Term Care, Amsterdam, the Netherlands
| | - Cees M. P. M. Hertogh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- University Network of Organizations for Care for the Elderly of VU University Medical Centre, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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Mazya AL, Boström AM, Bujacz A, Ekdahl AW, Kowalski L, Sandberg M, Gobbens RJJ. Translation and Validation of the Swedish Version of the Tilburg Frailty Indicator. Healthcare (Basel) 2023; 11:2309. [PMID: 37628509 PMCID: PMC10454910 DOI: 10.3390/healthcare11162309] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
The Tilburg Frailty Indicator (TFI) is a questionnaire with 15 questions designed for screening for frailty in community-dwelling older people. TFI has a multidimensional approach to frailty, including physical, psychological, and social dimensions. The aim of this study was to translate TFI into Swedish and study its psychometric properties in community-dwelling older people with multimorbidity. A cross-sectional study of individuals 75 years and older, with ≥3 diagnoses of the ICD-10 and ≥3 visits to the Emergency Department in the past 18 months. International guidelines for back-translation were followed. Psychometric properties of the TFI were examined by determining the reliability (inter-item correlations, internal consistency, test-retest) and validity (concurrent, construct, structural). A total of 315 participants (57.8% women) were included, and the mean age was 83.3 years. The reliability coefficient KR-20 was 0.69 for the total sum. A total of 39 individuals were re-tested, and the weighted kappa was 0.7. TFI correlated moderately with other frailty measures. The individual items correlated with alternative measures mostly as expected. In the confirmatory factor analysis (CFA), a three-factor model fitted the data better than a one-factor model. We found evidence for adequate reliability and validity of the Swedish TFI and potential for improvements.
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Affiliation(s)
- Amelie Lindh Mazya
- Division of Clinical Geriatrics, Department NVS, Karolinska Institutet, 141 83 Huddinge, Sweden
- Department of Geriatric Medicine of Danderyd Hospital, 182 88 Danderyd, Sweden
| | - Anne-Marie Boström
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, 141 86 Huddinge, Sweden
- Division of Nursing, Department NVS, Karolinska Institutet, 141 83 Huddinge, Sweden
- R&D Unit, Stockholms Sjukhem, 112 19 Stockholm, Sweden
| | - Aleksandra Bujacz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anne W. Ekdahl
- Division of Clinical Geriatrics, Department NVS, Karolinska Institutet, 141 83 Huddinge, Sweden
- Department of Clinical Sciences Helsingborg, Lund University, 251 87 Helsingborg, Sweden
| | - Leo Kowalski
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands
- Zonnehuisgroep Amstelland, 1180 HV Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
- Tranzo, Tilburg University, 5037 AB Tilburg, The Netherlands
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11
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Pasieczna AH, Szczepanowski R, Sobecki J, Katarzyniak R, Uchmanowicz I, Gobbens RJJ, Kahsin A, Dixit A. Importance analysis of psychosociological variables in frailty syndrome in heart failure patients using machine learning approach. Sci Rep 2023; 13:7782. [PMID: 37179399 PMCID: PMC10182994 DOI: 10.1038/s41598-023-35037-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/11/2023] [Indexed: 05/15/2023] Open
Abstract
The prevention and diagnosis of frailty syndrome (FS) in cardiac patients requires innovative systems to support medical personnel, patient adherence, and self-care behavior. To do so, modern medicine uses a supervised machine learning approach (ML) to study the psychosocial domains of frailty in cardiac patients with heart failure (HF). This study aimed to determine the absolute and relative diagnostic importance of the individual components of the Tilburg Frailty Indicator (TFI) questionnaire in patients with HF. An exploratory analysis was performed using machine learning algorithms and the permutation method to determine the absolute importance of frailty components in HF. Based on the TFI data, which contain physical and psychosocial components, machine learning models were built based on three algorithms: a decision tree, a random decision forest, and the AdaBoost Models classifier. The absolute weights were used to make pairwise comparisons between the variables and obtain relative diagnostic importance. The analysis of HF patients' responses showed that the psychological variable TFI20 diagnosing low mood was more diagnostically important than the variables from the physical domain: lack of strength in the hands and physical fatigue. The psychological variable TFI21 linked with agitation and irritability was diagnostically more important than all three physical variables considered: walking difficulties, lack of hand strength, and physical fatigue. In the case of the two remaining variables from the psychological domain (TFI19, TFI22), and for all variables from the social domain, the results do not allow for the rejection of the null hypothesis. From a long-term perspective, the ML based frailty approach can support healthcare professionals, including psychologists and social workers, in drawing their attention to the non-physical origins of HF.
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Affiliation(s)
| | - Remigiusz Szczepanowski
- Department of Computer Science and Systems Engineering, Faculty of Information and Communication Technology, Wroclaw University of Science and Technology, Wyb. Wyspiańskiego 27, 50-370, Wroclaw, Poland.
| | - Janusz Sobecki
- Department of Computer Science and Systems Engineering, Faculty of Information and Communication Technology, Wroclaw University of Science and Technology, Wyb. Wyspiańskiego 27, 50-370, Wroclaw, Poland
| | - Radosław Katarzyniak
- Department of Computer Science and Systems Engineering, Faculty of Information and Communication Technology, Wroclaw University of Science and Technology, Wyb. Wyspiańskiego 27, 50-370, Wroclaw, Poland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
| | | | - Anant Dixit
- Department of Computer Science and Systems Engineering, Faculty of Information and Communication Technology, Wroclaw University of Science and Technology, Wyb. Wyspiańskiego 27, 50-370, Wroclaw, Poland
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12
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Vaalburg AM, Boersma P, Wattel EM, Ket JCF, Hertogh CMPM, Gobbens RJJ. Supporting older patients in working on rehabilitation goals: A scoping review of nursing interventions. Int J Older People Nurs 2023:e12542. [PMID: 37082887 DOI: 10.1111/opn.12542] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Nurses are consistently present throughout the rehabilitation of older patients but are apprehensive about performing goal-centred care in the multidisciplinary team. OBJECTIVES The aim of this review was to explore working interventions on setting goals and working with goals designed for nurses in geriatric rehabilitation, and to describe their distinctive features. METHODS We performed a scoping review. We searched MEDLINE and CINAHL through August 4, 2021. Search terms related to the following themes: nurses, rehabilitation, geriatric, goal and method. We used snowballing to find additional. From the selected studies, we systematically extracted data on means, materials and the nursing role and summarized them in a narrative synthesis, using intervention component analysis. RESULTS The study includes 13 articles, describing 11 interventions which were developed for six different aims: improving multidisciplinary team care; increasing patient centredness; improving disease management by patients; improving the psychological, and emotional rehabilitation; increasing the nursing involvement in rehabilitation; or helping patients to achieve goals. The interventions appeal to four aspects of the nursing profession: assessing self-care skills incorporating patient's preferences; setting goals with patients, taking into account personal needs and what is medically advisable; linking the needs of the patient with multidisciplinary professional treatment and vice versa; and thus, playing an intermediate role and supporting goal achievement. CONCLUSIONS The interventions show that in goal-centred care, the nurse might play an important unifying role between patients and the multidisciplinary team. With the support of nurses, the patient may become more aware of the rehabilitation process and transfer of ownership of treatment goals from the multidisciplinary team to the patient might be achieved. Not many interventions were found meant to support the nursing role. This may indicate a blind spot in the rehabilitation community to the additional value of its contribution.
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Affiliation(s)
- Anne Marie Vaalburg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Petra Boersma
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Elizabeth M Wattel
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, Netherlands
- University Network of Organizations for Care for Older People of Amsterdam University Medical Centers (UNO Amsterdam), Amsterdam, Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, Netherlands
- University Network of Organizations for Care for Older People of Amsterdam University Medical Centers (UNO Amsterdam), Amsterdam, Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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13
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van der Ploeg T, Gobbens RJJ, Salem BE. Bayesian Techniques in Predicting Frailty among Community-Dwelling Older Adults in the Netherlands. Arch Gerontol Geriatr 2023; 105:104836. [PMID: 36343439 DOI: 10.1016/j.archger.2022.104836] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
Background Frailty is a syndrome that is defined as an accumulation of deficits in physical, psychological, and social domains. On a global scale, there is an urgent need to create frailty-ready healthcare systems due to the healthcare burden that frailty confers on systems and the increased risk of falls, healthcare utilization, disability, and premature mortality. Several studies have been conducted to develop prediction models for predicting frailty. Most studies used logistic regression as a technique to develop a prediction model. One area that has experienced significant growth is the application of Bayesian techniques, partly due to an increasing number of practitioners valuing the Bayesian paradigm as matching that of scientific discovery. Objective We compared ten different Bayesian networks as proposed by ten experts in the field of frail elderly people to predict frailty with a choice from ten dichotomized determinants for frailty. Methods We used the opinion of ten experts who could indicate, using an empty Bayesian network graph, the important predictors for frailty and the interactions between the different predictors. The candidate predictors were age, sex, marital status, ethnicity, education, income, lifestyle, multimorbidity, life events, and home living environment. The ten Bayesian network models were evaluated in terms of their ability to predict frailty. For the evaluation, we used the data of 479 participants that filled in the Tilburg Frailty indicator (TFI) questionnaire for assessing frailty among community-dwelling older people. The data set contained the aforementioned variables and the outcome "frail". The model fit of each model was measured using the Akaike information criterion (AIC) and the predictive performance of the models was measured using the area under the curve (AUC) of the receiver operator characteristic (ROC). The AUCs of the models were validated using bootstrapping with 100 repetitions. The relative importance of the predictors in the models was calculated using the permutation feature importance algorithm (PFI). Results The ten Bayesian networks of the ten experts differed considerably regarding the predictors and the connections between the predictors and the outcome. However, all ten networks had corrected AUCs >0.700. Evaluating the importance of the predictors in each model, "diseases or chronic disorders" was the most important predictor in all models (10 times). The predictors "lifestyle" and "monthly income" were also often present in the models (both 6 times). One or more diseases or chronic disorders, an unhealthy lifestyle, and a monthly income below 1800 euro increased the likelihood of frailty. Conclusions Although the ten experts all made different graphs, the predictive performance was always satisfying (AUCs >0.700). While it is true that the predictor importance varied all the time, the top three of the predictor importance consisted of "diseases or chronic disorders", "lifestyle" and "monthly income". All in all, asking for the opinion of experts in the field of frail elderly to predict frailty with Bayesian networks may be more rewarding than a data-driven forecast with Bayesian networks because they have expert knowledge regarding interactions between the different predictors.
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Affiliation(s)
- Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, the Netherlands
| | - Benissa E Salem
- School of Nursing, University of California, Los Angeles, USA
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14
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Gobbens RJJ, Uchmanowicz I. Frailty Viewed From a Nursing Perspective. SAGE Open Nurs 2023; 9:23779608221150598. [PMID: 36636626 PMCID: PMC9829991 DOI: 10.1177/23779608221150598] [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: 07/25/2022] [Revised: 11/18/2022] [Accepted: 12/24/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction More and more researchers are convinced that frailty should refer not only to physical limitations but also to psychological and social limitations that older people may have. Such a broad, or multidimensional, definition of frailty fits better with nursing, in which a holistic view of human beings, and thus their total functioning, is the starting point. Purpose In this article, which should be considered a Practice Update, we aim at emphasizing the importance of the inclusion of other domains of human functioning in the definition and measurement of frailty. In addition, we provide a description of how district nurses view frailty in older people. Finally, we present interventions that nurses can perform to prevent or delay frailty or its adverse outcomes. We present, in particular, results from studies in which the Tilburg Frailty Indicator, a multidimensional frailty instrument, was used. Conclusion The importance of a multidimensional assessment of frailty was demonstrated by usually satisfactory results concerning adverse outcomes of mortality, disability, an increase in healthcare utilization, and lower quality of life. Not many studies have been performed on nurses' opinions about frailty. Starting from a multidimensional definition of frailty, encompassing physical, psychological, and social domains, nurses are able to assess and diagnose frailty and conduct a variety of interventions to prevent or reduce frailty and its adverse effects. Because nurses come into frequent contact with frail older people, we recommend future studies on opinions of nurses about frailty (e.g., screening, prevention, and addressing).
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Affiliation(s)
- Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of
Applied Sciences, Amsterdam, the Netherlands,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands,Department of Family Medicine and Population Health, Faculty of
Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg
University, Tilburg, the Netherlands,Robbert J. J. Gobbens, Faculty of Health,
Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan
1109, 1081 HV Amsterdam, the Netherlands.
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences,
Wroclaw
Medical University, Wroclaw, Poland,Institute of Heart Diseases, University Hospital, Wroclaw,
Poland
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15
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van der Ploeg T, Gobbens RJJ. Prediction of COVID-19 Infections for Municipalities in the Netherlands: Algorithm Development and Interpretation. JMIR Public Health Surveill 2022; 8:e38450. [PMID: 36 PMCID: PMC9586255 DOI: 10.2196/38450] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/14/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background COVID-19 was first identified in December 2019 in the city of Wuhan, China. The virus quickly spread and was declared a pandemic on March 11, 2020. After infection, symptoms such as fever, a (dry) cough, nasal congestion, and fatigue can develop. In some cases, the virus causes severe complications such as pneumonia and dyspnea and could result in death. The virus also spread rapidly in the Netherlands, a small and densely populated country with an aging population. Health care in the Netherlands is of a high standard, but there were nevertheless problems with hospital capacity, such as the number of available beds and staff. There were also regions and municipalities that were hit harder than others. In the Netherlands, there are important data sources available for daily COVID-19 numbers and information about municipalities. Objective We aimed to predict the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands, using a data set with the properties of 355 municipalities in the Netherlands and advanced modeling techniques. Methods We collected relevant static data per municipality from data sources that were available in the Dutch public domain and merged these data with the dynamic daily number of infections from January 1, 2020, to May 9, 2021, resulting in a data set with 355 municipalities in the Netherlands and variables grouped into 20 topics. The modeling techniques random forest and multiple fractional polynomials were used to construct a prediction model for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands. Results The final prediction model had an R2 of 0.63. Important properties for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality in the Netherlands were exposure to particulate matter with diameters <10 μm (PM10) in the air, the percentage of Labour party voters, and the number of children in a household. Conclusions Data about municipality properties in relation to the cumulative number of confirmed infections in a municipality in the Netherlands can give insight into the most important properties of a municipality for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality. This insight can provide policy makers with tools to cope with COVID-19 and may also be of value in the event of a future pandemic, so that municipalities are better prepared.
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Affiliation(s)
- Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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16
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Song X, Hallensleben C, Shen H, Zhang W, Gobbens RJJ, Chavannes NH, Versluis A. REducing delay through edUcation on eXacerbations for people with chronic lung disease: Study protocol of a single-arm pre-post study. J Adv Nurs 2022; 78:2656-2663. [PMID: 35621365 PMCID: PMC9544068 DOI: 10.1111/jan.15311] [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] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/31/2022] [Accepted: 05/07/2022] [Indexed: 12/01/2022]
Abstract
AIM This study protocol aims to examine the effectiveness and preconditions of a self-management program-named REducing Delay through edUcation on eXacerbations (REDUX)-in China. BACKGROUND The high disease burden in people with chronic lung disease is mainly due to exacerbations. There is a need for effective exacerbation-management interventions. A nurse-led program, REDUX, helped patients self-manage exacerbations. DESIGN A single-arm pre-post study. METHODS Fifty-four patients and 24 healthcare professionals (HCPs) in Chinese primary care will be included. The core element of the program is a personalized action plan. HCPs will receive training in using the action plan to help patients manage exacerbations. The intervention will start when a patient is referred to the nurse for a post-exacerbation consultation and ends when the patient presents for the second post-exacerbation consultation. During the first post-exacerbation consultation, the patient and nurse will create the action plan. The primary outcomes in patients will include the delays between the onset of exacerbation and recognition, between exacerbation recognition and action, between exacerbation recognition and consultation with a doctor, and when the patients feel better after receiving medical help from HCPs. The secondary outcomes will include preconditions of the program. The ethics approval was obtained in September 2021. DISCUSSION This study will discuss a culturally adapted nurse-led self-management intervention for people with chronic lung disease in China. The intervention could help Chinese HCPs provide efficient care and reduce their workload. Furthermore, it will inform future research on tailoring nurse-led self-management interventions in different contexts. IMPACT The study will contribute to the evidence on the effectiveness and preconditions of REDUX in China. If effective, the result will assist the nursing of people with chronic lung disease. TRIAL REGISTRATION Registered in the Chinese clinical trial registry (ID: 2100051782).
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Affiliation(s)
- Xiaoyue Song
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands.,Faculty of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Hongxia Shen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Weihong Zhang
- Faculty of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Niels H Chavannes
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
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17
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van Wieringen M, Kee K, Gobbens RJJ, Nies H, Beersma B, Groenewegen P. Exploring crucial programme characteristics and group mechanisms of an empowerment programme for certified nursing assistants-A qualitative study. J Adv Nurs 2022; 78:2949-2959. [PMID: 35396871 PMCID: PMC9544706 DOI: 10.1111/jan.15259] [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: 04/18/2021] [Revised: 02/24/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
Aims To identify crucial programme characteristics and group mechanisms of, and lessons learned from hindrances in an empowerment programme for certified nursing assistants and contribute to the development of similar programmes in other care settings. Design Exploratory qualitative study. Methods Between May 2017 and September 2020, we used in‐depth interviews and participant observations to study four groups participating in an empowerment programme for certified nursing assistants (N = 44). Results We identified three crucial empowerment‐enhancing programme characteristics: (1) inviting participants to move outside their comfort zone of caregiving; (2) stimulating the use of untapped talents, competencies and interests; (3) supporting the rediscovery of participants' occupational role and worth. Crucial group mechanisms encompassed learning from and with each other, as well as mechanisms of self‐correction and self‐motivation. Hindrances included a perceived lack of direction, and a lack of organizational support and facilitation. Conclusion We showed the significance of creating an inviting and stimulating environment in which participants can explore and function in ways they otherwise would not. Likewise, we identified how this can help participants learn from, critically correct and motivate one another. Impact The programme under study was uniquely aimed to empower certified nursing assistants. Our insights on crucial programme characteristics and group mechanisms may benefit those who develop empowerment programmes, but also policymakers and managers in supporting certified nursing assistants and other nursing professions in empowerment endeavours. Such empowerment may enhance employee retention and make occupational members more likely to address challenges affecting their occupational group and the long‐term care sector.
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Affiliation(s)
| | - Karin Kee
- Department of Organization Sciences, VU Amsterdam, Amsterdam, the Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Faculty of Medicine and Health Sciences, Department Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Henk Nies
- Department of Organization Sciences, VU Amsterdam, Amsterdam, the Netherlands.,Director Strategy and Development, Vilans Centre of Expertise for Long-term Care, the Netherlands
| | - Bianca Beersma
- Department of Organization Sciences, VU Amsterdam, Amsterdam, the Netherlands
| | - Peter Groenewegen
- Department of Organization Sciences, VU Amsterdam, Amsterdam, the Netherlands
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18
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Uchmanowicz I, Pasieczna AH, Wójta-Kempa M, Gobbens RJJ, Młynarska A, Faulkner KM, Czapla M, Szczepanowski R. Physical, Psychological and Social Frailty Are Predictive of Heart Failure: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11030565. [PMID: 35160017 PMCID: PMC8836458 DOI: 10.3390/jcm11030565] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Little is known about frailty among patients hospitalized with heart failure (HF). To date, the limited information on frailty in HF is based on a unidimensional view of frailty, in which only physical aspects are considered when determining frailty. The aims of this study were to study different dimensions of frailty (physical, psychological and social) in patients with HF and the effect of different dimensions of frailty on the incidence of heart failure. Methods: The study used a cross-sectional design and included 965 patients hospitalized for heart failure and 164 healthy controls. HF was defined according to the ESC guidelines. The Tilburg Frailty Indicator (TFI) was used to assess frailty. Probit regression analyses and chi-square statistics were used to examine associations between the occurrence of heart failure and TFI domains of frailty. Results: Patients diagnosed with frailty were 15.3% more likely to develop HF compared to those not diagnosed with frailty (p < 0.001). An increase in physical, psychological and social frailty corresponded to an increased risk of HF of 2.9% (p < 0.001), 4.4% (p < 0.001) and 6.6% (p < 0.001), respectively. Conclusions: We found evidence of the association between different dimensions of frailty and incidence of HF.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wrocław, Poland;
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | | | - Monika Wójta-Kempa
- Department of Health Humanities and Social Science, Wroclaw Medical University, 51-618 Wrocław, Poland;
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland;
| | | | - Michał Czapla
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Correspondence:
| | - Remigiusz Szczepanowski
- Department of Computer Science and Systems Engineering, Wrocław University of Science and Technology, 50-370 Wrocław, Poland;
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van der Heijden EM, Klüter WJ, van der Maarel-Wierink CD, Gobbens RJJ. Exploring associations between multidimensional frailty and oral health in community-dwelling older people. A pilot study. Spec Care Dentist 2022; 42:361-368. [PMID: 35014046 PMCID: PMC9545350 DOI: 10.1111/scd.12691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/26/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 12/02/2022]
Abstract
Objective To determine the associations between four validated multidimensional self‐report frailty scales and nine indices of oral health in community‐dwelling older persons. Materials and Methods This pilot study was conducted in a sample of 208 older persons aged 70 years and older who visited two dental practices in the Netherlands. Frailty status was measured by four different self‐report frailty questionnaires: Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), Sunfrail Checklist (SC), and the Sherbrooke Postal Questionnaire (SPQ). Oral health was assessed by two calibrated examiners. Results The prevalence of frailty according to the four frailty measures TFI, GFI, SC, and SPQ was 32.8%, 31.5%, 24.5%, and 49.7%, respectively. The SC correlated with four oral health variables (DMFT, number of teeth, percentage of occlusal contacts, Plaque Index), the TFI with three (number of teeth, percentage of occlusal contacts, Plaque Index), the GFI only with DPSI, and the SPQ with the number of teeth and the number of occlusal contacts. Conclusion Of the studied multidimensional frailty scales, the SC and TFI were correlated with most oral health variables (four and three, respectively). However, it should be noticed that these correlations were small. Clinical relevance The SC and TFI might help to identify older people with risk of poor oral health so that preventive care can be used to ensure deterioration of oral health and maintenance of quality of life. Vice versa early detection of frailty by oral care professionals could contribute to interprofessional management of frailty.
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Affiliation(s)
| | - Wim J Klüter
- BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, Netherlands.,College of Dental Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Claar D van der Maarel-Wierink
- BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, Netherlands.,Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Robbert J J Gobbens
- BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, Netherlands.,Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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20
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van Assen MALM, Helmink JHM, Gobbens RJJ. Associations between lifestyle factors and multidimensional frailty: a cross-sectional study among community-dwelling older people. BMC Geriatr 2022; 22:7. [PMID: 34979945 PMCID: PMC8722011 DOI: 10.1186/s12877-021-02704-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 05/30/2021] [Accepted: 11/24/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Multidimensional frailty, including physical, psychological, and social components, is associated to disability, lower quality of life, increased healthcare utilization, and mortality. In order to prevent or delay frailty, more knowledge of its determinants is necessary; one of these determinants is lifestyle. The aim of this study is to determine the association between lifestyle factors smoking, alcohol use, nutrition, physical activity, and multidimensional frailty. METHODS This cross-sectional study was conducted in two samples comprising in total 45,336 Dutch community-dwelling individuals aged 65 years or older. These samples completed a questionnaire including questions about smoking, alcohol use, physical activity, sociodemographic factors (both samples), and nutrition (one sample). Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). RESULTS Higher alcohol consumption, physical activity, healthy nutrition, and less smoking were associated with less total, physical, psychological and social frailty after controlling for effects of other lifestyle factors and sociodemographic characteristics of the participants (age, gender, marital status, education, income). Effects of physical activity on total and physical frailty were up to considerable, whereas the effects of other lifestyle factors on frailty were small. CONCLUSIONS The four lifestyle factors were not only associated with physical frailty but also with psychological and social frailty. The different associations of frailty domains with lifestyle factors emphasize the importance of assessing frailty broadly and thus to pay attention to the multidimensional nature of this concept. The findings offer healthcare professionals starting points for interventions with the purpose to prevent or delay the onset of frailty, so community-dwelling older people have the possibility to aging in place accompanied by a good quality of life.
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Affiliation(s)
- Marcel A L M van Assen
- Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.,Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081, HV, Amsterdam, the Netherlands. .,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands. .,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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21
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Rezaei-Shahsavarloo Z, Atashzadeh-Shoorideh F, Ebadi A, Gobbens RJJ. Factors affecting missed nursing care in hospitalized frail older adults in the medical wards: a qualitative study. BMC Geriatr 2021; 21:555. [PMID: 34649518 PMCID: PMC8515677 DOI: 10.1186/s12877-021-02524-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units. METHODS This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba. RESULTS In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as "age-unfriendly structure," "inefficient care," and "frailty of older adults" could increase the risk of MNC. In addition, factors such as "support capabilities" and "ethical and legal requirements" will moderate MNC. CONCLUSIONS Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.
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Affiliation(s)
- Zahra Rezaei-Shahsavarloo
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing & Management, School of Nursing and Midwifery, Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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22
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Albers M, Gobbens RJJ, Reitsma M, Timmermans OAAMJ, Nies HLGR. Learning and innovation network in nursing: A concept analysis. Nurse Educ Today 2021; 104:104988. [PMID: 34246837 DOI: 10.1016/j.nedt.2021.104988] [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] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Approximately 4 years ago a new concept of learning in practice called the 'Learning and Innovation Network (LIN)' was introduced in The Netherlands. To develop a definition of the LIN, to identify working elements of the LIN in order to provide a preliminary framework for evaluation, a concept analysis was conducted. METHOD For the concept analysis, we adopted the method of Walker and Avant. We searched for relevant publications in the EBSCO host portal, grey literature and snowball searches, as well as Google internet searches and dictionary consults. RESULTS Compared to other forms of workplace learning, the LIN is in the centre of the research, education and practice triangle. The most important attributes of the LIN are social learning, innovation, daily practice, reflection and co-production. Often described antecedents are societal developments, such as increasing complexity of work, and time and space to learn. Frequently identified consequences are an attractive workplace, advancements of expertise of care professionals, innovations that endorse daily practice, improvement of quality of care and the integration of education and practice. CONCLUSIONS Based on the results of the concept analysis, we describe the LIN as 'a group of care professionals, students and an education representatives who come together in clinical practice and are all part of a learning and innovation community in nursing. They work together on practice-based projects in which they combine best practices, research evidence and client perspectives in order to innovate and improve quality of care and in which an integration of education, research and practice takes place'. We transferred the outcomes of the concept analysis to an input-throughput-output model that can be used as a preliminary framework for future research.
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Affiliation(s)
- M Albers
- Faculty of Health, Sports and Social Work, Inholland University of Apllied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, the Netherlands; Faculty of Social Sciences and Organization Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
| | - R J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Apllied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Groenelaan 7, 1186 AA Amstelveen, the Netherlands; Faculty of Medicine and Health Sciences, Department Family Medicine and Population Health, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - M Reitsma
- Vilans, National Centre of Expertise for Long-term Care, Churchilllaan 11, 3527 GV Utrecht, the Netherlands.
| | - O A A M J Timmermans
- Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Research Group Healthy Region, HZ University of Applied Sciences, Edisonweg 4, 4282 NW Vlissingen, the Netherlands.
| | - H L G R Nies
- Vilans, National Centre of Expertise for Long-term Care, Churchilllaan 11, 3527 GV Utrecht, the Netherlands; Faculty of Social Sciences and Organization Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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Gobbens RJJ, van der Ploeg T. Frailty at Risk Scale (FARS): development and application. Eur J Ageing 2021; 19:301-308. [DOI: 10.1007/s10433-021-00628-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 10/21/2022] Open
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Song X, Hallensleben C, Zhang W, Jiang Z, Shen H, Gobbens RJJ, Kleij RMJJVD, Chavannes NH, Versluis A. Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e24602. [PMID: 33788700 PMCID: PMC8047793 DOI: 10.2196/24602] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 12/22/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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Affiliation(s)
- Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Weihong Zhang
- Faculty of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zongliang Jiang
- Faculty of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Gobbens RJJ, van der Ploeg T. The Development of Multidimensional Frailty Over Seven Years A longitudinal study among Dutch community-dwelling older people using the Tilburg Frailty Indicator. Arch Gerontol Geriatr 2021; 95:104393. [PMID: 33752100 DOI: 10.1016/j.archger.2021.104393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/06/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To examine the development of multidimensional frailty, including physical, psychological and social components, over a period of seven years. To determine the effects of sociodemographic factors (gender, age, marital status, education, income) on the development of frailty. METHODS This longitudinal study was conducted in sample of 479 community-dwelling people aged ≥ 75 years living in the municipality of Roosendaal, the Netherlands. The Tilburg Frailty Indicator (TFI), a self-report questionnaire, was used to collect data about frailty. Frailty was assessed annually. RESULTS Frailty increased significantly over seven years among the people who completed the entire TFI all years (n = 121), the average score was 3.75 (SD 2.80) at baseline and 5.05 (SD 3.18) after seven years. Regarding frailty transitions, most participants remained unchanged from their baseline status. The transition from non-frail to frail was present in 8.3% to 12.6% of the participants and 5.1% to 10.7% made a transition from frail to non-frail. Gender (woman), age (≥80 years), marital status (not married/cohabiting), high level of education, and incomes from €601-€1800 were significantly associated with a higher frailty score. CONCLUSION This study showed that multidimensional frailty, assessed with the TFI, increased among Dutch community-dwelling people aged ≥75 years using a follow-up of seven years. Gender, age, marital status, education, and income were associated with frailty transitions. These findings provide healthcare professionals clues to identify people at increased risk of frailty, and target interventions which aim to prevent or delay frailty and its adverse outcomes, such as disability and mortality.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Tjeerd van der Ploeg
- Engineering, Design and Computer technology, Inholland University of Applied Sciences, Alkmaar, the Netherlands
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Rezaei-Shahsavarloo Z, Atashzadeh-Shoorideh F, Gobbens RJJ, Ebadi A, Ghaedamini Harouni G. The impact of interventions on management of frailty in hospitalized frail older adults: a systematic review and meta-analysis. BMC Geriatr 2020; 20:526. [PMID: 33272208 PMCID: PMC7712609 DOI: 10.1186/s12877-020-01935-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 06/19/2020] [Accepted: 11/26/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND One of the most challenging issues for the elderly population is the clinical state of frailty. Frailty is defined as a cumulative decline across psychological, physical, and social functioning. Hospitalization is one of the most stressful events for older people who are becoming frail. The aim of the present study was to determine the effectiveness of interventions focused on management of frailty in hospitalized frail older adults. METHODS A systematic review and meta-analysis of research was conducted using the Medline, Embase, Cochrane, ProQuest, CINAHL, SCOPUS and Web of Science electronic databases for papers published between 2000 and 2019. Randomized controlled studies were included that were aimed at the management of frailty in hospitalized older adults. The outcomes which were examined included frailty; physical, psychological, and social domains; length of stay in hospital; re-hospitalization; mortality; patient satisfaction; and the need for post discharge placement. RESULTS After screening 7976 records and 243 full-text articles, seven studies (3 interventions) were included, involving 1009 hospitalized older patients. The quality of these studies was fair to poor and the risk of publication bias in the studies was low. Meta-analysis of the studies showed statistically significant differences between the intervention and control groups for the management of frailty in hospitalized older adults (ES = 0.35; 95% CI: 0. 067-0.632; z = 2.43; P < 0.015). However, none of the included studies evaluated social status, only a few of the studies evaluated other secondary outcomes. The analysis also showed that a Comprehensive Geriatric Assessment unit intervention was effective in addressing physical and psychological frailty, re-hospitalization, mortality, and patient satisfaction. CONCLUSIONS Interventions for hospitalized frail older adults are effective in management of frailty. Multidimensional interventions conducted by a multidisciplinary specialist team in geriatric settings are likely to be effective in the care of hospitalized frail elderly. Due to the low number of RCTs carried out in a hospital setting and the low quality of existing studies, there is a need for new RCTs to be carried out to generate a protocol appropriate for frail older people.
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Affiliation(s)
- Zahra Rezaei-Shahsavarloo
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life style institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Gobbens RJJ, Maggio M, Longobucco Y, Barbolini M. The Validity of the SUNFRAIL Tool: A Cross-Sectional Study among Dutch Community-Dwelling Older People. J Frailty Aging 2020; 9:219-225. [PMID: 32996558 DOI: 10.14283/jfa.2020.4] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Early detection of frail older people is important. Timely intervention may allow health care professionals to prevent or delay the occurrence of adverse outcomes such as disability, increases in health care utilization, and premature death. OBJECTIVES We assessed the construct and criterion validity of the SUNFRAIL tool, a questionnaire for measuring frailty among older people. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study was carried out in a sample of Dutch citizens. A total of 195 community-dwelling persons aged 71 years and older completed the questionnaire. MEASUREMENTS Construct validity was examined by determining the correlation between the SUNFRAIL tool and the Tilburg Frailty Indicator (TFI). Criterion validity for the SUNFRAIL tool was determined by establishing the correlations with chronic diseases and adverse outcomes of frailty (disability, falls, indicators of health care utilization). Disability was measured using the Groningen Activity Restriction Scale. Participants also answered questions regarding falls and health care utilization. RESULTS The construct validity of this tool was good and showed significant correlations with the TFI. The correlation between SUNFRAIL total and TFI total was 0.624. The criterion validity of the SUNFRAIL tool was good for chronic diseases and good-to-excellent for adverse outcomes disability, receiving nursing care, and falls. The area under the curve for these outcomes was 0.840 (95% CI 0.781-0.899), 0.782 (95% CI 0.696-0.868), and 0.769 (95% CI 0.686-0.859), respectively. CONCLUSIONS The results of our study suggest that the SUNFRAIL tool is a valid instrument for assessing frailty in community-dwelling older people. It is an attractive instrument for use in practice because it takes little time for health care professionals and older people to complete the questionnaire, and it expresses the integral functioning of human beings.
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Affiliation(s)
- R J J Gobbens
- Robbert J.J. Gobbens, Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, the Netherlands, E-mail: ; phone: +31 6 21115578
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Gobbens RJJ, van der Ploeg T. The Prediction of Mortality by Disability Among Dutch Community-Dwelling Older People. Clin Interv Aging 2020; 15:1897-1906. [PMID: 33116444 PMCID: PMC7547136 DOI: 10.2147/cia.s271800] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/11/2020] [Accepted: 08/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To predict mortality by disability in a sample of 479 Dutch community-dwelling people aged 75 years or older. Methods A longitudinal study was carried out using a follow-up of seven years. The Groningen Activity Restriction Scale (GARS), a self-reported questionnaire with good psychometric properties, was used for data collection about total disability, disability in activities in daily living (ADL) and disability in instrumental activities in daily living (IADL). The mortality dates were provided by the municipality of Roosendaal (a city in the Netherlands). For analyses of survival, we used Kaplan–Meier analyses and Cox regression analyses to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results All three disability variables (total, ADL and IADL) predicted mortality, unadjusted and adjusted for age and gender. The unadjusted HRs for total, ADL and IADL disability were 1.054 (95%-CI: [1.039;1.069]), 1.091 (95%-CI: [1.062;1.121]) and 1.106 (95%-CI: [1.077;1.135]) with p-values <0.001, respectively. The AUCs were <0.7, ranging from 0.630 (ADL) to 0.668 (IADL). Multivariate analyses including all 18 disability items revealed that only “Do the shopping” predicted mortality. In addition, multivariate analyses focusing on 11 ADL items and 7 IADL items separately showed that only the ADL item “Get around in the house” and the IADL item “Do the shopping” significantly predicted mortality. Conclusion Disability predicted mortality in a seven years follow-up among Dutch community-dwelling older people. It is important that healthcare professionals are aware of disability at early stages, so they can intervene swiftly, efficiently and effectively, to maintain or enhance the quality of life of older people.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tjeerd van der Ploeg
- Faculty of Engineering, Design and Computer Technology, Inholland University of Applied Sciences, Alkmaar, the Netherlands
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Mazoochi F, Gobbens RJJ, Lotfi MS, Fadayevatan R. Diagnostic accuracy of the Tilburg Frailty Indicator (TFI) for early frailty detection in elderly people in Iran. Arch Gerontol Geriatr 2020; 91:104187. [PMID: 32777633 DOI: 10.1016/j.archger.2020.104187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/16/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
AIM Screening is one of the most important ways for early frailty detection that contributes to its prevention and timely treatment. The aim of this study was to determine the diagnostic value of the Persian version of the Tilburg Frailty Indicator (P-TFI) in the frailty screening. METHOD This is a diagnostic test accuracy study that uses known group method. It was designed based on a STARD statement and performed on 175 elderly people in the City of Kashan, Iran. The subjects were selected among older people available in health centers affiliated to Kashan University of Medical Sciences using purposive sampling. Data analysis was carried out using SPSS v16. Descriptive statistics were used to describe the characteristics of the research subjects. Independent t-test was used to determine the ability of the P-TFI to discriminate frail and non-frail individuals, and to evaluate the cut-off point and instrument accuracy, the receiver operating characteristic (ROC) curve was used. The best cut-off point was determined among the proposed points using Youden index. At the determined cut-off point, the diagnostic value parameters of the P-TFI (sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, accuracy, and diagnostic odds ratio) were calculated and their range was estimated with 95 % confidence interval. FINDINGS A total of 74.3 % of the sample was male and their mean age was 68.6 ± 54.44 years. The area under the ROC curve was calculated 0.922, indicating high accuracy of the instrument. The sensitivity and specificity of this instrument at the cut-off point of 4.5 were 0.95 and 0.86, respectively. Positive and negative predictive values were calculated 0.68 and 0.98, respectively, and the accuracy of the instrument was reported to be 0.88. CONCLUSION The P-TFI can be used as a sensitive and accurate instrument, which is highly applicable to screen frailty in older people.
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Affiliation(s)
- Faezeh Mazoochi
- Iranian Research Center on Ageing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Robbert J J Gobbens
- Rotterdam University of Applied Sciences, Museumpark 40, 3015 CX, Rotterdam, the Netherlands; Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.; Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mohammad-Sajjad Lotfi
- Iranian Research Center on Ageing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Fadayevatan
- Iranian Research Center on Ageing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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Song X, Zhang W, Hallensleben C, Versluis A, van der Kleij R, Jiang Z, Chavannes NH, Gobbens RJJ. Associations Between Obesity and Multidimensional Frailty in Older Chinese People with Hypertension. Clin Interv Aging 2020; 15:811-820. [PMID: 32606623 PMCID: PMC7294100 DOI: 10.2147/cia.s234815] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 10/16/2019] [Accepted: 04/11/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose To investigate the prevalence of multidimensional frailty in older people with hypertension and to examine a possible relationship of general obesity and abdominal obesity to frailty in older people with hypertension. Patients and Methods A sample of 995 community-dwelling older people with hypertension, aged 65 years and older and living in Zhengzhou (China), completed the Tilburg Frailty Indicator (TFI), a validated self-report questionnaire for assessing multidimensional frailty. In addition, socio-demographic and lifestyle characteristics were assessed by self-report, and obesity was determined by measuring waist circumference and calculating the body mass index. Results The prevalence of multidimensional frailty in this older population with hypertension was 46.5%. Using multiple linear regression analysis, body mass index was significantly associated with physical frailty (p = 0.001), and waist circumference was significantly positively associated with multidimensional frailty and all three frailty domains. Older age was positively associated with multidimensional frailty, physical frailty, and psychological frailty, while gender (woman) was positively associated with multidimensional, psychological, and social frailty. Furthermore, comorbid diseases and being without a partner were positively associated with multidimensional, physical, psychological, and social frailty. Of the lifestyle characteristics, drinking alcohol was positively associated with frailty domains. Conclusion Multidimensional frailty was highly prevalent among Chinese community-dwelling older people with hypertension. Abdominal obesity could be a concern in physical frailty, psychological frailty, and social frailty, while general obesity was concerning in relation to physical frailty.
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Affiliation(s)
- Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden 2333 ZD, The Netherlands.,School of Nursing, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Weihong Zhang
- School of Nursing, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden 2333 ZD, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden 2333 ZD, The Netherlands
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden 2333 ZD, The Netherlands
| | - Zongliang Jiang
- School of Nursing, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden 2333 ZD, The Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Obbia P, Graham C, Duffy FJR, Gobbens RJJ. Preventing frailty in older people: An exploration of primary care professionals' experiences. Int J Older People Nurs 2019; 15:e12297. [DOI: 10.1111/opn.12297] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 11/15/2019] [Accepted: 11/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Paola Obbia
- Piedmont Region Health Service Local Health Agency ASLCN1 Cuneo Italy
- Department of Clinical and Biological Sciences University of Turin Turin Italy
| | - Clair Graham
- School of Health and Life Sciences University of the West of Scotland Lanarkshire Campus UK
| | - F. J. Raymond Duffy
- School of Health and Life Sciences University of the West of Scotland Lanarkshire Campus UK
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work Inholland University of Applied Sciences Amsterdam The Netherlands
- Zonnehuisgroep Amstelland Amstelveen The Netherlands
- Department of Primary and Interdisciplinary Care Faculty of Medicine and Health Sciences University of Antwerp Antwerp Belgium
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Gobbens RJJ. Cross-sectional and Longitudinal Associations of Environmental Factors with Frailty and Disability in Older People. Arch Gerontol Geriatr 2019; 85:103901. [PMID: 31352186 DOI: 10.1016/j.archger.2019.103901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine cross-sectional and longitudinal associations of environmental factors with frailty and disability. METHODS This study was conducted in a sample of Dutch citizens. At baseline the sample consisted of 429 subjects (aged ≥ 65 years); a subset of this sample participated again two and half years later (N = 355). The participants completed a web-based questionnaire, "the Senioren Barometer", comprising seven scales for assessing environmental factors, and the Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS), for assessing frailty and disability, respectively. Environmental factors of interest were: nuisance; housing; facilities; residents; neighborhood; stench/noise; and traffic. RESULTS Sequential regression analyses demonstrated that all environmental factors together explained a significant part of the variance of physical and social frailty and disability in performing activities of daily living (ADL) and instrumental activities of daily living (IADL), measured at Time 1 (T1) and Time 2 (T2). These analyses also showed that four of the environmental factors were associated with at least one of the outcome measures: housing, nuisance, residents, and neighborhood. Housing was the only environmental factor associated with three different outcome measures (social frailty, ADL disability, IADL disability), assessed at T1 and T2. CONCLUSION The findings offer health-care and welfare professionals and also policymakers starting points for interventions. These interventions should focus, in particular, on housing, nuisance, residents, and neighborhood, because their impact on frailty and/or disability was the largest.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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van Rijckevorsel-Scheele J, Willems RCWJ, Roelofs PDDM, Koppelaar E, Gobbens RJJ, Goumans MJBM. Effects of health care interventions on quality of life among frail elderly: a systematized review. Clin Interv Aging 2019; 14:643-658. [PMID: 31040654 PMCID: PMC6453553 DOI: 10.2147/cia.s190425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 01/10/2023] Open
Abstract
Introduction Many health care interventions have been developed that aim to improve or maintain the quality of life for frail elderly. A clear overview of these health care interventions for frail elderly and their effects on quality of life is missing. Purpose To provide a systematic overview of the effect of health care interventions on quality of life of frail elderly. Methods A systematic search was conducted in Embase, Medline (OvidSP), Cochrane Central, Cinahl, PsycInfo and Web of Science, up to and including November 2017. Studies describing health care interventions for frail elderly were included if the effect of the intervention on quality of life was described. The effects of the interventions on quality of life were described in an overview of the included studies. Results In total 4,853 potentially relevant articles were screened for relevance, of which 19 intervention studies met the inclusion criteria. The studies were very heterogeneous in the design: measurement of frailty, health care intervention and outcome measurement differ. Health care interventions described were: multidisciplinary treatment, exercise programs, testosterone gel, nurse home visits and acupuncture. Seven of the nineteen intervention studies, describing different health care interventions, reported a statistically significant effect on subdomains of quality of life, two studies reported a statistically significant effect of the intervention on the overall quality of life score. Ten studies reported no statistically significant difference between the intervention and control groups. Conclusion Reported effects of health care interventions on frail elderly persons' quality of life are inconsistent, with most of the studies reporting no differences between the intervention and control groups. As the number of frail elderly persons in the population will continue to grow, it will be important to continue the search for effective health care interventions. Alignment of studies in design and outcome measurements is needed.
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Affiliation(s)
| | - Renate C W J Willems
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
| | - Pepijn D D M Roelofs
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
| | - Elin Koppelaar
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marleen J B M Goumans
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
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Santiago LM, Gobbens RJJ, Mattos IE, Ferreira DB. A comparison between physical and biopsychosocial measures of frailty: Prevalence and associated factors in Brazilian older adults. Arch Gerontol Geriatr 2018; 81:111-118. [PMID: 30553181 DOI: 10.1016/j.archger.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 09/18/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE To estimate the prevalence of frailty, according to Tilburg Frailty Indicator (TFI) and CHS index, to investigate the correlation between both instruments and to identify the factors associated with this condition in older users of primary health care. METHODS This is a sectional study with 302 individuals aged 60 years or more of Rio de Janeiro/Brazil. Sociodemographic, health, functional dependence and lifestyle variables were collected. Frailty was evaluated by the TFI (biopsychosocial frailty) and the CHS index (physical frailty). RESULTS The prevalence of frailty estimated by the TFI was 35.8% and by the CHS index was 23.5%, while 19.2% were considered frail by both instruments. Significant correlations were observed between the two measures (r = 0.675, p < 0.001) and between the CHS index and the physical (r = 0.744, p < 0.001) and psychological domains (r = 0.322, p < 0.001) of the TFI. Considering the TFI, sex, age, healthy lifestyle, osteoarticular diseases, stroke/ischemia and functional dependence in IADL were associated with frailty. By the CHS index, marital status, satisfaction with housing environment, osteoarticular diseases, medication, functional dependence in ADL and IADL were associated with frailty. CONCLUSION Our study demonstrates that the CHS index and the TFI identify different groups of frail older adults, and the factors associated with physical frailty and biopsychosocial frailty, also differ. Both instruments seem suitable to be used by primary health care professionals in Brazil. Nevertheless, we believe that a fully self-rated assessment is more practical to be applied routinely in this level of attention in the country.
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Affiliation(s)
- Lívia Maria Santiago
- Federal University of Rio de Janeiro, Faculty of Medicine, Rua Rodolpho Paulo Rocco, 255/ room 9E11, Cidade Universitária, 21941- 913, Rio de Janeiro, RJ, Brazil; National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan1109, 1081 HV, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Groenelaan 7, 1186 AA, Amstelveen, the Netherlands; Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Inês Echenique Mattos
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil.
| | - Daniele Bittencourt Ferreira
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil.
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Abstract
Objective To examine the relationship between frailty and pain, particularly to analyze whether pain predicts physical, psychological and social frailty, after controlling for the effects of life-course determinants and comorbidity. Design Cross-sectional. Methods A nonprobabilistic sample of 252 community dwelling elderly was recruited. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator and pain was measured with the Pain Impact Questionnaire. Hierarchical and logistic regression analyses were conducted. Results In this study, 52.4% of the participants were aged 80 years and over, and 75.8% were women. Pain and frailty were higher in women, and physical frailty was higher in those aged ≥80 years. After controlling for the effects of the determinants and comorbidity, pain predicted 5.8% of the variance of frailty, 5.9% of the variance of physical frailty, and 4.0% of the variance of psychological frailty, while the prediction of social frailty was nonsignificant. Overall, a greater pain impact score was associated with the presence of frailty (odds ratio 1.06; 95% CI 1.03–1.10; P < 0.001). Conclusion Frailty was independently predicted by pain, emphasizing the importance of its treatment, potentially contributing to the prevention of vulnerability, dependency, and mortality. Nonetheless, longitudinal studies are required to better understand the possible association between pain and frailty.
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Affiliation(s)
- Tiago Coelho
- Department of Occupational Therapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Vila Nova de Gaia, Portugal.,Department of Behaviour Sciences, UNIFAI/ICBAS, University of Porto, Porto, Portugal
| | - Constança Paúl
- Department of Behaviour Sciences, UNIFAI/ICBAS, University of Porto, Porto, Portugal
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental HealthCenter for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
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Santiago LM, Gobbens RJJ, van Assen MALM, Carmo CN, Ferreira DB, Mattos IE. Predictive validity of the Brazilian version of the Tilburg Frailty Indicator for adverse health outcomes in older adults. Arch Gerontol Geriatr 2018; 76:114-119. [PMID: 29494871 DOI: 10.1016/j.archger.2018.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/29/2018] [Accepted: 02/16/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aimed to determine the predictive value of the Brazilian Tilburg Frailty Indicator (TFI) for adverse health outcomes (falls, hospitalization, disability and death), in a follow-up period of twelve months. METHODS This longitudinal study was carried out with a sample of people using primary health care services in Rio de Janeiro, Brazil. At baseline the sample consisted of 963 people aged 60 years and older. A subset of all respondents participated again one year later (n = 640, 66.6% response rate). We used the TFI, the Katz's scale for assessing ADL disability and the Lawton Scale for assessing IADL disability. Falls, hospitalization and death were also assessed using a questionnaire. RESULTS The prevalence of frailty was 44.2% and the mean score of the TFI was 4.4 (SD = 3.0). There was a higher risk of loss in functional capacity in ADL (OR = 3.03, CI95% 1.45-6.29) and in IADL (OR = 1.51, CI95% 1.05-2.17), falls (OR = 2.08, CI95% 1.21-3.58), hospitalization (OR = 1.83, CI95% 1.10-3.06), and death (HR = 2.73, CI95% 1.04-7.19) for frail when compared to non-frail elderly, in the bivariate analyses. Controlling for the sociodemographic variables, the frailty domains together improved the prediction of hospitalization, falls and loss in functional capacity in ADL, but not loss in functional capacity in IADL. CONCLUSION The TFI is a good predictor of adverse health outcomes among elderly users of primary care services in Brazil and appears an adequate and easy to administer tool for monitoring their health conditions.
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Affiliation(s)
- Lívia Maria Santiago
- Federal University of Rio de Janeiro, Faculty of Medicine, Rua Rodolpho Paulo Rocco, 255/room 9E11, Cidade Universitária, Zip Code 21941- 913, Rio de Janeiro, RJ, Brazil; National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV, Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Groenelaan 7, 1186 AA, Amstelveen, The Netherlands; Department of General Practice, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Warandelaan 2, 90153, Tilburg University, Tilburg, The Netherlands; Department of Sociology, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands.
| | - Cleber Nascimento Carmo
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
| | - Daniele Bittencourt Ferreira
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
| | - Inês Echenique Mattos
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
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Abstract
BACKGROUND Geriatric rehabilitation concerns short-term integrated multidisciplinary care aimed at functional recovery and social participation for relatively frail elderly. Given the geriatric clients' complex care issues, nurses should possess sufficient and appropriate competencies in order to identify and assess the relevant symptoms and intervene effectively. Yet, nurses experience a certain apprehensiveness to perform their tasks and express difficulties in multidisciplinary communication and collaboration in a constructive manner. In addition to the client's and informal care giver's perception of their input in the geriatric rehabilitation process, this study provides an in-depth understanding of the way nurses perceive their role in geriatric rehabilitation. METHODS/DESIGN This descriptive study entails a quantitative and a qualitative component. The quantitative component concerns questionnaires for clients, informal care givers, nurses, and team leaders. The qualitative component aims to obtain in-depth information (i. e. opinions, meanings, and reflections) with regard to the decision making process and the performance of the rehabilitation care by means of open-ended questions (in the questionnaire) and semi-structured interviews. RESULTS Clients and informal care givers rate specific themes in geriatric rehabilitation in a more negative light than nurses and team leaders do. These themes concern the provision of information in the hospital (prior to admission in the rehabilitation facility), involvement in the draw-up of the treatment plan and rehabilitation goals, geriatric rehabilitation as a 24/7 activity, and taking into account the client's other life events. The latter three findings in particular, are caused by nurses' apprehensiveness to perform their tasks adequately. DISCUSSION Nurses working in geriatric rehabilitation, experience apprehensiveness to perform their tasks adequately. Uncertainty about the client's reaction or fear of damaging the relationship of trust, results in nurses not involving the clients and informal care givers in the draw-up of the rehabilitation goals. Apprehensiveness also submerges as the lack of experience or specific competences in considering the client's other life events. The recommendations address these aspects in particular.
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Affiliation(s)
| | - R van Balen
- Leiden University Medical Center, Leiden, Nederland
| | | | - T J E M Bakker
- Stichting Wetenschap Balans, Rotterdam, Nederland
- Hogeschool Rotterdam, Rotterdam, Nederland
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Dong L, Liu N, Tian X, Qiao X, Gobbens RJJ, Kane RL, Wang C. Reliability and validity of the Tilburg Frailty Indicator (TFI) among Chinese community-dwelling older people. Arch Gerontol Geriatr 2017; 73:21-28. [PMID: 28734173 DOI: 10.1016/j.archger.2017.07.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/17/2017] [Accepted: 07/01/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To translate the Tilburg Frailty Indicator (TFI) into Chinese and assess its reliability and validity. METHODS A sample of 917 community-dwelling older people, aged ≥60 years, in a Chinese city was included between August 2015 and March 2016. Construct validity was assessed using alternative measures corresponding to the TFI items, including self-rated health status (SRH), unintentional weight loss, walking speed, timed-up-and-go tests (TUGT), making telephone calls, grip strength, exhaustion, Short Portable Mental Status Questionnaire (SPMSQ), Geriatric Depression scale (GDS-15), emotional role, Adaptability Partnership Growth Affection and Resolve scale (APGAR) and Social Support Rating Scale (SSRS). Fried's phenotype and frailty index were measured to evaluate criterion validity. Adverse health outcomes (ADL and IADL disability, healthcare utilization, GDS-15, SSRS) were used to assess predictive (concurrent) validity. RESULTS The internal consistency reliability was good (Cronbach's α=0.71). The test-retest reliability was strong (r=0.88). Kappa coefficients showed agreements between the TFI items and corresponding alternative measures. Alternative measures correlated as expected with the three domains of TFI, with an exclusion that alternative psychological measures had similar correlations with psychological and physical domains of the TFI. The Chinese TFI had excellent criterion validity with the AUCs regarding physical phenotype and frailty index of 0.87 and 0.86, respectively. The predictive (concurrent) validities of the adverse health outcomes and healthcare utilization were acceptable (AUCs: 0.65-0.83). CONCLUSIONS The Chinese TFI has good validity and reliability as an integral instrument to measure frailty of older people living in the community in China.
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Affiliation(s)
- Lijuan Dong
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Na Liu
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Xiaoyu Tian
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Xiaoxia Qiao
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
| | - Robert L Kane
- School of Public Health, University of Minnesota, 55455, USA
| | - Cuili Wang
- School of Nursing, Shandong University, 250012 Jinan, China.
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Gobbens RJJ, van Assen MALM. Associations of Environmental Factors With Quality of Life in Older Adults. The Gerontologist 2017; 58:101-110. [DOI: 10.1093/geront/gnx051] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 04/11/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
| | - Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
- Department of Sociology, Utrecht University, the Netherlands
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van Assen MALM, Pallast E, Fakiri FE, Gobbens RJJ. Measuring frailty in Dutch community-dwelling older people: Reference values of the Tilburg Frailty Indicator (TFI). Arch Gerontol Geriatr 2016; 67:120-9. [PMID: 27498172 DOI: 10.1016/j.archger.2016.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The objectives of this study were to provide reference values of the Tilburg Frailty Indicator (TFI) for community-dwelling older people by age, sex, marital status, ethnicity, education, income, and residence, and examine the effects of these seven socio-demographic variables on frailty. METHODS 47,768 individuals aged 65 years and older living in the Netherlands completed a health questionnaire (58.5% response rate), including the TFI. The TFI is a self-report questionnaire for measuring frailty, developed from an integral approach of frailty, including physical, psychological, and social domains. RESULTS Reference values were provided for men and women separately, as a function of age. We found associations of all socio-demographic variables with frailty, also after controlling for the effects of age. These associations held for both sexes and for big cities as wells as more rural areas. For instance, the effect of age was large for total and physical frailty, women were more frail than men, and some very large average frailty differences between the ethnic groups were found, with autochthon people having the lowest frailty score. CONCLUSIONS In conclusion, this study offers reference values of the TFI by socio-demographic characteristics and explains frailty using these characteristics. This information will support researchers, policymakers and health care professionals in interpreting scores of the TFI, which may guide their efforts to reduce frailty and its adverse outcomes.
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Affiliation(s)
- Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands; Department of Sociology, Utrecht University, Utrecht, The Netherlands
| | - Esther Pallast
- Department of Health Promotion, Regional Public Health Service, Hart voor Brabant, 's-Hertogenbosch, The Netherlands
| | - Fatima El Fakiri
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.
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Abstract
BACKGROUND To assess the internal consistency reliability and construct validity of the Dutch version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD). METHODS The psychometric properties of the Dutch WHOQOL-OLD were examined in a cross-sectional study using a sample of 1,340 people aged 60 years or older. Participants completed a Web-based questionnaire, the 'Senioren Barometer'. Reliability was evaluated using Cronbach's alpha and corrected item-total correlations. Construct validity of the Dutch WHOQOL-OLD was evaluated with confirmatory factor analyses, and correlations within and between scales, using scales WHOQOL-BREF, Short Form Health Survey (SF-12), Tilburg Frailty Indicator (TFI), and the Emotional and Social Loneliness Scale (ESLS). RESULTS The reliabilities of the six WHOQOL-OLD facets or subscales were sufficient to good (.66-.91). The convergent validity of the WHOQOL-OLD was good, whereas our findings on the divergent validity of the WHOQOL-OLD were somewhat mixed. Findings corroborating the divergent validity were that the 6-factor model fitted better than the second-order factor model, and WHOQOL-OLD facets sensory abilities, past, present and future activities, death and dying, intimacy correlated more strongly with similar than dissimilar scales. Not fully supporting divergent validity were the extremely high correlations between the factors corresponding to autonomy, past, present and future activities, and social participation. CONCLUSION We offer Dutch healthcare and social workers an instrument with good psychometric properties for measuring quality of life in older people. Further research on interrelations between WHOQOL-OLD facets is recommended.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV, Amsterdam, The Netherlands. .,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.
| | - Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Department of Sociology, Utrecht University, Utrecht, The Netherlands
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Uchmanowicz I, Jankowska-Polańska B, Uchmanowicz B, Kowalczuk K, Gobbens RJJ. Validity and Reliability of the Polish Version of the Tilburg Frailty Indicator (TFI). J Frailty Aging 2016; 5:27-32. [PMID: 26980366 DOI: 10.14283/jfa.2015.66] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In the last decade, studies on frailty have become increasingly frequent in the literature on aging, and also the number of available questionnaires regarding frailty has increased over the years. Therefore, the choice of which questionnaire to use is becoming more difficult. OBJECTIVE The aim of this study was to assess the psychometric properties of the Polish version of the Tilburg Frailty Indicator (TFI), an instrument that identifies frailty in the elderly population. DESIGN Setting, and Participants. The study was carried out in a community-based setting in Wrocław, Poland. Nurses and doctors (general practitioners) administered the TFI in primary care facilities. Participants included a sample of 212 community dwelling elderly aged 60 or older (mean age:70.6 SD≥7.16). MEASUREMENTS The validation (assessment of face validity, content validity) was carried out in accordance with the literature. The Tilburg Frailty Indicator (TFI) consists of two different parts. One part addresses the potential determinants of frailty and the other specifically addresses the components of frailty, covering its physical, psychological and social domains. Scale reliability was estimated using two methods: Cronbach's alpha, measuring the scale's internal consistency, and the test-retest method, determining the scale's absolute stability. To assess test-retest reliability, the same group was re-interviewed by the same observer within 10-14 days of the first interview. RESULTS The test-retest reliability showed a high level of agreement for all items of the instrument, with values ranging from 96 to 100%. The Cronbach's Alpha internal consistency was 0.74. CONCLUSION The Polish version of the TFI proved to be a valid and reproducible tool for assessment of Frailty Syndrome for the Polish population. We would recommend to be used as the screening tool to assess frailty.
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Affiliation(s)
- I Uchmanowicz
- Izabella Uchmanowicz, Department of Clinical Nursing , Wrocław Medical University, K. Bartla 5, 51-618 Wroclaw, Poland. Tel.: +48 71 784 1824; Fax: +48 71 345 9324.
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Uchmanowicz I, Gobbens RJJ. The relationship between frailty, anxiety and depression, and health-related quality of life in elderly patients with heart failure. Clin Interv Aging 2015; 10:1595-600. [PMID: 26491276 PMCID: PMC4599570 DOI: 10.2147/cia.s90077] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [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] [Indexed: 01/23/2023] Open
Abstract
Objective Elderly people constitute over 80% of the population of patients with heart failure (HF). Frailty is a distinct biological syndrome that reflects decreased physiologic reserve and resistance to stressors. Moreover, frailty can serve as an independent predictor of visits to the emergency department, hospitalizations, and mortality. The purpose of this paper was to assess the relationship between frailty, anxiety and depression, and the health-related quality of life (HRQoL) of elderly patients with HF. Patients and methods The study included 100 patients (53 men and 47 women) with a diagnosis of HF. Frailty was measured using the Tilburg Frailty Indicator (TFI) scale. HRQoL was measured using the 36-Item Short Form Medical Outcomes Study Survey. To determine the prevalence of anxiety and depression, the Hospital Anxiety and Depression Scale was used. Results Frailty was found in 89% of the studied population. The study showed significant inverse correlations between the values of the physical component scale (PCS) domain results and TFI score, and a significant inverse correlation between the values of the mental component scale (MCS) domain and TFI score. When participants showed increased levels of frailty as measured by the TFI scale, there was also an increase in the levels of anxiety and depression. With increased anxiety and depression, there was deterioration in the quality of life of patients with HF. Conclusion Frailty has a negative impact on the HRQoL results of elderly patients with HF. The assessment of frailty syndrome, and anxiety and depression should be taken into account when estimating risk and making therapeutic decisions for cardiovascular disease treatment and care.
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Affiliation(s)
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands ; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
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Abstract
This study aims to assess the reliability, construct validity (convergent/divergent), and criterion validity of the Italian version of the Tilburg Frailty Indicator (TFI). The TFI is a self-report questionnaire for screening frailty in older adults. Two hundred and sixty-seven community-dwelling older adults were involved. Psychometric properties were analyzed using validated instruments. Adverse outcomes such as disability, falls, and visits to a general practitioner were detected. Participants were mainly women (59.9%), with a mean age of 73.4 years (SD = 6.0). Internal consistency reliability was acceptable. Construct validity was good, since each item of the TFI correlated as expected with corresponding frailty measures. Convergent and divergent validity were adequate for all the domains of the TFI. Criterion validity was excellent for disability and mediocre for the other two outcomes. This study supports the validity of the Italian TFI and offers to clinicians and scientists a multidimensional instrument for identifying frail individuals in the Italian context.
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Affiliation(s)
- Anna Mulasso
- Department of Psychology, University of Torino, Torino, Italy
| | - Mattia Roppolo
- Department of Psychology, University of Torino, Torino, Italy Department of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands Zonnehuisgroep Amstelland, Laan van de Helende Meesters 114, Amstelveen, The Netherlands
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Andreasen J, Lund H, Aadahl M, Gobbens RJJ, Sorensen EE. Content validation of the Tilburg Frailty Indicator from the perspective of frail elderly. A qualitative explorative study. Arch Gerontol Geriatr 2015; 61:392-9. [PMID: 26323651 DOI: 10.1016/j.archger.2015.08.017] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 01/11/2023]
Abstract
UNLABELLED The Tilburg Frailty Indicator is a questionnaire with a bio-psycho-social approach, which measures frailty by 15 questions. A questionnaire about frailty should be in alignment with experiences of frail elderly themselves as a target population is an important source of knowledge in content validation. AIM To validate the Tilburg Frailty Indicator on content in relation to the physical, psychological and social domain by exploring the experience of daily life of community dwelling frail elderly. METHODS The design was a qualitative content validation study. The participants were acutely admitted frail elderly discharged to home and interviewed one week after discharge. A deductive content analysis, with categories structured in advance, was performed. RESULTS A total of 422 meaning units were extracted from the transcriptions; 131 units related to the physical domain, 106 units to the psychological domain and 185 units to the social domain. 56 units were not linked into the existing structure of the questionnaire. 14 of 15 questions were confirmed from a target population perspective. The four issues pain, sleep quality, spirituality and meaningful activities that seem to be important elements for frail elderly were not directly covered by the questionnaire. DISCUSSION It seems likely that the majority of important items related to frailty are covered in the questionnaire. The findings add to the scientific body of knowledge in relation to the validity of the questionnaire. Future research should investigate the importance of the four issues pain, sleep quality, spirituality and meaningful activities in relation to the screening of frailty.
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Affiliation(s)
- Jane Andreasen
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, Denmark; Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
| | - Hans Lund
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Centre for Knowledge Based Practice, Bergen University College, Inndalsveien 28, Postbox 7030, N-5020 Bergen, Norway.
| | - Mette Aadahl
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup Hospital, Ndr. Ringvej 57, Afsnit 84/85, 2600 Glostrup, Denmark; Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Denmark.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, OZW-building, Room 6A-13, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Laan van de Helende Meesters 114, 1186 AM Amstelveen, The Netherlands.
| | - Erik E Sorensen
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, Denmark; Clinical Nursing Research Unit, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark.
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Abstract
The objectives of this study were to compare how different frailty measures (Frailty Phenotype/FP, Groningen Frailty Indicator/GFI and Tilburg Frailty Indicator/TFI) predict short-term adverse outcomes. Secondarily, adopting a multidimensional approach to frailty (integral conceptual model–TFI), this study aims to compare how physical, psychological and social frailty predict the outcomes. A longitudinal study was carried out with 95 community-dwelling elderly. Participants were assessed at baseline for frailty, determinants of frailty, and adverse outcomes (healthcare utilization, quality of life, disability in basic and instrumental activities of daily living/ADL and IADL). Ten months later the outcomes were assessed again. Frailty was associated with specific healthcare utilization indicators: the FP with a greater utilization of informal care; GFI with an increased contact with healthcare professionals; and TFI with a higher amount of contacts with a general practitioner. After controlling for the effect of life-course determinants, comorbidity and adverse outcome at baseline, GFI predicted IADL disability and TFI predicted quality of life. The effect of the FP on the outcomes was not significant, when compared with the other measures. However, when comparing TFI’s domains, the physical domain was the most significant predictor of the outcomes, even explaining part of the variance of ADL disability. Frailty at baseline was associated with adverse outcomes at follow-up. However, the relationship of each frailty measure (FP, GFI and TFI) with the outcomes was different. In spite of the role of psychological frailty, TFI’s physical domain was the determinant factor for predicting disability and most of the quality of life.
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Affiliation(s)
- Tiago Coelho
- School of Allied Health Technologies, Polytechnic Institute of Porto , Porto , Portugal ; UNIFAI, ICBAS, University of Porto , Porto , Portugal
| | | | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences , Amsterdam , The Netherlands ; Zonnehuisgroep Amstelland , Amstelveen , The Netherlands
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto , Porto , Portugal ; UNIFAI/CINTESIS Research Unit, Faculty of Medicine, University of Porto , Porto , Portugal
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Gobbens RJJ, Krans A, van Assen MALM. Validation of an integral conceptual model of frailty in older residents of assisted living facilities. Arch Gerontol Geriatr 2015; 61:400-10. [PMID: 26293001 DOI: 10.1016/j.archger.2015.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/03/2015] [Accepted: 06/05/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of this cross-sectional study was to examine the validity of an integral model of the associations between life-course determinants, disease(s), frailty, and adverse outcomes in older persons who are resident in assisted living facilities. METHODS Between June 2013 and May 2014 seven assisted living facilities were contacted. A total of 221 persons completed the questionnaire on life-course determinants, frailty (using the Tilburg Frailty Indicator), self-reported chronic diseases, and adverse outcomes disability, quality of life, health care utilization, and falls. Adverse outcomes were analyzed with sequential (logistic) regression analyses. RESULTS The integral model is partially validated. Life-course determinants and disease(s) affected only physical frailty. All three frailty domains (physical, psychological, social) together affected disability, quality of life, visits to a general practitioner, and falls. Contrary to the model, disease(s) had no effect on adverse outcomes after controlling for frailty. Life-course determinants affected adverse outcomes, with unhealthy lifestyle having consistent negative effects, and women had more disability, scored lower on physical health, and received more personal and informal care after controlling for all other predictors. CONCLUSION The integral model of frailty is less useful for predicting adverse outcomes of residents of assisted living facilities than for community-dwelling older persons, because these residents are much frailer and already have access to healthcare facilities. PRACTICAL IMPLICATIONS The present study showed that a multidimensional assessment of frailty, distinguishing three domains of frailty (physical, psychological, social), is beneficial with respect to predicting adverse outcomes in residents of assisted living facilities.
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Affiliation(s)
- Robbert J J Gobbens
- Inholland University of Applied Sciences, Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.
| | - Anita Krans
- Leliezorggroep, Rotterdam, The Netherlands; ISER, Rotterdam, The Netherlands
| | - Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Abstract
Background Chronic heart failure is a serious medical condition. Recently, there has been an increasing interest in frailty syndrome and self-care levels among patients with cardiovascular conditions. Demonstrating the influence of frailty syndrome on self-care could improve the quality of self-care and prevent the adverse effects of frailty syndrome. The purpose of this study was to assess the influence of frailty syndrome on the self-care capabilities of patients with chronic heart failure, and to identify factors associated with frailty. Methods The data were collected between January and July 2014. The study included 110 patients with chronic heart failure who were hospitalized in the cardiology clinic. Frailty syndrome was assessed using the Tilburg Frailty Indicator, a self-report questionnaire, and self-care behavior was assessed using the European Heart Failure Self-Care Behavior Scale. Results Fifty-four percent of the study patients were male and 46% were female. The mean age was 66±11 years, the mean Tilburg Frailty Indicator score was 7.45±3.02 points, and the mean self-care level was 27.6±7.13 points. Correlation analyses showed that patients with higher scores in the social components of the frailty scale had better self-care capabilities. Frailty was associated with age, education, duration of heart failure, number of hospitalizations, and New York Heart Association class. The effects of these patient characteristics differed across components of frailty (physical, psychological, social). Conclusion The social components of frailty syndrome adversely affect the ability to self-care in elderly patients with heart failure. It is relevant to use a multidimensional measurement of frailty.
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Affiliation(s)
| | - Marta Wleklik
- Department of Clinical Nursing, Wrocław Medical University, Wrocław, Poland
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands ; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
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Coelho T, Paúl C, Gobbens RJJ, Fernandes L. Determinants of frailty: the added value of assessing medication. Front Aging Neurosci 2015; 7:56. [PMID: 25954195 PMCID: PMC4404866 DOI: 10.3389/fnagi.2015.00056] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 10/17/2014] [Accepted: 04/02/2015] [Indexed: 01/09/2023] Open
Abstract
This study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (±7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (0-4 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8, 25.3, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of daily-consumed drugs was independently associated with physical frailty, and the consumption of medication for the cardiovascular system and for the blood and blood-forming organs explained part of the variance of total and physical frailty. The adverse effects of polymedication and its direct link with the level of comorbidities could explain the independent contribution of the amount of prescribed drugs to frailty prediction. On the other hand, findings in regard to medication type provide further evidence of the association of frailty with cardiovascular risk. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains highlight the relevance of the integral model of frailty. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty.
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Affiliation(s)
- Tiago Coelho
- Department of Occupational Therapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Vila Nova de Gaia Portugal ; The Research and Education Unit on Ageing, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto Portugal
| | - Constança Paúl
- The Research and Education Unit on Ageing, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto Portugal
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam Netherlands ; Zonnehuisgroep Amstelland, Amstelveen Netherlands
| | - Lia Fernandes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto Portugal
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Coelho T, Santos R, Paúl C, Gobbens RJJ, Fernandes L. Portuguese version of the Tilburg Frailty Indicator: Transcultural adaptation and psychometric validation. Geriatr Gerontol Int 2014; 15:951-60. [PMID: 25255891 DOI: 10.1111/ggi.12373] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Tiago Coelho
- School of Allied Health Sciences, Porto Polytechnic Institute, Vila Nova de Gaia, Portugal.,UNIFAI/ICBAS, University of Porto, Porto, Portugal
| | - Rubim Santos
- Activity and Human Movement Study Center, School of Allied Health Sciences, Porto Polytechnic Institute, Vila Nova de Gaia, Portugal
| | | | - Robbert J J Gobbens
- Research & Development Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Lia Fernandes
- UNIFAI/CINTESIS - Faculty of Medicine, University of Porto, Porto, Portugal
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