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Preventive Home Visits Among Frail Community-Dwelling Older Adults. The Added Value of Follow-Up Telephone Calls. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:444-457. [PMID: 38491960 DOI: 10.1080/19371918.2024.2325555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
People in need of care and support do not always find appropriate services. This paper aims to explore the content and added value of monthly follow-up telephone calls after preventive home visits. We used both monitoring data and qualitative semi-structured interviews (with older adults, formal and informal caregivers). Results indicate that a majority of older adults (N = 95) received a regular follow-up of four telephone calls. Social connection and involvement were mentioned by all three groups as positive aspects of the program. Although time-consuming, this paper draws attention to the added value of follow-up telephone calls after preventive home visits.
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Frailty as a determinant of dental attendance among community-dwelling older adults. Gerodontology 2023; 40:363-371. [PMID: 36336964 DOI: 10.1111/ger.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/05/2022] [Accepted: 10/24/2022] [Indexed: 08/15/2023]
Abstract
OBJECTIVES The aim of this study was to assess the association between different levels of frailty and dental attendance among home-dwelling older adults, in Belgium. BACKGROUND While many determinants of dental attendance among older adults have been identified, no study has focused on the role of frailty. MATERIALS AND METHODS This was a cross-sectional study on a random sample of home-dwelling adults aged 60 and over from two Belgian cities. Data were collected with a structured questionnaire through a participatory peer-research method. Time since the last dental attendance was the dependent variable. The independent variable was frailty, assessed with the Comprehensive Frailty Assessment Instrument, including physical, psychological, social, and environmental subdomains. Covariates were age, gender, having a partner, educational level, and household income, as well as self-perceived oral health. Data analysis included descriptive, bivariate (Chi-Square, ANOVA, and Kruskal-Wallis), and binomial logistic regression analyses. RESULTS The sample consisted of 1329 older adults with a mean age of 72.5 years (SD 8.9, range 60-103). In the low frailty group, 73% attended the dentist in the previous 12 months, while it was 62% and 54% in the medium and high frailty groups, respectively. In the fully adjusted model, the initial gradient in the relationship between overall frailty and dental attendance remained; those in the medium and the high frailty groups were respectively 1.46 (95% CI: 1.09, 1.95) and 1.67 (95% CI: 1.15, 2.43) times more likely to report no dental attendance in the previous year than the low frailty group. Similar associations could be seen in the physical and environmental frailty subdomains. CONCLUSION Frailty is consistently associated with less favourable dental attendance, independent from age, gender, socioeconomic factors, family composition, and self-perceived oral health. Once frailty has been detected, good interprofessional communication and care are needed to avoid the drop-out of older adults from the oral healthcare system.
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Transitions in robust and prefrail octogenarians after 1 year: the influence of activities of daily living, social participation, and psychological resilience on the frailty state. BMC Geriatr 2023; 23:485. [PMID: 37563561 PMCID: PMC10416541 DOI: 10.1186/s12877-023-04178-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 07/17/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Knowledge opportunities lie ahead as everyday activities, social participation, and psychological resilience might be important predictors for frailty state transitioning in the oldest old. Therefore, this article aims to examine whether changes in basic-, instrumental-, advanced- activities of daily living (b-, i-, a-ADLs), social participation, and psychological resilience predict both a transition from robustness to prefrailty or frailty and vice versa among community-dwelling octogenarians over a follow-up period of one year. METHODS To evaluate worsened and improved frailty transitions after one year in 322 octogenarians (Mage = 83.04 ± 2.78), the variables sex, ADLs (b-ADL-DI, i-ADL-DI, a-ADL-DI as baseline and as difference after 6 months values), the CD-RISC (Connor-Davidson Resilience Scale, as baseline and as difference after 6 months), the social participation variables (total participation score, being a member, total number of memberships, level of social participation, being a board member, volunteering, and formal participation as baseline and as difference after 6 months values), were included in a logistic regression analysis. RESULTS Limitations in a-ADLs at baseline (OR: 1.048, 95% confidence interval, 1.010-1.090) and an increment of limitations in a-ADLs after 6 months (OR: 1.044, 95% confidence interval, 1.007-1.085) were predictors to shift from robust to a worsened frailty state after one year follow-up. Additionally, being a woman (OR: 3.682, 95% confidence interval, 1.379-10.139) and social participation, specifically becoming a board member in 6 months (OR: 4.343, 95% confidence interval, 1.082-16.347), were protectors of robustness and thus related to an improved frailty transition after one year. CONCLUSIONS Encouraging healthy lifestyle behaviors to help the maintenance of ADLs, possibly leading to more social participation, could be promising in the prevention of frailty.
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Characterizing fall risk factors in Belgian older adults through machine learning: a data-driven approach. BMC Public Health 2022; 22:2210. [PMID: 36443808 PMCID: PMC9707258 DOI: 10.1186/s12889-022-14694-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Falls are a major problem associated with ageing. Yet, fall-risk classification models identifying older adults at risk are lacking. Current screening tools show limited predictive validity to differentiate between a low- and high-risk of falling. OBJECTIVE This study aims at identifying risk factors associated with higher risk of falling by means of a quality-of-life questionnaire incorporating biological, behavioural, environmental and socio-economic factors. These insights can aid the development of a fall-risk classification algorithm identifying community-dwelling older adults at risk of falling. METHODS The questionnaire was developed by the Belgian Ageing Studies research group of the Vrije Universiteit Brussel and administered to 82,580 older adults for a detailed analysis of risk factors linked to the fall incidence data. Based on previously known risk factors, 139 questions were selected from the questionnaire to include in this study. Included questions were encoded, missing values were dropped, and multicollinearity was assessed. A random forest classifier that learns to predict falls was trained to investigate the importance of each individual feature. RESULTS Twenty-four questions were included in the classification-model. Based on the output of the model all factors were associated with the risk of falling of which two were biological risk factors, eight behavioural, 11 socioeconomic and three environmental risk factors. Each of these variables contributed between 4.5 and 6.5% to explaining the risk of falling. CONCLUSION The present study identified 24 fall risk factors using machine learning techniques to identify older adults at high risk of falling. Maintaining a mental, physical and socially active lifestyle, reducing vulnerability and feeling satisfied with the living situation contributes to reducing the risk of falling. Further research is warranted to establish an easy-to-use screening tool to be applied in daily practice.
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The impact of covid-19 lockdown on the Quality of life, meaningful activities, and frailty in community-dwelling octogenarians: A study in Belgium. Aging Ment Health 2022:1-9. [PMID: 36415888 DOI: 10.1080/13607863.2022.2145457] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the impact of COVID-19 lockdown on quality of life (QoL), meaningful daily activities, and (pre)frailty in community-dwelling octogenarians. METHODS Cross-sectional design with bivariate and multiple linear regression modeling using a stepwise approach examining the level of QoL during the COVID-19 lockdown in a group of 215 community-dwelling octogenarians (Mage = 86.49 ± 3.02). A comprehensive set of biopsychosocial variables (FRAIL scale, general health, engagement in meaningful activities survey, questions on loneliness, and feelings) were used as explaining variables. RESULTS Particularly, a decrease in daily activities, social activities, and an increase in free times activities were observed, but the decrease in QoL could be explained by the meaningfulness in activities, together with experiencing emptiness in life, taking ≥ 4 medications a day and feeling down or depressed. CONCLUSIONS We tried to understand which components contribute to and might affect a person's QoL caused by restrictions imposed by the governance and its influence on the lives of the community-dwelling octogenarians. As such, this output could be a baseline for the development of minimally impacting countermeasures during future lockdowns. CLINICAL IMPLICATIONS Studying lifestyle changes and thus also variables related to QoL during a pandemic, may support policymakers and practitioners to develop relevant interventions.
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Internet use and cognitive frailty in older adults: a large-scale multidimensional approach. Eur J Ageing 2022; 19:1135-1144. [PMID: 36692741 PMCID: PMC9729622 DOI: 10.1007/s10433-022-00686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 01/26/2023] Open
Abstract
Although research on sociodemographic correlates of internet use in older adults without and with pronounced cognitive impairment is already quite extensive, much less is known about the relationship between cognitive frailty (CF) and this behaviour. As CF is associated to multidimensional frailty aspects, this study explored the relationship between internet use and CF, operationalised as Subjective Cognitive Impairment, in older adults by means of a comprehensive explanatory model including sociodemographic factors and multiple frailty measures. The dataset included a sample of community-dwelling 60 + older adults that were included in the Belgian Ageing Studies (BAS) and that completed survey questions on (i) internet use frequency and (ii) internet activities. Multidimensional frailty was measured with the CFAI-Plus. The analysis comprised a structural equation modelling (SEM) procedure. Internet use was frequent; however, it became less frequent with higher CF. Moreover, the latter used less tablets as compared to the no-low CF group. Navigating the web, sharing email and online banking were the most frequently reported activities. Tele-communicating with Skype, online shopping and using e-government services were the least frequent. Age, female gender, lower income and living with a partner were also negatively associated with internet use. To conclude, CF, along with other frailty and sociodemographic factors, was negatively related to internet use in older adults. Future research should focus, amongst others, on the dynamic processes underlying internet use in the population of older adults affected by CF.
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Abstract
OBJECTIVES Understanding of prefrailty's relationship with limitations in activities of daily living (ADLs) moderated by psychological resilience is needed, as resilience might support ADLs' maintenance and thus protect against frailty. Therefore, this study aims to analyze the influence of psychological resilience (using the Connor-Davidson Resilience Scale; CD-RISC) on the relation between ADLs and frailty status of older individuals (i.e. prefrail versus robust). DESIGN Cross-sectional design. SETTING UZ Brussels, Belgium. PARTICIPANTS Robust (Fried 0/4;n = 214; Age = 82.3 ± 2.1yrs) and prefrail (Fried 1-2/4; n = 191; Age = 83.8 ±3.2yrs) community-dwelling older individuals were included. MEASUREMENTS Frailty scores were obtained from weight loss, exhaustion, gait speed, and grip strength. A total Disability Index (DI) expressed dependency for basic (b-), instrumental (i-), and advanced (a-)ADLs. Mediation was investigated by estimating direct and indirect effects of all levels of ADLs and CD-RISC total score on prefrailty/robustness using a stepwise multiple regression approach. RESULTS Prefrailty/robustness significantly correlated with a-ADL-DI (point-biserial correlation (rpb) = 0.098; p<0.05). Adjusted for age and gender, the a-ADL-DI (p<0.05) had a significant protective direct effect against prefrailty. No effects were found with the CD-RISC total score. CONCLUSIONS Less limitation in a-ADLs is a directly correlated factor of prefrailty and might represent a higher likelihood of robustness.
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The relation between age of retirement and frailty in later life? A cross-sectional study in Flemish older adults. Arch Gerontol Geriatr 2021; 96:104473. [PMID: 34246958 DOI: 10.1016/j.archger.2021.104473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Policymakers in several European countries, concerned about the sustainability of their pension system, have raised the statutory retirement age. While several studies investigated the effect of retirement on health, the relationship between retirement and frailty is neglected. Notwithstanding, frailty is associated with adverse outcomes. OBJECTIVE The aim of this study was to examine the relationship between age of retirement and frailty in later life. METHODS Data of the Belgian Ageing Studies, a cross-sectional research project was used. The present study includes N=12659 participants (>60y) in 83 Flemish municipalities. To address reverse causality, only participants not retired because of health-related reasons were included. The Comprehensive Frailty Assessment Instrument, a multidimensional frailty scale with four domains (physical, psychological, social and environmental) was used to operationalize frailty. Univariate general linear regression analyses (GLM) were performed for scores on the total frailty scale and the four subdomains separately. The analysis was done for men and women separately, since both groups have different labor trajectories. RESULTS The present study found a negative association between age of retirement and physical frailty for both men and women in later life, and total frailty for men, although the differences were small. No evidence was found for a relation between age of retirement and the other subdomains of frailty. CONCLUSIONS The results suggest that age of retirement is not a clinically relevant predictor for frailty in later life. Differences within and between subpopulations (e.g., profession) can shed a new light on this relation.
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A Comprehensive Overview of Activities of Daily Living in Existing Frailty Instruments: A Systematic Literature Search. THE GERONTOLOGIST 2021; 61:e12-e22. [PMID: 31872238 DOI: 10.1093/geront/gnz147] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The relationship between frailty and disability in activities of daily living (ADLs) can be seen in different ways, with disability being-to varying degrees-a characteristic, negative outcome, or predictor of frailty. This conflation of definitions is partly a result of the different frailty tools used in research. Aiming to provide a comprehensive overview, this systematic literature search analyzed (i) if, (ii) to what extent, and (iii) how ADLs are evaluated by frailty instruments. RESEARCH DESIGN AND METHODS A search was performed in PubMed, Web of Knowledge, and PsycINFO to identify all frailty instruments, followed by categorization of the ADL items into basic (b-), instrumental (i-), and advanced (a-) ADLs. RESULTS In total, 192 articles described 217 frailty instruments, from which 52.1% contained ADL items: 45.2% b-ADLs, 35.0% i-ADLs, and 10.1% a-ADLs. The most commonly included ADL items were bathing (b-ADLs); using transportation (i-ADLs); and semiprofessional work engagement in organized social life or leisure activities (a-ADLs). These instruments all had a multidomain origin (χ 2 = 122.4, p < .001). DISCUSSION AND IMPLICATIONS Because 52.1% of all instruments included ADL items, the concepts of frailty and disability appear to be highly entangled. This might lead to circular reasoning, serious concerns regarding contamination, and invalid research results.
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Prefrailty: The Relationship Between Daily Activities and Social Participation in Older Persons. J Appl Gerontol 2021; 41:430-440. [PMID: 33554735 DOI: 10.1177/0733464821991007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To analyze prefrailty's relationship with limitations in activities of daily living (ADLs) and restrictions in social participation. METHOD Robust (Fried 0/4; n = 214; Mage = 82.3 years [SD ±2.1]) and prefrail (Fried 1-2/4; n = 191; Mage = 83.8 years [SD ±3.2]) community-dwelling older individuals were included. Frailty scores were obtained from weight loss, exhaustion, gait speed, and grip strength. A total disability index (DI) expressed dependency for basic (b-), instrumental (i-), and advanced (a-)ADLs. Total participation score, being a member, total number of memberships, being a board member, level of participation, membership over time, volunteering, and formal participation represented social participation. RESULTS Logistic regression retained age (OR = 1.224; 95% CI = [1.122, 1.335]), sex (OR = 3.818; 95% CI = [2.437, 5.982]), and a-ADL-DI (OR = 1.230; 95% CI = [1.018, 1.486]) as variables significantly related to prefrailty (68.3%; χ2 = 68.25; df = 3; p < .001). DISCUSSION Subtle limitations in a-ADLs, higher age, and being a man were associated with prefrailty, revealing the possible role of personal and culturally related a-ADLs as red flags for (pre)frailty.
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The association between frailty and quality of life when aging in place. Arch Gerontol Geriatr 2019; 85:103915. [DOI: 10.1016/j.archger.2019.103915] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/05/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
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ACCESS TO CARE AND SUPPORT OF FRAIL COMMUNITY-DWELLING OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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INCLUDING OLDER PEOPLE IN PUBLIC POLICY: STRENGTHS AND LIMITATIONS OF 14 YEARS OF BELGIAN AGEING STUDIES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Randomized controlled trial to evaluate a prevention program for frail community-dwelling older adults: a D-SCOPE protocol. BMC Geriatr 2018; 18:194. [PMID: 30149798 PMCID: PMC6109979 DOI: 10.1186/s12877-018-0875-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 08/06/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Frail community-dwelling older adults, whom might experience problems regarding physical, cognitive, psychological, social and environmental factors, are at risk for adverse outcomes such as disability, institutionalization and mortality. People in need of help do not always find their way to care and support services and are left undetected. The aim of the D-SCOPE project is to detect frail community-dwelling older adults who previously went unnoticed and to improve their access to care and support. Goal is to increase their frailty-balance, quality of life, meaning in life, life satisfaction, mastery, community inclusion and ageing well in place. METHODS/DESIGN The study is a prospective, longitudinal randomized four-armed controlled trial with follow-up at 6 months. The study group aims to include 900 community-dwelling older adults aged 60 years and over from 3 municipalities in Flanders (Belgium). While selecting the study group, risk profiles for frailty will be taken into account. Participants will be randomly selected from the census records in each municipality. Data will be collected prospectively at baseline (T0) and at follow-up, 6 months after baseline (T1). At baseline, participants who are at least mild frail on one of the 5 domains of frailty (CFAI-plus) or feel frail based on the subjective assessment of frailty will be randomly assigned to (1) the study group or (2) the control group. A mixed method design with the inclusion of quantitative and qualitative data analyses will be used to evaluate the efficacy and experiences of the detection and prevention program on frailty. DISCUSSION The study will contribute to an innovative vision concerning the organization of care and support, and a timely and accurate detection and support of community-dwelling older adults at risk for frailty. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov, on May 26, 2017, identifier: NCT03168204 .
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Abstract
Identifying frail older people, and in particular, people who are psychologically frail in a community setting is difficult. This article investigates predictors of psychological frailty and constructs a short and effective pre-detection tool for highly psychologically frail older people. The Belgian Ageing Studies, a cross-sectional study (n=28.245) was used. Measures included four items of the Geriatric Depression Scale, the psychological domain of the Comprehensive Frailty Assessment Instrument. First bivariate analyses were used. Afterwards, Chi-squared automatic interaction detector (CHAID) analysis was applied to gain an insight into the hierarchical order of predictors for high psychological frailty. Findings indicate that the combination of hopelessness and life dissatisfaction predicts high psychological frailty in 68.4% of cases. Early detection of frailty offers opportunities to start early interventions, and can delay or reduce frailty. In order to detect older people who are psychologically frail, a simple two question pre-detection tool was developed. To conclude: if a patient answers 'yes' to feeling hopeless and 'no' to having life satisfaction, this predicts with great probability (68.4%) high psychological frailty.
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Frailty differences in older adults' use of informal and formal care. Arch Gerontol Geriatr 2018; 79:69-77. [PMID: 30125830 DOI: 10.1016/j.archger.2018.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/26/2018] [Accepted: 05/30/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study examines different combinations of informal and formal care use of older adults and investigates whether these combinations differ in terms of need for care (physical and psychological frailty) and enabling factors for informal and formal care use (social and environmental frailty). METHODS Using cross-sectional data from the Belgian Ageing Studies (survey, N = 38,066 community-dwelling older adults), Latent Class Analysis (LCA) is used to identify combinations of informal and formal care use. Bivariate analyses are used to explore the relationship between the different combinations of care use and frailty. RESULTS Latent Class Analysis (LCA) identified 8 different types of care use, which vary in combinations of informal and formal caregivers. Older adults who are more likely to combine care from family and care from all types of formal caregivers are more physically, psychologically and environmentally frail than expected. Older adults who are more likely to receive care only from nuclear family, or only from formal caregivers are more socially frail than expected. CONCLUSIONS Older adults with a higher need for care are more likely to receive care from different types of informal and formal caregivers. High environmental frailty and low social frailty are related with the use of care from different types of informal and formal caregivers. This study confirms that informal care can act as substitute for formal care. However, this substitute relationship becomes a complementary relationship in frail older adults. Policymakers should take into account that frailty in older adults affects the use of informal and formal care.
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Detecting frail, older adults and identifying their strengths: results of a mixed-methods study. BMC Public Health 2018; 18:191. [PMID: 29378540 PMCID: PMC5789734 DOI: 10.1186/s12889-018-5088-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/17/2018] [Indexed: 01/07/2023] Open
Abstract
Background The debate on frailty in later life focuses primarily on deficits and their associations with adverse (health) outcomes. In addition to deficits, it may also be important to consider the abilities and resources of older adults. This study was designed to gain insights into the lived experiences of frailty among older adults to determine which strengths can balance the deficits that affect frailty. Methods Data from 121 potentially frail community-dwelling older adults in Flemish-speaking Region of Belgium and Brussels were collected using a mixed-methods approach. Quantitative data were collected using the Comprehensive Frailty Assessment Instrument (CFAI), Montreal Cognitive Assessment (MoCA), and numeric rating scales (NRS) for quality of life (QoL), care and support, meaning in life, and mastery. Bivariate analyses, paired samples t-tests and means were performed. Qualitative data on experiences of frailty, frailty balance, QoL, care and support, meaning in life, and mastery were collected using semi-structured interviews. Interviews were subjected to thematic content analysis. Results The “no to mild frailty” group had higher QoL, care and support, meaning in life, and mastery scores than the “severe frailty” group. Nevertheless, qualitative results indicate that, despite being classified as frail, many older adults experienced high levels of QoL, care and support, meaning in life, and mastery. Respondents mentioned multiple balancing factors for frailty, comprising individual-level circumstances (e.g., personality traits, coping strategies, resilience), environmental influences (e.g., caregivers, neighborhood, social participation), and macro-level features (e.g., health literacy, adequate financial compensation). Respondents also highlighted that life changes affected their frailty balance, including changes in health, finances, personal relationships, and living situation. Conclusion The findings indicate that frailty among older individuals can be considered as a dynamic state and, regardless of frailty, balancing factors are important in maintaining a good QoL. The study investigated not only the deficits, but also the abilities, and resources of frail, older adults. Public policymakers and healthcare organizations are encouraged to include these abilities, supplementary or even complementary to the usual focus on deficits.
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[Detection and prevention in later life: risk profiles for physical, psychological, social and environmental frailty.]. Tijdschr Gerontol Geriatr 2017; 49:1-11. [PMID: 29181776 DOI: 10.1007/s12439-017-0241-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In order to provide proactive care and support for older people attention is needed for the prevention of frailty among older adults. Subsequently, accurate case finding of those who are more at risk of becoming frail is crucial to undertake specific preventive actions. This study investigates frailty and risk profiles of frailty among older people in order to support proactive detection. Hereby, frailty is conceived not only as a physical problem, but also refers to emotional, social, and environmental hazards. Using data generated from the Belgian Ageing Studies (N = 21,664 home-dwelling older people), a multinomial logistic regression model was tested which included socio-demographic and socio-economic indicators as well as the four dimensions of frailty (physical, social, psychological and environmental). Findings indicate that for both men and women having moved in the previous 10 years and having a lower household income are risk factors of becoming multidimensional frail. However, studying the different frailty domains, several risk profiles arise (e. g. marital status is important for psychological frailty), and gender-specific risk groups are detected (e. g. non-married men). This paper elaborates on practical implications and formulates a number of future research recommendations to tackle frailty in an ageing society.
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Identifying frailty risk profiles of home-dwelling older people: focus on sociodemographic and socioeconomic characteristics. Aging Ment Health 2017; 21:1031-1039. [PMID: 27267783 DOI: 10.1080/13607863.2016.1193120] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This paper investigates risk profiles of frailty among older people, as these are essential for detecting those individuals at risk for adverse outcomes and to undertake specific preventive actions. Frailty is not only a physical problem, but also refers to emotional, social, and environmental hazards. METHODS Using data generated from the Belgian Ageing Studies, a cross-sectional study (n = 28,049), we tested a multivariate regression model that included sociodemographic and socioeconomic indicators as well as four dimensions of frailty, for men and women separately. RESULTS The findings indicated that for both men and women, increased age, having no partner, having moved house in the previous 10 years, having a lower educational level and having a lower household income are risk characteristics for frailty. Moreover, when looking at the different frailty domains, different risk profiles arose, and gender-specific risk characteristics were detected. DISCUSSION This paper elaborates on practical implications, and formulates a number of future research recommendations to tackle frailty in an aging society. The conclusion demonstrates the necessity for a thorough knowledge of risk profiles of frailty, as this will save both time and money and permit preventive actions to be more individually tailored.
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DETECTION AND PREVENTION OF FINANCIAL ELDER ABUSE: RESULTS FROM THE BELGIAN AGEING STUDIES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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EARLY DETECTION OF FRAILTY IN COMMUNITY-DWELLING OLDER ADULTS BY PREVENTIVE HOME VISITS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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SOCIAL RELATIONS ACROSS THE LIFE COURSE: PATHWAYS TO AND FROM SOCIAL EXCLUSION. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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FEELINGS OF LONELINESS IN AN URBANIZED COUNTRY: DOES PLACE AND CIVIC ENGAGEMENT MATTER? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Experiences and Effects of Structurally Involving Residents in the Nursing Home by Means of Participatory Action Research: A Mixed Method Study. J Am Med Dir Assoc 2017; 18:495-502. [PMID: 28238674 DOI: 10.1016/j.jamda.2016.12.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/13/2016] [Accepted: 12/23/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to examine the effects of introducing participatory action research (PAR) within the nursing home (NH) on residents' quality of life (QoL) and NH experience and participation, and to explore their experiences with PAR. DESIGN A mixed methods design was chosen, including a clustered randomized controlled trial (RCT) and qualitative interviews. SETTING For the RCT, 3 NHs were randomly allocated to 3 conditions: an intervention (weekly PAR activity), an active control (weekly reminiscence-activity), or passive control (care as usual). The qualitative study took place in the intervention NH. PARTICIPANTS Within the RCT, about 30 residents were recruited for assessments per NH, including 9 PAR participants and 10 reminiscence participants. Qualitative interviews were held with all PAR participants (residents and internal moderator). INTERVENTION PAR is a method to structurally involve residents in the NH operation. Weekly PAR sessions were held with 9 residents and 2 moderators. Here, residents critically analyzed and discussed the NH operation, identified possible problems, suggested improvements, which were further implemented by the NH and monitored by the PAR group. MEASUREMENTS Residents' NH experience (NH Active Aging Survey), QoL (Anamnestic Comparison Self-Assessment), and experienced participation (Impact on Participation and Autonomy) were measured in the RCT at pre-test, post-test (6 months), and follow-up (12 months). The qualitative study took into account interviews with the PAR stakeholders after 6 months. RESULTS The RCT showed residents' QoL improving more between pre-test and follow-up in the intervention and active control NH compared with the passive control NH. No other effects were observed. The qualitative data revealed a positive PAR experience. Participants enjoyed the activity and indicated various positive influences. Still, there was room for improvement, including communication toward other residents and between staff. CONCLUSIONS Notwithstanding the modest quantitative effects, PAR led to positive experiences and can have a future in the NH when solving some limitations.
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Older offenders deemed criminally irresponsible in Flanders (Belgium): Descriptive results from a retrospective case note study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 46:35-41. [PMID: 27021136 DOI: 10.1016/j.ijlp.2016.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION In Belgium, offenders who are deemed criminally irresponsible for their criminal actions because of mental illness or intellectual disability are subject to a specific safety measure with the dual objective of protecting society and providing mandated care to the offender. While Belgian law requires that offenders who are deemed criminally irresponsible should be in a hospital, clinic or other appropriate institution outside of prison, in practice, about one-third of all such offenders still reside in prison. Whether imprisoned or living in settings outside prison, there is a dearth of knowledge on the characteristics of the aging population among the criminally irresponsible offenders. OBJECTIVE This paper aimed to explore the characteristics of older offenders categorized as criminally irresponsible in Flanders (northern Belgium) with a focus on the differences between imprisoned older offenders deemed criminally irresponsible and their peers who are residing outside prison. METHOD A retrospective case note study of all offenders deemed criminally irresponsible, >60years of age (n=174), was conducted in the four Commissions of Social Defense, which implement the procedure in the case of those deemed criminally irresponsible in Flanders. The files were screened for (1) demographic characteristics, (2) criminal history as well as (3) mental and physical health issues. RESULTS One-fourth of the population were >70years of age. A total of 30.5% were in prison. Compared to their non-imprisoned peers, the imprisoned offenders had a history of having committed more serious violent crimes towards persons, such as homicides and sexual crimes. In addition, imprisoned older offenders categorized as criminally irresponsible are characterized more explicitly by personality traits that are likely to reduce their chances of being transferred to more appropriate settings in the community. IMPLICATIONS A comprehensive and systematic screening of all older offenders deemed criminally irresponsible with regard to health needs and social functioning, including age-related deterioration, alcoholism, and other causes of social disadvantages, is warranted to detect potentially hidden problems.
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Treatment and Control: A Qualitative Study of Older Mentally Ill Offenders' Perceptions on Their Detention and Care Trajectory. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2015; 59:964-985. [PMID: 24510370 DOI: 10.1177/0306624x14521129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The life of older mentally ill offenders (OMIOs) is often characterized by successive periods of detention in correctional facilities, admissions to psychiatric services, and unsuccessful attempts to live independently. Through in-depth interviews, eight personal stories from OMIOs under supervision of the commission of social defence in Ghent (Belgium) were analyzed in the phenomenological research tradition. The results of the study reveal that OMIOs had more positive and less negative experiences in prison settings when compared with other institutional care settings. Independent living, unsurprisingly, is favored the most. This may be due to the fact that the latter option fosters personal competence, feelings of being useful, personal choices, and contact with the "outside" world. Even in later lifetime, a combined approach of risk assessment with improvement of well-being remains valuable to stimulate offender rehabilitation. Therefore, more research into concepts that could be used to support OMIOs needs further consideration.
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Abstract
Purpose: Volunteering among older adults has received increasing attention from researchers, policy makers, and associations. However, there remains a lack of knowledge in how volunteering is impacted by other activities in the lives of older adults. In order to understand activity engagement in later life, insights into the extent to which activities compete with or complement each other are necessary. Methods: Data for the present research were derived from the Belgian Aging Studies ( N = 23,768). The main objective is to uncover the activities that impede or stimulate actual volunteering and/or the likeliness to volunteer at an older age. Results: Structural equation models indicate a strong positive correlation between altruistic types of activities and actual volunteering. Furthermore, older adults active in personal leisure activities are more drawn to be potential volunteers. Implications: The article demonstrates that the activity level of older people is not sufficient to understand volunteering, that is, a distinction between the types of activities is essential.
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Municipality and Neighborhood Influences on Volunteering in Later Life. J Appl Gerontol 2014; 35:601-26. [DOI: 10.1177/0733464814533818] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 04/05/2014] [Indexed: 11/16/2022] Open
Abstract
This article explores the relationships between municipality features and volunteering by older adults. In the literature, strong evidence exists of the influence of place on older people’s health. However, the question how neighborhoods and municipalities promote or hinder volunteer participation remains under-explored. Data for the research are derived from the Belgian Aging Studies. We estimate logistic multilevel models for older individuals’ engagement in volunteering across 141 municipalities in Belgium ( N = 67,144). Analysis shows that neighborhood connectedness, neighborhood satisfaction, home ownership, and presence of services predict voluntary engagement at older ages. The findings support that perceptions and quality of social resources that relate to neighborhoods may be important factors to explain volunteering among older adults. Moreover, the findings suggest that volunteering in later life must be considered within a broader framework.
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Relationships between the perceived neighborhood social environment and walking for transportation among older adults. Soc Sci Med 2014; 104:23-30. [DOI: 10.1016/j.socscimed.2013.12.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 11/08/2013] [Accepted: 12/06/2013] [Indexed: 10/25/2022]
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Developing Age-Friendly Cities: Case Studies From Brussels and Manchester and Implications for Policy and Practice. J Aging Soc Policy 2014; 26:52-72. [DOI: 10.1080/08959420.2014.855043] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Validation of the Comprehensive Frailty Assessment Instrument against the Tilburg Frailty Indicator. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Older adults' transportation walking: a cross-sectional study on the cumulative influence of physical environmental factors. Int J Health Geogr 2013; 12:37. [PMID: 23945285 PMCID: PMC3765082 DOI: 10.1186/1476-072x-12-37] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/13/2013] [Indexed: 12/03/2022] Open
Abstract
Background The physical environment may play a crucial role in promoting older adults’ walking for transportation. However, previous studies on relationships between the physical environment and older adults’ physical activity behaviors have reported inconsistent findings. A possible explanation for these inconsistencies is the focus upon studying environmental factors separately rather than simultaneously. The current study aimed to investigate the cumulative influence of perceived favorable environmental factors on older adults’ walking for transportation. Additionally, the moderating effect of perceived distance to destinations on this relationship was studied. Methods The sample was comprised of 50,685 non-institutionalized older adults residing in Flanders (Belgium). Cross-sectional data on demographics, environmental perceptions and frequency of walking for transportation were collected by self-administered questionnaires in the period 2004-2010. Perceived distance to destinations was categorized into short, medium, and large distance to destinations. An environmental index (=a sum of favorable environmental factors, ranging from 0 to 7) was constructed to investigate the cumulative influence of favorable environmental factors. Multilevel logistic regression analyses were applied to predict probabilities of daily walking for transportation. Results For short distance to destinations, probability of daily walking for transportation was significantly higher when seven compared to three, four or five favorable environmental factors were present. For medium distance to destinations, probabilities significantly increased for an increase from zero to four favorable environmental factors. For large distance to destinations, no relationship between the environmental index and walking for transportation was observed. Conclusions Our findings suggest that the presence of multiple favorable environmental factors can motivate older adults to walk medium distances to facilities. Future research should focus upon the relationship between older adults’ physical activity and multiple environmental factors simultaneously instead of separately.
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The comprehensive frailty assessment instrument: development, validity and reliability. Geriatr Nurs 2013; 34:274-81. [PMID: 23608069 DOI: 10.1016/j.gerinurse.2013.03.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 03/06/2013] [Accepted: 03/11/2013] [Indexed: 11/20/2022]
Abstract
Population aging forces governments to change their policy on elderly care. Older people, even if they are frail and disabled, are motivated to stay in their own homes and environment for as long as possible. Consequently, the early detection of frail older persons is appropriate to avoid adverse outcomes. Several instruments to detect frailty exist, but none use environmental indicators. This study addresses the development and psychometric properties of the Comprehensive Frailty Assessment Instrument (CFAI). This new self-reporting instrument includes physical, psychological, social and environmental domains. The CFAI showed good fit indices and a high reliability. The underlying structure of the CFAI demonstrates the multidisciplinary nature of frailty. Using the CFAI can stimulate nurses and other community healthcare providers toward a more holistic approach of frailty and can guide them to take appropriate interventions to prevent adverse outcomes such as disabilities or hospitalization.
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Abstract
The aim of this contribution is twofold: on one hand to examine the individual risk factors regarding feelings of unsafety among older people and on the other hand to investigate whether they differ between third-age adults (aged 60-79) and fourth-age adults (aged 80+). This study seeks to identify the relationship between demographic variables, lack of economic resources, well-being and perceived ageism on the one side and feelings of unsafety on the other. On the basis of data from the Belgian Ageing Studies (N = 26,116), it was found that fourth-age adults experienced higher levels of feelings of unsafety than third-age adults. Furthermore, hierarchical regression models indicated that gender, number of children and perceived ageism were significantly related to feelings of unsafety across the third and fourth ages. However, several individual characteristics were found to be specific to the different age groups. Conclusively, practical implications and research issues are critically discussed by emphasising the importance of tackling structural inequalities among older persons to reduce their feelings of unsafety.
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Physical environmental factors related to walking and cycling in older adults: the Belgian aging studies. BMC Public Health 2012; 12:142. [PMID: 22361255 PMCID: PMC3341198 DOI: 10.1186/1471-2458-12-142] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 02/23/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Socio-ecological models emphasize the relationship between the physical environment and physical activity (PA). However, knowledge about this relationship in older adults is limited. Therefore, the present study aims to investigate the relationship between area of residence (urban, semi-urban or rural) and older adults' walking and cycling for transportation and recreation. Additionally, relationships between several physical environmental factors and walking and cycling and possible moderating effects of area of residence, age and gender were studied. METHODS Data from 48,879 Flemish older adults collected in 2004-2010 through peer research were analyzed. Walking, cycling and environmental perceptions were assessed using self-administered questionnaires. The Study Service of the Flemish Government provided objective data on municipal characteristics. Multilevel logistic regression analyses were applied. RESULTS Urban participants were more likely to walk daily for transportation compared to rural (OR = 1.43; 95% CI = 1.22, 1.67) and semi-urban participants (OR = 1.32; 95% CI = 1.13, 1.54). Urban participants were less likely to cycle daily for transportation compared to semi-urban participants (OR = 0.72; 95% CI = 0.56, 0.92). Area of residence was unrelated to weekly recreational walking/cycling. Perceived short distances to services (ORs ranging from 1.04 to 1.19) and satisfaction with public transport (ORs ranging from 1.07 to 1.13) were significantly positively related to all walking/cycling behaviors. Feelings of unsafety was negatively related to walking for transportation (OR = 0.93, 95% CI = 0.91, 0.95) and recreational walking/cycling (OR = 0.95, 95% CI = 0.92, 0.97). In females, it was also negatively related to cycling for transportation (OR = 0.94, 95% CI = 0.90, 0.98). CONCLUSIONS Urban residents were more likely to walk for transportation daily compared to semi-urban and rural residents. Daily cycling for transportation was less prevalent among urban compared to semi-urban residents. Access to destinations appeared to be important for promoting both walking and cycling for transportation and recreation across all demographic subgroups. Additionaly, feelings of unsafety were associated with lower rates of walking for transportation and walking/cycling for recreation in all subgroups and cycling for transportation in females. No clear patterns emerged for other environmental factors.
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Abstract
The aim of this study was to examine the relation between social capital, defined in terms of social ties, place attachment, and civic participation, and feelings of unsafety in later life. Survey data for 24,962 people aged 60 years and older from 85 municipalities across Belgium provided the empirical evidence for the analysis. The results of the multiple regression analysis reveal that a lack of opportunities for political participation is the most important factor in interpreting feelings of unsafety. In addition, several features of place attachment proved to be associated with feelings of unsafety, such as neighborhood satisfaction and neighborhood involvement. Finally, some recommendations to reduce feelings of unsafety among older people are discussed. The results point to the need to enhance opportunities to give older people a voice in the process of political decision making as an important action in reducing feelings of unsafety.
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Verbal cued recall as a predictor of conversion to Alzheimer's disease in Mild Cognitive Impairment. Int J Geriatr Psychiatry 2009; 24:1094-100. [PMID: 19280679 DOI: 10.1002/gps.2228] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study was set up to investigate whether neuropsychological tests are able to predict conversion to AD among Mild Cognitive Impairment (MCI) patients. METHODS At baseline the cognitive part of the Cambridge Examination for Mental Disorders of the Elderly (CAMCOG), the Mini Mental Status Examination (MMSE), the Geriatric Depression Scale (GDS), a Dutch variation of Rey's Auditory Verbal Learning Test, the Memory Impairment Screen plus (MISplus) and the Visual Association Test (VAT) were administered to 40 patients diagnosed with MCI. After 18 months, MCI-patients were reassessed and a follow-up diagnosis was established. Of those who were seen for follow-up (n = 31), seven fulfilled (NINCDS-ADRDA) criteria of probable AD, while 24 did not convert. RESULTS A binary logistic regression analysis showed that the MISplus contributed most to the prediction of conversion (OR = 0.28, 95% CI 0.099-0.790). With a cut-off of 2 out of 6, a positive predictive value of 71.5%, a negative predictive value of 91.5% and an overall diagnostic accuracy of 87.0% were achieved. CONCLUSIONS This prospective, longitudinal study shows that a score of 0 or 1 out of 6 on the MISplus may be a good indicator of future (within 18 months) progression to AD among MCI-patients.
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Adolescents' mental health outcomes according to different types of exposure to ongoing terror attacks. J Youth Adolesc 2009; 38:850-62. [PMID: 19636786 DOI: 10.1007/s10964-008-9305-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Accepted: 06/20/2008] [Indexed: 02/08/2023]
Abstract
This study investigates the impact of several types of exposure to terror attacks on adolescents' psychological outcomes in the context of ongoing terror. A total of 913 adolescents (51% girls) aged 12 to 18 years (12-13.6 = 33%; 13.7-15.6 = 38%; 15.7-18 = 28%) took part in the study. Detailed data were collected concerning objective, subjective and "mixed" types of exposure to terror, as well as demographics, post-traumatic stress symptoms (PTSS), emotional and behavioral problems and overall psychological and psychiatric difficulties. Subjective exposure was found to be the most important contributor to adolescents' post-traumatic stress and other mental health problems in this context. Gender also had important effects. The effects of objective and mixed types of exposure, as well as age, were less prominent. We did find, however, that the more adolescents consulted media, the less they experienced behavioral and emotional problems. Given that subjective experiences appear to be the best factor in explaining mental health outcomes when adolescents are confronted with persistent terror, the cognitive and emotional dynamics along with the coping behavior linked to such experiences merit further investigation.
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Coping styles as moderating the relationships between terrorist attacks and well-being outcomes. J Adolesc 2009; 32:585-99. [PMID: 18775563 DOI: 10.1016/j.adolescence.2008.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Revised: 01/25/2008] [Accepted: 06/11/2008] [Indexed: 02/08/2023]
Abstract
This study aims to explore use of coping strategies among adolescents and their relationships with well being in the context of ongoing terrorism. Furthermore, we aim to explore to what extent coping styles in addition to exposure variables explain well being of adolescents facing ongoing terror. During September 2003, after three years of ongoing terror attacks, 913 Israeli adolescents aged 12-18 years, completed the following questionnaires during regular class sessions: Demographics, Achenbach's Youth Self Report; Exposure to Terror and Post Traumatic Stress (PTS) questionnaire; Adolescent Coping Scale (ACS) and Brief Symptoms Inventory. Adolescents employed mainly problem solving strategies which mean they have the capacity to cope well in spite of stressful events. Emotional focused coping was associated with PTS and mental health problems. Regression analysis of different exposure and coping variables revealed that exposure, appraisal (subjective exposure) and coping styles explained 26-37% of the variance of different psychological problems. The findings highlight the importance of appraisal (subjective exposure) and coping strategies, for understanding adolescents' mental health outcomes. Moreover, these findings are relevant to the development of prevention/intervention programs that facilitate youth's cognitive and emotional adjustments to ongoing trauma risks and terror threats.
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Abstract
BACKGROUND The developmental outcomes of children born after ICSI are still a matter of concern. The purpose of the present study was to investigate psychological outcomes for 5-year-old children born after ICSI and compare these with outcomes for children born after spontaneous conception (SC). METHODS Three hundred singleton children born after ICSI in Belgium, Sweden and the USA were matched by maternal age, child age and gender. Outcome measures included the Wechsler Preschool and Primary scales of intelligence (WPPSI-R), Peabody Developmental Motor Scales, Parenting Stress Index and Child Behaviour Checklist. RESULTS Regarding cognitive development, no significant differences were found on WPPSI-R verbal and performance scales between ICSI and SC children. However, some differences were noted on subtests of the Performance Scale. ICSI children more often obtained a score below 1 SD of the mean on the subtests: Object Assembly, Block Design and Mazes (all P<0.05). Significant differences by site (i.e. Belgium, Sweden and New York) were found on subtests related to parenting stress, child behaviour problems and motor development (all P<0.05). These findings can probably be explained by variables other than conception mode, such as cultural differences and selection bias. CONCLUSIONS Although the finding that a higher proportion of ICSI children obtained scores below the cut-off on some of the visual-spatial subscales of the WPPSI-R warrants further investigation, ICSI does not appear to affect the psychological well-being or cognitive development at age 5.
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MNA and odor perception. NESTLE NUTRITION WORKSHOP SERIES. CLINICAL & PERFORMANCE PROGRAMME 2001; 1:41-59; discussion 59-60. [PMID: 11490595 DOI: 10.1159/000062971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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[Women and their retirement: adaptation as a dynamic assessment process]. Tijdschr Gerontol Geriatr 1999; 30:6-11. [PMID: 10093885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
With this study we try to fill the gap in our knowledge about the retirement process for women. This study indicates that women assess their retirement in many different ways, both before their retirement (initial appraisal) and after it (tertiary appraisal). At the first interview before retirement almost half of the (63) women showed a positive appraisal, while 2.5 year after retirement almost 60% (of 51 women) showed a positive appraisal. We also notice an important diversity in the way they deal with the situation. Mostly problem-oriented and cognitive coping categories were used. The positive connection between the problem oriented coping on the one hand, and on the other hand a positive tertiary appraisal and positive changes in the appraisal underlines the efficacy of the problem-oriented coping. We found an important individual dynamic: almost half of the examined women (22 of 51) assesses their retirement differently during the retirement transition period. From an agogic point of view it is therefore important to pay attention to these individual trajectory changes.
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