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Verbeek H, Zwakhalen SMG, Schols JMGA, Kempen GIJM, Hamers JPH. The Living Lab In Ageing and Long-Term Care: A Sustainable Model for Translational Research Improving Quality of Life, Quality of Care and Quality of Work. J Nutr Health Aging 2020; 24:43-47. [PMID: 31886807 PMCID: PMC6934630 DOI: 10.1007/s12603-019-1288-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/02/2019] [Indexed: 01/27/2023]
Abstract
There is a strong need in long-term care for scientific research, so older people and their families, health care professionals, policy makers, and educators can benefit from new advancements and best available evidence in every day care practice. This paper presents the model of a sustainable and successful interdisciplinary collaboration between scientists, care providers and educators in long-term care: the "Living Lab in Ageing and Long-Term Care" by Maastricht University in the Netherlands. Its mission is to contribute with scientific research to improving i) quality of life of older people and their families; ii) quality of care and iii) quality of work of those working in long-term care. Key working mechanisms are the Linking Pins and interdisciplinary partnership using a team science approach, with great scientific and societal impact. A blueprint for the model is discussed, describing its business model and challenges in getting the model operational and sustainable are discussed.
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Affiliation(s)
- H Verbeek
- Dr. Hilde Verbeek, Associate Professor, Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands,
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Op Het Veld LPM, van Rossum E, Kempen GIJM, Beurskens AJHM, Hajema KJ, de Vet HCW. Can the Combined Use of Two Screening Instruments Improve the Predictive Power of Dependency in (Instrumental) Activities of Daily Living, Mortality and Hospitalization in Old Age? J Frailty Aging 2019; 8:180-185. [PMID: 31637403 DOI: 10.14283/jfa.2019.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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 Due to differences in the definition of frailty, many different screening instruments have been developed. However, the predictive validity of these instruments among community-dwelling older people remains uncertain. OBJECTIVE To investigate whether combined (i.e. sequential or parallel) use of available frailty instruments improves the predictive power of dependency in (instrumental) activities of daily living ((I)ADL), mortality and hospitalization. DESIGN, SETTING AND PARTICIPANTS A prospective cohort study with two-year follow-up was conducted among pre-frail and frail community-dwelling older people in the Netherlands. MEASUREMENTS Four combinations of two highly specific frailty instruments (Frailty Phenotype, Frailty Index) and two highly sensitive instruments (Tilburg Frailty Indicator, Groningen Frailty Indicator) were investigated. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for all single instruments as well as for the four combinations, sequential and parallel. RESULTS 2,420 individuals participated (mean age 76.3 ± 6.6 years, 60.5% female) in our study. Sequential use increased the levels of specificity, as expected, whereas the PPV hardly increased. Parallel use increased the levels of sensitivity, although the NPV hardly increased. CONCLUSIONS Applying two frailty instruments sequential or parallel might not be a solution for achieving better predictions of frailty in community-dwelling older people. Our results show that the combination of different screening instruments does not improve predictive validity. However, as this is one of the first studies to investigate the combined use of screening instruments, we recommend further exploration of other combinations of instruments among other study populations.
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Affiliation(s)
- L P M Op Het Veld
- Linda P.M. Op het Veld, MSc, Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, the Netherlands, Phone: +31 (0)45 400 6538, E-mail:
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Kempen GIJM, Metzelthin SF. TEACHING CAREGIVERS TO ACTIVELY ENGAGE OLDER ADULTS IN DAILY ACTIVITIES: CAREGIVERS’ PERFORMANCE AND PERSPECTIVES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands, Maastricht, Limburg
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Metzelthin SF, Smeets RGM, Hanssen WAG, Zijlstra GAR, van Rossum E, de Man-van Ginkel JM, Kempen GIJM. EXPERIENCES OF HOME CARE STAFF WITH THE STAY ACTIVE AT HOME PROGRAM. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - R G M Smeets
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | | | - G A R Zijlstra
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - E van Rossum
- Research Centre for Community Care, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, Netherlands; Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - J M de Man-van Ginkel
- Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Nursing Science, programme in Clinical Health Sciences University Medical Center Utrecht, Utrecht, Netherlands
| | - G I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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van Velthuijsen EL, Zwakhalen SMG, Kempen GIJM, Verhey FRJ. [Treatment of hypoactive delirium: is there a place for antipsychotics?]. Ned Tijdschr Geneeskd 2018; 162:D2660. [PMID: 30040299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hypoactive delirium is common among older hospitalised patients: between 29 and 64% of all older patients in hospital develop a delirium, of which the majority is of the hypoactive subtype. Hypoactive delirium often remains undiagnosed or is only diagnosed late and prognosis is worse than for a hyperactive delirium. Psychotic symptoms, fear, and distress are as frequent in hypoactive as in hyperactive delirium. The guideline of the Dutch College of General Practitioners and the multidisciplinary guideline of the Dutch Geriatrics Society differ in their advice on the pharmacological treatment of hypoactive delirium. Research into the effectiveness of antipsychotics so far did not differentiate between the different types of delirium. In patients with hypoactive delirium, antipsychotics should only be considered after all non-pharmacological options have been tried, no obvious and solvable cause for the delirium has been found and the patient is visibly suffering from the psychotic symptoms.
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Affiliation(s)
- Eveline L van Velthuijsen
- Universiteit Maastricht, Care and Public Health Research Institute (CAPHRI), afd. Health Services Research
- Contact: E.L. van Velthuijsen
| | - Sandra M G Zwakhalen
- Universiteit Maastricht, Care and Public Health Research Institute (CAPHRI), afd. Health Services Research
| | - G I J M Kempen
- Universiteit Maastricht, Care and Public Health Research Institute (CAPHRI), afd. Health Services Research
| | - Frans R J Verhey
- Universiteit Maastricht, Alzheimer Centrum Limburg, MHeNS School for Mental Health and NeuroScience, afd. Psychiatry and Neuropsychology
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Blom JW, Van den Hout WB, Den Elzen WPJ, Drewes YM, Bleijenberg N, Fabbricotti IN, Jansen APD, Kempen GIJM, Koopmans R, Looman WM, Melis RJF, Metzelthin SF, Moll van Charante EP, Muntinga ME, Numans ME, Ruikes FGH, Spoorenberg SLW, Stijnen T, Suijker JJ, De Wit NJ, Wynia K, Wind AW, Gussekloo J. Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis. Age Ageing 2018. [PMCID: PMC6108387 DOI: 10.1093/ageing/afy091] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting primary care sector. Interventions combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes quality of life (visual analogue scale 0–10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was −0.01 (95% confidence interval −0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.
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Affiliation(s)
- J W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, The Netherlands
| | - W B Van den Hout
- Department of Biomedical Data Sciences—Medical Decision Making, Leiden University Medical Center, RC Leiden, The Netherlands
| | - W P J Den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, The Netherlands
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, RC Leiden, The Netherlands
| | - Y M Drewes
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, RC Leiden, The Netherlands
| | - N Bleijenberg
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, GA Utrecht, The Netherlands
| | - I N Fabbricotti
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, CA Rotterdam, The Netherlands
| | - A P D Jansen
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, MB Amsterdam, The Netherlands
| | - G I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, MD Maastricht, The Netherlands
| | - R Koopmans
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - W M Looman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, CA Rotterdam, The Netherlands
| | - R J F Melis
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - S F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, MD Maastricht, The Netherlands
| | - E P Moll van Charante
- Department of General Practice, Academic Medical Center, DD Amsterdam, The Netherlands
| | - M E Muntinga
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, MB Amsterdam, The Netherlands
| | - M E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, The Netherlands
| | - F G H Ruikes
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - S L W Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Internal postal code FA10, AD Groningen, The Netherlands
| | - T Stijnen
- Department of Medical Statistics, Leiden University Medical Center, RC Leiden, The Netherlands
| | - J J Suijker
- Department of General Practice, Academic Medical Center, DD Amsterdam, The Netherlands
| | - N J De Wit
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, GA Utrecht, The Netherlands
| | - K Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Internal postal code FA10, AD Groningen, The Netherlands
| | - A W Wind
- Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, The Netherlands
| | - J Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, The Netherlands
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, RC Leiden, The Netherlands
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Smetcoren AS, Dury S, De Donder L, Dierckx E, De Witte N, Engelborghs S, De Deyn PP, van der Vorst A, Van der Elst M, Lambotte D, Hoeyberghs L, Fret B, Duppen D, De Roeck E, Kardol M, Schoenmakers B, De Lepeleire J, Zijlstra GAR, Kempen GIJM, Schols JMGA, Verté D. [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- A S Smetcoren
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België.
| | - S Dury
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - L De Donder
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - E Dierckx
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België.,Klinische en Levenslooppsychologie, Vrije Universiteit Brussel, Brussel, België
| | - N De Witte
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België.,Faculteit Mens en Welzijn, Hogeschool Gent, Gent, België
| | - S Engelborghs
- Biomedische Wetenschappen, Universiteit Antwerpen, Antwerpen, België
| | - P P De Deyn
- Biomedische Wetenschappen en Geneeskunde, Universiteit Antwerpen, Antwerpen, België
| | - A van der Vorst
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Nederland
| | - M Van der Elst
- Academisch Centrum voor Huisartsgeneeskunde, KU Leuven, Leuven, België
| | - D Lambotte
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - L Hoeyberghs
- Faculteit Mens en Welzijn, Hogeschool Gent, Gent, België
| | - B Fret
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - D Duppen
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - E De Roeck
- Klinische en Levenslooppsychologie, Vrije Universiteit Brussel, Brussel, België.,Biomedische Wetenschappen, Universiteit Antwerpen, Antwerpen, België
| | - M Kardol
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
| | - B Schoenmakers
- Academisch Centrum voor Huisartsgeneeskunde, KU Leuven, Leuven, België
| | - J De Lepeleire
- Academisch Centrum voor Huisartsgeneeskunde, KU Leuven, Leuven, België
| | - G A R Zijlstra
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Nederland
| | - G I J M Kempen
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Nederland
| | - J M G A Schols
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Nederland
| | - D Verté
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
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Warnier RMJ, van Rossum E, van Velthuijsen E, Mulder WJ, Schols JMGA, Kempen GIJM. Validity, Reliability and Feasibility of Tools to Identify Frail Older Patients in Inpatient Hospital Care: A Systematic Review. J Nutr Health Aging 2016; 20:218-30. [PMID: 26812520 DOI: 10.1007/s12603-015-0567-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The objective of this study is to identify and review screening tools for frailty in older adults admitted to inpatient hospital care with respect to their validity, reliability and feasibility. METHODS Studies were identified through systematically searching PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and PsycINFO and screening reference lists till June 2014. Papers dealing with screening tools aimed at identifying frail older patients in in-hospital care, and including information about validity, reliability or feasibility, were included in the review. The quality of the included studies was critically appraised via the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). RESULTS From the originally identified 2001 studies 32 studies met the inclusion criteria, in which 16 screening tools were presented. The screening tools showed different characteristics with respect to the number of items, the method of administration and the domains included. The most frequently studied tools with respect to predictive validity were the Identification Seniors At Risk (ISAR) and Triage Risk Stratification Tool (TRST). Studies retrieved poorer information about reliability and feasibility. Overall sensitivity was fairly good. The ISAR, ISAR-HP (Identification Seniors At Risk Hospitalized Patients) and Multidimensional Prognostic Index (MPI) generally had the best sensitivity. CONCLUSIONS Many screening tools are available for daily practice. These tools to identify frail older patients in inpatient hospital care could be useful. For no tool, however, is clear evidence available yet regarding validity, reliability and feasibility. The overall sensitivity of the included screening tools was fairly good, whereas information on reliability and feasibility was lacking for most tools. In future research more attention should be given to the latter items.
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Affiliation(s)
- R M J Warnier
- RMJ Warnier, Maastricht University Medical Center, Department of Integrated Care, Elderly care, PO-Box 5800, 6202 AZ Maastricht, The Netherlands, Telephone: 0031-433877540, Fax: 0031-433876527,
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Boots LMM, de Vugt ME, van Knippenberg RJM, Kempen GIJM, Verhey FRJ. A systematic review of Internet-based supportive interventions for caregivers of patients with dementia. Int J Geriatr Psychiatry 2014; 29:331-44. [PMID: 23963684 DOI: 10.1002/gps.4016] [Citation(s) in RCA: 287] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/17/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Because of the expected increase in the number of dementia patients, the unlikelihood of a cure in the near future, and the rising cost of care, there is an increasing need for effective caregiver interventions. Internet interventions hold considerable promise for meeting the educational and support needs of informal dementia caregivers at reduced costs. The current study aims to provide an overview of the evidence for the effectiveness, feasibility, and quality of Internet interventions for informal caregivers of people with dementia. METHODS A systematic literature search of five scientific databases was performed, covering literature published up to 10 January 2013. Twelve studies were identified. The quality of the included studies was assessed according to the Cochrane level of evidence and the criteria list of the Cochrane Back Review Group. RESULTS The intervention types, dosage, and duration differed widely, as did the methodological quality of the included studies. The overall level of evidence was low. However, the results demonstrate that Internet interventions for informal dementia caregivers can improve various aspects of caregiver well-being, for example, confidence, depression, and self-efficacy, provided they comprise multiple components and are tailored to the individual. Furthermore, caregivers could benefit from interaction with a coach and other caregivers. CONCLUSIONS Internet interventions for informal dementia caregivers may improve caregiver well-being. However, the available supporting evidence lacks methodological quality. More randomized controlled studies assessing interventions performed according to protocol are needed to give stronger statements about the effects of supportive Internet interventions and their most promising elements.
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Affiliation(s)
- L M M Boots
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
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Kempen GIJM. [Innovation in elderly care: from describing and explaining to interventions and implementation]. Tijdschr Gerontol Geriatr 2013; 44:239-241. [PMID: 24511622 DOI: 10.1007/s12439-013-0048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Zijlstra GAR, Du Moulin MFMT, van Haastregt JCM, de Jonge M, Kempen GIJM, van der Poel A. [Managing concerns about falls in older people: evaluation of the implementation of an evidence-based program]. Tijdschr Gerontol Geriatr 2013; 44:272-84. [PMID: 24218167 DOI: 10.1007/s12439-013-0045-1] [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] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A cognitive behavioral program reduced concerns about falling and related avoidance behavior among older community-dwelling adults in a randomized controlled trial. In the current study we examined the effects and acceptability of the program after nation-wide implementation into home care organizations in The Netherlands. METHODS In a one-group pretest-posttest study with data collection before the start of the program and at 2 and 4 months, the effects and acceptability of the program were assessed in 125 community-dwelling older people. The outcomes of the effect evaluation included concerns about falls, related avoidance behavior, falls, fall-related medical attention, feelings of anxiety, symptoms of depression, and loneliness. RESULTS Pretest-posttest analyses with the Wilcoxon signed-rank test and the paired t-test showed significant improvements at 4 months for concerns about falls, activity avoidance, number of falls in the past 2 months, feelings of anxiety, and symptoms of depression. No significant differences were shown for the other outcomes. DISCUSSION After implementation in home care organizations, the outcomes indicate positive program effects on concerns about falls, avoidance behavior, and falls in community-dwelling older people. Given the similarity in results, i.e. between those of the previously performed randomized controlled trial and those of the current pretest-posttest study, we conclude that the program can be successfully implemented in practice. This article is an adjusted, Dutch version of Zijlstra GA, van Haastregt JC, Du Moulin MF, de Jonge MC, van der Poel A, Kempen GI. Effects of the implementation of an evidenc-based program to manage concerns about falls in older adults. The Gerontologist 2013;53(5):839-849; doi: 10.1093/geront/gns142.
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Affiliation(s)
- G A R Zijlstra
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands,
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Zijlstra GAR, van Haastregt JCM, Kempen GIJM. ["A matter of balance--Netherlands": an effective intervention to reduce concerns about falls and related avoidance of activity in older people]. Tijdschr Gerontol Geriatr 2012; 43:164-74. [PMID: 23082409 DOI: 10.1007/s12439-012-0026-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Concerns about falls and related avoidance behavior are common among older people and may lead to decreased quality of life, decreased physical and psychosocial functioning, and premature admission to a nursing home. In a randomized controlled trial among 540 community-dwelling older people we studied the feasibility and effects of a cognitive behavioral program on concerns about falls, related avoidance of activity, and falls. Data of the process evaluation obtained from participants in the intervention group (n = 280) and the trainers (n = 6) showed that the program was considered as feasible by the trainers, and positively judged by participants and trainers. Furthermore, participants experienced benefits from attending the program (61% still reported benefits one year after the program). Prior to the start of the program 26% of the participants of the intervention dropped out, yet, among the participants who started the program completion was high (84%). The effect evaluation showed positive outcomes for concerns about falls, related avoidance of activity, and daily activity at 2 months (after the program) when comparing the intervention group with the control group (n = 260). Long-term effects were also shown for, amongst others, concerns about falls and recurrent falls. Following these positive results the cognitive behavioral group program is currently made available to geriatric care settings nationwide in the Netherlands.
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Affiliation(s)
- G A R Zijlstra
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
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Klabbers G, Bosma H, van den Akker M, Kempen GIJM, van Eijk JTM. Cognitive hostility predicts all-cause mortality irrespective of behavioural risk at late middle and older age. Eur J Public Health 2012; 23:701-5. [PMID: 22683771 DOI: 10.1093/eurpub/cks060] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Most but not all evidence supports hostility-related attributes to increase mortality risk. However, studies usually include single attributes, their effects have been studied predominantly in younger populations, and behavioural pathways explaining the mortality effect seem to differ by age. We examined the relationship between all-cause mortality and cognitive hostility, anger, aggression and rebelliousness, and their independence of health behaviours in a late middle-aged and older population. METHODS Data were derived from the longitudinal Dutch Study of Medical Information and Lifestyles in the city of Eindhoven, in the Southeast of the Netherlands study among 2679 late middle-aged and older Dutch people. Psychological characteristics were self-reported in 2004/2005, and mortality was monitored from 2005 to 2010. Cox regression analyses were used to calculate the mortality risk by each unique psychological variable with additional adjustments for the other psychological variables and for health behaviours. Baseline adjustments included age, sex, educational level and prevalent morbidity. RESULTS Cognitive hostility was associated with all-cause mortality, independent of health behaviours (on a scale ranging from 6 to 30, the hazard ratio (HR) was 1.05; 95% confidence interval [95% CI): 1.01-1.09]. Anger, aggression and rebelliousness were not associated with mortality risk. CONCLUSIONS In diminishing excess mortality risks, hostile cognitions might be acknowledged separately and additionally to the risk posed by unhealthy lifestyles.
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Affiliation(s)
- Gonnie Klabbers
- Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
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14
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Metzelthin SF, Daniels R, van Rossum E, de Witte LP, van den Heuvele WJA, Kempen GIJM. [The psychometric properties of three self-report screening instruments for identifying frail older people in the community]. Tijdschr Gerontol Geriatr 2011; 42:120-30. [PMID: 21834306 DOI: 10.1007/s12439-011-0022-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Frailty can lead towards serious adverse consequences, such as disability. With regard to prevention valid screening instruments are needed to identify frail older people. The aim was to evaluate and compare the psychometric properties of three screening instruments: the Groningen Frailty Indicator (GFI), the Tilburg Frailty Indicator (TFI) and the Sherbrooke Postal Questionnaire (SPQ). For validation purposes the Groningen Activity Restriction Scale (GARS) was added. METHODS A questionnaire was sent to 687 older people (> or = 70 years). (1) Agreement between instruments, (2) internal consistency, (3) cumulative scalability according to Mokken scale analysis and (4) construct validity were evaluated. RESULTS The response rate was 77%. Prevalence estimates of frailty ranged from 40% to 59%. The highest agreement was found between the GFI and TFI (Cohen's kappa = 0.74). Cronbach's alpha for the GFI, TFI and SPQ was 0.73, 0.79 and 0.26, respectively. The scalability of the three instruments was inadequate (Loevinger's H: 0.28, 0.30 and 0.09 for GFI, TFI and SPQ, respectively). Frailty scores correlated significantly with each other and with the GARS scores. CONCLUSION Especially the GFI and TFI seem to be useful to identify frail older people. Further research regarding their predictive validity is still needed.
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Affiliation(s)
- S F Metzelthin
- Vakgroep Verpleging en Verzorging, CAPHRI School for Public Health and Primary Care, Universiteit Maastricht
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15
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Kempen GIJM, Oude Wesselink SF, van Haastregt JCM, Zijlstra GAR. Long-term effect on mortality of a multicomponent cognitive behavioural group intervention to reduce fear of falling in older adults: a randomised controlled trial. Age Ageing 2011; 40:519-23. [PMID: 21551460 DOI: 10.1093/ageing/afr041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G I J M Kempen
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, The Netherlands.
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16
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Braeken APBM, Lechner L, Houben RMA, Van Gils FCJM, Kempen GIJM. Psychometric properties of the Screening Inventory of Psychosocial Problems (SIPP) in Dutch cancer patients treated with radiotherapy. Eur J Cancer Care (Engl) 2011; 20:305-14. [PMID: 20412287 DOI: 10.1111/j.1365-2354.2010.01182.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Screening Inventory of Psychosocial Problems (SIPP) was developed to assess psychosocial distress in Dutch cancer patients. It is short, easily completed by patients and quickly interpreted by medical staff. In this study, we investigated the psychometric properties of the SIPP in 289 Dutch cancer patients treated with radiotherapy. The SIPP was administered alongside the Hospital Anxiety and Depression Scale and the Mental Adjustment to Cancer scale. In-depth structured clinical interviews were also conducted with 76 patients. Results indicate that the psychometric properties of the SIPP are promising with respect to its reliability, construct validity as evaluated with confirmatory factor analysis, and convergent and divergent validity. Receiver operating characteristics analysis showed that the SIPP successfully differentiates between patients known to have symptoms of distress and those who do not. The SIPP is therefore a reliable and valid instrument for identifying distress in cancer patients. It differs from previously developed instruments in that it measures different domains of distress in only a few minutes, and provides opportunity for patients to indicate whether they would like to discuss identified problem areas. Due to its convenient format, the SIPP may easily be used to assess psychosocial distress in cancer patients as a routine part of the clinical consultation.
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Affiliation(s)
- A P B M Braeken
- Faculty of Health, Medicine & Life Sciences, Department of Health Care & Nursing Science, School for Public Health & Primary Care, Maastricht University, Maastricht, Netherlands.
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Klabbers G, Bosma H, Van der Does AJW, Vogelzangs N, Kempen GIJM, Van Eijk JTM, Penninx BWJH. The educational patterning of health-related adversities in individuals with major depression. J Affect Disord 2010; 126:96-102. [PMID: 20299107 DOI: 10.1016/j.jad.2010.02.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 02/22/2010] [Accepted: 02/22/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Major depressive disorder and depression severity are socially patterned, disfavouring individuals from lower socioeconomic groups. Depressive disorders are associated with several adverse health-related outcomes. We examined the educational patterning of somatic health, lifestyles, psychological function and treatment modalities in individuals suffering from major depressive disorder. METHODS We used cross-sectional medical and psychiatric data from 992 participants of The Netherlands Study of Depression and Anxiety (NESDA) with a diagnosed current major depressive disorder. Associations of education with somatic, lifestyle-related, and psychological outcomes, and with treatment modalities, adjusted for depression severity, were examined by means of (multinomial and binary) logistic and linear regression analyses. RESULTS In addition to and independent of major depressions being more severe in the less educated patients, metabolic syndrome, current smoking, low alcohol consumption, hopelessness and low control were more prevalent in a group of less educated individuals suffering from major depression, compared with their more highly educated peers. The less educated persons were more likely to be treated with antidepressant medication and less likely to receive psychotherapy treatment. None of these observations were explained by a higher depression severity in the less educated group. LIMITATIONS The cross-sectional design does not allow us to make direct causal inferences regarding the mutual influences of the different health-related outcomes. CONCLUSIONS Further research should explore the necessity and feasibility of routine screening for additional health risk, particularly among less educated depressed individuals.
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Affiliation(s)
- G Klabbers
- Department of Social Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands.
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18
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Zijlstra GAR, van Rens GHMB, Scherder EJA, Brouwer DM, van der Velde J, Verstraten PFJ, Kempen GIJM. Effects and feasibility of a standardised orientation and mobility training in using an identification cane for older adults with low vision: design of a randomised controlled trial. BMC Health Serv Res 2009; 9:153. [PMID: 19712448 PMCID: PMC2759927 DOI: 10.1186/1472-6963-9-153] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 08/27/2009] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Orientation and mobility training (O&M-training) in using an identification cane, also called symbol cane, is provided to people with low vision to facilitate independent participation in the community. In The Netherlands this training is mainly practice-based because a standardised and validly evaluated O&M-training in using the identification cane is lacking. Recently a standardised O&M-training in using the identification cane was developed. This training consists of two face-to-face sessions and one telephone session during which, in addition to usual care, the client's needs regarding mobility are prioritised, and cognitive restructuring techniques, action planning and contracting are applied to facilitate the use of the cane. This paper presents the design of a randomised controlled trial aimed to evaluate this standardised O&M-training in using the identification cane in older adults with low vision. METHODS/DESIGN A parallel group randomised controlled trial was designed to compare the standardised O&M-training with usual care, i.e. the O&M-training commonly provided by the mobility trainer. Community-dwelling older people who ask for support at a rehabilitation centre for people with visual impairment and who are likely to receive an O&M-training in using the identification cane are included in the trial (N = 190). The primary outcomes of the effect evaluation are ADL self care and visual functioning with respect to distance activities and mobility. Secondary outcomes include quality of life, feelings of anxiety, symptoms of depression, fear of falling, and falls history. Data for the effect evaluation are collected by means of telephone interviews at baseline, and at 5 and 17 weeks after the start of the O&M-training. In addition to an effect evaluation, a process evaluation to study the feasibility of the O&M-training is carried out. DISCUSSION The screening procedure for eligible participants started in November 2007 and will continue until October 2009. Preliminary findings regarding the evaluation are expected in the course of 2010. If the standardised O&M-training is more effective than the current O&M-training or, in case of equal effectiveness, is considered more feasible, the training will be embedded in the Dutch national instruction for mobility trainers. TRIAL REGISTRATION ClinicalTrials.gov NCT00946062.
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Affiliation(s)
- G A R Zijlstra
- Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Science, Maastricht, the Netherlands.
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Groffen DAI, Bosma H, van den Akker M, Kempen GIJM, van Eijk JTM. Personality and health as predictors of income decrease in old age: findings from the longitudinal SMILE study. Eur J Public Health 2009; 19:418-23. [PMID: 19380333 DOI: 10.1093/eurpub/ckp050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is much evidence for the influence of low socio-economic status on poor health. It is, however, also important to study the ways in which people attain and retain their socio-economic status and the factors that predict changes in socio-economic status, such as a decrease in income. Such mobility also occurs in older populations, in which financial and health-related changes are very common, especially after retirement. METHODS Three years of follow-up data from 1443 Dutch men and women aged 55 years and older who participated in the Study on Medical Information and Lifestyles Eindhoven (SMILE) were gathered. Logistic regression analyses were used to study the independent effects of physical and mental dysfunction and severity of chronic diseases and adverse personality factors on decrease in income. RESULTS Social anxiety (OR = 1.62, 95% CI: 1.09-2.40), physical dysfunction (OR = 1.71, 95% CI: 1.07-2.74) and severe diseases (OR = 1.37, 95% CI: 1.05-1.78) were significant predictors of decrease in income. These contributions were independent of each other, and remained robust after controlling for other confounding factors, such as gender, age and educational level and change in employment status. Mental dysfunction and other personality characteristics, such as hostility and mastery, did not contribute to decrease in income. CONCLUSION Social anxiety and poor physical health are relevant factors associated with decrease in income in old age. The findings suggest that these factors are important in retaining one's socio-economic status. Future longitudinal research is necessary to further disentangle the mechanisms and pathways related to socio-economic health inequalities along the life-course.
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Affiliation(s)
- D A I Groffen
- School for Public Health and Primary Care (CAPHRI), Department of Social Medicine, Maastricht University, 6200 MD Maastricht, the Netherlands
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20
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Kempen GIJM, Zijlstra GAR, van Haastregt JCM. [The assessment of fear of falling with the Falls Efficacy Scale-International (FES-I). Development and psychometric properties in Dutch elderly]. Tijdschr Gerontol Geriatr 2007; 38:204-12. [PMID: 17879824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Fear of falling is common in older persons. Different methods have been developed to assess fear of falling. The most well-know measure is the 10-item Falls Efficacy Scale (FES). However, the FES items (a) focus on low functioning older persons and particularly on in-home activities, (b) do not comprise social activities, and (c) were developed from a US perspective so that translation in European languages is hampered. To solve these issues, the 16-item Falls Efficacy Scale-International (FES-I) was recently developed within the Prevention of Falls Network Europe (ProFaNE). In this article, the Dutch version of the FES-I is presented and the psychometric properties in 213 Dutch persons aged 70 years of age and over are described. The FES-I showed to be unidimensional and internally consistent; the Cronbach alpha coefficient was 0.96. The 4 week test-retest intra-class correlation coefficient was 0.82. The associations of the FES-I sumscores with age, gender, falls history and overall fear of falling was as expected, indicating construct validity. In addition, the FES-I discriminated in the same extent as the original 10-item FES scale. We conclude that the FES-I showed acceptable reliability and construct validity and may be useful in cross-national research. Future studies should focus on the sensitivity to change of FES-I.
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Affiliation(s)
- G I J M Kempen
- Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Universiteit Maastricht.
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21
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Zijlstra GAR, van Haastregt JCM, van Eijk JTM, van Rossum E, Stalenhoef PA, Kempen GIJM. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing 2007; 36:304-9. [PMID: 17379605 DOI: 10.1093/ageing/afm021] [Citation(s) in RCA: 390] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about the prevalence rates and correlates of fear of falling and avoidance of activity due to fear of falling in the general population of community-living older people. OBJECTIVE To assess prevalence rates and study correlates of fear of falling and avoidance of activity due to fear of falling in this population. STUDY DESIGN AND SETTING cross-sectional study in 4,031 community-living people aged > or =70 years. RESULTS Fear of falling was reported by 54.3% and associated avoidance of activity by 379% of our population. Variables independently associated with fear of falling were: higher age (> or =80 years: odds ratio (OR) =1.79; 95% confidence interval (CI) =1.49-2.16), female gender (OR = 3.23; 95% CI = 2.76-3.79), poor perceived general health (OR = 6.93; 95% CI = 4.70-10.21) and multiple falls (OR = 5.72; 95% CI = 4.40-7.43). Higher age (> or =80 years: OR = 1.92; 95% CI = 1.59-2.32), poor perceived general health (OR = 11.91; 95% CI = 8.38-16.95) and multiple falls (OR = 4.64; 95% CI = 3.73-5.76) were also independently associated with avoidance of activity. CONCLUSIONS Fear of falling and avoidance of activities due to fear of falling, were highly prevalent in our sample of community-living older people. Particularly, poor perceived general health showed a strong, independent association with both, fear of falling, and related avoidance of activity. Findings of our study may help health care professionals to identify people eligible for interventions aimed at reducing fear of falling and activity restriction.
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Affiliation(s)
- G A R Zijlstra
- Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Health Care Studies, 6200 MD Maastricht, The Netherlands.
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Dagnelie PC, Pijls-Johannesma MCG, Lambin P, Beijer S, De Ruysscher D, Kempen GIJM. Impact of fatigue on overall quality of life in lung and breast cancer patients selected for high-dose radiotherapy. Ann Oncol 2007; 18:940-4. [PMID: 17363839 DOI: 10.1093/annonc/mdm057] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although studies show that cancer patients consider fatigue as an important problem, few, if any, studies have quantified the impact of fatigue on overall quality of life (QoL) in cancer patients. In the present study, we evaluated the relative impact of different QoL domains/subscales, including fatigue, on overall QoL in cancer patients preceding radiotherapy. PATIENTS AND METHODS Sixty-four patients with lung or breast cancer selected for high-dose radiotherapy on the primary tumour completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Multivariate models were fitted to define the impact of QLQ-C30 subscales, including fatigue, on overall QoL. RESULTS Of all QLQ-C30 subscales, fatigue showed by far the strongest univariate correlation with overall QoL (r = -0.76, P < 0.001); correlations for functioning subscales (r = 0.44-0.55) and symptom subscales (r = -0.31 to -0.45) were considerably lower. In multivariate analyses, adjusting for potential confounders, fatigue was the only subscale that independently contributed to overall QoL (standardized regression coefficient-0.57, P < 0.001). CONCLUSION Our results indicate that, of all QoL domains/subscales, fatigue is by far the predominant contributor to patient-perceived overall QoL in both lung and breast cancer patients preceding high-dose radiotherapy.
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Affiliation(s)
- P C Dagnelie
- Department of Epidemiology, Nutrition and Toxicology Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
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Kempen GIJM, Meier AJL, Bouwens SFM, van Deursen J, Verhey FRJ. [The psychometric properties of the Dutch version of the Telephone Interview Cognitive Status (TICS)]. Tijdschr Gerontol Geriatr 2007; 38:38-45. [PMID: 17447609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The Telephone Interview Cognitive Status (TICS) is an instrument to screen for dementia in older persons by telephone. Although the psychometric properties of the TICS have been studied in various countries, the quality of the Dutch version of the TICS was yet unknown. This paper presents the Dutch version of the TICS and reports on its reliability and validity among 51 patients of Maastricht University Hospital, The Netherlands. The Pearson and intra-class correlations for test-retest reliability were 0.93 and 0.92, respectively. The Pearson and intra-class correlations for inter-rater reliability were 0.91 and 0.90, respectively. Sensitivity and specificity were studied in relation to the Mini Mental State Examination (MMSE, cut-off point 23/ 24) and the diagnosis of dementia as assessed according to DSM-IV criteria. When using the TICS cut-off point of 26/27, the coefficients for sensitivity and specificity were at least 0.80. The percentages ROC under the curve were 90% and 93% with the MMSE and the diagnosis dementia as criterion, respectively. We conclude that the Dutch version of the TICS is an acceptable instrument for screening for dementia in older persons, particularly when face-to-face contact is not possible.
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Affiliation(s)
- G I J M Kempen
- Capaciteitsgroep Zorgwetenschappen, Faculty of Health, Medicine and Life Sciences, Universiteit Maastricht, Postbus 616, 6200 MD Maastricht.
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Dias N, Kempen GIJM, Todd CJ, Beyer N, Freiberger E, Piot-Ziegler C, Yardley L, Hauer K. [The German version of the Falls Efficacy Scale-International Version (FES-I)]. Z Gerontol Geriatr 2006; 39:297-300. [PMID: 16900450 DOI: 10.1007/s00391-006-0400-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 06/12/2006] [Indexed: 10/24/2022]
Abstract
The German version of the Falls Efficacy Scale-International Version (FES-I), which is presented, was developed for the documentation of fall-related selfefficacy in older persons by a EU-funded expert network (Prevention of Falls Network Europe ProFaNE). The FES-I represents a modification of the original Falls Efficacy Scale (FES), including additional items on complex functional performances and social aspects of falls. The FES-I shows high internal reliability (Cronbach's alpha = 0.96) as well as high test-retest reliability (r=0.96). The mean inter-item correlation was: r = 0.55 (Range r = 0.29-0.79). Results of validation studies for the FES-I in community dwelling older persons for different European countries and geriatric patients with cognitive impairment will be published in the near future.
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Affiliation(s)
- N Dias
- Bethanien Krankenhaus, Geriatrisches Zentrum GmbH, Rohrbacher Str. 149, 69126 Heidelberg, Germany
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Milne DJ, Mulder LL, Beelen HCM, Schofield P, Kempen GIJM, Aranda S. Patients' self-report and family caregivers' perception of quality of life in patients with advanced cancer: how do they compare? Eur J Cancer Care (Engl) 2006; 15:125-32. [PMID: 16643259 DOI: 10.1111/j.1365-2354.2005.00639.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study describes the concordance between advanced cancer patients' self-report of quality of life and their caregivers' perception of the patients' quality of life at two time points. It is often necessary for health professionals to rely on information about the patients' quality of life that is provided by family caregivers (proxy), even though information from the patients is considered 'the gold standard'. Therefore, it is important to establish how reliable this proxy information is. Data were collected 4-6 weeks following diagnosis of recurrent or progressive disease, and again 12 weeks later. Fifty-one patients and their caregivers completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), version 2.0 at both time points. Descriptive statistics were used to calculate patient and caregiver scores and describe the sample. The level of agreement between the two scores, the patients' self-report and the family caregivers' score, was calculated on the mean scores of each scale. In general, most caregivers were able to accurately rate the global quality of life, the level of functioning and the degree of symptom distress experienced by the person they were caring for, when compared with the patients' self-rating. Caregiver ratings for physical domains tended to be more in agreement with those of patients as compared with ratings of the psychosocial domains. This study suggests information from proxy raters is reliable when the proxy is a family caregiver, and this remains true over time.
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Affiliation(s)
- D J Milne
- Peter MacCallum Cancer Centre and School of Nursing, The University of Melbourne, Melbourne, Australia.
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Bosma H, Van Jaarsveld CHM, Tuinstra J, Sanderman R, Ranchor AV, Van Eijk JTM, Kempen GIJM. Low control beliefs, classical coronary risk factors, and socio-economic differences in heart disease in older persons. Soc Sci Med 2005; 60:737-45. [PMID: 15571892 DOI: 10.1016/j.socscimed.2004.06.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this study was to examine whether it is through their low control beliefs that low socio-economic status groups have higher risks of heart disease, and to examine whether this mechanism is more substantial than and independent of the mechanism via classical coronary risk factors. In a population-based prospective cohort study, participants were selected from 27 general practices in the north-eastern part of The Netherlands. In 1993, there were 3888 men and women, 57 years and older, who were without prevalent heart disease. During the 5-year follow-up period, 287 cases of incident heart disease (acute myocardial infarction and/or congestive heart failure) were registered (7%). Persons with a low socio-economic status had higher risks of heart disease (RR = 1.45 (95% CI: 1.06 - 1.99)) compared with their high status counterparts. On average, 4 percent of the socio-economic differences were accounted for by the classical coronary risk factors (e.g. smoking, hypertension) compared with 30 percent by the control beliefs. The contribution of the latter was largely independent of the former. Our findings support the hypothesis that socio-economic inequalities in heart disease-at least in middle-aged and older persons-may be based upon differences in control beliefs, more than upon differences in smoking rates and other classical risk factors.
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Affiliation(s)
- H Bosma
- Health Care Studies, Medical Sociology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Zijlstra GAR, van Haastregt JCM, van Eijk JT, Kempen GIJM. Evaluating an intervention to reduce fear of falling and associated activity restriction in elderly persons: design of a randomised controlled trial [ISRCTN43792817]. BMC Public Health 2005; 5:26. [PMID: 15780139 PMCID: PMC1084249 DOI: 10.1186/1471-2458-5-26] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 03/21/2005] [Indexed: 11/19/2022] Open
Abstract
Background Fear of falling and associated activity restriction is common in older persons living in the community. Adverse consequences of fear of falling and associated activity restriction, like functional decline and falls, may have a major impact on physical, mental and social functioning of these persons. This paper presents the design of a trial evaluating a cognitive behavioural group intervention to reduce fear of falling and associated activity restriction in older persons living in the community. Methods/design A two-group randomised controlled trial was developed to evaluate the intervention. Persons 70 years of age or over and still living in the community were eligible for study if they experienced at least some fear of falling and associated activity restriction. A random community sample of elderly people was screened for eligibility; those eligible for study were measured at baseline and were subsequently allocated to the intervention or control group. Follow-up measurements were carried out directly after the intervention period, and then at six months and 12 months after the intervention. People allocated to the intervention group were invited to participate in eight weekly sessions of two hours each and a booster session. This booster session was conducted before the follow-up measurement at six months after the intervention. People allocated to the control group received no intervention as a result of this trial. Both an effect evaluation and a process evaluation were performed. The primary outcome measures of the effect evaluation are fear of falling, avoidance of activity due to fear of falling, and daily activity. The secondary outcome measures are perceived general health, self-rated life satisfaction, activities of daily life, feelings of anxiety, symptoms of depression, social support interactions, feelings of loneliness, falls, perceived consequences of falling, and perceived risk of falling. The outcomes of the process evaluation comprise the performance of the intervention according to protocol, the attendance and adherence of participants, and the participants' and facilitators' opinion about the intervention. Data of the effect evaluation will be analysed according the intention-to-treat and on-treatment principle. Data of the process evaluation will be analysed using descriptive techniques.
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Affiliation(s)
- GAR Zijlstra
- Universiteit Maastricht, Faculty of Health Sciences, Department of Health Care Studies, section Medical Sociology, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- Care and Public Health Research Institute, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - JCM van Haastregt
- Universiteit Maastricht, Faculty of Health Sciences, Department of Health Care Studies, section Medical Sociology, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- Care and Public Health Research Institute, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - JThM van Eijk
- Universiteit Maastricht, Faculty of Health Sciences, Department of Health Care Studies, section Medical Sociology, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- Care and Public Health Research Institute, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - GIJM Kempen
- Universiteit Maastricht, Faculty of Health Sciences, Department of Health Care Studies, section Medical Sociology, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- Care and Public Health Research Institute, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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Arnold R, Ranchor AV, Sanderman R, Kempen GIJM, Ormel J, Suurmeijer TPBM. The Relative Contribution of Domains of Quality of Life to Overall Quality of Life for Different Chronic Diseases. Qual Life Res 2004; 13:883-96. [PMID: 15233502 DOI: 10.1023/b:qure.0000025599.74923.f2] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined the contribution of the quality of life (QoL) domains physical, social and psychological functioning to the explanation of overall QoL. Various disorders may differentially affect QoL domains due to disease-specific factors and, consequently, the relationship between QoL domains and overall QoL may vary between diseases. We therefore studied this relationship for several diseases as well as the differential impact of these diseases on QoL. The present study had a cross-sectional design. We selected patients (aged 57 years and older) with one of the following eight chronic medical conditions: lung disorder, heart condition, hypertension, diabetes mellitus, back problems, rheumatoid arthritis, migraine, or dermatological disorders. The total group of respondents included 1457 patients and 1851 healthy subjects. Regression analyses showed that the domain of psychological functioning contributed to overall QoL for all disorders, whereas physical and social functioning contributed to overall QoL for some disorders. Differences were found between most patient groups and healthy subjects with respect to physical functioning; with respect to social and psychological functioning some groups differed from the healthy group. Explanations for the findings and implications for clinical practice are discussed.
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Affiliation(s)
- R Arnold
- Northern Centre for Healthcare Research (NCH), Department of Health Sciences, University of Groningen, The Netherlands.
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Knol HR, Haken L, Kempen GIJM. Disablement process and the utilization of home care among non-institutionalized elderly people: contrasting results between cross-sectional and panel data. Disabil Rehabil 2003; 25:845-55. [PMID: 12851095 DOI: 10.1080/0963828031000090542] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE In this article we studied the role of disablement process variables in home care utilization in a cross-sectional and in a panel approach among low-functioning community dwelling elderly people. METHODS We analysed data from a prospective follow-up study in The Netherlands (n = 555) and used three outcome variables: professional home care (yes or no) measured in the same year as the process variables (cross-sectional approach), professional home care (yes or no) also after 2 years (panel-approach: no change) and the new users of professional home care 2 years later (panel-approach: change). Process variables were categorized as pathology, functional limitations, disability, risk factors and psychosocial attributes. RESULTS Trajectories of home care utilization can be divided into an unchanging part and a changing part. Both parts are not predicted by the same process variables. For instance disability did not predict the new users of professional home care 2 years later, but correlated strongly with the stable users. The changing part was predicted by the beginning of the process of disablement (i.c. pathology). In addition, far most predictors could be considered as additive in stead of interactive. CONCLUSIONS It is important to take into consideration the design of the investigation in studying the disablement process: cross-sectional data and panel data provide different results.
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Affiliation(s)
- H R Knol
- Department of Sociology, University of Groningen, Grote Rozenstr. 31, 9712TG Groningen, The Netherlands.
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Kempen GIJM, Sanderman R, Scaf-Klomp W, Ormel J. Gender differences in recovery from injuries to the extremities in older persons. A prospective study. Disabil Rehabil 2003; 25:827-32. [PMID: 12851093 DOI: 10.1080/0963828021000056875] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This paper examines gender differences in trajectories of basic activities of daily living after fall-related injuries to the extremities in independently living older people in the Netherlands. METHOD The study comprised a prospective design. Data were collected from 31 men and 140 women at baseline, when they had not yet sustained injuries (hip fractures, other fractures or contortions and dislocations), and 8 weeks, 5 months and 12 months after their accident. Analysis of variance was used to test for differences in change in basic activities of daily living between baseline and follow-ups for men, for women and for the total study sample while adjusting for several covariates. RESULTS The patients did not generally regain their pre-injury levels of functioning 12 months after their event. However, in contrast to the women, older men more closely reached their pre-injury levels of functioning. Although women deteriorated more than men, differences were not statistically significant at 8 weeks and 5 months post-injury. Long-term recovery, however, was significantly associated with gender when the impact of severity seemed to have expired. CONCLUSIONS Recovery of basic activities of daily living one year after injuries to the extremities seems to be influenced by gender. Female patients recovered less well compared to males. These gender-related changes warrant concern and attention in clinical practice.
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Affiliation(s)
- G I J M Kempen
- Department of Health Care Studies, Section of Medical Sociology, Maastricht University, Maastricht, The Netherlands.
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van Jaarsveld CHM, Sanderman R, Ranchor AV, Ormel J, van Veldhuisen DJ, Kempen GIJM. Gender-specific changes in quality of life following cardiovascular disease: a prospective study. J Clin Epidemiol 2002; 55:1105-12. [PMID: 12507674 DOI: 10.1016/s0895-4356(02)00506-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gender-specific changes in Quality of Life (QoL) following cardiovascular disease (CVD) were studied in 208 patients to determine whether gender-related differences in postmorbid QoL result from differences in disease severity, premorbid QoL, or different CVD-related recovery. Premorbid data were available from a community-based survey. Follow-ups were done at 6 weeks, 6 months, and 12 months after diagnosis. Results showed that females had worse QoL at all three postmorbid assessments compared to males. However, multivariate analyses adjusting for premorbid gender differences and disease severity showed no significant gender-related differences for physical and psychologic functioning. Therefore, gender differences in QoL following CVD mainly result from premorbid differences in QoL, age, comorbidity, and disease severity at the time of diagnosis, and do not appear to be the consequence of gender-specific recovery. However, in clinical practice it is important to acknowledge the poorer QoL of females following CVD.
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Affiliation(s)
- C H M van Jaarsveld
- Northern Centre for Healthcare Research, Department of Public Health and Health Psychology, University of Groningen, P.O. Box 196, The Netherlands.
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