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Sturge J, Janus S, Zuidema S, Frederiks B, Schweda M, Landeweer E. The Moral and Gender Implications of Measures Used to Modulate the Mobility of People With Dementia Living in Residential Care Environments: A Scoping Review. Gerontologist 2024; 64:gnad071. [PMID: 37330640 PMCID: PMC10943503 DOI: 10.1093/geront/gnad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Policies and measures often restrict the mobility of people with dementia living in residential care environments to protect them from harm. However, such measures can violate human rights and affect the quality of life. This review aims to summarize the literature on what is known about measures used to modulate the life-space mobility of residents with dementia living in a residential care environment. Furthermore, moral and sex and gender considerations were explored. RESEARCH DESIGN AND METHODS A scoping review framework was referenced to summarize the literature. A total of 5 databases were searched: PubMed, Embase, CINAHL, SCOPUS, and Web of Science. The studies for eligibility using the Rayyan screening tool. RESULTS A total of 30 articles met the inclusion criteria. A narrative description of the findings of the articles is presented across 3 themes: (1) measures and strategies used to modulate the life-space mobility; (2) moral aspects; and (3) sex and gender considerations. DISCUSSION AND IMPLICATIONS Various measures are used to modulate the life-space mobility of people with dementia living in residential care facilities. Research exploring the sex and gender differences of people with dementia is lacking. With a focus on human rights and quality of life, measures used to restrict or support mobility must support the diverse needs, capacity, and dignity of people with dementia. Noting the capacity and diversity of people with dementia will require society and public space to adopt strategies that promote safety and mobility to support the quality of life of people with dementia.
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Affiliation(s)
- Jodi Sturge
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Brenda Frederiks
- Department of Ethics, Law and Humanities, University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Mark Schweda
- Division of Ethics in Medicine, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Elleke Landeweer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Hovenga N, Landeweer E, Vinckers F, Leget C, Zuidema S. Family involvement in dementia special care units in nursing homes: A qualitative care ethical study into family experiences. J Adv Nurs 2024; 80:200-213. [PMID: 37458271 DOI: 10.1111/jan.15794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 12/18/2023]
Abstract
AIM To explore the moral dimension of family experiences with being involved in the care of their loved one with dementia in the nursing home, using the care ethical framework of Tronto. DESIGN This qualitative study used a care ethical approach in which empirical data and care ethical theory were dialectically related and mutually informing. METHODS Fifteen close family members of nursing home residents with dementia were interviewed between February 2020 and October 2020. Forty-two interviews were conducted, based on a semi-structured open-ended design. A thematic narrative approach combined with the five phases of care as defined by Tronto was used to analyse the empirical data. Subsequently, Tronto's identified ethical qualities were used to identify the moral dimension of these empirical findings. RESULTS We found that in the care process (1) family can find it difficult to recognize their loved one's care needs; (2) both family and staff are reluctant to discuss the allocation of responsibilities with each other; (3) family sometimes feels insecure when it comes to connecting with their loved one; (4) family is often reluctant to provide feedback to staff when they are critical about the care that has been given; and (5) family is generally mild in judging staff, due to staff shortages. The care ethical interpretation of these findings showed that the moral qualities of attentiveness, responsibility, competence, responsiveness, and solidarity are under pressure to a certain extent. CONCLUSION Family experiences moral distress during the care process, which hinders family involvement in nursing homes for people with dementia. IMPACT Nursing home staff can look for and pilot strategies focused on supporting families to act more in accordance with the moral qualities that are under pressure. This can improve family involvement in practice. PATIENT OR PUBLIC CONTRIBUTION No Patient/Public Contribution. IMPLICATIONS FOR PRACTICE/POLICY Nursing home staff paying more attention to families' emotional struggles related to the decline of their loved one, could help families to be more attentive to noticing true care needs of the resident. Both family and nursing home staff should take more often initiatives to evaluate the division of care responsibilities with each other. Nursing home staff should help family connect with their loved one during their visits if they experience difficulties in doing so. Nursing home staff taking more often initiatives to contact family and ask them how they perceive the care for their loved one, can positively affect the responsiveness of both family and staff. It would be helpful if nursing home management could ensure the presence of sufficient and qualified staff so that the first four phases of the care process are not hindered by the lack of staff.
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Affiliation(s)
- Nina Hovenga
- Department of Primary- and Long-term Care, University Medical Center Groningen, Groningen, Netherlands
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Elleke Landeweer
- Department of Primary- and Long-term Care, University Medical Center Groningen, Groningen, Netherlands
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Floor Vinckers
- Department of Primary- and Long-term Care, University Medical Center Groningen, Groningen, Netherlands
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Utrecht, Netherlands
| | - Sytse Zuidema
- Department of Primary- and Long-term Care, University Medical Center Groningen, Groningen, Netherlands
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
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Landeweer E, Hovenga N, Noten S, Vinckers F, Witte JD, Stoop A, Zuidema S. Moral lessons from residents, close relatives and volunteers about the COVID-19 restrictions in Dutch and Flemish nursing homes. Philos Ethics Humanit Med 2023; 18:12. [PMID: 37670362 PMCID: PMC10481572 DOI: 10.1186/s13010-023-00140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND During the COVID-19 outbreak in 2020, national governments took restrictive measures, such as a visitors ban, prohibition of group activities and quarantine, to protect nursing home residents against infections. As 'safety' prevailed, residents and close relatives had no choice but to accept the restrictions. Their perspectives are relevant because the policies had a major impact on them, but they were excluded from the policy decisions. In this study we looked into the moral attitudes of residents, close relatives and volunteers regarding the restrictions in retrospect, and what moral lessons they considered important. METHODS We conducted 30 semi-structured interviews with residents and close relatives and one focus group meeting with volunteers working in nursing homes. Data were transcribed verbatim and analyzed inductively. Subsequently, three Socratic dialogue meetings with residents, close relatives and volunteers were organized in which first analysis outcomes were discussed and dialogues were fostered into moral lessons for future pandemics. Outcomes were combined with moral theory following an empirical bioethics design. RESULTS Critical perspectives regarding the COVID-19 restrictions grew in time. Various moral values were compromised and steered moral lessons for our future. The participants recognized three moral lessons as most important. First, constructing tailored (well-balanced) solutions in practice is desirable. Second, proper recognition is needed for the caring role that close relatives fulfill in practice. Third, a responsive power distribution should be in place that includes all stakeholder perspectives who are affected by the restrictions. DISCUSSION Comparing the results with moral theory strengthens the plea for inclusion of all stakeholder groups in decision-making processes. To further concretize the moral lessons, tailored solutions can be realized with the use of moral case deliberations. Proper recognition includes actions addressing moral repair and including counter-stories in the debate. Responsive power distribution starts with providing clear and trustworthy information and including all perspectives.
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Affiliation(s)
- Elleke Landeweer
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands.
| | - Nina Hovenga
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands
| | - Suzie Noten
- TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE, The Netherlands
| | - Floor Vinckers
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands
| | - Jasper de Witte
- HIVA- Research Institute for Work and Society, KU Leuven, P.O. Box 5300, 3000, Leuven, Belgium
| | - Annerieke Stoop
- TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE, The Netherlands
| | - Sytse Zuidema
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands
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Rasing N, Janus S, Smalbrugge M, Koopmans R, Zuidema S. Usability of an app-based clinical decision support system to monitor psychotropic drug prescribing appropriateness in dementia. Int J Med Inform 2023; 177:105132. [PMID: 37364356 DOI: 10.1016/j.ijmedinf.2023.105132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Guidelines recommend reluctant psychotropic drug (PD) prescribing in nursing home residents with dementia and neuropsychiatric symptoms (NPS), as efficacy of PDs is limited, and side effects are common. Nevertheless, PDs are commonly prescribed to reduce NPS. A smartphone application that evaluates appropriateness of PD prescriptions and provides recommendations from the revised Dutch guideline on problem behaviour in dementia may promote guideline adherence and increase appropriate prescribing. OBJECTIVE This study aimed to assess user experiences, barriers and facilitators of the Dutch 'Psychotropic Drug Tool' smartphone application (PDT) in the context of appropriate prescribing of PDs to nursing home residents with dementia and NPS. METHODS/DESIGN The PDT was developed according to the recommendations of the Dutch guideline for treatment of NPS in people with dementia. Feedback provided during usability testing with two end-users was applied to improve the PDT before implementation in day-to-day practice. Sixty-three prescribers were asked to use the PDT at their own convenience for four months. User expectations and experiences were assessed at baseline and after four months with the System Usability Scale and the Assessment of Barriers and Facilitators for Implementation. RESULTS Expected usability (M = 72.59; SD = 11.84) was similar to experienced usability after four months (M = 69.13; SD = 16.48). Appreciation of the PDTs user-friendliness (on average 6.7 out of 10) and design (7.3) were moderately positive, in contrast to the global rating of the PDT (5.7). Perceived barriers for PDT use were time consumption and lack of integration with existing electronic systems. Perceived facilitators were ease of use and attractive lay out. For broader implementation, physicians suggested a change in direction of the PDT: start assessment of appropriateness based on the list of NPS instead of PD as primary input. CONCLUSIONS In this pragmatic prospective cohort study we found that the PDT was used by elderly care physicians, with mediocre user satisfaction. The PDT will be optimized based on user feedback regarding experienced usability, barriers and facilitators, after which broader implementation can be initialized. The Medical Ethics Review Board of the University Medical Center Groningen declared this is a non-WMO study (UMCG RR Number: 201800284).
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Affiliation(s)
- Naomi Rasing
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sarah Janus
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin Smalbrugge
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Medicine for Older People, de Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Sytse Zuidema
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Fassmer AM, Allers K, Helbach J, Zuidema S, Freitag M, Zieschang T, Hoffmann F. Hospitalization of German and Dutch Nursing Home Residents Depend on Different Long-Term Care Structures: A Systematic Review on Periods of Increased Vulnerability. J Am Med Dir Assoc 2023; 24:609-618.e6. [PMID: 36898411 DOI: 10.1016/j.jamda.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To investigate proportions of hospitalized nursing home residents during periods of increased vulnerability, ie, the first 6 months after institutionalization and the last 6 months before death, and comparing the figures between Germany and the Netherlands. DESIGN Systematic review, registered in PROSPERO (CRD42022312506). SETTING AND PARTICIPANTS Newly admitted or deceased residents. METHODS We searched MEDLINE via PubMed, EMBASE, and CINAHL from inception through May 3, 2022. We included all observational studies that reported the proportions of all-cause hospitalizations among German or Dutch nursing home residents during these defined vulnerable periods. Study quality was assessed using the Joanna Briggs Institute's tool. We assessed study and resident characteristics and outcome information and descriptively reported them separately for both countries. RESULTS We screened 1856 records for eligibility and included 9 studies published in 14 articles (Germany: 8; Netherlands: 6). One study for each country investigated the first 6 months after institutionalization. A total of 10.2% of the Dutch and 42.0% of the German nursing home residents were hospitalized during this time. Overall, 7 studies reported on in-hospital deaths, with proportions ranging from 28.9% to 29.5% for Germany and from 1.0% to 16.3% for the Netherlands. Proportions for hospitalization in the last 30 days of life ranged from 8.0% to 15.7% (Netherlands: n = 2) and from 48.6% to 58.0% (Germany: n = 3). Only German studies assessed the differences by age and sex. Although hospitalizations were less common at older ages, they were more frequent in male residents. CONCLUSIONS AND IMPLICATIONS During the observed periods, the proportion of nursing homes residents being hospitalized differed greatly between Germany and the Netherlands. The higher figures for Germany can probably be explained by differences in the long-term care systems. There is a lack of research, especially for the first months after institutionalization, and future studies should examine the care processes of nursing home residents following acute events in more detail.
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Affiliation(s)
- Alexander M Fassmer
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany.
| | - Katharina Allers
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Jasmin Helbach
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michael Freitag
- Division of General Practice, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Tania Zieschang
- Division of Geriatrics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Falk Hoffmann
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
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Van Tellingen O, Lentzas A, Zuidema S, Çitirikkaya C, Venekamp N, Beijnen J. The ABCB1/ABCG2 inhibitor elacridar is a more potent pharmacoenhancer compared to tariquidar for treatment of intracranial tumors with small molecule drugs. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Background Family involvement in nursing homes is generally recognized as highly
valuable for residents, staff and family members. However, family
involvement continues to be challenging in practice. Aim To contribute to the dialogue about family involvement and develop strategies
to improve family involvement in the nursing home. Methods This interpretative synthesis consists of a thematic analysis and care
ethical interpretation of issues regarding family involvement from the
perspective of families in nursing homes reported in literature. Findings This study reveals the complexities of family involvement in the nursing home
by drawing attention to the moral dimension of the issues experienced by
families, as seen through the theoretical lens of Baier’s care ethical
concept of trust as a theoretical lens. The synthesis of literature resulted
in a thematic categorization of issues reported by families, namely,
family–staff relationship, psychosocial factors and organizational
circumstances. The care ethical interpretation of the synthesis of
literature showed that the concept of trust resonates with all reported
issues. Trust evolves over time. Early issues are mostly related to getting
to know each other. Secondly, families want to experience that staff are
competent and of good will. Difficult feelings families may have, such as
guilt or loneliness, and dealing with the deterioration of the loved one
puts families in a vulnerable position. This power imbalance between family
and staff impedes a trusting relationship. Issues related to organizational
circumstances, such as understaffing, also undermine families' trust in
staff and the nursing home. Discussion and conclusion Baier’s theoretical concept of trust provides a deeper insight into the moral
dimension of family involvement from the perspective of families in the
nursing home. To improve family involvement in practice, we propose to aim
future interventions at reinforcing trust in the relationship between family
and staff as well as in the organizational context in which these care
relationships occur.
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Affiliation(s)
- Nina Hovenga
- 10173University Medical Center Groningen, Netherlands
| | | | - Sytse Zuidema
- 10173University Medical Center Groningen, Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Netherlands
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Kosters J, Janus SIM, Van Den Bosch KA, Zuidema S, Luijendijk HJ, Andringa TC. Soundscape Optimization in Nursing Homes Through Raising Awareness in Nursing Staff With MoSART. Front Psychol 2022; 13:871647. [PMID: 35719498 PMCID: PMC9199855 DOI: 10.3389/fpsyg.2022.871647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Soundscapes in nursing homes are often suboptimal for residents. This can cause them feeling anxious and unsafe, or develop behavioral and psychological problems. Residents with dementia cannot adapt nursing home environments to their needs due to cognitive and physical limitations. It is up to the staff of psycho-geriatric wards to improve the soundscape. We evaluated the effect of the sound awareness intervention Mobile Soundscape Appraisal and Recording Technology (MoSART+) on soundscapes in nursing homes. Methods The MoSART+ intervention was carried out in four nursing homes and took three months in each home. The MoSART+ intervention involved training ambassadors, assessing the soundscape with the MoSART application by the nursing staff to raise their sound awareness on random time points, discussing the measurements, and implementing micro-interventions. Soundscapes were assessed from 0 to 100 on four attributes: pleasantness, eventfulness, complexity, and range of affordances. Based on these scores, soundscapes were classified in four dimensions: calm, lively, boring, and chaotic. Nursing staff graded the environment on a scale of 0 to 10. T-test and Z-tests were used to analyze data. Results Staff recorded 1882 measurements with the MoSART app. "People," "music, TV, and radio," and "machines and appliances" were the most prevalent sound sources before and after the implementation of micro-interventions. Post-implementation of micro-interventions, soundscapes were pleasant (median 69.0; IQR 54.0-81.0), of low complexity (33.0; 18.0-47.0), uneventful (27.0; 14.0-46.5), and gave moderate affordances (50.0; 35.0-67.0). Changes in attributes were statistically significant (p < 0.01). The proportion of the dimension calm increased (z = 12.7, p < 0.01), the proportion of chaotic decreased (z = 15.0, p < 0.01), and the proportion of lively decreased not statically significant (z = 0.68, p = 0.79). The proportion of boring was unchanged. The proportion of grades ≥6 increased after implementation of the micro-interventions (z = 15.3, p < 0.01). The micro-interventions focused on removing or reducing disturbing sounds and were unique for each nursing home. Discussion The MoSART+ intervention resulted in a statistically significantly improvement of soundscapes, and more favorable evaluations of the nursing staff. The intervention empowered staff to adapt soundscapes. Nursing homes can improve soundscapes by raising sound awareness among staff. Trial Registration Netherlands National Trial Register (NL6831).
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Affiliation(s)
- Janouk Kosters
- Department of General Practice and Elderly Care, University Medical Center Groningen, Groningen, Netherlands
| | - Sarah I M Janus
- Department of General Practice and Elderly Care, University Medical Center Groningen, Groningen, Netherlands
| | | | - Sytse Zuidema
- Department of General Practice and Elderly Care, University Medical Center Groningen, Groningen, Netherlands
| | - Hendrika J Luijendijk
- Department of General Practice and Elderly Care, University Medical Center Groningen, Groningen, Netherlands
| | - Tjeerd C Andringa
- Department of General Practice and Elderly Care, University Medical Center Groningen, Groningen, Netherlands.,SoundAppraisal BV, Groningen, Netherlands
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Rasing NL, Janus S, Vink A, Zuidema S. The impact of COVID-19 on music therapy provision in Dutch care homes. Nordic Journal of Music Therapy 2022. [DOI: 10.1080/08098131.2022.2084637] [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: 10/18/2022]
Affiliation(s)
- Naomi Larissa Rasing
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sarah Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Annemieke Vink
- Department of Music Therapy, ArtEZ University of the Arts, Academy of Music, Enschede, the Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Du J, Janus S, Voorthuis B, van Manen J, Achterberg W, Smalbrugge M, Zwijsen S, Gerritsen D, Koopmans R, Zuidema S. Time trends in psychotropic drug prescriptions in Dutch nursing home residents with dementia between 2003 and 2018. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5697. [PMID: 35297551 PMCID: PMC9311063 DOI: 10.1002/gps.5697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Several European studies investigated the trends in psychotropic drug prescriptions (PDPs) among nursing home (NH) residents and reported a decline in antipsychotics prescriptions. Since the Dutch long-term care system differs from other European systems (e.g. higher threshold for NH admission and trained elderly care physicians), this study explores the trends in PDPs in Dutch NH residents with dementia. METHODS The study used data from nine studies, comprising two cross-sectional studies, one cohort study, and six cluster-randomized controlled trials, collected in Dutch NHs between 2003 and 2018. With multilevel logistic regression analysis, NHs as a random effect, we estimated the trends in PDPs overall and for five specific psychotropic drug groups (antipsychotics, antidepressants, anxiolytics, hypnotics, and anti-dementia drugs), adjusting for confounders: age, gender, severity of dementia, severity of neuropsychiatric symptoms, and length of stay in NHs. RESULTS The absolute prescription rate of antipsychotics was 37.5% in 2003 and decreased (OR = 0.947, 95% CI [0.926, 0.970]) every year. The absolute prescription rate of anti-dementia drugs was 0.8% in 2003 and increased (OR = 1.162, 95% CI [1.105, 1.223]) per year. The absolute rate of overall PDPs declined from 62.7% in 2003 to 40.4% in 2018. CONCLUSIONS Among Dutch NH residents with dementia, the odds of antipsychotics prescriptions decreased by 5.3% per year while the odds of anti-dementia drug prescriptions increased by 16.2%. There were no distinct trends in antidepressants, anxiolytics, and hypnotics prescriptions. However, overall PDPs were still high. The PDPs in NH residents remain an issue of concern.
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Affiliation(s)
- Jiamin Du
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Sarah Janus
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Brenda Voorthuis
- Health Technology and Services Research DepartmentTechnical Medical CentreUniversity of TwenteEnschedeThe Netherlands
| | | | - Wilco Achterberg
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older PeopleAmsterdam Public Health Research InstituteAmsterdam UMC ‐ Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Sandra Zwijsen
- Quality DepartmentKorian Zorg, Korian GroupArnhemThe Netherlands
| | - Debby Gerritsen
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - Raymond Koopmans
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
- Joachim en AnnaCenter for Specialized Geriatric CareNijmegenThe Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
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Abstract
Background: Paratonia is a dementia-induced motor abnormality. Although paratonia affects virtually all people with dementia, it is not well known among clinicians and researchers. Objective: The aim of this study was to perform a systematic review of the literature on the definition, pathogenesis, diagnosis, and intervention of paratonia as well as to propose a research agenda for paratonia. Methods: In this systematic review, the Embase, PubMed, CINAHL, and Cochrane CENTRAL databases were searched for articles published prior to December 2019. Two independent reviewers performed data extraction and assessed the risk of bias of the studies. The following data were extracted: first author, year of publication, study design, study population, diagnosis, assessment, pathogenesis, therapy and interventions. Results: Thirty-five studies met the inclusion criteria and were included. Most studies included in the review mention clinical criteria for paratonia. Additionally, pathogenesis, method of assessment, diagnosis, and paratonia severity as are interventions to address paratonia are also discussed. Conclusion: This systematic review outlines what is currently known about paratonia, as well as discusses the preliminary research on the underlying mechanisms of paratonia. Although paratonia has obvious devastating impacts on health and quality of life, the amount of research to date has been limited. In the last decade, there appears to have been increased research on paratonia, which hopefully will increase the momentum to further advance the field.
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Affiliation(s)
- Hans Drenth
- Research group Healthy Ageing, Allied Health Care and Nursing, University of Applied Sciences Groningen, Groningen, the Netherlands.,ZuidOostZorg, center for Elderly Care, Drachten, the Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ivan Bautmans
- Frailty in Ageing Research Group and Gerontology Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Galit Kleiner
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Jeff and Diane Ross Movement Disorders Clinic, Baycrest Center for Geriatric Health, Toronto, ON, Canada
| | - Hans Hobbelen
- Research group Healthy Ageing, Allied Health Care and Nursing, University of Applied Sciences Groningen, Groningen, the Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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12
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Bunk S, Zuidema S, Koch K, Lautenbacher S, De Deyn PP, Kunz M. Pain processing in older adults with dementia-related cognitive impairment is associated with frontal neurodegeneration. Neurobiol Aging 2021; 106:139-152. [PMID: 34274699 DOI: 10.1016/j.neurobiolaging.2021.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/23/2021] [Accepted: 06/12/2021] [Indexed: 12/14/2022]
Abstract
Experimental pain research has shown that pain processing seems to be heightened in dementia. It is unclear which neuropathological changes underlie these alterations. This study examined whether differences in pressure pain sensitivity and endogenous pain inhibition (conditioned pain modulation (CPM)) between individuals with a dementia-related cognitive impairment (N=23) and healthy controls (N=35) are linked to dementia-related neurodegeneration. Pain was assessed via self-report ratings and by analyzing the facial expression of pain using the Facial Action Coding System. We found that cognitively impaired individuals show decreased CPM inhibition as assessed by facial responses compared to healthy controls, which was mediated by decreased gray matter volume in the medial orbitofrontal and anterior cingulate cortex in the patient group. This study confirms previous findings of intensified pain processing in dementia when pain is assessed using non-verbal responses. Our findings suggest that a loss of pain inhibitory functioning caused by structural changes in prefrontal areas might be one of the underlying mechanisms responsible for amplified pain responses in individuals with a dementia-related cognitive impairment.
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Affiliation(s)
- Steffie Bunk
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kathrin Koch
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | | | - Peter P De Deyn
- Alzheimer Center Groningen, Department Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Miriam Kunz
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany
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13
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Drenth H, Zuidema S, Bautmans I, Hobbelen H. The role of inflammaging and advanced glycation end products on paratonia in patients with dementia. Exp Gerontol 2020; 142:111125. [PMID: 33132147 DOI: 10.1016/j.exger.2020.111125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 01/20/2023]
Abstract
Impaired motor function is a prominent characteristic of aging. Inflammatory processes and oxidative stress from advanced glycation end-products are related to impaired motor function and could plausibly be a contributing factor to the pathogenesis of paratonia, a specific motor disorder in people with dementia. Severe paratonia results in a substantial increase of a caretaker's burden and a decrease in the quality of life. The pathogenesis of paratonia is not well understood, and no effective interventions are available to combat it. Intensive glycaemic control, reducing oxidative stress, possibly combined with a low AGE diet and AGE targeting medication may be the key method for preventing advanced glycation end-product accumulation and reducing the inflammatory burden as well as possibly postponing or preventing paratonia.
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Affiliation(s)
- Hans Drenth
- Research Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences, PO Box 3109, 9701 DC Groningen, the Netherlands; ZuidOostZorg, Organisation for Elderly Care, Burg. Wuiteweg 140, 9203 KP Drachten, the Netherlands.
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD Groningen, HPC FA21, the Netherlands.
| | - Ivan Bautmans
- Frailty in Ageing Research Group and Gerontology Department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium.
| | - Hans Hobbelen
- Research Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences, PO Box 3109, 9701 DC Groningen, the Netherlands; Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD Groningen, HPC FA21, the Netherlands.
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14
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Bunk S, Emch M, Koch K, Lautenbacher S, Zuidema S, Kunz M. Pain Processing in Older Adults and Its Association with Prefrontal Characteristics. Brain Sci 2020; 10:brainsci10080477. [PMID: 32722197 PMCID: PMC7465457 DOI: 10.3390/brainsci10080477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 02/02/2023] Open
Abstract
Aging is known to affect nociceptive processing, e.g., the ability to inhibit pain. This study aims to investigate whether pain responses in older individuals are associated with prefrontal characteristics, namely (i) executive functioning performance and (ii) structural brain variations in the prefrontal cortex. Heat and pressure stimuli were applied to assess pressure pain sensitivity and endogenous pain inhibition in 46 healthy older individuals. Executive functioning performance was assessed in three domains (i.e., cognitive inhibition, shifting, and updating) and structural brain variations were assessed in both gray and white matter. Overall pain responses were significantly associated with the executive functioning domains cognitive inhibition and shifting. However, no specific type of pain response showed an especially strong association. Endogenous pain inhibition specifically showed a significant association with gray matter volume in the prefrontal cortex and with variations in white matter structure of tracts connecting the prefrontal cortex with the periaqueductal gray. Hierarchical regression analyses showed that these variations in the prefrontal cortex can explain variance in pain inhibition beyond what can be explained by executive functioning. This might indicate that known deficits in pain inhibition in older individuals are associated with structural variations in prefrontal areas.
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Affiliation(s)
- Steffie Bunk
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands; (S.Z.); (M.K.)
- Correspondence: ; Tel.: +31-503616686
| | - Mónica Emch
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; (M.E.); (K.K.)
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, 82152 Martinsried, Germany
| | - Kathrin Koch
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; (M.E.); (K.K.)
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, 82152 Martinsried, Germany
| | | | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands; (S.Z.); (M.K.)
| | - Miriam Kunz
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands; (S.Z.); (M.K.)
- Department of Medical Psychology and Sociology, University of Augsburg, 86159 Augsburg, Germany
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15
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Abstract
Abstract. A growing body of literature suggests that chronic-pain patients suffer from problems in various neuropsychological domains, including executive functioning. In order to better understand which components of executive functioning (inhibition, shifting and/or updating) might be especially affected by pain and which mechanisms might underlie this association, we conducted a systematic review, including both chronic-pain studies as well as experimental-pain studies. The chronic-pain studies (N = 57) show that pain is associated with poorer executive functioning. The findings of experimental-pain studies (N = 28) suggest that this might be a bidirectional relationship: Pain can disrupt executive functioning, but poorer executive functioning might also be a risk factor for higher vulnerability to pain.
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Affiliation(s)
- Stefanie Bunk
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, The Netherlands
| | - Lukas Preis
- Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, The Netherlands
| | | | - Miriam Kunz
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, The Netherlands
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16
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Gold C, Eickholt J, Assmus J, Stige B, Wake JD, Baker FA, Tamplin J, Clark I, Lee YEC, Jacobsen SL, Ridder HMO, Kreutz G, Muthesius D, Wosch T, Ceccato E, Raglio A, Ruggeri M, Vink A, Zuidema S, Odell-Miller H, Orrell M, Schneider J, Kubiak C, Romeo R, Geretsegger M. Music Interventions for Dementia and Depression in ELderly care (MIDDEL): protocol and statistical analysis plan for a multinational cluster-randomised trial. BMJ Open 2019; 9:e023436. [PMID: 30928926 PMCID: PMC6475205 DOI: 10.1136/bmjopen-2018-023436] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION In older adults, dementia and depression are associated with individual distress and high societal costs. Music interventions such as group music therapy (GMT) and recreational choir singing (RCS) have shown promising effects, but their comparative effectiveness across clinical subgroups is unknown. This trial aims to determine effectiveness of GMT, RCS and their combination for care home residents and to examine heterogeneity of treatment effects across subgroups. METHODS AND ANALYSIS This large, pragmatic, multinational cluster-randomised controlled trial with a 2×2 factorial design will compare the effects of GMT, RCS, both or neither, for care home residents aged 65 years or older with dementia and depressive symptoms. We will randomise 100 care home units with ≥1000 residents in total across eight countries. Each intervention will be offered for 6 months (3 months 2 times/week followed by 3 months 1 time/week), with extension allowed if locally available. The primary outcome will be the change in the Montgomery-Åsberg Depression Rating Scale score at 6 months. Secondary outcomes will include depressive symptoms, cognitive functioning, neuropsychiatric symptoms, psychotropic drug use, caregiver burden, quality of life, mortality and costs over at least 12 months. The study has 90% power to detect main effects and is also powered to determine interaction effects with gender, severity and socioeconomic status. ETHICS AND DISSEMINATION Ethical approval has been obtained for one country and will be obtained for all countries. Results will be presented at national and international conferences and published in scientific journals. TRIAL REGISTRATION NUMBERS NCT03496675; Pre-results, ACTRN12618000156280.
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Affiliation(s)
- Christian Gold
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jasmin Eickholt
- Faculty of Applied Social Sciences, University of Applied Sciences Würzburg-Schweinfurt, Würzburg, Germany
| | - Jörg Assmus
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
| | - Brynjulf Stige
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
| | | | - Felicity Anne Baker
- Faculty of Fine Arts and Music, University of Melbourne, Southbank, Victoria, Australia
| | - Jeanette Tamplin
- Faculty of Fine Arts and Music, University of Melbourne, Southbank, Victoria, Australia
| | - Imogen Clark
- Faculty of Fine Arts and Music, University of Melbourne, Southbank, Victoria, Australia
| | - Young-Eun Claire Lee
- Faculty of Fine Arts and Music, University of Melbourne, Southbank, Victoria, Australia
| | | | | | - Gunter Kreutz
- Department of Music, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | | | - Thomas Wosch
- Faculty of Applied Social Sciences, University of Applied Sciences Würzburg-Schweinfurt, Würzburg, Germany
| | - Enrico Ceccato
- Department of Mental Health, Azienda ULSS 8 Berica, Vicenza, Italy
| | - Alfredo Raglio
- Music Therapy Research Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Mirella Ruggeri
- Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Annemiek Vink
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Music therapy Department, Academy of Music, ArtEZ University of the Arts, Enschede, The Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Helen Odell-Miller
- The Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Christine Kubiak
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | - Renee Romeo
- King’s Health Economics, King’s College London, London, UK
| | - Monika Geretsegger
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
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17
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Poulos CJ, Bayer A, Beaupre L, Clare L, Poulos RG, Wang RH, Zuidema S, McGilton KS. A comprehensive approach to reablement in dementia. Alzheimers Dement (N Y) 2017; 3:450-458. [PMID: 29067351 PMCID: PMC5654482 DOI: 10.1016/j.trci.2017.06.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As society grapples with an aging population and increasing prevalence of disability, “reablement” as a means of maximizing functional ability in older people is emerging as a potential strategy to help promote independence. Reablement offers an approach to mitigate the impact of dementia on function and independence. This article presents a comprehensive reablement approach across seven domains for the person living with mild-to-moderate dementia. Domains include assessment and medical management, cognitive disability, physical function, acute injury or illness, assistive technology, supportive care, and caregiver support. In the absence of a cure or ability to significantly modify the course of the disease, the message for policy makers, practitioners, families, and persons with dementia needs to be “living well with dementia”, with a focus on maintaining function for as long as possible, regaining lost function when there is the potential to do so, and adapting to lost function that cannot be regained. Service delivery and care of persons with dementia must be reoriented such that evidence-based reablement approaches are integrated into routine care across all sectors. We present a comprehensive reablement approach in dementia. The reablement approach is described across seven domains. Reablement aims to maintain or regain function, or adapt to lost function. Evidence-based reablement should be integrated into routine care across all sectors.
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Affiliation(s)
- Christopher J Poulos
- HammondCare, Centre for Positive Ageing, Sydney, Australia.,School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Antony Bayer
- Division of Population Medicine, Cardiff University, Penarth, Wales, UK
| | - Lauren Beaupre
- Departments of Physical Therapy and Surgery (Division of Orthopaedic Surgery), University of Alberta, Edmonton, Canada
| | - Linda Clare
- REACH, School of Psychology, University of Exeter, Exeter, UK
| | - Roslyn G Poulos
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Rosalie H Wang
- Intelligent Assistive Technology and Systems Lab, Deptarment of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center, University of Groningen, Groningen, Netherlands
| | - Katherine S McGilton
- Faculty of Nursing, Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada
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18
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Fosse A, Zuidema S, Boersma F, Malterud K, Schaufel MA, Ruths S. Nursing Home Physicians' Assessments of Barriers and Strategies for End-of-Life Care in Norway and The Netherlands. J Am Med Dir Assoc 2017; 18:713-718. [PMID: 28465128 DOI: 10.1016/j.jamda.2017.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/11/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Working conditions in nursing homes (NHs) may hamper teamwork in providing quality end-of-life (EOL) care, especially the participation of NH physicians. Dutch NH physicians are specialists or trainees in elderly care medicine with NHs as the main workplace, whereas in Norway, family physicians usually work part time in NHs. Thus, we aimed at assessing and comparing NH physicians' perspectives on barriers and strategies for providing EOL care in NHs in Norway and in The Netherlands. DESIGN A cross-sectional study using an electronic questionnaire was conducted in 2015. SETTING AND PARTICIPANTS All NH physicians in Norway (approximately 1200-1300) were invited to participate; 435 participated (response rate approximately 35%). Of the total 1664 members of the Dutch association of elderly care physicians approached, 244 participated (response rate 15%). MEASUREMENTS We explored NH physicians' perceptions of organizational, educational, financial, legal, and personal prerequisites for quality EOL care. Differences between the countries were compared using χ2 test and t-test. RESULTS Most respondents in both countries reported inadequate staffing, lack of skills among nursing personnel, and heavy time commitment for physicians as important barriers; this was more pronounced among Dutch respondents. Approximately 30% of the respondents in both countries reported their own lack of interest in EOL care as an important barrier. Suggested improvement strategies were routines for involvement of patients' family, pain- and symptom assessment protocols, EOL care guidelines, routines for advance care planning, and education in EOL care for physicians and nursing staff. CONCLUSIONS Inadequate staffing levels, as well as lack of competence, time, and interest emerge as important barriers to quality EOL care according to Dutch and Norwegian NH physicians. Their perspectives were mostly similar, despite large educational and organizational differences. Key strategies for improving EOL care in their facilities comprise education and incorporating available palliative care tools and systems.
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Affiliation(s)
- Anette Fosse
- Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, The Netherlands
| | - Froukje Boersma
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, The Netherlands
| | - Kirsti Malterud
- Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margrethe Aase Schaufel
- Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Sabine Ruths
- Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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19
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Roets-Merken L, Zuidema S, Vernooij-Dassen M, Dees M, Hermsen P, Kempen G, Graff M. Problems identified by dual sensory impaired older adults in long-term care when using a self-management program: A qualitative study. PLoS One 2017; 12:e0173601. [PMID: 28323846 PMCID: PMC5360251 DOI: 10.1371/journal.pone.0173601] [Citation(s) in RCA: 9] [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: 07/20/2016] [Accepted: 02/21/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To gain insights into the problems of dual sensory impaired older adults in long-term care. Insights into these problems are essential for developing adequate policies which address the needs of the increasing population of dual sensory impaired older adults in long-term care. METHODS A qualitative study was conducted in parallel with a cluster randomized controlled trial. Dual sensory impaired older adults in the intervention group (n = 47, age range 82-98) were invited by a familiar nurse to identify the problems they wanted to address. Data were taken from the semi-structured intervention diaries in which nurses noted the older adults' verbal responses during a five-month intervention period in 17 long-term care homes across the Netherlands. The data were analyzed using descriptive statistics and qualitative content analysis based on the Grounded Theory. FINDINGS The 47 dual sensory impaired older adults identified a total of 122 problems. Qualitative content analysis showed that the older adults encountered participation problems and problems controlling what happens in their personal environment. Three categories of participation problems emerged: (1) existential concerns of not belonging or not being able to connect with other people, (2) lack of access to communication, information and mobility, and (3) the desire to be actively involved in care delivery. Two categories of control-in-personal-space problems emerged: (1) lack of control of their own physical belongings, and (2) lack of control regarding the behavior of nurses providing daily care in their personal environment. CONCLUSIONS The invasive problems identified indicate that dual sensory impaired older adults experience great existential pressures on their lives. Long-term care providers need to develop and implement policies that identify and address these problems, and be aware of adverse consequences of usual care, in order to improve dual sensory impaired residents' autonomy and quality of life.
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Affiliation(s)
- Lieve Roets-Merken
- Donders Institute for Cognition, Brain and Behaviour, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Kalorama Foundation, Beek-Ubbergen, The Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Myrra Vernooij-Dassen
- Donders Institute for Cognition, Brain and Behaviour, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marianne Dees
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Gertrudis Kempen
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care Maastricht University, Maastricht, The Netherlands
| | - Maud Graff
- Donders Institute for Cognition, Brain and Behaviour, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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20
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Drenth H, Zuidema S, Bunt S, Bautmans I, van der Schans C, Hobbelen H. The Contribution of Advanced Glycation End product (AGE) accumulation to the decline in motor function. Eur Rev Aging Phys Act 2016; 13:3. [PMID: 26949420 PMCID: PMC4779236 DOI: 10.1186/s11556-016-0163-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/01/2016] [Indexed: 12/23/2022] Open
Abstract
Diminishing motor function is commonly observed in the elderly population and is associated with a wide range of adverse health consequences. Advanced Glycation End products (AGE's) may contribute to age-related decline in the function of cells and tissues in normal ageing. Although the negative effect of AGE's on the biomechanical properties of musculoskeletal tissues and the central nervous system have been previously described, the evidence regarding the effect on motor function is fragmented, and a systematic review on this topic is lacking. Therefore, a systematic review was conducted from a total of eight studies describing AGE's related to physical functioning, physical performance, and musculoskeletal outcome which reveals a positive association between high AGE's levels and declined walking abilities, inferior ADL, decreased muscle properties (strength, power and mass) and increased physical frailty. Elevated AGE's levels might be an indication to initiate (early) treatment such as dietary advice, muscle strengthening exercises, and functional training to maintain physical functions. Further longitudinal observational and controlled trial studies are necessary to investigate a causal relationship, and to what extent, high AGE's levels are a contributing risk factor and potential biomarker for a decline in motor function as a component of the ageing process.
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Affiliation(s)
- Hans Drenth
- />Research Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences, PO Box 3109, 9701 DC Groningen, The Netherlands
- />Zuid Oost Zorg, Organisation for Elderly Care. Burg, Wuiteweg 140, 9203 KP Drachten, The Netherlands
| | - Sytse Zuidema
- />Department of General Practice, University of Groningen, University Medical Center Groningen, PO Box 196 9700 AD, Groningen, HPC FA21 The Netherlands
| | - Steven Bunt
- />Research Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences, PO Box 3109, 9701 DC Groningen, The Netherlands
| | - Ivan Bautmans
- />Frailty in Ageing Research Group and Gerontology Department, Free University of Brussels, Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Cees van der Schans
- />Research Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences, PO Box 3109, 9701 DC Groningen, The Netherlands
| | - Hans Hobbelen
- />Research Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences, PO Box 3109, 9701 DC Groningen, The Netherlands
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21
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Robben S, van Kempen J, Heinen M, Zuidema S, Olde Rikkert M, Schers H, Melis R. Preferences for receiving information among frail older adults and their informal caregivers: a qualitative study. Fam Pract 2012; 29:742-7. [PMID: 22532402 DOI: 10.1093/fampra/cms033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient involvement in clinical decision making is increasingly advocated. Although older patients may be more reluctant to become involved, most do appreciate being informed. However, knowledge about their experiences with and preferences for receiving information is limited, and even less is known about these topics for frail older people. OBJECTIVE To explore the experiences of frail older people and informal caregivers with receiving information from health care professionals as well as their preferences for receiving information. METHODS We conducted semi-structured interviews with frail older people (n = 11, 65-90 years) and informal caregivers (n = 11, 55-87 years). Interviews were transcribed verbatim and analysed using a grounded theory approach. RESULTS Frail older people and informal caregivers varied in their information needs and discussed both positive and negative experiences with receiving information. They preferred receiving verbal information from their physician during the consultation; yet would appreciate receiving brief, clearly written information leaflets in addition. They employed several strategies to enhance the information provided, i.e. advocacy, preparing for a consultation and searching their own information. Contextual factors for receiving information, such as having enough time and having a good relationship with professionals involved, were considered of great importance. CONCLUSIONS Participants described a wide range of experiences with and preferences for receiving information. However, even if the information provided would meet all their preferences, this would be of limited significance if not provided within the context of an ongoing trusting relationship with a professional, such as a GP or practice nurse, who genuinely cared for them.
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Affiliation(s)
- Sarah Robben
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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van Eijk MS, van der Linde H, Buijck B, Geurts A, Zuidema S, Koopmans R. Predicting prosthetic use in elderly patients after major lower limb amputation. Prosthet Orthot Int 2012; 36:45-52. [PMID: 22252778 DOI: 10.1177/0309364611430885] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND The main determinants of prosthetic use known from literature apply to the younger patient with lower limb amputation. Studies aimed at identifying determinants of outcome of lower limb amputation in elderly patients with multimorbidity that rehabilitate in skilled nursing facilities (SNFs) are scarce. OBJECTIVES To predict prosthetic use and physical mobility in geriatric patients admitted to SNFs for rehabilitation after lower limb amputation and the impact of multimorbidity. STUDY DESIGN Prospective design. METHODS Univariate and multivariate logistic and linear regression analyses were used to identify determinants that were independently related to prosthetic use and the timed-up-and-go test (TUG test). RESULTS Of 55 eligible patients, 38 had complete assessments on admission and at discharge. Fifty per cent was provided with a prosthesis. Multimorbidity was present in 53% of the patients. Being able to ambulate independently, and having a transtibial amputation (rather than a higher level of amputation), without phantom pain determined prosthetic use (R(2)=56%), while cognitive abilities, low amputation level, and pre-operative functional abilities were independently associated with the TUG test (R(2)=82%). CONCLUSIONS Elderly patients referred to an SNF for prosthetic training have a high probability of using a prosthesis when having an independent ambulation after transtibial amputation, without phantom pain. These patients should be considered for prosthetic training.
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Affiliation(s)
- Monica Spruit- van Eijk
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, the Netherlands.
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Abstract
The prevalence of neuropsychiatric symptoms and the influence of predictive factors in cognitively impaired nursing home patients were reviewed. Articles were identified by means of a MEDLINE and PsychInfo literature search. Neuropsychiatric symptoms were present in more than 80% of the cognitively impaired patients. Prevalences ranged considerably, from 3% to 54% for delusions, 1% to 39% for hallucinations, 8% to 74% for depressed mood, 7% to 69% for anxiety, 17% to 84% for apathy, 48% to 82% for aggression or agitation, and 11% to 44% for physical aggression. Neuropsychiatric symptoms seemed to be predicted not only by dementia type or stage but also by the psychosocial environment and the amount of psychoactive medication and physical restraints used. Neuropsychiatric symptoms are common and influenced by both the disease itself and the psychosocial environment of the institutional setting. The latter may have important consequences for staff planning and education and the future design of care facilities.
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Affiliation(s)
- Sytse Zuidema
- Department of Nursing Home Medicine, Radboud University Nijmegen, Medical Centre, Nijmegen, the Netherlands.
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