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Strategies of care: changing elderly care in Italy and the Netherlands
- Author:
- ROIT Barbara Da
- Publisher:
- Amsterdam University Press
- Publication year:
- 2010
- Pagination:
- 220p.
- Place of publication:
- Amsterdam
This book traces the changes in the elderly care systems of Italy and the Netherlands since the early 1990s, drawing attention to the advantages and disadvantages of these two very different models. It examines the formal care system of the Dutch, and reveals how this system, despite strong policy pressures, has remained relatively stable, while the Italian system has undergone major transitions despite minimal policy intervention. Based on a wealth of data and extensive interviews with both caregivers and patients, this book is designed for anyone interested in the future of European health care debates. Contents include: changing care systems - an introduction; the context and policy trajectories; the challenge of dependence; changing care packages; care packages in practice; the creation of care packages and the transformations of care systems; and conclusions.
Care-giving in dementia: contours of a curriculum
- Author:
- MIESEN Bere
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 9(4), November 2010, pp.473-489.
- Publisher:
- Sage
The problems confronting people with dementia and their families are discussed, elaborating various factors that determine how they cope with the trauma of the disease. Against this background, the tasks for professional care-givers are then identified. The authors suggest that care-giving in dementia is a speciality that should be based on a high level of expertise and a professional approach. Core topics are then set out, forming the building blocks for a curriculum, with areas based on the relational perspective of caring for people with dementia. The authors conclude that to ensure a high standard of professional care-giving in dementia, such training is necessary as a life-long attachment alone is not enough.
High incidence of clinically relevant depressive symptoms in vulnerable persons of 75 years or older living in the community
- Authors:
- DOZEMAN Els, et al
- Journal article citation:
- Aging and Mental Health, 14(7), September 2010, pp.828-833.
- Publisher:
- Taylor and Francis
Incidence rates of depressive symptoms and their predictors were examined in a vulnerable elderly population. In a community-based cohort, 651 vulnerable elderly people aged 75 and over were identified by means of the COOP-WONCA charts (Dartmouth Coop Functional Health Assessment Charts/World Organisation of Family Doctors). To study the incidence of clinically relevant symptoms of depression and their predictors, 266 people with no symptoms were selected and measured again for clinical relevant symptoms of depression at 6 and 18 months. Logistic regression analyses were applied to determine risk indicators. The results showed that after 18 months 48% of the elderly people had developed clinically relevant symptoms of depression. No specific risk factors were identified within this population. The article concludes that the incidence of depressive symptoms identified in the study were considerably higher than those previously found in elderly populations living in the community. A vulnerable health status is associated with a high risk of depressive symptoms.
Depression in Dutch homes for the elderly: under-diagnosis in demented residents?
- Authors:
- BALLER Menke, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(7), July 2010, pp.712-718.
- Publisher:
- Wiley
Although community-based studies have reported an increased incidence of depression among demented persons compared with non-demented persons, it is not clear whether this relationship also exists among institutionalised elderly persons. The aim of this study was to compare the prevalence of diagnosed depressive disorders and mood symptoms between demented and non-demented residents living in homes for the elderly. The study was done on 787 residents, 313 demented and 463 non-demented, with a mean age of 84 years in 16 homes for the elderly in the Netherlands. A cross-sectional analysis was performed of routine outcome measurements collected by trained nurse assistants using the Resident Assessment Instrument (RAI) between January 2007 and April 2008. The nurse assistants recorded all known medical diagnoses including dementia and depression, as well as a structured observation of the presence or absence of 11 mood symptoms over the last 3 days. The results showed that 24.6% of participants were diagnosed with a depressive disorder, with no statistically significant difference between demented and non-demented persons. Mood symptoms were more prevalent in demented residents. Among residents with mood symptoms, demented residents were less likely to be diagnosed with a depressive disorder than non-demented residents. The article concludes that the prevalence of diagnosed depressive disorders was comparable between demented and non-demented residents. However, demented residents suffered more from mood symptoms and may be at risk of under-diagnosis of depression.
Preferences for long-term care services: willingness to pay estimates derived from a discrete choice experiment
- Authors:
- NIEBOER Anna P., KOOLMAN Xander, STOLK Elly A.
- Journal article citation:
- Social Science and Medicine, 70(9), May 2010, pp.1317-1325.
- Publisher:
- Elsevier
Ageing populations increase pressure on long-term care. Optimal resource allocation requires a mix of care services based on costs and benefits, and requires knowledge of how individuals place value on particular aspects of long-term care. This study elicits preferences in the elderly population for long-term care services for varying types of patients. A discrete choice experiment was conducted in a general population subsample of 1082 people aged 50–65 years drawn from the Dutch Survey Sampling International panel. To ascertain relative preferences for long-term care and willingness to pay for these, participants were asked to choose the best of 2 care scenarios for 4 groups of hypothetical patients: frail and demented elderly, with and without partner. The scenarios described long-term care using 10 attributes: hours of care, organised social activities, transportation, living situation, same person delivering care, room for individual preferences, coordination of services, punctuality, time on waiting list, and co-payments. Overall, the results showed that long-term care services were thought to produce greatest well-being for the patients without a partner and those with dementia. Individuals combining these 2 risk factors were thought to benefit the most from all services except transportation which was considered more important for the frail elderly. The results support the notion that long-term care services represent different value for different types of patients and that the value of a service depends upon the social context. Policy-making would profit from allocation models in which budgetary requirements of different services can be balanced against the well-being they produce for individuals.
Creative interaction with people in advanced dementia
- Author:
- ZOUTEWELLE-MORRIS Sarah
- Journal article citation:
- Journal of Dementia Care, 18(1), January 2010, pp.20-22.
- Publisher:
- Hawker
In this final article in a series discussing how a creative attitude can open new possibilities for caregivers in the areas of communication and activity design for people with dementia, the author suggests ideas for applying the principles of creative communication and activity to caring for and communicating with people in advanced stages of dementia, using examples from her work with a non-profit organisation in Holland. The article covers addressing the healthy part of the person, activities based on hand movements and other gestures, holding and physical objects, just being there, and witnessing as an active gesture of accepting what is without trying to do anything about it. The author asserts that non-verbal communication, humour, the ability to take emotional risks and to improvise in the moment are not extras in the field of dementia care but essentials.
The harmonisation of longitudinal data: a case study using data from cohort studies in The Netherlands and the United Kingdom
- Authors:
- BATH Peter A., DEEG Dorly, POPPELAARS Jan
- Journal article citation:
- Ageing and Society, 30(8), November 2010, pp.1419-1437.
- Publisher:
- Cambridge University Press
This paper examined the challenges and requirements associated with harmonising data from two independently-conceived datasets from The Netherlands and the UK. The objectives were to create equivalent samples and variables, and to identify the methodological differences that affect the comparability of the samples. Twenty six harmonised variables were found: demographic composition and personal finances, physical health, mental health and loneliness, contacts with health services, physical activity, religious attendance and pet ownership. The ways in which the methodological differences between the two studies and their different selective attrition might lead to sample differences were carefully considered. It was concluded that the challenges of conducting cross-national comparative research using independent datasets include differences in sampling, study design, measurement instruments, response rates and selective attrition. The authors concluded that comparative studies about socio-cultural differences must first identify and address these challenges.
Empowered or overpowered? Service use, needs, wants and demands in elderly patients with cognitive impairments
- Authors:
- WOLFS Claire A. G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(10), October 2010, pp.1006-1012.
- Publisher:
- Wiley
Current treatment options are often not sufficiently used by patients suffering from dementia or mild cognitive impairment. This study investigated to what extent and in what way these patients use the available treatment options, and identified factors and reasons that play a role in the non-utilisation of these options. Results revealed that counselling, medication, activities and home care were the options that were most frequently used by the 252 patients and caregivers who were included in the study. Group guidance and admissions were the main treatment categories that had not been used. The most important reasons given were refusal by the patient and the fact that help was not necessary yet according to the caregiver. Burden of care and cognition were the most important factors in predicting which of the treatment options were not utilised. Many patients and caregivers were not aware of the treatment options available to them. Awareness of these options is necessary to avoid situations in which the need for care support has become an acute necessity.
Major depressive disorder in late life: a multifocus perspective on care needs
- Authors:
- HOUTJES W., et al
- Journal article citation:
- Aging and Mental Health, 14(7), September 2010, pp.874-880.
- Publisher:
- Taylor and Francis
To gain insight into the needs of outpatients with late-life depression this study interviewed 99 outpatients aged 58-92 who were receiving treatment for major depressive disorder from six specialised mental health care facilities in the Netherlands. They were interviewed using the Dutch version of the Camberwell Assessment of Needs for the Elderly (CANE-NL) to identify met and unmet needs and the Montgomery-Asberg Depression Rating Scale to measure depression severity. The results showed that depression severity levels varied from remission (23%), mild (31%), moderate (31%), to severe depression (15%). The average number of needs reported was 8.86, comprising 6.5 met needs and 2.3 unmet needs. Most of the unique variance in depression severity was explained by psychological unmet needs, more in particular by needs representing psychological distress. The environmental, social or physical unmet needs showed less or no meaningful predictive value for variance in depression severity. The article concludes that systematic needs assessment may be a necessary complement to medical examination and a prerequisite for the development of tailored treatment plans for older people with depression.
Improvement in personal meaning mediates the effects of a life review intervention on depressive symptoms in a randomized controlled trial
- Authors:
- WESTERHOF Gerben J., et al
- Journal article citation:
- Gerontologist, 50(4), August 2010, pp.541-549.
- Publisher:
- Oxford University Press
This study investigated the impact of a life review intervention on personal meaning in life and the mediating effect of personal meaning on depressive symptoms as the primary outcome of this form of indicated prevention. A randomised controlled trial was conducted with 83 older people obtaining life review compared to 88 watching a video about the art of growing older. Measurements took place before and after the intervention as well as at a 6 month follow-up. Findings revealed that those who followed life review initially improved in personal meaning more than those in the control group, although at follow-up the difference was no longer significant. Improvements in meaning during the intervention predicted decreases in depressive symptoms later in time and mediated the effects of the programme on depressive symptoms. The authors concluded that personal meaning is important in contemporary society, which some older people find difficult to achieve. The findings show that it is possible to support older people in their search for meaning by means of life review and that this helps in alleviating depressive symptoms.