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The heterogeneity of socially isolated older adults: a social isolation typology
- Author:
- MACHIELSE Anja
- Journal article citation:
- Journal of Gerontological Social Work, 58(4), 2015, pp.338-356.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Recent statistics show a growing number of older adults who are living alone and are socially isolated. It is against this background that, in recent years, many interventions have been developed to address social isolation among the elderly. Evaluative studies show that most interventions are hardly effective, though. An important reason for this is the heterogeneity of the socially isolated. This article offers insight into this heterogeneity by presenting a typology with different profiles of socially isolated older adults and the intervention implications of this typology. The typology is derived from an extensive qualitative study on socially isolated elderly individuals in the Netherlands. The typology imposes some degree of order to a diversity of circumstances, ambitions, and possibilities of the socially isolated elderly, thereby deepening the understanding of the heterogeneity of this population. The definition of social isolation used in this study starts from a societal angle of incidence, namely the current policy context of Western European welfare states, in which governments emphasize the importance of independence and self-reliance of their citizens. Developed from that perspective, the typology provides a theoretical basis for applying interventions aimed at increasing self-reliance of social isolated elderly. This perspective on social isolation also has consequences for the way in which the effectiveness of interventions to alleviate social isolation is assessed. (Publisher abstract)
Access to long-term care: perceptions and experiences of older Dutch people
- Authors:
- SCHIPPER Lisette, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 16(2), 2015, pp.83-93.
- Publisher:
- Emerald
Purpose: Despite the current focus on demand-based care, little is known about what clients consider important when they have a request for formal long-term care services. The paper aims to discuss this issue. Design/methodology/approach: Questions about the access process to care services were added to the “Senior Barometer”, a Dutch web-based questionnaire that assesses the opinion of older people about different aspects in life. The questionnaire surveyed both people who already requested care services (“users”), and people that did not (“future clients”). Findings: The results show a significant difference in what people expect to be the first step from what users actually did, when requesting formal care services. In addition, there was a significant difference on how “users” and “future clients” rated several access service aspects. Research limitations/implications:The results give valuable information on how both “users” and “future clients” value the access process. The findings also provide valuable input for organisations providing long-term care for older clients about the important issues that have to be considered when organising the access process. Originality/value: This study shows what older people in the Netherlands find important during the access process to care and this has not been explored before. The difference between what “users” and “future clients” find of importance in the care access process suggests that it is difficult for people to foresee what will be important once the need for care arrives, or where they will turn to with a request for care services. (Edited publisher abstract)
"Interactive surfaces" technology as a potential tool to stimulate physical activity in psychogeriatric nursing home residents
- Authors:
- BRAUN Susy M., et al
- Journal article citation:
- Disability and Rehabilitation: Assistive Technology, 10(6), 2015, pp.486-492.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Purpose: This study aimed to determine whether and how psychogeriatric nursing home residents would respond to the interactive surfaces on the floor without receiving instructions and to determine how long residents would be physically active. Methods: The 'interactive surfaces' technology includes different graphic shapes that are projected through a beamer on a floor. The surfaces are 'activated' by a person’s movements in the area of the projection field, which is detected by an infrared camera. Every day for 1 h during an 11-day period one of seven different projections was shown. Spontaneous observed physical responses were counted, clustered and visualised in a tree diagram. Duration of physically responses was measured per session and during the total observation period of 11 h. Results: During 343 of 490 observations residents (n = 58) noticed the interactive surface and in 148 observations they engaged physically. In total, 4067 s (1 h, 7 min and 47 s) of physical activity were measured. Individual times that residents were active ranged from 3 to 415 s. Conclusions: Interactive surfaces technology may be a promising tool in psychogeriatric nursing home residents to stimulate physical activity. Further research is needed to assess its full potential. (Edited publisher abstract)
The relation between social network site usage and loneliness and mental health in community-dwelling older adults
- Authors:
- AARTS S., PEEK S.T.M., WOUTERS E.J.M.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(9), 2015, pp.942-949.
- Publisher:
- Wiley
Background: This study aimed to examine whether and how social network sites usage is related to loneliness and mental health in community-dwelling older adults. Method: The study population included community-dwelling older adults aged 60 and over residing in the Netherlands (n = 626). Univariate and multivariate linear regression analyses, adjusted for potentially important confounders, were conducted in order to investigate the relation between social network sites usage and (emotional and social) loneliness and mental health. Results: More than half of the individuals (56.2%) reported to use social network sites at least several times per week. Social network sites usage appeared unrelated to loneliness in general, and to emotional and social loneliness in particular. Social network sites usage also appeared unrelated to mental health. Several significant associations between related factors and the outcomes at hand were detected. Conclusion: In this sample, which was representative for the Dutch population, social network sites usage was unrelated to loneliness and/or mental health. The results indicate that a simple association between social network site usage and loneliness and mental health as such, cannot automatically be assumed in community-dwelling older adults. (Edited publisher abstract)
A 13-year prospective cohort study on the effects of aging and frailty on the depression–pain relationship in older adults
- Authors:
- SANDERS Joost B., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(7), 2015, pp.751-757.
- Publisher:
- Wiley
Objectives: The primary aim of the study is to investigate the effect of age and aging on the association between pain and depression over 13 years. The authors hypothesised that (1) this association would become stronger with age and frailty and that (2) this association is mainly driven by somatic and psychological factors. Methods: Data were derived from the Longitudinal Aging Study Amsterdam, a prospective population-based cohort study with four follow-up measurements over 13 years, consisting of 1528 respondents (mean age 67.9 ± 8.1). Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale; pain was measured with an adapted version of the Nottingham Health Profile. Follow-up time and age were used as proxy variables for ageing and gait speed as frailty marker. Cognition, mastery and neuroticism were measured using the mini mental state examination, the Pearlin Mastery Scale and the Dutch Personality Questionnaire respectively. Results: Linear mixed models showed that pain and depressive symptoms were associated over the 13-year follow-up: b = 0.095, p < 0.001. Neither aging nor frailty changed this association. Measured somatic and psychological characteristics explained 40% of the covariance between pain and depressive symptoms over time. Discussion: When dealing with people suffering from pain and depression, interventions should be similar for all aged people, encompassing both somatic and psychological factors, irrespective of age or frailty status (Edited publisher abstract)
Overcoming old in age-friendliness
- Authors:
- LINDENBERG J., WESTENDORP R.G.J.
- Journal article citation:
- Journal of Social Work Practice, 29(1), 2015, pp.85-98.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
In this article, the authors explore views on an age-friendly space in the Netherlands by analysing the responses of older individuals (N = 54) in focus groups and by examining the perspectives around an age-friendly zone in the Netherlands, Parkstad Limburg. The authors found that a central issue in the wishes for living at a later age are adjustments to envisioned physical limitations that come with the ageing process; this includes adjustments to ensure safety, accessibility and mobility, in order to facilitate older individuals' efforts to stay engaged with the world around them. In their wishes, the older participants constructed ideal dwelling places that closely resembled a senior home, but at the same time they rejected wishing to live in a place that was identified as a senior home. The authors explain this paradox by the representation of such a space as being for old people, i.e. needy older individuals, which was not how the older participants wished to be identified. It is concluded that the conception of age-friendly environments will have to face the difficult challenge of overcoming the association with old age, while simultaneously taking into account adjustments that signify and relate to the ageing process and that seem inescapably tied to oldness. (Edited publisher abstract)
Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication
- Authors:
- SPAANS Harm-Pieter, et al
- Journal article citation:
- British Journal of Psychiatry, 206(1), 2015, pp.67-71.
- Publisher:
- Cambridge University Press
Background: Severe depression can be a life-threatening disorder, especially in elderly patients. A fast-acting treatment is crucial for this group. Electroconvulsive therapy (ECT) may work faster than medication. Aims: To compare the speed of remission using ECT v. medication in elderly in-patients. Method: The speed of remission in in-patients with a DSM-IV diagnosis of major depression (baseline MADRS score ≥20) was compared between 47 participants (mean age 74.0 years, s.d. = 7.4) from an ECT randomised controlled trial (RCT) and 81 participants (mean age 72.2 years, s.d. = 7.6) from a medication RCT (nortriptyline v. venlafaxine). Results: Mean time to remission was 3.1 weeks (s.d. = 1.1) for the ECT group and 4.0 weeks (s.d. = 1.0) for the medication group; the adjusted hazard ratio for remission within 5 weeks (ECT v. medication) was 3.4 (95% CI 1.9-6.2). Conclusions: Considering the substantially higher speed of remission, ECT deserves a more prominent position in the treatment of elderly patients with severe depression. (Original abstract)
The ideal neighbourhood for ageing in place as perceived by frail and non-frail community-dwelling older people
- Authors:
- DIJK Hanna M. van, et al
- Journal article citation:
- Ageing and Society, 35(8), 2015, pp.1771-1795.
- Publisher:
- Cambridge University Press
Due to demographic changes and a widely supported policy of ageing in place, the number of community-dwelling older people will increase immensely. Thus, supportive neighbourhoods enabling older people to age in place successfully are required. Using Q-methodology, this study examined older people's perceptions of the comparative importance of neighbourhood characteristics for ageing in place. Based on the World Health Organization's Global Age-friendly Cities guide and the eight domains identified (outdoor spaces and buildings, transportation, housing, social participation, respect and social approval, civic participation, communication and information, and community support and health services), the authors developed 26 statements about physical and social neighbourhood characteristics. Thirty-two older people in Rotterdam, half of whom were frail, rank-ordered these statements. Q-factor analysis revealed three distinct viewpoints each among frail and non-frail older people. Comparisons within and between groups are discussed. Although both frail and non-frail older people strongly desired a neighbourhood enabling them to age in place, they have divergent views on such a neighbourhood. Older people's dependence on the neighbourhood seems to be dynamic, affected by changing social and physical conditions and levels of frailty. (Edited publisher abstract)
Tailored mental health care after nursing home admission: improving transfers of people with dementia with behavioral problems. an explorative study
- Authors:
- MIERLO L.D. van, et al
- Journal article citation:
- Aging and Mental Health, 19(10), 2015, pp.902-911.
- Publisher:
- Taylor and Francis
Objectives: In the Netherlands, many community-dwelling people with dementia and behavioural disturbances and their family caregivers receive mental health care from a community psychiatric nurse (CPN). To promote continuity of care for these persons after moving to a nursing home, a transfer intervention was developed. The aim of this explorative study was to evaluate this intervention and its implementation. Method: A qualitative explorative study design was used. CPNs visited professional nursing home carers, people with dementia and family caregivers six weeks after moving, advised on how to manage behavioural problems of their former clients and provided support to family caregivers. Twenty-two interviews were conducted with participants exposed to the intervention (5 CPNs, 5 family and 12 nursing home carers) and with 11 stakeholders (i.e., nursing home and mental health care managers, professional caregivers) to identify facilitators and barriers to the implementation. Data were collected in 2012 and 2013. Results: The follow-up visit at six weeks met the need for background information of new admitted patients and helped family caregivers close off the period prior to the move. It did not meet the original purpose of providing nursing home staff with advice about problem behaviours on time: six weeks after the move was experienced as too late. Conclusion: The transfer intervention increased the awareness of nursing home staff about personal and behavioural characteristics of residents with dementia and supported caregivers in coping with the new situation. The timing of the intervention could be improved by scheduling it immediately after the move. (Edited publisher abstract)
Reducing disability in community-dwelling frail older people: cost-effectiveness study alongside a cluster randomised controlled trial
- Authors:
- METZELTHIN Silke F., et al
- Journal article citation:
- Age and Ageing, 44(3), 2015, pp.390-396.
- Publisher:
- Oxford University Press
Background: Although proactive primary care, including early detection and treatment of community-dwelling frail older people, is a part of the national healthcare policy in several countries, little is known about its cost-effectiveness. Objective: To evaluate the cost-effectiveness of a proactive primary care approach in community-dwelling frail older people. Design and setting: Embedded in a cluster randomised trial among 12 Dutch general practitioner practices, an economic evaluation was performed from a societal perspective with a time horizon of 24 months. Method: Frail older people in the intervention group received an in-home assessment and interdisciplinary care based on a tailor-made treatment plan and regular evaluation and follow-up. Practices in the control group delivered usual care. The primary outcome for the cost-effectiveness and cost-utility analysis was disability and health-related quality of life, respectively. Results: Multilevel analyses among 346 frail older people showed no significant differences between the groups regarding disability and health-related quality of life at 24 months. People in the intervention group used, as expected, more primary care services, but there was no decline in more expensive hospital and long-term care. Total costs over 24 months tended to be higher in the intervention group than in the control group (€26,503 versus €20,550, P = 0.08). Conclusions: The intervention under study led to an increase in healthcare utilisation and related costs without providing any beneficial effects. This study adds to the scarce amount of evidence of the cost-effectiveness of proactive primary care in community-dwelling frail older people. (Edited publisher abstract)