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Objective: Aging societies will bring an increase in the number of long-term care patients with mental-physical multimorbidity (MPM). This paper aimed to describe the natural course of neuropsychiatric symptoms (NPS) in patients with MPM in the first 8 months after admission to a geronto-psychiatric nursing home (GP-NH) unit. Methods: Longitudinal cohort study among 63 patients with MPM no dementia living in 17 GP-NH units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, and brief neuropsychological testing, among which our primary outcome measure the Neuropsychiatric Inventory (NPI). Descriptive and bivariate analyses were conducted. Results: Our study showed a significant increase of the NPI total score (from 25.3 to 29.3, p = 0.045), and the total scores of a NPI hyperactivity cluster (from 9.7 to 11.8, p = 0.039), and a NPI mood/apathy cluster (from 7.7 to 10.1, p = 0.008). Just over 95% had any clinically relevant symptom at baseline and/or six months later, of which irritability was the most prevalent and persistent symptom and the symptom with the highest incidence. Hyperactivity was the most prevalent and persistent symptom cluster. Also, depression had a high persistence. Conclusions: Our results indicate the omnipresence of NPS of which most were found to be persistent. Therefore, we recommend to explore opportunities to reduce NPS in NH patients with MPM, such as creating a therapeutic milieu, educating the staff, and evaluating patient's psychotropic drug use. [ABSTRACT FROM AUTHOR]

Loneliness is seen as an important problem, contributing to serious health problems. As a baseline measurement for the evaluation of a community project aimed at reducing loneliness in Rotterdam, loneliness was measured, as well as potential correlates. This article describes models of social and emotional loneliness among older adults. This study was conducted among 3,821 randomly selected community dwelling citizens of 65 years and older. Loneliness was measured by using the Jong-Gierveld loneliness questionnaire/scale. As potential correlates demographic, health and psychological and social variables were included. Data were subjected to multiple hierarchically regression analysis. Emotional loneliness was reported by 60% and social loneliness by 47% of the sample. Women were more emotionally lonely than men , while men reported more social loneliness than women. Emotional social support and quality of life were strongest in predicting emotional loneliness and social capital in the neighbourhood, companionship and instrumental support were strongest predictors for social loneliness. Demographic variables predicted variability in emotional loneliness. The strength of the correlates differed between the two dimensions of loneliness. In the design of interventions to prevent and reduce loneliness among older adults, strategies should be developed aimed at the specific dimensions of loneliness. [ABSTRACT FROM AUTHOR]

We investigated the 2-week prevalence and correlates of very frequent physical aggression (PA) and vocalizations in nursing home (NH)-residents with dementia. This cross-sectional study used combined data of 2074 NH-residents from four studies, collected from 119 dementia special care units in 26 Dutch NH. Very frequent PA was defined as scoring 6 or 7 on the items 'hitting', pushing', 'biting' and 'kicking' of the Cohen Mansfield Agitation Inventory; very frequent vocalizations as scoring 6 or 7 on 'screaming' and 'making strange noises'. We compared NH-residents with very frequent PA or vocalizations with residents with less frequent PA or vocalizations, assessing correlates using univariate and multivariate multilevel logistic regression analyses. We found a 2-week prevalence of 2.2% (95% confidence interval (CI): 1.63–2.89) of very frequent PA and 11.5% of very frequent vocalizations (95% CI: 10.23–12.98). Very frequent PA was only associated with apathy (odds ratio (OR)=1.93, 95% CI: 1.04–3.61). Correlates of very frequent vocalizations were age (OR = 0.97, 95% CI: 0.951–0.998), dementia severity (overall p-value 0.020), antipsychotic drug use (OR = 1.56, 95% CI: 1.08–2.26), antiepileptic drug use (OR = 2.75, 95% CI: 1.34–5.68) and euphoria (OR = 2.01, 95% CI: 1.22–3.31). Characteristics of NH-residents with very frequent PA or very frequent vocalizations differ from those of NH-residents with less frequent PA or vocalizations. Frontal lobe damage, boredom, pain and/or external factors may explain several of the found associations, but further research is necessary. Our findings may contribute to better care for these residents and thereby to improving their quality of life. [ABSTRACT FROM AUTHOR]

We translated and modified an ambiance scale for use by (in)formal caregivers in Dutch nursing homes. We tested validity and reliability of the modified Ambiance Scale. Convenience sampling was used to enrol (in)formal caregivers in three nursing homes in the Netherlands. 104 questionnaires were filled in; 45 by informal caregivers, 46 by formal caregivers. Ten caregivers filled in the questionnaire twice for test-retest purposes. Three original items were used, and seven newly were added to form the modified Ambiance Scale. Each item consisted of an adjective pair assessing an aspect of ambiance on a scale of 1 (homelike) to 5 (institutional). Caregivers filled in the questionnaire on two different days to assess intra rater reliability. Differences in scoring between formal and informal caregivers and between original and new items were analyzed. The questionnaire was easy to comprehend and fill in. Internal consistency was good (a = 0.93). Validity was found to be good. Factor analysis demonstrated that eight items identified as one factor. No differences in scoring between the first and second assessment were found (p<.001). Formal caregivers scored ambiance more chaotic than informal caregivers did (p<.01). No differences in scoring between original and new items were found (p =.06). This study demonstrated that the modified Ambiance Scale had good internal consistency, moderate replicability and both informal and formal caregivers' overall ratings were comparable. The modified Ambiance Scale is a valid, reliable and easy to use tool to assess ambiance in nursing home settings. [ABSTRACT FROM AUTHOR]

Objectives: Anxious depression is associated with severe impairment and bad prognoses. We hypothesize that recent life-events are associated with more anxiety in late-life depression and that this is conditional upon the level of certain personality traits. Method: Baseline data of the Netherlands Study of Depression in Older Persons (NESDO) were used. In 333 patients (≥60 years) suffering from a major depressive disorder, anxiety was assessed with the BAI, personality traits with the NEO-FFI and the Mastery Scale, and life-events with the Brugha questionnaire. Multiple linear regression analyses were applied with anxiety severity as dependent and life-events and personality traits as independent variables. Results: 147 patients (44.1%) had recently experienced one or more life-events. The presence of a lifeevent is not associated with anxiety (p = .161) or depression severity (p = .440). However, certain personality traits interacted with life-events in explaining anxiety severity. Stratified analyses showed that life-events were associated with higher anxiety levels in case of high levels of neuroticism and openness and low levels of conscientiousness or mastery. Conclusions: In the face of a life-event, personality traits may play a central role in increased anxiety levels in late-life depression. [ABSTRACT FROM AUTHOR]

Background: Promoting adaptation, improving well-being and maintaining an optimal quality of life (QOL) is an important aspect in dementia care. The purpose of this study was to identify determinants of QOL in young onset dementia, and to assess differences in QoL domains between people with Alzheimer's disease (AD) and frontotemporal dementia (FTD). Methods: In total 135 persons with AD and 58 persons with FTD were included from two prospective cohort studies. QOL was assessed with the proxy reported quality of life in Alzheimer's disease questionnaire (QoL-AD). Possible determinants were explored using multiple linear regression and included sociodemographic variables, diagnosis, dementia severity, disease awareness, neuropsychiatric symptoms, met and unmet needs and hours of personal and instrumental care. Differences between QOL domains in people with AD and FTD were calculated using Mann-Whitney U tests. Results: Lower QOL was associated with more depressive symptoms, lower disease awareness, and a higher amount of needs, both met and unmet. People with AD scored lower on the memory and higher on the friends' subscale. No differences were found for the other items. Conclusion: This study demonstrates a unique set of determinants of QOL in AD and FTD. Interventions directed towards these specific factors may improve QOL. [ABSTRACT FROM AUTHOR]

Objectives: The implementation of new health services is a complex process. This study investigated the first phase of the adaptive implementation of the Dutch Meeting Centres Support Programme (MCSP) for people with dementia and their carers in three European countries (Italy, Poland, the UK) within the JPND-MEETINGDEM project. Anticipated and experienced factors influencing the implementation, and the efficacy of the implementation process, were investigated. Findings were compared with previous research in the Netherlands. Method: A qualitative multiple case study design was applied. Checklist on anticipated facilitators and barriers to the implementation and semi-structured interview were completed by stakeholders, respectively at the end and at the beginning of the preparation phase. Results: Overall, few differences between countries were founded. Facilitators for all countries were: added value of MCSP matching needs of the target group, evidence of effectiveness of MCSP, enthusiasm of stakeholders. General barriers were: competition with existing care and welfare organizations and scarce funding. Some countries experienced improved collaborations, others had difficulties finding a socially integrated location for MCSP. The step-by-step implementation method proved efficacious. Conclusion: These insights into factors influencing the implementation of MCSP in three European countries and the efficacy of the step-by-step preparation may aid further implementation of MCSP in Europe. [ABSTRACT FROM AUTHOR]

Objectives:The ability to manage one's life with some degree of independence, to fulfill basic obligations, and to participate in social activities are social functions that delineate the core of ‘social health’. We examine to what extent clients of community care in Europe (n= 2884) complete such activities despite their cognitive problems. We focus on mildly and moderately impaired people, aged 65+ years. Methods:Data were collected using the interRAI HC-Assessment in IBenC-project. We tested the association between participants' capacity and performance in three LADLs (instrumental activities of daily living) and their cognitive performance and specific memory problems. Results:About 30% of home care clients in Europe suffer from mild-to-moderate cognitive impairment. Their relatively independent coping with requirements of routine activities is strongly determined by overall cognitive performance. Specific memory functions seem unimportant, except for procedural memory. It is striking that all clients, and particularly those with mild-to-moderate cognitive impairment, interact mostly with close relatives and friends. Mild-to-moderate cognitive limitations do not hinder clients from coping semi-independently with routine requirements. Discussion:When considering the influence of cognitive function on clients' capacity and performance in everyday activities and social relations, a comprehensive construct of cognitive function has to be applied. [ABSTRACT FROM PUBLISHER]

Objectives: Despite the centrality of time to the aging process, the well-being consequences of different temporal orientations for optimal aging are poorly understood. We investigate one underexamined area of temporal orientation, namely a balanced time perspective, in a large, lifespan sample from the Netherlands. Method: Participants consisted of 512 Dutch adults ranging in age from 17 to 92 years (Mage = 46.46, SD = 21.37), including 186 male and 326 females. Participants completed a measure of balanced time perspective, mental health, and wisdom. Results: Results indicated that a balanced time perspective uniquely predicted both mental health and wisdom even after controlling for demographic, physical health, and personality variables. Younger adults tended to be more future-oriented relative to older adults while older adults tended to be more past-oriented relative to younger adults. Further, both midlife and younger adults were more likely to have a balanced time perspective relative to older adults. Conclusion: A balanced time perspective is associated with higher well-being and wisdom across the adult age span. [ABSTRACT FROM AUTHOR]