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A study on elderly inmates of nursing homes who died within one year of joining the nursing home is presented. The effect of chronic ailments and other diseases on their mortality is examined.

Severe dementia and adverse outcomes of nursing home-acquired pneumonia: evidence for mediation by functional and pathophysiological decline.

This article evaluates the operation of health care system in terms of its meeting the demands and needs of the older persons in the Netherlands. Data show that about 8% of the older population live in the residential or nursing homes.

Dementia is a process arising from neurological impairment and social psychological pressures. The conditions if left untreated can aggravate into malignant social psychology like infantilization, stigmatization, ignoring etc. A study is presented to show that snoezelen, a method of stimulating the senses of light, sound, smell and taste of the elderly dementia patients inhibits the progress of the dementia.

The treatment of nursing home residents in Missouri and Netherlands is compared to examine dementia and lower respiratory tract infection (LRI). Results indicate more aggressive care for US nursing home residents with LRI and dementia as compared to care for Dutch residents.

Research indicates that dementia patients with pneumonia suffer substantially regardless of whether or not they are treated with antibiotics, and implications for symptomatic treatment are discussed. Studies were conducted on 662 demented nursing home patients in the Netherlands, 77% of whom were given antibiotics and 23% whom were not.

Using a guideline for decision-making Summary points * We have developed a guideline to help physicians to decide whether to forgo curative treatment of pneumonia in patients with dementia who [...]

Non-treatment decisions concerning demented patients are complex: in addition to issues concerning the health of patients, ethical and legal issues are involved. This paper describes a method for the development of a guideline that clarifies the steps to be taken in the decision making process whether to forgo curative treatment of pneumonia in psychogeriatric nursing home patients. The method of development consisted of seven steps. Step 1 was a literature study from which ethical, juridical and medical factors concerning the patient's health and prognosis were identified. In step 2, a questionnaire was sent to 26 nursing home physicians to determine the relative importance of these factors in clinical practice. In a meeting of nine experienced physicians (step 3), the factors identified in step 2 were confirmed by most of these professionals. To prevent the final guideline being too directive, a concept guideline that included ethical and legal aspects was designed in the form of a 'checklist of considerations' (step 4). Experts in the fields of nursing home medicine, ethics and law reviewed and commented on the concept guideline (step 5). The accordingly adapted 'checklist of considerations' was tested in a pilot study (step 6), after which all experts endorsed the checklist (step 7). The resulting 'checklist of considerations' structures the decision making process according to three primary domains: medical aspects, patient's autonomy, and patient's best interest (see annex at end of paper). (Journal of Medical Ethics 2000;26:114-120) Keywords: Decision making; medical futility; patient advocacy; pneumonia; practice guidelines; nursing homes, Introduction Physicians involved in the care of elderly patients with a limited life expectancy are often confronted with the dilemma of whether treatment should be given or should be considered [...]

Samenvatting: Achtergrond: Dit artikel beschrijft de studieopzet van een studie naar de klinische en economische effecten van een multidisciplinair integraal zorgmodel op functionele gezondheid, kwaliteit van zorg en kwaliteit van leven van ouderen in verzorgingshuizen. Methode: De studie is opgezet als een cluster gerandomiseerd gecontroleerd klinisch onderzoek in vijf interventiehuizen en vijf huizen met gebruikelijke zorg in het noordwesten van Nederland bij in totaal meer dan 500 bewoners. Alle bewoners die niet terminaal ziek zijn en die in staat zijn om een ‘informed consent’ te tekenen en die geïnterviewd kunnen worden, worden geïncludeerd. Voor de bewoners die cognitieve problemen hebben, zullen de partners en/of naaste familieleden benaderd worden voor het beantwoorden van de vragenlijst. Het multidisciplinaire integrale zorgmodel bestaat uit verschillende elementen: (1) Een multidimensionale geriatrische beoordeling van de functionele gezondheid en zorgbehoefte van de bewoners uitgevoerd door getrainde verzorgenden met de internetapplicatie van de Long Term Care Facility versie van het Resident Assessment Instrument (RAIview). RAIview levert directe identificatie van probleemgebieden die de basis vormen voor een individueel zorgplan. (2) De uitkomsten van RAIview worden besproken in een multidisciplinair overleg met de betrokken verzorgende, de huisarts, specialist ouderengeneeskunde en psycholoog en zo nodig andere betrokken disciplines. Op dit overleg worden de zorgplanacties vastgesteld die tot verbetering van de functionele gezondheid en vermindering van risicofactoren kunnen leiden. Het zorgplan wordt met de bewoner en/of familie besproken en aan de wensen van de bewoner aangepast. (3) De huisarts kan bij complexe problematiek de specialist ouderengeneeskunde en/of de psycholoog consulteren. Uitkomstmaten zijn: 32 risico-indicatoren voor kwaliteit van zorg (gebaseerd op RAIview), kwaliteit van leven (SF12), functionele gezondheid (COOP-WONCA), zelfredzaamheid (GARS), mening van de bewoner over de kwaliteit van zorg (QUOTE), ziekenhuis- en verpleeghuisopname, sterfte, gezondheidszorggebruik en kosten. Discussie: Dit onderzoek is naar wij weten uniek omdat er nog geen studies gedaan zijn naar de effecten en kosten van een multidisciplinair integraal zorgmodel op de functionele gezondheid en kwaliteit van zorg voor kwetsbare ouderen in verzorgingshuizen. Trial registratienummer: ISRCTNI1076857

van Marum RJ, Meijer JH, Ribbe MW. The relationship between pressure ulcers and skin blood flow response after a local cold provocation. Arch Phys Med Rehabil 2002;83;40-3. Objective:To study the relationship between an impaired blood flow response after a local cold stimulus, testing nerve regulation of the local blood flow response, and an increased risk of developing pressure ulcers. Design:An observational, longitudinal, prospective study. Setting:Dutch nursing home. Patients:Eighty-two newly admitted somatic nursing home patients, age 60 years and older. Intervention:A local cold stimulus (17°C) applied to the trochanter major. Main Outcome Measures:On admission, blood flow response to a local cold stimulus. As the stimulus was withdrawn, the temperature measured at the skin increased asymptotically toward the final temperature, Tf. The velocity of this rise was characterized by the time constant, τ, of the process. On admission, and weekly during a 4-week follow-up period, the presence or absence of pressure ulcers was verified. Results:The blood flow response time correlated significantly with the risk of developing pressure ulcers. The patients who developed pressure ulcers during the follow-up period had a significantly longer response time than the patients who did not. Conclusions:Malfunction of the nervous regulatory mechanisms of the local blood flow is partially responsible for an increased susceptibility to pressure ulcer formation. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

OBJECTIVE:To find out why Dutch general practitioners (GPs) and nursing home physicians (NHPs), and patients (according to their physician) opt for active voluntary euthanasia rather than for physician‐assisted suicide, or vice‐versa.