37 results on '"Schols JM"'
Search Results
2. Cost-effectiveness of a disease-specific oral nutritional support for pressure ulcer healing.
- Author
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Cereda E, Klersy C, Andreola M, Pisati R, Schols JM, Caccialanza R, and D'Andrea F
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- Administration, Oral, Aged, Aged, 80 and over, Antioxidants administration & dosage, Antioxidants economics, Arginine administration & dosage, Arginine economics, Endpoint Determination, Female, Humans, Male, Malnutrition drug therapy, Malnutrition economics, Pressure Ulcer economics, Zinc administration & dosage, Zinc economics, Cost-Benefit Analysis, Dietary Supplements economics, Pressure Ulcer drug therapy, Wound Healing drug effects
- Abstract
Background & Aims: The Oligo Element Sore Trial has shown that supplementation with a disease-specific nutritional formula enriched with arginine, zinc, and antioxidants improves pressure ulcer (PU) healing in malnourished patients compared to an isocaloric-isonitrogenous support. However, the use of such a nutritional formula needs to be supported also by a cost-effectiveness evaluation., Methods: This economic evaluation - from a local healthcare system perspective - was conducted alongside a multicenter, randomized, controlled trial following a piggy-back approach. The primary efficacy endpoint was the percentage of change in PU area at 8 weeks. The cost analysis focused on: the difference in direct medical costs of local PU care between groups and incremental cost-effectiveness ratio (ICER) of nutritional therapy related to significant study endpoints (percentage of change in PU area and ≥40% reduction in PU area at 8 weeks)., Results: Although the experimental formula was more expensive (mean difference: 39.4 Euros; P < 0.001), its use resulted in money saving with respect to both non-nutritional PU care activities (difference, -113.7 Euros; P = 0.001) and costs of local PU care (difference, -74.3 Euros; P = 0.013). Therefore, given its efficacy it proved to be a cost-effective intervention. The robustness of these results was confirmed by the sensitivity analyses., Conclusion: The use of a disease-specific oral nutritional formula not only results in better healing of PUs, but also reduces the costs of local PU care from a local healthcare system perspective., (Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)
- Published
- 2017
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3. Response to the 'Letter to the Editor on the Maastricht Sarcopenia Study'.
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Ter Borg S, Verlaan S, de Groot LC, de Vries JH, Meijboom S, Mijnarends DM, Luiking YC, and Schols JM
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- Humans, Sarcopenia
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- 2016
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4. Differences in Nutrient Intake and Biochemical Nutrient Status Between Sarcopenic and Nonsarcopenic Older Adults-Results From the Maastricht Sarcopenia Study.
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Ter Borg S, de Groot LC, Mijnarends DM, de Vries JH, Verlaan S, Meijboom S, Luiking YC, and Schols JM
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- Aged, Aged, 80 and over, Diet Surveys, Female, Geriatric Assessment, Humans, Male, Nutritional Status, Diet, Energy Intake, Sarcopenia
- Abstract
Background: There is growing evidence of a relationship between nutrients and muscle mass, strength, and physical performance. Although nutrition is seen as an important pillar of treating sarcopenia, data on the nutritional intake of sarcopenic older adults are limited., Objective: To investigate potential nutritional gaps in the sarcopenic population, the present study compared nutrient intake and biochemical nutrient status between sarcopenic and nonsarcopenic older adults., Design: The Maastricht Sarcopenia Study included 227 community-dwelling older adults (≥65 years) from Maastricht, 53 of whom were sarcopenic based on the European Working Group on Sarcopenia in Older People algorithm. Habitual dietary intake was assessed with a food frequency questionnaire and data on dietary supplement use were collected. In addition, serum 25-hydroxyvitamin D, magnesium and α-tocopherol/cholesterol, plasma homocysteine and red blood cell n-3, and n-6 fatty acids profiles were assessed. Nutrient intake and biochemical nutrient status of the sarcopenic groups were compared with those of the nonsarcopenic groups. The robustness of these results was tested with a multiple regression analysis, taking into account between-group differences in characteristics., Results: Sarcopenic older adults had a 10%-18% lower intake of 5 nutrients (n-3 fatty acids, vitamin B6, folic acid, vitamin E, magnesium) compared with nonsarcopenic older adults (P < .05). When taking into account dietary supplement intake, a 19% difference remained for n-3 fatty acids intake (P = .005). For the 2 biochemical status markers, linoleic acid and homocysteine, a 7% and 27% difference was observed, respectively (P < .05). The higher homocysteine level confirmed the observed lower vitamin B intake in the sarcopenic group. Observed differences in eicosapentaenoic acid and 25-hydroxyvitamin D between the groups were related to differences in age and living situation., Conclusions: Sarcopenic older adults differed in certain nutritional intakes and biochemical nutrient status compared with nonsarcopenic older adults. Dietary supplement intake reduced the gap for some of these nutrients. Targeted nutritional intervention may therefore improve the nutritional intake and biochemical status of sarcopenic older adults., (Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2016
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5. The Martin Vigorimeter Represents a Reliable and More Practical Tool Than the Jamar Dynamometer to Assess Handgrip Strength in the Geriatric Patient.
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Sipers WM, Verdijk LB, Sipers SJ, Schols JM, and van Loon LJ
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- Aged, 80 and over, Female, Humans, Male, Muscle Strength, Reproducibility of Results, Sarcopenia physiopathology, Geriatric Assessment, Hand Strength physiology, Muscle Strength Dynamometer standards
- Abstract
Background: Geriatric patients with low skeletal muscle mass and strength generally have a relatively poor clinical outcome following acute illness. Therefore, it is recommended to routinely assess skeletal muscle mass and strength in patients admitted to the acute care geriatric ward. Handgrip strength is generally measured as a proxy for muscle strength and/or functional performance., Objective: To compare the applicability and test-retest reliability of measuring handgrip strength using the Jamar dynamometer and the Martin Vigorimeter in geriatric patients during hospitalization., Design: A total of 96 geriatric patients (age 85 ± 5 y) admitted to the acute care geriatric ward participated in this study. Handgrip strength was assessed 3 times on 2 different occasions within 1 week of hospital admission using both the Jamar dynamometer and the Martin Vigorimeter., Results: Maximal handgrip strength as determined over the 3 successive attempts performed on 2 occasions averaged 17 ± 7 kg and 35 ± 13 kPa when using the Jamar dynamometer and Martin Vigorimeter, respectively. Handgrip strength was significantly greater when using the dominant versus nondominant hand using both the Jamar dynamometer (17 ± 7 kg vs 16 ± 7 kg; P = .003) and Martin Vigorimeter (34 ± 12 kPa vs 33 ± 13 kPa; P = .022). Test-retest reliability showed an ICC of 0.94 and 0.92 when applying the Jamar dynamometer or Martin Vigorimeter, respectively (both P < .001). Furthermore, handgrip strength assessed with the Jamar and Martin Vigorimeter showed a strong correlation for both the first (ρ = 0.83, P < .001) and second measurement (ρ = 0.79, P < .001). Almost 80% of the geriatric patients needed help from nursing staff with transfer from bed to an arm-rested chair measuring handgrip strength with the Jamar dynamometer according to the Southampton protocol, which is not necessary when using the Martin Vigorimeter., Conclusion: The Martin Vigorimeter represents a reliable and more practical tool than the Jamar dynamometer to assess handgrip strength in the geriatric patient on admission to the acute geriatric ward., (Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2016
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6. Should All Elderly Persons Undergo a Cognitive Function Evaluation? Where Is the Patient's Perspective?
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Verhey FR, de Vugt ME, and Schols JM
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- Aged, Health Knowledge, Attitudes, Practice, Humans, Middle Aged, Cognitive Dysfunction diagnosis, Cognitive Dysfunction epidemiology, Mass Screening, Patients psychology
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- 2016
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7. A randomized controlled trial on the benefits and respiratory adverse effects of morphine for refractory dyspnea in patients with COPD: Protocol of the MORDYC study.
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Verberkt CA, van den Beuken-van Everdingen MH, Franssen FM, Dirksen CD, Schols JM, Wouters EF, and Janssen DJ
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- Administration, Oral, Adult, Aged, Aged, 80 and over, Analgesics, Opioid adverse effects, Clinical Protocols, Delayed-Action Preparations, Double-Blind Method, Dyspnea etiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Morphine adverse effects, Prospective Studies, Quality of Life, Treatment Outcome, Analgesics, Opioid therapeutic use, Dyspnea drug therapy, Morphine therapeutic use, Pulmonary Disease, Chronic Obstructive complications
- Abstract
Dyspnea is one of the most reported symptoms of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and is often undertreated. Morphine has proven to be an effective treatment for dyspnea and is recommended in clinical practice guidelines, but questions concerning benefits and respiratory adverse effects remain. This study primarily evaluates the impact of oral sustained release morphine (morphine SR) on health-related quality of life and respiratory adverse effects in patients with COPD. Secondary objectives include the impact on exercise capacity, the relationship between description and severity of dyspnea and the presence of a clinically relevant response to morphine, and cost-effectiveness. A single-center, randomized, double blind, placebo controlled intervention study will be performed in 124 patients with COPD who recently completed a comprehensive pulmonary rehabilitation program. Participants will receive 20-30 mg/24h morphine SR or placebo for four weeks. After the intervention, participants will be followed for twelve weeks. Outcomes include: the COPD Assessment Test, six minute walking test, Multidimensional Dyspnea Scale and a cost diary. Furthermore, lung function and arterial blood gasses will be measured. These measures will be assessed during a baseline and outcome assessment, two home visits, two phone calls, and three follow-up assessments. The intervention and control group will be compared using uni- and multivariate regression analysis and logistic regression analysis. Finally, an economic evaluation will be performed from a societal and healthcare perspective. The current manuscript describes the rationale and methods of this study and provides an outline of the possible strengths, weaknesses and clinical consequences., (Copyright © 2016 Elsevier Inc. All rights reserved.)
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- 2016
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8. To what extent do structural quality indicators of (nutritional) care influence malnutrition prevalence in nursing homes?
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van Nie-Visser NC, Meijers JM, Schols JM, Lohrmann C, Spreeuwenberg M, and Halfens RJ
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- Aged, Aged, 80 and over, Austria epidemiology, Body Weight, Cross-Sectional Studies, Energy Intake, Female, Germany epidemiology, Hospitals, Humans, Male, Netherlands epidemiology, Nutrition Assessment, Nutrition Policy, Prevalence, Surveys and Questionnaires, Malnutrition epidemiology, Nursing Homes standards, Quality Indicators, Health Care standards
- Abstract
Background & Aims: Many residents in European healthcare institutions are malnourished, with reported malnutrition prevalence rates of up to 60%. Due to the negative effects of malnutrition it is important to optimize the quality of nutritional care. If structural quality indicators of nutritional care might improve resident care and outcome is not yet known. The aim of this study is to explore whether structural quality indicators for nutritional care influence malnutrition prevalence in Dutch, German and Austrian nursing homes., Methods: This study follows a cross-sectional, multi-center design. Data were collected by using a standardised questionnaire at resident, ward and institution level., Results: Data from 214 nursing homes (NL = 133, G = 61, A = 20) were analysed. The prevalence of malnutrition varied significantly between the three countries (NL = 18.2% G = 20.1% A = 22.5%). Two structural quality indicators at ward level namely (1) the policy that the care file should include the nutritional intake for each patient and (2) having a weight measurement policy at ward level are predictive for malnutrition prevalence. Furthermore also the variable country was of influence., Conclusions: A policy of registering nutritional intake in the file of the patient and a policy to assess the patient's weight regularly have a positive influence on malnutrition prevalence., (Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)
- Published
- 2015
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9. Clinical Interpretation of Elevated Concentrations of Cardiac Troponin T, but Not Troponin I, in Nursing Home Residents.
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Cardinaels EP, Daamen MA, Bekers O, ten Kate J, Niens M, van Suijlen JD, van Dieijen-Visser MP, Brunner-La Rocca HP, Schols JM, and Mingels AM
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- Aged, 80 and over, Biomarkers blood, Creatinine blood, Cystatin C blood, Female, Glomerular Filtration Rate, Heart Failure epidemiology, Humans, Kidney Diseases blood, Kidney Diseases epidemiology, Male, Netherlands epidemiology, Prognosis, Troponin I blood, Heart Failure blood, Nursing Homes, Troponin T blood
- Abstract
Objective: Cardiac troponins T (cTnT) and I (cTnI) are the preferred biomarkers to detect myocardial damage. The present study explores the value of measuring cardiac troponins (cTn) in nursing home residents, by investigating its relation to heart failure and 1-year mortality using 1 cTnT and 2 cTnI assays that are widely used in clinical practice., Design: All participants underwent extensive clinical examinations and echocardiographic assessment for the diagnosis of heart failure. cTn was measured using high-sensitive (hs)- cTnT (Roche), hs-cTnI (Abbott), and sensitive cTnI (Beckman) assays. The glomerular filtration rate was estimated (eGFR) using serum creatinine and cystatin C concentrations. Data on all-cause mortality were collected at 1-year follow-up., Participants and Setting: Participants were 495 long-term nursing home residents, older than 65 years, of 5 Dutch nursing home organizations., Results: Median (IQR) concentrations were 20.6 (17.8-30.6), 6.8 (4.1-12.5), and 4.0 (2.0-8.0) ng/L for hs-cTnT, hs-cTnI, and cTnI, respectively. In total, 79% had elevated hs-cTnT concentrations, whereas only 9% and 5% of hs-cTnI and cTnI concentrations were elevated. Most important and independent determinants for higher hs-cTnT and hs-cTnI concentrations were heart failure and renal dysfunction. Whereas both heart failure (odds ratio [OR] 3.4) and eGFR lower than 60 mL/min/1.73 m(2) (OR 3.6) were equal contributors to higher hs-cTnT concentrations (all P < .001), hs-cTnI and cTnI were less associated with renal dysfunction (OR of, respectively, 1.9 and 2.1; P < .01) in comparison with heart failure (OR 4.3 and 4.7, respectively, P < .001). Furthermore, residents with higher hs-cTnT or hs-cTnI concentrations (fourth quartile) had respectively 4 versus 2 times more risk of 1-year mortality compared with lower concentrations., Conclusion: Regardless of their cardiac health, hs-cTnT but not hs-cTnI concentrations were elevated in almost all aged nursing home residents, questioning the use of the current diagnostic cutoff in elderly with high comorbidity. Nonetheless, measuring cardiac troponins, especially hs-cTnT, had a promising role in assessing future risk of mortality., (Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2015
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10. Patient-Clinician Communication About End-of-Life Care in Patients With Advanced Chronic Organ Failure During One Year.
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Houben CH, Spruit MA, Schols JM, Wouters EF, and Janssen DJ
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- Aged, Chronic Disease, Female, Follow-Up Studies, Heart Failure psychology, Humans, Kidney Failure, Chronic psychology, Longitudinal Studies, Male, Pulmonary Disease, Chronic Obstructive psychology, Communication, Heart Failure therapy, Kidney Failure, Chronic therapy, Physician-Patient Relations, Pulmonary Disease, Chronic Obstructive therapy, Terminal Care psychology
- Abstract
Context: Patient-clinician communication is an important prerequisite to delivering high-quality end-of-life care. However, discussions about end-of-life care are uncommon in patients with advanced chronic organ failure., Objectives: The aim was to examine the quality of end-of-life care communication during one year follow-up of patients with advanced chronic organ failure. In addition, we aimed to explore whether and to what extent quality of communication about end-of-life care changes toward the end of life and whether end-of-life care communication is related to patient-perceived quality of medical care., Methods: Clinically stable outpatients (n = 265) with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure were visited at home at baseline and four, eight, and 12 months after baseline to assess quality of end-of-life care communication (Quality of Communication questionnaire). Two years after baseline, survival status was assessed, and if patients died during the study period, a bereavement interview was done with the closest relative., Results: One year follow-up was completed by 77.7% of the patients. Quality of end-of-life care communication was rated low at baseline and did not change over one year. Quality of end-of-life care communication was comparable for patients who completed two year follow-up and patients who died during the study. The correlation between quality of end-of-life care communication and satisfaction with medical treatment was weak., Conclusion: End-of-life care communication is poor in patients with chronic organ failure and does not change toward the end of life. Future studies should develop an intervention aiming at initiating high-quality end-of-life care communication between patients with advanced chronic organ failure and their clinicians., (Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2015
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11. Instruments to assess sarcopenia and physical frailty in older people living in a community (care) setting: similarities and discrepancies.
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Mijnarends DM, Schols JM, Meijers JM, Tan FE, Verlaan S, Luiking YC, Morley JE, and Halfens RJ
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- Age Distribution, Aged, Aged, 80 and over, Assisted Living Facilities statistics & numerical data, Chi-Square Distribution, Cross-Sectional Studies, Female, Humans, Incidence, Independent Living statistics & numerical data, Male, Netherlands, Reproducibility of Results, Risk Assessment, Sarcopenia epidemiology, Severity of Illness Index, Sex Distribution, Activities of Daily Living, Frail Elderly statistics & numerical data, Geriatric Assessment methods, Sarcopenia diagnosis
- Abstract
Objectives: Both sarcopenia and physical frailty are geriatric syndromes causing loss of functionality and independence. This study explored the association between sarcopenia and physical frailty and the overlap of their criteria in older people living in different community (care) settings. Moreover, it investigated the concurrent validity of the FRAIL scale to assess physical frailty, by comparison with the widely used Fried criteria., Design: Data were retrieved from the cross-sectional Maastricht Sarcopenia Study (MaSS)., Setting: The study was undertaken in different community care settings in an urban area (Maastricht) in the south of the Netherlands., Participants: Participants were 65 years or older, gave written informed consent, were able to understand Dutch language, and were not wheelchair bound or bedridden., Intervention: Not applicable., Measurements: Sarcopenia was identified using the algorithm of the European Working Group on Sarcopenia in Older People. Physical frailty was assessed by the Fried criteria and by the FRAIL scale. Logistic regression was performed to assess the association between sarcopenia and physical frailty measured by the Fried criteria. Spearman correlation was performed to assess the concurrent validity of the FRAIL scale compared with the Fried criteria., Results: Data from 227 participants, mean age 74.9 years, were analyzed. Sarcopenia was identified in 23.3% of the participants, when using the cutoff levels for moderate sarcopenia. Physical frailty was identified in 8.4% (≥3 Fried criteria) and 9.3% (≥3 FRAIL scale criteria) of the study population. Sarcopenia and physical frailty were significantly associated (P = .022). Frail older people were more likely to be sarcopenic than those who were not frail. In older people who were not frail, the risk of having sarcopenia increased with age. Next to poor grip strength (78.9%) and slow gait speed (89.5%), poor performance in other functional tests was common in frail older people. The 2 physical frailty scales were significantly correlated (r = 0.617, P < .001)., Conclusion: Sarcopenia and physical frailty were associated and partly overlap, especially on parameters of impaired physical function. Some evidence for concurrent validity between the FRAIL scale and Fried criteria was found. Future research should elicit the value of combining sarcopenia and frailty measures in preventing disability and other negative health outcomes., (Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2015
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12. Assessment of care problems in Romania: feasibility and exploration.
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Ghinescu M, Olaroiu M, Aurelian S, Halfens RJ, Dumitrescu L, Schols JM, Rahnea-Nita G, Curaj A, Alexa I, and van den Heuvel WJ
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- Accidental Falls prevention & control, Aged, Aged, 80 and over, Cross-Sectional Studies, Feasibility Studies, Fecal Incontinence prevention & control, Female, Health Services Needs and Demand, Hospitals, Hospitals, Psychiatric, Humans, Male, Nursing Homes, Pressure Ulcer prevention & control, Prevalence, Romania epidemiology, Surveys and Questionnaires, Urinary Incontinence prevention & control, Accidental Falls statistics & numerical data, Fecal Incontinence epidemiology, Pressure Ulcer epidemiology, Quality of Health Care, Urinary Incontinence epidemiology
- Abstract
Objectives: The objective of this study was to study the feasibility of a recently developed instrument, LPZ-International, which assesses care problems in health care, and to describe the prevalence of care problems in Romanian health care institutions. Large differences exist in care services in Europe. Data on quality of care are absent or incomplete in Central-Eastern European countries. These countries, including Romania, have faced dramatic socioeconomic changes, which led to negative changes in quality of care., Design: Cross-sectional study., Setting: Hospital wards, mental care institutions, and nursing homes., Participants: Nine health care institutions and admitted 394 patients., Measures: LPZ-International was introduced in 9 health care institutions in Romania. Assessed care problems included pressure ulcers, urinary and fecal incontinence, malnutrition, falls, and physical restraints. The data were collected between November 2013 and March 2014. Two health care professionals completed the questionnaire by hand at the patient's site., Results: Six of the 9 health care institutions and 90% of the patients participated, which indicates the feasibility of LPZ-International, as did the completeness of the questionnaire. The data showed a high consistency and only a few were missing. The most frequent care problem was urinary and fecal incontinence, especially in the nursing home. Pressure ulcers and malnutrition were less frequent care problems in Romanian patients. Physical restraints were frequently applied in the nursing home and geriatrics and oncology wards., Conclusions: LPZ-International is a feasible instrument to assess care problems. The differences between wards and countries in the prevalence of care problems indicate differences in quality of care and the need for high-quality, comparative research., (Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2015
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13. Nutritional care; do process and structure indicators influence malnutrition prevalence over time?
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Meijers JM, Tan F, Schols JM, and Halfens RJ
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- Administration, Oral, Aged, 80 and over, Body Mass Index, Cross-Sectional Studies, Dietary Supplements, Female, Home Care Services, Humans, Long-Term Care, Longitudinal Studies, Male, Micronutrients administration & dosage, Netherlands, Nutrition Assessment, Prevalence, Surveys and Questionnaires, Weight Loss, Malnutrition epidemiology, Nutritional Support methods
- Abstract
To date, no information is available about the effect of structural and process factors of nutritional care on the prevalence of malnutrition over time in the long-term care sector. This study analyzes the trend of malnutrition prevalence rates between 2007 and 2011 in the long-term care sector, and the related effects of(1) process indicators such as nutritional screening and treatment and 2) structural indicators (guideline, protocol or nutritional screening policy). From 2007 to 2011, the Dutch National Prevalence Measurement of Care Problems (LPZ) was performed in Dutch long-term care organizations using a standardized questionnaire involving measurements at institutional, ward and resident level. The data were analyzed by mixed-linear regression for longitudinal data. Presence of malnutrition was assessed by BMI, undesired weight loss and nutritional intake. Seventy-four care homes were included (26,101 residents). The malnutrition prevalence trend significantly decreased (P < 0.001) from 26% to 18% from 2007 to 2011. In the final model of the mixed effects analysis only the interacted process indicators nutritional screening and oral nutritional supplementation (ONS) were significant in influencing malnutrition prevalence rates over time. Structural indicators had no impact on the malnutrition prevalence over time. In conclusion, over time a lower prevalence of malnutrition is associated with a higher degree of nutritional screening. As might be expected, a higher prevalence of malnutrition is associated with higher use of ONS. Structural nutritional screening is an important intervention to tackle the problem of malnutrition in the long term care sector., (Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)
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- 2014
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14. One-year stability of care dependency in patients with advanced chronic organ failure.
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Janssen DJ, Schols JM, Wouters EF, and Spruit MA
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- Activities of Daily Living, Age Factors, Aged, Comorbidity, Female, Health Status, Hospitalization statistics & numerical data, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Netherlands, Sampling Studies, Severity of Illness Index, Disability Evaluation, Health Services Needs and Demand, Heart Failure epidemiology, Kidney Failure, Chronic epidemiology, Pulmonary Disease, Chronic Obstructive epidemiology
- Abstract
Objectives: Care dependency is a determinant of quality of life and survival among patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), or chronic renal failure (CRF). The objectives of this study were to explore the profiles of care dependency in patients with advanced COPD, CHF, or CRF; to study the changes in care dependency during 1-year follow-up; and to study whether 1-year changes in care dependency are comparable between patients with advanced COPD, CHF, or CRF., Design: Longitudinal observational study., Participants: Clinically stable patients with advanced COPD (n = 105), CHF (n = 80), or CRF (n = 80) were recruited at outpatient clinics of 7 Dutch hospitals., Measurements: Patients were visited at home at baseline, and at 4, 8, and 12 months to assess demographic and clinical characteristics, comorbidities (Charlson comorbidity index), care dependency (Care Dependency Scale), mobility, health status, and symptom burden., Results: COPD and CHF patients reported a higher baseline level of care dependency than patients with CRF. Care dependency differed between patients with COPD, CHF, or CRF in the items 'getting (un)dressed,' 'hygiene,' 'contact with others,' and 'sense of rules/values.' One-year follow-up was completed by 206 patients (77.7%). Patients with COPD were more likely to experience an increase in care dependency. An increase in care dependency was associated with higher age, higher number of hospital admissions, decrease in health status, and worsening of Charlson comorbidity index score., Conclusions: Care dependency profiles differ between patients with COPD, CHF, or CRF. Patients with advanced COPD are at risk for a 1-year increase in care dependency. Regular assessment of care dependency and addressing care dependency in palliative care programs for patients with advanced COPD, CHF, or CRF are needed., (Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)
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- 2014
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15. The economic value of enteral medical nutrition in the management of disease-related malnutrition: a systematic review.
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Freijer K, Bours MJ, Nuijten MJ, Poley MJ, Meijers JM, Halfens RJ, and Schols JM
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- Cost Savings, Cost-Benefit Analysis, Dietary Supplements, Hospitalization economics, Humans, Malnutrition economics, Nutrition Assessment, Enteral Nutrition economics, Malnutrition therapy
- Abstract
Economic evaluations for medical nutrition, such as oral nutritional supplements (ONS), are relatively uncommon compared with other health technologies, and represent an area that has not been reviewed so far. In this systematic review, economic evaluations of enteral medical nutrition in the management of disease-related malnutrition (DRM) were reviewed and qualified to estimate the economic value. Initially, 481 studies were found, of which 37 full-text articles were assessed for eligibility and were rated on their quality using the Quality of Health Economic Studies (QHES) instrument. The final review focused on the high QHES quality economic evaluation studies. As both the studied medical nutrition intervention and the form of the economic evaluation varied, a quantitative synthesis (meta-analysis) was not attempted but a critical analysis and comparison of the individual study results were performed. ONS was the most studied intervention, covering several patient populations and different health care settings. Outcomes included cost savings (n = 3), no significant extra costs per unit of clinical and/or functional improvement (n = 1), or significantly higher costs per unit of clinical and/or functional improvement but still cost-effective for the used threshold (n = 4). This review shows that the use of enteral medical nutrition in the management of DRM can be efficient from a health economic perspective., (Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
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16. Dynamic preferences for site of death among patients with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure.
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Janssen DJ, Spruit MA, Schols JM, and Wouters EF
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- Aged, Chronic Disease, Female, Heart Failure psychology, Humans, Kidney Failure, Chronic psychology, Longitudinal Studies, Male, Needs Assessment, Netherlands epidemiology, Patient Preference psychology, Prevalence, Pulmonary Disease, Chronic Obstructive psychology, Terminal Care statistics & numerical data, Advance Care Planning statistics & numerical data, Attitude to Death, Heart Failure mortality, Kidney Failure, Chronic mortality, Patient Preference statistics & numerical data, Pulmonary Disease, Chronic Obstructive mortality, Terminal Care psychology
- Abstract
Context: To die at the preferred site is a key principle of a good death., Objectives: To examine one-year stability of preferences for site of death among patients with advanced chronic organ failure, and to assess agreement between the actual site of death and the site patients indicated in advance as their preferred site., Methods: Clinically stable outpatients (n=265) with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure were visited at home at baseline and four, eight, and 12 months after baseline to assess their preferred site of death. One-year follow-up was completed by 77.7% of the patients. A bereavement interview was done with the closest relative of patients who died within two years after baseline (n=66, 24.9%) to assess their actual site of death., Results: During one-year follow-up, 61.2% of the patients changed their preference for site of death. During the home interview before their death, 51.5% reported to prefer to die at home. A considerable portion of the patients (57.6%) died in the hospital, and 39.4% of the patients died at the site they reported previously as their preferred site (κ=0.07, P=0.42)., Conclusion: Preferences for site of death may change in patients with advanced chronic organ failure. Future studies should explore whether and to what extent discussing the possibilities for the site of end-of-life care as a part of advance care planning can prepare patients and relatives for in-the-moment decision making and improve end-of-life care., Trial Registration: NTR 1552 Dutch Trial Register., (Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)
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- 2013
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17. Keys to successfully embedding scientific research in nursing homes: a win-win perspective.
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Verbeek H, Zwakhalen SM, Schols JM, and Hamers JP
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- Aged, Cooperative Behavior, Humans, Interprofessional Relations, Organizational Policy, Quality Assurance, Health Care, Evidence-Based Practice education, Nursing Homes organization & administration
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- 2013
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18. Do patients in Dutch nursing homes have more pressure ulcers than patients in German nursing homes? A prospective multicenter cohort study.
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Meesterberends E, Halfens RJ, Spreeuwenberg MD, Ambergen TA, Lohrmann C, Neyens JC, and Schols JM
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- Aged, Aged, 80 and over, Female, Germany epidemiology, Humans, Incidence, Male, Multivariate Analysis, Netherlands epidemiology, Pressure Ulcer epidemiology, Proportional Hazards Models, Prospective Studies, Risk Factors, Nursing Homes, Pressure Ulcer prevention & control, Quality of Health Care
- Abstract
Objectives: To investigate whether the incidence of pressure ulcers in nursing homes in the Netherlands and Germany differs and, if so, to identify resident-related risk factors, nursing-related interventions, and structural factors associated with pressure ulcer development in nursing home residents., Design: A prospective multicenter cohort study., Setting: Ten nursing homes in the Netherlands and 11 nursing homes in Germany (around Berlin and Brandenburg)., Participants: A total of 547 newly admitted nursing home residents, of which 240 were Dutch and 307 were German. Residents had an expected length of stay of 12 weeks or longer., Measurements: Data were collected for each resident over a 12-week period and included resident characteristics (eg, demographics, medical history, Braden scale scores, nutritional factors), pressure ulcer prevention and treatment characteristics, staffing ratios and other structural nursing home characteristics, and outcome (pressure ulcer development during the study). Data were obtained by trained research assistants., Results: A significantly higher pressure ulcer incidence rate was found for the Dutch nursing homes (33.3%) compared with the German nursing homes (14.3%). Six factors that explain the difference in pressure ulcer incidence rates were identified: dementia, analgesics use, the use of transfer aids, repositioning the residents, the availability of a tissue viability nurse on the ward, and regular internal quality controls in the nursing home., Conclusion: The pressure ulcer incidence was significantly higher in Dutch nursing homes than in German nursing homes. Factors related to residents, nursing care and structure explain this difference in incidence rates. Continuous attention to pressure ulcer care is important for all health care settings and countries, but Dutch nursing homes especially should pay more attention to repositioning residents, the necessity and correct use of transfer aids, the necessity of analgesics use, the tasks of the tissue viability nurse, and the performance of regular internal quality controls., (Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)
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- 2013
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19. Validity and reliability of tools to measure muscle mass, strength, and physical performance in community-dwelling older people: a systematic review.
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Mijnarends DM, Meijers JM, Halfens RJ, ter Borg S, Luiking YC, Verlaan S, Schoberer D, Cruz Jentoft AJ, van Loon LJ, and Schols JM
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- Aged, Aged, 80 and over, Diagnostic Imaging, Health Status Indicators, Humans, Middle Aged, Reproducibility of Results, Activities of Daily Living, Geriatric Assessment methods, Muscle Strength physiology, Muscle, Skeletal physiology, Sarcopenia diagnosis
- Abstract
Background: This study critically appraises the measurement properties of tools to measure muscle mass, strength, and physical performance in community-dwelling older people. This can support the selection of a valid and reliable set of tools that is feasible for future screening and identification of sarcopenia., Methods: The databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane were systematically searched (January 11, 2012). Studies were included if they investigated the measurement properties or feasibility, or both, of tools to measure muscle mass, strength, and physical performance in community-dwelling older people aged ≥60 years. The consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was used for quality appraisal of the studies., Results: Sixty-two publications were deemed eligible, including tools for muscle mass (n = 16), muscle strength (n = 15), and physical performance (n = 31). Magnetic resonance imaging, computed tomography, and a 4-compartment model were used as gold standards for muscle mass assessment. Other frequently used measures of muscle mass are dual-energy x-ray and the bioelectrical impedance (BIA); however, reliability data of the BIA are lacking. Handheld dynamometry and gait speed or a short physical performance battery provide a valid and reliable measurement of muscle strength and physical performance, respectively., Conclusions: It can be concluded that several tools are available for valid and reliable measurements of muscle mass, strength, and performance in clinical settings. For a home-setting BIA, handheld dynamometry and gait speed or a short physical performance battery are the most valid, reliable, and feasible. The combination of selected instruments and its use for the screening and identification of sarcopenia in community-dwelling older people need further evaluation., (Copyright © 2013. Published by Elsevier Inc.)
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- 2013
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20. Prevalence and spread of multidrug resistant Escherichia coli isolates among nursing home residents in the southern part of The Netherlands.
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van der Donk CF, Schols JM, Driessen CJ, Hagenouw RG, Meulendijks A, and Stobberingh EE
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- Chi-Square Distribution, Cross Infection microbiology, Escherichia coli Infections microbiology, Female, Humans, Male, Microbial Sensitivity Tests, Netherlands epidemiology, Prevalence, Anti-Bacterial Agents therapeutic use, Cross Infection drug therapy, Cross Infection epidemiology, Disease Outbreaks, Drug Resistance, Bacterial, Escherichia coli Infections drug therapy, Escherichia coli Infections epidemiology, Nursing Homes
- Abstract
Objectives: Empiric antibiotic treatment should be based on recent surveillance data. Therefore, we conducted a surveillance of (multidrug) resistance of Escherichia coli and antibiotic use among Dutch nursing home (NH) residents. Pulsed-field gel electrophoresis and multilocus sequence typing were used to describe the spread of multidrug-resistant strains., Design: Observational study., Setting: Five NHs in the southern part of The Netherlands., Participants: A total of 337 NH residents from both somatic and psychogeriatric wards., Measurements: The prevalence and spread of antibiotic resistance and multidrug resistant E. coli isolates collected from urine samples and antibiotic use among the NH residents were investigated., Results: A total of 208 E. coli isolates were collected from 308 urine samples. Resistance to amoxicillin-clavulanic acid was 23% and resistance to ciprofloxacin was 16%. Resistance to trimethoprim-sulfamethoxazole was 19%, whereas nitrofurantoin resistance was less than 1%. Multidrug resistance was observed in 28 of the 208 isolates (13%). Several isolates showed a similar pulsed-field gel electrophoresis pulsotype and multilocus sequence typing type. Sequence type (ST) 131 was the most prevalent (48%) and was demonstrated in all NHs and with four different pulsotypes. Consumption of antibiotics for systemic use was 64.4 defined daily dose (DDD)/1000 residents/day. Amoxicillin-clavulanic acid was most frequently prescribed (20.92 DDD/1000 residents/day), followed by the quinolones (14.8 DDD/1000 residents/day)., Conclusion: We observed a high prevalence of antibiotic resistance and antibiotic use. In particular, the use of and resistance to fluoroquinolones is concerning. Because of the high prevalence of resistance, many agents are no longer suitable for empiric treatment. E. coli ST131, which has also been demonstrated in this study, poses a potential risk to this vulnerable population. We have clearly demonstrated that the resistance among NH residents is different from elderly living at home and hospitalized patients, and with the emergence of resistant strains, such as ST131, NHs are a potential reservoir for multidrug resistant bacteria., (Copyright © 2013. Published by Elsevier Inc.)
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- 2013
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21. Care dependency independently predicts two-year survival in outpatients with advanced chronic organ failure.
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Janssen DJ, Wouters EF, Schols JM, and Spruit MA
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- Aged, Comorbidity, Female, Humans, Longitudinal Studies, Male, Netherlands epidemiology, Predictive Value of Tests, Proportional Hazards Models, Prospective Studies, Surveys and Questionnaires, Survival Rate, Health Services Needs and Demand, Outpatients, Pulmonary Disease, Chronic Obstructive mortality, Pulmonary Disease, Chronic Obstructive therapy
- Abstract
Objective: Previous studies suggest that care dependency may predict survival in hospitalized patients, but the prognostic value of care dependency in clinically stable outpatients with advanced chronic organ failure remains unknown. The objective of this study was to assess whether and to what extent care dependency predicts 2-year survival in patients with advanced chronic organ failure., Design: Longitudinal observational study., Setting: Patients were recruited at the outpatient clinic of one academic and six general hospitals in The Netherlands., Participants: A total of 265 clinically stable outpatients with advanced chronic obstructive pulmonary disease (n = 105), chronic heart failure (n = 80), and chronic renal failure (n = 80) were included at baseline., Measurements: Care dependency was assessed using the Care Dependency Scale (CDS), a 15-item self-administered questionnaire. In addition, patients performed a Timed Up and Go test to assess mobility. Finally, demographics, clinical characteristics, and 2-year survival were recorded., Results: At baseline, 116 patients (43.8%) reported a CDS score ≤ 68 points and were considered as care dependent. In total, 66 patients (24.9%) died within 2 years. The Cox regression model showed that a higher CDS score (lower level of care dependency) was associated with a lower probability of dying within 2 years (hazard ratio, 0.95; 95% CI: 0.90-0.97), whereas older age was associated with a greater probability of dying within 2 years (hazard ratio, 1.06; 95% CI, 1.03-1.09)., Conclusion: The level of care dependency independently predicts 2-year survival among clinically stable outpatients with advanced chronic organ failure. Therefore, regular assessment of the level of care dependency should be included in clinical care for patients with advanced chronic organ failure., (Copyright © 2013. Published by Elsevier Inc.)
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- 2013
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22. Insight into advance care planning for patients on dialysis.
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Janssen DJ, Spruit MA, Schols JM, van der Sande FM, Frenken LA, and Wouters EF
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- Aged, Aged, 80 and over, Communication, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Patient Satisfaction, Surveys and Questionnaires, Advance Care Planning, Advance Directives, Dialysis, Physician-Patient Relations, Terminal Care
- Abstract
Context: Advance care planning is not included in regular clinical care for patients on dialysis. Insight into life-sustaining treatment preferences and communication about end-of-life care is necessary to develop interventions to improve advance care planning for patients on dialysis., Objectives: This cross-sectional observational study aimed to understand the preferences for life-sustaining treatments of outpatients on dialysis and to study the quality of patient-physician communication about end-of-life care and barriers and facilitators to this communication., Methods: The following outcomes were assessed in 80 clinically stable dialysis patients: demographics, clinical characteristics, life-sustaining treatment preferences (cardiopulmonary resuscitation and mechanical ventilation, and Willingness to Accept Life-Sustaining Treatment instrument), preference for site of death, quality of communication (Quality of Communication Questionnaire), and barriers and facilitators to communication about end-of-life care (Barriers and Facilitators Questionnaire)., Results: Patients were able to indicate their preferences for life-sustaining treatments and site of death. Preferences for life-sustaining treatments depend on the specific treatment, the expected outcome of treatment, and likelihood of an adverse outcome. Life-sustaining preferences were discussed with the nephrologist by 30.3% of the patients. Quality of the patient-physician communication about end-of-life care was rated poor. This study identified several barriers and facilitators to end-of-life care communication., Conclusion: Patients should receive information about treatment burden, expected outcome, and the likelihood of an adverse outcome when discussing life-sustaining treatments. Quality of patient-physician communication about end-of-life care needs to improve. Barriers and facilitators to communication about end-of-life care provide direction for future interventions to facilitate advance care planning for patients on dialysis., (Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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23. Professional caregivers' mental health problems and burnout in small-scale and traditional long term care settings for elderly people with dementia in the Netherlands and Belgium.
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de Rooij AH, Luijkx KG, Declercq AG, Emmerink PM, and Schols JM
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- Adult, Aged, Aged, 80 and over, Belgium epidemiology, Female, Humans, Male, Mental Health, Middle Aged, Netherlands epidemiology, Surveys and Questionnaires, Young Adult, Burnout, Professional epidemiology, Dementia, Nursing Homes, Nursing Staff psychology
- Abstract
Objectives: The aim of this study was to provide an insight into burnout and mental health problems of professional caregivers working in traditional and small-scale long term care settings for elderly residents with dementia in the Netherlands and Belgium., Design: This study was part of a larger study investigating similarities and differences between traditional and small-scale long term care settings for elderly residents with dementia. In this article, the perspective of the professional caregiver is of central importance. A survey was conducted among professional caregivers of residents with dementia, older than 65 years, at 2 measurement moments (at baseline and after 12 months)., Setting: The questionnaire was administered to professionals working in traditional and small-scale long term care settings in the Netherlands and Belgium., Participants: Professional caregivers (n = 80) working in 5 different care settings completed a questionnaire., Measurements: The questionnaire included items on personal data, mental health problems (GHQ-12), and burnout (UBOS-C, divided into emotional exhaustion, depersonalization, and personal accomplishment). Analyses were conducted using Mixed Models analysis., Results: Although mental health problems and emotional strain increased significantly over time in both types of settings and countries, overall levels of health problems and burnout were low. As regards emotional strain, professional caregivers in small-scale living facilities showed significantly increased levels in comparison with traditional units. Two significant differences between the countries were also found, with less "depersonalization" and more "personal accomplishment" in Dutch settings compared with Belgian settings. No differences emerged for type of setting or over time on "depersonalization" and "personal accomplishment." The analyses were controlled for age, sex, educational level, and work experience in dementia care, but did not yield significant effects., Conclusion: Owing to cutbacks in expenditure, the growing number of people with dementia, and the heavier workload, the working environment will become increasingly challenging. Future research should focus on training professional caregivers working in long term care settings how to maximize the quality of client interaction while keeping burnout and mental health problems to a minimum., (Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
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24. Family caregiving in advanced chronic organ failure.
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Janssen DJ, Spruit MA, Wouters EF, and Schols JM
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- Aged, Aged, 80 and over, Cross-Sectional Studies, Family Relations, Female, Heart Failure diagnosis, Humans, Longitudinal Studies, Male, Middle Aged, Multiple Organ Failure diagnosis, Multiple Organ Failure nursing, Needs Assessment, Netherlands, Pulmonary Disease, Chronic Obstructive diagnosis, Quality of Life, Renal Insufficiency, Chronic diagnosis, Risk Assessment, Self-Help Groups, Severity of Illness Index, Stress, Psychological, Surveys and Questionnaires, Caregivers psychology, Heart Failure nursing, Pulmonary Disease, Chronic Obstructive nursing, Renal Insufficiency, Chronic nursing
- Abstract
Objectives: To assess caregiver burden as well as positive aspects of family caregiving in advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and chronic renal failure (CRF)., Design: Cross-sectional observational study., Setting: Patients recruited at the outpatient clinics of academic and general hospitals in the Netherlands., Participants: Patients with advanced COPD (n = 73), CHF (n = 45), and CRF (n = 41) and their family caregivers., Measurements: Caregiver burden and positive aspects of caregiving were assessed using the Family Appraisal of Caregiving Questionnaire for Palliative Care and were compared among family caregivers of patients with COPD, CHF, or CRF using linear regression analysis while controlling for characteristics of patients and family caregivers., Results: Most family caregivers were female partners of participating patients. Caregiver distress and caregiver strain scores were relatively low, whereas scores for positive caregiving appraisals and family well-being were relatively positive. Caregiver strain, positive caregiving appraisals, and family well-being were comparable for family caregivers of patients with COPD, CHF, or CRF. Caregiver distress was higher for family caregivers of patients with COPD than CHF. The experience of caregiving was influenced by being the patient's spouse, patient's psychological symptoms, and the presence of comorbidities., Conclusions: Family caregiving for patients with COPD, CHF, or CRF should not only be seen as a burden, but also as a positive experience. To support family caregivers, attention should be paid to caregiver burden and the positive aspects of family caregiving., (Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)
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- 2012
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25. Estimating the costs associated with malnutrition in Dutch nursing homes.
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Meijers JM, Halfens RJ, Wilson L, and Schols JM
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- Dietetics standards, Humans, Interviews as Topic, Malnutrition diet therapy, Netherlands epidemiology, Nursing Homes standards, Nutrition Assessment, Nutritional Status, Prevalence, Prospective Studies, Retrospective Studies, Surveys and Questionnaires, Health Care Costs, Malnutrition economics, Malnutrition epidemiology, Nursing Homes economics
- Abstract
Backgrounds & Aims: Malnutrition in western health care involves a tremendous burden of illness. In this study the economic implications of malnutrition in Dutch nursing homes are investigated as part of the Health and Economic Impact of Malnutrition in Europe Study from the European Nutrition for Health Alliance., Methods: A questionnaire was developed, focussing on the additional time and resources spent to execute all relevant nutritional activities in nursing home patients with at risk of malnutrition or malnourished. Results were extrapolated on national level, based on the prevalence rates gathered within the national Prevalence Measurement of Care Problems 2009., Results: The normal nutritional costs are 319 million Euro per year. The total additional costs of managing the problem of malnutrition in Dutch nursing homes involve 279 million Euro per year and are related to extra efforts in nutritional screening, monitoring and treatment. The extra costs for managing nursing home residents at risk of malnutrition are 8000 euro per patient and 10000 euro for malnourished patients., Conclusions: The extra costs related to malnutrition are a considerable burden for the nursing home sector and urge for preventive measures., (Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2012
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26. A multicenter randomized controlled trial to compare subacute 'treatment as usual' with and without mental practice among persons with stroke in Dutch nursing homes.
- Author
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Braun SM, Beurskens AJ, Kleynen M, Oudelaar B, Schols JM, and Wade DT
- Subjects
- Activities of Daily Living, Aged, Aged, 80 and over, Female, Humans, Male, Outcome Assessment, Health Care, Recovery of Function, Nursing Homes, Stroke Rehabilitation
- Abstract
Objective: Systematic reviews suggest that mental practice as an additional therapy for people with stroke might be effective and suggest that more trials with better defined interventions are needed. This study investigated whether imagining the skilled movement systematically can contribute to a quicker and/or better recovery of stroke patients in long term care., Design: A multicenter randomized controlled trial., Setting: Dutch nursing homes., Participants: Stroke patients in the subacute phase of recovery., Interventions: Study participants were randomly assigned to the control or experimental group. Over a 6-week intervention period, both groups received multi professional therapy as usual. Additionally, patients in the experimental group had instruction on mental practice with a 4-step framework embedded in regular therapy time., Main Outcome: Outcomes were assessed at 6 weeks and 6 months with the patient-perceived effect on performance of daily activities (10-point Numeric Rating Scale). Six secondary outcomes on impairment and activity level were also assessed. Primary analyses were performed according to the intention-to-treat principle. Generalized estimating equations (GEE) were used to analyze effects., Results: Thirty-six adult stroke patients (average age 77.8, ± 7.2 years) participated in the trial. No effect in favor of the mental practice intervention on any outcome measure could be detected at either measuring points., Conclusions: This study could not show differences between embedded mental practice and current standard of care. However, stroke pathways in Dutch nursing homes select specific and frail patients, which might have reduced the effects of training., (Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
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27. Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: a systematic review of RCTs.
- Author
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Neyens JC, van Haastregt JC, Dijcks BP, Martens M, van den Heuvel WJ, de Witte LP, and Schols JM
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- Aged, Female, Humans, Male, Program Evaluation, Randomized Controlled Trials as Topic, Safety Management organization & administration, Accidental Falls prevention & control, Residential Facilities, Safety Management methods
- Abstract
Objectives: There is extensive literature on interventions to prevent or reduce falls in elderly people. These findings, however, were based mainly on studies of community-living persons. The primary aim of the present study was to report the effectiveness and implementation aspects of interventions aimed at reducing falls in elderly residents in long-term care facilities: a systematic review of randomized controlled trials (RCTs)., Data Sources: MEDLINE, EMBASE, CINAHL, and hand searching of reference lists of included RCTs., Review Methods: RCTs that assessed fall incidents (falls, fallers, recurrent fallers, fall-related injuries) among elderly residents in long-term care facilities were included in this narrative review. Two independent reviewers abstracted data: general program characteristics (setting, population, intervention program) and outcomes, detailed program characteristics (assessment, intervention content, individually tailored, multidisciplinary), and implementation aspects (feasibility, implications for practice). The CONSORT Statement 2001 Checklist was used regarding the quality of reporting RCTs., Results: Twenty trials met the inclusion criteria. Seven trials, 4 multifactorial and 3 monofactorial, showed a significant reduction in the fall rate, the percentage of recurrent fallers, or both the fall rate and the percentage of persons sustaining femoral fractures. The positive effective programs were as follows: a comprehensive structured individual assessment with specific safety recommendations; a multidisciplinary program including general strategies tailored to the setting and strategies tailored specifically to residents; a multifaceted intervention including education, environmental adaptation, balance, resistance training, and hip protector; calcium plus vitamin D supplementation; vitamin D supplementation; a clinical medication review; and a multifactorial intervention (fall risk evaluation, specific and general interventions)., Conclusions: In general, because of the limited number of included trials, the evidence is inconclusive for multifaceted and single interventions in long-term care facilities. Most of the reviewed studies did not find a significant positive effect on fall incidents. However, our data support the conclusions of Gillespie et al. that multifactorial interventions in long-term care populations seem more likely to be beneficial. However, single interventions (eg, targeting vitamin D insufficiency) can be effective. Furthermore, a careful approach is needed as programs to prevent falls in these settings may be ineffective or even may have adverse effects. This may occur especially when a program is not feasible for the setting in which it is implemented., (Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
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28. Risk factors for aspiration pneumonia in frail older people: a systematic literature review.
- Author
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van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, and de Baat C
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Risk Factors, Pneumonia, Aspiration etiology
- Abstract
Objective: To systematically review the risks for aspiration pneumonia in frail older people and the contribution of bad oral health among the risk factors., Design: Systematic literature review., Setting: PubMed (Medline), Web of Science, Cochrane Library, EMBASE, and CINAHL were searched for eligible studies, published in English in the period January 2000 to April 2009., Participants: Frail older people., Measurements: Only publications with regard to hospitalized, institutionalized, or frail home-dwelling people of 60 years and older were eligible. Two authors independently assessed the publications for their methodological quality. Unadjusted and adjusted odds ratios and their corresponding 95% confidence intervals for respective risk factors related to aspiration pneumonia were extracted. The results were evaluated according to the levels of evidence of the Oxford Centre for Evidence-based Medicine., Results: A total of 21 publications fulfilled the quality criteria. Evidence level 2a (systematic review with homogeneity of cohort studies) was found for a positive relationship between aspiration pneumonia and age, male gender, lung diseases, dysphagia, and diabetes mellitus; 2b (individual cohort study) for severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, and bad oral health; 3a (systematic review with homogeneity of case-control studies) for malnutrition; 3b (individual case-control study) for Parkinson's disease and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health among the risk factors seems limited., Conclusion: Thirteen significant risk factors were identified: age, male gender, lung diseases, dysphagia, diabetes mellitus, severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, bad oral health, malnutrition, Parkinson's disease, and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health seems limited., (Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
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29. The Tilburg Frailty Indicator: psychometric properties.
- Author
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Gobbens RJ, van Assen MA, Luijkx KG, Wijnen-Sponselee MT, and Schols JM
- Subjects
- Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Netherlands, Quality of Life, Surveys and Questionnaires standards, Frail Elderly, Psychometrics
- Abstract
Objectives: To assess the reliability, construct validity, and predictive (concurrent) validity of the Tilburg Frailty Indicator (TFI), a self-report questionnaire for measuring frailty in older persons., Design: Cross-sectional., Setting: Community-based., Participants: Two representative samples of community-dwelling persons aged 75 years and older (n = 245; n = 234)., Measurements: The TFI was validated using the LASA Physical Activity Questionnaire, BMI, Timed Up & Go test, Four test balance scale, Grip strength test, Shortened Fatigue Questionnaire, Mini-Mental State Examination, Center for Epidemiologic Studies Depression Scale, Anxiety subscale of the Hospital Anxiety and Depression Scale, Mastery Scale, Loneliness Scale, and the Social Support List. Adverse outcomes were measured using the Groningen Activity Restriction Scale and questions regarding health care use. Quality of life was measured using the WHOQOL-BREF., Results: The test-retest reliability of the TFI was good: 0.79 for frailty, and from 0.67 to 0.78 for its domains for a 1-year time interval. The 15 single components, and the frailty domains (physical, psychological, social) of the TFI correlated as expected with validated measures, demonstrating both convergent and divergent construct validity of the TFI. The predictive validity of the TFI and its physical domain was good for quality of life and the adverse outcomes disability and receiving personal care, nursing, and informal care., Conclusion: This study demonstrates that the psychometric properties of the TFI are good, when performed in 2 samples of community-dwelling older people. The results regarding the TFI's validity provide strong evidence for an integral definition of frailty consisting of physical, psychological, and social domains., (Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)
- Published
- 2010
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30. Determinants of frailty.
- Author
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Gobbens RJ, van Assen MA, Luijkx KG, Wijnen-Sponselee MT, and Schols JM
- Subjects
- Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Netherlands, Frail Elderly psychology, Frail Elderly statistics & numerical data, Health Status, Surveys and Questionnaires
- Abstract
Objectives: To determine which determinants predict frailty and domains of frailty (physical, psychological, social) in a community-dwelling sample of elderly persons., Design: Cross-sectional., Setting: Community-based., Participants: A representative sample of 484 community-dwelling persons aged 75 years and older., Measurements: The Tilburg Frailty Indicator (TFI), a self-report questionnaire, was used to collect information about determinants of frailty and to assess frailty and domains of frailty (physical, psychological, social)., Results: Results were obtained by regression and mediation analyses. The 10 determinants explain about 35% of the variance of frailty. After controlling for other determinants, medium income, an unhealthy lifestyle, and multimorbidity predicted frailty. The effects of other determinants differed across domains of frailty; age predicted physical frailty, life events predicted psychological frailty, whereas being a woman predicted social frailty because older women have a higher probability of living alone., Conclusion: Our finding that the effect of the determinants of frailty differs across frailty domains suggests that it is essential to divide the concept of frailty into domains., (Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)
- Published
- 2010
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31. In search of an integral conceptual definition of frailty: opinions of experts.
- Author
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Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, and Schols JM
- Subjects
- Aged, Aged, 80 and over, Humans, Review Literature as Topic, Surveys and Questionnaires, United States, Concept Formation, Expert Testimony, Frail Elderly
- Abstract
Introduction: There are many different conceptual definitions of frailty in circulation. Most of these definitions focus mainly on physical problems affecting older people. Only a few also draw attention to other domains of human functioning such as the psychological domain. The authors of this article fear that this could lead to fragmentation of care for frail older people. The aim is to develop an integral conceptual definition of frailty that starts from the premise of a holistic view of the person., Methods: To achieve this, a literature search was carried out. Thereafter a group of experts (N=20) were consulted, both verbally during 2 expert meetings and via a written questionnaire. These experts were asked which existing conceptual definition of frailty places most stress on the integral functioning of older people., Results: The experts expressed a clear preference for one of the conceptual definitions. The result of the literature search and the consultation with the experts led to a new integral conceptual definition of frailty., Conclusion: The conceptual definition is intended to offer a framework for an operational definition of frailty for identifying frail older people., (Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)
- Published
- 2010
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32. Decreasing trends in malnutrition prevalence rates explained by regular audits and feedback.
- Author
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Meijers JM, Candel MJ, Schols JM, van Bokhorst-de van der Schueren MA, and Halfens RJ
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Body Mass Index, Female, Health Maintenance Organizations, Hospitals statistics & numerical data, Humans, Male, Malnutrition classification, Malnutrition prevention & control, Middle Aged, Netherlands epidemiology, Nursing Homes, Prevalence, Surveys and Questionnaires, Weight Loss, Young Adult, Feedback, Malnutrition epidemiology, Medical Audit statistics & numerical data
- Abstract
To our knowledge, no studies have analyzed the influence of annual audit and feedback on the prevalence rates of malnutrition. This study analyzes the trend of malnutrition prevalence rates between 2004 and 2007 and the effects of previous audits and feedback from the annual Dutch National Prevalence Measurement of Care Problems (LPZ) and the effect of the participation in Dutch national improvement programs. From 2004 to 2007, an annual multicenter study was performed in Dutch hospitals, nursing homes, and home care organizations using a standardized questionnaire involving measurements at institutional, ward, and patient levels. The data were analyzed by logistic multilevel analysis. Nutritional status was assessed by BMI, undesired weight loss, and nutritional intake. In total, 80 hospitals, 141 nursing homes, and 48 home care organizations participated. The prevalence of malnutrition tended to decrease in hospitals and home care over the years. In nursing homes, prevalence rates were stable. Furthermore, the more often hospitals and home care organizations participated in the annual LPZ audits, the lower the prevalence rate of malnutrition (P < 0.001). Participation in national improvement programs also resulted in lower prevalence rates (P = 0.027). In conclusion, malnutrition prevalence rates have decreased over the last 4 y in hospitals and home care in The Netherlands. Participation in the LPZ and involvement in national improvement programs positively influenced these malnutrition prevalence rates, possibly indicating that increasing awareness and actively working toward improvement could be important in lowering these rates.
- Published
- 2009
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33. A rational approach to nutritional assessment.
- Author
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Soeters PB, Reijven PL, van Bokhorst-de van der Schueren MA, Schols JM, Halfens RJ, Meijers JM, and van Gemert WG
- Subjects
- Aged, Body Composition, Cognition, Humans, Immunity, Inflammation, Muscle Strength, Reference Standards, Risk Factors, Malnutrition diagnosis, Nutrition Assessment
- Abstract
Background & Aims: Consensus regarding definitions of malnutrition and methods to assess nutritional state is lacking. We propose a definition and its operationalization., Methods: A definition was formulated on the basis of the pathophysiology of malnutrition, while reviewing the metabolic and physiological characteristics of different populations, considered to be malnourished. The definition was operationalized to yield measures to perform nutritional assessment., Results: Malnutrition was defined as "a subacute or chronic state of nutrition in which a combination of varying degrees of over- or undernutrition and inflammatory activity has led to a change in body composition and diminished function". Its operationalization led to four elements that may serve as the basis of nutritional assessment: (1) measurement of nutrient balance, (2) measurement of body composition, (3) measurement of inflammatory activity, and (4) measurement of muscle, immune and cognitive function. Most elements measured should be validated with gold standards; normal values should be obtained in different populations. Values obtained in people considered to be at nutritional risk should be related to outcome., Conclusion: A definition is proposed that reflects the pathophysiology of malnutrition and that, when operationalized, will lead to measures reflecting this pathophysiology. Such an approach may yield comparable and reproducible rates and degrees of malnutrition in populations as well as in individuals.
- Published
- 2008
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34. Day care for demented elderly in a dairy farm setting: positive first impressions.
- Author
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Schols JM and van der Schriek-van Meel C
- Subjects
- Activities of Daily Living, Aged, Attitude of Health Personnel, Attitude to Health, Cross-Sectional Studies, Day Care, Medical psychology, Dementia complications, Dementia psychology, Family psychology, Female, Geriatric Assessment, Health Services Needs and Demand, Humans, Institutionalization, Interpersonal Relations, Long-Term Care organization & administration, Long-Term Care psychology, Male, Mental Disorders etiology, Netherlands, Nursing Homes organization & administration, Program Evaluation, Quality of Life psychology, Research Design, Dairying organization & administration, Day Care, Medical organization & administration, Dementia prevention & control, Frail Elderly psychology
- Abstract
Objective: Long-term care for demented patients in the Netherlands is changing. The focus is now more on quality of life and delaying institutionalization by offering substitutes to the traditional nursing home. In this article, we present a new type of day care, offered on a small dairy farm setting., Design: A small observational study was performed to get a first impression of the effects of care farm day care on demented patients. Also, global comparisons were made between patients attending day care in the farm setting and patients attending regular day care in a nursing home., Results: Demented patients attending day care on the farm showed fewer behavioral problems, used, on average, fewer drugs, including psychotropic drugs, and were more actively involved in normal daily activities. Moreover, family caregivers were more satisfied with this new type of day care., Conclusion: Currently, there is only a scant amount of information to support the therapeutic effects of day care in farm settings. This experience indicates a positive trend of this new form of day care. Well-designed longitudinal follow-up studies are needed to provide more substantial evidence of positive patient outcomes in this new care setting.
- Published
- 2006
- Full Text
- View/download PDF
35. Information exchange between general practitioner and nursing home physician in The Netherlands.
- Author
-
Schols JM and de Veer AJ
- Subjects
- Aged, Aged, 80 and over, Attitude of Health Personnel, Female, Geriatric Assessment, Health Care Surveys, Humans, Long-Term Care, Male, Medical Staff psychology, Netherlands, Partnership Practice, Physicians, Family psychology, Quality of Health Care, Surveys and Questionnaires, Family Practice standards, Homes for the Aged organization & administration, Institutional Practice standards, Interdisciplinary Communication, Nursing Homes organization & administration
- Abstract
Background: In response to the specific characteristics of nursing home residents, the Netherlands has become the only country to develop the specialty of nursing home medicine. The "nursing home physician" has attained independent status. This development has, however, created a division between medical care in the community and medical care in nursing homes, which challenges the quality of the transitional processes taking place when a patient is admitted to or discharged from nursing home care., Objectives: To give insight into the type of medical information exchanged between general practitioners (GPs) and nursing home physicians (NHPs) at the time of admission, while a patient is under care of the NHP, and at the time of discharge., Methods: Questionnaires were sent to a sample of 780 GPs, who were selected using a 2-phase sample strategy. Three hypothetical patient vignettes, involving the admission of a patient to a nursing home, to day care, and to an outreaching nursing home care project, were constructed and presented in the questionnaire. GPs were asked to answer questions about the information exchanged during the care of a patient illustrated in each vignette only if they were really familiar with a patient such as presented. The advantage of hypothetical patient vignettes is that each physician reacts to a standardized situation., Results: In the case of admitting a patient to or discharging a patient from the nursing home, results indicate that the continuity of care at those moments will be better ensured if GPs have more frequent personal contacts with NHPs. In the case of day care patients, the study also reveals that GPs who have frequent personal contact with NHPs will share relevant patient information significantly more often at the start of the day care program, both during day care and also when intercurrent medical problems occur. Similar findings can be expected in patients receiving outreaching nursing home care., Conclusions: The findings indicate the advantages of personal contacts between different medical professionals in exchanging specific patient information. It can be expected that this will lead to more tailor-made medical care for the patient. Adequate exchange of relevant information is an important aspect of mutual collaboration between professionals. Recommendations as to how to achieve more personal contact and a better collaboration among medical professionals are proposed.
- Published
- 2005
- Full Text
- View/download PDF
36. Nursing home and nursing home physician: the Dutch experience.
- Author
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Schols JM, Crebolder HF, and van Weel C
- Subjects
- Aged, Aged, 80 and over, Geriatric Assessment, Health Services for the Aged trends, Homes for the Aged trends, Humans, Institutional Practice, Netherlands, Nursing Homes trends, Patient Care Team trends, Physician-Patient Relations, Quality Assurance, Health Care, Sick Role, Specialization, Health Services for the Aged organization & administration, Homes for the Aged organization & administration, Nursing Homes organization & administration, Patient Care Team organization & administration, Physician's Role
- Abstract
Dutch nursing home care today includes a broad range of institutional and outreaching care functions. Medical care is an essential part of this care. Nursing home medicine in The Netherlands has developed as an officially acknowledged medical specialty. This is unique because The Netherlands is the only country in which nursing home medicine is a specific medical discipline. Because of this, a continuum in the medical care for the elderly has been developed: the family physician for medical care in the community, the nursing home physician for the institutionalized elderly, and the clinical geriatrician plus other medical specialists for elderly who require hospital care. This article describes the characteristics of Dutch nursing home care and nursing home medicine and the advantages of this system. The article also shows that the combination of the medical knowledge of family physician and nursing home physician can be expected to increase the quality of medical care for the disabled elderly in institutions and in the community.
- Published
- 2004
- Full Text
- View/download PDF
37. Heat-related mortality among nursing-home patients.
- Author
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Mackenbach JP, Borst V, and Schols JM
- Subjects
- Activities of Daily Living, Aged, Aged, 80 and over, Female, Humans, Male, Netherlands epidemiology, Hot Temperature, Mortality, Nursing Homes
- Published
- 1997
- Full Text
- View/download PDF
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