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Researchers propose that the convoy of care model should be used to study care networks of frail, older individuals. Care convoys are defined as the evolving collection of individuals who may or may not have close personal connections to the recipient or to one another, but who provide care, including help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), socio-emotional care, skilled health care, monitoring, and advocacy. This study reports on community-dwelling older adults' experiences of their care convoy, how care convoys change over time, and perceived (positive) outcomes. A qualitative analysis among 65 semi-structured interviews with frail, community-dwelling older adults demonstrates a great variety in the composition of care convoys. Participants were often actively involved in their care convoy and valued the social/relational aspect of care. Care and support covered a wide range of activities, with some activities being provided by specific types of caregivers. Participants expressed the adequacy of their care convoy in terms of satisfaction and sufficiency. Noteworthy, participants who were satisfied with their care convoy did not necessarily receive sufficient help. Policies and practice should recognize the relational aspect of care, the complex interplay between all actors, and the dynamic character of care convoys. ispartof: QUALITATIVE HEALTH RESEARCH vol:30 issue:4 pages:583-597 ispartof: location:United States status: published

In het verlenen van goede zorg en ondersteuning voor ouderen is aandacht nodig voor de preventie van kwetsbaarheid bij ouderen. Een gerichte casefinding van (mogelijk) kwetsbare ouderen is hierbij essentieel om correcte preventieve maatregelen te nemen. Dit onderzoek heeft als doel om risicoprofielen en risicofactoren van kwetsbaarheid bij ouderen in kaart te brengen om zo vroegtijdige detectie mogelijk te maken. Kwetsbaarheid wordt hierbij niet enkel gezien als een fysiek probleem, maar omvat ook psychische, sociale en omgevingscomponenten. Multinomiale logistische regressie analyses op data van de Belgian Ageing Studies (N = 21.664 thuiswonende ouderen) onderzoeken de relatie van socio-demografische en socio-economische factoren op de vier domeinen van kwetsbaarheid (i. e. fysieke, psychische, sociale en omgevingskwetsbaarheid) en totale kwetsbaarheid. De resultaten tonen dat zowel mannen als vrouwen die verhuisd zijn in de afgelopen 10 jaar of een lager inkomen hebben, een groter risico hebben om kwetsbaar te zijn. Voor elk domein afzonderlijk zijn er specifieke risicofactoren gevonden (zoals burgerlijke staat bij psychische kwetsbaarheid). Daarnaast zijn er verschillen tussen risicoprofielen bij mannen en vrouwen. Zo vormt bij mannen het land van herkomst een risicofactor voor kwetsbaarheid, terwijl dit bij vrouwen niet het geval is. Op basis van de resultaten worden praktische aanbevelingen alsook toekomstige onderzoekspistes uitgewerkt voor de detectie en preventie van kwetsbaarheid bij ouderen.

The Belgian Ageing Studies was developed as a participatory project involving older people to assess the age-friendliness of their community and to develop a local policy plan based on the findings of the assessment. This contribution will look back at 14 years of the Belgian Ageing Studies, and reflect on the realizations, strengths and limitations of this research-policy program. An online-survey was sent out to all communities who participated throughout the years. Results will highlight both the strengths (e.g. research for and by older people; broadened view of policy domains important for older people, establishment of a sustainable peer-research program rather than a one-time project) and limitations (e.g. difficulties in translating research results into policy action plans, difficulties in reaching migrant groups) from the research project. The paper concludes by discussing key recommendations for Belgian Ageing Studies 2.0 in order to tackle exclusion of older people in public policy.

Frailty in later life is mostly associated with health decline and a greater risk in adverse events. Despite their situation, these frail older adults often manage to age in place and often play an active role in their family or community. This paper focuses on the experience of frail older adults’ meaning in life and their connectedness with their social environment. 121 semi-structured qualitative interviews of older adults in Belgium were analysed. 101 Respondents (aged 60 and over) were mildly or severely frail in the physical, social, psychological or environmental domain. Findings indicate that, even severely frail older adults, experience a positive meaning in life. Key-dimensions of meaning in life were self- and moral worth, competence, purpose, connectedness, excitement and sense of coherence. The discussion highlights the various interpretations of the outcomes, while taking different frailty types and the social environment into account.

This paper presents results of the Belgian-Dutch Detection-Support and Care for Older people: Prevention and Empowerment (D-SCOPE) project. The aim of the project is to detect frail community-dwelling older adults who previously went unnoticed and to increase their wellbeing through tailored made interventions. This particular study uses the data of the first wave of a longitudinal study and investigates whether social neighbourhood aspects (i.e. social cohesion, low-key participation and feelings of safety) or physical neighbourhood aspects (i.e. presence of basic services, traffic, walkability) moderate the relationship between frailty and dimensions of wellbeing (i.e. life satisfaction, meaning in life, mastery) for frail older adults. The Comprehensive Frailty Assessment Instrument (CFAI-plus) was used for the assessment of multidimensional frailty in a stratified sample based on risk profiles for frailty (n= 872). Overall, results indicate a difference of moderating effects between the different dimensions of frailty. For the social environment, interaction effects were found between social cohesion and mastery. For the physical environment, most interaction effects were found for basic services in the neighbourhood and outcomes life satisfaction, meaning in life and mastery. This paper contributes to the larger D-SCOPE study and shows that both physical and social aspects of the living environment of older adults are balancing factors for frailty in later life and are important elements to age well in place.

In 2013 the Flemish Government launched a call for innovative projects named ‘Care Living Labs’ to tackle future care challenges such as the rising demand for care, staff shortages and budgetary restrictions. The main objective of these care living labs was to create new care concepts, processes and products and to test them in daily practice. For this paper, the living lab of ‘Active Caring Community’ will be discussed with a specific focus on the ‘OPA-project’. OPA is a Dutch abbreviation for ‘Ouderen wonen PAssend’ which can be translated as ‘appropriate housing for older adults’. The OPA-project wants to examine the housing adequacy of older people’s dwellings in the neighbourhood by including older volunteers in the housing-screening process.

Despite numerous researches concerning frailty in older people, frailty is often approached in relation to negative outcomes (mortality, institutionalization, co-morbidity, etc.) and do not consider positive outcomes such as quality of life and autonomy. Furthermore research often provides evidence of the effects of informal care on the wellbeing of informal caregivers and not of the older care recipient. Consequently, this paper aims to explore the quality of life and autonomy of older people, and how informal care contribute to this. Therefore, we analyze semi-structured, qualitative interviews among community-dwelling older people from Belgium (N = 121) from the D-SCOPE study, an international research project that focuses on prevention and detection of frailty in older people. Results indicate that older people receive informal care from different types of informal caregivers (partner, daughter, neighbor, etc.), which provides support within different domains of frailty. Although informal care can improve the quality of life of older people in several ways, older people often experience losses in their autonomy resulting in a decrease in quality of life. Older care recipients furthermore acknowledge that informal caregivers can also be frail. Conclusively, this study provides evidence that informal care counteracts the feeling of frailty in older people, and enforces their quality of life. However, informal caregivers need to be supported, as frailty not only occurs in older care recipients but also in informal caregivers.

Timely detection of frailty and preventive home interventions can allow older people to age well at home. Research indicates that preventive home visits can have a preventive effect on frailty for a well-defined population. The current paper will test the effectiveness and experiences with a consecutive model of preventive home visits: step 1 visit by volunteers, step 2: visit by professionals. Quantitative and qualitative data are collected during preventive home visits performed among 450 community-dwelling older adults living in three cities in Flanders, varying in urbanisation rate (Tienen, Gent and Knokke-Heist). Results point towards the possibilities and constraints of performing preventive home visits by volunteers and develop guidelines and profiles. Second, findings demonstrate the effectiveness of the preventive home visits in terms of “detected cases who are frail but lacked care and support”. Finally, preventive home visits can guide to the most appropriate interventions, taking into account the clients’ preferences.

PurposeAssessing the validity of the Comprehensive Frailty Assessment Instrument (CFAI) in comparison with the Tilburg Frailty Indicator (TFI).BackgroundWhen ageing, most individuals prefer to age in place even if they are frail. Detecting frail older persons in the community becomes a challenge for professionals and policymakers. Most international frailty instruments emphasize physical factors. The CFAI was developed from a multidimensional perspective, measuring a physical, a psychological, a social and an environmental domain and showed good validity and reliability. The novelty of the CFAI is the environmental domain, which is important because older people will highly depend on their environment when ageing in place. In this study, the CFAI is validated against the TFI.DesignScale validation study.MethodsOne hundred and seventy-eight respondents aged 60 and over participated in this study. Internal consistency and explained variance of the CFAI and the subscales was assessed. Next, the correlation between the two scales was evaluated. Convergent and divergent validity between the subscales of the CFAI and TFI was assessed.ResultsThe internal consistency of the CFAI was 0.759. The correlation between the CFAI and TFI was 0.590. Correlations between the physical, psychological and social domains of both scales was good and the environmental domain showed weak correlations with all other domains, pointing to convergent and divergent validity.ConclusionThe CFAI is found to be valid in comparison with the TFI and can be used by health care professionals for the detection of frail older people living in the community.Keywords: Community care, Elderly, Frail elderly, Validation studies