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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 order to provide proactive care and support for older people attention is needed for the prevention of frailty among older adults. Subsequently, accurate case finding of those who are more at risk of becoming frail is crucial to undertake specific preventive actions. This study investigates frailty and risk profiles of frailty among older people in order to support proactive detection. Hereby, frailty is conceived not only as a physical problem, but also refers to emotional, social, and environmental hazards. Using data generated from the Belgian Ageing Studies (N = 21,664 home-dwelling older people), a multinomial logistic regression model was tested which included socio-demographic and socio-economic indicators as well as the four dimensions of frailty (physical, social, psychological and environmental). Findings indicate that for both men and women having moved in the previous 10 years and having a lower household income are risk factors of becoming multidimensional frail. However, studying the different frailty domains, several risk profiles arise (e. g. marital status is important for psychological frailty), and gender-specific risk groups are detected (e. g. non-married men). This paper elaborates on practical implications and formulates a number of future research recommendations to tackle frailty in an ageing society.

Institutional dementia care is increasingly directed towards small-scale and homelike care environments, in The Netherlands as well as abroad. In these facilities, a small number of residents, usually six to eight, live together, and normal daily household activities and social participation are emphasized. In a quasi-experimental study, we studied the effects of small-scale, homelike care environments on residents (n = 259), family caregivers (n = 206) and nursing staff (n = 305). We compared two types of institutional nursing care during a 1 year period (baseline assessment and follow-up measurements at 6 and 12 months): (28) small-scale, homelike care environments and (21) psychogeriatric wards in traditional nursing homes. A matching procedure was applied to increase comparability of residents at baseline regarding functional status and cognition. This study was unable to demonstrate convincing overall effects of small-scale, homelike care facilities. On our primary outcome measures, such as quality of life and behaviour of residents and job satisfaction and motivation of nursing staff, no differences were found with traditional nursing homes. We conclude that small-scale, homelike care environments are not necessarily a better care environment than regular nursing homes and other types of living arrangements should be considered carefully. This provides opportunities for residents and their family caregivers to make a choice which care facility suits their wishes and beliefs best.

Concerns about falls and related avoidance behavior are common among older people and may lead to decreased quality of life, decreased physical and psychosocial functioning, and premature admission to a nursing home. In a randomized controlled trial among 540 community-dwelling older people we studied the feasibility and effects of a cognitive behavioral program on concerns about falls, related avoidance of activity, and falls. Data of the process evaluation obtained from participants in the intervention group (n = 280) and the trainers (n = 6) showed that the program was considered as feasible by the trainers, and positively judged by participants and trainers. Furthermore, participants experienced benefits from attending the program (61% still reported benefits one year after the program). Prior to the start of the program 26% of the participants of the intervention dropped out, yet, among the participants who started the program completion was high (84%). The effect evaluation showed positive outcomes for concerns about falls, related avoidance of activity, and daily activity at 2 months (after the program) when comparing the intervention group with the control group (n = 260). Long-term effects were also shown for, amongst others, concerns about falls and recurrent falls. Following these positive results the cognitive behavioral group program is currently made available to geriatric care settings nationwide in the Netherlands.

The Screening Inventory of Psychosocial Problems (SIPP) was developed to assess psychosocial distress in Dutch cancer patients. It is short, easily completed by patients and quickly interpreted by medical staff. In this study, we investigated the psychometric properties of the SIPP in 289 Dutch cancer patients treated with radiotherapy. The SIPP was administered alongside the Hospital Anxiety and Depression Scale and the Mental Adjustment to Cancer scale. In-depth structured clinical interviews were also conducted with 76 patients. Results indicate that the psychometric properties of the SIPP are promising with respect to its reliability, construct validity as evaluated with confirmatory factor analysis, and convergent and divergent validity. Receiver operating characteristics analysis showed that the SIPP successfully differentiates between patients known to have symptoms of distress and those who do not. The SIPP is therefore a reliable and valid instrument for identifying distress in cancer patients. It differs from previously developed instruments in that it measures different domains of distress in only a few minutes, and provides opportunity for patients to indicate whether they would like to discuss identified problem areas. Due to its convenient format, the SIPP may easily be used to assess psychosocial distress in cancer patients as a routine part of the clinical consultation.

Fear of falling is common in older persons. Different methods have been developed to assess fear of falling. The most well-know measure is the 10-item Falls Efficacy Scale (FES). However, the FES items (a) focus on low functioning older persons and particularly on in-home activities, (b) do not comprise social activities, and (c) were developed from a US perspective so that translation in European languages is hampered. To solve these issues, the 16-item Falls Efficacy Scale-International (FES-I) was recently developed within the Prevention of Falls Network Europe (ProFaNE). In this article, the Dutch version of the FES-I is presented and the psychometric properties in 213 Dutch persons aged 70 years of age and over are described. The FES-I showed to be unidimensional and internally consistent; the Cronbach alpha coefficient was 0.96. The 4 week test-retest intra-class correlation coefficient was 0.82. The associations of the FES-I sumscores with age, gender, falls history and overall fear of falling was as expected, indicating construct validity. In addition, the FES-I discriminated in the same extent as the original 10-item FES scale. We conclude that the FES-I showed acceptable reliability and construct validity and may be useful in cross-national research. Future studies should focus on the sensitivity to change of FES-I.

The Telephone Interview Cognitive Status (TICS) is an instrument to screen for dementia in older persons by telephone. Although the psychometric properties of the TICS have been studied in various countries, the quality of the Dutch version of the TICS was yet unknown. This paper presents the Dutch version of the TICS and reports on its reliability and validity among 51 patients of Maastricht University Hospital, The Netherlands. The Pearson and intra-class correlations for test-retest reliability were 0.93 and 0.92, respectively. The Pearson and intra-class correlations for inter-rater reliability were 0.91 and 0.90, respectively. Sensitivity and specificity were studied in relation to the Mini Mental State Examination (MMSE, cut-off point 23/ 24) and the diagnosis of dementia as assessed according to DSM-IV criteria. When using the TICS cut-off point of 26/27, the coefficients for sensitivity and specificity were at least 0.80. The percentages ROC under the curve were 90% and 93% with the MMSE and the diagnosis dementia as criterion, respectively. We conclude that the Dutch version of the TICS is an acceptable instrument for screening for dementia in older persons, particularly when face-to-face contact is not possible.

Gender-specific changes in Quality of Life (QoL) following cardiovascular disease (CVD) were studied in 208 patients to determine whether gender-related differences in postmorbid QoL result from differences in disease severity, premorbid QoL, or different CVD-related recovery. Premorbid data were available from a community-based survey. Follow-ups were done at 6 weeks, 6 months, and 12 months after diagnosis. Results showed that females had worse QoL at all three postmorbid assessments compared to males. However, multivariate analyses adjusting for premorbid gender differences and disease severity showed no significant gender-related differences for physical and psychologic functioning. Therefore, gender differences in QoL following CVD mainly result from premorbid differences in QoL, age, comorbidity, and disease severity at the time of diagnosis, and do not appear to be the consequence of gender-specific recovery. However, in clinical practice it is important to acknowledge the poorer QoL of females following CVD.