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Nightshift workers go against the natural sleep–wake rhythm. Light can shift the circadian clock but can also induce acute alertness. This placebo-controlled exploratory field study examined the effectiveness of light glasses to improve alertness while reducing the sleep complaints of hospital nurses working nightshifts. In a crossover within-subjects design, 23 nurses participated, using treatment glasses and placebo glasses. Sleepiness and sleep parameters were measured. A linear mixed model analysis on sleepiness revealed no significant main effect of the light intervention. An interaction effect was found indicating that under the placebo condition, sleepiness was significantly higher on the first nightshift than on the last night, while under the treatment condition, sleepiness remained stable across nightshift sessions. Sleepiness during the commute home also showed a significant interaction effect, demonstrating that after the first nightshift, driver sleepiness was higher for placebo than for treatment. Subjective sleep quality showed a negative main effect of treatment vs. placebo, particularly after the first nightshift. In retrospect, both types of light glasses were self-rated as effective. The use of light glasses during the nightshift may help to reduce driver sleepiness during the commute home, which is relevant, as all participants drove home by car or (motor) bike.

This paper reports on the research methods used in five different projects aimed at supporting people living with dementia in their everyday lives and activities of daily living. In all five projects, people living with dementia and their informal carers were involved. Applied methods ranged from passive involvement in the form of observations to very active involvement consisting of consultation rounds and think-aloud sessions. The projects highlighted that people living with dementia can still contribute to the development of solutions that support them in the self-management of their symptoms and challenges, as well as technological solutions that support them in daily living. LinkedIn: https://www.linkedin.com/in/jvhoof1980/

Background: The diffusion of telehealth into hospital care is still low, partially because of a lack of telehealth competence among nurses. In an earlier study, we reported on the knowledge, skills, and attitudes (KSAs) nurses require for the use of telehealth. The current study describes hospital nurses' confidence in possessing these telehealth KSAs. Method: In a cross-sectional study, we invited 3,543 nurses from three hospitals in the Netherlands to rate their self-confidence in 31 telehealth KSAs on a 5-point Likert scale, using an online questionnaire. Results: A total of 1,017 nurses responded to the survey. Nine KSAs were scored with a median value of 4.0, 19 KSAs with a median value of 3.0, and three KSAs with a median value of 2.0. Conclusion: Given that hospital nurses have self-confidence in only nine of the 31 essential telehealth KSAs, continuing education in additional KSAs is recommended to support nurses in gaining confidence in using telehealth. [ J Contin Educ Nurs. 2019;50(1):26–34.]

The common ocular pathologies relating to the aging eye, such as cataract, diabetic retinopathy, glaucoma, or macular degeneration, are all known to reduce visual functioning. Less wellknown is the effect of common, age-related dry eye disease (DED). The impact of DED on daily activities can be intense, especially with reduced visual functioning, for example, an inability to watch television, or read from a tablet or smartphone screen. As a result of reduced visual functioning, DED is particularly problematic for ageing office-workers. Moreover, office work involving computer-use is known to adversely affect the tear film. Consequently, with the extension in retirement age in the working population, an increase in the incidence and extent of (dry) eye-related problems can be expected. This literature paper addresses the impact of age-related DED on visual functioning, the complexity of assessing visual functioning in daily activities at home or at work, the development of dry eye symptoms with increasing age, and the relationship of these issues with environmental factors. Special attention is made to the influence of light and light conditions that can positively and negatively influence visual functioning.

This work examined window/door opening as means of bedroom ventilation and the consequent effect upon occupants’ sleep, using data from 17 healthy volunteers. Bedroom CO 2 level, temperature, and relative humidity were measured over 5 days, for two cases: open window or door (internal, bedroom door), and closed window and door. Participant filled questionnaires and sleep diary provided subjective measure of sleep quality. Actigraphy objectively monitored the participants during sleep. Additionally, a FlexSensor, placed under pillows of participants, detected movement during sleep. Average CO 2 level for the Open conditions was 717 ppm (SD = 197 ppm) and for Closed conditions was 1150 ppm (SD = 463 ppm). Absolute humidity levels were similar for both conditions, while Open conditions were slightly cooler (mean = 19.7°C, SD = 1.8°C) than Closed (mean = 20.1°C, SD = 1.5°C). Results showed significant correlations (P

PurposeThe International Commission on Illumination (CIE) recommends researchers to investigate a wide variety of behavioural and health outcomes. However, researchers often investigate only a part of occupational health (OH) in relation to light. A literature study (2002–2017) regarding the relationship between office lighting conditions and OH was performed to identify gaps and methodological issues.MethodThe OH outcomes investigated in this paper were grouped according to the International Classification of Diseases and analysed per category: physical and physiological health, mental health, eye health, sleep parameters and visual comfort.ResultsFindings from the literature study (20 eligible papers) showed that all OH aspects were mostly but not exclusively measured subjectively. Furthermore, most studies investigated only a fraction of office lighting parameters and OH aspects.ConclusionsIt seems that Correlated Colour Temperature (CCT) and illuminance mainly correlate with OH. However, this may also be explained by gaps and methodological issues in studies described in eligible papers. Based on the literature study, an overview was composed elucidating gaps and methodological issues of office lighting and OH studies. It can be used to design and target the purpose of light and health research.

Physical inactivity in patients with chronic obstructive pulmonary disease (COPD) is associated with poor health status and increased disease burden. The present study aims to test the efficacy of a previously developed mobile (m)Health intervention to improve or maintain physical activity in patients with COPD after pulmonary rehabilitation.A randomised controlled trial was performed in 32 physiotherapy practices in the Netherlands. COPD patients were randomised into intervention or usual care groups. The intervention consisted of a smartphone application for the patients and a monitoring website for the physiotherapists. Measurements were performed at 0, 3, 6 and 12 months. Physical activity, functional exercise capacity, lung function, health-related quality of life and body mass index were assessed.157 patients started the study and 121 completed it. There were no significant positive effects of the intervention on physical activity (at 0 months: intervention 5824±3418 steps per weekday, usual care 5717±2870 steps per weekday; at 12 months: intervention 4819±2526 steps per weekday, usual care 4950±2634 steps per weekday; p=0.811) or on the secondary end-points. There was a significant decrease over time in physical activity (pAlthough functional exercise capacity did not deteriorate, our mHealth intervention did not improve or maintain physical activity in patients with COPD after a period of pulmonary rehabilitation.

In the Netherlands, over 40% of nursing home residents are estimated to have visual impairments. This results in the loss of basic visual abilities. The nursing home environment fits more or less to residents’ activities and social participation. This is referred to as environmental fit. To raise professional awareness of environmental fit, an Environmental Observation tool for the Visually Impaired was developed. This tool targets aspects of the nursing home environment such as ‘light’, the use of ‘colours and contrasts’ and ‘furnishing and obstacles’. Objective of this study is to validate the content of the observation tool to have a tool applicable for practice. Based on the content validity approach, we invited a total of eight experts, six eye care professionals and two building engineering researchers, to judge the relevance of the items. The Item Content Validity approach was applied to determine items to retain and reject. The content validity approach led to a decrease in the number of items from 63 to 52. The definitive tool of 52 items contains 21 for Corridors , 17 for the Common Room , and 14 for the Bathroom . All items of the definite tool received an Item-Content Validity Index of ≥ 0.88 and a Scale-Content Validity Index of ≥ 0.71. The content validity index of the scale and per item has been applied, resulting in a tool that can be applied in nursing homes. The tool might be a starting point of a discussion among professional caregivers on environmental interventions for visually impaired older adults in nursing homes.

Summary Background Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education. Method In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%. Results Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth. Discussion/Conclusion Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding telehealth education in their curriculum.

Currently, 4% of older adults reside in long-term care facilities in the Netherlands. Nursing home residents tend to have multimorbidity that is associated with considerable disabilities and a high level of care dependency. In the Dutch adult population the highest estimated prevalence (>40%) of visual impairment (low vision and blindness) was found in the subgroup of residents in nursing homes (NHs). The aim of this study is to describe the current practice of eye care by Dutch nursing home physicians (NHPs).A digital online survey was developed to describe the eye care activities of nursing home physicians and their cooperation in this perspective with other professionals.Of 1573 NHPs present in the Netherlands, 125 (8%) responded.Results show that more than 50% of the NHPs regularly examine ‘distant vision’, ‘near vision’ and ‘the visual field’. However, 23%, 33% and 45% almost never or never examine the ‘visual field’, ‘near vision’ and ‘distant vision’, respectively. Data regarding eye care, regularly recorded in the client files by more than 50% of the NHPs, are medical data involving ‘use of eye medication’, ‘eye disease’, and ‘eye surgery in the past’. Less commonly recorded is ‘the use of reading glasses’ as well as ‘eye pain’.Inside of the NH, (head) nurses and ward nurses (chi2 = 309, df = 5, p = 0.000), and outside of the NH, ophthalmologists and low vision specialists are most frequently contacted about eye related issues (chi2 = 224, df = 4, p = 0.000). Opticians are rarely contacted, and optometrists and orthoptists are ‘never’ contacted by more than 50% of the NHPs. Moreover, 50% of the NHPs noted that collaboration with external eye care professionals is ‘not structural’.This study shows that, according to NHPs, relevant visual aspects are not structurally examined and recorded in the client files. Outside of the NH, NHPs tend to have a less frequent collaborative relationship with optometrists, orthoptists and opticians compared to ophthalmologists and low vision specialists. The NHP’s role in providing eye care can be improved by development of guidelines for structural eye screening, improvement of recording in client files, and exploring plus undertaking collaboration with other eye care professionals.

The purpose of the project was to increase the daily activities and exercises of single-living older people with one or more limitations in functioning after a period of rehabilitation.

The widespread use of telehealth, providing healthcare remotely, is hampered by various barriers. Dutch nurses currently working in practice never received education in this new way of healthcare delivery. Education is frequently suggested as a strategy to overcome barriers in telehealth use. However, the nature and effectiveness of such education has not yet been specified and tested in practice. In a previous study, we identified 14 nursing telehealth activities and accompanying competencies. In the current study, we established the effectiveness of training in these competencies on nurses' subjective knowledge, self-efficacy and usage of telehealth. A two-day tailored training program in nursing telehealth activities was evaluated in a Dutch context among 37 participants across three settings: (a) twelve primary care (PC), (b) fourteen homecare (HC) and (c) eleven hospital (H) nurses. In each team, telehealth knowledge significantly increased during the training sessions. In each team, nurses' telehealth self-efficacy also significantly increased 6–10 weeks after the training. After the training, the number of remote consultations increased from 2 to 12 in primary care, 12 to 35 in homecare and decreased from 28 to 17 in the hospital setting. We conclude that training nurses in telehealth activities contributes to their knowledge and self-efficacy.

Background: If eHealth interventions are not used (properly), their potential benefits cannot be fulfilled. User perceptions of eHealth are an important determinant of its successful implementation. This study examined how patients with chronic obstructive pulmonary disease (COPD) and their physiotherapists (PHTs) value an eHealth self-management intervention following a period of use.Objective: The study aimed to evaluate the perceptions of COPD patients and their PHTs as eHealth users.Methods: In this study, an eHealth self-management intervention (website and mobile phone app) aimed at stimulating physical activity (PA) in COPD patients was evaluated by its users (patients and PHTs). As participants in a randomized controlled trial (RCT), they were asked how they valued the eHealth intervention after 6 months’ use. Interview requests were made to 33 PHTs from 26 participating practices, and a questionnaire was sent to 76 patients. The questionnaire was analyzed in Excel (Microsoft). The interviews with the PHTs and text messages (short message service, SMS) sent between patients and PHTs were transcribed and independently coded in MAXQDA 10 for Windows (VERBI GmbH).Results: A total of 60 patients with COPD filled out the questionnaire, and 24 PHTs were interviewed. The mobile phone app was used 89.0% (160.2/180 days) (standard deviation [SD] 18.5) of the time by patients; 53% (13/24) of PHTs reported low or no use. Patients scored the ease of use of the app 5.09 (SD 1.14) (on a 7-point scale). They found the presentation of the PA information in the app to be clear, insightful, and stimulating. All PHTs judged the website as explicit and user-friendly but had trouble devising a new PA goal for their patients. Patients mostly sent informative, neutral messages concerning the PA goal, and PHTs sent mostly motivating, positive messages concerning the PA goal. Messages were not perceived as supportive in reaching the PA goal according to the patients. Perceived usefulness of the intervention for the PHTs was the objective measurement of PA, the ability to see PA patterns over time, and the ability to use the intervention as a tool to give their patients insight into their PA. For patients, it was that the intervention supported them in increasing their PA and that it made them feel fitter. Barriers to use of the intervention according to the PHTs were time constraints and financial reasons. Seventy-nine percent (19/24) of the PHTs and 58% (35/60) of the patients mentioned they would be interested in using the intervention in the future.Conclusions: PHTs and COPD patients had positive feelings regarding the functionality and potential of the eHealth self-management intervention. This paper addresses a number of topics that may aid in the successful development and implementation of these types of eHealth interventions in the future.

BACKGROUND: At present, persons with dementia and their family caregivers in the Netherlands are not adequately supported to modify their dwellings to match their personal needs. OBJECTIVE: To facilitate aging-in-place for persons with dementia, a website was designed. METHODS: The website was designed with persons with dementia and their spouses. In consultation sessions existing websites were discussed. Based on this discussion, a demonstration website was created and then discussed with and judged by the participants. Visits to the website were monitored using Google Analytics. RESULTS: Participants prefer a website that is easy to print. In addition, the navigation menu should have a maximum of three levels, and the website menu should be positioned on the left. Participants dislike the use of meaningless photographs because these do not add any value to the information given. CONCLUSIONS: Participants prefer a website that is as accessible as reading a book. Some differences are related to culture, such as the participants dislike for the use of English terms. Therefore, preferences or dislikes of items on a website could not be generalized as such. However, the preferences and dislikes may provide useful input for the design process of an appropriate website.

Information and communications technology (ICT) has the potential to contribute to the quality of life of older adults. The aim of this study was to analyze the use of a broad array of ICT devices and services among Dutch older adults and to determine whether demographics and health outcomes are associated with this use. A questionnaire was dispensed among a group of Dutch older adults (≥65 years). A univariate analysis of covariance was used to analyse results. Two hundred ninety-one subjects filled out the questionnaire. Reported use of newer technologies was lower compared with older technologies. Increased age (p = 0.048, Confidence Interval [CI]: -0.73: -0.004), lower degree of education (p = 0.008, CI: -59.64: -5.59), birthplace outside of Europe (p = 0.024, CI: -21.99: -0.73), lower income (p = 0.005, CI: -46.44:25.38), less arthrosis of the hands (p = 0.042, CI: -1.38:21.11), and a lower physical functioning (p = 0.008, CI: 1.43:9.41) resulted in a lower ICT use score with an adjusted R2 of 0.311. Older adults are slower to adapt to newer technologies. It appears it is not the degree of physical restrictions, but rather the degree of adaptability to these restrictions that influence the use of ICT. ispartof: Assistive Technology vol:29 issue:4 pages:188-196 ispartof: location:United States status: published

Background: Patients with chronic obstructive pulmonary disease (COPD) demonstrate reduced levels of daily physical activity (DPA) compared to healthy controls. This results in a higher risk of hospital admission and shorter survival. Performing regular DPA reduces these risks.Objective: To develop an eHealth intervention that will support patients with COPD to improve or maintain their DPA after pulmonary rehabilitation.Methods: The design process consisted of literature research and the iterative developing and piloting phases of the Medical Research Council (MRC) model for complex clinical interventions and the involvement of end users. Participants were healthy adults and persons with COPD.Results: The mobile phone interface met all the set requirements. Participants found that the app was stimulating and that reaching their DPA goals was rewarding. The mean (SD) scores on a 7-point scale for usability, ease of use, ease of learning, and contentment were 3.8 (1.8), 5.1 (1.1), 6.0 (1.6), and 4.8 (1.3), respectively. The mean (SD) correlation between the mobile phone and a validated accelerometer was 0.88 (0.12) in the final test. The idea of providing their health care professional with their DPA data caused no privacy issues in the participants. Battery life lasted for an entire day with the final version, and readability and comprehensibility of text and colors were favorable.Conclusions: By employing a user-centered design approach, a mobile phone was found to be an adequate and feasible interface for an eHealth intervention. The mobile phone and app are easy to learn and use by patients with COPD. In the final test, the accuracy of the DPA measurement was good. The final version of the eHealth intervention is presently being tested by our group for efficacy in a randomized controlled trial in COPD patients.

Aim and objectives. To improve (eye)care in nursing homes by reporting and assessing visual functioning to enhance professional caregivers' awareness of visual problems. Background. Older adults experience visual problems owing to biological ageing or eye disease. In the Netherlands, the prevalence of visual impairments is the highest in the subgroup of nursing home residents (41·3%). These impairments influence quality of life in terms of limiting daily activities and participation in social activities. Furthermore, 63% of visual problems are defined as 'avoidable blindness'. For this reason, screening of visual functioning in the nursing home is of major importance. Moreover, visual functioning should also be taken into account to prevent the incidence of falls. Design. A field study on recorded information of visual functioning and visual assessment in nursing homes. Methods. Assessment of visual functioning of 259 residents in nursing homes. Subsequently, recorded information in client files is related to the assessment outcome. Results. Only in 101 (39%) of the 259 client records was some information on visual functioning found in client files. Whether a prescription for new glasses was dispensed made no difference in reporting on visual functioning in the client record. In more than half of the cases assessed as 'low vision or blindness', no information about visual functioning was found. Furthermore, no information was found in 31% (80/259) cases of suspected visual problems (referrals). A significant proportion of client records (p Language: en

Over 40% of nursing home residents in the Netherlands are estimated to have visual impairments. In this study, light conditions in Dutch nursing homes were assessed in terms of horizontal and vertical illuminances and colour temperature. Results showed that in the seven nursing homes vertical illuminances in common rooms fell significantly below the 750 lx reference value in at least 65% of the measurements. Horizontal illuminance measurements in common rooms showed a similar pattern. At least 55% of the measurements were below the 750 lx threshold. The number of measurements at the window zone was significantly higher than the threshold level of 750 lx. Illuminances in the corridors fell significantly below the 200 lx threshold in at least three quarters of the measurements in six of the seven nursing homes. The colour temperature of light fell significantly below the reference value for daylight of 5000 K with median scores of 3400 to 4500 K. A significant difference in colour temperature was found between recently constructed nursing homes and some older homes. Lighting conditions of the examined nursing homes were poor. With these data, nursing home staff have the means to improve the lighting conditions, for instance, by encouraging residents to be seated next to a window when performing a task or during meals.

People with dementia may have an altered sensitivity to indoor environmental conditions compared to other older adults and younger counterparts. This paper, based on literature review and qualitative research, provides an overview of needs regarding thermal comfort and the design and implementation of heating, ventilation and air conditioning systems for people with dementia and other relevant stakeholders through the combined use of the International Classification of Functioning, Disability and Health, and the Model of Integrated Building Design. In principle, older adults do not perceive thermal comfort differently from younger adults. Due to the pathology of people with dementia, as well as their altered thermoregulation, the perception of the thermal environment might be changed. Many people with dementia express their discomfort through certain behaviour that is considered a problem for both family and professional carers. Ethical concerns are raised as well in terms of who is in charge over the thermal conditions, and the protection against temperature extremes in hot summers or cold winters. When implementing heating, ventilation and air conditioning systems one should consider aspects like user–technology interaction, diverging needs and preferences within group settings, safety issues, and minimising negative behavioural reactions and draught due to suboptimal positioning of outlets. At the same time, technology puts demands on installers who need to learn how to work with customers with dementia and their family carers.

In Western societies, the vast majority of people with dementia live at home and wish to remain doing so for as long as possible. Aging in place can be facilitated through a variety of environmental interventions, including home modifications. This article provides an overview of existing design principles and design goals, and environmental interventions implemented at home, based on literature study and additional focus group sessions. There is a multitude of design principles, design goals, and environmental interventions available to assist with activities of daily living and functions, although few systematic studies have been conducted on the efficacy of these goals and interventions. The own home seems to be a largely ignored territory in research and government policies, which implies that many problems concerning aging in place and environmental interventions for dementia are not adequately dealt with.

The ageing of society goes together with an increasing number of older adults with dementia. This group has specific housing and care needs reflecting their physical and mental health status, which has implications for the housing market, the public housing task, and the related provision of care. Within the European Union, there are various care and welfare regimes that constitute an underlying cause of the broad range of solutions chosen to organise care and housing of older adults with dementia. These regimes also account for the large differences that exist in the current housing situation of older adults with dementia in relation to the level of care they receive and the involvement of relatives. The paper zooms in on the situation in the Netherlands, where national policies focus on (1) ageing-in-place, (2) the separation of residence and care, and (3) substitution of institutional by non-institutional types of living. Within institutional settings, a transition is made towards small-scale group accommodation (SSGA) for older adults with dementia. Solutions within the domain of care consist of facilitating family carers, whereas housing solutions are directed to SSGA and use of technology and implementation of modifications to the living environment.

The vast majority of older adults want to remain living independently at home, with or without a sufficient amount of professional home care, even when overall health is starting to decline. The ageing of society and the increase in the number of very old elders goes together with an increase in the number of people with dementia. About two thirds of the diagnosed people in the Netherlands live at home. Dementia has severe implications to the quality of daily life, in particular to independent functioning. This sets extra demands to living environments. Older adults with dementia and their partners ask for living environments that support independence, compensate for declining vitality, and lower the burden of family care. For this purpose, a first concept of a design for a dementia dwelling is presented in this paper, which incorporates modifications in terms of architecture, interior design, the indoor environment, and technological solutions. These design features were derived from literature search and focus group sessions. Current design guidelines are frequently based on practical experience only, and therefore, more systematic field research should be carried out to find evidence for the various design modifications. Also, it needs to be studied how the design features of the dementia dwelling can be incorporated into the existing housing stock.

The concept of the physician assistant (PA) in the United States has served as a model for other countries in providing one solution for the challenges in their health care systems. In the Netherlands there is a growing shortage of adequately trained health care workers, an increasing demand for medical services, a growing political pressure to contain the costs of health care, a shift from hospital care to outpatient care and from curative care to preventive care, and an increased demand to apply emerging biomedical technologies in health care. The concept of "demand-driven care" - a concept that empowers the patient in the coordination and organization of health care - plays a key role in the modernization of the Dutch health care system and forms an instrument to liberalize public activities. The need to meet these challenges has made it necessary to develop curricula for new types of health care professionals in the Netherlands, and to identify professional core competencies, relevant for physicians and PAs.

Networked and ubiquitous information and communication technologies (ICTs) and ambient intelligence are increasingly used in the home environment to facilitate independent living for older adults. These systems collect and disperse a high volume of personal data, which is used for assistance and monitoring by professional carers in order to provide more responsive care for high-risk individuals. These personal data are often also sent to commercial service providers. The computerisation of the home environments, while providing many positive potential uses, goes together with concerns about privacy, sensitivity of data, ethics, and the inclusion of all groups of older adults, also those with dementia. It is arguable that present privacy regulation lags behind technological developments, especially with society moving into the era of ambient intelligence, which promises to intensify data collection in kind, frequency and volume. Also, personal control by older users is becoming ever more laborious to exercise in ambient intelligence environments. A combined agenda of technological and legislative developments is needed to support, as well as inform, the wider public and especially the older population about the legitimacy and the appropriateness of the data collection for the service provided. While principles hold just as much for the internet domain as for ambient intelligence, the complexity and diversity of the latter call for extra care to ensure transparency for the older population.

Background: The demand for care is increasing, whereas in the near future the number of people working in professional care will not match with the demand for care. eHealth technology can help to meet the growing demand for care. Despite the apparent positive effects of eHealth technology, there are still barriers to technology adoption related to the absence of a composite set of knowledge and skills among health care professionals regarding the use of eHealth technology. Objective: The objective of this paper is to discuss the competencies required by health care professionals working in home care, with eHealth technologies such as remote telecare and ambient assisted living (AAL), mobile health, and fall detection systems. Methods: A two-day collaborative workshop was undertaken with academics across multiple disciplines with experience in working on funded research regarding the application and development of technologies to support older people. Results: The findings revealed that health care professionals working in home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in eHealth care. This paper argues that eHealth care technology skills must be instilled in health care professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age in place. Educating health care professionals with the necessary skill training in eHealth care will improve service delivery and optimise the eHealth care potential to reduce costs by improving efficiency. Moreover, embedding eHealth care competencies within training and education for health care professionals ensures that the benefits of new technologies are realized by casting them in the context of the larger system of care. These care improvements will potentially support the independent living of older persons at home. Conclusions: This paper describes the health care professionals' competencies and requirements needed for the use of eHealth technologies to support elderly adults to age in place. In addition, this paper underscores the need for further discussion of the changing role of health care professionals working in home care within the context of emerging eHealth care technologies. The findings are of value to local and central government, health care professionals, service delivery organizations, and commissioners of care to use this paper as a framework to conduct and develop competencies for health care professionals working with eHealth technologies.

The architecture, engineering and construction (AEC) sector can make an essential contribution to needed breakthroughs and provide new solutions for the improvement of independent and active living in the built environment, including for older adults. This is related to (i) reducing impediments of immobility and maintaining autonomy at home, (ii) reducing the number of accidents and increasing health, (iii) developing integrated care and cure of disabled and aging people, (iv) providing a setting that enables physical, environmental, and social integration, and (v) meeting personal needs, e.g. by realizing new forms of living arrangements that reduce loneliness and improve communication and social expectations in the built environment.

We developed an online survey for COPD patients to investigate which reasons patients themselves list for being less active. In addition, this survey provides information on whether the internet proves to be a usable platform to administer surveys in COPD patients.

In the Netherlands, the Dutch Ministry of Health, Welfare and Sport (MINVWS) encourages the use of smart home automation (SHA) in small-scale senior accommodations (SSSAs). The initiatives were evaluated in order to determine which of the smart home automation systems contribute to enhance quality of care and improve the quality of life of residents.

Background: Persons with Chronic Obstructive Pulmonary Disease (COPD), performing some level of regular physical activity, have a lower risk of both COPD-related hospital admissions and mortality. COPD patients of all stages seem to benefit from exercise training programs, thereby improving with respect to both exercise tolerance and symptoms of dyspnea and fatigue. Physical inactivity, which becomes more severe with increasing age, is a point of concern in healthy older adults. COPD might worsen this scenario, but it is unclear to what degree. This literature review aims to present the extent of the impact of COPD on objectively-measured daily physical activity (DPA). The focus is on the extent of the impact that COPD has on duration, intensity, and counts of DPA, as well as whether the severity of the disease has an additional influence on DPA. Results: A literature review was performed in the databases PubMed [MEDLINE], Picarta, PEDRO, ISI Web of Knowledge and Google scholar. After screening, 11 studies were identified as being relevant for comparison between COPD patients and healthy controls with respect to duration, intensity, and counts of DPA. Four more studies were found to be relevant to address the subject of the influence the severity of the disease may have on DPA. The average percentage of DPA of COPD patients vs. healthy control subjects for duration was 57%, for intensity 75%, and for activity counts 56%. Correlations of DPA and severity of the disease were low and/or not significant. Conclusions: From the results of this review, it appears that patients with COPD have a significantly reduced duration, intensity, and counts of DPA when compared to healthy control subjects. The intensity of DPA seems to be less affected by COPD than duration and counts. Judging from the results, it seems that severity of COPD is not strongly correlated with level of DPA. Future research should focus in more detail on the relation between COPD and duration, intensity, and counts of DPA, as well as the effect of disease severity on DPA, so that these relations become more understandable. Background Chronic Obstructive Pulmonary Disease (COPD) is a disabling airway disease with variable extrapulmonary effects that may contribute to disease severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. The characteristic symptoms of COPD are cough, sputum production, and dyspnea upon exertion [1].

Purpose In the Netherlands 43% of nursing home residents have visual impairments1. Visual impairments can be a result of the normal ageing process or specific diseases. Vision impairment can result in the loss of basic visual abilities: acuity, contrast sensitivity, or visual field 2. In 56% of the cases of low vision, treatment, or slow down, of further decline is possible1. Still, 44% of people affected by low vision remain untreated. The impact of vision loss affects daily care and the design of the environment for older adults in the nursing home. Basic strategies for a healthy living environment for older adults with low vision include: (i) increasing illuminance levels, (ii) controlling brightness (glare) and luminance ratio, (iii) using clear and contrasting colours, (iv) arranging a convenient layout of spaces, and (v) clear acoustics2-4,6. In this pilot study, an assessment was made of the light situation in nursing homes in the Netherlands. Method Light conditions were assessed in common spaces and corridors in three nursing homes using a Konica Minolta chromameter CL-200 to measure vertical (at the eye, gazing direction) and horizontal (for instance, table level) illuminance levels as well as colour temperature (Tc [K]). The results were compared to the minimum illumination levels as given in a guideline by the Dutch Society for Illumination (NSVV). Results & Discussion Results show that the illumination level in the nursing homes fell far below standard5 in over 90% of measurements (min-max 6-2,500 lx), with Tc levels of min-max 2,300-6,250 K. Light conditions in private rooms were better. Assuming that specific tasks are performed in common rooms, additional illumination is needed to perform (I)ADL tasks and for leisure. Light conditions in corridors vary according to the position in the corridor. Right below the luminaires conditions met the lower criteria, although levels decline sharply when stepping out of the direct flux. Such variation may go together with an increased risk for falls.

There are currently about 6 million – mainly older – people with dementia in the European Union. With ageing, a number of sensory changes occur. Dementia syndrome exacerbates the effects of these sensory changes and alters perception of stimuli. People with dementia have an altered sensitivity for indoor environmental conditions, which can induce problematic behaviour with burdensome symptoms to both the person with dementia and the family carer. This paper, based on literature review, provides an overview of the indoor environmental parameters, as well as the integrated design and implementation of relevant building systems. The overview is presented in relation to the intrinsic ageing of senses, the responses of older people with dementia and the impact on other relevant stakeholders through the combined use of the International Classification of Functioning, Disability and Health, and the Model of Integrated Building Design. Results are presented as indicators of the basic value, functional value and economic value, as well as a synthesis of building-related solutions. Results can help designers and building services engineers to create optimal environmental conditions inside the living environments for people with dementia, and can be used to raise awareness among health care professionals about of the influence of the indoor environment on behaviour of the person with dementia.

Purpose In the Netherlands, the prevalence of visual impairments is the highest among the subgroup of nursing home residents. Over 40 percent are estimated to have visual impairments1. Older adults experience visual problems due to biological aging or eye disease2. These problems can affect several visual functions as well as daily functions in general3,4. Providing appropriate lighting of sufficient intensity and color temperature (CT), and making use of capabilities of the visual environment in the nursing home4 is one of the tasks for professional carers.Light conditions were measured in order to find out to what extent older adults live with the proper lighting conditions. With these data, we wanted to enhance the awareness among care professionals of how light conditions affect the daily lives of the nursing home residents. Moreover, care professionals and technical staff could make the right improvements to the nursing home environment based on the outcomes. Method We assessed light conditions (Konica Minolta chromameter CL-200) in seven nursing homes in the Netherlands. Light conditions were measured in places where residents spend most of their time during the day. In total, 59 living rooms and corridors were assessed in this study. Horizontal and vertical illuminances as well as CT were measured and compared to the values given in a guideline by the Dutch Society for Illumination5. The study was performed between October 2009 and the end of March 2010 at daytime between 10:00 and 15:00 hours. By measuring in autumn, winter and early spring, the contribution of daylight to the indoor illuminance levels was kept at a minimum. Results & Discussion In general lighting conditions encountered in the nursing homes were poor. Four-fifths of the measured illuminances in the common rooms were below the 1,000 lx threshold. Illuminances in the corridors fell below the 200 lx threshold in at least three quarters of the measurements. This means that nursing home residents may have difficulty carrying out tasks and could fall during transfers. The CT of light to which nursing home residents were exposed, fell below the reference value for daylight of 5,000 K with median scores of 3,400 to 4,500 K. High CT of light, in combination with higher illuminances, may positively affect the biological clock, resulting in better sleep quantity and quality.Nursing home staff should be aware of these data in order to arrange better light conditions. Technical staff should be aware that lighting guidelines are not specifically developed for older adults. Special attention should be paid to the fact that older adults need more light than younger persons to perform Activities of Daily Living (ADL).

Objective: Chronic lung problems often constrain physical independence of older occupants. The usefulness and practicality of an existing physical independence level assessment has been studied. Methods: Nine independently living older occupants (aged 52-73) with chronic lung disease participated in a pilot study. Physical performance in daily activities was determined from heart-rate and body-movement registrations during a seven-day period at home and a standardised cycle ergometer test in hospital. The individual’s baseline for physical independence was deduced from physical performance outdoors. Results: The highest actual energy expenditure at a relative physical strain of 40% allowed us to assign subjects to physical independence levels 3 (4 subjects) or 4 (5 subjects). At level 3 activity accommodations, technical aids, and informal assistance are required; at level 4 professional assistance is needed too. Subjects at level 4 had lower values of body weight, body height, peak oxygen uptake, and peak minute ventilation than subjects at level 3. The severity of airflow limitations did not predict physical independence level. Physical performance during outdoor walking showed a higher relative physical strain (above 40%) at physical independence level 4 as compared to 3. This high strain limits duration of performance as a way of activity accommodation. Conclusion: Physical independence level assessment is suited to distinguish baselines for physical independence levels 3 and 4 under daily living conditions in older occupants with chronic lung disease. In the future, the assessment method may give insight into the influence of efficacious interventions on physical performance parameters.

Objective: Reflection on visual problems in nursing homes. Data Sources: Eye examinations, documented visual problems and illuminance levels. Study design: The optometric examinations and recorded visual problems were combined with illuminance data. Data collection: In seven nursing homes, 259 residents underwent an optometric examination. Their client records were analyzed for information regarding visual functioning. The illuminance data were ranked to set the quality of the lighting conditions. Principal findings: 50% of the referred residents had problems with cataracts, retinal problems (21%), suspected glaucoma (13%), and other pathologies (16%). The information was not current in 56% of the records. The quality of lighting conditions was low or moderate. Conclusion: The finding of poor lighting conditions in nursing homes in combination with a high prevalence of visual problems (with cataract found to be the most common age related pathology), stretches the need of enhanced awareness of eye care by professional caregivers.

Self-management for people with chronic diseases is now widely recognized as an essential part of treatment. Despite the high expectations and the growing body of evidence in terms of its effectiveness, a wide application of self-management programs is inhibited due to several challenges. Worldwide, a variety of complex and multifactorial interventions have been evaluated in very heterogeneous patient populations leaving healthcare professionals in doubt about what works best and what works in whom. In this letter to the editor the authors systematically reflect on the current evidence of patient-specific determinants of success of self-management and argument the urge for increased scientific efforts to establish tailored self-management in patients with chronic disease.

A 27-year-old female office clerk with widespread atopic dermatitis (AD) since infancy appeared to be highly sensitized and exposed to molds, storage mites, and chicken feathers and moderately sensitized to house-dust mites and grass and birch pollens. Hardly any textiles were present in her home; that is, only 28 m2, which is less than 25% of the Dutch national average. The causal relationship between eczema and molds plus storage mites in this case of AD was strengthened by the positive effect of an unusual, multidisciplinary home-sanitation program involving cleaning of mineral surfaces and ventilation improvement. This home-sanitation program led to a gradual drop of total IgE and clinical symptom scores to 21% and 13%, respectively, of the original values.

Inheritance and allergen exposure are key factors in the development and the course of atopic allergy, expressed as conjunctivitis, rhinitis, asthma or dermatitis. This study concerns the clinical significance of mite and mite-allergen avoidance measures based on intensive cleaning with acaricide (solidified benzylbenzoate) added (10 dwellings), and without biocidal activity (10 other homes) as a control in a double-blind trial with matched pairs. Twenty subjects with persisting rhinitic complaints were selected. They lived in 20 different dwellings and were ail sensitized to pyroglyphid mites; 12 of them were also sensitized to stored product miles (Acari). Daily symptoms and medication score, guanine and dust exposure, total and mite-specific IgE in serum, eosinophilia in the blood and in the nasal smear, intracutaneous tests with house dust mite and storage mite extracts were compared in both pairs and groups. Acarological data, physiochemical aspects and exposure assessment are discussed in detail elsewhere. Symptom scores dropped significantly, as did the total IgE and exposure to dust and mite products in the acaricidal cleaner treatment group. After 1 year, the daily symptoms median was 47% (P= 0.025), total IgE was 38% (P=0.0049), and exposure to dust and mite products (guanine exposure) was 53% (P= 0.0449) better or lower than in the controls. Intensive cleaning, without acaricidal treatment performed twice a year, resulted in clinical improvement in four out of 10 subjects, of whom none became free of complaints. In the Acarosan treatment group (cleaning+ benzylbenzoate) eight out of 10 subjcets improved, in three cases subjective symptoms disappeared. The conclusion is that mite avoidance in homes can be carried out successfully with a special acaricidal cleaning formulation Acarosan.

Home telehealth (HT) refers to the use of videoconferencing to provide care to patients remotely and can help older adults age in place. However, these technologies are unlikely to impact care unless health care providers are motivated to use them. Education may play a key role in increasing motivation to use and competence regarding HT. To help guide the development of nursing education to facilitate adoption and use, the current study examined predictors of Dutch nurses’ willingness to use HT, based on a survey of 67 Dutch nurses with and 126 without HT experience. Nurses’ willingness to use this technology was predicted by HT’s (a) perceived usefulness to the client, (b) effort expectancy, (c) social influence, and (d) cost expectations. These observed relationships are anticipated to help with the development of effective educational programs to increase HT use and, therefore, improve older adults’ quality of life. [ Journal of Gerontological Nursing, 41 (4), 47–56.]

Nightshift work can negatively impact sleep, performance, and health. Careful manipulation of light exposure patterns can help reduce these negative effects but is challenging in conditions of rapidly rotating shiftwork and due to individual differences. As chronotype is related to shiftwork tolerance, we explored patterns of sleep, sleepiness, and light exposure during the first day of nightshift work between earlier and later chronotypes, based on data from an observational field study among rapidly rotating hospital nurses. Due to the limited sample size, only descriptive analyses and visual inspection were conducted. In line with findings of lower shiftwork tolerance, earlier chronotypes (N=6) seemed to be sleepier during work and sleep less than later types (N=7). Differences were also observed in light exposure patterns, revealing potential for light exposure interventions, and suggesting a contribution to shiftwork tolerance. For future intervention studies in aiming to identify a light exposure strategy, our findings highlight the importance of investigating light exposure relative to the individual circadian phase.