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De laatste jaren is er veel te doen over de kwaliteit van de gezondheidszorg voor de snel groeiende groep kwetsbare ouderen, specifiek de kwaliteit van de verpleeghuiszorg. De bescheiden resultaten uit wetenschappelijk onderzoek naar mogelijke verbetering, zoals die naar voren komen in het NPO-programma, laten zien dat interventies bij kwetsbare ouderen niet gemakkelijk succesvol zijn toe te passen. De afgesproken interventies worden in de helft van de gevallen niet uitgevoerd. Onderzoek laat zien dat op het gebied van kwetsbare ouderen de opleiding van professionals (o.a. verpleegkundigen, artsen) ernstig tekortschiet. Het gevolg van de tekortschietende opleidingen is dat er bij de meeste disciplines sprake is van relatieve onbevoegdheid en onbekwaamheid op het gebied van de gezondheidszorg voor kwetsbare ouderen. Regering, inspectie en betrokken koepelorganisaties zouden de focus hierop moeten richten in plaats van de controle aan te scherpen. Als we ons beleid niet veranderen en niet investeren in de oplossing van de fundamentele tekortkomingen in het onderwijs, inclusief de herregistraties, blijven we bouwen op drijfzand. Het opstellen van een convenant tussen veldpartijen en IGZ/VWS en OCW lijkt een volgende noodzakelijke stap om dit fundamentele opleidingsprobleem binnen vijf jaar tot een oplossing te brengen.

De laatste jaren is er veel te doen over de kwaliteit van de gezondheidszorg voor de snel groeiende groep kwetsbare ouderen, specifiek de kwaliteit van de verpleeghuiszorg. De bescheiden resultaten uit wetenschappelijk onderzoek naar mogelijke verbetering, zoals die naar voren komen in het NPO-programma, laten zien dat interventies bij kwetsbare ouderen niet gemakkelijk succesvol zijn toe te passen. De afgesproken interventies worden in de helft van de gevallen niet uitgevoerd. Onderzoek laat zien dat op het gebied van kwetsbare ouderen de opleiding van professionals (o.a. verpleegkundigen, artsen) ernstig tekortschiet. Het gevolg van de tekortschietende opleidingen is dat er bij de meeste disciplines sprake is van relatieve onbevoegdheid en onbekwaamheid op het gebied van de gezondheidszorg voor kwetsbare ouderen. Regering, inspectie en betrokken koepelorganisaties zouden de focus hierop moeten richten in plaats van de controle aan te scherpen. Als we ons beleid niet veranderen en niet investeren in de oplossing van de fundamentele tekortkomingen in het onderwijs, inclusief de herregistraties, blijven we bouwen op drijfzand. Het opstellen van een convenant tussen veldpartijen en IGZ/VWS en OCW lijkt een volgende noodzakelijke stap om dit fundamentele opleidingsprobleem binnen vijf jaar tot een oplossing te brengen.

Lecture based on abstract at APNEP congress 2016, Porto.

Lecture based on abstract at APNEP congress 2016, Porto.

Undernutrition is a major health problem in the growing elderly population. It is estimated that one in ten Dutch community-dwelling older adults is suffering from undernutrition, and one in three Dutch older adults who receive home care. Undernutrition may lead to many negative consequences, ranging from fatigue and falls to impaired immune function and death. This makes undernutrition an obvious target for preventive measures. Undernutrition can be defined as “a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein, and other nutrients causes measurable adverse effects on tissue/body form (body shape, size and composition) and function, and clinical outcome”. In addition, it is often described as protein energy malnutrition. Adequate protein intake may to some extent prevent and reverse this process. However, throughout ageing, it becomes increasingly difficult to reach adequate protein intake due to higher protein needs and lower protein intakes. Finding solutions to assist older adults in reaching their optimal protein intake is necessary. In our overall research project, we considered 1.2g protein per kg weight per day (g/kg/d) as adequate protein intake. In Dutch community-dwelling older adults, protein intake is around 1.0 g/kg/d, implying room for improvement. However, it is possible that many of these older adults deal with physiological changes, medical conditions, and physical and mental limitations that impair their appetite and food provision. For these older adults with higher protein needs, merely recommending that they eat more would not be realistic. It would be more realistic to explore strategies that increase protein intake without having to increase food intake. This calls for the exploration of instruments that match the needs and preferences of older adults: protein-enriched regular products. One particular group that can be identified as a target group for such products, are older adults who receive home care. Undernutrition prevalence is high in this group, which may be explained by their health problems that led to this dependence on home care. Likewise, many of these older adults also depend on meals-on-wheels. These meals-on-wheels recipients, regardless of whether they receive home care or not, often risk undernutrition too. In both these (overlapping) care-dependent groups, difficulties in adhering to energy and protein recommendations can be discerned. For this reason, enriching the readymade meals that these older adults receive may contribute to the prevention of protein undernutrition by increasing protein intake while keeping food intake the same. Here, protein enrichment instruments can be used to prevent undernutrition, but only when implemented in a timely manner. Adequate undernutrition management systems are therefore necessary to facilitate timely intervention, ensuring that the developed protein-enriched meals are actually offered and effective. For this reason, the overall aim of our research project was to gain insight into the current state of undernutrition management in community-dwelling older adults in the Netherlands and explore the role of protein-enriched regular products as a supportive instrument in protein undernutrition management. In Study 1 (chapter 2) we explored the experiences of 22 Dutch nutrition and care professionals and researchers with undernutrition awareness, monitoring, and treatment among community-dwelling older adults. This qualitative study among, for example, dietitians, general practitioners, nurse practitioners, and home care nurses provided insight into the current bottlenecks within the existing undernutrition management guidelines. In these telephone interviews, these experts also discussed the current dietary behaviour problems of older adults and their impact on undernutrition risk. The experts’ experiences implied that undernutrition awareness is limited, among both older adults and care professionals. In addition, the interviewees were unclear about which professionals are responsible for monitoring and which monitoring procedures are preferred. The dietitians feel that they become involved too late, leading to decreased treatment effectiveness. In general, the interviewees desired more collaboration and a coherent and feasible allocation of responsibilities regarding undernutrition monitoring and treatment. This implied that the available guidelines on undernutrition management require more attention and facilitation. In the following mixed-methods study (chapter 3), with interviews, we qualitatively explored the dietary behaviour and undernutrition risk of 12 Dutch elderly meals-on-wheels clients, one of the largest at-risk groups. We followed up on this information by quantifying the topics that emerged from the qualitative exploration of experienced bottlenecks in performing adequate dietary behaviour. For this, we used a survey among 333 meals-on-wheels clients. The interviews with elderly meals-on-wheels clients made clear that they have fixed and habitual eating patterns, while at the same time their appetite had decreased throughout the years. This was confirmed by the survey finding that regular portion size meals were perceived as too large by the oldest group aged over 75y. In addition, as the professionals suggested earlier, the interviewed elderly clients indeed showed limited awareness of undernutrition risk. Simultaneously, the survey showed that almost one in four elderly meals-on-wheels clients was undernourished. These findings led to the conclusion that staying close to the identified dietary habits may facilitate small yet effective modifications within these habits to prevent inadequate nutritional intake. Still, the limited awareness of undernutrition risk was expected to play a limiting role in whether clients believe they need dietary modifications. Consequently, informing them about this need could facilitate their motivation to implement modifications. After learning about the general dietary behaviour of these older adults, we used this information for Study 3 (chapter 4). We developed two kinds of protein-enriched readymade meals that are in line with the needs and preferences of older adults: one of regular size (450g) and one of reduced size (400g). We tested these meals in a lab setting in 120 community-dwelling older adults in a single-blind randomised crossover trial. One day a week at lunchtime, for four weeks, participants had to consume and evaluate a readymade meal. Overall, regardless of portion size, the protein-enriched meals led to higher protein intakes in vital older adults in a lab setting during lunch. In this crossover study, the participants liked the protein-enriched meals and the regular meals equally. However, we did not find the expected lower ratings of satiety after the reduced-size meals, while one reduced-size enriched meal and another regular-size enriched meal led to higher ratings of subsequent satiety. This higher satiety in the enriched meals could lead to compensational behaviour on the remainder of the day. After establishing that the protein-enriched meals were effective and acceptable in the lab setting, we moved to the homes of older adults to test the meals in a longer-term study in Study 4 (chapter 5). In this double-blind randomised controlled trial of two weeks, we also included protein-enriched bread to assess whether both this bread and the meals could increase daily protein intake to 1.2g/kg/d in 42 community-dwelling older adults to reach optimal protein intake. We found that the enriched products again led to higher protein intakes and a high liking. The mean protein intake per day was 14.6g higher in the intervention group, which amounted to a protein intake of 1.25g/kg/d, compared with 0.99g/kg/d in the control group. In addition, the meals scored 7.7 out of 10, while the bread scored 7.8 out of 10, which both were comparable with their regular counterparts. Lastly, we found no negative effect of compensational behaviour throughout the day. These promising findings indicated that we achieved a good match between older adults’ needs and preferences regarding protein intake. In the general discussion of this thesis (chapter 6), we combined our learnings from the four studies to reflect on protein undernutrition management in community-dwelling older adults and the possible role of protein-enriched regular products. We have discussed a conceptual framework consisting of three wheels of protein undernutrition management. In the first wheel regarding awareness, we proposed that limited awareness of adequate nutrition and body composition forms the largest bottleneck in undernutrition management. When this awareness is generated among both older adults and professionals, it will benefit the second wheel of monitoring. Here, we argued that a policy and the actual facilitation of that policy are required for this monitoring to succeed. When the monitoring is performed adequately, in the third wheel, the appropriate treatment can be carried out. We discussed that personalisation and evaluation of this treatment are important conditions. All in all, the public health implications that we have discussed on the basis of our findings can be summarised by the three key messages that could help us ace in adequate protein undernutrition management: address awareness in both older adults and professionals, facilitate continuous collaboration between professionals, and offer protein-enriched products expediently.

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 (chi 2 = 309, df = 5, p = 0.000), and outside of the NH, ophthalmologists and low vision specialists are most frequently contacted about eye related issues (chi 2 = 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.

Norschoten deelt haar ervaringen met het ontwikkelings- en realisatieproces van de toegepaste zorgdomotica graag. Daarom heeft Norschoten in samenwerking met Noaber Foundation onderzoek laten doen door het Lectoraat ICT-innovaties in de Zorg van de hogeschool Windesheim. In dit boekje staan de belangrijkste uitkomsten van het onderzoek.

Current many changes are taking place in the elderly care: care is changing from supply-oriented to demand driven, problems have to be more serious than previously to get a placement in a nursing home, furthermore the demand for heavier care will increase due to ageing. The aim of this study is to acquire a clear insight in the decision-making process with regard to placement in a nursing home facility.

De zorg in verpleeghuizen is nog lang niet overal goed afgestemd op oudere migranten met dementie. Dit verhaal over een 78-jarige Turkse man met dementie laat zien hoe mantelzorgers vol compassie zorgen voor hun familielid, maar ook hoe beperkt de middelen zijn die verzorgenden tot hun beschikking hebben. De casus is gebaseerd op interviews met meerdere betrokkenen, maar wordt hier verteld vanuit het perspectief van twee personen: een dochter en een verzorgende.

Norschoten deelt haar ervaringen met het ontwikkelings- en realisatieproces van de toegepaste zorgdomotica graag. Daarom heeft Norschoten in samenwerking met Noaber Foundation onderzoek laten doen door het Lectoraat ICT-innovaties in de Zorg van de hogeschool Windesheim. In dit boekje staan de belangrijkste uitkomsten van het onderzoek.

Current many changes are taking place in the elderly care: care is changing from supply-oriented to demand driven, problems have to be more serious than previously to get a placement in a nursing home, furthermore the demand for heavier care will increase due to ageing. The aim of this study is to acquire a clear insight in the decision-making process with regard to placement in a nursing home facility.

The first objective was to investigate if the Safety Attitudes Questionnaire (SAQ) is appropriate to measure the safety attitude of caregivers in nursing and residential homes, and second, to compare safety attitude of these caregivers with available data of caregivers in other settings (ie, inpatients, intensive care unit (ICU) and ambulatory care).

Het doel van dit onderzoek is het krijgen van inzicht in de staat van de mondzorg die door verpleegkundigen en verzorgenden wordt uitgevoerd en de manier waarop mondzorg in het zorgsysteem is ingebed, om zo evt. verbeteringen of behoud van de mondzorg te bewerkstelligen. Mede mogelijk gemaakt door studenten Mondzorgkunde jaar 3, semester I, 2013-2014.

In verpleeg- en verzorgingshuizen is er enerzijds maar een zeer kleine groep die voldoende bewegen volgens de beweegnorm en anderzijds brengen de meeste bewoners een groot aantal uren zittend (sedentair) door. Juist dit sedentair gedrag is sterk geassocieerd met cardiovasculaire mortaliteit (sterfte door hart- en vaatziekten), zelfs na correctie voor het aantal uren bewegen. Naast het aanmoedigen van fysieke activiteit dient sedentair gedrag dus eveneens meegenomen te worden in beweeginterventies. Effectieve beweeginterventies op maat (zoals de Physical Activity Centre-methodiek) kunnen een belangrijke bijdrage leveren om enerzijds gezondheidsrisico’s terug te dringen en anderzijds kwaliteit van leven te verhogen (beweegangst verkleinen, vertrouwen bieden, eenzaamheid tegen gaan, zelfredzaamheid vergroten).

Er komen steeds meer ouderen in Nederland. Zij doen over het algemeen een groter beroep op de gezondheidszorg, wat tot stijgende zorgkosten leidt en een lagere kwaliteit van leven. Eten en drinken speelt een belangrijke rol bij de preventie van ziekte. Hoewel er steeds meer aandacht is voor de voedingsstatus van ouderen en screeningsprocedures steeds meer toegepast worden, laten de laatste metingen in Nederland zien dat 17% van de cliënten in instellingen ondervoed is en dat 28% risico loopt op ondervoeding. Om ziekte en daarmee verhoogde zorgkosten te voorkomen, en om de kwaliteit van leven te optimaliseren, is preventie van ondervoeding bij ouderen noodzakelijk. Het onderzoek ‘Genieten aan tafel’ beoogde de maaltijdbeleving van verpleeghuiscliënten te optimaliseren, met als doel om eetlust, voedingsstatus, functionele status en kwaliteit van leven te verbeteren en zo zorgkosten te verminderen.

In verpleeg- en verzorgingshuizen is er enerzijds maar een zeer kleine groep die voldoende bewegen volgens de beweegnorm en anderzijds brengen de meeste bewoners een groot aantal uren zittend (sedentair) door. Juist dit sedentair gedrag is sterk geassocieerd met cardiovasculaire mortaliteit (sterfte door hart- en vaatziekten), zelfs na correctie voor het aantal uren bewegen. Naast het aanmoedigen van fysieke activiteit dient sedentair gedrag dus eveneens meegenomen te worden in beweeginterventies. Effectieve beweeginterventies op maat (zoals de Physical Activity Centre-methodiek) kunnen een belangrijke bijdrage leveren om enerzijds gezondheidsrisico’s terug te dringen en anderzijds kwaliteit van leven te verhogen (beweegangst verkleinen, vertrouwen bieden, eenzaamheid tegen gaan, zelfredzaamheid vergroten).

Het doel van dit onderzoek is het krijgen van inzicht in de staat van de mondzorg die door verpleegkundigen en verzorgenden wordt uitgevoerd en de manier waarop mondzorg in het zorgsysteem is ingebed, om zo evt. verbeteringen of behoud van de mondzorg te bewerkstelligen. Mede mogelijk gemaakt door studenten Mondzorgkunde jaar 3, semester I, 2013-2014.

Er komen steeds meer ouderen in Nederland. Zij doen over het algemeen een groter beroep op de gezondheidszorg, wat tot stijgende zorgkosten leidt en een lagere kwaliteit van leven. Eten en drinken speelt een belangrijke rol bij de preventie van ziekte. Hoewel er steeds meer aandacht is voor de voedingsstatus van ouderen en screeningsprocedures steeds meer toegepast worden, laten de laatste metingen in Nederland zien dat 17% van de cliënten in instellingen ondervoed is en dat 28% risico loopt op ondervoeding. Om ziekte en daarmee verhoogde zorgkosten te voorkomen, en om de kwaliteit van leven te optimaliseren, is preventie van ondervoeding bij ouderen noodzakelijk. Het onderzoek ‘Genieten aan tafel’ beoogde de maaltijdbeleving van verpleeghuiscliënten te optimaliseren, met als doel om eetlust, voedingsstatus, functionele status en kwaliteit van leven te verbeteren en zo zorgkosten te verminderen.

Binnen het Expertisecentrum Gezondheidszorg en Technologie van Fontys (Fontys EGT1) loopt het meerjaarse project Verpleeghuis van de Toekomst (VETO). Binnen Fontys EGT wordt ruimte gegeven aan een minor gezondheidszorg en technologie aan derdejaars studenten, stagiaires en afstudeerders. Studenten werken in interdisciplinaire groepen aan projecten en onderwijs, onder andere aan het maken van prototypes die met eindgebruikers getest worden.

Wageningen Universiteit heeft een project opgezet om de ambiance tijdens de maaltijden in verpleeghuizen te verbeteren. Onderzocht is op welke wijze de ambiance kan worden verbeterd en wat de bewoners en personeel daarvan vinden. De bedoeling van het project is om een succesvolle methode in meerdere verpleeghuizen te implementeren. Een goede sfeer tijdens de maaltijden heeft namelijk een positief effect op de voedingstoestand en kwaliteit van leven van verpleeghuisbewoners. De eerste reacties van bewoners en personeel zijn positief

In Nederland is 80% van de mensen die een beenamputatie ondergaat ouder dan 65 jaar. UMCG-onderzoeker Lauren Fortington onderzocht hoe en in welke mate het oudere mensen na een beenamputatie mogelijk wordt gemaakt om te leven. Zij stelt dat revalidatie na de beenamputatie verder moet gaan dan alleen het been. Chronisch vaatlijden of type 2 diabetes kunnen leiden tot onomkeerbare afsluiting van bloedvaten of levensbedreigende infecties. Dit zijn de belangrijkste redenen voor beenamputaties bij ouderen. Ondanks betere preventie en medische behandeling, is amputatie in sommige gevallen de beste optie om een halt te roepen aan langdurige pijn, ziekenhuisopnames en infectie/afsluiting van de bloedvaten en daarmee leven weer mogelijk te maken. Alleen een oudere leeftijd is geen belemmering om na een beenamputatie weer mobiel te worden, stelt Fortington. Het “mogelijk maken om te leven” houdt in dat revalidatieteams in verpleeghuizen ook moeten kijken naar psychische en sociale factoren. Vóór de amputatie zijn zowel het medisch onderzoek en beslissingen sterk gericht op de operatie. Input van het revalidatieteam in deze fase kan helpen om andere behandelmogelijkheden af te wegen en na te denken over het meest wenselijke moment waarop de amputatie plaatsvindt. Revalidatieteams met inbreng van verschillende disciplines zouden overwogen moeten worden, aldus Fortington.

In Nederland is 80% van de mensen die een beenamputatie ondergaat ouder dan 65 jaar. UMCG-onderzoeker Lauren Fortington onderzocht hoe en in welke mate het oudere mensen na een beenamputatie mogelijk wordt gemaakt om te leven. Zij stelt dat revalidatie na de beenamputatie verder moet gaan dan alleen het been. Chronisch vaatlijden of type 2 diabetes kunnen leiden tot onomkeerbare afsluiting van bloedvaten of levensbedreigende infecties. Dit zijn de belangrijkste redenen voor beenamputaties bij ouderen. Ondanks betere preventie en medische behandeling, is amputatie in sommige gevallen de beste optie om een halt te roepen aan langdurige pijn, ziekenhuisopnames en infectie/afsluiting van de bloedvaten en daarmee leven weer mogelijk te maken. Alleen een oudere leeftijd is geen belemmering om na een beenamputatie weer mobiel te worden, stelt Fortington. Het “mogelijk maken om te leven” houdt in dat revalidatieteams in verpleeghuizen ook moeten kijken naar psychische en sociale factoren. Vóór de amputatie zijn zowel het medisch onderzoek en beslissingen sterk gericht op de operatie. Input van het revalidatieteam in deze fase kan helpen om andere behandelmogelijkheden af te wegen en na te denken over het meest wenselijke moment waarop de amputatie plaatsvindt. Revalidatieteams met inbreng van verschillende disciplines zouden overwogen moeten worden, aldus Fortington.

One of the areas that is included in facility management is relocation and move management. This exploratory research focuses on the relocation of nursing home residents and the influence on their wellbeing. As other organizations, nursing homes do change over time. Such changes may include reorganizations, mergers, and closures. At the same time such changes will foster a changing demand for space. As a direct consequence there may be a need to relocate residents leading to transitional and irreversible spatial interventions in the life of these nursing home residents. This may affect their physiological and psychological wellbeing: be reminded that a relocation process may cause serious stress and related health problems at these residents. The aim of this paper is to provide a literature review of studies on relocation outcomes. Because no recent literature was found on the particular Dutch situation, other studies have been reviewed in order to expose the diversity of studies and varying results. It is confirmed that relocation influences the wellbeing of nursing home residents. Positive or negative influences are determined by the organization of the relocation. Positive influences can be expected, for instance, if residents are mentally well-prepared prior to the move, if extra staff is deployed to stay in close contact with residents during the move, and if facility managers develop after-care programs until residents are completely accustomed to the new situation.

In Nederland is 80% van de mensen die een beenamputatie ondergaat ouder dan 65 jaar. UMCG-onderzoeker Lauren Fortington onderzocht hoe en in welke mate het oudere mensen na een beenamputatie mogelijk wordt gemaakt om te leven. Zij stelt dat revalidatie na de beenamputatie verder moet gaan dan alleen het been. Chronisch vaatlijden of type 2 diabetes kunnen leiden tot onomkeerbare afsluiting van bloedvaten of levensbedreigende infecties. Dit zijn de belangrijkste redenen voor beenamputaties bij ouderen. Ondanks betere preventie en medische behandeling, is amputatie in sommige gevallen de beste optie om een halt te roepen aan langdurige pijn, ziekenhuisopnames en infectie/afsluiting van de bloedvaten en daarmee leven weer mogelijk te maken. Alleen een oudere leeftijd is geen belemmering om na een beenamputatie weer mobiel te worden, stelt Fortington. Het “mogelijk maken om te leven” houdt in dat revalidatieteams in verpleeghuizen ook moeten kijken naar psychische en sociale factoren. Vóór de amputatie zijn zowel het medisch onderzoek en beslissingen sterk gericht op de operatie. Input van het revalidatieteam in deze fase kan helpen om andere behandelmogelijkheden af te wegen en na te denken over het meest wenselijke moment waarop de amputatie plaatsvindt. Revalidatieteams met inbreng van verschillende disciplines zouden overwogen moeten worden, aldus Fortington.

One of the areas that is included in facility management is relocation and move management. This exploratory research focuses on the relocation of nursing home residents and the influence on their wellbeing. As other organizations, nursing homes do change over time. Such changes may include reorganizations, mergers, and closures. At the same time such changes will foster a changing demand for space. As a direct consequence there may be a need to relocate residents leading to transitional and irreversible spatial interventions in the life of these nursing home residents. This may affect their physiological and psychological wellbeing: be reminded that a relocation process may cause serious stress and related health problems at these residents. The aim of this paper is to provide a literature review of studies on relocation outcomes. Because no recent literature was found on the particular Dutch situation, other studies have been reviewed in order to expose the diversity of studies and varying results. It is confirmed that relocation influences the wellbeing of nursing home residents. Positive or negative influences are determined by the organization of the relocation. Positive influences can be expected, for instance, if residents are mentally well-prepared prior to the move, if extra staff is deployed to stay in close contact with residents during the move, and if facility managers develop after-care programs until residents are completely accustomed to the new situation.

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OBJECTIVES: Mechanical load during patient handling activities is an important risk factor for low back pain among nursing personnel. The aims of this study were to describe required and actual use of ergonomic devices during patient handling activities and to assess the influence of these ergonomic devices on mechanical load during patient handling activities. METHODS: For each patient, based on national guidelines, it was recorded which specific ergonomic devices were required during distinct patient handling activities, defined by transferring a patient, providing personal care, repositioning patients in the bed, and putting on and taking off anti-embolism stockings. During real-time observations over ~60 h among 186 nurses on 735 separate patient handling activities in 17 nursing homes, it was established whether ergonomic devices were actually used. Mechanical load was assessed through observations of frequency and duration of a flexed or rotated trunk >30° and frequency of pushing, pulling, lifting or carrying requiring forces 230 N from start to end of each separate patient handling activity. The number of patients and nurses per ward and the ratio of nurses per patient were used as ward characteristics with potential influence on mechanical load. A mixed-effect model for repeated measurements was used to determine the influence of ergonomic devices and ward characteristics on mechanical load. RESULTS: Use of ergonomic devices was required according to national guidelines in 520 of 735 (71%) separate patient handling activities, and actual use was observed in 357 of 520 (69%) patient handling activities. A favourable ratio of nurses per patient was associated with a decreased duration of time spent in awkward back postures during handling anti-embolism stocking (43%), patient transfers (33%), and personal care of patients (24%) and also frequency of manually lifting patients (33%). Use of lifting devices was associated with a lower frequency of forces exerted (64%), adjustable bed and shower chairs with a shorter duration of awkward back postures (38%), and an anti-embolism stockings slide with a lower frequency of forces exerted (95%). CONCLUSIONS: In wards in nursing homes with a higher number of staff less awkward back postures as well as forceful lifting were observed during patient handling activities. The use of ergonomic devices was high and associated with less forceful movements and awkward back postures. Both aspects will most likely contribute to the prevention of low back pain among nurses.

OBJECTIVES: Mechanical load during patient handling activities is an important risk factor for low back pain among nursing personnel. The aims of this study were to describe required and actual use of ergonomic devices during patient handling activities and to assess the influence of these ergonomic devices on mechanical load during patient handling activities. METHODS: For each patient, based on national guidelines, it was recorded which specific ergonomic devices were required during distinct patient handling activities, defined by transferring a patient, providing personal care, repositioning patients in the bed, and putting on and taking off anti-embolism stockings. During real-time observations over ~60 h among 186 nurses on 735 separate patient handling activities in 17 nursing homes, it was established whether ergonomic devices were actually used. Mechanical load was assessed through observations of frequency and duration of a flexed or rotated trunk >30° and frequency of pushing, pulling, lifting or carrying requiring forces 230 N from start to end of each separate patient handling activity. The number of patients and nurses per ward and the ratio of nurses per patient were used as ward characteristics with potential influence on mechanical load. A mixed-effect model for repeated measurements was used to determine the influence of ergonomic devices and ward characteristics on mechanical load. RESULTS: Use of ergonomic devices was required according to national guidelines in 520 of 735 (71%) separate patient handling activities, and actual use was observed in 357 of 520 (69%) patient handling activities. A favourable ratio of nurses per patient was associated with a decreased duration of time spent in awkward back postures during handling anti-embolism stocking (43%), patient transfers (33%), and personal care of patients (24%) and also frequency of manually lifting patients (33%). Use of lifting devices was associated with a lower frequency of forces exerted (64%), adjustable bed and shower chairs with a shorter duration of awkward back postures (38%), and an anti-embolism stockings slide with a lower frequency of forces exerted (95%). CONCLUSIONS: In wards in nursing homes with a higher number of staff less awkward back postures as well as forceful lifting were observed during patient handling activities. The use of ergonomic devices was high and associated with less forceful movements and awkward back postures. Both aspects will most likely contribute to the prevention of low back pain among nurses.

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.

In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families (PF) as well as for healthcare staff. The discussions focus on traditional and institutionally designed healthcare facilities (HCF) relative to the actual well-being of patients as an indicator of their health and recovery. This review investigates and structures the scientific research on an evidence-based healthcare design for PF and staff outcomes. Evidence-based design has become the theoretical concept for what are called healing environments. The results show the effects on PF and staff from the perspective of various aspects and dimensions of the physical environmental factors of HFC. A total of 798 papers were identified that fitted the inclusion criteria for this study. Of these, 65 articles were selected for review: fewer than 50% of these papers were classified with a high level of evidence, and 86% were included in the group of PF outcomes. This study demonstrates that evidence of staff outcomes is scarce and insufficiently substantiated. With the development of a more customer-oriented management approach to HCF, the implications of this review are relevant to the design and construction of HCF. Some design features to consider in future design and construction of HCF are single-patient rooms, identical rooms, and lighting. For future research, the main challenge will be to explore and specify staff needs and to integrate those needs into the built environment of HCF.

Deze module is ontwikkeld in het kader van het ZonMw-project 'Implementatie van richtlijnen, handleidingen en protocollen rond Eten & Drinken in de praktijk van verpleeg-, verzorgingshuizen en thuiszorg en in de opleidingen tot verpleegkundige en verzorgende', kortweg het project 'Eten & Drinken' genoemd.

In dit rapport is onderzocht op welke manier scholen en zorginstellingen voedsel aanbieden en hoe dit aanbod het voedselkeuzegedrag van leerlingen en de eetlust van ouderen beïnvloedt.

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.

In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families (PF) as well as for healthcare staff. The discussions focus on traditional and institutionally designed healthcare facilities (HCF) relative to the actual well-being of patients as an indicator of their health and recovery. This review investigates and structures the scientific research on an evidence-based healthcare design for PF and staff outcomes. Evidence-based design has become the theoretical concept for what are called healing environments. The results show the effects on PF and staff from the perspective of various aspects and dimensions of the physical environmental factors of HFC. A total of 798 papers were identified that fitted the inclusion criteria for this study. Of these, 65 articles were selected for review: fewer than 50% of these papers were classified with a high level of evidence, and 86% were included in the group of PF outcomes. This study demonstrates that evidence of staff outcomes is scarce and insufficiently substantiated. With the development of a more customer-oriented management approach to HCF, the implications of this review are relevant to the design and construction of HCF. Some design features to consider in future design and construction of HCF are single-patient rooms, identical rooms, and lighting. For future research, the main challenge will be to explore and specify staff needs and to integrate those needs into the built environment of HCF.

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.