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Objectives: While many studies have explored the benefits of support giving or receiving for older people, little is known about how the balance between giving and receiving instrumental support in non-relative relationships affects home-dwelling older people. This study examines the relation between long-term support balance and subjective well-being in relationships with non-relatives among older people across 11 European countries. Method: 4,650 Participants aged 60 years and above from three waves of the Survey of Health and Retirement in Europe (SHARE) were included. Support balance was calculated as the intensity difference between support received and support given across three waves. Multiple auto-regressive analyses were conducted to test the relationship between support balance and subjective well-being, as indicated by quality of life, depression, and life satisfaction. Results: The impact of balanced versus imbalanced support on all subjective well-being measurements was not significantly different. Compared to balanced support, imbalanced receiving was negatively related to subjective well-being and imbalanced giving was not related to better subjective well-being. Compared to imbalanced receiving, imbalanced giving showed to be the more beneficial for all subjective well-being measures. Discussion: Our results highlight the beneficial role of imbalanced giving and balanced support for older people compared to imbalanced receiving. Policies and practices should prioritize creating an age-friendly environment that promotes active participation and mutual support among older people, as this may be effective to enhance their well-being.

Over the last decades, child protection workers (CPWs) have largely focused on improving their work with a strength-based approach in order to empower families. This study investigates to what extent CPWs draw on families' strengths, that is, by promoting autonomy and competencies and by involving their informal networks in goal formulation. This quantitative study analysed the goals, as stated in case files, formulated by CPWs for 177 families within a single Dutch child protection service. 48.6% of CPWs prioritise promoting families' autonomy in goal formulation. With regard to competencies, only 40.1% of the goals refer to the families' competencies. In addition, the support system that the goals call upon tends to be dominated by formal rather than informal networks (in 71.2% of cases). While it is true that child protection cases can benefit from the support of a formal networks, CPWs overwhelmingly failed to encourage support from existing informal networks (in 95.5% of cases). There were no relationships between these percentages and the nature of the family problems or the question of whether or to what extent the CPWs identified the specific strengths of families. These findings show that half of the CPWs had integrated a strength-based approach in their daily practice to some extent, and therefore improvements are needed in order to more successfully encourage families to change.

Background: Integrated care is enhanced by integration on system, organizational, professional, and clinical levels including functional and normative integration. Many studies have been done on functional integration on these different levels, less studies focus on how normative integration takes place. In this study, we focus on the question: what differences in frames of refence must be addressed to establish consensus on appropriate care for People with Multiple Problems?Methods:A mixed-method Delphi study was carried out in which professionals and managers regularly involved in care for people with multiple problems (PWMPs) worked towards consensus on appropriate care delivery through the assessment of 15 vignettes representing real trajectories of PWMPs. Results:No consensus on appropriate care delivery was reached on any of the 15 vignettes. Five differences in perspective explained the dissensus: 1) an individual versus a systemic perspective on the client; 2) a focus on self-expressed needs of clients or professionally assessed (normative) needs; 3) client-directed or caregiver-directed care; 4) client as victim of circumstances or responsible for circumstances; 5) a focus on barriers or opportunities. Conclusions: In general, panelists agreed that care for PWMPs should be integrated. However, the further integrated care was to be operationalized in practice the greater the dissensus between panelists emerged. To understand how these differences in perspectives may be overcome to provide care for PWMPs normative integration needs to be studied during actual processes of care delivery.

OBJECTIVES: Although many studies have explored the benefits of support giving or receiving for older people, little is known about how the balance between giving and receiving instrumental support in nonrelative relationships affects home-dwelling older people. This study examines the relationship between long-term support balance and subjective well-being in relationships with nonrelatives among older people across 11 European countries. METHODS: A total of 4,650 participants aged 60 years and older from 3 waves of the Survey of Health and Retirement in Europe were included. Support balance was calculated as the intensity difference between support received and support given across 3 waves. Multiple autoregressive analyses were conducted to test the relationship between support balance and subjective well-being, as indicated by quality of life, depression, and life satisfaction. RESULTS: The impact of balanced versus imbalanced support on all subjective well-being measurements was not significantly different. Compared to balanced support, imbalanced receiving was negatively related to subjective well-being and imbalanced giving was not related to better subjective well-being. Compared to imbalanced receiving, imbalanced giving showed to be the more beneficial for all subjective well-being measures. DISCUSSION: Our results highlight the beneficial role of imbalanced giving and balanced support for older people compared to imbalanced receiving. Policies and practices should prioritize creating an age-friendly environment that promotes active participation and mutual support among older people, as this may be effective to enhance their well-being.

Background: Informal caregivers of people with dementia (PwD) living at home are often the primary source of care, and, in their role, they often experience loss of quality of life. Implementation science knowledge is needed to optimize the real-world outcomes of evidence-based interventions (EBIs) for informal caregivers. This scoping review aims to systematically synthesize the literature that reports implementation strategies employed to deliver home- and community-based EBIs for informal caregivers of PwD, implementation outcomes, and the barriers and facilitators to implementation of these EBIs. Methods: Embase, MEDLINE, Web of Science, and Cochrane Library were searched from inception to March 2021; included studies focused on “implementation science,” “home- and community-based interventions,” and “informal caregivers of people with dementia.” Titles and abstracts were screened using ASReview (an innovative AI-based tool for evidence reviews), and data extraction was guided by the ERIC taxonomy, the Implementation Outcome Framework, and the Consolidated Framework for Implementation Science Research; each framework was used to examine a unique element of implementation. Results: Sixty-seven studies were included in the review. Multicomponent (26.9%) and eHealth (22.3%) interventions were most commonly reported, and 31.3% of included studies were guided by an implementation science framework. Training and education-related strategies and provision of interactive assistance were the implementation strategy clusters of the ERIC taxonomy where most implementation strategies were reported across the reviewed studies. Acceptability (82.1%), penetration (77.6%), and appropriateness (73.1%) were the most frequently reported implementation outcomes. Design quality and packaging (intervention component suitability) and cosmopolitanism (partnerships) constructs, and patient’s needs and resources and available res

In this mixed methods case study we examined the relationship structure within an integrated dementia care (IDC) network and showed how personal and organisational interests can affect interorganisational cooperation. Our research was theory-driven and consisted of three phases: a Social Network Analysis (SNA) based on data from questionnaires (n=24-26), explorative interviews with network partners (n=14) and a focus group with network coordinators (n=7) to explore the conceptual generalisability of the single case of the IDC-network. The developed social networks graphs revealed that highly connected organisations are established care organisations that deliver case management, while smaller care organisations or welfare organisations tend to be more peripheral. Care-related, strategic, and financial interests influence the level of participation of organisations in the IDC-network, while personal intrinsic motivations determine a representative’s contribution to the network. Conflicting interests, especially clashing visions and financial interests, strongly influence the network structure. The results show that conflicting interests form a barrier to successfully realise the collective goal of an IDC-network, i.e., optimising the wellbeing of people with dementia and their informal caregivers in the region. Thus, IDC-networks should act to manage, resolve and prevent disputes arising from conflicting interests.

Dementia is one of the leading causes of death and disability among citizens and a societal challenge because of aging worldwide. As dementia has physical, psychological, social, material, and economic impacts, both research and care practice require many disciplines to develop and implement diagnostics, medical and psychosocial interventions, and support, crossing all domains of housing, public services, care, and cure. Notwithstanding large research efforts, much knowledge about mechanisms, interventions, and needs’ based care pathways is still lacking. To cope with these challenges in research and practice, this paper is the first to question how generalist and specialist orientations can be unfolded. In the Netherlands, all dementia professors (N = 44) at eight Dutch academic centers have been interviewed. Qualitative analyses revealed three subgroups of dementia professors, one with a generalist orientation, one adhering to specialist approaches, and a third group that pleas for mixed orientations, with some differences between research and care practice. Each group has arguments for its generalist/specialist vision, but the synthesis suggests a paradigm of personalized and integrated dementia care, aimed at the individual in his own living environment. Sustainable strategies to cope with dementia require (inter)national programs and strong collaboration to build multi- and interdisciplinarity within and between research and practice.

TreeContainment is a well-known problem within phylogenetics, which asks whether a binary phylogenetic tree is embedded in a binary phylogenetic network. For this problem, Jones, Weller and van Iersel (2022) have created an algorithm that uses dynamic programming on tree-decompositions to achieve a running time that is exponential in the tree-width parameter instead of in the number of reticulations. However, due to the implicit formulations of two crucial steps in this algorithm, this running time cannot be achieved in practice without finding ways to generate the required structures explicitly. This paper provides two new sub-algorithms that can do that. To further improve the performance of the algorithm, I introduce a number of criteria and other methods that can be used to reduce the number of structures generated. Additionally, I describe a way to manipulate the nice tree-decompositions to create a more favorable order of bags for the dynamic programming. These sub-algorithms and improvements are used by two new algorithms TWITCH and PITCH, whose implementations are compared to a brute force algorithm and a new branching cherry-picking algorithm named BOTCH. The latter has an FPT running time that is exponential in the number of vertices that have only reticulations as children. The comparisons show that the implementations of the dynamic programming algorithms TWITCH and PITCH are slower in practice than the brute force algorithm, despite their numerous improvements. Of the four new implementations, BOTCH has the best test results and it is shown to be fast in practice., Applied Mathematics

Until the 1980s, institutional elder care was virtually unknown in China. In a few decades, China had to construct a universal social safety net and assure basic elderly care. China’s government has been facing several challenges: the eroding traditional family care, the funding to assure care services for the older population, as well as the shortage of care delivery services and nursing staff. This paper examines China’s Five-Year Policy Plans from 1994 to 2020. Our narrative review analysis focuses on six main topics revealed in these policies: care infrastructure, community involvement, home-based care, filial piety, active aging and elder industry. Based on this analysis, we identified several successive and often simultaneously strategic steps that China introduced to contend with the aging challenge. In Western countries, elder care policies have been shifting to the home care approach. China introduced home care as the elder care cornerstone and encouraged the revival of the filial piety tradition. Although China has a unique approach, the care policies for the aged population in China and Western countries are converging by emphasizing home-based care, informal care and healthy aging.

Background: Neuropsychiatric symptoms occur frequently in many nursing home residents with dementia. Despite the availability of multidisciplinary guidelines, neuropsychiatric symptoms are often inadequately managed. Three proven effective methods for managing neuropsychiatric symptoms were integrated into a single intervention method: the STIP-Method, a personalized integrated stepped-care method to prevent and treat neuropsychiatric symptoms. The STIP-Method comprises 5 phases of clinical reasoning to neuropsychiatric symptoms and 4 stepped-care interventions and is supported with a web application. Objective: This study aims to identify the facilitators and barriers in the implementation of the STIP-Method in nursing homes. Methods: A mixed methods design within a participatory action research was used to implement the STIP-Method in 4 facilities of 2 Dutch nursing home organizations. In total, we aimed at participation of 160-200 persons with dementia and expected an intervention fidelity of 50% or more, based on earlier studies regarding implementation of effective psychosocial interventions to manage neuropsychiatric symptoms. All involved managers and professionals were trained in the principles of the STIP-Method and in using the web application. An advisory board of professionals, managers, and informal caregivers in each facility supported the implementation during 21 months, including an intermission of 6 months due to the COVID-19 pandemic. In these 6-weekly advisory board meetings, 2 researchers stimulated the members to reflect on progress of the implementation by making use of available data from patient records and the web application. Additionally, the 2 researchers invited the members to suggest how to improve the implementation. Data analysis will involve (1) analysis of facilitators and barriers to the implementation derived from verbatim text reports of advisory board meetings to better understand the implementation process; (2) analysis of p

Introduction: Cooperation is key to provide integrated dementia care. However, different kinds of (personal and organisational) interests will affect collaboration in integrated dementia care (IDC) networks. Hence, it is crucial to understand how interests influence relations in IDC-networks in order to shape future policies. Methods: A sequential mixed methods single case study design was used, in three phases: a Social Network Analysis (SNA) based on data from questionnaires (n = 24–26), explorative interviews with network partners (n = 14) and a focus group with network coordinators (n = 7) to explore the conceptual generalisability of the single case of the IDC-network. Results: The SNA revealed that highly connected organisations were often established care organisations that deliver case management, while smaller care organisations or welfare organisations tend to be less connected. Care-related, strategic, and financial interests influence participation of organisations in the IDC-network, while personal intrinsic motivations determine a representative’s contribution to the network. Especially conflicting interests strongly influence the network structure. Discussion and conclusion: We conclude that conflicting interests in IDC-networks stand in the way of reaching the collective goal of an IDC-network, i.e., optimising the wellbeing of people with dementia and their informal caregivers in the region. Thus, IDC-networks should act to manage, resolve and prevent disputes arising from conflicting interests.

Older persons are vulnerable to depression SFduring the ageing process. Financial resources and social participation are expected to have an impact on depressive symptoms. This study investigated the relationship between financial support from children and depression among Chinese older persons, as well as the mediating effect of social participation in this relationship. Data from 7163 participants aged 60 and above were extracted from wave 2015 and 2018 of the China Health and Retirement Longitudinal Survey (CHARLS). A multivariate regression analysis was performed on both cross-sectional data and two-wave longitudinal data to test our hypotheses. The results revealed that financial support from children was negatively associated with depressive symptoms in both the short-term and the long-term. In addition, this relationship was partially mediated by social participation in the short-term association and fully mediated by social participation in the long-term, where financial support was positively related to social participation, and social participation was negatively associated with depressive symptoms. This study offers an in-depth insight into the relationship between financial support from children and depression among Chinese older persons. Policies and initiatives to stimulate social participation should be promoted to improve older persons’ mental health.

Introduction Ageing in place, supported by formal home and community services and informal caregivers, is the most used long-term care option for people with dementia (PwD). Informal caregivers are inundated by their caregiving responsibilities and resultantly suffer consequences. Despite the multitude of clinical effectiveness studies on interventions that support informal caregivers, there is a paucity of information regarding their implementation process. This scoping review aims to identify the implementation strategies, implementation outcomes, and barriers and facilitators that impede or support the dissemination and uptake of interventions that support informal caregivers of PwD at home. Methods and analysis This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols, and the scoping review will follow the systematic steps of the PRISMA-Extension for Scoping Reviews guideline. The search strategy will include publications produced from inception to 8 March 2021 and will be conducted in the search engines Embase, Medline (Ovid), Web of Science and Cochrane Central Register of Controlled Trials (Wiley), followed by a three-stage approach. First, title and abstracts will be screened by two independent reviewers. Second, full-text articles will also be screened by both reviewers and, in case of disagreement, by a third reviewer. The first two stages are based on a set of inclusion and exclusion criteria. Reference lists of the final included studies will also be checked for relevant articles. Data from the final included studies will be extracted and synthesised using the Expert Recommendations for Implementing Change compilation and Proctor's implementation outcomes to ensure homogenous and standardised reporting of implementation information. Ethics and dissemination The review findings will be published in a peer-reviewed journal and disseminated at geriatric and implementation conferences to inform re