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

The present study focuses on elder abuse in the home care setting. The aim of this study was to explore home care nurses' definition, general perspectives and experiences of elder abuse, and the barriers they experience to avoid elder abuse. Individual qualitative interviews were held with Flemish home care nurses ( N  = 17), employed by a Dutch home nursing organization. Data analysis was performed using reflexive thematic analysis. Results showed that (1) participants' understanding of elder abuse was based on intuition and daily practice. (2) Participants highlighted several institutional barriers to avoid elder abuse. (3) The participating home care organizations did not have a standard protocol to report or handle elder abuse. Institutional structures, procedures and decisions should be critically reviewed as to how they lead to staff abusing older adults.

Compassionate communities are gaining momentum as a new public health approach emphasizing community support during times of serious illness, death, and bereavement. However, evidence on their development, particularly in higher education, is limited. This study investigates the development of a Compassionate University, examining the underlying processes and contextual factors shaping its development. A longitudinal process evaluation was conducted, using field notes right-now surveys, individual interviews, focus groups, and strategic learning debriefs. Factors that facilitated the development process included leadership support, the establishment of the Compassionate Schools Learning Network, and alignment with existing university programs. Barriers were the lack of guiding examples, the fragmented university environment, resource constraints, and limited prioritization. Cognitive and social processes that supported the work involved recognizing the value of Compassionate University and adapting implementation strategies based on empirical feedback. However, challenges such as building coherence, engaging stakeholders, and assessing the work hampered the development process.

This study investigates the impact of the overall intensity and changes in grandparental caregiving on loneliness in grandparents in European countries. Data from waves 5 to 8 of the Survey on Health, Ageing, and Retirement in Europe (SHARE) were used (N individuals = 30,896 and N observations = 48,562). We included grandparents (aged 50 years and over) with at least one grandchild at the beginning of the study. The analyses reveal that any intensity of grandparental care decreases the risk of loneliness. When looking at changes in grandparental care the results show that stable caregiving roles appeared to reduce loneliness, while starting to provide grandparental care makes grandparents more vulnerable to loneliness. In conclusion, our findings underscore that consistent grandparental care is important for grandparents in mitigating loneliness, highlighting the importance of sustained caregiving roles over fluctuations in caregiving intensity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: The guiding principle of current aging policies has been to promote older adults to live in their private homes, but little attention has been paid to social exclusion of older adults receiving home-based care. The aim of this study is to increase understanding on different patterns of multidimensional social exclusion among older adults receiving formal home care services, and through this to shed light on the possible challenges of current aging-in-place policies., Methods: The survey data were collected in 2022 among older adults aged 65 to 102 years receiving home care services in Finland and merged with administrative data (n = 733). A latent class analysis was used to identify different types of social exclusion. Multinomial logistic regression modeling examined factors associated with different social exclusion types., Results: Four social exclusion types were identified: (1) not excluded (16.9%), (2) homebound economically excluded (40.1%), (3) excluded from social relations (28.6%), and (4) multidimensionally excluded (14.3%). Poor self-rated health and poor functional ability significantly increase the risk of being multidimensionally excluded or homebound economically excluded. The group using home care and medical services the most are the most multidimensionally excluded. The group living in urban areas are more likely to be excluded from social relations., Discussion: Different types of social exclusion should be acknowledged when addressing social exclusion among home care clients. Enhanced measures should be developed to support older adults using home and healthcare services the most, as they are at high risk of severe exclusion., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Background: Compassionate communities have been put forward as a promising model for community-based support for people facing serious illness, caregiving, dying, and loss. In particular, educational institutions are increasingly acknowledged as potential settings to function as compassionate schools and compassionate workplaces, cultivating acceptance and validation of these experiences beyond the university setting., Objectives: This paper investigates the activities and outcomes of a compassionate community initiative-the Compassionate University program at the Vrije Universiteit Brussel in Belgium., Design: Ripple Effects Mapping was used to guide the focus group and individual interviews conducted with core team members responsible for the development and implementation of the Compassionate University program., Methods: During the focus group and individual interviews, the core team members reflected on the program contributions, with their narratives visually depicted via a hand-drawn mind map. Qualitative data derived from this mind map were entered into XMIND mapping software and fine-tuned based on the focus group and individual interview transcripts and additional project records., Results: Thematic analysis identified four outcome areas that encapsulate the key contributions of the Compassionate University program: (i) increased acceptance and integration of topics such as serious illness, death, and bereavement into existing practices; (ii) broader support for and formalization of compassionate procedures and policies; (iii) emergence of informal networks and internal collaboration on the topics; and (iv) diffusion of compassionate ideas beyond the university., Conclusion: The Compassionate University program facilitates a cultural shift within the university environment, fostering greater acceptance of integrating topics such as serious illness, death, and bereavement into existing practices. Additionally, compassionate procedures and policies for students and staff have been formalized, and core team members are increasingly called upon to provide support on these matters. Notably, Compassionate University stands out as one of the pioneering initiatives in Europe, attracting different educational institutions seeking guidance on cultivating a more compassionate environment., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2024.)

People in need of care and support do not always find appropriate services. This paper aims to explore the content and added value of monthly follow-up telephone calls after preventive home visits. We used both monitoring data and qualitative semi-structured interviews (with older adults, formal and informal caregivers). Results indicate that a majority of older adults ( N  = 95) received a regular follow-up of four telephone calls. Social connection and involvement were mentioned by all three groups as positive aspects of the program. Although time-consuming, this paper draws attention to the added value of follow-up telephone calls after preventive home visits.

Serious illness, death, and bereavement are common experiences within the work and study context. This study aims to explore the experiences and support needs of university students and staff confronted with serious illness, death, and bereavement. Semi-structured interviews and focus groups were conducted with 21 students and 26 staff. A thematic analysis resulted in three overarching themes: the university as a high-pressure environment; navigating the complex university information and support system; and disenfranchized grief. Four themes were identified in terms of what participants needed from the university: clear processes and procedures; flexibility in policy application; proactive support and recognition; and activities to enhance awareness and interpersonal communication skills. Findings from this study could enable higher education institutions to become more compassionate schools and workplaces.

Background: In recent years, there has been a rise in international (care) movements that prioritise community-centred initiatives such as age-friendly communities, compassionate communities or integrated community care. Although these movements have different focal points, they share common features: seeking to address systemic failures in (care) services, value the participation of end-users, focus on unmet (care) needs, through a local, neighbourhood-oriented approach. In the Flemish and Brussels regions notably the concept of Caring Neighbourhoods is experiencing rapid growth., Objectives: The objective of the present study is to examine the development and implementation of 35 Caring Neighbourhood initiatives in Flanders and Brussels (Belgium) to explore the added value of such projects, as well as the crucial elements for creating Caring Neighbourhoods., Design: Thirty-five caring neighbourhood projects were examined by means of five focus group interviews with project coordinators ( n  = 34) and five focus group interviews with neighbourhood residents ( n  = 27), using participant-generated photo elicitation., Methods: The focus group sessions were recorded, transcribed and data were labelled using an inductive analytical framework, following the steps of reflexive thematic analysis., Results: The analysis of the 35 Caring Neighbourhoods showed that fostering connections was key in building Caring Neighbourhoods: connections among residents, connections between residents and care and support services and among care services themselves. The three primary ways to connect people were through activities, places and people. Also, the role of the Caring Neighbourhood coordinator is highlighted as key, which should focus on weaving existing resources, facilitating and coaching instead of organising. Altogether, the projects brought meaning and value to participants' lives, enhancing overall life satisfaction and well-being, with an emphasis on physical and psychosocial care and support., Conclusion: Through critically reflecting on our results and other research, we call on researchers to pay increased attention in research on community-centred care initiatives to death, dying and grief, equity and social justice and the need for both warm and cold solidarity., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2024.)

Objectives: The aim of this systematic review and meta-analysis is to assess the prevalence of loneliness in many countries worldwide which have different ways of assessing it., Design: Systematic review and meta-analysis., Setting: We searched seven electronic databases for English peer-reviewed studies published between 1992 and 2021., Participants: We selected English-language peer-reviewed articles, with data from non-clinical populations of community-dwelling older adults (>60 years), and with "loneliness" or "lonely" in the title., Measurements: A multilevel random-effects meta-analysis was used to estimate the prevalence of loneliness across studies and to pool prevalence rates for different measurement instruments, data collection methods, and countries., Results: Our initial search identified 2,021 studies of which 45 ( k = 101 prevalence rates) were included in the final meta-analysis. The estimated pooled prevalence rate was 31.6% ( n = 168,473). Measurement instrument was a statistically significant moderator of the overall prevalence of loneliness. Loneliness prevalence was lowest for single-item questions and highest for the 20-item University of California-Los Angeles Loneliness Scale. Also, differences between modes of data collection were significant: the loneliness prevalence was significantly the highest for face-to-face data collection and the lowest for telephone and CATI data collection. Our moderator analysis to look at the country effect indicated that four of the six dimensions of Hofstede also caused a significant increase (Power Distance Index, Uncertainty Avoidance Index, Indulgence) or decrease (Individualism) in loneliness prevalence., Conclusions: This study suggests that there is high variability in loneliness prevalence rates among community-dwelling older adults, influenced by measurement instrument used, mode of data collection, and country.

Objectives: The aim of this study is to increase the understanding of loneliness experienced as positive, by exploring the demographic and situational characteristics of older people who experience loneliness as positive., Method: Two binary logistic regressions were conducted using data from those aged 60+ from the BBC Loneliness Experiment ( N  = 5250)., Results: The first binary logistic regression compared participants who experience loneliness always as positive ( N  = 219) to those participants who never experience loneliness as positive ( N  = 3004). Spending time alone did not emerge as relevant to experiencing loneliness as positive, but enjoying time alone was important (OR = 1.561 (95% CI = 1.313 - 1.856)). The lonelier older people were, the less likely they experienced loneliness as positive (OR = 0.708 (95% CI =0.644 - 0.779)). Men were more likely to experience loneliness as positive compared to women (OR = 1.734 (95% CI = 1.269 - 2.370)). Lastly, the experience of loneliness as positive was likely to decrease when older people had more years of education (OR = 0.887 (95% CI = 0.853 - 0.921)) but increased with age (OR = 1.067 (95% CI = 1.037 - 1.098)). The results of the second binary logistic regression comparing participants who indicated loneliness purely as positive with those participants indicate to experience loneliness sometimes as positive ( N  = 2027), are in line with the first regression analyses., Conclusion: The results are critically discussed by emphasizing the role of norms and cultures, gerotranscendence, and severity of loneliness, which might influence the experiences of loneliness. Further qualitative research is needed to elucidate the meanings of these positive experiences of loneliness.

Aims and Objectives: The aim of this study was to identify the barriers and facilitators experienced by healthcare professionals while caring for patients with a migration background., Background: People with a migration background often face several structural inequalities and barriers in terms of accessibility to, and affordability of, healthcare. In order to provide quality care for patients with a migration background, it is important to understand which barriers healthcare professionals experience that prevent them from providing care and which factors can facilitate this., Design and Methods: Qualitative research following the COREQ criteria. A total of six focus groups (n = 37) and 12 individual interviews were conducted with a multidisciplinary sample: doctors, nurses, social workers, and occupational therapists. Nursing and medical students were also included. Thematic content analysis was used., Results: Key findings suggest that the main barrier is that healthcare professionals regard people with a migration background as "the other". Healthcare professionals do not feel secure or competent to provide care for these "others." According to the healthcare professionals, the hospital structures-and, particularly, the managerial instances-appear to be only slightly supportive. Structural barriers at the level of the healthcare system, such as limited implementation of care coordination and austerity measures (time pressure or economic restrictions), were also perceived as barriers. Facilitators can be the healthcare professionals' attitude or the flexibility of the management., Conclusions: Healthcare professionals experience barriers in caring for people with a migration background. Othering plays a key role in building or maintaining several barriers. A multilevel approach is necessary to tackle these barriers and enable facilitators., Relevance to Clinical Practice: Raising awareness about "othering" in the educational programs of students and healthcare professionals is essential. Also, deploying support mechanisms and valuing the competences of multicultural and multi-lingual healthcare professionals can help facilitate quality care for patients with a migrant background., Patient or Public Contribution: Patients, informal and formal caregivers participated in the study at several stages (e.g.: by involving them during the research design phase or providing feedback and input at specific moments across the study). In addition, community participants played a key role also during the research design and data analysis phases as well as by facilitating patients' recruitment., (© 2022 John Wiley & Sons Ltd.)

Background: Compassionate Communities have been put forward as a new model for community-based palliative care to positively impact the health and wellbeing of those experiencing challenges of serious illness, death, dying, and loss. Despite the growing international movement to develop these public health initiatives to end-of-life care, only a handful of initiatives have undergone some form of evaluation., Aim: To provide guidance on designing evaluation research by identifying theoretical frameworks to understand the development, implementation, and underlying mechanisms of Compassionate Communities., Methods: To identify suitable theoretical frameworks for the study of Compassionate Communities, we applied two steps. The first step examined the characteristics of Compassionate Communities and translated them into assessment criteria for the selection of theoretical frameworks. The second step consisted of applying the identified assessment criteria to a list of widely used and highly cited theoretical frameworks., Results: Three well-established theoretical frameworks were identified as being most suitable to study the development, implementation, and underlying mechanisms of Compassionate Communities: The Consolidated Framework for Implementation Research (CFIR), the integrated-Promoting Action on Research Implementation in Health Services framework (i-PARIHS), and the Extended Normalization Process Theory (ENPT)., Conclusions: The article supports and encourages the use of theoretical frameworks to evaluate the complex processes behind public health palliative care initiatives. The complementary use of two determinant frameworks and an implementation theory provides theoretical grounding to gain rich insights into the emergent and shifting interplays between agency, social processes, and contextual factors that shape the development and implementation of Compassionate Communities.

This study aimed to understand whether older adults not only received but also provided help during the first COVID-19 lockdown in Belgium, which factors motivated them to help, and whether older adults differed from younger age groups in terms of helping behavior and motives. Bivariate analyses were performed using data generated from an online cross-sectional survey in Belgium ( N = 1892 ).The results showed that older adults who received help also provided it. This "interdependence" - mutual or reciprocal dependence - occurred regardless of age. In terms of motives for providing help, both older adults and their younger peers were primarily motivated by present-oriented and emotion-related motivation: older people were motivated to provide help by altruistic values and humanism, and enhancement motives linked to self-development.Policy implications of these results entail: during crisis situations, make use of the bond between older adults and their neighbors, such as caring communities.

Background: As people age, the risk of becoming frail increases, often leading to negative outcomes and less well-being. Within the light of prevention, early detection and guidance to the right care and support is crucial. This study aimed to give an overview of the descriptive results of the D-SCOPE program and evaluate the process., Methods: The D-SCOPE program was developed as a detection and prevention program for frail community-dwelling older adults. The program creates a continuum of care and support, consisting of 6 steps: (1) Targeted case-finding using risk profiles for purposeful selection, (2) Preventive home-visit by an older volunteer, (3) Home visits by a professional, (4), Warm referral, (5) Monthly follow-up and (6) Long-term follow-up by home visit. The effectiveness of this program, in terms of satisfaction and meaningfulness, was studied quantitatively by means of a randomized controlled trial amongst 869 people with a frailty risk profile and qualitatively by 15 focus groups interviews., Results: The quantitative study revealed that 83.9% of the participants found the different home visits within the D-SCOPE program useful. The focus group interviews shed light on several issues and advantages: a more efficient case finding due to the applied risk factors for frailty, a more intensive tailor-made care and support due to the warm referral, the importance of both small-scaled and larger interventions based on the wishes irrespective of the state of frailty of the older persons, the focus on a strengths-based instead of a deficit-based approach and the follow up as being one of the greatest strengths of the project. However, to fully understand the benefits of the program a shift in mind from intervention to prevention is necessary., Conclusions: Our quantitative data show that most participants found the home visits meaningful and were satisfied with the intervention. The qualitative findings provided more insights into the experiences of the participants with the process. Based on these insights of the 6-step model of preventive home visits, municipalities and organizations can apply this model to carry out more targeted home visits., Trial Registration: This trial was registered at ClinicalTrials.gov, on 30/05/2017, identifier: NCT03168204., (© 2022. The Author(s).)

Compassionate Communities are places and environments in which people, networks, and institutions actively work together and are empowered to improve the circumstances, health, and well-being of those facing serious illness, death, dying, and loss. The study of their development, implementation, and evaluation requires an interdisciplinary research approach that has hitherto been lacking. In 2020, 8 research groups from 4 faculties at Vrije Universiteit Brussel united in the interdisciplinary Compassionate Communities Center of Expertise (COCO) to investigate Compassionate Communities. This article describes the first results of COCO: (a) an interdisciplinary mode of collaboration, (b) a shared conceptual understanding and definition of Compassionate Communities, and (c) a shared research agenda on Compassionate Communities., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The aim of the present study is to describe a stepwise approach to study which contextual factors might moderate the effect of healthcare interventions and to test feasibility of this approach within the D-SCOPE project., Design: Exploratory case study., Setting: In the D-SCOPE project, a complex intervention by means of home visits was set up to improve access to tailored care in three municipalities (Ghent, Knokke-Heist and Tienen)., Methods: One designed and tested an approach including five steps: (1) a theoretical/conceptual discussion of relevant contextual factor domains was held; (2) a search was done to find appropriate web-based public datasets which covered these topics with standardised information; (3) a list of all identified contextual factors was made (inventory); (4) to reduce the long list of contextual factors, a concise list of most relevant contextual factors was developed based on the opinion of two independent reviewers and (5) a nominal grouping technique (NGT) was applied., Results: Three public web-based datasets were found resulting in an inventory of 157 contextual factors. After the selection by two independent reviewers, 41 contextual factors were left over and presented in a NGT which selected 10 contextual factors. The NGT included seven researchers, all familiar with the D-SCOPE intervention, with various educational backgrounds and expertise and lasted approximately 1 hour., Conclusion: The present study shows that a five-step approach is feasible to determine relevant contextual factors that might affect the results of an intervention study. Such information may be used to correct for in the statistical analyses and for interpretation of the outcomes of intervention studies.NCT03168204., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This qualitative study investigates through a realist evaluation how the work training programme of 10 community health workers (CHWs) contributed to culturally competent home care services. A European Social Fund project trained 10 jobseekers with migration backgrounds to become CHWs in Brussels (Belgium). Three research questions were formulated: (a) What increase in the cultural competence of the home care organisations can be identified at the end of the project? (b) How did the training contribute to this increase? (c) Which factors and preconditions made the positive outcomes of the training more likely? This study analysed 10 mid-term interviews with individual CHWs in training and four focus groups at the end of the project with CHWs, care employees, trainers and project coordinators (N = 25). First, the results showed that the increase in cultural competence was located mostly on the surface structure of the organisation (e.g. adapting communication materials) and not in its deeper structure. Second, the principles of strengths-based education proved to be important during the training (e.g. getting to know, recognise and address the competences and skills of the CHWs). Third, contextual factors at the micro-level (e.g. interest in care and cultures), the exo-level (e.g. management culture) and the macro-level (e.g. policy regulations) could foster or hinder the process of increasing cultural competence. This paper concludes that although the project contributed to a shift in organisational culture towards cultural competence, it remains challenging to effect a similar shift in the deep structure of care organisations., (© 2021 John Wiley & Sons Ltd.)

This study used focus group interviews with 40 older Chinese long-term care residents to explore their motivators and barriers to social participation in institutional settings informed by their lived experience. Using inductive thematic analysis, we found that motivators include pursuit of healthy ageing (better physical and mental health) and pursuit of meaningful ageing (sense of achievement and being useful, increased connectedness and realization of dreams from earlier life). The reported barriers illuminate structural components such as life-course experiences, long-term care-related barriers and Chinese policy-related barriers. The discussion highlights the importance of understanding the multidimensionality of motivators and barriers to social participation. To promote healthy ageing among institutionalized residents, staff and policy makers are recommended to initiate and support meaningful activities for residents. Residents' individual dreams and accumulated life-course disadvantages experienced long before admission to long-term care should also be considered when devising effective interventions to increase residents' level of social participation., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Area-Based Compassionate Communities are community public health interventions which focus on the role of the community in palliative care provision. They apply a set of actions based on the Ottawa Charter for Health Promotion which aims to increase people's control over their health., Aim: To review and compare Area-Based Compassionate Communities with respect to their contextual characteristics, development processes and evaluations., Design: A systematic integrative review with narrative synthesis. Registered in Prospero: CRD42020173406., Data Sources: Five databases (Pubmed, Web of Science, PsycInfo, Embase and Scopus) were consulted, consisting of publications from 1999 onwards. This was supplemented with grey literature and author-provided documentation., Results: Twenty articles were drawn from the peer reviewed search, three from grey literature and two from author-provided documentation. Notwithstanding the substantial variation in what is reported, all Area-Based Compassionate Community initiatives focus on multiple action areas of the Ottawa Charter for Health Promotion. Variability in their contextual and developmental characteristics is high. Only a minority of initiatives have been evaluated and although conclusions are generally positive, what is evaluated often does not match their aims. Attaining support from policy makers can help in obtaining funding early in the project. Strengthening people's social networks was a recurring community engagement strategy., Conclusions: While the concept of Area-Based Compassionate Communities is gaining momentum as a new paradigm for the creation of palliative care capacity across society, only a handful of initiatives have been described. The lack of formal evaluations of their envisaged health benefits indicates a pressing need for rigorous research about ongoing and future initiatives.

Objectives: Although older adults often experience negative life events or loss experiences, they rarely experience large decreases in their quality of life or well-being. Emotionally satisfying relationships in older adults may serve as a protective factor that reduces the impact of negative events in decreasing well-being. The availability of these close social contacts is essential, and their potential for alleviating feelings of loneliness after negative events could have an important role in promoting well-being. The aim of this study was to test the hypothetical moderation and mediation effects of social and emotional loneliness on the occurrence of negative old-age life events and well-being in later life., Design: This was a cross-sectional survey conducted as part of the Detection, Support and Care for older people - Prevention and Empowerment research project (2015-2018)., Setting: Participants were community-dwelling older adults in Flanders (Belgium)., Participants: The sample composed of 770 participants aged 60 years and over., Measurements: Participant demographics, social and emotional loneliness, and subjective well-being were measured. Moderation and mediation analyses were performed using the regression-based approach as conducted by Hayes and Rockwood (2017)., Results: Results indicated that a low degree of (social) loneliness is a protective, moderating factor and (emotional) loneliness is a mediating factor on the effects of negative life events on well-being in later life., Conclusions: Findings highlight the importance of emotionally and socially satisfying social contacts in order to maintain positive subjective well-being in later life when negative life events may occur.

Background: Policymakers in several European countries, concerned about the sustainability of their pension system, have raised the statutory retirement age. While several studies investigated the effect of retirement on health, the relationship between retirement and frailty is neglected. Notwithstanding, frailty is associated with adverse outcomes., Objective: The aim of this study was to examine the relationship between age of retirement and frailty in later life., Methods: Data of the Belgian Ageing Studies, a cross-sectional research project was used. The present study includes N=12659 participants (>60y) in 83 Flemish municipalities. To address reverse causality, only participants not retired because of health-related reasons were included. The Comprehensive Frailty Assessment Instrument, a multidimensional frailty scale with four domains (physical, psychological, social and environmental) was used to operationalize frailty. Univariate general linear regression analyses (GLM) were performed for scores on the total frailty scale and the four subdomains separately. The analysis was done for men and women separately, since both groups have different labor trajectories., Results: The present study found a negative association between age of retirement and physical frailty for both men and women in later life, and total frailty for men, although the differences were small. No evidence was found for a relation between age of retirement and the other subdomains of frailty., Conclusions: The results suggest that age of retirement is not a clinically relevant predictor for frailty in later life. Differences within and between subpopulations (e.g., profession) can shed a new light on this relation., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

While activity participation in later life has attracted considerable attention from policymakers and scholars, indoor and outdoor engagement among older Chinese migrants in Europe is understudied. Using in-depth interviews with 21 older Chinese migrants in the Netherlands and seven in Belgium, this study is among the first to explore older Chinese migrants' activity participation experiences from the perspective of Confucianism, the cornerstone of Chinese culture. More specifically, the impact of four acknowledged principles of Confucianism are considered: hierarchical relationships, family system, benevolence and emphasis on education. The findings show that, like a double-edged sword, these four principles have positive and negative effects on older Chinese migrants' activity participation. Hierarchical relationships promote formal organisational participation, yet concurrently dividing the Chinese community into smaller subgroups and endangering solidarity within the community. With regard to family system, which emphasizes intergenerational responsibility and obligation, older Confucianist migrants prioritise taking care of their grandchildren, resulting in less time to participate in outdoor activities. Benevolence, the third principle of Confucianism, restrains older Chinese migrants from political participation while encouraging them to attend community meetings where food is shared. Lastly, emphasis on education, of which self-cultivation is an important aspect, helps older Chinese migrants overcome feelings of loneliness and makes them prefer self-learning activity above formal learning settings (e.g. language learning) organised by the government. The article ends with policy recommendations on how to increase older Chinese migrants' outdoor activities., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Research highlights that patients from ethnic minority groups often receive lower quality of care. This study contributes to the knowledge and understanding of culturally sensitive care and explores health care professionals' definitions and perceptions of this concept and how they deliver this in practice., Method: This qualitative study conducted a total of six focus groups ( n = 34) and four in-depth interviews with six categories of health care professionals in Belgium. Thematic content analysis was used., Results: The results indicate that the concept of culturally sensitive care is perceived quite narrowly. Professionals are likely to portray their own frame of reference and find it challenging to show empathy with patients with a different background. Othering (micro-racism by defining "the other") is a powerful example., Discussion: The discussion reveals the significance of increasing cultural awareness and understanding, sensitizing about current narrow perceptions, and enhancing culturally sensitive care in the Belgian health care setting.

Older migrants may be one of the most vulnerable populations during the coronavirus pandemic, yet the degree of impact remains largely unknown. This study explores (1) the consequences of the coronavirus pandemic for older Chinese migrants in Belgium and the Netherlands in terms of increased loneliness and its risk factors (reduced in-person contact, decreased social participation, feelings of existential threat) and protective factors (increased non-in-person contact, more individual activities), and (2) which risk and protective factors have contributed to the incidence and prevention of higher loneliness levels. Using quantitative data of a survey among 98 Chinese migrants aged 50 years and older in Belgium ( n  = 84) and the Netherlands ( n  = 14), the findings first indicate that the coronavirus pandemic has a significant impact on older Chinese migrants' lives. One in five experienced more loneliness. Second, reduced social participation (measured as less frequent participation in outdoor group activities) and financial insecurity (measured as experiencing financial difficulties) lead to higher than pre-pandemic loneliness levels. Problem-focused coping strategies (measured as increased non-in-person contact, via telephone or social media) and emotion-focused coping (measured as finding distraction through increased participation in individual activities) were not found to protect against increased loneliness in the pandemic. Two practical implications for loneliness interventions for older Chinese migrants are put forward. Organizing COVID-19-safe social participation activities and paying more attention to older Chinese migrants' financial situation can be beneficial when addressing higher levels of loneliness due to the coronavirus pandemic., (© The Author(s), under exclusive licence to Springer Nature B.V. 2021.)

Objectives: Despite growing interest in the impact of physical and social environment on mental health, data are lacking on the potential mediating effects of loneliness. We examined it in the association of several social and physical environmental characteristics with mental health among older adults in three municipalities in Flanders (Belgium). Methods: A total of 869 people aged 60 and over were interviewed. Loneliness was assessed through the De Jong Gierveld short scales for emotional and social loneliness. Social participation and social cohesion were assessed following the Neighborhood scales whereas physical environment characteristics were selected from the Neighborhood Environment Walkability Scale. Mental health was assessed through subscale psychological frailty of the Comprehensive Frailty Assessment Instrument plus (CFAI-plus). Linear regression models, including mediation analysis, were used to analyze the survey data. Results: After adjusting for individual characteristics, physical and social environment factors were significantly related to mental health with the significant mediation of emotional and social loneliness. Percentages mediated by both dimensions together were 61% for social cohesion, 43% for social participation, 35% for safety and 25% for mobility. Compared with social loneliness, emotional loneliness was a stronger mediating factor, particularly for mobility and safety. No significant associations between traffic density or basic service availability and mental health were found. Discussion: Improving the social and physical environment might result in a reduction in the prevalence of loneliness and in consequent improvement of mental health among older adults. Special attention should be paid to different types of loneliness.

Population aging and international migration are two of the most critical social trends shaping the world today. As a result, scholars across the globe have begun to investigate how to better incorporate ethnicity into gerontological research. The integration of insights from life-course theory, post-colonial, and feminist theories have resulted in valuable attempts to tackle issues related to ethnicity and old age. Inspired by these bodies of research, this paper explores how decolonial perspectives can strengthen social gerontological research at the intersection of ethnicity and old age. This theoretical paper advances four key insights drawn from decolonial perspectives that expose some current blind spots in gerontological research at the intersection of aging and ethnicity. Through a process of awareness and resistance decolonial perspectives reveal that: 1) colonial thinking is deeply embedded in research; 2) critical reflection about who is considered the "knower" in research is warranted; 3) alternative ways to generate, analyze, and publish knowledge exist; and 4) the places and systems of knowledge production are not neutral. To address these issues empirically, decolonial frameworks call us to actions that include decolonizing the conceptual underpinnings of the research enterprise, scholars themselves, research-in-action (through "epistemic disobedience"), and current knowledge systems and structures that reflect and reinforce colonialism. Potential applications of these insights are explored, but acknowledged as an essential first step on a nascent path. This paper concludes by arguing that decolonial perspectives offer a more genuine gaze by demanding nuanced reflections of contemporary realities aging persons embodying the intersection of aging and ethnicity, like racialized older migrants and ethnic minorities, while simultaneously revealing how historically-rooted power hierarchies that are often invisible constrain their aging experiences., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Butyricimonas virosa is a Gram-negative rod who was first identified in rat faces in 2009. Since then only six human infections have been described in literature of which five bacteremia and one bone abscess. We report a clinical case of a subcutaneous infection mimicking necrotizing fasciitis due to B. virosa., Patient and Methods: A 78-year-old man was referred to our hospital because of a wound infection at the surgical site with suspicion of necrotizing fasciitis. Treatment consisted of immediate surgical exploration with obtainment of intra-operative specimens for microbiologic examination, 15 d of negative pressure wound therapy (NPWT) and antibiotic treatment with piperacillin-tazobactam (12 d) plus vancomycin (9 d)., Results: Surgical exploration did not show necrotising fasciitis but a subcutaneous infection mimicking necrotising fasciitis. The results of the intra-operative specimens revealed the presence of B.virosa and Finegoldia magna. Cultures taken during the NPWT replacements became negative and the patient was able to leave the hospital after 18 d., Conclusions: Considering there was no necrotizing infection present it may have been possible to safely close the wound sooner. However, it is difficult to differentiate between an actual necrotizing fasciitis and a subcutaneous infection mimicking necrotizing fasciitis. Therefore further studies on effective assessment tools to diagnose necrotizing fasciitis, such as the (modified) laboratory risk indicator for necrotizing fasciitis (LRINEC) score and enhanced computed tomography (CT), could be helpful.

Objectives: The advantages of social participation for older adults are well established and have been adopted in aging policy frameworks. However, little is known about the social participation of frail older adults. This research examined the types of social interaction of very frail older adults and the factors influencing this participation., Method: Interviews with 38 very frail older adults were analyzed using Levasseur and colleagues' (Levasseur, Richard, Gauvin, & Raymond (2010). Inventory and analysis of definitions of social participation found in the aging literature: Proposed taxonomy of social activities. Social Science and Medicine (1982), 71, 2141-2149) taxonomy activity levels of involvement with others. A qualitative hybrid approach with inductive and deductive thematic analyses was used., Results: Participants often disengaged from activities with high involvement with others, preferring activities with less involvement. Low-key participation emerged as an important type of social participation enabling frail older adults to remain engaged in society. Key factors that influenced social participation were functional decline, and the physical (e.g., traffic, the disappearance of local stores) and social environment (e.g., social networks and the presence of meeting places such as community centers)., Discussion: Findings advance our knowledge and recognition of the different ways frail older adults participate in society. Despite their frailty, older adults wish to stay socially active. Focusing on the social environment in the frameworks and policies of Age-Friendly Cities and Communities will benefit these individuals., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a systemic inflammatory process predominantly affecting upper and lower respiratory tract and kidneys. Valvular heart disease is a rare manifestation of GPA., Case Summary: We report two cases of acute valvular heart disease mimicking acute endocarditis caused by GPA. Both patients were middle-aged females with acute aortic valve regurgitation suggestive of possible infective endocarditis. In their recent medical history, atypical otitis and sinusitis were noted. The first patient was admitted with heart failure and the second patient because of persisting fever. Echocardiogram revealed severe aortic regurgitation with an additional structure on two cusps, suggestive of infective endocarditis in both patients. Urgent surgical replacement was performed; however, intraoperative findings did not show infective endocarditis, but severe inflammatory changes of the valve and surrounding tissue. In both patients, the valve was replaced by a prosthetic valve. Microscopic examination of the valve/myocardial biopsy showed diffuse acute and chronic inflammation with necrosis and necrotizing granulomas, compatible with GPA after infectious causes were excluded. Disease remission was obtained in both patients, in one patient with Rituximab and in the other with Glucocorticoids and Cyclophosphamide. Both had an uneventful follow-up., Discussion: Granulomatosis with polyangiitis can be a rare cause of acute aortic valve regurgitation mimicking infective endocarditis with the need for surgical valve replacement. Atypical ear, nose, and throat symptoms can be a first sign of GPA. Symptom recognition is important for early diagnosis and appropriate treatment to prevent further progression of the disease., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background and Aim: Caregivers in the home environment have an important role in timely detecting and responding to abuse. The aim of this review was to provide insight into both the existing tools for the assessment of and interventions for elder abuse by formal and informal caregivers in the home environment, and to categorize them according to a public health perspective, into primary, secondary, tertiary or quaternary prevention., Methods: We selected the assessment tools and interventions that can be used by caregivers in the home environment included in previous reviews by Gallione et al (2017) and Fearing et al (2017). To identify published studies after these reviews, a search was performed using PubMed, Cochrane Database, CINAHL and Web of Science., Results: In total, fifteen assessment tools and twelve interventions were included. The number of assessment tools for elder abuse for use in the home environment is increasing; however, tools must be validated over different cultures and risk groups. In addition, the tools lack attention for the needs of vulnerable older persons such as persons with dementia. Existing interventions for caregivers in the home environment lack evidence for addressing elder abuse and do not address potential adverse effects (quaternary prevention)., Conclusion: Assessment tools for elder abuse need further testing for validity and reliability for use by caregivers in the home environment. For interventions, meaningful outcome measures are needed. Important to note is that quaternary prevention requires more attention. This argues for taking into account perspectives of (abused) older persons and caregivers in the development of assessment tools and interventions protocols., Competing Interests: Liesbeth De Donder reports the following as it might give an appearance of potential influence: the paper/literature review has found fifteen assessment tools that met our inclusion criteria of which four were not included in the systematic review by Gallione et al. These four instruments are discussed and one of these four is the Risk on Elder Abuse and Mistreatment Instrument (REAMI) of which I am the developer/first author of the validation paper (De Donder et al, 2018). The authors report no other potential conflicts of interest in this work., (© 2020 Van Royen et al.)