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This systematic review aimed to provide an overview of reablement interventions according to the recently published ReAble definition and their effect on Activities of Daily Living (ADL). In addition, the most common and promising features of these reablement interventions were identified. Four electronic bibliographic databases were searched. Articles were included when published between 2002 and 2020, which described a Randomised or Clinical Controlled Trial of a reablement intervention matching the criteria of the ReAble definition, and had ADL functioning as an outcome. Snowball sampling and expert completion were used to detect additional publications. Two researchers screened and extracted the identified articles and assessed methodological quality; discrepancies were resolved by discussion and arbitration by a third researcher. Twenty relevant studies from eight countries were included. Ten of these studies were effective in improving ADL functioning. Identifying promising features was challenging as an equal amount of effective and non-effective interventions were included, content descriptions were often lacking, and study quality was moderate to low. However, there are indications that the use of more diverse interdisciplinary teams, a standardised assessment and goal-setting method and four or more intervention components (i.e. ADL-training, physical and/or functional exercise, education, management of functional disorders) can improve daily functioning. No conclusions could be drawn concerning the effectiveness on ADL functioning. The common elements identified can provide guidance when developing reablement programmes. Intervention protocols and process evaluations should be published more often using reporting guidelines. Collecting additional data from reablement experts could help to unpack the black box of reablement.

This systematic review aimed to provide an overview of reablement interventions according to the recently published ReAble definition and their effect on Activities of Daily Living (ADL). In addition, the most common and promising features of these reablement interventions were identified. Four electronic bibliographic databases were searched. Articles were included when published between 2002 and 2020, which described a Randomised or Clinical Controlled Trial of a reablement intervention matching the criteria of the ReAble definition, and had ADL functioning as an outcome. Snowball sampling and expert completion were used to detect additional publications. Two researchers screened and extracted the identified articles and assessed methodological quality; discrepancies were resolved by discussion and arbitration by a third researcher. Twenty relevant studies from eight countries were included. Ten of these studies were effective in improving ADL functioning. Identifying promising features was challenging as an equal amount of effective and non-effective interventions were included, content descriptions were often lacking, and study quality was moderate to low. However, there are indications that the use of more diverse interdisciplinary teams, a standardised assessment and goal-setting method and four or more intervention components (i.e. ADL-training, physical and/or functional exercise, education, management of functional disorders) can improve daily functioning. No conclusions could be drawn concerning the effectiveness on ADL functioning. The common elements identified can provide guidance when developing reablement programmes. Intervention protocols and process evaluations should be published more often using reporting guidelines. Collecting additional data from reablement experts could help to unpack the black box of reablement.The online version contains supplementary material available at 10.1007/s10433-022-00693-3.

Objectives:To explore and compare the experiences of care home visits during the pandemic in the UK and the Netherlands.Design:Qualitative semi-structured interview studiesSetting and Participants:Family carers of relatives residing in care homes in the UK and the Netherlands were interviewed remotely.Methods:Family carers were asked about their experiences of care home visits during the pandemic, and specifically in the Netherlands after care homes had reopened. Transcripts were analyzed in each country separately in the native language using thematic analysis, before discussing findings at multiple analysis meetings.Results:Across 125 interviews, we developed four themes: (1) different types of contact during lockdown; (2) deterioration of resident health and well-being; (3) emotional distress of both visitors and residents; and (4) compliance to guidelines and regulations. Visiting in both the UK and the Netherlands was beneficial, if possible in the UK, yet was characterized by alternative forms of face-to-face visits which was emotionally distressing for many family carers and residents. In the Netherlands, government guidance did enable early care home visitation, while the UK was lacking any guidance leading to care homes implementing restrictions differently.Conclusions and Implications:Early and clear guidance, as well as communication, is required in future pandemics, and in this ongoing pandemic, to enable care home visits between residents and loved ones. It is important to take learnings from this global pandemic to reimagine long-term care, highlighting the value of socializing for care home residents.

Purpose: We aimed to identify assistive technologies that are promising for addressing loneliness in people living with dementia in long-term care. Materials and methods: A scoping review was conducted. EBSCO, PubMed, Cochrane Library, and ProQuest were searched from 2000 to 2020. The included studies were selected by three independent researchers and summarised, compared, and categorized according to technology type. Publications were eligible for inclusion when they reported on psychosocial interventions aiming to reduce loneliness and/or social isolation in people with dementia in long-term care settings. Results: Twenty-four papers were included (20 original research papers and four reviews). Most studies were conducted in Australia and Europe. The studies aimed to investigate two different types of assistive technology: social robots, and multimedia computer systems. Most studies focussed on behaviour, engagement, and mood as primary outcomes. Only one study directly aimed to alleviate loneliness. Conclusions: Even though only one study addressed loneliness directly, it became clear that assistive technologies used to apply psychosocial interventions have the potential to impact loneliness in people with dementia in long-term care. However, it remains unclear why loneliness was not included as an outcome and how loneliness could become a key outcome in evaluating assistive technologies.IMPLICATIONS FOR REHABILITATION Loneliness among older adults is associated with health risks, such as the development of dementia, depression, and increased mortality. Ambient Assisted Living (AAL) technologies have been studied to address loneliness for older adults; however people with dementia are often excluded from such studies. This diverse group of technologies is shown to have a promising impact on outcomes, such as social engagement, quality of life, and mood, but loneliness was studied less often. More research is needed to discover the potential of assistive technologies for people with dementia living in long-term care.

Green Care Farms (GCF) are innovative long-term care environments and an alternative to regular nursing homes in the Netherlands. Following a culture change movement, GCFs have radically altered the care environment. Research suggests positive effects on residents. However, knowledge is limited regarding their physical, social and organizational environment. This article explores the care environment of 24-h GCFs for people with dementia and its impact on residents and their daily life. An ethnographic study using mixed methods was carried out at a GCF in the Netherlands between June and October 2021. Researchers lived on the GCF and completed 28 days of participatory observations in three groups. During the day, informal conversations were held with residents (n = 48), staff and family members. Twenty four semi-structured interviews were conducted with residents, their family members, staff and the managers, complemented by a focus group with staff. The physical environment was additionally assessed with the OAZIS-dementia tool. Data collection methods informed each other. Qualitative data was thematically analyzed, quantitative data descriptively. Four themes were identified as crucial during daily life on the GCF: stimulating the senses, engaging in purposeful activities, sharing responsibilities and creating a community in a new home. Realizing these topics in practice, physical, social and organizational environmental components were highly interrelated. The physical environment encouraged and facilitated meaningful in-/outdoor activities and social encounters. The organizational environment supported the use of the physical environment by aligning processes and transporting the vision. The social environment focused on collaboration and creating a home-like atmosphere by including residents in household- and farm chores. This community-building led to more meaningful activities and social interaction. In conclusion, this study revealed the central influence of the management in paving the way for a new form of care delivery. As leaders shape the three environments, the organization influences the design of the physical environment and the actions taking place within it. By creating a community, the care home benefits residents, their families and staff equally. The conscious interrelation and harmonization of the physical, social and organizational components of a long-term care environment has the potential to improve the daily life of residents.

A qualitative study was conducted to examine the experiences of informal caregivers of persons with dementia pertaining interprofessional collaboration with and among healthcare professionals in home care (HC), nursing homes and during home to nursing home transitions in palliative care. Semi-structured interviews were performed with bereaved informal caregivers. Data were analysed using a critical realist approach. The two main themes that emerged were: ( 1) Informal caregivers’ roles in interprofessional collaboration with healthcare professionals and ( 2) Informal caregivers’ perception of interprofessional collaboration among healthcare professionals. Informal caregivers’ roles were identified in three collaboration processes: information exchange, care process and shared decision-making. Interprofessional collaboration among healthcare professionals was more perceptible on the collaboration outcome level (e.g. being up to date with the health status of the person with dementia; acting proactive, being adequate and consistent in the care process; and giving a warm welcome) than on the collaboration processes level (e.g. communicating and being involved in team processes). Our study revealed that intrinsic and extrinsic factors and interprofessional collaboration among healthcare professionals affected informal caregivers’ collaborative roles. In summary, our study showed that informal caregivers have important roles as team members in the continuity and quality of palliative care for persons with dementia.

Background: Care home residents are often passive and lack active engagement in meaningful activities. The aim of this qualitative study was to co-develop a plan for a meaningful garden space in an urban care home in the north of England, to inform the subsequent building of such a garden space on the care home premises. Methods: Members of staff participated in focus groups conducted at the care home. Family carers were interviewed by telephone. Both focus groups and interviews were audio-recorded, with transcripts analysed independently using thematic analysis by two researchers, and consensus achieved on final themes. Findings: Two focus groups with staff (n = 17) and seven interviews with family carers were held. Thematic analysis generated seven key themes for the garden about its meaning and environmental features: (1) Current opinions on physical environment; (2) access; (3) adaptation to the environment; (4) staffing; (5) socialising; (6) sensory features; and (7) active meaningful participation. The garden needed to be accessible to residents in wheelchairs, and in all weathers and seasonal conditions, as well as being adapted to the needs of people living with dementia. Areas for social activities, such as picnics, and intergenerational activities, as well as private spaces, were recommended. Throughout the garden, sensory features were suggested, incorporating the use of vision, smell, touch, and sound, such as through water features. Moreover, it was recommended that residents should be able to contribute to the delivery of the activities themselves, including through a café and a vegetable garden. Conclusions: Family carers and staff considered that the garden would benefit from an intensive update to meet the needs of residents. This study therefore has practical implications for care home design, which are of even greater importance since the pandemic, as outdoor spaces were considered safer for care home visiting.

One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature.

Purpose We aimed to identify assistive technologies that are promising for addressing loneliness in people living with dementia in long-term care. Materials and methods A scoping review was conducted. EBSCO, PubMed, Cochrane Library, and ProQuest were searched from 2000 to 2020. The included studies were selected by three independent researchers and summarised, compared, and categorized according to technology type. Publications were eligible for inclusion when they reported on psychosocial interventions aiming to reduce loneliness and/or social isolation in people with dementia in long-term care settings. Results Twenty-four papers were included (20 original research papers and four reviews). Most studies were conducted in Australia and Europe. The studies aimed to investigate two different types of assistive technology: social robots, and multimedia computer systems. Most studies focussed on behaviour, engagement, and mood as primary outcomes. Only one study directly aimed to alleviate loneliness. Conclusions Even though only one study addressed loneliness directly, it became clear that assistive technologies used to apply psychosocial interventions have the potential to impact loneliness in people with dementia in long-term care. However, it remains unclear why loneliness was not included as an outcome and how loneliness could become a key outcome in evaluating assistive technologies.

BackgroundInactive behaviour is common in older adults during hospitalisation and associated with poor health outcomes. If patients at high risk of spending little time standing/walking could be identified early after admission, they could be given interventions aimed at increasing their time spent standing/walking. This study aims to identify older adults at high risk of low physical activity (PA) levels during hospitalisation.MethodsProspective cohort study of 165 older adults (≥ 70 years) admitted to the department of Internal Medicine of Maastricht University Medical Centre for acute medical illness. Two prediction models were developed to predict the probability of low PA levels during hospitalisation. Time spent standing/walking per day was measured with an accelerometer until discharge (≤ 12 days). The average time standing/walking per day between inclusion and discharge was dichotomized into low/high PA levels by dividing the cohort at the median (50.0%) in model 1, and lowest tertile (33.3%) in model 2. Potential predictors—Short Physical Performance Battery (SPPB), Activity Measure for Post-Acute Care (AM-PAC), age, sex, walking aid use, and disabilities in activities of daily living—were selected based on literature and analysed using logistic regression analysis. Models were internally validated using bootstrapping. Model performance was quantified using measures of discrimination (area under the receiver operating characteristic curve (AUC)) and calibration (Hosmer and Lemeshow (H–L) goodness-of-fit test and calibration plots).ResultsModel 1 predicts a probability of spending ≤ 64.4 min standing/walking and holds the predictors SPPB, AM-PAC and sex. Model 2 predicts a probability of spending ≤ 47.2 min standing/walking and holds the predictors SPPB, AM-PAC, age and walking aid use. AUCs of models 1 and 2 were .80 (95% confidence interval (CI) = .73—.87) and .86 (95%CI = .79—.92), respectively, indicating good discriminative ability. Both models demonstrate near perfect calibration of the predicted probabilities and good overall performance, with model 2 performing slightly better.ConclusionsThe developed and internally validated prediction models may enable clinicians to identify older adults at high risk of low PA levels during hospitalisation. External validation and determining the clinical impact are needed before applying the models in clinical practise.

Summary Polypharmacy is very common in older adults and increases the risk of inappropriate and unsafe prescribing for older adults. Older adults, particularly women (who make up the majority of this age group), are at the greatest risk for drug-related harm. Therefore, optimising drug prescribing for older people is very important. Identifying potentially inappropriate medications and opportunities for judicious deprescribing processes are intrinsically linked, complementary, and essential for optimising medication safety. This Review focuses on optimising prescribing for older adults by reducing doses or stopping drugs that are potentially harmful or that are no longer needed. We explore how sex (biological) and gender (sociocultural) factors are important considerations in safe drug prescribing. We conclude by providing a practical approach to optimising medication safety that clinicians can routinely apply to the care of their older patients, highlighting how sex and gender considerations inform medication decision making.

Objectives: The present study aimed at investigating the prevalence of prefrailty and frailty in South American older adults according to the setting and region. Design: A literature search combining the terms “frailty”, “South America” or a specific country name was performed on PubMed, EMBASE, Lilacs, and Scielo to retrieve articles published in English, Portuguese or Spanish on or before August 2019. Participants: Older adults aged 60+ years from any setting classified as frail according to a validated scale were included in the study. Measurements: Frailty assessment by a validated scale. Results: One-hundred eighteen reports (98 performed from Brazil, seven from Chile, five from Peru, four from Colombia, two from Ecuador, one from Argentina, and one from Venezuela) were included in the study. The mean prevalence of prefrailty in South America was 46.8% (50.7% in older in-patients, 47.6% in the community, and 29.8% in nursing-home residents). The mean prevalence of frailty in South America was 21.7% (55.8% in nursing-home residents, 39.1% in hospitalized older adults, and 23.0% in the community). Conclusions: Prefrailty and frailty are highly prevalent in South American older adults, with rates higher than those reported in Europe and Asia. In the community, almost one-in-two is prefrail and one-in-five is frail, while hospitalized persons and nursing-home residents are more frequently affected. These findings indicate the need for immediate attention to avoid frailty progression toward negative health outcomes. Our findings also highlight the need for specific guidelines for the management of frailty in South America.

Maxime Billot,1,2 Riccardo Calvani,3,4 Annele Urtamo,5 Juan Luis Sánchez-Sánchez,6 Cecilia Ciccolari-Micaldi,1 Milan Chang,7,8 Regina Roller-Wirnsberger,9 Gerhard Wirnsberger,10 Alan Sinclair,11 Nieves Vaquero-Pinto,12 Satu Jyväkorpi,5 Hanna Öhman,5 Timo Strandberg,13,14 Jos MGA Schols,15 Annemie MWJ Schols,16 Nick Smeets,17 Eva Topinkova,18 Helena Michalkova,19 Anna Rita Bonfigli,20 Fabrizia Lattanzio,20 Leocadio Rodríguez-Mañas,21 Hélio Coelho-Júnior,4 Marianna Broccatelli,4 Maria Elena D’Elia,4 Damiano Biscotti,4 Emanuele Marzetti,3,4 Ellen Freiberger22 1Clinical Gerontology, University Hospital of Limoges, Limoges, France; 2PRISMATICS (Predictive Research in Spine/Neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France; 3Università Cattolica del Sacro Cuore, Rome, Italy; 4Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; 5University of Helsinki, Department of General Practice and Primary Health Care, Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland; 6Foundation for Biomedical Research Getafe University Hospital, Madrid, Spain; 7Faculty of Health Promotion, Sports and Leisure Studies, School of Education, University of Iceland, Reykjavik, Iceland; 8The Icelandic Gerontological Research Center, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland; 9Medical University of Graz, Department of Internal Medicine, Graz, Austria; 10Medical University of Graz, Division of Nephrology, Department of Internal Medicine, Graz, Austria; 11Foundation for Diabetes Research in Older People, Diabetes Frail Ltd., Luton, UK; 12University Hospital of Ramon Cajal IRYCIS, Madrid, Spain; 13University of Helsinki, Clinicum, Helsinki, Finland; Helsinki University Hospital, Medicine and Rehabilitation, Helsinki, Finland; 14University of Oulu, Center for Life Course Health Research, Oulu, Finland; 15Department of Health Services Research, Maastricht University Medical Center, Maastricht, The Netherlands; 16Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands; 17Department of Health & Fitness, Maastricht University Medical Center, Maastricht, The Netherlands; 18 First Faculty of Medicine, Charles University, Prague, Czech Republic; 19Faculty of Social and Health Sciences, South Bohemian University, Ceske Budejovice, Czech Republic; 20Scientific Direction, IRCCS INRCA, Ancona, Italy; 21Geriatrics Service, University Hospital of Getafe, Madrid, Spain; 22Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Nürnberg, GermanyCorrespondence: Maxime Billot CHU De Poitiers, PRISMATICS (Predictive Research in Spine/Neurostimulation Management and Thoracic Innovation in Cardiac Surgery)Poitiers University Hospital, 2 Rue De La Miléterie, Poitiers 86021, FranceTel +33 549 443 224Email maxime.billot2@gmail.comAbstract: One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature.Keywords: physical exercise, muscle mass, strength, walking, balance, better aging

Maxime Billot,1,2 Riccardo Calvani,3,4 Annele Urtamo,5 Juan Luis Sánchez-Sánchez,6 Cecilia Ciccolari-Micaldi,1 Milan Chang,7,8 Regina Roller-Wirnsberger,9 Gerhard Wirnsberger,10 Alan Sinclair,11 Nieves Vaquero-Pinto,12 Satu Jyväkorpi,5 Hanna Öhman,5 Timo Strandberg,13,14 Jos MGA Schols,15 Annemie MWJ Schols,16 Nick Smeets,17 Eva Topinkova,18 Helena Michalkova,19 Anna Rita Bonfigli,20 Fabrizia Lattanzio,20 Leocadio Rodríguez-Mañas,21 Hélio Coelho-Júnior,4 Marianna Broccatelli,4 Maria Elena D’Elia,4 Damiano Biscotti,4 Emanuele Marzetti,3,4 Ellen Freiberger22 1Clinical Gerontology, University Hospital of Limoges, Limoges, France; 2PRISMATICS (Predictive Research in Spine/Neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France; 3Università Cattolica del Sacro Cuore, Rome, Italy; 4Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; 5University of Helsinki, Department of General Practice and Primary Health Care, Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland; 6Foundation for Biomedical Research Getafe University Hospital, Madrid, Spain; 7Faculty of Health Promotion, Sports and Leisure Studies, School of Education, University of Iceland, Reykjavik, Iceland; 8The Icelandic Gerontological Research Center, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland; 9Medical University of Graz, Department of Internal Medicine, Graz, Austria; 10Medical University of Graz, Division of Nephrology, Department of Internal Medicine, Graz, Austria; 11Foundation for Diabetes Research in Older People, Diabetes Frail Ltd., Luton, UK; 12University Hospital of Ramon Cajal IRYCIS, Madrid, Spain; 13University of Helsinki, Clinicum, Helsinki, Finland; Helsinki University Hospital, Medicine and Rehabilitation, Helsinki, Finland; 14University of Oulu, Center for Life Course Health Research, Oulu, Finland; 15Department of Health Services Research, Maastricht University Medical Center, Maastricht, The Netherlands; 16Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands; 17Department of Health & Fitness, Maastricht University Medical Center, Maastricht, The Netherlands; 18 First Faculty of Medicine, Charles University, Prague, Czech Republic; 19Faculty of Social and Health Sciences, South Bohemian University, Ceske Budejovice, Czech Republic; 20Scientific Direction, IRCCS INRCA, Ancona, Italy; 21Geriatrics Service, University Hospital of Getafe, Madrid, Spain; 22Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Nürnberg, GermanyCorrespondence: Maxime Billot CHU De Poitiers, PRISMATICS (Predictive Research in Spine/Neurostimulation Management and Thoracic Innovation in Cardiac Surgery)Poitiers University Hospital, 2 Rue De La Miléterie, Poitiers 86021, FranceTel +33 549 443 224Email maxime.billot2@gmail.comAbstract: One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature.Keywords: physical exercise, muscle mass, strength, walking, balance, better aging

Introduction No study has investigated how exercise modifies the effect of fall-related drugs (FRDs) on falls among people with Alzheimer's disease (AD). Objective The aim of this study was to investigate how exercise intervention and FRDs interact with fall risk among patients with AD. Methods In the FINALEX trial, community-dwelling persons with AD received either home-based or group-based exercise twice weekly for 1 year (n = 129); the control group received normal care (n = 65). The number of falls was based on spouses' fall diaries. We examined the incidence rate ratios (IRRs) for falls among both non-users and users of various FRDs (antihypertensives, psychotropics, drugs with anticholinergic properties [DAPs]) in both control and combined intervention groups. Results Between the intervention and control groups, there was no difference in the number of falls among those without antihypertensives or psychotropics. In the intervention group taking antihypertensives, the IRR was 0.5 falls/person-year (95% confidence interval [CI] 0.4-0.6), while in the control group, the IRR was 1.5 falls/person-year (95% CI 1.2-1.8) [p

Background orthostatic hypotension (OH) is one out of many risk factors believed to contribute to an increased fall risk in elderly subjects but it is unclear whether an independent association between OH and falling exists. Objectives to perform an individual patient data (IPD) meta-analysis of prospective observational studies investigating the relationship between OH and falling. Design MEDLINE, EMBASE, the Cochrane Library and the abstracts of annual meetings of selected hypertension societies were searched. Both one-stage (analysing all IPD from all studies simultaneously) and two-stage (analysing IPD per study, and then pooling the results) methods were used, and both logistic and cox regression analyses were performed. The study protocol was published on PROSPERO (2015:CRD42015019178). Results from 34 selected abstracts, 6 studies were included. IPD were provided in 1,022 patients from 3 cohorts and were included in the IPD meta-analysis. The one-stage meta-analysis showed a significant relationship between OH and time to first fall incident (hazard ratio (HR) 1.52 (95% Confidence Interval (CI) 1.23-1.88)). No significant relationship between OH and falling was found in the one-stage logistic regression analysis and the two-stage logistic and cox regression analyses. Conclusions this IPD meta-analysis of prospective observational studies showed a clear and significant relationship between OH and time to first fall incident. Although the ORs of falling was not significantly different for patients with and without OH, a the cox regression analyses reporting HRs and including time to incident provided more clinically relevant information in present meta-analysis.

Background: Orthostatic hypotension (OH) is one out of many risk factors believed to contribute to an increased fall risk in elderly subjects but it is unclear whether an independent association between OH and falling exists.Objectives: To perform an individual patient data (IPD) meta-analysis of prospective observational studies investigating the relationship between OH and falling.Design: MEDLINE, EMBASE, the Cochrane Library and the abstracts of annual meetings of selected hypertension societies were searched. Both one-stage (analysing all IPD from all studies simultaneously) and two-stage (analysing IPD per study, and then pooling the results) methods were used, and both logistic and cox regression analyses were performed. The study protocol was published on PROSPERO (2015:CRD42015019178).Results: From 34 selected abstracts, 6 studies were included. IPD were provided in 1,022 patients from 3 cohorts and were included in the IPD meta-analysis. The one-stage meta-analysis showed a significant relationship between OH and time to first fall incident (hazard ratio (HR) 1.52 (95% Confidence Interval (CI) 1.23-1.88)). No significant relationship between OH and falling was found in the one-stage logistic regression analysis and the two-stage logistic and cox regression analyses.Conclusions: This IPD meta-analysis of prospective observational studies showed a clear and significant relationship between OH and time to first fall incident. Although the ORs of falling was not significantly different for patients with and without OH, a the cox regression analyses reporting HRs and including time to incident provided more clinically relevant information in present meta-analysis.

Bakgrund: Att ha kontakt med närstående till personer med demenssjukdom ingår i omvårdnadspersonalens dagliga arbete. Det finns i forskning beskrivet hur närstående upplever sin situation och i riktlinjer beskrivs vikten av att kommunicera med närstående utifrån ett personcentrerat förhållningssätt. Syfte: Att beskriva omvårdnadspersonalens erfarenheter av att kommunicera med närstående till personer med demenssjukdom. Metod: Kvalitativ intervjustudie med induktiv ansats. Åtta semistrukturerade intervjuer med undersköterskor anställda på särskilt boende anpassat för personer med demenssjukdom. Resultat: I studien identifierades fyra huvudkategorier och tolv underkategorier. Huvudkategorierna var: strävan efter att vara professionell, relationen mellan omvårdnadspersonal och närstående, bemötande av närståendes behov och behov av teamsamverkan. Slutsats: Ett professionellt förhållningssätt och ett gott bemötande är några av de viktigaste förmågorna som omvårdnadspersonalen innehar. Att förekomma och ta initiativ till kontakt även om det inte finns någon egentlig anledning skapar trygga och välmående närstående. En närvarande sjuksköterska och ett väl sammansvetsat multiprofessionellt team ökar kvaliteten på omvårdnaden av personer med demenssjukdom. Background: Contact with relatives to people with dementia is included in the daily work of the nursing staff. In research, it is described how relatives experience their situation and guidelines describe the importance of communicating with relatives based on a personcentered approach. Aim: To describe the nursing staff's experiences of communicating with relatives to people with dementia. Method: Qualitative interview study with inductive approach. Eight semi-structured interviews with nursing staff employed on nursing-home specially adapted for people with dementia. Result: The study identified four main categories and twelve subcategories. The main categories were: the pursuit of being professional, the relationship between nursing staff, addressing the needs of relatives and relatives and the need for team collaboration. Conclusion: A professional approach and good treatment is one of the most important abilities that nursing staff possess. To occur and initiate contact even if there is no real reason creates safe and prosperous relatives. A present nurse and a well-knit multi-professional team increase the quality of care for people with dementia.

Adequate interprofessional collaboration is essential to provide high quality palliative dementia care across different settings. Within interprofessional collaboration, nurses are the frontline healthcare professionals (HCPs), who interact closely with people with dementia, their loved ones, and other HCPs. A survey was conducted to explore the needs of nurses regarding interprofessional collaboration in home care (HC) organisations, nursing homes (NHs) and during NH admissions. The survey identified the perceived quality of and preferred needs regarding interprofessional collaboration. In total, 384 participants (53.9% home care nurses) completed the survey. The most frequently reported collaboration needs in HC organisations and NH were optimal communication content e.g. information transfer and short communication lines (being able to easily contact other disciplines), and coordination e.g. one contact person, and clear task division and responsibilities). During NH admissions, it was important to create transparency about agreements concerning end-of-life wishes, optimize nurse-to-nurse handover during NH admissions (through performing visits prior to admissions, and receiving practical information on how to guide relatives), and improve coordination (e.g. one contact person). In conclusion, the key collaboration needs were organising central coordination, establishing optimal communication, and creating transparency on end-of-life care agreements.

Objectives To evaluate predictors of mortality in patients residing in nursing-homes (NHs) or long-term care facilities (LTCFs) with diagnosis of NH-acquired pneumonia (NHAP). Methods We conducted an observational, prospective study (December 2013-December 2015) of patients residing in nine NHs/LTCFs of Central and Northern Italy with diagnosis of NHAP. Data on demographics, comorbidities, microbiology, and therapies were entered into an electronic database. To identify risk factors associated with 30-day mortality, we performed univariable and multivariable analyses, and predictors were internally validated using a bootstrap resampling procedure. We derived a prediction rule using the coefficients obtained from the multivariable logistic regression. The model obtained was assessed using the area under the receiver operating characteristic curve (AUROC). Results Overall, 446 patients with NHAP were included in the final cohort. The median age was 80 (IQR 75–87) years. A definite aetiology was obtained in 120 (26.9%) patients; of these, 66 (55%) had a culture positive for a multidrug-resistant pathogen. The 30-day mortality was 28.7%. On multivariate analysis, malnutrition (OR 7.8; 95% CI 3–20.2, 2 points), bilateral pneumonia (OR 3.7; 95% CI 1.4–9.8, 1 point), acute mental status deterioration (OR 6.2; 95% CI 2.2–17.6, 2 points), hypotension (OR 7.7; 95% CI 2.3–24.9, 2 points), and PaO 2 /FiO 2 ratio ≤250 (OR 7.4; 95% CI 2.2–24.2, 2 points) were independently associated with 30-day mortality. The derived prediction rule showed an AUROC of 0.83 (95% CI 0.78–0.87, p Conclusions NH residents with pneumonia have specific risk factors associated with 30-day mortality. Malnutrition and acute mental change appear as major determinants of death in this population.

Background: Although it is recognised that the dialysis population is ageing rapidly, geriatric complications such as falls are poorly appreciated, despite the many risk factors for falls in this population. The objective of this study was to determine the incidence, complications and risk factors for falls in an elderly dialysis population.Methods: A one-year observational study of chronic dialysis patients aged >= 70 years. At baseline, patient characteristics were noted and during follow-up the vital parameters and laboratory values were recorded. Patients were questioned weekly about falls, fall circumstances and consequences by trained nurses.Results: 49 patients were included with a median age of 79.3 years (70-89 years). During follow-up 40 fall accidents occurred in 27 (55%) patients. Falls resulted in fractures in 15% of cases and in hospital admissions in 15%. In haemodialysis (HD) patients, the mean systolic blood pressure (SBP) before HD was lower in fallers compared with non-fallers (130 vs. 143 mmHg). Several patients in the lower blood pressure category received antihypertensive medication. For every 5 mmHg lower SBP (before HD) the fall risk increased by 30% (hazard ratio (HR) 1.30, 95% CI 1.03-1.65, p = 0.03). Furthermore, fall risk increased by 22% for every 10 pmol/l rise of parathyroid hormone (HR 1.22, 95% CI 1.06-1.39, p = 0.004).Conclusions: Elderly dialysis patients have a high incidence of falls accompanied by a high fracture rate. Given the high complication rate, elderly patients at risk of falling should be identified and managed. Reduction of blood pressurelowering medication might be a treatment strategy to reduce falls.

Contains fulltext : 170080.pdf (Publisher’s version ) (Open Access) OBJECTIVE: To gain insights into the problems of dual sensory impaired older adults in long-term care. Insights into these problems are essential for developing adequate policies which address the needs of the increasing population of dual sensory impaired older adults in long-term care. METHODS: A qualitative study was conducted in parallel with a cluster randomized controlled trial. Dual sensory impaired older adults in the intervention group (n = 47, age range 82-98) were invited by a familiar nurse to identify the problems they wanted to address. Data were taken from the semi-structured intervention diaries in which nurses noted the older adults' verbal responses during a five-month intervention period in 17 long-term care homes across the Netherlands. The data were analyzed using descriptive statistics and qualitative content analysis based on the Grounded Theory. FINDINGS: The 47 dual sensory impaired older adults identified a total of 122 problems. Qualitative content analysis showed that the older adults encountered participation problems and problems controlling what happens in their personal environment. Three categories of participation problems emerged: (1) existential concerns of not belonging or not being able to connect with other people, (2) lack of access to communication, information and mobility, and (3) the desire to be actively involved in care delivery. Two categories of control-in-personal-space problems emerged: (1) lack of control of their own physical belongings, and (2) lack of control regarding the behavior of nurses providing daily care in their personal environment. CONCLUSIONS: The invasive problems identified indicate that dual sensory impaired older adults experience great existential pressures on their lives. Long-term care providers need to develop and implement policies that identify and address these problems, and be aware of adverse consequences of usual care, in order to improve dual sensory impaired residents' autonomy and quality of life.

Clinical ethics support mechanisms in healthcare are increasing but little is known about the specific developments in elderly care. The aim of this paper is to present a systematic literature review on the characteristics of existing ethics support mechanisms in institutional elderly care. A review was performed in three electronic databases (Pubmed, CINAHL/PsycINFO, Ethxweb). Sixty papers were included in the review. The ethics support mechanisms are classified in four categories: 'institutional bodies' (ethics committee and consultation team); 'frameworks' (analytical tools to assist care professionals); 'educational programmes and moral case deliberation'; and 'written documents and policies'. For each category the goals, methods and ways of organising are described. Ethics support often serves several goals and can be targeted at various levels: case, professional or organisation. Over the past decades a number of changes have taken place in the development of ethics support in elderly care. Considering the goals, ethics support has become more outreaching and proactive, aiming to qualify professionals to integrate ethics in daily care processes. The approaches in clinical ethics support have become more diverse, more focused on everyday ethical issues and better adapted to the concrete learning style of the nursing staff. Ethics support has become less centrally organised and more connected to local contexts and primary process within the organisation.

Objectives: Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the importance of a clear evidence-based implementation strategy to improve oral health care. The aim of this study is to review implementation strategies used to promote or improve oral health care for older people in long term care facilities from the perspective of behaviour change, to code strategy content at the level of determinants, and to explore their effectiveness.Design: Systematic review of literature. Data sources: The digital databases of the Cochrane Library, PubMed and Cinahl have been searched up to September 2011 for relevant articles.Review methods: After a systematic selection process, included studies were quality assessed by three researchers. We extracted the study characteristics using the EPOC Data Collection Checklist and Data Abstraction Form. Strategy content was extracted and coded by using the Coding Manual for Behavioural Change Techniques. This manual groups the behaviour change techniques under relevant behavioural determinants.Results: Twenty studies were included in this review. Implementation strategies were delivered by dental hygienists or dentists. Oral health care was performed by nurses and nurse assistants in all studies.All studies addressed knowledge, mostly operationalized as one educational session. Knowledge was most often combined with interventions addressing self efficacy. Implementation strategies aimed at knowledge (providing general information), self-efficacy (modelling) or facilitation of behaviour (providing materials to facilitate behaviour) were most often identified as successful in improving oral health.Conclusions: Knowledge, self-efficacy and facilitation of behaviour are determinants that are often addressed in implementation strategies for successful improvement of oral health care in older patients. Strategies addressing increasing memory, feedback of clinical outcomes, and mobilizing social norm are promising and should be studied in the future. However, as the quality and heterogeneity of studies is a reason for concern, it is not possible to unequivocally recommend strategies or combinations of strategies for improving oral health care in the older population. When choosing strategies to improve oral health care, care professionals should thoroughly examine the setting and target group, identify barriers to change and tailor their implementation strategies to these barriers for oral health care. (C) 2012 Elsevier Ltd. All rights reserved.

OBJECTIVE: Fall prevention is a major issue in the ageing society. This study provides an overview of all risk factors for falls of older citizens.METHOD: A literature search was conducted to retrieve studies of the past 25 years. All participants from the studies lived in the community or institutions and were aged 60 or older. The following key word combinations were used, limited to the title: elderly or older people or older adults and fall and risk. The risk factors were categorised as relevant and amendable, relevant but non amendable, inconclusive or unsupported.RESULTS: In total 30 publications were studied in 2013 in Enschede, the Netherlands. The relevant intrinsic risk factors are muscle strength, balance capacity, reactive power, dual tasking and sleep disturbance. Relevant extrinsic risk factors are home hazards, wrong use of assistive devices and bad footwear. Behaviour-related risk factors are hurrying, risk taking, physical inactivity and fear of falling. Relevant symptoms that could be caused by underlying risk factors are mobility problems, gait problems, vertigo, use of assisting devices and history of falls.CONCLUSIONS: Several risk factors are determined to be relevant and amendable. The provided overview could be used to create fall preventive measures for elderly.

Objectives: Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the importance of a clear evidence-based implementation strategy to improve oral health care. The aim of this study is to review implementation strategies used to promote or improve oral health care for older people in long term care facilities from the perspective of behaviour change, to code strategy content at the level of determinants, and to explore their effectiveness. Design: Systematic review of literature. Data sources: The digital databases of the Cochrane Library, PubMed and Cinahl have been searched up to September 2011 for relevant articles. Review methods: After a systematic selection process, included studies were quality assessed by three researchers. We extracted the study characteristics using the EPOC Data Collection Checklist and Data Abstraction Form. Strategy content was extracted and coded by using the Coding Manual for Behavioural Change Techniques. This manual groups the behaviour change techniques under relevant behavioural determinants. Results: Twenty studies were included in this review. Implementation strategies were delivered by dental hygienists or dentists. Oral health care was performed by nurses and nurse assistants in all studies. All studies addressed knowledge, mostly operationalized as one educational session. Knowledge was most often combined with interventions addressing self efficacy. Implementation strategies aimed at knowledge (providing general information), self-efficacy (modelling) or facilitation of behaviour (providing materials to facilitate behaviour) were most often identified as successful in improving oral health. Conclusions: Knowledge, self-efficacy and facilitation of behaviour are determinants that are often addressed in implementation strategies for successful improvement of oral health care in older patients. Strategies addressing increasing memory, feedback of clinical outcomes, and mobilizing social norm are promising and should be studied in the future. However, as the quality and heterogeneity of studies is a reason for concern, it is not possible to unequivocally recommend strategies or combinations of strategies for improving oral health care in the older population. When choosing strategies to improve oral health care, care professionals should thoroughly examine the setting and target group, identify barriers to change and tailor their implementation strategies to these barriers for oral health care. (C) 2012 Elsevier Ltd. All rights reserved.