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Background Since dementia is an irreversible progressive disease characterized by a decline in mental functions and overall health, a palliative care approach is recommended. Nevertheless, many persons with dementia experience burdensome hospitalizations in end-of-life care. Their quality of life during hospitalization can be improved by palliative nursing care that suits their fragile health. Aim To explore hospital nurses' perceived support needs while providing high-quality palliative care for persons with dementia and to identify differences between nurses in different ward types and at different educational levels. Design Cross-sectional, multicenter survey study. Method Between January 2021 and April 2021, a convenience sample of Dutch hospital nurses received a web-based questionnaire on the topics of palliative caregiving, communication, collaboration, and hospital admissions. The data were analyzed using descriptive statistics. Results The survey was completed by 235 nurses. The most frequently endorsed support needs were "communicating with persons with severe dementia" (58.3%), "appointing a permanent contact person in the care for persons with dementia" (53.6%), and "dealing with family disagreement in end-of-life care" (53.2%). If nurses had more time to provide care, 66.4% of them would prioritize providing personal attention. Most support needs identified by nurses were similar. Conclusion A heterogeneous group of nurses demonstrates overall similar support needs in providing palliative care for persons with dementia and their families in the hospital setting. Clinical Relevance Nursing practices should implement dementia-friendly interventions to improve the quality of dementia care in the hospital.

Spousal loss due to nursing home admission or death is challenging for the well-being of the remaining partner and for aging in place. We explored: “How does social network change due to spousal loss impact older adults who are aging in place?.” In-depth interviews were held with six older women who were aging in place and who lost their spouses in the past two years. Narrative analysis was conducted. Results indicate that the impact varies in three dimensions and that variations within dimensions follow three themes. The results emphasize the complexity of impact and the urgent need for a person-centred approach toward older adults after spousal loss.

Persoonsgerichte zorg is bij geriatrische revalidatie (GR) het resultaat van gezamenlijke goal setting en het volgen van de voortgang tijdens de revalidatie. Het impliceert een actieve betrokkenheid van de patiënt. Samenwerking tussen zorgprofessionals en patiënten is waardevol bij goal setting en draagt bij aan persoonsgerichte zorg. Met deze studie onderzoeken we hoe in de praktijk invulling wordt gegeven aan actieve participatie, welke wensen GR-patiënten hebben en welke handvatten hiervoor nodig zijn. Hiervoor werden cross-sectioneel semigestructureerde interviews afgenomen bij 23 GR-patiënten gedurende 1 jaar. Het onderzoek laat zien dat patiënten actief benaderd en ondersteund willen worden door zorgprofessionals voor actieve patiëntparticipatie. De mate waarin en de manier waarop is verschillend, waardoor een flexibele aanpak nodig is die rekening houdt met de behoeften en mogelijkheden van de patiënt en diens omgeving. Vanuit dit onderzoek zijn aanbevelingen voor de praktijk geformuleerd

Background Multidimensional frailty, including physical, psychological, and social components, is associated to disability, lower quality of life, increased healthcare utilization, and mortality. In order to prevent or delay frailty, more knowledge of its determinants is necessary; one of these determinants is lifestyle. The aim of this study is to determine the association between lifestyle factors smoking, alcohol use, nutrition, physical activity, and multidimensional frailty. Methods This cross-sectional study was conducted in two samples comprising in total 45,336 Dutch community-dwelling individuals aged 65 years or older. These samples completed a questionnaire including questions about smoking, alcohol use, physical activity, sociodemographic factors (both samples), and nutrition (one sample). Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Results Higher alcohol consumption, physical activity, healthy nutrition, and less smoking were associated with less total, physical, psychological and social frailty after controlling for effects of other lifestyle factors and sociodemographic characteristics of the participants (age, gender, marital status, education, income). Effects of physical activity on total and physical frailty were up to considerable, whereas the effects of other lifestyle factors on frailty were small. Conclusions The four lifestyle factors were not only associated with physical frailty but also with psychological and social frailty. The different associations of frailty domains with lifestyle factors emphasize the importance of assessing frailty broadly and thus to pay attention to the multidimensional nature of this concept. The findings offer healthcare professionals starting points for interventions with the purpose to prevent or delay the onset of frailty, so community-dwelling older people have the possibility to aging in place accompanied by a good quality of life.

Background and objective: Person centered care (PCC) has become the gold standard for providing care in nursing homes (NHs). Therefore, it is important for healthcare professionals in NHs to learn PCC-skills and to be supported to learn about- and improve the quality of PCC they provide. At this moment an instrument to support healthcare professionals in NHs to monitor and evaluate PCC is limited. The aim of the study was to develop a self-evaluation tool that provides healthcare professionals in NHs insight into the extent to which they provide PCC to residents, so that they can learn and further improve their current ways of working in a person-centered way.Methods: A three-round Delphi study with an expert panel (n = 25) in the domains of PCC, quality of NH care and education of caring staff. Findings were validated by residents and relatives during semi-structured interviews. Thematic analysis and descriptive statistics were used to analyze the data.Results: In the first round the experts did not provide measuring instruments, but we identified 18 key aspects of PCC. In the second round, three clusters were identified, and a scale was added, to enable assessment. In the third round, we deduplicated, restructured and used more clear language. This led to 14 key aspects of PCC, 24 measures, grouped into five clusters: knowing the resident, establishing relationship, a respectful approach, making decisions jointly and personal development. The result is a PCC self-scan for healthcare professionals in NHs. Residents and relatives, agreed with all aspects and stated that no aspects were missing.Conclusions: In this study we developed an accessible self-report learning tool for healthcare professionals that makes it possible to evaluate and improve their PCC-skills and improve the quality of PCC in NHs.

Objectives:On May 11, the Dutch Government allowed 26 nursing homes to welcome 1 visitor per resident, after 2 months of lockdown. The study aimed to monitor in-depth the feasibility of the regulations and their impact on the well-being of residents, their visitors, and healthcare staff.Design:Mixed-methods study in 5 of the 26 facilities; the facilities were affiliated to an academic network of nursing homes.Participants:Visitors and healthcare professionals.Intervention:Allowing visitors using local regulations based on national guidelines.Measurements:Digital questionnaire, analyzing documentation such as infection prevention control protocols, attending meetings of COVID-19 crisis teams, in-depth telephone or in-person interviews with visitors and healthcare professionals, and on-site observations.Results:National guidelines were translated with great variety into local care practice. Healthcare professionals agreed that reopening would increase the well-being of the residents and their loved ones. However, there were also great worries for increasing workload, increasing the risk of emotional exhaustion, and the risk of COVID-19 infections. Compliance with local regulations was generally satisfactory, but maintaining social distance and correctly wearing face masks appeared to be difficult. Care staff remained ambivalent for fear of infections. In general, allowing visitors was experienced as having a positive impact on the well-being of all stakeholders. Nevertheless, some residents with dementia showed negative effects.Conclusion:The complete lockdown of Dutch nursing homes had a substantial impact on the well-being of the residents. The reopening was welcomed by all stakeholders, but provided a high organizational workload as well as feelings of ambivalence among care staff. In the second wave, a more tailored approach is being implemented. However, facilities are sometimes still struggling to find the right balance between infection control and well-being.

Achtergrond: De Personality Inventory for DSM-5 Brief Form + Modified (PID-5-BF+M) is een zelfrapportage vragenlijst die maladaptieve persoonlijkheidstrekken meet, zoals gedefinieerd door de dimensionale classificaties van persoonlijkheidsstoornissen in DSM-5 Sectie 3 en ICD-11. Het instrument combineert beide classificaties en brengt hiermee zes persoonlijkheidsdomeinen en 18 onderliggende persoonlijkheidsfacetten in kaart, die telkens door twee items geoperationaliseerd worden. Deze studie onderzocht de constructvaliditeit van deze vragenlijst bij oudere volwassenen, door de factorstructuur en de schaalbetrouwbaarheid van de domeinen en de facetten na te gaan. Daarnaast onderzocht deze studie ook de relatie tussen maladaptieve persoonlijkheidstrekken en veerkracht, gemeten door de Connor-Davidson Resilience Scale (CD-RISC). Methode: De PID-5-BF+M werd ingevuld door 251 oudere volwassenen uit de algemene populatie, bij 104 respondenten werd ook de CD-RISC afgenomen. Resultaten: De hiërarchische factorstructuur van de PID-5-BF+M werd bevestigd bij ouderen. Daarnaast bleken de domein- en facetschalen intern consistent. De correlaties met de CD-RISC toonden logische verbanden. Het domein Negatieve affectiviteit en de facetten Emotionele Labiliteit, Ongerustheid en Onverantwoord Gedrag waren negatief geassocieerd met veerkracht. Conclusie: Op basis van deze resultaten ondersteunt de huidige studie de constructvaliditeit van de PID-5-BF+M bij oudere volwassenen. Toekomstig onderzoek naar de leeftijdsneutraalheid van het instrument is echter nog nodig.

Autonomy is important for people, even when they have physical impairments and are living in nursing homes. The way staff respond to residents is important for the realisation of autonomy. In order to gain knowledge about what nursing home staff, registered and assistant nurses, occupational therapists and nutritional assistants do and experience in relation to the autonomy of residents, a qualitative study design was chosen. Shadowing, a non-participatory observation method, was used. A total of 15 staff members of a care unit from two different nursing homes participated. Short interviews followed these observations to reflect on intentions of observed activities. The COREQ guidelines were used to report on the study. Four activities to enhance autonomy were identified: getting to know each older adult as a person and responding to his/her needs; encouraging an older adult to perform self-care; stimulating an older adult to make choices; and being aware of interactions. The exploration showed that staff considered it important to strengthen autonomy of older adults living in nursing homes and that they used different activities related to autonomy. However, activities could both enhance as well as hinder autonomy.

Background and objective: Stories from older adults give insight into their personal lives and in the care they receive. The story as a quality instrument is a narrative quality improvement method with which care professionals can interview older adults about how care is experienced. Each performed interview will be translated into a portrait containing the core themes of the shared story. The objective of this study was to assess the feasibility of and experiences with the story as a quality instrument amongst care professionals and older adults receiving long-term care.Methods: Five care locations providing nursing home care and one providing home care participated in the current study. In total 19 trained care professionals performed interviews with 52 older adults. Both the performed interviews and written portraits were scored according to preset criteria to establish the compliance to the predetermined protocol. Next to that, experiences from care professionals as insider researchers and respondents were gathered.Results: Overall the fidelity for performing the interview was good. In 90% of cases interviewers posed one inviting open question. Following, interviewers used proposed interviewing techniques such as asking in depth questions, asking for an example or summarizing what has been said. In 20 of the interviews, the respondents input accounted for over 80% of the total number of words, and in 27 interviews the respondents’ input accounted for 60%-80%. Fidelity with the protocol for drawing up portraits was sufficient in most cases. In 66% the portrait contained all important themes and in 32% the majority of important themes. One portrait missed a significant proportion of themes mentioned during the interview. The experiences from care professionals consist of successes, challenges, added value and prerequisites.Conclusions: Care professionals were mostly capable of following the method according to protocol after being trained. The method is believed to be a promising innovation because care professionals play a key role in gathering and using stories to improve quality of care. The outcomes can be used by care professionals to learn and improve within their care location according to the quality framework for nursing home care.

Background Frailty is a syndrome that is defined as an accumulation of deficits in physical, psychological, and social domains. On a global scale, there is an urgent need to create frailty-ready healthcare systems due to the healthcare burden that frailty confers on systems and the increased risk of falls, healthcare utilization, disability, and premature mortality. Several studies have been conducted to develop prediction models for predicting frailty. Most studies used logistic regression as a technique to develop a prediction model. One area that has experienced significant growth is the application of Bayesian techniques, partly due to an increasing number of practitioners valuing the Bayesian paradigm as matching that of scientific discovery.Objective We compared ten different Bayesian networks as proposed by ten experts in the field of frail elderly people to predict frailty with a choice from ten dichotomized determinants for frailty.Methods We used the opinion of ten experts who could indicate, using an empty Bayesian network graph, the important predictors for frailty and the interactions between the different predictors. The candidate predictors were age, sex, marital status, ethnicity, education, income, lifestyle, multimorbidity, life events, and home living environment. The ten Bayesian network models were evaluated in terms of their ability to predict frailty. For the evaluation, we used the data of 479 participants that filled in the Tilburg Frailty indicator (TFI) questionnaire for assessing frailty among community-dwelling older people. The data set contained the aforementioned variables and the outcome “frail”. The model fit of each model was measured using the Akaike information criterion (AIC) and the predictive performance of the models was measured using the area under the curve (AUC) of the receiver operator characteristic (ROC). The AUCs of the models were validated using bootstrapping with 100 repetitions. The relative importance of the predictors in the models was calculated using the permutation feature importance algorithm (PFI).Results The ten Bayesian networks of the ten experts differed considerably regarding the predictors and the connections between the predictors and the outcome. However, all ten networks had corrected AUCs 0.700. Evaluating the importance of the predictors in each model, “diseases or chronic disorders” was the most important predictor in all models (10 times). The predictors “lifestyle” and “monthly income” were also often present in the models (both 6 times). One or more diseases or chronic disorders, an unhealthy lifestyle, and a monthly income below 1800 euro increased the likelihood of frailty.Conclusions Although the ten experts all made different graphs, the predictive performance was always satisfying (AUCs >0.700). While it is true that the predictor importance varied all the time, the top three of the predictor importance consisted of “diseases or chronic disorders”, “lifestyle” and “monthly income”. All in all, asking for the opinion of experts in the field of frail elderly to predict frailty with Bayesian networks may be more rewarding than a data-driven forecast with Bayesian networks because they have expert knowledge regarding interactions between the different predictors.

Our aim was to examine the co-design process of two educational programs based on scientific research, to investigate which factors influenced the co-design processes and which lessons we learned. Participatory qualitative research on multiple cases was conducted with representatives of the university, healthcare education (university of applied science), secondary vocational education and training and nursing home care practice. Data were analyzed using a critical creative hermeneutic analysis. Three themes influenced the co-design processes: (1) facilitation of the processes, (2) team members’ attributes and (3) diverse interests and structures. Participants’ diversity slowed down and deepened the collaboration. The positive climate and personal attributes enabled the processes. The complexity of the co-design processes, conflicting interests and making use of the full potential of the diversity were challenging aspects. These challenges can be overcome by organizing and facilitating co-design processes skillfully.

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.

In previous research on aging and place, it comes forward that many people mainly prefer to age in place because they feel connected to their homes and secure in a familiar environment. This paper aims to understand how older adults living independently at home construct their residential happiness. We used photo-elicitation to explore how objects and places are considered important for their residential happiness by older adults (n = 37) in various residential settings in The Netherlands. The findings demonstrate that places and objects either directly evoke unique feelings of residential happiness or via attached personal stories.

De wens om thuis oud te worden (‘ageing in place’) is populair bij ouderen,maar hoe zit dat voor ouderen met een migratieachtergrond? Wat zijn hunwoonervaringen? Hoe staan zij tegenover ‘ageing in place’? Waar en hoe wensenzij oud te worden? En verschilt dit van ouderen zonder migratieachtergrond?&nbsp

De diverse zorgvragen van ouderen in België worden niet beantwoord in het huidige formele zorgaanbod. Daarom zoeken ouderen naar alternatieve zorgvormen. Een daarvan is het laten inwonen van buitenlandse zorgverleners, al heeft dat complexe gevolgen. Hoewel ouderen een antwoord vinden op hun zorgvragen, lopen inwonende zorgverleners een risico op precaire werkomstandigheden.

Veel medewerkers geven de voorkeur aan informele vormen van leren en ontwikkelen op de werkplek, terwijl formele leeractiviteiten gangbaarder zijn in organisaties. Deze activiteiten lijken vaak geïnitieerd door managers en HR-functionarissen en vinden veelal buiten de werkplek plaats. Dit terwijl arbeidsmarkttekorten noodzaken om leren en ontwikkelen in het dagelijkse werk vorm te geven. Dit artikel gaat in op het potentieel van participatief actieonderzoek om te leren en te ontwikkelen op de werkplek. Er wordt verslag gedaan van een actieonderzoeksproject binnen de verpleeghuiscontext. Onderzocht is hoe leren en ontwikkelen plaatsvonden en welke werkzame elementen binnen het actieonderzoeksproject hieraan bijdroegen. Resultaten laten zien dat leren en ontwikkelen in en van werk plaatsvinden op het moment dat authentieke situaties, direct beleefd worden. Ook helpt het als de authentieke situaties verkend worden vanuit verschillende perspectieven en als er mogelijkheden gezien worden voor nieuw of anders handelen. Regels en routines kunnen de integratie van leren en ontwikkelen in het werk beperken. Op basis van opgedane ervaringen en geleerde lessen worden aanbevelingen gegeven.

Background Older adults prefer to age in place. Social network change and health decline challenge ageing in place, as stressors that make age-related advantages disappear. The aim of this study was to explore social network change and health decline and its impact on older adults who are ageing in place. Method In-depth interviews (n = 16) were conducted with older adults who were ageing in place and who were experiencing health decline and social network change. Procedures for grounded theory building were followed to analyse the interviews with respondents who were discharged from the hospital less than 4 months ago (n = 7). Narrative analysis was conducted to reach a deeper understanding of the expected complexity of experiences of this targeted sample. Results Results encompass a typology with four types of impact: A. Sneak preview of old age, B. Disruptive transition into old age, C. Drastically ageing, and D. Steadily ageing. Additionally, indications were found that older adults should be able to move along the four types of impact and ideally could end up in quartile D, experiencing little or no impact at all (anymore). Conclusion The results present an optimistic view on the possibilities of older adults to continue ageing in place despite experiencing unavoidable and uncontrollable stressors in life. Also, the results provide leads for practice, to develop an action perspective for home care nurses and gerontological social workers to determine and reduce the impact of social network change and health decline on older adults who are ageing in place. Suggestions for further research would be to unravel how to detect temporal setbacks in successful ageing in place.

Background and objectives Residential care facilities (RCFs) strive to enhance autonomy for people with dementia and to enhance informal care provision, although this is difficult. This study explored how RCF staff can enhance autonomy and improve informal care by looking at the influence of interactions (contact and approachability between residents, staff members and informal caregivers) and the physical environment, including the use of technologies. Research design and methods A realist evaluation multiple-case study was conducted using document analyses, eight semi-structured interviews with staff members and relatives and 56 hours of observations of residents across two RCFs aiming to provide person-centred care. Realist logic of analysis was performed, involving Context-Mechanism-Outcome configurations. Findings The behaviour, attitudes and interactions of staff members with residents and informal caregivers appeared to contribute to the autonomy of people with dementia and enhance informal care provision. The physical environment of the RCFs and the use of technologies were less relevant to enhancing autonomy and informal care provision, although they can support staff members in providing person-centred care in daily practice. Discussion and implications The findings add to those of other studies regarding the importance of interaction between residents, staff members and informal caregivers. The findings provide insight for other RCFs on how successfully to enhance autonomy for their residents and to improve informal care provision, as well as, more broadly, how to implement person-centred care.

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Aim:To determine whether cytisine was at least as effective as varenicline in supporting smoking abstinence for ≥ 6 months in New Zealand indigenous Māori or whānau (extended-family) of Māori, given the high smoking prevalence in this population.Design:Pragmatic, open-label, randomized, community-based non-inferiority trial.Setting:Bay of Plenty, Tokoroa and Lakes District Health Board regions of New Zealand.Participants:Adult daily smokers who identified as Māori or whānau of Māori, were motivated to quit in the next 2 weeks, were aged ≥ 18 years and were eligible for subsidized varenicline. Recruitment used multi-media advertising.InterventionsA total of 679 people were randomly assigned (1 : 1) to receive a prescription for 12 weeks of cytisine or varenicline, plus low-intensity cessation behavioural support from the prescribing doctor and community stop-smoking services or a research assistant. Day 5 of treatment was the designated quit date.Measurements:The primary outcome was carbon monoxide-verified continuous abstinence at 6 months, analysed as intention-to-treat (with multiple imputation for missing data). Secondary outcomes measured at 1, 3, 6 and 12 months post-quit date included: self-reported continuous abstinence, 7-day point prevalence abstinence, cigarettes per day, time to (re)lapse, adverse events, treatment adherence/compliance and acceptability, nicotine withdrawal/urge to smoke and health-care utilization/health-related quality of life.Findings:Verified continuous abstinence rates at 6 months post-quit date were 12.1% (41 of 337) for cytisine versus 7.9% (27 of 342) for varenicline [risk difference 4.29%, 95% confidence interval (CI) = –0.22 to 8.79; relative risk 1.55; 95% CI = 0.97–2.46]. Sensitivity analyses confirmed that the findings were robust. Self-reported adverse events over 6 months occurred significantly more frequently in the varenicline group (cytisine: 313 events in 111 participants; varenicline: 509 events in 138 participants, incidence rate ratio 0.56, 95% CI = 0.49–0.65, P < 0.001) compared with the cytisine group. Common adverse events were headache, nausea and difficulty sleeping.Conclusion:A randomized controlled trial found that cytisine was at least as effective as varenicline at supporting smoking abstinence in New Zealand indigenous Māori or whānau (extended-family) of Māori, with significantly fewer adverse events.

Objectives: Residential care facility (RCF) residents with dementia are highly dependent on care. This can influence their experience of intimacy and sexuality. The perspective of residents and their spouses with regard to love, intimacy, and sexuality were explored and analyzed.Methods: The study was designed using the IPA methodology. Eight in-depth interviews were held with 12 participants: four couples and four individual residents with dementia.Results: Varied stories were shared; however, dementia had a great impact on all of them. Love, intimacy, and being together were considered fundamentally important by both couples and individual participants, although profound dilemmas were encountered. While only one couple experienced physical sexuality within the RCF, other participants reported that love and being intimate were the most important aspects of their current relationship. Regarding the possibility of fulfilling their needs within the RCF, a secure feeling of privacy was considered to be important, but was absent at the time of the survey.Conclusions: Although challenging to appropriately facilitate at RCFs, love, intimacy, and sexuality are still important aspects for residents with dementia and their spouses.Clinical implications: This study addresses these dilemmas and ads to the normalization of love, intimacy, and sexuality within RCF settings; the findings will hopefully improve the wellbeing of residents with dementia and that of their spouses.

Background Research on the nature of a “good death” has mostly focused on dying with cancer and other life-limiting diseases, but less so on dementia. Conceptualizing common cross-cultural themes regarding a good end of life in dementia will enable developing international care models. Methods We combined published qualitative studies about end of life with dementia, focus group and individual interviews with the researchers, and video-conferencing and continuous email discussions. The interviews were audio-recorded and transcribed verbatim. The data were analyzed thematically, and the researchers developed common themes referring to their original studies. Results Fourteen qualitative researchers representing 14 cross-cultural studies covering qualitative data of 121 people with dementia and 292 family caregivers. The researchers and data were from eight countries UK, The Netherlands, Japan, Portugal, Germany, Canada, Brazil, and Ireland. Three focus groups, five individual interviews, and video-conferencing were conducted and feedback on multiple iterations was gained by 190 emails between May 2019 and April 2020 until consensus was achieved. Nine cross-culturally common themes emerged from the discussions and shared interpretation of the data of persons with dementia and family caregivers. Three represent basic needs: “Pain and Symptoms Controlled,” “Being Provided Basic Care,” and “A Place like Home.” Other themes were “Having Preferences Met,” “Receiving Respect as a Person,” “Care for Caregivers,” “Identity Being Preserved,” “Being Connected,” and “Satisfaction with Life and Spiritual Well-being.” “Care for Caregivers” showed the greatest difference in emphasis across cultures. Good relationships were essential in all themes. Conclusions The common cross-cultural themes comprise a framework underpinned by value placed on personhood and dignity, emphasizing that interdependency through relationships is essential to promote a good end of life with dementia. These themes and valuing the importance of relationships as central to connecting the themes could support care planning and further development of a dementia palliative care model. Trial registration The Graduate School and Faculty of Medicine Kyoto University (R1924–1).

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.

BackgroundCountries are adapting their health and social care systems to better meet the needs of growing populations with (multiple) chronic conditions. To guide this process, assessment of the ‘patient experience’ is becoming increasingly important. For this purpose, the Person-Centred Coordinated Care Experience Questionnaire (P3CEQ) was developed in the United Kingdom, and translated into several languages.AimThis study aimed to assess the internal and construct validity of the Dutch P3CEQ to capture the experience of person-centred coordinated care of people with chronic conditions in the Netherlands.Participants and MethodsAdults with chronic conditions (N = 1098) completed the Dutch P3CEQ, measures of health literacy and patient activation, and reported the use and perceived quality of care services. Data analysis included Principal Component and reliability analysis (internal validity), analysis of variance and Student's T-tests (construct validity).ResultsThe two-component structure found was pretty much the same as in the UK validation study. Sociodemographic correlates also resembled those found in the United Kingdom. Women, persons who were less educated, less health-literate or less activated experienced less person-centred coordinated care. P3CEQ scores correlated positively with general practitioner performance scores and quality ratings of the total care received.ConclusionThe Dutch P3CEQ is a valid instrument to assess the experience of person-centred coordinated care among people with chronic conditions in the Netherlands. Awareness of inequity and more attention to communication skills in professional training are needed to ensure that care professionals better recognize the needs of women, lower educated or less health-literate persons, and improve their experiences of care.Patient ContributionThe P3CEQ has been developed in collaboration with a range of stakeholders. Eighteen persons with (multiple) chronic conditions participated as patient representatives and codesign experts in (four) codesign workshops. Other patient representatives participated in cognitive testing of the English-language instrument. The usability of the P3CEQ to capture the experience of person-centred coordinated care of older persons has been examined by interviewing 228 older European service users, including 13 living in the Netherlands, as part of the SUSTAIN project. More than a thousand persons with chronic conditions participated in the validation study of the Dutch P3CEQ.

Summary Background Combination nicotine replacement therapy shows additive cessation benefits. We aimed to find out the effectiveness of combining nicotine patches with an e-cigarette (with and without nicotine) on six-month smoking abstinence. Methods We did a pragmatic, three-arm, parallel-group trial in New Zealand in adult smokers who were e-cigarette naive and motivated to quit smoking. Participants were recruited from the general population using national media advertising. Participants were randomly assigned (1:4:4), with the use of stratified block randomisation, to receive 14 weeks (2 weeks before the agreed quit date) of 21 mg, 24h nicotine patches, patches plus an 18 mg/L nicotine e-cigarette, or patches plus a nicotine-free e-cigarette. We advised participants to use one patch daily, with e-cigarette use as and when necessary or desired. Participants and researchers were masked to e-liquid nicotine content. We offered 6 weeks of telephone-delivered behavioural support. The primary outcome was exhaled carbon monoxide (CO)-verified continuous smoking abstinence 6 months after the agreed quit date. Primary analysis was by intention to treat, with sensitivity analysis by per protocol, treatment adherence, varying CO cutoffs, and complete case analysis. This paper presents the main analyses and is registered with ClinicalTrials.gov, NCT02521662. Findings Between March 17, 2016 and Nov 30, 2017, 1124 people were assigned to nicotine patches (patches only group, n=125), patches plus a nicotine e-cigarette (patches plus nicotine e-cigarette group, n=500), or patches plus a nicotine-free e-cigarette (patches plus nicotine-free e-cigarette group, n=499). 62 (50%) of 125 participants in the patches only group withdrew or were lost to follow-up by 6 months compared with 161 (32%) of 500 in the patches plus nicotine e-cigarette group and 162 (33%) of 499 in the patches plus nicotine-free e-cigarette group. 35 (7%) participants in the patches plus nicotine e-cigarette group had CO-verified continuous abstinence at 6 months compared with 20 (4%) in the patches plus nicotine-free e-cigarette group (risk difference [RD] 2·99 [95% CI 0·17–5·81]), and three (2%) people in the patches only group (RD 4·60 [1·11–8·09]). 18 serious adverse events occurred in 16 people in the patches plus nicotine e-cigarette group compared with 27 events in 22 people in the patches plus nicotine-free e-cigarette group and four events in three people in the patches only group. In the patches plus nicotine e-cigarette group, two life-threatening serious adverse events were reported (two separate heart attacks in the one participant). In the patches plus nicotine-free e-cigarette group, one death occurred (accidental drug overdose) and one life-threatening serious adverse event (heart attack). No significant between-group differences were noted for serious adverse events, and none were treatment-related. Interpretation Combining reduced-harm nicotine products, such as nicotine patches with a nicotine e-cigarette, can lead to a modest improvement in smoking cessation over and above that obtained from using patches plus a nicotine-free e-cigarette (or patches alone), with no indication of any serious harm in the short-term. Future e-cigarette trials should focus on their use alone or in combination with usual smoking cessation support, given issues with differential loss to follow-up and withdrawal if a usual care group is used as a comparator. Funding Health Research Council of New Zealand.

During the COVID-19 outbreak in March 2020, restrictive measures (e.g., prohibiting physical visits and group activities) were introduced in nursing homes to protect older residents. Although the importance of social contacts and social activities to fulfill social needs and avoid loneliness is known, these were challenged during the pandemic. This qualitative study specifically focused on how residents, close relatives, and volunteers in nursing homes experienced the restrictive measures in retrospect and gained insights into the impact of the restrictive measures on social needs and loneliness, and the lessons that could be learned. Thirty semi-structured, face-to-face interviews with residents and close relatives, and one online focus group with ten volunteers, were conducted. Recruitment took place at psychogeriatric and somatic units in the Northern, Eastern and Southern regions of the Netherlands and Flanders, Belgium. The interviews and focus group were transcribed verbatim, and an open, inductive approach was used for analysis. Alternative ways of social contact could not fully compensate for physical visits. Generally, participants reported that it was a difficult time, indicated by feelings of loneliness, fear, sadness, and powerlessness. A great diversity in loneliness was reported. The most important reasons for feeling lonely were missing close social contacts and social activities. The diversity in the impact of restrictive measures depended on, e.g., social needs, coping strategies, and character. Restrictive COVID-19 measures in nursing homes resulted in negative emotions and unmet social needs of residents, close relatives, and volunteers. During future outbreaks of the COVID-19 virus or another virus or bacterium, for which restrictive measures may be needed, nursing homes should actively involve residents, close relatives, and volunteers to balance safety, self-determination, and well-being.

Achtergrond: De Two-Minute Step Test (TMST) is een meetinstrument gericht op het beoordelen van uithoudingsvermogen. Verscheidene psychometrische eigenschappen van de TMST-NL (Nederlands vertaalde versie) zijn onderzocht bij intramuraal wonende ouderen. De gevoeligheid voor verandering en de responsiviteit is bij deze patiëntenpopulatie nog niet vastgesteld. Doel: Het vaststellen van de gevoeligheid voor verandering en de responsiviteit (Minimal Clinical Important Difference) van de TMST-NL bij intramuraal wonende ouderen. Design: Prospectief responsiviteitsonderzoek. Methode: De onderzoekspopulatie bestond uit intramuraal wonende ouderen. Deelnemers hebben twee meetmomenten (T0 en T1) ondergaan waartussen ze drie maanden fysiotherapie gericht op uithoudingsvermogen ontvingen. Om de gevoeligheid van verandering te meten werd de distributie methode gebruikt waarbij de correlatie met de 6-minuten wandeltest (6MWT) werd getoetst. Via de anker methode met de Receiver Operating Characteristic (ROC) curve werd de MCID bepaald. Metingen voor het aerobe uithoudingsvermogen werden verricht met de TMST-NL en de 6-minuten wandeltest (6MWT). De Global Rating of Change (GRC) en de Borg Category-Ratio10 (BORG-CR10) werden gebruikt als subjectieve vragenlijsten om verandering van de gezondheidssituatie en vermoeidheid te meten. Resultaten: Intramurale ouderen (N=50) met een gemiddelde (SD) leeftijd van 83,96 jaar (6,96) zijn geïncludeerd. De correlatie tussen de verschilscores van de TMST-NL en de 6MWT over de deelnemerspopulatie die T1 ook hebben afgerond (N= 36) kwam uit op r=0.51 (P

Dementie en depressie zijn twee veel voorkomende pathologieën op oudere leeftijd. Een vroege, accurate detectie van beide ziektebeelden is, in het kader van een adequate ondersteuning en zorgplanning, onontbeerlijk. Hoewel er bij dementie, en in mindere mate ook bij depressie verschillende cognitieve capaciteiten onder druk staan, toont muziektherapie duidelijk aan dat de gevoelswereld van de oudere persoon niet stilvalt. In deze studie wilden we exploreren op welke manier een analyse van het muziektherapeutisch proces een bijdrage kan leveren aan de differentiële diagnose tussen dementie en depressie. Meer specifiek werd in dit onderzoek nagegaan of we op basis van muzikale improvisaties kunnen differentiëren tussen ouderen met dementie en ouderen met depressie. Methodisch maakten we gebruik van muzikale improvisaties op piano, uitgevoerd door tien patiënten met dementie, negen patiënten met depressie en zestien gezonde controles. De veronderstelling, dat vooral de improvisaties van personen met depressie afwijkend zouden zijn van beide andere groepen, lijkt bevestigd te worden in de resultaten. Zowel uit het kwantitatieve als uit het kwalitatieve luik van onze studie bleken de variabelen ‘gedeelde puls’, ‘tempo’ en ‘volume’ interessant te zijn bij het stellen van de differentiële diagnose dementie versus depressie. We stellen verder onderzoek voor naar deze drie mogelijks zeer waardevolle parameters in studies met een groter aantal deelnemers.

Introduction: Although the importance of maintaining autonomy for nursing home residents is recognised, little is known about this process in daily practice. Aim: The aim was to explore how residents maintain autonomy and how staff acts in relation to the autonomy of residents. Method: Shadowing, a non-participative observational method, including a short interview at the end, was used. Seventeen residents with physical impairments living in two different nursing homes were shadowed in their own environment during daily activities. Moreover, fifteen staff members, working in the same nursing homes, were shadowed. Field notes of the shadowing were typed out and the recorded interviews were transcribed verbatim resulting in a report per respondent. These were coded and thematically analysed. Results: Residents maintained autonomy by; ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. Four activities of staff were identified; ‚getting to know each older adult as a person and responding to her/his needs‘, ‚encouraging an older adult to self-care‘, ‚stimulating an older adult to make choices‘ and ‚being aware of interactions‘. Discussion and Conclusion: Maintaining autonomy requires effort from both residents and staff. Although most residents with physical impairments experience restrictions in their autonomy because of the care-environment they live in, residents seemed to maintain autonomy in daily life. Moreover, staff consider it important to strengthen the autonomy of residents and use different activities to enhance autonomy. Relevance for research and practice: These insights help to improve autonomy of nursing home residents because the perspectives of both residents and staff are included. Therefore, the next step is to transfer these insights towards nursing home practice in such a way that it enhances staff and older adults to better maintain autonomy

Contains fulltext : 251453.pdf (Publisher’s version ) (Open Access) AIMS AND OBJECTIVES: To explore the perspectives of people with dementia on being cared for by others, on the future and on the end of life, and to evaluate the capability and willingness of participants to have these conversations. BACKGROUND: Awareness about perspectives of people with dementia should decrease stigmatisation and improve their quality of life. Applying palliative care principles from an early stage is important to address diverse needs and to anticipate the future. Few studies investigate perspectives of people with dementia regarding palliative care, including advance care planning. DESIGN: Qualitative descriptive design. METHODS: We performed in-depth interviews with 18 community-dwelling persons with dementia in South-Limburg, the Netherlands. Transcripts were analysed using an inductive content analysis. Two authors coded the data and regularly compared coding. All authors discussed abstraction into categories and themes. We followed the COREQ reporting guidelines. RESULTS: Five overarching themes derived from the interviews were as follows: (a) My life still has value and meaning, (b) I am my own unique individual, (c) I place my trust in other people, (d) The future worries me, and (e) I accept and embrace what life brings. CONCLUSIONS: Participants' thoughts about the future and the end of life involved feelings of ambiguity and anxiety, but also of contentment and resignation. Despite worrying thoughts of decline, participants primarily demonstrated resilience and acceptance. They expressed appreciation and trust towards those who care for them. They wished to be recognised as unique and worthy humans, until the end of life. RELEVANCE TO CLINICAL PRACTICE: This study demonstrates capability and willingness of people with dementia to discuss the future and end-of-life topics. Public and professional awareness may facilitate opportunities for informal end-of-life discussions. Healthcare professionals should promote belongingness of persons with dementia and strive to build equal, trustful care relationships with them and their families.

Background Dementia is widely considered a progressive condition associated with changes in cognitive capacities, which promotes the idea that people with dementia need to anticipate end-of-life care preferences. There is a growing body of interventions meant to support advance care planning (ACP) for people with dementia and their families. However, a deeper understanding of their experiences and expectations regarding planning the end of life is needed to inform ethically sound and person-centered ACP. This study explores how end-of-life care planning for people with dementia is experienced and perceived in practice. Methods We conducted a secondary analysis of qualitative data from in-depth interviews and ethnographic fieldwork. Participants included people with dementia living in the community or in nursing homes, family caregivers, and professional caregivers. During reflective sessions, the researchers moved back and forth between their original data and overarching topics related to ACP. Both performed deductive coding to filter relevant information from their data. Ongoing discussions allowed for the fine-tuning of themes. Results End-of-life care planning for people with dementia can encompass a paradox of control. While it may foster a sense of being in control, it may also feel like relinquishing control over future situations. It raises concerns regarding responsibility, as present, former and future wishes may not align. Family caregivers are often responsible for concrete end-of-life decision-making, prompting them to weigh previous wishes against present situations. Further, people with dementia may wish to focus on the present and distance themselves from the future. Discussion Advance decisions about end-of-life care are often decontextualized and people may find it difficult to oversee their future conditions and preferences. The widely recognized purpose of ACP to exert control over end-of-life care may need revision to match the needs of people with dementia while they are coping with their condition and an uncertain future.

Background COVID-19 was first identified in December 2019 in the city of Wuhan, China. The virus quickly spread and was declared a pandemic on March 11, 2020. After infection, symptoms such as fever, a (dry) cough, nasal congestion, and fatigue can develop. In some cases, the virus causes severe complications such as pneumonia and dyspnea and could result in death. The virus also spread rapidly in the Netherlands, a small and densely populated country with an aging population. Health care in the Netherlands is of a high standard, but there were nevertheless problems with hospital capacity, such as the number of available beds and staff. There were also regions and municipalities that were hit harder than others. In the Netherlands, there are important data sources available for daily COVID-19 numbers and information about municipalities. Objective We aimed to predict the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands, using a data set with the properties of 355 municipalities in the Netherlands and advanced modeling techniques. Methods We collected relevant static data per municipality from data sources that were available in the Dutch public domain and merged these data with the dynamic daily number of infections from January 1, 2020, to May 9, 2021, resulting in a data set with 355 municipalities in the Netherlands and variables grouped into 20 topics. The modeling techniques random forest and multiple fractional polynomials were used to construct a prediction model for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands. Results The final prediction model had an R2 of 0.63. Important properties for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality in the Netherlands were exposure to particulate matter with diameters Conclusions Data about municipality properties in relation to the cumulative number of confirmed infections in a municipality in the Netherlands can give insight into the most important properties of a municipality for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality. This insight can provide policy makers with tools to cope with COVID-19 and may also be of value in the event of a future pandemic, so that municipalities are better prepared.

Background Social interactions are important for people living with dementia in a nursing home. However, not much is known about interactions and relationships between residents and family caregivers and related experiences of family caregivers. We aim to advance the knowledge on how family caregivers interact with people living with dementia in a nursing home and how they maintain or redesign a meaningful connection. Methods Qualitative research using interviews with family caregivers (n = 31) to explore perspectives on their interaction and relationship with the person living with dementia. Interviews were held during the reopening of nursing homes after the first COVID-19 lockdown in the Netherlands. In this situation, family caregivers became more aware of their interaction and relationship with the resident, which provided a unique opportunity to reflect on this. The interviews explored the interaction and relationship in a broad sense, not specifically for the COVID-19 situation. Thematic analysis was performed to analyze the data. Results We were able to identify three key themes reflecting the experiences of family caregivers: (1) changes in the interaction and relationship, (2) strategies to promote connection, and (3) appreciation of the interaction and relationship. From the viewpoint of family caregivers, the interaction and relationship are important for both the resident living with dementia and for themselves, and family caregivers have different strategies for establishing a meaningful connection. Nevertheless, some appear to experience difficulties with constructing such a connection with the resident. Conclusions Our results provide a basis for supporting family caregivers in perceiving and establishing mutuality and reciprocity so that they can experience togetherness.

Background and objective: Practically trained (student) caregivers (further: caregivers) make up the majority of care staff in nursing homes (NHs). To keep up with the fast-changing healthcare environment and ensure a high quality of care, it is important to know how to stimulate continuous work-based learning (WBL) among this group. The purpose of the study was to systematically study the scientific literature published to date on (1) how caregivers learn in NHs and (2) what facilitates or impedes their learning.Methods: A scoping review was carried out, systematically searching six scientific databases. A total of 35 studies published from January 2009 to February 2021 were included. Study characteristics, learning mechanisms, facilitators, and barriers to learning were extracted and synthesized.Results: None of the studies specifically focused on how caregivers learn. Yet, we identified various learning mechanisms, and found that learning by theory or supervision was most frequently engaged in. Most learning mechanisms used among the groups in the included studies were planned and formal and developed and initiated by others out of the context. Three main themes were identified among the facilitators and barriers of WBL: individual learning, collective learning, and resources for learning. An interdependency between (sub)themes was found.Conclusions: The way caregivers in NHs learn is understudied. Moreover, both their informal learning and the support they receive to be(come) active learners has been overlooked. As WBL provides caregivers with opportunities to learn within a real-life setting, we suggest more research on informal learning mechanisms.

(Op dit artikel zit een embargo van 12 maanden. Per oktober 2020 open access beschikbaar). Social needs are important basic human needs; when not satisfied, loneliness and social isolation can occur and subsequently sickness or even premature death. For older people social needs can be more difficult to satisfy be­cause of the loss of resources such as health and mobility. Interventions for older people to satisfy social needs are often not evaluated and when evaluated are not proven successful. Technological interventions can be successful, but the relationship between technology and social wellbeing is complex and more research in this area is needed. The aim of this research is to uncover design opportunities for technological interventions to fulfil social needs of older people. Context-mapping sessions are a way to gain more insight into the social needs of older people and to involve them in the design of interventions to fulfil social needs. Participants of the context-mapping sessions were older people and social workers working with older people. Four sessions with a total of 20 participants were held to generate ideas for interventions to satisfy social needs. The results are transcripts from the discussion parts of the context-mapping sessions and collages the participants cre­ated. The transcripts were independently analysed and inductive codes were attached to quotations in the transcripts that are relevant to the research question and subsequently thematic analysis took place. Collages made by the participants were independently ana­lysed by the researchers and after discussion consensus was reached about important themes. The following three main themes emerged: ‘connectedness’, ‘independence’ and ‘meaningfulness’. Technology was not identified as a separate theme, but was addressed in relation to the above mentioned themes. Staying active in a meaningful way, for example by engaging in volunteer work, may fulfil the three needs of being connected, independent and meaningful. In addition, interventions can also focus on the need to be and remain independent and to deal with becoming more dependent. The older people in our study have an ambivalent attitude towards technology, which needs to be taken into account when designing an intervention. We conclude this paper by making recommendations for possible technological interventions to fulfil social needs.

Background If technologies are to support aging in place, then it is important to develop fundamental knowledge on what causes stability and changes in the use of technologies by seniors. However, longitudinal studies on the long-term use of technologies that have been accepted into the home (i.e., post-implementation use) are very scarce. Many factors potentially could influence post-implementation use, including life events, age-related decline, changes in personal goal orientation, and various types of social influences. The aforementioned factors are likely to be interrelated, adding to the complexity. The goal of this study is to better understand changes and stability in the use of technologies by independent-living seniors, by using a dynamical systems theory approach. Methods A longitudinal qualitative field study was conducted involving home visits to 33 community-dwelling seniors in the Netherlands, on three occasions (2012–2014). Interviews were held on technology usage patterns, including reasons for stable, increased, declined and stopped use. Technologies were included if they required electric power in order to function, were intended to be used in or around the home, and could support activities of daily living, personal health or safety, mobility, communication, and physical activity. Thematic analysis was employed, using constant case comparison to better understand dynamics and interplay between factors. In total, 148 technology use patterns by 33 participants were analyzed. Results A core of six interrelated factors was closely linked to the frequency of technology use: emotional attachment, need compatibility, cues to use, proficiency to use, input of resources, and support. Additionally, disruptive forces (e.g., social influences, competition with alternative means, changes of personal needs) could induce change by affecting these six factors. Furthermore, long-term technology use was in some cases more resilient to disruption than in other cases. Findings were accumulated in a new framework: Dynamics In Technology Use by Seniors (DITUS). Conclusions Similar to aging, the use of technologies by older people is complex, dynamic and personal. Periods of stability and change both occur naturally. The DITUS framework can aid in understanding stability and instability of technology use, and in developing and implementing sustainable technological solutions for aging in place. Electronic supplementary material The online version of this article (10.1186/s12877-019-1241-9) contains supplementary material, which is available to authorized users.

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Background: The quality of the care relationship between a client and a professional is important in long-term care, as most clients depend on support for a lengthy period. The three largest client groups who receive longterm care in the Netherlands are older adults who are physically or mentally frail, people with mental health problems and people with intellectual disabilities. There is little clarity about how generic and variable the determinants of the quality of care relationships are across these client groups. The aim of this study is to explore and compare the determinants of the quality of care relationships in these three client groups in long-term care. Methods: This participatory study involving clients as co-researchers was held in three healthcare organizations, each providing long-term care to one client group. The research was conducted by three teams consisting of researchers and co-researchers. We interviewed clients individually and professionals in focus groups. The focus was on care relationships with professionals where there is weekly recurring contact for at least 3 months. Clients and professionals were selected using a convenience sample. The interviews were coded in open, axial and selective coding. The outcomes were compared between the client groups. Results: The study sample consisted of 30 clients and 29 professionals. Determinants were categorized into four levels: client, professional, between client and professional, and context. The findings show that the majority of the determinants apply to the care relationships within all three client groups. At the professional level, eleven generic determinants were found. Eight determinants emerged at the client level of which two were found in two client groups only. At the level between a client and a professional, six determinants were found of which one applied to mental healthcare and disability care only. Five determinants were found at the contextual level of which two were specific for two client groups. Conclusions: The study yielded a variety of determinants that came to the fore in all three client groups in long-term care. This suggests that including a homogenous client group from a single care setting is not necessary when studying the quality of long-term care relationships. This work was funded by the Netherlands Organisation for Health Research and Development (ZonMw) [grant number 516012506, 2016]. The funder played no role in the design of the study, collection, analysis or interpretation of data, or in writing the manuscript.

SAMENVATTING Zowel in Vlaanderen als in Nederland werd de voorbije jaren sterk geinvesteerd in preventie en interventieprogramma’s om kwetsbaarheid bij ouderen tegen te gaan. Kwetsbaarheid wordt doorgaans gedetecteerd door gezondheidsprofessionals. Deze studie exploreerde hoe andere professionals buiten de zorgsector zoals postbodes, winkelbediendes of apothekers een antennefunctie kunnen hebben in de detectie van kwetsbare ouderen door hen door te verwijzen naar zorg wanneer dit nodig is. Daarnaast werd nagegaan in welke situaties zij acties ondernemen en welke ondersteuning nodig is om de rol van antenneberoep op te nemen. 18 professionals werden individueel (n=12) of in focusgroep (n=6) geinterviewd. Resultaten van dekwalitatieve analyse tonen aan dat zij veelvuldig in contact komen met kwetsbare ouderen tijdens het uitoefenen van hun beroepsactiviteit. Door in gesprek te gaan met de ouderen detecteren zij verschillende vormen van kwetsbaarheid. Zij kunnen en willen een sleutelrol opnemen om deze ouderen door te verwijzen naar zorgondersteuning maar stellen zich vragen omtrent de privacy. Een centraal meldpunt per gemeente zien zij als een oplossing. ABSTRACT Background: When older adults have early symptoms of frailty, research indicates that an early intervention can delay or avoid adverse frailty outcomes such as hospitalization or institutionalization. Frailty is to date mostly detected in a medical setting. General practitioners or home care nurses are care professionals who are the key persons in this detection. The informal network of frail older people as well has a crucial role in avoiding the worsening of frailty and the prevention of adverse frailty outcomes. Unfortunately, not all older adults in need of care have adequate care networks. In the past years, many policies have seriously invested in prevention and intervention programs for frail older adults. Within the D-SCOPE study, the potential role of ‘non-care professionals’ is explored for detecting frail older adults without an informal network and potentially leading them to formal care. Professionals such as pharmacists, mailmen or cashiers have frequent contact with frail older adults and can be seen as “antenna professionals” given they receive considerable information from their clients or costumers. This explorative study researched (a) whether antenna professionals can detect frail communitydwelling older adults, (b) which action they undertake when they detect a frail person and which barriers may occur to initiate an action and (c) which support is needed to be an antenna professional. Methods: 18 persons with different professions were interviewed: pharmacists, police inspector, bank clerk, mailmen, local business owners such as florist and grocer, manager from a hair salon or supermarket and more. Professionals who didn’t had contact with frail community-dwelling older adults during their work were excluded for an interview. Participants were asked to what extend they had contact with frail older adults who were according to them in need for help, if they ever referred them towards appropriate care, what an antenna profession meant to them, what support they need to act as one and which barriers one can expect for this kind of function. All interviews were thematically analyzed. Results: The professionals could detect frailty in numerous ways. Physical frailty was visually noticeable and by starting conversations, other psychological and social frailty became visible while practicing the profession. Not seldom older adults themselves shared tragic stories of their lives. Cognitive frailty was recognized with alert signs, for example when older adults came to buy the same item twice. These professionals regularly initiate actions that were sometimes linked to their profession such as giving advice or delivering groceries. Just listening to the story could also be seen as an action for helping frail persons. In specific cases, situations were passed towards healthcare professionals or relatives. Barriers for referring frail older adults towards care organizations were concerns about privacy, fear of losing the continuity of the daily activities, correct estimating if one in fact needed help and finding the right balance between professional and personal life. Most participants in the study thought they could act as an antenna function for referring towards professional care although they are most concerned about the privacy regulation on this matter. One central contact point in the community for referring frail older adults was believed to be a solution to prevent frailty worsening and the question to mention this anonymously was more than once raised. More concerns of the possible antenna professionals were found in three evolutions that were analyzed across the interviews. A first was the disappearance of local business owners in the community. A second was the decline of neighborhood social capital, which makes older adults increasingly turn to neighborhood stores for social contact. A third evolution is the transformation of the social character of antenna profession in a digitized world or higher work pressure. Discussion and conclusion: The findings illustrate that professionals can have an antenna function in the detection of different types of frailty. To use the information of these professionals, their concerns should sincerely be acknowledged. Not only was correctly estimating if one effectively needs help a concern, also privacy issues were discussed. Referring a frail person with care needs anonymously is straightforward not possible according to the European Union regulation on the protection of natural persons with regard to the processing of personal data. Therefore, all professionals must have the permission of the older adult before referring him or her to a care or welfare organization. It should be noted that this study was explorative and possible other persons with an antenna function such as members from clubs or societies for older adults, neighborhood volunteers, priests or Imams were not included in this study and could have an important antenna function as well. The findings of this study however provide a basis for care or welfare organizations in the development of a policy towards the implementation of professionals with an antenna function for detecting frail community-dwelling older adults. These professionals already have valuable information that can be used to prevent frailty worsening.

Background:The attitudes of care staff toward the sexuality of residents with dementia they care for is assumed to influence the residents’ expression of their sexuality in the way they want. This paper examines the effect of organizational factors, person-centered care, and the culture of the organization on the attitudes of care staff toward the sexuality of residents with dementia in residential care facilities (RCF) .Methods:Care staff in different functions at six RCF organizations (N = 187) participated. Using a survey, we gathered information on demographics and care-staff careers, attitudes toward resident sexuality, the culture of the organization, person-centered care, and knowledge of resident sexuality. Ordinary least square (OLS) hierarchical analyses were performed to analyze results.Results:Care staff attitudes were found to be positively affected by person-centered care, and marginally positively affected by a supportive culture in the organization, Moreover, knowledge of resident sexuality positively affected care staff ‘attitudes toward resident sexuality, and the presence of policy regarding resident sexuality affected them negatively .Conclusions:Despite different study limitations, these results give a first insight in a broad perspective on care staff attitudes toward resident sexuality. In addition to improving knowledge of the care staff, enhancing person-centered care and a supportive culture in the organization will improve care-staff attitudes toward resident sexuality.

Objectives: The Person-centered Care (PCC) philosophy emphasizes close care relationships to enable care professionals to recognize the needs of nursing home residents with dementia. This study explored how care professionals make sense of resident behavior with regard to intimacy and sexuality.Methods: 26 nursing home care professionals (15 Nurses, 9 Health Care Professionals and 2 Managers) completed in-depth interviews that were subjected to an Interpretative Phenomenological Analysis (IPA).Results: Three thematic layers were identified. 1. Care Professionals pursue a “true” understanding of intimate and sexual behavior that underpins a resident’s expression. 2. When care professionals feel the need to protect themselves, they can reframe a specific care relation in order to continue care. 3. The social context around the resident, from family to professionals (i.e. peers), influences interpretation of behavior and, consequently, the provision of care.Conclusions: Intimate and sexual expressions of residents can put care relations under pressure. Care relations that lack professional distance may compromise care professionals’ judgments, impede their natural boundaries and decrease their well-being.Clinical implications: Along with implementing PCC principles, organizations should empower staff to develop, discuss and include self-reflection skills and personal boundaries within their work.