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Background Care for activities of daily living (ADL) performed by nursing professionals is poorly informed by scientific evidence. To address the nursing professionals’ need for guidance, we developed a clinical practice guideline on ADL care. This guideline comprises key recommendations (KRs) on involving care receivers and informal caregivers in ADL care, identifying ADL care needs, and effective ADL interventions. With the actual guideline use depending on different factors, insight into these influencing factors is necessary prior to the actual implementation. In a pilot implementation, we aimed to measure the use of KRs in various relevant care settings and to identify and explore these influencing factors. Methods In a pilot implementation study, mixed methods were applied where (1) nursing professionals weekly and retrospectively registered the frequency of the used key recommendations in a three-week period; (2) a survey was used to identify impeding and facilitating factors; and (3) focus groups were conducted to explore additional factors and how they influence KR use. Descriptive analysis was performed on registration and survey data, while focus group data was analyzed deductively. Results Seven nursing care teams participated from the hospital (n = 1), rehabilitation (n = 2), home-care (n = 1), and long-term care (n = 3). The use of KRs varied between KRs and across care settings, with the most frequently used KRs being on involving care receivers in ADL related care choices. KRs were least applied to assessing ADL functioning. The survey on factors influencing the implementation showed how the majority of factors across domains and care settings were generally perceived as facilitating, including the inner setting, the innovation itself, and individuals. Impeding factors mainly related to low tension for change and limited personal benefits. Additional constructs addressed in six focus group sessions included innovation characteristics (e.g. procedural clarity) and cooperation with care receivers. Conclusions The KRs generally appear implementable across care settings, with limited factors hindering the KR use. Despite the impression that the KRs are generally perceived as highly compatible with current norms and workflows, low tension for change raises questions on the awareness of current opportunities for improvement in ADL nursing care.

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.

Introduction: Case-mix based prospective homecare payment is being implemented in several countries to achieve high-quality, efficient, client-centered care. With case-mix, clients are allocated, based on their relevant characteristics (such as independence in activities of daily living (ADL)), into homogeneous groups with similar resource use. In the Netherlands, as part of an ongoing reform of the Dutch homecare payment system, a case-mix model was developed using Case-Mix Short Form (CM-SF) questionnaire data. However, this model, explaining 21% of the variance in homecare use, still requires improvement. Therefore, the aim of this Delphi-study was to identify predictors that could improve its predictive value, according to district nurses and healthcare purchasing experts.Methods: The CM-SF contains eleven items on commonly used predictors from existing case-mix models, i.e. on illness prognosis (n=1), functional status in terms of ADL (n=6), self-reliance in terms of instrumental ADL (IADL) (n=2), cognitive functioning (n=1), and informal care (n=1). In the first Delphi-round, participants scored the relevance of these eleven client characteristics for predicting homecare use, using a 9-Point Likert scale. Participants could suggest missing relevant characteristics. In the second round, after an expert panel meeting, participants re-assessed relevance of pre-existing characteristics previously assessed uncertain and of a selection of suggested characteristics. Median and inter-quartile ranges were calculated to determine relevance.Results: In the first Delphi-round, participants suggested 142 client characteristics, of which eleven were selected for further assessment. The eleven characteristics of the CM-SF and eleven suggested characteristics were assessed on their relevance for predicting homecare use by seventeen district nurses and five purchasing experts. In the second Delphi-round, of the 22 characteristics in total, ten client characteristics were assessed as relevant, with ‘Cognitive functioning’, ‘Learning ability’, and ‘Social network’ achieving the highest consensus for relevance. Other relevantly assessed client characteristics were among others ‘Multi-morbidity’, ‘Mental functioning’, and ‘Resilience’. Twelve characteristics were assessed uncertain, which largely concern characteristics regarding a client’s daily functioning (including ‘Toileting’ and ‘Dressing’) and physical health status (including ‘Skin problems’ and ‘Malnutrition’). None of the 22 characteristics was found irrelevant. Conclusions: In general, client characteristics suggested by the participants were more likely to be considered relevant compared to CM-SF items. According to district nurses and health insurers, homecare use could be predicted better by including other more holistic predictors in case-mix classification, such as on mental functioning and social network. Implications: The challenge remains to operationalize characteristics such as ‘Social network’ and ‘Health literacy’, which are more difficult to objectively measure in a feasible way. Furthermore, for successful homecare prospective payment, all stakeholders should be kept on board in the decision-making process regarding the development and implementation of case-mix classification.

Ageing with a disability increases the risk of hospitalization and nursing home admission. Ageing in place interventions aiming to reduce disability are often not sufficiently effective and inadequately theory-based. There are many models available on disability, but it is unclear how they define disability, what their differences are, and how they evolved throughout the years. This paper aims to provide an overview of the evolution of these models and to elaborate on the causal mechanisms of disability. A literature review was conducted as part of the TRANS-SENIOR international training and research network. PubMed and Google Scholar were searched, and snowball sampling was applied to eligible publications. Data were extracted from the included publications, and a thematic analysis was performed on the retrieved data. Overall, 29 publications were included in the final sample. All included models arose from three original models and could be divided into two types: linear models and models on the interaction between the person and the environment. Thematic analysis led to three distinct evolutionary trends: (1) from a unidirectional linear path to a multidirectional nonlinear path, (2) from the consequences of disease towards the consequences of person–environment interaction, and (3) from disability towards health and functioning. Our findings suggest that by optimizing the use of personal as well as environmental resources, and focusing on health and functioning, rather than disability, an older person’s independence and wellbeing can be improved, especially while performing meaningful daily activities in accordance with the person’s needs and preferences. ispartof: European Journal Of Ageing vol:19 issue:3 ispartof: location:Germany status: Published online

Purpose This study aims to provide a detailed description of the nurses in the lead (NitL) programme for empowering community nurse leadership in implementing evidence. Design/methodology/approach The NitL programme is described using the template for intervention description and replication-checklist. Findings The NitL programme consists of two components. The first component is a systematic approach with implementation steps and tools to empower community nurses in implementing evidence targeted at encouraging functional activities of older adults offered via a Web-based eLearning programme. The second component is training to empower community nurses in enabling team members to change their practice, which focussed on motivational interviewing, influencing behaviour, dealing with resistance to change and coaching delivered as a combination of group training in practice and background theory via a web-based eLearning programme. Research limitations/implications Further research is needed to evaluate the feasibility and effects of the NitL programme. Practical implications The NitL programme has been developed in cooperation with community nurses to meet their needs in practice and has the potential to develop leadership for the core tasks of community nurses. Originality/value The NitL programme has been developed to empower the leadership of community nurses in implementing evidence targeted at encouraging functional activities of older adults. The leadership role of community nurses is key for delivering high-quality care and implementing evidence within the community care setting for encouraging functional activities of older adults to preserve their independence.

[This corrects the article DOI: 10.1007/s10433-021-00668-w.].© Springer Nature B.V. 2022.

Teuni H Rooijackers,1,2 Silke F Metzelthin,1,2 Erik van Rossum,1– 3 Gertrudis IJM Kempen,1,2 Silvia MAA Evers,1 Andrea Gabrio,4 GA Rixt Zijlstra1 1Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; 2Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands; 3Research Center for Community Care, Academy of Nursing, Zuyd University of Applied Sciences, Heerlen, the Netherlands; 4Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, the NetherlandsCorrespondence: Teuni H RooijackersDepartment of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the NetherlandsTel +31 43-388-1711Email t.rooijackers@maastrichtuniversity.nlPurpose: Training and supporting homecare staff in reablement aims to change staff behavior from “doing for” to “doing with” older adults and is assumed to benefit the health and quality of life of older adults and reduce healthcare utilization and costs. This study evaluated the cost-effectiveness and cost-utility of the staff reablement training program “Stay Active at Home” (SAaH) from a societal perspective.Participants and Methods: An economic evaluation was embedded in a 12-month cluster randomized controlled trial. Ten Dutch homecare nursing teams participated (n = 313 staff members), of which five teams were trained in reablement and the other five provided usual care. Cost and effect data were collected from 264 older adults at baseline, 6 and 12 months. Costs included “intervention,” “healthcare,” and “patient and family” costs (collectively, societal costs) and were assessed using questionnaires and client records or estimated by bottom-up micro-costing. Effects included sedentary behavior and quality-adjusted life years (QALYs). Multiple imputed bootstrapped data were used to generate cost-effectiveness planes and acceptability curves.Results: No statistically significant differences were observed between the intervention and control group in terms of sedentary time (adjusted mean difference: 4.8 minutes [95% CI – 26.4, 36.0]), QALYs ( 0.01 [95% CI – 0.03, 0.04]), and societal costs ( € 2216 [95% CI – 459, 4895]), except lower costs for domestic help in the intervention group ( €– 173 [95% CI – 299, – 50]). The probability that SAaH was cost-effective compared to usual care ranged from 7.1% to 19.9%, depending on the willingness-to-pay (WTP) (€ 0‒€ 50,000)/minute of sedentary time averted and was 5.9% at a WTP of € 20,000/QALY gained.Conclusion: SAaH did not improve outcomes or reduce costs and was not cost-effective from a societal perspective compared to usual care in Dutch older adults receiving homecare. Consequently, there is insufficient evidence to justify widespread implementation of the training program in its current form.Trial Registration: ClinicalTrials.gov: NCT03293303.Keywords: cluster randomized controlled trial, cost-effectiveness, cost-utility, home and community-based care services, independence, aged

Training and supporting homecare staff in reablement aims to change staff behavior from "doing for" to "doing with" older adults, i.e., supporting client activation. We evaluated the effectiveness of the reablement training program "Stay Active at Home" (SAaH) on staff self-efficacy and outcome expectations regarding client activation in a cluster randomized controlled trial. Ten Dutch homecare nursing teams, comprising 135 nursing team members and 178 domestic workers, were randomized into the intervention group (SAaH) or control group (usual care). Data on self-efficacy and outcome expectations were collected at baseline, 6 and 12 months using scales developed for this study. Mixed-effects regression showed no differences between the study groups on either outcome. Therefore, widespread implementation of SAaH in its current form cannot be recommended. More research is needed on the development and psychometric properties of scales to assess staff behavior and behavioral determinants (e.g., self-efficacy and outcomes expectations) regarding client activation. (C) 2021 The Author(s). Published by Elsevier Inc.

With an ageing society, the demand for health and social care is increasing. Traditionally, staff provide care for their clients rather than with them. In contrast, reablement aims to support people to maximise their competences to manage their everyday life as independently as possible. There is considerable variation between and within countries regarding the conceptual understanding of the approach. This variation affects the ability to evaluate reablement approaches systematically, compare and aggregate findings from different studies, and hinders the development of a robust evidence. Therefore, a Delphi study was conducted in 2018/9 with the aim of reaching agreement on the characteristics, components, aims and target groups of reablement, leading towards an internationally accepted definition of reablement. The study consisted of four Web-based survey rounds. In total, 82 reablement experts from 11 countries participated, reaching agreement on five characteristics (e.g. person-centred), seven components (e.g. goal-oriented treatment plan) and five aims (e.g. increase clients’ independency). Furthermore, most experts agreed that reablement is an inclusive approach irrespective of the person's age, capacity, diagnosis or setting. Based on these features, a definition of reablement was developed, which was accepted by 79 per cent of participating experts. This study is a significant step towards providing conceptual clarity about reablement. Future research should focus on evaluating the implementation of agreed reablement components to inform practice, education and policy.

Background The Netherlands is currently investigating the feasibility of moving from fee-for-service to prospective payments for home healthcare, which would require a suitable case-mix system. In 2017, health insurers mandated a preliminary case-mix system as a first step towards generating information on client differences in relation to care use. Home healthcare providers have also increasingly adopted standardized nursing terminology (SNT) as part of their electronic health records (EHRs), providing novel data for predictive modelling. Objective To explore the predictive potential of SNT data for improvement of the existing preliminary Dutch case-mix classification for home healthcare utilization. Methods We extracted client-level data from the EHRs of a large home healthcare provider, including data from the existing Dutch case-mix system, SNT data (specifically, NANDA-I) and the hours of home healthcare provided. We evaluated the predictive accuracy of the case-mix system and the SNT data separately, and combined, using the machine learning algorithm Random Forest. Results The case-mix system had a predictive performance of 22.4% cross-validated R-squared and 6.2% cross-validated Cumming’s Prediction Measure (CPM). Adding SNT data led to a substantial relative improvement in predicting home healthcare hours, yielding 32.1% R-squared and 15.4% CPM. Discussion The existing preliminary Dutch case-mix system distinguishes client needs to some degree, but not sufficiently. The results indicate that routinely collected SNT data contain sufficient additional predictive value to warrant further research for use in case-mix system design.

Background: Case-mix based payment of health care services offers potential to contain expenditure growth and simultaneously support needs-based care provision. However, limited evidence exists on its application in home health care (HHC). Therefore, this study aimed to synthesize available international literature on existing case-mix models for HHC payment. Methods: We performed a systematic review of scientific literature, supplemented with grey literature. We searched for literature using six scientific databases, reference lists, expert consultation, and targeted websites. Data on study design, case-mix model attributes, and conclusions were extracted narratively. Results: Of 3303 references found, 22 scientific studies and 27 grey documents met eligibility criteria. Eight case-mix models for HHC were identified, from the US, Canada, New Zealand, Australia, and Germany. Three countries have implemented a case-mix model as part of a HHC payment system. Different combinations of in total 127 unique case-mix predictors are included across models to predict HHC use. Case-mix models also differ in targeted services, operationalization, and outcome measures and predictive power. Conclusions: Case-mix based payment is not yet widely used within HHC. Multiple varieties were found between HHC case-mix models, and no one best form of a model seems to exist. Even though varieties are partly inevitable due to country-specific contexts, developing a shared vision in case-mix model attributes would be key to achieving efficient, needs-based HHC. (C) 2020 The Authors. Published by Elsevier B.V.

To face the challenges of an ageing population, many Western countries nowadays stimulate an ageing in place policy to empower older adults to grow old in their own homes with the highest degree of self‐reliance. However, many community‐living older adults experience limitations in (instrumental) activities of daily living ((I)ADLs), which may result in a need for home‐care services. Unfortunately, home‐care workers often provide support by taking over tasks, as they are used to doing things for older adults rather than with them, which undermines their possibilities to maintain their self‐care capabilities. In contrast, reablement focuses on capabilities and opportunities of older adults, rather than on disease and dependency. Consequently, older adults are stimulated to be as active as possible during daily and physical activities. The 'Stay Active at Home' programme was designed to train home‐care workers to apply reablement in practice. To explore the experiences of home‐care workers with this programme an exploratory study was conducting in the Netherlands, between April and July, 2017. In total, 20 participants were interviewed: nine nurses (including a district nurse), 10 domestic support workers and the manager of the domestic support workers. The semi‐structured interviews focused on the experienced improvements with regard to knowledge, skills, self‐efficacy and social support. Furthermore, the most and least appreciated programme components were identified. The study has shown that home‐care workers perceived the programme as useful to apply reablement. However, they also need more support with mastering particular skills and dealing with challenging situations. Future implementation of the 'Stay Active at Home' programme can potentially benefit from small adaptions. Furthermore, future research is needed to examine whether the programme leads to more (cost‐) effective home care.

The COVID-19 pandemic has severely affected healthcare delivery across the world. However, little is known about COVID-19’s impact on home healthcare (HHC) services. Our study aimed to: (1) describe the changes in volume and intensity of HHC services and the crisis management policies implemented; (2) understand the responses and the experiences of HHC staff and clients. We conducted an explanatory sequential mixed methods study. First, retrospective client data (N = 43,495) from four Dutch HHC organizations was analyzed. Second, four focus group interviews were conducted for the strategic, tactical, operational, and client levels of the four HHC organizations. Our results showed that both the supply of and demand for Dutch HHC decreased considerably, especially during the first wave (March–June 2020). This was due to factors such as fear of infection, anticipation of a high demand for COVID-19-related care from the hospital sector, and lack of personal protective equipment. The top-down management style initially applied made way for a more bottom-up approach in the second wave (July 2020–January 2021). Experiences vary between levels and waves. HHC organizations need more responsive protocols to prevent such radical scaling-back of HHC in future crises, and interventions to help HHC professionals cope with crisis situations.

Background The Nurses in the Lead (NitL) programme consists of a systematic approach and training to 1) empower community nurses in implementing evidence, targeted at encouraging functional activities of older adults, and 2) train community nurses in enabling team members to change their practice. This article aims to describe the process evaluation of NitL. Methods A mixed-methods formative process evaluation with a predominantly qualitative approach was conducted. Qualitative data were collected by interviews with community nurses (n = 7), focus groups with team members (n = 31), and reviewing seven implementation plans and 28 patient records. Quantitative data were collected among community nurses and team members (N = 90) using a questionnaire to assess barriers in encouraging functional activities and attendance lists. Data analysis was carried out through descriptive statistics and content analysis. Results NitL was largely executed according to plan. Points of attention were the use and value of the background theory within the training, completion of implementation plans, and reporting in patient records by community nurses. Inhibiting factors for showing leadership and encouraging functional activities were a lack of time and a high complexity of care; facilitating factors were structure and clear communication within teams. Nurses considered the systematic approach useful and the training educational for their role. Most team members considered NitL practical and were satisfied with the coaching provided by community nurses. To optimise NitL, community nurses recommended providing the training first and extending the training. The team members recommended continuing clinical lessons, which were an implementation strategy from the community nurses. Conclusions NitL was largely executed as planned, and appears worthy of further application in community care practice. However, adaptations are recommended to make NitL more promising in practice in empowering community nurse leadership in implementing evidence.

Background/Objectives: Homecare staff often take over activities instead of “doing activities with” clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the “Stay Active at Home” (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior. Design: Cluster randomized controlled trial (c-RCT). Setting: Dutch homecare (10 nursing teams comprising a total of 313 staff members). Participants: 264 clients (aged ≥65 years). Intervention: SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual. Measurements: Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed. Results: We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] 22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI 1.5, 2.6], p = 0.589) or for most secondary outcomes. Conclusion: Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.

Self-efficacy and outcome expectations regarding client activation determine professionals' level of actively engaging clients during daily activities. The Client Activation Self-Efficacy and Outcome Expectation Scales for nurses and domestic support workers (DSWs) were developed to measure these concepts. This study aimed to assess their psychometric properties. Cross-sectional data from a sample of Dutch nurses (n=150) and DSWs (n=155) were analysed. Descriptive statistics were used to examine floor and ceiling effects. Con-struct validity was assessed by testing research-based hypotheses. Internal consistency was determined with Cronbach's alpha. The scales for nurses showed a ceiling effect. There were no floor or ceiling effects in the scales for domestic support workers. Three out of five hypotheses could be confirmed (construct validity). For all scales, Cronbach's alpha coefficients exceeded 0.70. In conclusion, all scales had moderate construct validity and high internal consistency. Further research is needed concerning their construct validity, test-retest reliability and sensitivity to change.(c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Background Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n = 4). Results The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment. Trial registration ClinicalTrials.gov (Identifier NCT03293303). Registered 26 September 2017.

Background: Communication between nursing staff and people with dementia can be challenging. According to the literature, communication is seen as a process of social- and/or informational exchange between a sender and a receiver in a context. Factors related to these elements determine the quality of communication. Insight into the factors involved in the communication process between nursing staff and people with dementia is limited and a comprehensive model of communication in dementia care is lacking.Objectives: To identify and visualize factors associated with communication between nursing staff and people with dementia.Design: A scoping review of scientific literature.Data Sources: Scientific articles were retrieved from the bibliographic databases of PubMed, CINAHL and PsycINFO.Review Methods: The reviewing process was directed by the Joanna Briggs guidelines for scoping reviews. Full-text articles describing the communication process between nursing staff and people with dementia were eligible for inclusion. A data extraction form was used to identify factors associated with communication. Following a directed content analysis approach, factors were categorized in one of three categories: nursing staff; people with dementia; or context. Each category was thematically analysed to identify themes and subthemes.Results were visualized into a communication model. Results: The review included 31 articles; in total, 115 factors were extracted. Thematic analysis of nursing stafffactors (n = 78) showed that communication is associated with professional characteristics, individual experiences, verbal - and non-verbal communication skills, communication approach and values. Factors attributed to people with dementia (n = 22) concerned client characteristics, functional status, behaviour, verbal communication skills and values. Contextual factors (n = 15) related to organization of care, time and situation. Based on these results, the Contac-d model was constructed.Conclusions: The Contac-d model gives a comprehensive overview of factors involved in the communication process between nursing staff and people with dementia, providing insight in potential starting points for communication improvement, e.g. respect for needs, identity and privacy of people with dementia, a flexible and adapted communication approach and matching language. Additionally, results suggest that an appealing location, longer duration of the interaction, and music in the surrounding may improve communication in certain situations. However, it was not feasible based on current literature to recommend what works to improve communication in which situations. Future studies should study factors and their interrelatedness in specific care situations. Authors further believe that more attention should be paid to strengths and capabilities of people with dementia and to non-modifiable factors that influence communication. (c) 2020 The Author(s). Published by Elsevier Ltd.

Background Community care professionals need to encourage older adults in performing functional activities to maintain independence. However, professionals often perform functional activities on behalf of older adults. To change this, insights into the behavior and barriers of professionals in encouraging activities are required. In the current study, the MAINtAIN questionnaire, which was developed for nursing homes, was adopted. The objective was to create a modified version that is suitable for measuring behavior and barriers of community care professionals in encouraging functional activities of clients in the community care setting. The overall aims were to assess the content validity, construct validity, and internal consistency of the modified version. Methods Data was collected by qualitative and quantitative methods in two phases. During phase one, the MAINtAIN was assessed on appropriateness and feasibility by community nurses (N = 7), and the adapted questionnaire was assessed on content validity by research experts (N = 9) and community care professionals (N = 18). During phase two, the psychometric properties of the adapted MAINtAIN-C were assessed in community care professionals (N = 80). Construct validity was evaluated by an Exploratory Factor Analysis (EFA), and internal consistency was determined by calculating Cronbach’s alpha coefficients. Results The formulation, verbs, and wording of the MAINtAIN were adapted; some items were excluded and relevant items were added, resulting in the MAINtAIN-C with two scales, showing good content validity. The Behaviors scale (20 items) measures perceived behavior in encouraging functional activities, expressing good internal consistency (Cronbach’s alpha: .92). The Barriers scale measures barriers in encouraging functional activities related to two dimensions: 1) the clients’ context (7 items), with good internal consistency (.78); and 2) the professional, social, and organizational contexts (21 items), showing good internal consistency (.83). Conclusions The MAINtAIN-C seems promising to assess the behavior and barriers of community care professionals in encouraging functional activities. It can be used to display a possible difference between perceived and actual behavior, to develop strategies for removing barriers in encouraging activities to foster behavioral change. The results also provide guidance for further research in a larger sample to obtain more insight into the psychometric properties.

IntroductionCompared with fee-for-service systems, prospective payment based on casemix classification is thought to promote more efficient, needs-based care provision. We aim to develop a casemix classification to predict the costs of home care in the Netherlands.Methods and analysisThe research is designed as a multicentre, cross-sectional cohort study using quantitative methods to identify the relative cost predictors of home care and combine these into a casemix classification, based on individual episodes of care. The dependent variable in the analyses is the cost of home care utilisation, which is operationalised through various measures of formal and informal care, weighted by the relative wage rates of staff categories. As independent variables, we will use data from a recently developed Casemix Short-Form questionnaire, combined with client information from participating home care providers’ (nursing) classification systems and data on demographics and care category (ie, a classification mandated by health insurers). Cost predictors are identified using random forest variable importance measures, and then used to build regression tree models. The casemix classification will consist of the leaves of the (pruned) regression tree. Internal validation is addressed by using cross-validation at various stages of the modelling pathways. The Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis statement was used to prepare this study protocol.Ethics and disseminationThe study was classified by an accredited Medical Research Ethics Committee as not subject to the Dutch Medical Research Involving Human Subjects Act. Findings are expected in 2020 and will serve as input for the development of a new payment system for home care in the Netherlands, to be implemented at the discretion of the Dutch Ministry of Health, Welfare and Sports. The results will also be published in peer-reviewed publications and policy briefs, and presented at (inter)national conferences.

Patients often experience a functional decline due to physical inactivity during illness. Nurses can influence the physical activity of patients while assisting them with activities of daily living. The purpose of this study was to identify effective interventions that are embedded in daily nursing care (irrespective of care setting) that aim to optimize the functional status of patients by increasing their physical activity. A systematic review was performed and reported following the preferred reporting items for systematic reviews and meta‐analyses. PubMed, CINAHL, and Cochrane were searched for studies from January 2002 to March 2019. The critical appraisal tools from the Joanna Briggs Institute were used to assess the risk of bias in individual studies. Study characteristics, intervention key components, and reported effects of included studies were extracted, summarized narratively, and compared. Twenty studies, evaluating nine different interventions were included. In these interventions, eight key components were identified. Four components were included in all six interventions with a positive effect on mobility, physical activity, or functional status. These components were: assessment of patient's functionality; goal setting with the patient; establishment of an individualized plan; and engagement of patients in physical and daily activity. The effects were limited due to the risk of bias in the studies, small sample sizes, limited clinical meaning of the effects, and variability of the adherence to the interventions. Multicomponent interventions were the most promising to enhance the functional status of patients. Future research should evaluate these interventions using research methods aiming at producing more rigorous evidence.

Objectives: Complex interventions are criticized for being a "black box", which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary-care programs aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare, and synthesize the development and evaluation of nine primary-care programs within a controlled trial to further improve the development and evaluation of complex interventions. Study Design and Setting: A systematic overview of all written data on the nine proactive primary-care programs was conducted using a validated item list. The nine proactive primary-care programs involved 214 general practices throughout the Netherlands. Results: There was little or no focus on the (1) context surrounding the care program, (2) modeling of processes and outcomes, (3) intervention fidelity and adaptation, and (4) content and evaluation of training for interventionists. Conclusions: An in-depth analysis of the context, modeling of the processes and outcomes, measurement and reporting of intervention fidelity, and implementation of effective training for interventionists is needed to enhance the development and replication of future complex interventions. (C) 2018 The Authors. Published by Elsevier Inc.

Wijkverpleegkundigen staan op de voorgrond in het proces van kwaliteitsverbetering binnen het eigen team. Dit vereist leiderschap. Het project Nurses in the Lead richt zich op het versterken van leiderschapscompetenties van wijkverpleegkundigen bij het implementeren van evidence-based innovaties gericht op het stimuleren van zelfredzaamheid bij ouderen.

Background During hospitalization patients frequently have a low level of physical activity, which is an important risk factor for functional decline. Function Focused Care (FFC) is an evidence-based intervention developed in the United States to prevent functional decline in older patients. Within FFC, nurses help older patients optimally participate in functional and physical activity during all care interactions. FFC was adapted to the Dutch Hospital setting, which led to Function Focused Care in Hospital (FFCiH). FFCiH consists of four components: (1) ‘Environmental and policy assessment’; (2) ‘Education’; (3) ‘Goal setting with the patient’ and (4) ‘Ongoing motivation and mentoring’. The feasibility of FFCiH in the Dutch hospital setting needs to be assessed. Objective Introduce FFCiH into Dutch hospital wards, to assess the feasibility of FFCiH in terms of description of the intervention, implementation, mechanisms of impact, and context. Design Mixed method design Setting(s) A Neurological and a Geriatric ward in a Dutch Hospital. Participants 56 Nurses and nursing students working on these wards. Methods The implementation process was described and the delivery was studied in terms of dose, fidelity, adaptions, and reach. The mechanisms of impact were studied by the perceived facilitators and barriers to the intervention. Qualitative data were collected via focus group interviews, observations, and field notes. Quantitative data were collected via evaluation forms and attendance/participation lists. Results A detailed description of FFCiH in terms of what, how, when, and by whom was given. 54 Nurses (96.4%) on both wards attended at least 1 session of the education or participated in bedside teaching. The nurses assessed the content of the education sessions with a mean of 7.5 (SD 0.78) on a 0–10 scale. The patient files showed that different short and long-term goals were set. Several facilitators and barriers were identified, which led to additions to the intervention. An important facilitator was that nurses experienced FFCiH as an approach that fits with the principles underpinning their current working philosophy. The experienced barriers mainly concern the implementation elements of the FFCiH-components ‘Education’ and ‘Ongoing motivation and mentoring’. Optimizing the team involvement, improving nursing leadership during the implementation, and enhancing the involvement of patients and their family were activities added to FFCiH to improve future implementation. Conclusions FFCiH is feasible for the Dutch hospital setting. Strong emphasis on team involvement, nursing leadership, and the involvement of patients and their families is recommended to optimize future implementation of FFCiH in Dutch hospitals. What is already known • Function Focused Care is an evidence-based intervention that prevents functional decline among hospitalized elderly; • It is proven to be effective in assistant living facilities, nursing homes, home care, and acute care settings in the United States; • It is unknown if the intervention can be implemented in the Dutch Hospital Setting. What this paper adds • This study showed the feasibility of Function Focused Care in Hospital and the challenges in some elements of the intervention; • Optimizing the team involvement, improving nursing leadership during the implementation, and enhancing the involvement of patients and their family were added to FFCiH to improve future implementation. • This feasibility study can guide the use of process evaluation in examining the feasibility of an intervention in daily practice.

Stay Active at Home (SAaH) was developed to change homecare professionals’ behavior towards encouraging older adults’ independence in daily activities. This mixed-methods study evaluated SAaH regarding implementation, mechanisms of impact, and context. SAaH was implemented in five Dutch homecare teams (162 professionals). Quantitative data were collected from all professionals, and five focus groups with 23 professionals and 4 interventionists were performed. Data were analyzed using descriptive statistics and qualitative content analysis. SAaH was feasible to implement. Professionals visited on average 73% of the programme meetings. They reported positive changes in their knowledge, attitude, and skills, and perceived social and organizational support regarding the new way of working. The extent to which professionals applied SAaH in practice varied. SAaH was easier to apply among new clients. Perceived barriers were time pressure and staff shortages, and people’s resistance to change. Tailoring the intervention to professionals’ needs and wishes could improve their compliance. Part of a symposium sponsored by Nursing Care of Older Adults Interest Group.

In shared decision making, the exploration of preferred personal health outcomes is important. Patient-reported outcome measures (PROMs) provide input for discussions between patients and healthcare professionals. The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) PROM is a multidimensional questionnaire on the physical and mental health and wellbeing of older adults. This study investigates how the TOPICS-MDS could be used in individual healthcare conversations. We explored views of older adults regarding 1) whether the health domains they want to discuss are included in the TOPICS-MDS and 2) the comprehensibility of the TOPICS-MDS for healthcare conversations with older adults. A three-round Delphi study was conducted. A total of 57 older adults participated in the study, the mean (SD) age was 71.5 (8.5) years, and 78.9% of the participants were female. The participants were divided into four panels based on educational level and cultural background. We used online questionnaires and focus groups. Consensus was pre-defined to be the point when ≥75% of the participants agreed that a domain was important or very important (scored on a 5-point Likert scale). The inter-expert agreement was computed for Round 1 and 3 with Kendall's W. Round 2 was a focus-group. Qualitative data were analyzed by content analysis. Older adults considered 'functional limitations', 'emotional wellbeing', 'social functioning' and 'quality of life' to be important domains of the TOPICS-MDS to discuss in healthcare conversations. The participants added 'coping with stress', 'dealing with health conditions and the effects on life' as extra domains for healthcare conversations. Challenges regarding the comprehensibility of the TOPICS-MDS included difficult words and lengthy or sensitive questions. Questions that included multiple topics were difficult to understand. The TOPICS-MDS covers the domains of life that older adults value as important to discuss with healthcare professionals, and two additional domains were identified. For older adults with a low level of education or a culturally diverse background, the TOPICS-MDS needs to be adjusted for comprehensibility.

Functional decline in older adults often lead towards acute or long-term care. In practice, caregivers often focus on completion of care tasks and of prevention of injuries from falls. This task based, safety approach inadvertently results in fewer opportunities for older adults to be actively involved in activities. Further deconditioning and functional decline are common consequences of this inactivity. To prevent or postpone these consequences Function Focused Care (FFC) was developed meaning that caregivers adapt their level of assistance to the capabilities of older adults and stimulate them to do as much as possible by themselves. FFC was first implemented in institutionalized long-term care in the US, but has spread rapidly to other settings (e.g. acute care), target groups (e.g. people with dementia) and countries (e.g. the Netherlands). During this symposium, four presenters from the US and the Netherlands talk about the impact of FFC. The first presentation is about the results of a stepped wedge cluster trial showing a tendency to improve activities of daily living and mobility. The second presentation is about a FFC training program. FFC was feasible to implement in home care and professionals experienced positive changes in knowledge, attitude, skills and support. The next presenter reports about significant improvements regarding time spent in physical activity and a decrease in resistiveness to care in a cluster randomized controlled trial among nursing home residents with dementia. The fourth speaker presents the content and first results of a training program to implement FFC in nursing homes. Nursing Care of Older Adults Interest Group Sponsored Symposium

In recent years, Function Focused Care (FFC) interventions have been developed and implemented in Dutch home care, nursing homes and acute care. These interventions aimed to train nursing staff to adapt their level of support to the capabilities of elderly and to maintain/optimize their self-reliance and physical functioning. After synthesizing knowledge and experiences from the existing FFC-interventions, an advanced FFC-intervention was developed for application in long-term care: ‘SELF’. SELF comprises seven interactive sessions, is theoretically grounded, primarily focuses on behavior change in nursing staff, is tailored to the ward’s needs, is multidisciplinary in nature, and focuses on all care interactions. Currently, SELF is pilot-tested in one psycho-geriatric ward with 17 nursing staff members. Questionnaires on outcome-expectations, self-efficacy and intention to stimulate elderly are assessed at baseline and after 3 months. Field notes and interviews are used to assess its feasibility and acceptability. Experiences will guide the further refinement of ‘SELF’. Part of a symposium sponsored by Nursing Care of Older Adults Interest Group.

Many hospitalized patients experience decline in functional status. Function Focused Care (FFC) has demonstrated to improve patients’ functional status in long-term care. In a stepped wedge cluster trial in 893 hospitalized geriatric and stroke patients, we investigated the effectiveness of FFC compared to usual care (FFC: n=427, UC: n=466) on ADL and mobility. We measured the Barthel Index and the Elderly Mobility Scale, and analysed using a mixed-model multi-level method. At discharge, 3 month and 6 months, the mean difference (MD) was in favour of FFC, although at none of the time points the level of significance was reached: the MD for ADL was respectively: 0.79 (95%CI: -0.98-2.56), 0.43 (95%CI: 0.10-1.79), and 0.57 (95%CI: -1.34- 2.48). For mobility, the MD was respectively 0.89 (95%CI: -1.01-2.80), 0.78 (95%CI: -1.18; 2.75), and 1.09 (95%CI: -0.88-3.07). Although the results are inconclusive, FFC shows a tendency to improve ADL and mobility in hospitalized patients. Part of a symposium sponsored by Nursing Care of Older Adults Interest Group.

Wijkverpleegkundigen in Nederland indiceren sinds 2015 weer zelf. Indiceren houdt in dat zij vaststellen welke zorg nodig is. Alle verpleegkundigen worden geacht om via een brede anamnese te komen tot geobjectiveerde, onderbouwde (verpleegkundige) diagnoses die gekoppeld kunnen worden aan verpleegkundige interventies en zorgresultaten. Het Normenkader Indiceren van V&VN ondersteunt dat.

Background: Supporting older people with several healthcare needs in sustaining adequate functioning and independence puts a major challenge on the healthcare system. Proactive approaches are needed. Objectice: This study summarizes the (cost-)effectiveness of eight proactive, multidisciplinary,[for full text, please go to the a.m. URL], 51. Kongress für Allgemeinmedizin und Familienmedizin

Activities of Daily Living are a series of basic activities performed by individuals on a daily basis necessary for independent living at home or in the community. ADL are part of basic nursing care which describe aspects of care that are fundamental to all patients’ health and well-being, regardless of diagnosis, cultural background or healthcare setting. In daily practice, nursing staff is confronted with challenges when providing ADL-care. In order to provide nursing professionals with practical tools to tackle daily challenges, a deeper insight into the perceived challenges by nursing staff, care receivers and informal caregivers is necessary. Therefore, two ‘world-café’ sessions were organized to explore daily challenges in ADL-care. In a World Café, participants are regarded as experts of their own lived experience and experiential knowledge. By creating a hospitable environment (i.e. a café-style ambience) individual and collective knowledge and ideas can be shared. Care receivers, informal caregivers and professionals including nurses, nursing-assistants, physical therapists, occupational therapist, and other stakeholders (N=53) participated in these ‘world-cafés’. The session’s output comprised ‘graphic recordings’ (paper tablecloths and post its) of the conversations that have been analyzed using content analysis. Findings showed reported challenges regarding receiving, providing and organizing ADL-care. Challenges on organizational level comprised for example both bilateral agreements and communication. Whereas reported care related issues related to challenges such as the assessment of care receivers’ needs and the use of assistive devices in the provision of ADL-care. The inventoried challenges will be addressed in an ADL-quality standard for nursing staff.

Fee‐for‐service, funding care on an hourly rate basis, creates an incentive for home‐care providers to deliver high amounts of care. Under casemix funding, in contrast, clients are allocated—based on their characteristics—to homogenous, hierarchical groups, which are subsequently funded to promote more effective and efficient care. The first step in developing a casemix model is to understand which client characteristics are potential predictors of home‐care needs. Nurses working in home care (i.e. home‐care nurses) have a good insight into clients’ home‐care needs. This study was conducted in co‐operation with the Dutch Nurses’ Association and the Dutch Healthcare Authority. Based on international literature, 35 client characteristics were identified as potential predictors of home‐care needs. In an online survey (May, 2017), Dutch home‐care nurses were asked to score these characteristics on relevance, using a 9‐point Likert scale. They were subsequently asked to identify the top five client characteristics. Data were analysed using descriptive statistics. The survey was completed by 1,007 home‐care nurses. Consensus on relevance was achieved for 15 client characteristics, with “terminal phase” being scored most relevant, and “sex” being scored as the least relevant. Relevance of the remaining 20 characteristics was uncertain. Additionally, based on the ranking, “ADL functioning” was ranked as most relevant. According to home‐care nurses, both biomedical and psychosocial client characteristics need to be taken into account when predicting home‐care needs. Collaboration between clinical practice, policy development, and science is necessary to realise a funding model, to work towards the Triple Aim (improved health, better care experience, and lower costs).

In the Netherlands, 95% of older adults (≥65 years) are community-dwelling with 20% of them receiving homecare services. The ‘Stay Active at Home’ program focuses on doing self-care and domestic tasks with older adults rather than for them. The training program for professionals was pilot-tested using a mixed-methods design. Out of 33 professionals, who were invited to participate in the pilot, 20 attended the kick-off meeting of whom 18 agreed to participate in the study; 94% were female with an average age of 43.7 years. Face-to-face interviews showed that professionals particularly valued the practical examples to stimulate active engagement in daily and physical activities and the possibility to exchange experiences with their colleagues. Furthermore, the weekly newsletter with tips & tricks is perceived as useful to remain aware of the needed behavioral change. Overall, a trend towards better scores for knowledge, self-efficacy and outcome expectation were found.

Background: To provide adequate nursing care it is important for nursing staff to communicate effectively with people with dementia. Due to their limited communication skills, people with dementia have difficulties in understanding communication and expressing themselves verbally. Nursing staff members often report communication difficulties with people with dementia, which emphasises the urgent need for interventions to improve their communication with people in this specific target group. Objectives: To provide an up-to-date overview of communication interventions that are applicable during daily nursing care activities, irrespective of care setting, and to describe the effects on communication outcomes in people with dementia and nursing staff. Design: Systematic literature review Data sources: The Cochrane Library, CINAHL, PsycINFO, and Pubmed databases were searched for all articles published until the 23rd of February 2016. Review methods: Papers were included, if: (1) interventions focused on communication between nursing staff and people with dementia and were applicable during daily nursing care; (2) studies were (randomised) controlled trials; (3) papers were written in English, Dutch, or German. Data were extracted on content and communication outcomes of interventions, and on methodological quality of the studies. The data extraction form and methodological quality checklist were based on the Method Guidelines for Systematic Reviews for the Cochrane Back Review Group. Results: Six studies on communication interventions were included. All of the studies incorporated a communication skills training for nursing staff with a broad range in frequency, duration and content. In addition, there was wide variation in the communication outcome measures used. Four studies measured non-verbal communication, all found positive effects on at least some of the communication outcomes. Four studies measured verbal communication, of which three found positive effects on at least one of the measured outcomes. Methodological quality assessment demonstrated a high risk of bias in five of the six studies. Conclusions: Few studies have been identified with wide variation in interventions and outcome measures. In addition, the methodological shortcomings make it difficult, to draw conclusions about the effectiveness. More research is needed to develop and evaluate communication interventions. Additionally, it is useful to reach consensus on defining and measuring communication. (C) 2017 Elsevier Ltd. All rights reserved.

De toenemende vergrijzing is een uitdaging voor de gezondheidszorg: met minder mensen en minder geld moet een groeiende groep ouderen goede, betaalbare zorg houden. In het kader van het nationaal programma ouderenzorg (npo) zijn er afgelopen jaren zo’n tien onderzoeken naar de effectiviteit van proactieve ouderenzorg uitgevoerd, maar de resultaten daarvan zijn bescheiden. In zwitserland heeft onlangs een vergelijkbaar onderzoek plaatsgevonden naar de langetermijneffecten van health risk assessment (hra) en health counseling. Wat betekent dit onderzoek voor nederland?.

Nurses often report communication difficulties in caring for people with dementia (PWD). Evidence-based interventions to enhance communication are scarce. Therefore, we developed a theory-informed intervention using the Behavior Change Wheel with the aim to improve communication between nurses and PWD. First, ideal communication was defined (targeted behavior) based on the scientific literature, policy reports and consultations of experts (n=7). Second, a focus group meeting with relevant stakeholders (n=7) was organized and observations of nurses (n=9) and PWD (n=9) during daily nursing care were conducted to understand their current behavior and to identify facilitators and barriers for the targeted behavior. Reviewing the literature and consulting experts have shown that ideal communication has to be person-centered and therefore should be tailored to the needs and capacities of PWD. Furthermore, next to verbal communication, attention should be paid to non-verbal communication, including the use of pictograms, objects, and touch. Additionally, the environment has to be recognizable and comprehendible for PWD. However, the focus group meeting and observations have shown that current behavior of nurses is often characterized by a task-oriented instead of person-centered approach. Furthermore, non-verbal communication (e.g., eye contact) is insufficiently used. Identified facilitators and barriers for the ideal communication relate to nurses’ characteristics (e.g., knowledge, awareness, and skills), social influences, and other environmental factors (e.g., resources). These insights were used to develop a theory-informed intervention in close collaboration with relevant stakeholders (e.g., nurses, speech therapists, and policy makers). The systematic development of the intervention and its final version will be presented.

Achtergrond Kwetsbaarheid kan leiden tot negatieve gezondheidsuitkomsten zoals beperkingen. Om deze te voorkomen zijn valide screeningsinstrumenten nodig om kwetsbare ouderen op te sporen. Doel van deze studie was de evaluatie en vergelijking van drie instrumenten: de Groningen Frailty Indicator (GFI), de Tilburg Frailty Indicator (TFI) en de Sherbrooke Postal Questionnaire (SPQ). Voor constructvalidering was de Groningen Activiteiten Restrictie Schaal (GARS) toegevoegd. Methode Een vragenlijst werd naar 687 ouderen (≥70 jaar) gestuurd. Geevalueerd werden (1) de prevalentie van kwetsbaarheid, (2) de betrouwbaarheid, (3) de cumulatieve schaalbaarheid volgens het schaalmodel van Mokken, en (4) de constructvaliditeit. Resultaten De respons bedroeg 77%. Prevalentieschattingen varieerden van 40% tot 59%. De grootste overeenstemming in kwetsbaarheid bestond tussen de GFI en TFI (Cohens kappa=0,74). Cronbachs alpha voor de GFI, TFI en SPQ bedroeg respectievelijk 0,73, 0,79 en 0,26. Geen van de ‘frailty’-instrumenten vormt een monotoon homogene set van items met een hierarchie in de moeilijkheidsgraad van de items (Loevingers H-coefficienten voor GFI, TFI en SPQ: 0,28, 0,30 en 0,09). Er werden significante correlaties gevonden tussen de scores voor kwetsbaarheid onderling en tussen deze scores en die op de GARS. Conclusie Vooral de GFI en TFI lijken bruikbaar voor het opsporen van kwetsbare ouderen. Aanvullend onderzoek naar het voorspellend vermogen van deze ‘frailty’-instrumenten voor beperkingen in het dagelijks leven is echter nog nodig. De oorspronkelijke versie van dit vertaalde en bewerkte artikel van deze auteurs is verschenen in BMC Public Health, 2010;10:176.