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SamenvattingPatiëntbetrokkenheid is een belangrijk thema in de zorg. Cliëntenraden vervullen hierin een belangrijke rol. Tegelijkertijd is er nog weinig bekend over hun rol bij de besluitvorming tijdens crises, en wat we van deze ervaringen kunnen leren. De coronacrisis liet echter zien dat wanneer besluitvorming plaatsvindt in interorganisationele netwerken, en sterk top-down en gecentraliseerd is, er weinig ruimte overblijft voor patiëntbetrokkenheid. Wij stellen dat zowel bestuurders als cliëntenraden meer werk moeten maken van patiëntbetrokkenheid in interorganisationele netwerken en tijdens crisissituaties.

The sense of safety and security of older people is a widely acknowledged action domain for policy and practice in age-friendly cities. Despite an extensive body of knowledge on the matter, the theory is fragmented, and a classification is lacking. Therefore, this study investigated how older people experience the sense of safety and security in an age-friendly city. A total of four focus group sessions were organised in The Hague comprising 38 older people. Based on the outcomes of the sessions, the sense of safety and security was classified into two main domains: a sense of safety and security impacted by intentional acts and negligence (for instance, burglary and violence), and a sense of safety and security impacted by non-intentional acts (for instance, incidents, making mistakes online). Both domains manifest into three separate contexts, namely the home environment, the outdoor environment and traffic and the digital environment. In the discussions with older people on these derived domains, ideas for potential improvements and priorities were also explored, which included access to information on what older people can do themselves to improve their sense of safety and security, the enforcement of rules, and continuous efforts to develop digital skills to improve safety online. Original article at MDPI; DOI: https://doi.org/10.3390/ijerph19073960

PurposeThis illustrative case study describes and evaluates drivers of effective inter-organizational collaboration to mitigate the impact and spread of COVID-19 among homeless people in two cities in the Netherlands. The aims of this study are: (1) to explore the strategic and operational policy responses in two local integrated care settings at the start of the crisis, (2) to identify best policy practices and lessons learned. The authors interpret and evaluate the findings by combining insights from the population health management (PHM) and collaborative governance literature.Design/methodology/approachThe authors describe and illustrate the experiences of two Dutch municipalities, Rotterdam and The Hague, in the early policy responses to sudden operational challenges around the impact of COVID-19 on homeless people as experienced by local decision-makers, medical doctors and clients.FindingsThe authors show that best policy practices revolve around (1) using data and risk stratification methods for identifying and targeting populations at-risk in local policy making, and (2) having an inter-organizational data sharing architecture in place ex ante. These two factors were clear prerequisites for tailor-made policy responses for newly-defined groups at risk with the existing and well-documented vulnerable population, and executing crisis-induced tasks efficiently.Originality/valueThis paper is among the first to illustrate the potential of combining collaborative governance and PHM perspectives to identify key drivers of effective local governance responses to a healthcare crisis in an integrated care setting.

Background: In many Western countries, the state pension age is being raised to stimulate the extension of working lives. It is not yet well understood whether the health of older adults supports this increase. In this study, future health of Dutch adults aged 60 to 68 (i.e., the expected state pension age) is explored up to 2040. Methods: Data are from the Dutch Health Interview Survey 1990–2017 (N ≈ 10,000 yearly) and the Dutch Public Health Monitor 2016 (N = 205,151). Health is operationalized using combined scores of self-reported health and limitations in mobility, hearing or seeing. Categories are: good, moderate and poor health. Based on historical health trends, two scenarios are explored: a stable health trend (neither improving nor declining) and an improving health trend. Results: In 2040, the health distribution among men aged 60–68 is estimated to be 63–71% in good, 17–28% in moderate and 9–12% in poor health. Among women, this is estimated to be 64–69%, 17–24% and 12–14%, respectively. Conclusions: This study’s explorations suggest that a substantial share of people will be in moderate or poor health and, thus, may have difficulty continuing working. Policy aiming at sustainable employability will, therefore, remain important, even in the case of the most favorable scenario.

In the Netherlands, there is a growing need for collective housing for older people to bridge the gap between ageing in place and institutional care facilities. The participation of older people in the concept and design stages is important to tune the market supply to the needs of (future) residents. However, social entrepreneurs find it challenging to involve older people. This chapter explores various ways older people can be involved in developing new housing initiatives. The ladder of citizen participation is used here to explore different roles that (future) residents could play with varying levels of influence, from non-participation to citizen power. Considerations for meaningful participation are discussed. Furthermore, a Dutch case study is presented, in which real estate was transformed based on the involvement of older people, which illustrates how by using an innovative method, partnerships could be formed between (future) residents and decision-makers. This chapter concludes that apart from housing itself, the built and outdoor environment should also be considered to improve the living conditions of older people.

Objectives Like other western countries, the Netherlands has abolished early retirement schemes and is currently increasing the statutory retirement age. It is likely that also older workers with disabilities will be required to work longer. We examine the change in working life expectancy (WLE) with disability of older workers by comparing data from three periods: 1992-1996, 2002-2006 and 2012-2016. Methods Data are from the Longitudinal Aging Study Amsterdam (LASA). Respondents aged 55-65 with a paid job at baseline were included (N=1074). Disability was measured using the Global Activity Limitations Indicator (GALI). First, a continuous-time three-state survival model was created. Second, WLE with and without disability were estimated using MSM and ELECT in R. The modifying effects of gender and educational level were examined. Results Among those initially in paid employment, total WLE increased over 20 years. For example at age 58, total WLE increased from 3.7 to 5.5 years. WLE with disability at age 58 increased from 0.8 to 1.5 years. There was no difference in WLE with disability between male and female workers or low- and highly educated workers. Conclusions Between the 1990s and the 2010s, subsequent generations of older workers with disabilities have extended their working lives. The findings emphasize the importance of workplace interventions that facilitate older workers with disabilities to maintain well-being and work ability. In addition, the question arises whether current exit routes out of the workforce are still adequate.

Zowel in Den Haag als in Haarlem en Purmerend wordt met ouderen gewerkt aan het maken van films. Werken met film is een prachtige manier om mensen samen te brengen, thema’s te onderzoeken en de deelnemers de gelegenheid te geven hun verhaal te vertellen en van waarde te zijn voor anderen. Dankzij het bedieningsgemak van de iPad is het eenvoudiger geworden om ook met weinig technische kennis een mooi beeldverhaal te maken.

In the Netherlands, there is a growing need for collective housing for older people to bridge the gap between ageing-in-place and institutional care facilities. Participation of older people in the concept and design phases is important to tune the market supply to the needs of (future) residents, yet social entrepreneurs find it challenging to involve older people. This commentary explores various ways older people can participate in the development of new housing initiatives. The ladder of citizen participation is applied to explore different roles that (future) residents could play with levels of influence varying from non-participation to citizen power. Considerations for meaningful participation are discussed, in order to show how collaborations can be formed between (future) residents and decision makers. Original article at: https://doi.org/10.3390/healthcare9030301 © 2021 by the authors. Licensee MDPI.

Older adults with lower limb osteoarthritis (LLOA) are highly dependent on their physical and social environment for being physically active. Longitudinal data from 2286 older adults (M age = 73.8 years; 50.3% female) in six European countries were analyzed using cross-lagged Structural Equation Modeling (SEM) and multi-group SEM. In cross-sectional analyses, neighborhood resources were associated with physical activity (r = 0.26;p

Objectives: To study associations between perceived neighborhood resources and time spent by older adults in active travel. Methods: Respondents in six European countries, aged 65–85 years, reported on the perceived presence of neighborhood resources (parks, places to sit, public transportation, and facilities) with response options “a lot,” “some,” and “not at all.” Daily active travel time (total minutes of transport-related walking and cycling) was self-reported at the baseline (n = 2,695) and 12–18 months later (n = 2,189). Results: Reporting a lot of any of the separate resources (range B’s = 0.19–0.29) and some or a lot for all four resources (B = 0.22, 95% confidence interval [0.09, 0.35]) was associated with longer active travel time than reporting none or fewer resources. Associations remained over the follow-up, but the changes in travel time were similar, regardless of the neighborhood resources. Discussion: Perceiving multiple neighborhood resources may support older adults’ active travel. Potential interventions, for example, the provision of new resources or increasing awareness of existing resources, require further study.

De Werkplaatsen Sociaal Domein (WSD) bestaan ruim 10 jaar en zijn inmiddels een gevestigd instituut geworden in de praktijkontwikkeling van het sociale domein in Nederland. In de 15 werkplaatsen wordt praktijkgericht onderzoek gedaan in netwerken van regionale samenwerkingspartners van gemeenten, maatschappelijke organisaties & onderzoekers, studenten en docenten van hogescholen. Rondom gedeelde thema’s zoals armoede, de sociale basis, sociale teams, integraal samenwerken, formeel-informele samenwerking en eigen regie proberen zij tot duurzame praktijkverbetering te komen vanuit een gezamenlijk kennis- en ontwikkelingsproces. Geen wonder dus dat samen leren een belangrijk element van het proces van deze werkplaatsen vormt. De WSD werken allemaal dan ook met een of andere vorm van actieonderzoek of actieleermethoden. Vanwege het doorgaans grote aantal betrokkenen in de regionale netwerken heeft dat veelal de vorm van een leergemeenschap-achtige setting met zogeheten communities of practice of leerateliers.

Pain is a key symptom of osteoarthritis (OA) and has been linked to poor mental health. Pain fluctuates over time within individuals, but a paucity of studies have considered day-to-day fluctuations of joint pain in relation to affective symptoms in older persons with OA. This study investigated the relationship of pain severity as well as within-person pain variability with anxiety and depression symptoms in 832 older adults with OA who participated in the European Project on OSteoArthritis (EPOSA): a 6-country cohort study. Affective symptoms were examined with the Hospital Anxiety and Depression Scale, pain severity was assessed with the Western Ontario and McMaster Universities OA Index and the Australian/Canadian Hand Osteoarthritis Index, and intraindividual pain variability was measured using pain calendars assessed at baseline, 6, and 12 to 18 months. Age-stratified multiple linear regression analyses adjusted for relevant confounders showed that more pain was associated with more affective symptoms in older-old participants (74.1–85 years). Moreover, older-old participants experienced fewer symptoms of anxiety (ratio = .85, 95% confidence interval [CI], .77–.94), depression (ratio = .90, 95% CI, .82–.98), and total affective symptoms (ratio = .87, 95% CI, .79–.94) if their pain fluctuated more. No such association was evident in younger-old participants (65–74.0 years). These findings imply that stable pain levels are more detrimental to mental health than fluctuating pain levels in older persons. Perspective This study showed that more severe and stable joint pain levels were associated with anxiety and depressive symptoms in older persons with OA. These findings emphasize the importance of measuring pain in OA at multiple time points, because joint pain fluctuations may be an indicator for the presence of affective symptoms.

De COVID-19 pandemie zal een blijvende impact hebben op het sociaal- en gezondheidsdomein in Nederland en roept fundamentele vragen op over de organisatie ervan. Er zijn in het afgelopen jaar veel beleidsinitiatieven ontstaan in de zorg en het sociaal domein over professionele en organisatorische grenzen heen. Al voor de crisis was er een toenemende urgentie om de zorg en ondersteuning meer te organiseren rond bepaalde groepen van kwetsbare clienten, geleverd op de juiste plek, gericht op een zo groot mogelijke kwaliteit van leven. De crisisrespons heeft voor nieuwe multisectorale verbindingen tussen organisaties gezorgd in de dienstverlening aan sommige van deze kwetsbare groepen. Daklozenopvang is een goed voorbeeld van een beleidsterrein waar multisectorale samenwerking, het belang van zorg op de juiste plek en acute uitdagingen in de dienstverlening tijdens de crisis samenkwamen. In dit artikel beschrijven wij de crisisrespons van de lokale overheid met betrekking tot de daklozenopvang in Rotterdam en Den Haag aan de hand van interviews met vijf stakeholders in strategische en operationele besluitvormingsposities. Daarnaast zijn clienten in verschillende opvanglocaties bevraagd op hun evaluatie van de ervaren veranderingen in de dienstverlening. We distilleren de ‘lessons learned’ tijdens de crisis en reflecteren op de houdbaarheid van deze lessen voor toekomstig beleid.

Objective: To determine whether there is an association between osteoarthritis (OA) and incident social isolation using data from the European Project on OSteoArthritis (EPOSA) study.Design: Prospective, observational study with 12 to 18 months of follow-up.Setting: Community dwelling.Participants: Older people living in six European countries.Measurements: Social isolation was assessed using the Lubben Social Network Scale and the Maastricht Social Participation Profile. Clinical OA of the hip, knee, and hand was assessed according to American College of Rheumatology criteria. Demographic characteristics, including age, sex, multijoint pain, and medical comorbidities, were assessed.Results: Of the 1967 individuals with complete baseline and follow-up data, 382 (19%) were socially isolated and 1585 were nonsocially isolated at baseline; of these individuals, 222 (13.9%) experienced social isolation during follow-up. Using logistic regression analyses, after adjustment for age, sex, and country, four factors were significantly associated with incident social isolation: clinical OA, cognitive impairment, depression, and worse walking time. Compared to those without OA at any site or with only hand OA, clinical OA of the hip and/or knee, combined or not with hand OA, led to a 1.47 times increased risk of social isolation (95% confidence interval = 1.03-2.09).Conclusion: Clinical OA, present in one or two sites of the hip and knee, or in two or three sites of the hip, knee, and hand, increased the risk of social isolation, adjusting for cognitive impairment and depression and worse walking times. Clinicians should be aware that individuals with OA may be at greater risk of social isolation.

Al jaren stimuleert de overheid oudere werkenden om langer door te werken. De gemiddelde uittreedleeftijd is hiermee gestegen van 61 jaar in 2006 naar 64,5 jaar in 2016. In een recent onderzoek met gegevens van de Longitudinal Aging Study Amsterdam (LASA) is onderzocht in hoeverre de stijging van de uittreedleeftijd samen is gegaan met een toename in het aantal jaren dat men met gezondheidsbeperkingen doorwerkt.

Background: This study examines the association of both pain severity and within-person pain variability with physical activity (PA) in older adults with osteoarthritis (OA). Methods: Data from the European Project on OSteoArthritis were used. At baseline, clinical classification criteria of the American College of Rheumatology were used to diagnose OA in older adults (65–85 years). At baseline and 12–18 months follow-up, frequency and duration of participation in the activities walking, cycling, gardening, light and heavy household tasks, and sports activities were assessed with the Longitudinal Aging Study Amsterdam Physical Activity Questionnaire. Physical activity was calculated in kcal/day, based on frequency, duration, body weight and the metabolic equivalent of each activity performed. At baseline and 12–18 months follow-up, pain severity was assessed using the pain subscales of the Western Ontario and McMaster Universities OA Index and the Australian/Canadian Hand OA Index. Within-person pain variability was assessed using two-week pain calendars that were completed at baseline, 6 months follow-up and 12–18 months follow-up. Results: Of all 669 participants, 70.0% were women. Sex-stratified multiple linear regression analyses showed that greater pain severity at baseline was cross-sectionally associated with less PA in women (Ratio = 0.95, 95% CI = 0.90–0. 99), but not in men (Ratio = 0.99, 95% CI = 0.85–1.15). The longitudinal analyses showed a statistically significant inverse association between pain severity at baseline and PA at follow-up in women (Ratio = 0.94, 95% CI = 0.89–0.99), but not in men (Ratio = 1.00, 95% CI = 0.87–1.11). Greater pain variability over 12–18 months was associated with more PA at follow-up in men (Ratio = 1.18, 95% CI = 1.01–1.38), but not in women (Ratio = 0.94, 95% CI = 0.86–1.03). Conclusions: Greater pain severity and less pain variability are associated with less PA in older adults with OA. These associations are different for men and women. The observed sex differences in the various associations should be studied in more detail and need replication in future research., The Indicators for Monitoring COPD and Asthma - Activity and Function in the Elderly in Ulm study (IMCA - ActiFE) was supported by the European Union [No.: 2005121] and the Ministry of Science, Baden-Württemberg. The Italian cohort study is part of the National Research Council Project on Aging (PNR). The Longitudinal Aging Study Amsterdam (LASA) is financially supported by the Dutch Ministry of Health, Welfare and Sports, Directorate of Long-term Care. The Penagrande study was partially supported by the National Fund for Health Research (Fondo de Investigaciones en Salud) of Spain [project numbers FIS PI 05/1898; FIS RETICEF RD06/0013/1013 and FIS PS09/02143]. The Swedish Twin Registry is supported in part by the Swedish Ministry of Higher Education. The Hertfordshire Cohort Study is funded by the Medical Research Council of Great Britain, Arthritis Research UK, the British Heart Foundation and the International Osteoporosis Foundation. The funding sources had no role in the study design, the collection, analysis and interpretation of the data, in the writing of the report and in the decision to submit the article for publication.

Participatory video design is a novel approach to collect experiences and perceptions of older people about the age-friendliness of their city or neighborhood. In this article, we describe how this co-creative method can add to specific knowledge about the preferences and needs of older people about the improvement or preservation of their environment. We describe two examples of this approach in the cities of The Hague and Leiden, the Netherlands. Persons of 60 years and older were invited to participate in a &ldquo, workshop&rdquo, on filmmaking focusing on age-friendly cities. A professional filmmaker and a researcher of the University of Applied Sciences worked in co-creation with older people, to produce short films on the topics that were perceived as important from the perspective of the participants. The older people worked in couples to produce their short films about the city or their neighborhood. Topics of the films included communication and information, outdoor spaces, social relations, and community support. The use of participatory video design can foster empowerment and social interaction among older participants, and insight into the preferences and needs of older people regarding age-friendly cities.

This study aimed to examine the associations of perceptions of neighbourhood cohesion and neighbourhood problems and objectively measured neighbourhood deprivation with the use of neighbourhood resources by older adults with and without lower limb osteoarthritis (LLOA), and to assess whether these relationships are stronger in older persons with LLOA than in those without the condition. Data from the Hertfordshire Cohort Study were used. American College of Rheumatology classification criteria were used to diagnose clinical LLOA (knee and/or hip osteoarthritis). Use of neighbourhood resources was assessed using the Home and Community Environment instrument. Participants were asked about their perceptions of neighbourhood cohesion and neighbourhood problems. Objective neighbourhood deprivation was assessed using the Index of Multiple Deprivation score based on 2010 census data. Of the 401 participants (71-80 years), 74 (18.5 %) had LLOA. The neighbourhood measures were not significantly associated with use of resources in the full sample. A trend for a negative association between use of public transport and perceived neighbourhood problems was observed in participants with LLOA (OR = 0.77, 99 % CI = 0.53-1.12), whereas a trend for a positive association between perceived neighbourhood problems and use of public transport was found in participants without LLOA (OR = 1.18, 99 % CI = 1.00-1.39). The perception of more neighbourhood problems seems only to hinder older adults with LLOA to make use of public transport. Older adults with LLOA may be less able to deal with neighbourhood problems and more challenging environments than those without the condition.

Older people spend much time participating in leisure activities, such as taking part in organized activities and going out, but the extent of participation may differ according to both individual and environmental resources available. Chronic health problems become more prevalent at higher ages and likely necessitate tapping different resources to maintain social participation. This paper compares predictors of participation in social leisure activities between older people with and those without multimorbidity. The European Project on Osteoarthritis (EPOSA) was conducted in Germany, UK, Italy, The Netherlands, Spain and Sweden (N = 2942, mean age 74.2 (5.2)). Multivariate regression was used to predict social leisure participation and degree of participation in people with and without multimorbidity. Fewer older people with multimorbidity participated in social leisure activities (90.6 %), compared to those without multimorbidity (93.9 %). The frequency of participation was also lower compared to people without multimorbidity. Higher socioeconomic status, widowhood, a larger network of friends, volunteering, transportation possibilities and having fewer depressive symptoms were important for (the degree of) social leisure participation. Statistically significant differences between the multimorbidity groups were observed for volunteering and driving a car, which were more important predictors of participation in those with multimorbidity. In contrast, self-reported income appeared more important for those without multimorbidity, compared to those who had multimorbidity. Policies focusing on social (network of friends), physical (physical performance) and psychological factors (depressive symptoms) and on transportation possibilities are recommended to enable all older people to participate in social leisure activities.

Objective To investigate patterns of physical activity in older adults with knee osteoarthritis (OA) compared to older adults without knee OA across 6 European countries. We expect country-specific differences in the physical activity levels between persons with knee OA compared to persons without knee OA. A varying degree of physical activity levels across countries would express a facilitating or impeding influence of the social, environmental, and other contextual factors on a physically active lifestyle. Methods Baseline cross-sectional data from the European Project on Osteoarthritis were analyzed. In total, 2,551 participants from 6 European countries (Germany, Italy, The Netherlands, Spain, Sweden, and the UK) were included. Results Participants with knee OA were less likely to follow physical activity recommendations and had poorer overall physical activity profiles than those without knee OA (mean 62.9 versus 81.5 minutes/day, respectively; P = 0.015). The magnitude of this difference varied across countries. Detailed analysis showed that low physical activity levels in persons with knee OA could be attributed to less everyday walking time (odds ratio 1.31, 95% confidence interval 1.07–1.62). Conclusion This study highlighted the fact that having knee OA is associated with a varying degree of physical activity patterns in different countries. This national variation implies that low levels of physical activity among persons with knee OA cannot be explained exclusively by individual or disease-specific factors, but that social, environmental, and other contextual factors should also be taken into account.

Background:Significant correlation has been previously demonstrated between radiographic and clinical diagnoses of knee osteoarthritis (OA); however, the specific findings on clinical examination that relate best to a radiographic diagnosis have not been fully elicited.Aims:We aimed to explore the relationship between clinical symptoms and physical findings with radiographic diagnoses of tibiofemoral and patellofemoral OA.Methods:This study was based on 409 individuals from the Hertfordshire Cohort Study, born between 1931 and 1939. Antero-posterior and lateral radiographs were taken of both knees. The presence of tibiofemoral and patellofemoral OA was defined according to the Kellgren and Lawrence score. Clinical symptoms, assessed using WOMAC, and physical findings were ascertained by examination. Relationships were assessed using multilevel univariate logistic regression.Results:In the 775 knees studied, the prevalence of physical findings was crepitus (25%), tibiofemoral tenderness (15%), bony swelling (12%), and pain on flexion (10%). Thirty-one percent (n = 238) knees demonstrated tibiofemoral OA, 28% (n = 220) showed patellofemoral OA, and 16% demonstrated OA in both locations. A global clinical symptom score was associated with increased risk of tibiofemoral OA (OR 12.5, 95% CI 5.4–29.0) and patellofemoral OA (OR 5.1, 95% CI 2.3–13.1). On clinical examination, the presence of crepitus, tibiofemoral tenderness, bony swelling, and pain on flexion was associated with increased risk of tibiofemoral OA; however, only tenderness was found to be associated with patellofemoral OA.Conclusion:Global clinical symptom score was associated with radiographic tibiofemoral and patellofemoral OA. However, individual clinical signs were more strongly associated with tibiofemoral than patellofemoral OA.

This study aimed to explore the loneliness of several groups of older immigrants in Canada compared to native-born older adults. Data from the Canadian General Social Survey, Cycle 22 (N older adults = 3,692) were used. The dependent variable is the 6 item De Jong Gierveld loneliness scale. Determinants of loneliness included country of birth, ethnic background (cultural context); belongingness (community context) and social networks (social context). Results showed that only some immigrant groups are significantly lonelier than older adults born in Canada. Immigrants with similar language and culture are not lonelier; while those from countries that differ in native language/culture are significantly higher on loneliness. Multivariate analyses showed the importance of cultural background, of composition of the network of relatives and friends, and of local participation and feelings of belonging to the Canadian society in explaining loneliness of older immigrants.

While older people live in developing countries, little is known about the relative importance of features of their communities in influencing their liveability. We examine components of home and neighbourhood among older South Africans. Linear regression analyses revealed that features of home (basic amenities, household composition, financial status and safety) and neighbourhood (ability to shop for groceries, participate in organizations and feel safe from crime) are significantly associated with life satisfaction. Approaches to liveability that are person-centred and also set within contexts beyond home and neighbourhood are needed to address boundaries between home and neighbourhood; incorporate personal resources into liveability models and import broader environmental contexts such as health and social policy.

Background:Older adults with osteoarthritis (OA) often report that their disease symptoms are exacerbated by weather conditions. This study examines the association between outdoor physical activity (PA) and weather conditions in older adults from 6 European countries and assesses whether outdoor PA and weather conditions are more strongly associated in older persons with OA than in those without the condition.Methods:The American College of Rheumatology classification criteria were used to diagnose OA. Outdoor PA was assessed using the LASA Physical Activity Questionnaire. Data on weather parameters were obtained from weather stations.Results:Of the 2439 participants (65–85 years), 29.6% had OA in knee, hand and/or hip. Participants with OA spent fewer minutes in PA than participants without OA (Median = 42.9, IQR = 20.0 to 83.1 versus Median = 51.4, IQR = 23.6 to 98.6; P < .01). In the full sample, temperature (B = 1.52; P < .001) and relative humidity (B = –0.77; P < .001) were associated with PA. Temperature was more strongly associated with PA in participants without OA (B = 1.98; P < .001) than in those with the condition (B = 0.48; P = .47).Conclusions:Weather conditions are associated with outdoor PA in older adults in the general population. Outdoor PA and weather conditions were more strongly associated in older adults without OA than in their counterparts with OA.

Guided by trends of increased prevalence and social acceptance of stepfamilies, the authors argue that stepparents are more likely to include stepchildren in their personal network in recent times. Data are from observations by 2 studies: (a) the Living Arrangements and Social Networks of Older Adults Study and (b) the Longitudinal Aging Study Amsterdam in 1992-2009 of 247 Dutch stepparents age 54-91 years. The results revealed that in 1992, 63% of the stepparents had stepchildren in their personal network, and this percentage increased to 85% in 2009. The network membership of stepchildren was less likely for stepparents from living-apart-together partnerships. Stepmothers less often included stepchildren in their personal network than stepfathers. Both effects may be understood in terms of family commitment. Stepfamily boundaries have become more permeable over time, suggesting that there is an increased potential for support exchange and caregiving within stepfamilies.

BACKGROUND: This study examined the associations of objectively measured neighbourhood built environment characteristics with objectively measured physical activity (PA) in older people with and without lower limb osteoarthritis (LLOA), and assessed whether these relationships differ between both groups.METHODS: Data from the Dutch component of the European Project on OSteoArthritis were used. American College of Rheumatology classification criteria were used to diagnose LLOA (knee and/or hip osteoarthritis). Daily average time spent on total PA and separate PA intensity categories, including light PA, low-light PA, high-light PA, and moderate to vigorous PA, were measured using Actigraph GT3X accelerometers. Geographic Information Systems were used to measure street connectivity (number of street connections per km(2)) and distances (in km) to resources (health care resources, retail resources, meeting places, and public transport) within neighbourhoods. Multiple Linear Regression Analyses were used to examine the associations between measures of the neighbourhood built environment and PA, adjusted for several confounders.RESULTS: Of all 247 participants (66-85 years), 41 (16.6 %) had LLOA. The time spent on any PA did not differ significantly between participants with and without LLOA (LLOA: Mean = 268.3, SD = 83.3 versus non-LLOA: Mean = 275.8, SD = 81.2; p = 0.59). In the full sample, no measures of the neighbourhood built environment were statistically significantly associated with total PA. Larger distances to specific health care resources (general practice and physiotherapist) and retail resources (supermarket) were associated with more time spent on PA in older people with LLOA than in those without LLOA. In particular, the associations of light and high-light PA with distances to these specific resources were stronger in participants with LLOA compared to their counterparts without LLOA.CONCLUSIONS: Specific attributes of the neighbourhood built environment are more strongly associated with PA in older people with LLOA than in those without LLOA. Knowledge on the relationship between objectively measured neighbourhood characteristics and PA in older people with and without LLOA could be used to inform policymakers and city planners about adaptation of neighbourhoods and their infrastructures to appropriately facilitate PA in healthy and functionally impaired older adults.

OBJECTIVE: To evaluate the role of comorbidity and pain in the association between hip/knee osteoarthritis (OA) with self-reported as well as performance-based functional limitations in a general elderly population.METHODS: We analyzed the data of 2,942 individuals, ages between 65 and 85 years, who participated in the European Project on Osteoarthritis, which was made up of 6 European cohorts (from Germany, Italy, The Netherlands, Spain, Sweden, and the UK). Outcomes included self-reported physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the participants' performance-based physical function was evaluated using the walking test.RESULTS: While comorbidity did not affect the significant association between hip/knee OA and physical function limitations found in the participants, pain reduced the effect of OA on self-reported physical function, and it cancelled the effect of OA on the walking test. Obesity, anxiety, depression, and cardiovascular diseases were associated with the worst WOMAC scores. Obesity, cognitive impairment, depression, peripheral artery disease, and stroke were associated with the worst walking times.CONCLUSION: These findings demonstrate that while comorbidity is strongly and independently associated with functional limitations, it does not affect the OA-physical function association. Hip/knee OA is associated with self-reported impairment in physical function, which was only partially mediated by pain. Its association with physical function, as evaluated by the walking test, was instead completely mediated by pain.

Objectives. This article examines the effect that family structure has on the contact between older adults and their (step)children. A comparison is made among 3 family structures: biological families, complex stepfamilies, and simple stepfamilies. Methods. The sample consists of respondents aged 55 years or older from the "Living Arrangements and Social net- works of Older Adults in the netherlands" survey of 1992. The contact between biological relationships and steprelation - ships is measured by means of 2 items: contact frequency and whether contact is perceived as regular and important. Results. Parents have less contact with their biological children in stepfamilies compared with parents with their chil - dren in biological families. The contact with biological children is perceived as more often regular and important in bio - logical families and complex stepfamilies compared with simple stepfamilies. no difference was found in the contact between stepparents and stepchildren in simple and complex stepfamilies. However, the contact with stepchildren is perceived as more often regular and important in simple stepfamilies in comparison to complex stepfamilies. Discussion. It is not so much the difference between biological children and stepchildren that counts when studying the contact between (step)parents and (step)children, as what the structure of the aging (step)family is.

This study investigates whether the frequency of contact and support exchanged in relationships between parents and adult children declines over successive cohorts and over individual time in the Netherlands. Respondents included a birth cohort from 1928 to 1937 with data collected in 1992 (N=941) and in 2002 (N=574) and a birth cohort from 1938 to 1947 with data collected in 2002 (N=884). We assessed cohort and time-sequential changes. Parents of the later cohort had more contact and support exchanges with their children than the earlier cohort, revealing that families have not declined in importance. Furthermore, longitudinally, contact and supportive exchanges with adult children decreased, suggesting that parents and children devote less time to intergenerational relationships during this “empty nest” phase.

Background There is a societal need that workers prolong their working lives. By adopting a life course perspective, this study aimed to investigate the influence of work motives and motivation, health, job characteristics, skills, and financial and social situation on working beyond retirement, and differences between ‘on time’ and ‘off time’ retirees (retirement age 65 and

Objective.This study examined whether daily weather conditions, 3-day average weather conditions, and changes in weather conditions influence joint pain in older people with osteoarthritis (OA) in 6 European countries.Methods.Data from the population-based European Project on OSteoArthritis were used. The American College of Rheumatology classification criteria were used to diagnose OA in older people (65–85 yrs). After the baseline interview, at 6 months, and after the 12–18 months followup interview, joint pain was assessed using 2-week pain calendars. Daily values for temperature, precipitation, atmospheric pressure, relative humidity, and wind speed were obtained from local weather stations. Multilevel regression modelling was used to examine the pain-weather associations, adjusted for several confounders.Results.The study included 810 participants with OA in the knee, hand, and/or hip. After adjustment, there were significant associations of joint pain with daily average humidity (B = 0.004, p < 0.01) and 3-day average humidity (B = 0.004, p = 0.01). A significant interaction effect was found between daily average humidity and temperature on joint pain. The effect of humidity on pain was stronger in relatively cold weather conditions. Changes in weather variables between 2 consecutive days were not significantly associated with reported joint pain.Conclusion.The associations between pain and daily average weather conditions suggest that a causal relationship exist between joint pain and weather variables, but the associations between day-to-day weather changes and pain do not confirm causation. Knowledge about the relationship between joint pain in OA and weather may help individuals with OA, physicians, and therapists to better understand and manage fluctuations in pain.

Objective Epidemiological studies of knee osteoarthritis (OA) have often used a radiographic definition. However, the clinical syndrome of OA is influenced by a broad range of factors in addition to the structural changes required for radiographic OA. Hence more recently several studies have adopted a clinical or self-reported approach to OA diagnosis rather than a radiographic approach. The aim of this study was to investigate agreement between radiographic OA and the clinical and self-reported diagnoses of OA. Design Data were available for 199 men and 196 women in the Hertfordshire Cohort Study (HCS), UK. Participants completed a questionnaire detailing self-reported OA. Clinical OA was defined based on American College of Rheumatology (ACR) criteria. Knee radiographs were taken and graded for overall Kellgren and Lawrence (K&L) score. Results The mean (standard deviation (SD)) age of study participants was 75.2 (2.6) years and almost identical proportions of men and women. The prevalence of knee OA differed depending on the method employed for diagnosis; 21% of the study participants self-reported knee OA, 18% of the participants had clinical knee OA and 42% of the participants had radiographic OA. Of those 72 study participants with a self-reported diagnosis of knee OA 52 (72%) had a radiographic diagnosis of knee OA, while 66% (39 out of 59) of study participants with clinical knee OA had a diagnosis of radiographic knee OA. However 58% of those participants diagnosed with radiographic OA did not have either self-reported knee OA or a diagnosis of clinical OA. Therefore in comparison with the radiographic definition of OA, both the clinical and self-report definitions had high specificity (91.5% & 91.5% respectively) and low sensitivity (24.5% and 32.7% respectively). Conclusion There is modest agreement between the radiographic, clinical and self-report methods of diagnosis of knee OA.

To investigate patterns of physical activity in older adults with knee osteoarthritis (OA) compared to older adults without knee OA across 6 European countries. We expect country-specific differences in the physical activity levels between persons with knee OA compared to persons without knee OA. A varying degree of physical activity levels across countries would express a facilitating or impeding influence of the social, environmental, and other contextual factors on a physically active lifestyle.Baseline cross-sectional data from the European Project on Osteoarthritis were analyzed. In total, 2,551 participants from 6 European countries (Germany, Italy, The Netherlands, Spain, Sweden, and the UK) were included.Participants with knee OA were less likely to follow physical activity recommendations and had poorer overall physical activity profiles than those without knee OA (mean 62.9 versus 81.5 minutes/day, respectively; P = 0.015). The magnitude of this difference varied across countries. Detailed analysis showed that low physical activity levels in persons with knee OA could be attributed to less everyday walking time (odds ratio 1.31, 95% confidence interval 1.07-1.62).This study highlighted the fact that having knee OA is associated with a varying degree of physical activity patterns in different countries. This national variation implies that low levels of physical activity among persons with knee OA cannot be explained exclusively by individual or disease-specific factors, but that social, environmental, and other contextual factors should also be taken into account.

This study focused on two conceptually distinct measures of the filial responsibility expectations of older adults: a vignette technique and an attitude item scale. Data were based on 1,553 respondents aged 61 to 92 years who participated in the Longitudinal Aging Study Amsterdam in 1998to 1999.The results showed that the item scale had multiple dimensions of filial expectations. Older adults distinguished between emotional-, instrumental-, contact-, and information-oriented expectations. The vignette technique resulted in a unidimensional measurement of expectations. The intercorrelation between the scores of the item scale and vignette technique was modest, indicating a certain amount of overlap. Child characteristics incorporated into the vignettes added to the specificity of measurements of the filial expectations. The authors observed that older adults were more likely to have expectations for care from an adult child who is not employed and does not have children. Minor differences between sons and daughters were observed.

Background: Osteoarthritis (OA) is the most common cause of disability in the elderly. Clinical frailty is associated with high mortality, but few studies have explored the relationship between OA and frailty. The objective of this study was to consider the association between OA and frailty/pre-frailty in an elderly population comprised of six European cohorts participating in the EPOSA project. Methods: Longitudinal study using baseline data and first follow-up waves, from EPOSA; 2,455 individuals aged 65-85 years were recruited from pre-existing population-based cohorts in Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. Data were collected on clinical OA at any site (hand, knee or hip), based on the clinical classification criteria developed by the American College of Rheumatology (ACR). Frailty was defined according to Fried's criteria. The covariates considered were age, gender, educational level, obesity and country. We used multinomial logistic regression to analyse the associations between OA, frailty/pre-frailty and other covariates. Results: The overall prevalence of clinical OA at any site was 30.4 % (95 % CI:28.6-32.2); frailty was present in 10.2 % (95 % CI:9.0-11.4) and pre-frailty in 51.0 % (95 % CI:49.0-53.0). The odds of frailty was 2.96 (95 % CI:2.11-4.16) and pre-frailty 1.54 (95 % CI:1.24-1.91) as high among OA individuals than those without OA. The association remained when Knee OA, hip OA or hand OA were considered separately, and was stronger in those with increasing number of joints. Conclusions: Clinical OA is associated with frailty and pre-frailty in older adults in European countries. This association might be considered when designing appropriate intervention strategies for OA management, The study was supported by a non-commercial private funder. The Indicators for Monitoring COPD and Asthma - Activity and Function in the Elderly in Ulm study (IMCA - ActiFE) was supported by the European Union (No.: 2005121) and the Ministry of Science, Baden-Württemberg. The Italian cohort study is part of the National Research Council Project on Aging (PNR). The Longitudinal Aging Study Amsterdam (LASA) is financially supported by the Dutch Ministry of Health, Welfare and Sports. The Peñagrande study was partially supported by the National Fund for Health Research (Fondo de Investigaciones en Salud) of Spain (project numbers FIS PI 05/1898; FIS RETICEF RD06/0013/1013 and FIS PS09/02143). The Swedish Twin Registry is supported in part by the Swedish Ministry of Higher Education. The Hertfordshire Cohort Study is funded by the Medical Research Council of Great Britain, Arthritis Research UK, the British Heart Foundation and the International Osteoporosis Foundation.