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Many older patients with cancer depend on their family members for care and support and involve their family members in treatment decision-making in different stages of the cancer trajectory. Although family involvement is advocated in person-centered care, little is known about family involvement in decision-making specifically for older patients, and evidence-based strategies are scarce. The aim of this scoping review is to provide deeper understanding of factors influencing family involvement in treatment decision-making for older patients with cancer. Four databases were searched for quantitative-, qualitative- and mixed-method empirical studies describing factors influencing family involvement in treatment decision-making for older patients with cancer: PubMed, EMBASE, CINAHL and PsycINFO. Three independent researchers reviewed the papers for eligibility and quality and contributed to the data extraction and analysis. Twenty-seven papers were included, sixteen quantitative studies, nine qualitative studies and two mixed-method studies. Five categories of factors influencing family involvement emerged: 1) patient characteristics, 2) family member characteristics, 3) family system characteristics, 4) physician’s role and 5) cultural influences. These factors affect the level of family control in decision-making, treatment choice, decision agreement, and levels of stress and coping strategies of patients and family members. This review reveals a complex interplay of factors influencing family involvement in treatment decision-making for older patients with cancer that is rooted in characteristics of the family system. The findings underscore the need for development and implementation of evidence-based strategies for family involvement in treatment decision-making as part of patient-centered care for older patients with cancer.

In chapter 2 we described and quantified the prevalence and characteristics of RDs, and the co-occurrence of RDs with other delusions, using a semi structured diagnostic interview in older adults diagnosed with either affective or nonaffective psychotic disorders. Results showed that RDs were fairly common in both diagnostic groups, psychotic depression and schizophrenia. RDs were markedly higher among patients with psychotic depression compared to younger samples. RDs with delusions of grandeur, Cotard and Schneider appear to be related to non-affective psychosis (schizophrenia). The delusional characteristic bizarreness and the presence of more psychotic symptoms are significantly more common in this combination of delusions. In psychotic depression, RDs with delusions of guilt occurred predominantly with more symptoms of distress compared to patients without this combination of delusions. In chapter 3 we explored the prevalence and content of religious hallucinations (RHs), how they relate to the diagnosis, and how RDs and RHs related to patients’ denominational background and other aspects of religiousness. Results showed that the prevalence of RHs amounted to 18.7%, no statistically significant difference between the prevalence in schizophrenia (17.5%) and in psychotic depression (9.4%). Moreover, the contents of the RHs about the Devil or Satan were quite common, and more prevalent in patients with psychotic depression. RDs and RHs were significantly more prevalent in psychotic depressed patients who were raised as or were currently affiliated as strict Protestants. Religion is likely to act as a symptom-formation factor for psychotic symptoms in strict Protestant older adults. In chapter 4 we aimed to obtain more insight into the course of RDs over time. Results showed that, although RDs in older adults decline in the clinical course of psychotic depression, the course is unfavorable compared to psychotic depression without RDs with regards to depressive symptom severity. In schizophrenia the most persistent course (87%) pertained to RDs compared to other types of delusions. We also demonstrated that patients with RDs applied more positive religious coping compared to patients without RDs regardless of remission or non-remission of RDs. In chapter 5 mental health professionals (MHPs) described and qualified four vignettes (a psychosis vignette, a spiritual experience vignette, a mourning reaction and a melancholia vignette). The answers to four questions (concerning etiology, pharmacotherapy, seriousness, mental health care) were per vignette quantified. Results showed that the non-medical professionals (psychologists and social psychiatric nurses) considered the melancholia vignette more frequently as a religious or spiritual problem, pharmacotherapy as less useful and mental health care assistance as less desirable compared to the medical professionals (psychiatrists, trainee psychiatrists). In chapter 6 we described and quantified the ability of four categories CMs of various Christian denominations (N=143) and the group of (MHPs) (N = 73) to distinguish the four vignettes as described in the previous chapter. Results showed that Evangelical CMs most frequently viewed the two psychiatric vignettes as a religious or spiritual problem, and certainly when compared to the MHPs. The need for psychiatric care in the event of the psychosis vignette was only acknowledged by the strict Protestant CMs to much the same extent as the MHPs. In chapter 7 we described and quantified the ability of CMs as a group to recognize serious psychopathology compared to that of MHPs as a group. The same vignettes were applied. Results showed that the MHPs and CMs considered the P-states clearly more in need of psychiatric care and more as a serious problem than the NP-states. Though, CMs considered the P-states significantly more often as a religious or spiritual problem as well as significantly less often as in need of psychiatric care than the MHPs did.

In chapter 2 we described and quantified the prevalence and characteristics of RDs, and the co-occurrence of RDs with other delusions, using a semi structured diagnostic interview in older adults diagnosed with either affective or nonaffective psychotic disorders. Results showed that RDs were fairly common in both diagnostic groups, psychotic depression and schizophrenia. RDs were markedly higher among patients with psychotic depression compared to younger samples. RDs with delusions of grandeur, Cotard and Schneider appear to be related to non-affective psychosis (schizophrenia). The delusional characteristic bizarreness and the presence of more psychotic symptoms are significantly more common in this combination of delusions. In psychotic depression, RDs with delusions of guilt occurred predominantly with more symptoms of distress compared to patients without this combination of delusions. In chapter 3 we explored the prevalence and content of religious hallucinations (RHs), how they relate to the diagnosis, and how RDs and RHs related to patients’ denominational background and other aspects of religiousness. Results showed that the prevalence of RHs amounted to 18.7%, no statistically significant difference between the prevalence in schizophrenia (17.5%) and in psychotic depression (9.4%). Moreover, the contents of the RHs about the Devil or Satan were quite common, and more prevalent in patients with psychotic depression. RDs and RHs were significantly more prevalent in psychotic depressed patients who were raised as or were currently affiliated as strict Protestants. Religion is likely to act as a symptom-formation factor for psychotic symptoms in strict Protestant older adults. In chapter 4 we aimed to obtain more insight into the course of RDs over time. Results showed that, although RDs in older adults decline in the clinical course of psychotic depression, the course is unfavorable compared to psychotic depression without RDs with regards to depressive symptom severity. In schizophrenia the most persistent course (87%) pertained to RDs compared to other types of delusions. We also demonstrated that patients with RDs applied more positive religious coping compared to patients without RDs regardless of remission or non-remission of RDs. In chapter 5 mental health professionals (MHPs) described and qualified four vignettes (a psychosis vignette, a spiritual experience vignette, a mourning reaction and a melancholia vignette). The answers to four questions (concerning etiology, pharmacotherapy, seriousness, mental health care) were per vignette quantified. Results showed that the non-medical professionals (psychologists and social psychiatric nurses) considered the melancholia vignette more frequently as a religious or spiritual problem, pharmacotherapy as less useful and mental health care assistance as less desirable compared to the medical professionals (psychiatrists, trainee psychiatrists). In chapter 6 we described and quantified the ability of four categories CMs of various Christian denominations (N=143) and the group of (MHPs) (N = 73) to distinguish the four vignettes as described in the previous chapter. Results showed that Evangelical CMs most frequently viewed the two psychiatric vignettes as a religious or spiritual problem, and certainly when compared to the MHPs. The need for psychiatric care in the event of the psychosis vignette was only acknowledged by the strict Protestant CMs to much the same extent as the MHPs. In chapter 7 we described and quantified the ability of CMs as a group to recognize serious psychopathology compared to that of MHPs as a group. The same vignettes were applied. Results showed that the MHPs and CMs considered the P-states clearly more in need of psychiatric care and more as a serious problem than the NP-states. Though, CMs considered the P-states significantly more often as a religious or spiritual problem as well as significantly less often as in need of psychiatric care than the MHPs did.

In chapter 2 we described and quantified the prevalence and characteristics of RDs, and the co-occurrence of RDs with other delusions, using a semi structured diagnostic interview in older adults diagnosed with either affective or nonaffective psychotic disorders. Results showed that RDs were fairly common in both diagnostic groups, psychotic depression and schizophrenia. RDs were markedly higher among patients with psychotic depression compared to younger samples. RDs with delusions of grandeur, Cotard and Schneider appear to be related to non-affective psychosis (schizophrenia). The delusional characteristic bizarreness and the presence of more psychotic symptoms are significantly more common in this combination of delusions. In psychotic depression, RDs with delusions of guilt occurred predominantly with more symptoms of distress compared to patients without this combination of delusions. In chapter 3 we explored the prevalence and content of religious hallucinations (RHs), how they relate to the diagnosis, and how RDs and RHs related to patients’ denominational background and other aspects of religiousness. Results showed that the prevalence of RHs amounted to 18.7%, no statistically significant difference between the prevalence in schizophrenia (17.5%) and in psychotic depression (9.4%). Moreover, the contents of the RHs about the Devil or Satan were quite common, and more prevalent in patients with psychotic depression. RDs and RHs were significantly more prevalent in psychotic depressed patients who were raised as or were currently affiliated as strict Protestants. Religion is likely to act as a symptom-formation factor for psychotic symptoms in strict Protestant older adults. In chapter 4 we aimed to obtain more insight into the course of RDs over time. Results showed that, although RDs in older adults decline in the clinical course of psychotic depression, the course is unfavorable compared to psychotic depression without RDs with regards to depressive symptom severity. In schizophrenia the most persistent course (87%) pertained to RDs compared to other types of delusions. We also demonstrated that patients with RDs applied more positive religious coping compared to patients without RDs regardless of remission or non-remission of RDs. In chapter 5 mental health professionals (MHPs) described and qualified four vignettes (a psychosis vignette, a spiritual experience vignette, a mourning reaction and a melancholia vignette). The answers to four questions (concerning etiology, pharmacotherapy, seriousness, mental health care) were per vignette quantified. Results showed that the non-medical professionals (psychologists and social psychiatric nurses) considered the melancholia vignette more frequently as a religious or spiritual problem, pharmacotherapy as less useful and mental health care assistance as less desirable compared to the medical professionals (psychiatrists, trainee psychiatrists). In chapter 6 we described and quantified the ability of four categories CMs of various Christian denominations (N=143) and the group of (MHPs) (N = 73) to distinguish the four vignettes as described in the previous chapter. Results showed that Evangelical CMs most frequently viewed the two psychiatric vignettes as a religious or spiritual problem, and certainly when compared to the MHPs. The need for psychiatric care in the event of the psychosis vignette was only acknowledged by the strict Protestant CMs to much the same extent as the MHPs. In chapter 7 we described and quantified the ability of CMs as a group to recognize serious psychopathology compared to that of MHPs as a group. The same vignettes were applied. Results showed that the MHPs and CMs considered the P-states clearly more in need of psychiatric care and more as a serious problem than the NP-states. Though, CMs considered the P-states significantly more often as a religious or spiritual problem as well as significantly less often as in need of psychiatric care than the MHPs did.

In chapter 2 we described and quantified the prevalence and characteristics of RDs, and the co-occurrence of RDs with other delusions, using a semi structured diagnostic interview in older adults diagnosed with either affective or nonaffective psychotic disorders. Results showed that RDs were fairly common in both diagnostic groups, psychotic depression and schizophrenia. RDs were markedly higher among patients with psychotic depression compared to younger samples. RDs with delusions of grandeur, Cotard and Schneider appear to be related to non-affective psychosis (schizophrenia). The delusional characteristic bizarreness and the presence of more psychotic symptoms are significantly more common in this combination of delusions. In psychotic depression, RDs with delusions of guilt occurred predominantly with more symptoms of distress compared to patients without this combination of delusions. In chapter 3 we explored the prevalence and content of religious hallucinations (RHs), how they relate to the diagnosis, and how RDs and RHs related to patients’ denominational background and other aspects of religiousness. Results showed that the prevalence of RHs amounted to 18.7%, no statistically significant difference between the prevalence in schizophrenia (17.5%) and in psychotic depression (9.4%). Moreover, the contents of the RHs about the Devil or Satan were quite common, and more prevalent in patients with psychotic depression. RDs and RHs were significantly more prevalent in psychotic depressed patients who were raised as or were currently affiliated as strict Protestants. Religion is likely to act as a symptom-formation factor for psychotic symptoms in strict Protestant older adults. In chapter 4 we aimed to obtain more insight into the course of RDs over time. Results showed that, although RDs in older adults decline in the clinical course of psychotic depression, the course is unfavorable compared to psychotic depression without RDs with regards to depressive symptom severity. In schizophrenia the most persistent course (87%) pertained to RDs compared to other types of delusions. We also demonstrated that patients with RDs applied more positive religious coping compared to patients without RDs regardless of remission or non-remission of RDs. In chapter 5 mental health professionals (MHPs) described and qualified four vignettes (a psychosis vignette, a spiritual experience vignette, a mourning reaction and a melancholia vignette). The answers to four questions (concerning etiology, pharmacotherapy, seriousness, mental health care) were per vignette quantified. Results showed that the non-medical professionals (psychologists and social psychiatric nurses) considered the melancholia vignette more frequently as a religious or spiritual problem, pharmacotherapy as less useful and mental health care assistance as less desirable compared to the medical professionals (psychiatrists, trainee psychiatrists). In chapter 6 we described and quantified the ability of four categories CMs of various Christian denominations (N=143) and the group of (MHPs) (N = 73) to distinguish the four vignettes as described in the previous chapter. Results showed that Evangelical CMs most frequently viewed the two psychiatric vignettes as a religious or spiritual problem, and certainly when compared to the MHPs. The need for psychiatric care in the event of the psychosis vignette was only acknowledged by the strict Protestant CMs to much the same extent as the MHPs. In chapter 7 we described and quantified the ability of CMs as a group to recognize serious psychopathology compared to that of MHPs as a group. The same vignettes were applied. Results showed that the MHPs and CMs considered the P-states clearly more in need of psychiatric care and more as a serious problem than the NP-states. Though, CMs considered the P-states significantly more often as a religious or spiritual problem as well as significantly less often as in need of psychiatric care than the MHPs did.

Background Frailty is associated with COVID-19 severity in clinical settings. No general population-based studies on the association between actual frailty status and COVID-19 hospitalization are available. Aims To investigate the association between frailty and the risk of COVID-19 hospitalization once infected. Methods 440 older adults who participated in the Lifelines COVID-19 Cohort study in the Northern Netherlands and reported positive COVID-19 testing results (54.2% women, age 70 ± 4 years in 2021) were included in the analyses. COVID-19 hospitalization status was self-reported. The Groningen Frailty Indicator (GFI) was derived from 15 self-reported questionnaire items related to daily activities, health problems, and psychosocial functioning, with a score ≥ 4 indicating frailty. Both frailty and COVID-19 hospitalization were assessed in the same period. Poisson regression models with robust standard errors were used to analyze the associations between frailty and COVID-19 hospitalization. Results Of 440 older adults included, 42 were hospitalized because of COVID-19 infection. After adjusting for sociodemographic and lifestyle factors, a higher risk of COVID-19 hospitalization was observed for frail individuals (risk ratio (RR) [95% CI] 1.97 [1.06–3.67]) compared to those classified as non-frail. Discussion Frailty was positively associated with COVID-19 hospitalization once infected, independent of sociodemographic and lifestyle factors. Future research on frailty and COVID-19 should consider biomarkers of aging and frailty to understand the pathophysiological mechanisms and manifestations between frailty and COVID-19 outcomes. Conclusions Frailty was positively associated with the risk of hospitalization among older adults that were infected with COVID-19. Public health strategies for frailty prevention in older adults need to be advocated, as it is helpful to reduce the burden of the healthcare system, particularly during a pandemic like COVID-19.

Background Reducing inequalities in physical activity (PA) and PA-associated health outcomes is a priority for public health. Interventions to promote PA may reduce inequalities, but may also unintentionally increase them. Thus, there is a need to analyze equity-specific intervention effects. However, the potential for analyzing equity-specific effects of PA interventions has not yet been sufficiently exploited. The aim of this study was to set out a novel equity-specific re-analysis strategy tried out in an international interdisciplinary collaboration. Methods The re-analysis strategy comprised harmonizing choice and definition of outcomes, exposures, socio-demographic indicators, and statistical analysis strategies across studies, as well as synthesizing results. It was applied in a collaboration of a convenience sample of eight European PA intervention studies in adults aged ≥45 years. Weekly minutes of moderate-to-vigorous PA was harmonized as outcome. Any versus no intervention was harmonized as exposure. Gender, education, income, area deprivation, and marital status were harmonized as socio-demographic indicators. Interactions between the intervention and socio-demographic indicators on moderate-to-vigorous PA were analyzed using multivariable linear regression and random-effects meta-analysis. Results The collaborative experience shows that the novel re-analysis strategy can be applied to investigate equity-specific effects of existing PA interventions. Across our convenience sample of studies, no consistent pattern of equity-specific intervention effects was found. Pooled estimates suggested that intervention effects did not differ by gender, education, income, area deprivation, and marital status. Conclusions To exploit the potential for equity-specific effect analysis, we encourage future studies to apply the strategy to representative samples of existing study data. Ensuring sufficient representation of ‘hard to reach’ groups such as the most disadvantaged in study samples is of particular importance. This will help to extend the limited evidence required for the design and prioritization of future interventions that are most likely to reduce health inequalities.

Objective. Although regular physical activity is an effective secondary prevention strategy for patients with a chronic disease, it is unclear whether patients change their daily physical activity after being diagnosed. Therefore, the aims of this study were to (1) describe changes in levels of physical activity in middle-aged women before and after diagnosis with a chronic disease (heart disease, diabetes, asthma, breast cancer, arthritis, depression); and to (2) examine whether diagnosis with a chronic disease affects levels of physical activity in these women.Methods. Data from 5 surveys (1998-2010) of the Australian Longitudinal Study on Women's Health (ALSWH) were used. Participants (N = 4840, born 1946-1951) completed surveys every three years, with questions about diseases and leisure time physical activity. The main outcome measure was physical activity, categorized as: nil/sedentary, low active, moderately active, highly active.Results. At each survey approximately half the middle-aged women did not meet the recommended level of physical activity. Between consecutive surveys, 41%-46% of the women did not change, 24%-30% decreased, and 24%-31% increased their physical activity level. These proportions of change were similar directly after diagnosis with a chronic disease, and in the years before or after diagnosis. Generalized estimating equations showed that there was no statistically significant effect of diagnosis with a chronic disease on levels of physical activity in women.Conclusion. Despite the importance of physical activity for the management of chronic diseases, most women did not increase their physical activity after diagnosis. This illustrates a need for tailored interventions to enhance physical activity in newly diagnosed patients. (C) 2015 Elsevier Inc. All rights reserved.

The present document describes a nutritional approach that is nested in the European Innovation Partnership for Active and Healthy Aging (EIP-AHA) and aims to provide the first common European program translating an integrated approach to nutritional frailty in terms of a multidimensional and transnational methodology. The document has been developed by the A3 Nutrition Action Area of the EIP-AHA and aims at providing a stepwise approach to malnutrition in older citizens, identifying adequate interventions based on a unified assessment and ICT-supported solutions. “NutriLive” is an integrated nutritional approach, represented by a structured Screening-Assessment-Monitoring-Action-Pyramid-Model (SAM-AP). Its core concept is the stratification of the nutritional needs, considered by the working group as the key for targeted, effective, and sustainable interventions. “NutriLive” tries to close gaps in epidemiological data within an aging population, creating a unified language to deal with the topic of nutrition and malnutrition in Europe. By assembling all the validated screening, assessment, and monitoring tools on malnutrition in a first pyramid, which is interrelated to a second intervention pyramid, the A3 Nutrition WG identifies a common, integrated vision on the nutritional approach to frailty, which applies to the various health care settings.

Background: Due to the rapidly increasing number of older people worldwide, the prevalence of frailty among older adults is expected to escalate in coming decades. It is crucial to recognize early onset symptoms to initiate specific preventive care. Therefore, early detection of frailty with appropriate screening instruments is needed. The aim of this study was to evaluate the underlying dimensionality of the Groningen Frailty Indicator (GFI), a widely used self-report screening instrument for identifying frail older adults. In addition, criterion validity of GFI subscales was examined and composition of GFI scores was evaluated.Methods: A cross-sectional study design was used to evaluate the structural validity, internal consistency and criterion validity of the GFI questionnaire in older adults aged 65 years and older. All subjects completed the GFI questionnaire (n = 1508). To assess criterion validity, a smaller sample of 119 older adults completed additional questionnaires: De Jong Gierveld Loneliness Scale, Hospital Anxiety Depression Scale, RAND-36 physical functioning, and perceived general health item of the EuroQol-5D. Exploratory factor analysis and Mokken scale analysis were used to evaluate the structural validity of the GFI. A Venn diagram was constructed to show the composition of GFI subscale scores for frail subjects.Results: The factor structure of the GFI supported a three-dimensional structure of the scale. The subscales Daily Activities and Psychosocial Functioning showed good internal consistency, scalability, and criterion validity (Daily Activities: Cronbach's alpha = 0.81, H-s = .84, r = -.62; Psychosocial Functioning: Cronbach's alpha = 0.80, H-s = .35, r = -.48). The subscale Health Problems showed less strong internal consistency but acceptable scalability and criterion validity (Cronbach's alpha = .57, H-s = .35, r = -.48). The present data suggest that 90% of the frail older adults experience problems in the Psychosocial Functioning domain.Conclusions: The present findings support a three-dimensional factor structure of the GFI, suggesting that a multidimensional assessment of frailty with the GFI is possible. These GFI subscale scores produce a richer assessment of frailty than with a single overall sum GFI score, and likely their use will contribute to more directed and customized care for older adults.