Search

Autonomy is important in every stage of life. However, little is known about how autonomy is enhanced for older adults living in residential care facilities (RCFs). This leads to the research question: which facilitators and barriers to autonomy of older adults with physical impairments due to ageing and chronic health conditions living in RCFs are known? The results will be organised according to the framework of person-centred practice, because this is related to autonomy enhancement. To answer the research question, a systematic literature search and review was performed in the electronic databases CINAHL, PsycINFO, PubMed, Social Services Abstracts and Sociological Abstracts. Inclusion and exclusion criteria were derived from the research question. Selected articles were analysed and assessed on quality using the Mixed Methods Appraisal Tool. Facilitators and barriers for autonomy were found and arranged in four themes: characteristics of residents, prerequisites of professional care-givers, care processes between resident and care-giver, and environment of care. The established facilitators and barriers are relational and dynamic. For a better understanding of the facilitators and barriers to autonomy for older adults with physical impairments living in RCFs, a description is based on the 35 included articles. Autonomy is a capacity to influence the environment and make decisions irrespective of having executional autonomy, to live the kind of life someone desires to live in the face of diminishing social, physical and/or cognitive resources and dependency, and it develops in relationships. The results provide an actual overview and lead to a better understanding of barriers and facilitators for the autonomy of older adults with physical impairments in RCFs. For both residents and care-givers, results offer possibilities to sustain and reinforce autonomy. Scientifically, the study creates new knowledge on factors that influence autonomy, which can be used to enhance autonomy. [ABSTRACT FROM AUTHOR]

Social needs are important basic human needs. When social needs are not fulfilled, it can lead to mental and physical health problems. In an ageing society, meeting the social needs of older adults is important to sustain their wellbeing and quality of life. Social technology is used by younger people attempting to fulfil social needs. The aim of this study is to understand the social needs of older people and the role of social technology in fulfilling these needs. Using this information we will uncover opportunities for (technological) interventions. We conducted a qualitative explorative field study by interviewing 19 community-dwelling older adults. The participants were selected by professional care-givers with the help of a list of criteria for people at risk of social isolation or loneliness. Semi-structured interviews were held, using a topic list covering the following topics: social networks, social support, connectedness, neighbourhood, activities and hobbies, as well as use of and experiences with social technology. After thematic analysis, inductive codes were attached to quotations relevant to the research question. The results were described in four sections: (a) social needs and relationships; (b) the influence of life history and personality; (c) possibilities and barriers to meet social needs; and (d) use of and attitude towards social technology. The results indicate that the group of participants is heterogeneous and that their social needs and the way they try to meet these are diverse. The Social Production Functions Theory of Successful Aging (SPF-SA) was found to be a useful basis for interpreting and presenting the data. Social needs such as connectedness, autonomy, affection, behavioural confirmation and status are important for the wellbeing of older people. Although the need for affection is most easy to fulfil for older people, it looks like satisfaction of the need for behavioural confirmation and status are in some cases preferred, especially by the male participants. Resources such as relationships, activities, personal circumstances and social technology can help meet social needs. Where there is a lack of (physical) resources such as health problems, reduced mobility, death of network members, fear of rejection and gossip, and poor financial circumstances, meeting social needs can be more difficult for some older people. Social technology now plays a modest role in the lives of older people and in fulfilling their social needs. Because of its potential and its role in the lives of younger people, social technology can be seen as a promising resource in the satisfaction of social needs. However, since it is yet unknown how and to what extent the use of social network technologies, such as Facebook, can be beneficial for older people, more research in this area is needed. Based on our findings, we conclude that the world of older individuals is getting smaller. The loss of resources, e.g. the loss of one's health and mobility, may make it more difficult for an older person to connect with the world outside, which may result in a smaller social network. We therefore suggest that interventions to support older adults to meet their social needs may focus on two aspects: supporting and improving the world close by and bringing the world outside a little bit closer. [ABSTRACT FROM AUTHOR]

Social needs are important basic human needs. When social needs are not satisfied, this can lead to mental and physical health problems. With a growing population of older adults and the need for them to stay healthy and community-dwelling, satisfying social needs is important. The aim of this review is to give more insight into the social needs of older people and subsequently into the characteristics of effective interventions for satisfying older people's social needs. A systematic review of the existing literature on quantitative, qualitative and mixed empirical studies on the social needs of older people was conducted. The themes that emerged were diversity, proximity, meaning of the relationship and reciprocity. These themes offered several intervention implications. Participation in hobbies and in volunteer work and being connected were among the main findings. The social needs of older people are diverse. They focus on both the intimate and the peripheral members of their networks. When satisfying social needs, reciprocity is important. The feeling of connectedness to others and to a community or neighbourhood contributes to wellbeing as well as a feeling of independence. Staying active by doing volunteer work or participating in (leisure) social activities satisfies social needs. Therefore, interventions should focus especially on the connectedness, participation and independence of the older adult. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care interventions introduced in response to the increased demand for long-term care entail profound changes to the health workforce. This exploratory study aims to provide an overview of the workforce changes implemented as part of integrated chronic care interventions. Methods: An interactive and emergent research design was used consisting of a literature review, qualitative expert questionnaires and case reports. We defined integrated care as interventions targeting at least two of the six Chronic Care Model components. Workforce changes were defined as those changes experienced by clinical and non-clinical staff responsible for public and individual health intervention. Results: Seven workforce changes were identified: (1) nurse involvement, (2) multidisciplinary staff, (3) multidisciplinary protocols/pathways, (4) provider training, (5) case manager/care coordinator, (6) team meetings, and (7) new positions. Most interventions included more than one of these workforce changes. Conclusion: The results of this study provide detailed insights into the current implementation of workforce changes in integrated care interventions and thereby pave the way for further investigations into the relative effectiveness of different workforce changes within the scope of complex interventions. Advancing knowledge in this area is essential for fostering health systems’ capacity to cope with the challenges related to the current demographic and epidemiological trends. [ABSTRACT FROM AUTHOR]

BACKGROUND: The person-centered perspective of residential care facility (RCF) residents with dementia with regard to their intimate and sexual lives is largely neglected in research. OBJECTIVE: We aim to provide methodological considerations and reflections on a performed qualitative study. Recommendations and a guide to study design are provided to inform and encourage future research on the inclusion of people with dementia as participants. METHODS: Methodological recommendations and reflections are described in chronological order of the procedure. Fragments of interviews are included for further illustration and clarification. RESULTS: Considering preparation, close involvement of clinical practice and extensive deliberation regarding study design tended to be important. Considering procedure, investment in contacts with clinical practice and authorized representatives; an introduction meeting; person-centered inclusion and consent; profound skills in interviewing participants with dementia and flexibility in data collection were proven of importance. Considering data analysis and study quality, including field notes and aiming at a balance between study quality and practicability to enhance study 'rigor' were found important. CONCLUSION: Including the person-centered perspective in research on intimacy and sexuality of RCF residents with dementia, is challenging and takes a flexible and creative approach. It is, however, worthwhile to close the gap in literature. [ABSTRACT FROM AUTHOR]

Introduction: In this paper, we provide a detailed and explicit description of the processes and decisions underlying and shaping the emergent multimethod research design of our study on workforce changes in integrated chronic care. Theory and methods: The study was originally planned as mixed method research consisting of a preliminary literature review and quantitative check of these findings via a Delphi panel. However, when the findings of the literature review were not appropriate for quantitative confirmation, we chose to continue our qualitative exploration of the topic via qualitative questionnaires and secondary analysis of two best practice case reports. Results: The resulting research design is schematically described as an emergent and interactive multimethod design with multiphase combination timing. In doing so, we provide other researchers with a set of theory- and experience-based options to develop their own multimethod research and provide an example for more detailed and structured reporting of emergent designs. Conclusion and discussion: We argue that the terminology developed for the description of mixed methods designs should also be used for multimethod designs such as the one presented here. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The delivery of integrated care is a priority in many countries' efforts to improve health outcomes for people at risk of or with diabetes. This study aims to provide an overview of the different types of integrated care interventions for type 2 diabetes and to report their outcomes. Methods A systematic literature search was conducted in PubMed and Cochrane for the period 2003-2013. Article selection and data extraction were performed independently by three researchers and results were discussed together. The chronic care model ( CCM) was used to describe intervention types. Results Forty-four articles met the inclusion criteria. Most interventions included all CCM components and a variety of sub-components. Most studies reported positive patient, process and health service utilization measures. The information on costs was limited and inconsistent. The low number of articles reporting comparable outcome measures made it difficult to make meaningful statements about an association between intervention type and outcomes. Conclusions Future research would benefit from a more uniform understanding of integrated care as well as intermediate outcome measurements that allow for the establishment of a chain of evidence from specific intervention types to specific outcomes achieved. It is expected that such a comprehensive approach will reveal important insights as to which integrated care intervention types and settings are most conducive to successful implementation and would thereby be of relevance to policy makers and practitioners involved in the financing, management and delivery of integrated care. [ABSTRACT FROM AUTHOR]

Background: Most older adults prefer to age in place, and supporting older adults to remain in their own homes and communities is also favored by policy makers. Technology can play a role in staying independent, active and healthy. However, the use of technology varies considerably among older adults. Previous research indicates that current models of technology acceptance are missing essential predictors specific to community-dwelling older adults. Furthermore, in situ research within the specific context of aging in place is scarce, while this type of research is needed to better understand how and why community-dwelling older adults are using technology.Objective: To explore which factors influence the level of use of various types of technology by older adults who are aging in place and to describe these factors in a comprehensive model.Methods: A qualitative explorative field study was set up, involving home visits to 53 community-dwelling older adults, aged 68-95, living in the Netherlands. Purposive sampling was used to include participants with different health statuses, living arrangements, and levels of technology experience. During each home visit: (1) background information on the participants' chronic conditions, major life events, frailty, cognitive functioning, subjective health, ownership and use of technology was gathered, and (2) a semistructured interview was conducted regarding reasons for the level of use of technology. The study was designed to include various types of technology that could support activities of daily living, personal health or safety, mobility, communication, physical activity, personal development, and leisure activities. Thematic analysis was employed to analyze interview transcripts.Results: The level of technology use in the context of aging in place is influenced by six major themes: challenges in the domain of independent living; behavioral options; personal thoughts on technology use; influence of the social network; influence of organizations, and the role of the physical environment.Conclusion: Older adults' perceptions and use of technology are embedded in their personal, social, and physical context. Awareness of these psychological and contextual factors is needed in order to facilitate aging in place through the use of technology. A conceptual model covering these factors is presented. [ABSTRACT FROM AUTHOR]

Background: Integrated care interventions for chronic conditions can lead to improved outcomes, but it is not clear when and why this is the case. This study aims to answer the following two research questions: First, what are the context, mechanisms and outcomes of integrated care for people with type 2 diabetes? Second, what are the relationships between context, mechanisms and outcomes of integrated care for people with type 2 diabetes?Methods: A systematic literature search was conducted for the period 2003-2013 in Cochrane and PubMed. Articles were included when they focussed on integrated care and type 2 diabetes, and concerned empirical research analysing the implementation of an intervention. Data extraction was performed using a common data extraction table. The quality of the studies was assessed with the Mixed Methods Appraisal Tool. The CMO model (context + mechanism = outcome) was used to study the relationship between context factors (described by the barriers and facilitators encountered in the implementation process and categorised at the six levels of the Implementation Model), mechanisms (defined as intervention types and described by their number of Chronic Care Model (sub-)components) and outcomes (the intentional and unintentional effects triggered by mechanism and context).Results: Thirty-two studies met the inclusion criteria. Most reported barriers to the implementation process were found at the organisational context level and most facilitators at the social context level. Due to the low number of articles reporting comparable quantitative outcome measures or in-depth qualitative information, it was not possible to make statements about the relationship between context, mechanisms and outcomes.Conclusions: Efficient resource allocation should entail increased investments at the organisational context level where most barriers are expected to occur. It is likely that investments at the social context level will also help to decrease the development of barriers at the organisational context level, especially by increasing staff involvement and satisfaction. If future research is to adequately inform practice and policy regarding the impact of these efforts on health outcomes, focus on the actual relationships between context, mechanisms and outcomes should be actively incorporated into study designs. [ABSTRACT FROM AUTHOR]

Purpose of the study The access process is an important first step in the long-term institutional care for older people. Access can be seen as a concept consisting of three closely related dimensions: availability, affordability and acceptability (three A's). This study takes a new perspective by investigating how older clients experience the access process. Design and methods Data were gathered through interviews with representatives of clients that were recently admitted in a long-term care facility, or if possible with clients themselves. A total of 33 respondents from 4 organizations that provide long-term institutional care were interviewed. Results The first contact with the long-term care provider was made in several different ways. Finding a location nearby family was a common aim, which in urgent situations was not always feasible. Most respondents were satisfied about the process and felt taken care of personally. Yet, many respondents mention the lack of practical information and ‘guidance’ in the complexity of elder care. For acceptability, having a dedicated liaison in the organization was relevant. Implications The study revealed that the 3A model can be used to understand how older clients or their representatives experience the operational access process to long-term care. Especially the dimensions' availability and acceptability seemed to shape their experience. [ABSTRACT FROM AUTHOR]

Background: Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. Methods: An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model was used to study the relationship between context factors, mechanisms and outcomes. Dutch integrated care involves care groups, bundled payments, patient involvement, health professional cooperation and task substitution, evidence-based care protocols and a shared clinical information system. Community involvement is not (yet) part of Dutch integrated care. Results: Barriers to the implementation of integrated care included insufficient integration between the patient databases, decreased earnings for some health professionals, patients' insufficient medical and policy-making expertise, resistance by general practitioner assistants due to perceived competition, too much care provided by practice nurses instead of general practitioners and the funding system incentivising the provision of care exactly as described in the care protocols. Facilitators included performance monitoring via the care chain information system, increased earnings for some health professionals, increased focus on self-management, innovators in primary and secondary care, diabetes nurses acting as integrators and financial incentives for guideline adherence. Economic and political context and health IT-related barriers were discussed as the most problematic areas of integrated care implementation. The implementation of integrated care led to improved communication and cooperation but also to insufficient and unnecessary care provision and deteriorated preconditions for person-centred care. Conclusions: Dutch integrated diabetes care is still a work in progress, in the academic and the practice setting. This makes it difficult to establish whether overall quality of care has improved. Future efforts should focus on areas that this study found to be problematic or to not have received enough attention yet. Increased efforts are needed to improve the interoperability of the patient databases and to keep the negative consequences of the bundled payment system in check. Moreover, patient and community involvement should be incorporated. [ABSTRACT FROM AUTHOR]

Purpose: Although frailty was originally a medical concept, nowadays more and more researchers are convinced of its multidimensional nature, including a psychological and social domain of frailty as well as a physical domain. The objective of this study was to test the hypothesis that the prediction of quality of life by physical frailty components is improved by adding psychological and social frailty components. Methods: This cross-sectional study was carried out with a sample of Dutch citizens. A total of 1,031 people aged 65 years and older completed a Web-based questionnaire containing the Tilburg Frailty Indicator for measuring physical, psychological, and social frailty, and the WHOQOL-BREF for measuring four quality of life domains (physical health, psychological, social relations, environmental). Results: The findings show that the prediction of all quality of life domains by eight physical components of frailty was improved after adding four psychological and three social frailty components. The psychological frailty component ‘feeling down’ significantly improved the prediction of all four quality of life domains, after controlling for the effects of background characteristics and all other frailty components. Conclusion: This study emphasizes the importance of a multidimensional assessment of frailty in the prediction of quality of life in older people. [ABSTRACT FROM AUTHOR]

Aims and objectives. To provide insight into family caregiver perspectives on social relations within the 'caregiving triangle' between family caregiver, professional caregiver and elderly resident with dementia. Results were compared between traditional versus small-scale long-term care settings in the Netherlands and Belgium. Background. Residential dementia care is shifting towards a more holistic and person-centred approach. Until now, little is known about family caregiver perspectives. Design. A quasi-experimental longitudinal design. Methods. This study was part of a larger research project focusing on the quality of life of residents with dementia in traditional and small-scale settings ( n = 179). This study focused on family caregivers related to these residents ( n = 64). They filled in a questionnaire containing 25 items (baseline and after 12 months) related to their perspectives on the interaction within the 'caregiving triangle'. Analyses were performed using mixed models and logistic regression. Results. Compared to traditional settings, family caregivers of relatives with dementia living in small-scale settings had more contact with the professional caregivers, were more satisfied with this contact and felt that staff paid more attention to their feelings as family members. They also reported that staff showed better listening skills towards the residents. Furthermore, compared to those in Belgium, family caregivers in the Netherlands perceived staff to be less hurried and more accepting of help from family and felt that staff more often takes the resident seriously. Conclusion. In the move towards more person-centred care for residents with dementia, this study finds preliminary evidence for the importance of integrating the family perspective. Relevance to clinical practice. Gaining more insight into the perspectives of family caregivers on the social relations within the 'caregiving triangle' may provide knowledge about the importance of the social system surrounding elderly residents with dementia and can provide pointers for future research. [ABSTRACT FROM AUTHOR]

Abstract: Background: The number of people living with dementia worldwide is increasing, resulting in a need for more residential care. In response to criticism of the traditional medical approach to residential dementia care, many large nursing homes are transforming their traditional care facilities into more home-like small-scale living facilities. Objectives: This study examined the assumed benefits of small-scale living for residents with dementia, compared to traditional long-term care in the Netherlands and Belgium. The primary outcome was quality of life, divided into nine different domains. Design: The study had a longitudinal design within a one-year time interval. Settings: Five long-term care settings in the Netherlands and Belgium containing four traditional and twelve small-scale living units participated in the study. Participants: Data were obtained from 179 residents with dementia (age>65 years) (Dutch small-scale N =51, traditional N =51, Belgian small-scale N =47, traditional N =30). Methods: Nurses and nursing assistants were trained to fill in the questionnaires. Results: In the Dutch sample, residents in small-scale settings had higher mean scores on ‘social relations’, ‘positive affect’, and ‘having something to do’ than residents in traditional settings. Moreover, mean scores on ‘caregiver relation’ and ‘negative affect’ remained stable over time among residents in small-scale settings, but decreased in traditional settings. These differences could not be explained by differences in behavioural characteristics, behavioural interventions, or social interaction. In the Belgian sample, fewer differences were found between traditional and small-scale settings. Nevertheless, residents in small-scale settings were reported to experience less ‘negative affect’ than those in traditional settings, which could be explained by differences in depression. Over time, however, residents ‘felt more at home’ in traditional settings, whereas no such increase was found for small-scale settings. Moreover, the mean quality of life scores on ‘restless behaviour’, ‘having something to do’ and ‘social relations’ decreased in small-scale settings, but remained stable in traditional settings. Conclusions: Both small-scale and traditional settings appear to have beneficial effects on different domains of quality of life of residents with dementia. Future research should focus more on the quality and content of the care provided, than on the effects of the scale and design of the environment in long-term care settings. [Copyright &y& Elsevier]

Introduction: There are many different conceptual definitions of frailty in circulation. Most of these definitions focus mainly on physical problems affecting older people. Only a few also draw attention to other domains of human functioning such as the psychological domain. The authors of this article fear that this could lead to fragmentation of care for frail older people. The aim is to develop an integral conceptual definition of frailty that starts from the premise of a holistic view of the person. Methods: To achieve this, a literature search was carried out. Thereafter a group of experts (N=20) were consulted, both verbally during 2 expert meetings and via a written questionnaire. These experts were asked which existing conceptual definition of frailty places most stress on the integral functioning of older people. Results: The experts expressed a clear preference for one of the conceptual definitions. The result of the literature search and the consultation with the experts led to a new integral conceptual definition of frailty. Conclusion: The conceptual definition is intended to offer a framework for an operational definition of frailty for identifying frail older people. [Copyright &y& Elsevier]

Background: As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Methods: Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Results: Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. Conclusion: The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further enable demand-based provision of long-term care by means of modularity. [ABSTRACT FROM AUTHOR]

Research has shown that interprofessional collaboration (IPC) and education (IPE) may potentially lead to better care for residents in nursing homes, but their implementation is challenging. This study evaluates the implementation of a co-designed IPE program and investigates what and how healthcare students learn and what factors influence their learning. A mixed-methods approach was used to evaluate three cases, with student participation in the IPE (n = 72). The study comprised pre- and posttests, focus groups, and interviews (n = 54). The results indicate that students developed their interprofessional skills and person-centered practice, as confirmed by both the students and educators in the interviews. Additionally, the findings suggest that others also learned from the program. The study emphasizes the influence of workplace learning culture, resources, organizational infrastructure for IPC, and educators’ embeddedness in the care organization on learning outcomes. The findings suggest that IPE is stimulated and accelerated by existing IPC and can stimulate or accelerate existing IPC. As the enabling factors are interrelated, addressing them simultaneously on all organizational levels may result in the faster development of an IPE-ready organization. [ABSTRACT FROM AUTHOR]

Background: Many health systems have implemented integrated care as an alternative approach to health care delivery that is more appropriate for patients with complex, long-term needs. The objective of this article was to analyse the implementation of integrated care at a German geriatric hospital and explore whether the use of a "context-mechanisms-outcomes"-based model provides insights into when and why beneficial outcomes can be achieved.Methods: We conducted 15 semi-structured interviews with health professionals employed at the hospital. The data were qualitatively analysed using a "context-mechanisms-outcomes"-based model. Specifically, mechanisms were defined as the different components of the integrated care intervention and categorised according to Wagner's Chronic Care Model (CCM). Context was understood as the setting in which the mechanisms are brought into practice and described by the barriers and facilitators encountered in the implementation process. These were categorised according to the six levels of Grol and Wensing's Implementation Model (IM): innovation, individual professional, patient, social context, organisational context and economic and political context. Outcomes were defined as the effects triggered by mechanisms and context, and categorised according to the six dimensions of quality of care as defined by the World Health Organization, namely effectiveness, efficiency, accessibility, patient-centeredness, equity and safety.Results: The integrated care intervention consisted of three main components: a specific reimbursement system ("early complex geriatric rehabilitation"), multidisciplinary cooperation, and comprehensive geriatric assessments. The inflexibility of the reimbursement system regarding the obligatory number of treatment sessions contributed to over-, under- and misuse of services. Multidisciplinary cooperation was impeded by a high workload, which contributed to waste in workflows. The comprehensive geriatric assessments were complemented with information provided by family members, which contributed to decreased likelihood of adverse events.Conclusions: We recommend an increased focus on trying to understand how intervention components interact with context factors and, combined, lead to positive and/or negative outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care is expected to contribute to improved health outcomes, better patient experiences and increased cost effectiveness, but so far, findings have been mixed. Our objective was to develop a model for the comprehensive evaluation of integrated care interventions that provides insights into when, why and how successful outcomes can be achieved. Methods: A preliminary model was developed based on the Context-Mechanism-Outcome Model and further developed based on its application to a literature review, two case studies and an expert questionnaire. Results: The COMIC Model for studying the Context, Outcomes and Mechanisms of Integrated Care interventions assumes that an intervention is introduced using certain mechanisms (categorised according to the Chronic Care Model), which are met with particular context factors (described by barriers and facilitators and categorised according to the Implementation Model), which combined, contribute to specific outcomes (categorised by the WHO dimensions of quality of care). Discussions: Using the COMIC Model makes it possible to comprehensively study the interplay of the mechanisms, context and outcomes of integrated care interventions and thereby provides insights into when, why and how integrated care contributes to improved outcomes. As such, the COMIC Model does not in itself propose 'what works' but makes it possible for people involved in the implementation of integrated care to find the answer to what works, when and why themselves. Since the COMIC Model supports comprehensive and explicit descriptions of how specific context factors shaped the implementation of an intervention, evaluations conducted in one setting are likely to also provide lessons learned that are of added value to other organisations in other settings. Conclusions: The COMIC Model makes it possible to (1) comprehensively analyse the mechanisms, context and outcomes of a specific case, (2) to make the relationships between the mechanisms, context and outcomes within each case visible, and (3) to compare two cases to each other in a systematic way that adds value to the analysis. [ABSTRACT FROM AUTHOR]

It is important to evaluate how residents, their significant others, and professional caregivers experience life in a nursing home to improve quality of care based on their needs and wishes. Narratives are a promising method to assess this experienced quality of care as they enable a rich understanding, reflection, and learning. In the Netherlands, narratives are becoming a more substantial element within the quality improvement cycle of nursing homes. The added value of using narrative methods is that they provide space to share experiences, identify dilemmas in care provision, and provide rich information for quality improvements. The use of narratives in practice, however, can also be challenging as this requires effective guidance on how to learn from this data, incorporation of the narrative method in the organizational structure, and national recognition that narrative data can also be used for accountability. In this article, 5 Dutch research institutes reflect on the importance, value, and challenges of using narratives in nursing homes. [ABSTRACT FROM AUTHOR]

Introduction: In discussing the importance of the relationship between what is being studied and how this is studied, various researchers have called for an increased focus on examining the implementation process of integrated care interventions and its relationship to the outcomes achieved instead of a narrow focus on outcomes only. Therefore, this study has two objectives: First, to examine the international scientific literature for current evidence on the impact of the implementation of integrated care for type 2 diabetes mellitus on its outcomes, and second, to investigate the extent to which the CMO model (context + mechanism = outcome) can be applied to the analysis of this relationship. Methods: A systematic literature search was conducted in PubMed and Cochrane for the period 2003-2013. We operationalised the components of the CMO model as follows: mechanism was defined as intervention type, context as barriers and facilitators encountered in the implementation process, and outcomes as intentional and unintentional effects of the intervention. Wagner's Chronic Care Model (CCM) was used to identify intervention types and the implementation model by Grol and Wensing was used to categorise barriers and facilitators. Results: 44 articles met the inclusion criteria. Overall study quality was acceptable, except for four studies to be treated with caution. We found that the CMO model could be applied to all included studies. Regarding mechanisms, most studies reported interventions including all four CCM components and a variety of sub-components. Regarding context, most barriers were related to the organisational context and most facilitators to the social context. Regarding outcomes, most studies reported positive patient, process and health services utilisation outcomes. The information on costs was limited and inconsistent. We found no association between mechanism, context and outcomes. Discussion/Limitations: The CMO model proved to be applicable to the analysis of international scientific literature on integrated care for type 2 diabetes and helped to identify rich evidence on all three components of the model. However, the very low number of articles adequate for quantitative analysis as well as the low number of articles reporting useful qualitative insights made it extremely difficult to make meaningful statements about the presence or absence of associations between mechanism, context and outcomes. Conclusion/Lessons Learned: The CMO model is a useful tool for the analysis of the implementation of integrated care for chronic diseases. However, based on research conducted without specific focus on the CMO model, a retrospective analysis of the relationships between mechanism, context and outcomes is not possible. Suggestions for future research: Future research should explicitly incorporate the CMO approach in its research design so as to make it possible to study the relationships between intervention type, implementation context, and outcomes of integrated care. [ABSTRACT FROM AUTHOR]

Introduction: Previous research has shown that integrated care can lead to improved processes and patient outcomes. However, this is not always the case and there is a lack of evidence regarding the reasons why and in which cases integrated care works. This study contributes to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. Methods: An embedded single case study with two units of analysis was conducted, including 26 interviews with care group staff and health care providers. The CMO model (context + mechanism = outcome) was used to study the relationship between context factors (as categorised by the Implementation Model), mechanisms (as defined by the Chronic Care Model) and outcomes (operationalised as aspects of quality of care). Results: Dutch integrated care reflects five of the six chronic care model components, namely health system, self-management support, delivery system design, decision support, and clinical information system. Barriers were found at all levels of the IM and included decreases earnings, too many innovations, the negative role of some health insurers, yearly changes in insurance policies, the funding system incentivising the provision of care exactly as described in the care protocols, patients' insufficient medical and policy-making expertise, disease-specific care management, resistance by GPs and GP assistants, too much care provided by PNs, and insufficient integration between the various patient databases. Facilitators were also found at all levels of the IM and included increased earnings, care group management and support, financial incentives for care innovations, health insurer cooperation, financial pressure in the health sector, increased focus on self-management, GP support, innovators, tradition of transmural cooperation, integrators, performance monitoring via the care chain information system, and financial incentives for guideline adherence. Discussion/Limitations: The implementation of integrated care led to perceived improvements in certain aspects of quality of care such as improved communication and cooperation but also to perceived deteriorations in others such as insufficient and unnecessary care provision and the preconditions for person-centred care. With so many diverse factors impacting on the outcomes achieved, respondents' opinions varied on whether, overall, integrated care had led to improved or deteriorated quality of care. Moreover, having been conducted in a single country and for a single chronic condition only, the results are still too context-specific to claim generalizability to other settings and conditions. Conclusion/Lessons Learned: Evaluation research benefits from an increased focus on 'how' and 'why' questions in combination with 'what has been achieved' questions using the CMO model, which will be necessary if scientific research is to provide valuable recommendations to integrated chronic care practice. Suggestions for future research: To achieve generalizability, future research should focus on the development of an integrated framework for analysing the implementation of integrated care interventions for people suffering from chronic conditions, focusing on the different mechanisms by which and context in which these are implemented and linking those factors to the outcomes achieved. [ABSTRACT FROM AUTHOR]

Background: Relocations within and between nursing homes often induce stress, anxiety, and depression in residents and cause additional workload for and burnout in staff. To prevent this, many nursing homes deploy pre-transition initiatives, bridging initiatives, and post-transition initiatives to support residents and staff during the relocation process. As little is known about these initiatives, this study aims to explore the pre-relocation, bridging and post-relocation initiatives used for relocations within and between nursing homes. Methods: In seven Dutch nursing homes, eight focus groups were conducted with two to six participants (N = 37) who were actively involved in relocation processes in different roles (i.e., managers, healthcare professionals, support staff, client council members, residents and family). The focus groups were conducted based on a predefined topic list and lasted approximately 60 min. The transcripts were recorded, transcribed verbatim and analysed using thematic coding. Results: Nursing homes had to be inventive in developing relocation initiatives as neither shared guidelines nor knowledge exchange on this topic were available. A total of thirty-seven relocation initiatives were identified in these seven nursing homes. Nineteen pre-relocation initiatives were identified, of which eight emphasized information and engagement, three highlighted training and practice and eight stressed orientation and visualization. Seven bridging initiatives were identified, of which four emphasized coordination and continuity and three highlighted entertainment and celebration. Eleven post-relocation initiatives were identified, of which seven emphasized evaluation and troubleshooting and four highlighted change and adjustment. Conclusion: The identified relocation initiatives were developed unassisted by nursing homes, due to a lack of shared guidelines, knowledge exchange and mutual learning on this topic. Therefore, it may be expedient and more effective to develop general guidelines for relocations within and between nursing homes in collaboration with nursing homes. [ABSTRACT FROM AUTHOR]

Background and Objectives To protect residents with dementia from harm, nursing homes (NHs) often have closed-door policies. However, current research suggests a positive influence of freedom of movement, that is, the right to (decide to) independently move from one place to another, on the health of NH residents with dementia. This systematic review aims to collate, summarize, and synthesize the scientific evidence published to date on the influence of freedom of movement on health among NH residents with dementia. Research Design and Methods Multiple databases were searched up until March 2021. Peer-reviewed qualitative, quantitative, and mixed methods studies were included. Health was operationalized using the Positive Health framework, encompassing 6 dimensions: bodily functions, mental functions and perception, existential dimension, quality of life, social and societal participation, and daily functioning. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Results Sixteen studies were included of good to excellent quality. Compared to closed NHs, freedom of movement in semiopen and open NHs may have a positive influence on bodily functions, mental functions and perception, quality of life, and social and societal participation. The influence on daily functioning and on the existential dimension remains unclear. Discussion and Implications Freedom of movement of NH residents with dementia is often studied as part of a larger context in which other factors may contribute to health benefits. More research is therefore needed to unravel the underlying mechanisms of the positive influence of freedom of movement on health. [ABSTRACT FROM AUTHOR]

Residential care facilities (RCFs) provide 24/7 care to older adults with cognitive and/or physical disabilities and aim to provide person-centered care (PCC). Maintaining residents' autonomy is important to provide PCC, for example, with shared decision-making (SDM). Residents are largely dependent on multiple stakeholders, which could jeopardize their autonomy, especially regarding unhealthy behaviors, such as smoking tobacco or drinking alcohol. This case study explores the dynamics of multiple stakeholders around four RCF residents regarding their alcohol and/or tobacco use. Four RCF residents who smoke tobacco and/or drink alcohol were selected from a previous study, and their (in)formal caregivers were additionally invited to participate. A qualitative research design was chosen, and semi-structured interviews were conducted. The Ethics Review Board from the Tilburg University School of Social and Behavioral Sciences (Reference: RP39) and the executive boards of the two participating organizations granted approval. Narrative portraiture resulted in four case descriptions. Two cases focused mostly on tobacco use, and two cases focused mostly on alcohol use. Multiple stakeholders were involved on different levels: family bought alcohol or cigarettes, and team managers supported care professionals. However, little interaction was found between stakeholders. In these cases, limited interaction between the stakeholders, including the resident, jeopardizes SDM and, in this way, PCC regarding residents' alcohol and/or tobacco use. SDM on this topic could enhance interaction between all stakeholders involved, which could increase PCC. Finally, the cases indicate a constant struggle between protecting residents from adverse outcomes of alcohol and tobacco use and enhancing their autonomy. [ABSTRACT FROM AUTHOR]

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

Person-centred care (PCC) in residential care facilities (RCFs) is valuable but creates challenges for care professionals balancing involvement and a partnership approach for residents while considering the health and safety outcomes of all residents. This review evaluates what is known about the substance use and misuse of residents living in RCFs and what is important to study in future research to enhance PCC, especially in cases in which residents wish to choose unhealthy behaviours. A scoping review was conducted and exclusion criteria were set. The included papers were assessed on methodological quality using the Mixed Methods Appraisal Tool and the results were qualitatively analysed. The included papers consisted of studies regarding alcohol, tobacco and illicit drugs. The results showed that care professionals are involved in facilitating and regulating alcohol and tobacco. The focus of the included papers is on alcohol and tobacco. Five of the 16 papers assessed the residents' perspective. This review highlights the importance of incorporating the perspectives of residents, care professionals and the organisation to enhance PCC and enable residents to make shared and well-informed decisions in dialogue with care professionals. Future research should also assess the distinction between substance use and misuse, and how this affects implementing PCC in RCFs. [ABSTRACT FROM AUTHOR]

Background: Narratives have the potential to promote person-centred practice, yet few studies have been undertaken on the impact of a narrative approach on learning for care professionals or students. With this in mind, we co-designed an educational programme on the use of older persons' narratives for professionals in research, education and nursing. Aims: To investigate the impact of attending a narrative educational programme on the learning of nursing and healthcare assistant students, and on their person-centred practice. We also examined what factors characterised and influenced this learning. Methods: This was a mixed-methods evaluation study. We evaluated the impact of a narrative educational programme on third-year healthcare assistant students and second-year nursing students. Students were invited to complete a survey before and after the educational programme. After the programme, we performed interviews with all the educators and some of the students. Results: Students' learning from the narratives was varied, and there were differences in the extent to which the programme raised awareness. Some students demonstrated new understandings, actions and behaviours. Students self-reported that they had experienced learning related to 12 learning outcomes and to their person-centred practice. According to educators and students, this learning was experiential and reflective, and was influenced by the students' level of participation, personal characteristics and openness to other perspectives, as well as the educators' guidance and the workplace conditions. Conclusion: This study shows that the educational programme 'Tell Me! Learning From Narratives' can contribute to the learning of healthcare assistant and nursing students in terms of their understanding of the field of narrative inquiry as well as the development of their person-centred practice. Providing support for educators is a prerequisite for the programme to work. Implications for practice: * The programme has the potential to contribute to a person-centred care curriculum * Self-evaluation, for example via the self-scan person-centred care survey in this study, prompts awareness in students * Educators should be supported in their use of a narrative approach, person-centred care values and didactic skills * Educators should reflect the values of person-centred care in their practice and in their relationships with students as role models [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aim of this study was to provide an insight into burnout and mental health problems of professional caregivers working in traditional and small-scale long term care settings for elderly residents with dementia in the Netherlands and Belgium. Design: This study was part of a larger study investigating similarities and differences between traditional and small-scale long term care settings for elderly residents with dementia. In this article, the perspective of the professional caregiver is of central importance. A survey was conducted among professional caregivers of residents with dementia, older than 65 years, at 2 measurement moments (at baseline and after 12 months). Setting: The questionnaire was administered to professionals working in traditional and small-scale long term care settings in the Netherlands and Belgium. Participants: Professional caregivers (n = 80) working in 5 different care settings completed a questionnaire. Measurements: The questionnaire included items on personal data, mental health problems (GHQ-12), and burnout (UBOS-C, divided into emotional exhaustion, depersonalization, and personal accomplishment). Analyses were conducted using Mixed Models analysis. Results: Although mental health problems and emotional strain increased significantly over time in both types of settings and countries, overall levels of health problems and burnout were low. As regards emotional strain, professional caregivers in small-scale living facilities showed significantly increased levels in comparison with traditional units. Two significant differences between the countries were also found, with less “depersonalization” and more “personal accomplishment” in Dutch settings compared with Belgian settings. No differences emerged for type of setting or over time on “depersonalization” and “personal accomplishment.” The analyses were controlled for age, sex, educational level, and work experience in dementia care, but did not yield significant effects. Conclusion: Owing to cutbacks in expenditure, the growing number of people with dementia, and the heavier workload, the working environment will become increasingly challenging. Future research should focus on training professional caregivers working in long term care settings how to maximize the quality of client interaction while keeping burnout and mental health problems to a minimum. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aim of this study was to provide an insight into burnout and mental health problems of professional caregivers working in traditional and small-scale long term care settings for elderly residents with dementia in the Netherlands and Belgium. Design: This study was part of a larger study investigating similarities and differences between traditional and small-scale long term care settings for elderly residents with dementia. In this article, the perspective of the professional caregiver is of central importance. A survey was conducted among professional caregivers of residents with dementia, older than 65 years, at 2 measurement moments (at baseline and after 12 months). Setting: The questionnaire was administered to professionals working in traditional and small-scale long term care settings in the Netherlands and Belgium. Participants: Professional caregivers (n = 80) working in 5 different care settings completed a questionnaire. Measurements: The questionnaire included items on personal data, mental health problems (GHQ-12), and burnout (UBOS-C, divided into emotional exhaustion, depersonalization, and personal accomplishment). Analyses were conducted using Mixed Models analysis. Results: Although mental health problems and emotional strain increased significantly over time in both types of settings and countries, overall levels of health problems and burnout were low. As regards emotional strain, professional caregivers in small-scale living facilities showed significantly increased levels in comparison with traditional units. Two significant differences between the countries were also found, with less “depersonalization” and more “personal accomplishment” in Dutch settings compared with Belgian settings. No differences emerged for type of setting or over time on “depersonalization” and “personal accomplishment.” The analyses were controlled for age, sex, educational level, and work experience in dementia care, but did not yield significant effects. Conclusion: Owing to cutbacks in expenditure, the growing number of people with dementia, and the heavier workload, the working environment will become increasingly challenging. Future research should focus on training professional caregivers working in long term care settings how to maximize the quality of client interaction while keeping burnout and mental health problems to a minimum. [Copyright &y& Elsevier]

For people with dementia living in nursing homes, autonomy is important. However, they experience difficulty with being heard as an autonomous person, as well as with expressing their preferences and choices. The question is how to support their autonomy. Despite extensive efforts to support autonomy in daily care for people with dementia living in nursing homes, we do not know exactly what works for whom, in which context, how and why. The objective of this realist review is to explore what is known in literature on autonomy support interventions for people with dementia in nursing homes. A rapid realist review of literature. To understand how autonomy is supported, a realist approach was applied that entailed identifying the research question, searching for information, performing a quality appraisal, extracting data, synthesizing the evidence and validating the findings with a panel of experts. Causal assumptions were derived from articles found in four bibliographic databases (PubMed, PsychInfo, Cochrane and CINAHL) leading to context (C)–mechanism (M)–outcome (O) configurations. Data extraction from the included articles ultimately resulted in sixteen CMO configurations on four themes: a. preferences and choice : interventions for supporting autonomy in nursing homes and their results, b. personal characteristics of residents and family : people with dementia and their family being individuals who have their own character, habits and behaviors, c. competent nursing staff each having their own level of knowledge, competence and need for support, and d. interaction and relationships in care situations: the persons involved are interrelated, continuously interacting in different triangles composed of residents, family members and nursing staff. The findings showed that results from interventions on autonomy in daily-care situations are likely to be just as related not only with the characteristics and competences of the people involved, but also to how they interact. Autonomy support interventions appear to be successful when the right context factors are considered. [ABSTRACT FROM AUTHOR]

Background and Objectives: COVID-19 disproportionally affects older adults living in nursing homes. The purpose of this review was to explore and map the scientific literature on the health impact of COVID-19 and related restrictive measures during the first and second wave among nursing home residents. A specific focus was placed on health data collected among nursing home residents themselves.Research Design and Methods: In this study, best practices for scoping reviews were followed. Five databases were systematically searched for peer-reviewed empirical studies published up until December 2020 in which data were collected among nursing home residents. Articles were categorized according to the type of health impact (physical, social and/or psychological) and study focus (impact of COVID-19 virus or related restrictive measures). Findings were presented using a narrative style.Results: Of 60 included studies, 57 examined the physical impact of COVID-19. All of these focused on the direct impact of the COVID-19 virus. These studies often used an observational design and quantitative data collection methods, such as swab testing or reviewing health records. Only three studies examined the psychological impact of COVID-19 of which one study focused on the impact of COVID-19-related restrictive measures. Findings were contradictory; both decreased and improved psychological wellbeing was found during the pandemic compared with before. No studies were found that examined the impact on social wellbeing and one study examined other health-related outcomes, including preference changes of nursing home residents in Advanced Care planning following the pandemic.Discussion and Implications: Studies into the impact of the first and second wave of the COVID-19 pandemic among nursing home residents predominantly focused on the physical impact. Future studies into the psychological and social impact that collect data among residents themselves will provide more insight into their perspectives, such as lived experiences, wishes, needs and possibilities during later phases of the pandemic. These insights can inform policy makers and healthcare professionals in providing person-centered care during the remaining COVID-19 pandemic and in future crisis periods. [ABSTRACT FROM AUTHOR]

Background: Community engagement is seen as key to citizen‐centred and sustainable healthcare systems as involving citizens in the designing, implementation and improvement of services and policies is thought to tailor these more closely to communities' own needs and experiences. Organizations have struggled to reach out to and involve disadvantaged citizens. This paper examines how if, why, and when low‐income citizens wish to be involved. Methods: For this qualitative realist case‐study, 19 interviews (one dyad) were held with (20) low‐income citizens in two Dutch municipalities. Additionally, the results were discussed with a reference panel consisting of professionals and citizens to enrich the results and to ensure the results had face validity. Results: The results showed four different ways in which low‐income citizens wished to be involved: (a) in a practical/volunteer way; (b) as a buddy; (c) as a lay expert; (d) not involved at all. The factors affecting citizens' interest and capacity to participate include citizens' own experiences of the services they access and their personal situations, e.g. their mental or physical health, extent of financial crisis, family situation, home environment. None of the interviewees was currently involved, but all had ideas for improving health(care) services and policies. Citizens' experiences of the services they accessed acted as a motivator for some to be involved as they wanted to ensure others would not have the same struggles, while for others their own needs and an apathetic system remained too high a barrier. To enable involvement, citizens need continued support for their own health(care) and financial situation, better communication and accessibility from services, practical support (e.g., training and bus passes) and recognition for their input (e.g., monetary compensation). Conclusion: The study shows that citizens' experiences of the services they accessed influenced if and how they wanted to be involved with health and care services. Despite the fact that all participants had shared solid ideas for improving services and policies, they were hindered by a bureaucratic, impersonal and inaccessible system. Organizations seem to underestimate the required investments to reach out to low‐income citizens and the support required to ensure their involvement. Patient and Public Involvement (PPI) in Study: Citizens as well as PPI organizations were members of the reference panel who helped formulate the research questions and recruitment strategy. The local reference panel also helped to interpret and refine the initial findings. [ABSTRACT FROM AUTHOR]

Purpose: To assess the predictive validity of frailty and its domains (physical, psychological, and social), as measured by the Tilburg Frailty Indicator (TFI), for the adverse outcomes disability, health care utilization, and quality of life. Design and Methods: The predictive validity of the TFI was tested in a representative sample of 484 community-dwelling persons aged 75 years and older in 2008 (response rate 42%). A subset of all respondents participated 1 year later (N = 336, 69%) and again 2 years later (N = 266, 55%). We used the TFI, the Groningen Activity Restriction Scale assessing disability, seven indicators of health care utilization, and a brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). The WHOQOL-BREF was assessed in 2008 and 2010; all others were assessed in 2008, 2009, and 2010. Results: The predictive validity of the TFI assessed in 2008 for disability, health care utilization, and quality of life was corroborated by (a) medium to very large associations of frailty with adverse outcomes 1 or 2 years later; (b) mostly good to excellent area under the curve of total frailty; and (c) an increase in predictive accuracy of most adverse outcomes, even after controlling for that same adverse outcome in 2008, and life-course determinants and multimorbidity. Physical frailty was mostly responsible for the predictive validity of the TFI. Implications: This study showed that the TFI is a valid instrument to predict disability, many indicators of health care utilization, and quality of life of older people, 1 and 2 years later. [ABSTRACT FROM PUBLISHER]

Gobbens R.J., van Assen M.A., Luijkx K.G. & Schols J.M. (2012) Testing an integral conceptual model of frailty. Journal of Advanced Nursing 68(9), 2047-2060. Abstract Aim. This paper is a report of a study conducted to test three hypotheses derived from an integral conceptual model of frailty. Background. The integral model of frailty describes the pathway from life-course determinants to frailty to adverse outcomes. The model assumes that life-course determinants and the three domains of frailty (physical, psychological, social) affect adverse outcomes, the effect of disease(s) on adverse outcomes is mediated by frailty, and the effect of frailty on adverse outcomes depends on the life-course determinants. Methods. In June 2008 a questionnaire was sent to a sample of community-dwelling people, aged 75 years and older ( n = 213). Life-course determinants and frailty were assessed using the Tilburg Frailty Indicator. Adverse outcomes were measured using the Groningen Activity Restriction Scale, the WHOQOL-BREF and questions regarding healthcare utilization. The effect of seven self-reported chronic diseases was examined. Results. Life-course determinants, chronic disease(s), and frailty together explain a moderate to large part of the variance of the seven continuous adverse outcomes (26-57%). All these predictors together explained a significant part of each of the five dichotomous adverse outcomes. The effect of chronic disease(s) on all 12 adverse outcomes was mediated at least partly by frailty. The effect of frailty domains on adverse outcomes did not depend on life-course determinants. Conclusion. Our finding that the adverse outcomes are differently and uniquely affected by the three domains of frailty (physical, psychological, social), and life-course determinants and disease(s), emphasizes the importance of an integral conceptual model of frailty. [ABSTRACT FROM AUTHOR]

Objective To examine whether client experiences measured with the Consumer Quality Index (CQ-index or CQI) questionnaires are used in Dutch nursing homes and homes for the elderly for quality improvement. Design Information was gathered through face-to-face interviews with day-to-day workers, quality managers and middle and senior management representatives on the subjects of quality policy and CQI. Setting Twelve long-term care organizations in the Netherlands. Study Participants A total of 47 employees were interviewed. Results Long-term care organizations that systematically incorporate client experiences into their quality system are more active in using the CQI for quality improvement: information was disseminated throughout the organization, project groups pointed out quality improvement initiatives and every worker was involved in this process. These organizations had often held a certificate for their quality policy for some length of time. In other organizations, CQI information was used less systematically. For instance, only the quality manager was involved, or improvement initiatives were left to employees working in the primary process. The actual improvement initiatives varied. For example, employees created more individual time for clients to avoid the feeling of being rushed; other organizations changed the food delivery to enhance food enjoyment. Conclusions Although measuring client experiences obligatory, it is not sufficient guarantee that client feedback is used for quality improvement. Although measuring client experiences has led to various improvement initiatives, their effectiveness remains unclear. There is need for guidance on effective improvement of client experiences. [ABSTRACT FROM AUTHOR]

Objectives: To assess the reliability, construct validity, and predictive (concurrent) validity of the Tilburg Frailty Indicator (TFI), a self-report questionnaire for measuring frailty in older persons. Design: Cross-sectional. Setting: Community-based. Participants: Two representative samples of community-dwelling persons aged 75 years and older (n = 245; n = 234). Measurements: The TFI was validated using the LASA Physical Activity Questionnaire, BMI, Timed Up & Go test, Four test balance scale, Grip strength test, Shortened Fatigue Questionnaire, Mini-Mental State Examination, Center for Epidemiologic Studies Depression Scale, Anxiety subscale of the Hospital Anxiety and Depression Scale, Mastery Scale, Loneliness Scale, and the Social Support List. Adverse outcomes were measured using the Groningen Activity Restriction Scale and questions regarding health care use. Quality of life was measured using the WHOQOL-BREF. Results: The test-retest reliability of the TFI was good: 0.79 for frailty, and from 0.67 to 0.78 for its domains for a 1-year time interval. The 15 single components, and the frailty domains (physical, psychological, social) of the TFI correlated as expected with validated measures, demonstrating both convergent and divergent construct validity of the TFI. The predictive validity of the TFI and its physical domain was good for quality of life and the adverse outcomes disability and receiving personal care, nursing, and informal care. Conclusion: This study demonstrates that the psychometric properties of the TFI are good, when performed in 2 samples of community-dwelling older people. The results regarding the TFI''s validity provide strong evidence for an integral definition of frailty consisting of physical, psychological, and social domains. [Copyright &y& Elsevier]

Objectives: To determine which determinants predict frailty and domains of frailty (physical, psychological, social) in a community-dwelling sample of elderly persons. Design: Cross-sectional. Setting: Community-based. Participants: A representative sample of 484 community-dwelling persons aged 75 years and older. Measurements: The Tilburg Frailty Indicator (TFI), a self-report questionnaire, was used to collect information about determinants of frailty and to assess frailty and domains of frailty (physical, psychological, social). Results: Results were obtained by regression and mediation analyses. The 10 determinants explain about 35% of the variance of frailty. After controlling for other determinants, medium income, an unhealthy lifestyle, and multimorbidity predicted frailty. The effects of other determinants differed across domains of frailty; age predicted physical frailty, life events predicted psychological frailty, whereas being a woman predicted social frailty because older women have a higher probability of living alone. Conclusion: Our finding that the effect of the determinants of frailty differs across frailty domains suggests that it is essential to divide the concept of frailty into domains. [Copyright &y& Elsevier]

Background: Municipalities have been trying to involve citizens as citizen participation is thought to improve municipalities' accountability, the quality of services, and to align policies and services to communities' needs. This study examined citizens' participation preferences in policymaking by investigating their health policy priorities, expectations of involvement, and required support. Methods: For this case-study the realist evaluation approach was applied to focus groups with citizens and to a workshop with a local panel consisting of professionals, citizens and citizen representatives. Results: This study showed that citizens want to be involved in (health) policymaking with the aim of improving their communities' quality of life and living environment and prioritised local services and amenities (e.g. suitable housing, public transport, health and care services). Instead, professionals' priorities were focussed on singular public health issues related to prevention and lifestyle factors. The results also show that citizens felt responsible for driving citizen participation and representing community needs to the municipality, but needed the municipality to improve their communication and accessibility in order to do so successfully. Furthermore, the professionals on the panel indicated that they needed training on how to reach out to citizens. Such training should highlight how to better align their language to citizens' lived experiences. They also wanted their organisations to provide more space, flexibility and resources to build relationships with citizens in order to provide improved communication and accessibility to citizens. Conclusion: The difference in priorities between citizens and professionals highlights the importance of involving citizens in policymaking. Moreover, citizens' involvement can act as a lever for change to bring a wider range of services and policy sectors together and has the potential to better align policies to citizens' lived experiences and hopefully increase the democratic legitimacy of policymaking. However, to fulfil such potential municipalities will need to invest in improving their accessibility and communication with communities. [ABSTRACT FROM AUTHOR]

Background: Staff members, and their attitudes, are crucial for providing person-centered care in residential care facilities for people with dementia. However, the literature on the attitudes of nursing staff regarding person-centered care is limited. The objective of this study is to explore the association between staff characteristics (age, education level, years of work experience and function, i.e., care or welfare) and staff attitudes toward perceived person-centered care provision and including informal caregivers in the caregiving process in residential care facilities. Methods: A convenience sample of 68 care staff – nurses and nurse assistants - welfare staff members – activity counselors, hostesses, and living room caretakers - of two residential care facilities filled out a questionnaire. Staff attitudes regarding perceived person-centered care were measured with the Person-centered Care Assessment Tool (P-CAT). Staff attitudes regarding informal care provision were measured with the Attitudes Toward Families Checklist (AFC). Multiple linear regression analysis explored the association between variables age, work experience, education, and function (care or welfare). Results: A higher age of staff was associated with a more negative attitude toward perceived person-centered care and informal care provision. Welfare staff had a more negative attitude toward the inclusion of informal caregivers than care staff. The perceived person-centered care provision of the care and welfare staff was both positive. Work experience and education were not associated with perceived person-centered care provision or informal care provision. Conclusion: This study is one of the first to provide insight into the association between staff characteristics and their attitude toward their perceived person-centered care provision and informal care provision. A higher age of both the care and welfare staff was associated with a more negative attitude toward their perceived person-centered care and informal care provision. Welfare staff had a less positive attitude toward informal care provision. Additionally, future studies, also observational studies and interview studies, are necessary to collect evidence on the reasons for negative attitudes of older staff members towards PCC and informal care giving, to be able to adequately target these reasons by implementing interventions that eliminate or reduce these negative attitudes. [ABSTRACT FROM AUTHOR]

Social networks are sources of support and contribute to the well‐being of older adults who are ageing in place. As social networks change, especially when accompanied by health decline, older adults' sources of support change and their well‐being is challenged. Previous studies predominantly used quantitative measures to examine how older adults' social networks change. Alternatively, this study explores the impact of changing social networks on older adults' lives by examining their personal experiences. We held four focus groups, two with a total of 14 older adults who are ageing in place and receiving home care and two with a total of 20 home‐care nurses from different regions and organisations in the Netherlands. Subsequently, an expert team of home‐care professionals and managers discussed and verified the results. Procedures for grounded theory building were used for analysis. We revealed four themes of high‐impact experiences: (a) struggling with illness/death of the spouse; (b) working out a changing relationship with (grand)children; (c) regretting the loss of people they have known for so long and (d) feeling dependent and stressed when helpers enter the network. Also, network dynamics were found to follow three consecutive stages: (a) awareness of social network change; (b) surprise when social network change actually occurs and (c) acceptance and adjusting to new circumstances. Together, the four themes of experiences and three stages of network change form an integrative model of the role of social network dynamics for older adults' lives when ageing in place. [ABSTRACT FROM AUTHOR]

Background: Most seniors wish to live independently for as long as possible. Gerontechnologies such as personal alarms or remote control systems, have the potential to help them age in place. For seniors, assessing what is the most appropriate technology for their aging in place needs can be difficult. Professionals specifically tasked with matching seniors' needs with technology solutions can greatly help here. Yet not much is known about the challenges these professionals face or how they can optimize their matchmaking service.Methods: Participatory action research was conducted in the Netherlands, in two phases. In phase one, ten matchmaking dialogues between municipal technology consultants and seniors were observed, followed by interviews with both technology consultants and seniors to understand the current matchmaking service. In phase two, a new matchmaking tool was co-created with technology consultants and other professionals over the course of four co-creation session. Variants of the tool were tested out in nine additional matchmaking dialogues. The Cycle of Technology Acquirement by Independent-Living Seniors (C-TAILS) model, which can be used to understand both origins and consequences of technology acquirement by independent-living seniors, was used as a theoretical lens.Results: Important challenges for municipal technology consultants in their current matchmaking practice are: making the matchmaking service more demand oriented and creating an accurate and complete overview of relevant factors within the seniors' individual situation so that an optimal match can be made. Together with technology consultants and other professionals, a new Gerontechnologies Matchmaking (GTM) tool was created to help overcome these challenges. Evaluation of the tool showed that it better includes each senior's personal, social, physical and technological context, within the matchmaking service.Conclusion: Professionals who help seniors match gerontechnology to their aging in place needs experience a variety of challenges in the delivery of their service. Currently, few tools are available for them to overcome these challenges. The newly developed GTM tool can help overcome challenges and optimize matchmaking services. Further testing of the tool in different contexts is needed to determine its generalizability. [ABSTRACT FROM AUTHOR]

Background and Objectives For people with dementia living in residential care facilities, maintaining autonomy and receiving informal care are important. The objective of this review is to understand how caregiving approaches and physical environment, including technologies contribute to the maintenance of autonomy and informal care provision for this population. Research Design and Methods A literature review of peer-reviewed articles published between January 1995 and July 2017 was performed. Realist logic of analysis was used, involving context, mechanism and outcome configurations. Results Forty-nine articles were included. The improvement of the relationship between residents and formal/informal caregivers is important. This increases the knowledge (sharing) about the resident and contributes to their autonomy. A social, flexible, and welcoming attitude of the formal caregiver improves the provision of informal care. Specially designed spaces, for instance, therapeutic gardens, create activities for residents that remind them of themselves and contribute to their autonomy. Use of technologies reduces caregiver's time for primary tasks and therefore enables secondary tasks such as interaction with the residents. Discussion and Implications The results revealed how residential care facilities could maintain autonomy of their residents and improve informal care delivery using caregiving approaches and the physical environment including technologies. The results are supporting toward each other in maintaining autonomy and also helped in enhancing informal care provision. For residential care facilities that want to maintain the autonomy of their residents and improve informal care delivery, it is important to pay attention to all aspects of living in a residential care facility. [ABSTRACT FROM AUTHOR]

Introduction: The growing prevalence of chronic diseases and rising number of older and often multi-morbid patients have led to an increasing demand for complex, long-term care. During the past decades, integrated care has been endorsed as a means to approach these challenges. This is expected to contribute to better outcomes, increased efficiency and improved access to care. The aim of our study was the investigation of a best practice case of integrated care implementation at a geriatric care hospital in Germany. Specifically, we studied the type of integrated care intervention that was implemented, the barriers and facilitators to its implementation, as well as the outcomes achieved. Background: At the case site, geriatric patients receive care according to the criteria of the national framework of geriatric early rehabilitative complex treatments. These include the provision of care to a geriatric patient population (i.e. multimorbid, older than 60 years) by a multidisciplinary team conducting weekly team meetings and performing a comprehensive geriatric assessments. The length of stay is usually between 15 and 21 days, after which patients are discharged or transferred to a different institution. Methods: A qualitative case study was conducted at a geriatric hospital in Germany. Fifteen semi-structured interviews were conducted with medical doctors, occupational therapists, neuropsychologists, physical therapists and nurses. Relationships between mechanisms (as defined by the Chronic Care Model), context factors (as categorised by the Implementation Model) and outcomes (operationalised as aspects of quality of care) were studied. Results: Integrated care at the geriatric hospital involved components related to the health system, delivery system design and decision support. Self-management support was practiced by individual health professionals but not implemented in a structured way. The staff used a documentation system but because of its age and limitations it could not be considered an information system. Community involvement was not found. Barriers included IT problems, resistance to change by health professionals, problematic leadership, unclear division of tasks, problematic patient transfers to and from the geriatric hospital and cost pressure. Facilitators included the involvement of family members in care process and discharge management, a cooperation attitude among the team members, and flat hierarchical structures. Negative outcomes included frustration among staff members, less time available for the patients and, in some cases, a lower quality of care for the patients. Positive outcomes included successful discharges of complex patients to their homes and a high level of staff satisfaction. Discussion: The analysis of the interplay between the mechanisms, context factors and outcomes is still ongoing. However, the preliminary findings show that evaluations of complex interventions require complex methods of analysis. Instead of simply focusing on input and output, it is necessary to investigate the specific type of integrated care intervention that was implemented, the barriers and facilitators by which its execution was met, as well as the different outcomes that were achieved. During the conference we will specifically focus on these issues and discuss implications for future integrated care practice and research. [ABSTRACT FROM AUTHOR]