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A psychoeducation program that was originally developed by the Dutch Association for Autism was adjusted for older adults to enhance its feasibility and efficacy in later life. In this study, we explored the effects of this adapted psychoeducation program for older autistic adults in a pre-test -- post-test 6-month follow-up design. A total of 61 patients (55-78 years) and 44 proxies (a person close to them) participated in the study; attrition rate was high for the follow-up assessment. As hypothesized, an increase in knowledge and acceptance of the diagnosis was observed, with a strong and positive correlation between patients and proxies for knowledge. Furthermore, ambiguous results were observed on coping with the diagnosis and no positive effects on psychological distress were found. The feedback of participants and proxies about the psychoeducation program was largely positive. Future research with larger group samples and larger time scales is necessary to gain more insight into the effectiveness of the psychoeducation program. It seems worthwhile to further adjust the program to the needs and requirements of older adults, and to help older autistic adults to construct a new narrative of themselves, and the life they have lived, in the light of the recent autism diagnosis.

Most of the social science research is based on the implied assumption that measurement error is the same across key socio-demographic groups and all differences in key statistics of interest are real. Nevertheless, there is evidence that this is not the case. In this paper, the authors tackle this important topic by investigating if data quality is different in three key groups analysed in social research: the unemployed, the low-income respondents and the elderly respondents. This paper investigates if the assumption of equal data quality across these three key variables in a popular online probability panel in the Netherlands. To do this the authors use multiple types of variables and multiple statistical approaches to evaluate data quality

Background: We aimed to gain more insight into autonomy of older people with intellectual disabilities in a residential care facility in making choices. Methods: We performed a descriptive ethnographic study in a residential facility in the Netherlands for 22 persons, aged 54-89 years, with mild to moderate intellectual disabilities (IQ <70) and low social-emotional development levels. We combined participant observations and qualitative interviews. Results: Based on the observations, the main themes for the interviews were established. Residents indicated to be free to make independent choices, and experienced less autonomy with regard to health issues and finances. Support staff stated that residents' level of autonomy depends on residents' characteristics, needs, preferences, the attitude of support staff and the rules of the care institution. Conclusion: Residents had a clear view on their autonomy in making independent choices. Support staff is mindful of preserving residents' autonomy, which in practice is limited.

There are currently no old-age specific interventions for autistic adults. Therefore, in this explorative study, we examined the possible effects of a co-designed psychoeducation program for older autistic adults (55+ years), with a multiple case study design (N = 9, age 56-73 years; Netherlands Trial Register (code Trial NL5670)). For each participant, also a person close to them (a proxy) participated. This allowed us to calculate a discrepancy score regarding autistic traits and cognitive challenges. The main hypothesis was that our program, delivered after general psychoeducation, would result in a discrepancy reduction between self and proxy reports. However, contrary to our hypothesis, we observed neither intervention effects on our primary outcome measures (discrepancy scores) nor the secondary outcome measures (mastery, self-efficacy, self-esteem, self-stigmatization, quality of life, and hope and future perspectives). Thus, despite co-designing the current intervention, the results were not promising. However, the positive feedback and suggestions of the participants make developing an improved version of a specific psychoeducation program for older autistic adults still a worthwhile pursuit.

Background: Information regarding the common-daily support needs of older people with intellectual disabilities remains scarce, despite the necessity of such knowledge to the provision of adequate support. This exploratory study aims to identify the most important support needs. Method: A mixed-method design was conducted, in which 11 semi-structured interviews were held with psychologists to gain insight into the support needs of older people with intellectual disabilities. Results: The data provide an overview of the support needs of older people with intellectual disabilities in all quality-of-life (QoL) domains. Physical well-being, emotional well-being, interpersonal relationships and self-determination were identified as the most important domains for older people with intellectual disabilities. Conclusions: The findings of this study may guide the development of a specific training for support staff and constitute a valuable contribution to raising awareness among support staff concerning the broad range of support needs existing among older people with intellectual disabilities.

Background: Although the current preventive measures relating to COVID-19 can lead to challenges in the daily work of direct support workers (e.g. keeping 1.5 m distance), it remains vital to uphold the principles of person-centred care when working with older people with intellectual disabilities. The current study explores the extent to which direct support workers have been able to apply a specific form of person-centred care (i.e. integrated emotion-oriented care, or IEOC) when working with older people with intellectual disabilities during the COVID-19 pandemic. Method: Six direct support workers from five facilities serving older people with intellectual disabilities in the Netherlands participated in this qualitative study. They participated in a two-hour focus group, which was transcribed verbatim, and the transcript was analysed thematically. Results: Three themes emerged: (i) the negative impact of changes due to the COVID-19 measures on service users; (ii) the adaptation of direct support workers to changes due to the COVID-19 measures; and (iii) putting the needs and wishes of service users first. Conclusion: This study provides first impressions into the experiences of direct support workers providing person-centred care to older people with intellectual disabilities during the COVID-19 pandemic.

This study aimed to review the validity and/or reliability of light-intensity physical activity (LPA) questionnaires and identify the most suitable questionnaires for measurement of LPA in adults. Following the PRISMA-P 2020 guidelines, we searched MEDLINE, PsycINFO, CINAHL, Scopus, Embase, and MedNar. Only studies that targeted adults [greater than or equal to]18 years old and used LPA measured by accelerometer and/or heart rate monitor as an objective criterion were included. The search resulted in 2748 article hits, from which we extracted 16 studies with 14 questionnaires. The 7-Day Sedentary and LPA Log and LPA Questionnaire were specifically designed for LPA measurement, and the Community Health Activities Model Program for Seniors physical activity self-report questionnaire scale has been revised for LPA measurement. These questionnaires had comparatively high reliability and validity in this review. Most studies contained methodological limitations such as test-retest period. In the future, more accurate reliability/validity studies should be conducted for each questionnaire.

The COVID-19 pandemic emphasises the importance of care for our societies, yet underscores the inferiority of relational caring practices. During this time, we studied the participatory work of artists working with older adults using participant observations, in-depth interviews and visual ethnography. In this article, we present a case study of one arts initiative, a theatre company engaging seniors in the Netherlands, using ethics and aesthetics of care as sensitising concepts. The findings reveal that this work can promote relational forms of care. This study makes visible how different forms of care can be identified in a participatory art project.

In this conversation analytic study, we investigate requests for assistance in the third-age (65+) language classroom. Seven Dutch seniors participated in a one-month course of English as a foreign language. We found that these seniors asked many language-related questions which fell into one of three categories: (1) production-oriented questions, (2) comprehension-oriented questions and (3) wonderment questions. These questions differ in the ways the sequences are shaped: (a) what precedes the request for assistance, (b) the person who is recruited to provide the assistance, (c) the person who offers the assistance, and (d) the response to the provided assistance and the subsequent interaction. We found wonderment questions to be the most prevalent category. Our findings suggest that the senior learners in our data show clear ownership and agency over their own learning process, demonstrated by their active participation and frequent (wonderment) questions in the classroom.

Prior research suggests that autistic adults are at increased risk for developing the core motor components of Parkinson's disease (i.e. parkinsonism) although knowledge is limited to date. Therefore, we explore: (1) the prevalence of both continuous self-reported motor features typical of parkinsonism and the screen positivity rate for parkinsonism in two samples of older autistic adults without a suspected intellectual disability: the Netherlands-Sample (N = 296, 50-81 years; 183 males; 113 females) and the United States of America-Sample (N = 209, 50-83 years; 100 males; 109 females), and (2) whether there are differences between those who Screen+ versus Screen- for parkinsonism. Within the Netherlands-Sample only, the age of onset of the motor features was investigated. Self-reported parkinsonism features were prevalent in both samples (the Netherlands-Sample [approximately] 17% screened positive, mean age of onset ranging from 35.9 to 50.4 years; the United States of America-Sample [approximately] 33% screened positive). Autistic adults (the Netherlands-Sample) screening positive encountered more health problems than those who screened negative. In both samples, autistic adults who screened positive did not differ on current antipsychotic medication use relative to those who screened negative. The next step is to determine whether a positive screen for parkinsonism on this self-report questionnaire also implies that there is a higher risk for idiopathic Parkinson's disease.

Whereas executive functions are known to be closely tied to successful language processing in children and younger adults, less is known about how age-related decline in these functions affects language processing in elderly adults. Because the abilities to use linguistic context and resolve potential ambiguities such as between an idiom's figurative and literal meaning depend on executive functions, we investigated this issue by examining elderly adults' processing of idioms in context. We recorded event-related potentials of 25 younger (age 18-28) and 25 elderly adults (age 61-74) while they read literal sentences and sentences containing an idiom (e.g., the Dutch idiom "to walk against the lamp," meaning "to get caught"), each preceded by a neutral or predictive context sentence. Participants' use of context was hypothesized to relate to working memory capacity, while their ability to disambiguate idioms was hypothesized to depend on inhibition skills. Both groups showed facilitated processing for idioms compared with literal sentences and for sentences preceded by predictive compared with neutral contexts, indexed by a reduced N400. However, only elderly adults showed an increased P600 for literal but not idiomatic sentences preceded by a predictive context, suggesting that they rely on linguistic context when a sentence's meaning needs to be computed word by word, but not when a large part is retrieved from memory (as in idioms). Our findings suggest that in both younger and elderly adults processing literal sentences requires more cognitive effort than processing idiomatic sentences, and that cognitive aging affects language when processing is effortful.

Emergency physicians (EPs) often regard care for older adults as complex, while they lack sufficient geriatric skills. This study evaluates the effect of a geriatric education program on EPs' geriatric knowledge, attitude and medical practice when treating older adults. A mixed-methods study was performed on EPs from two Dutch hospitals. Effects were measured by pre-post tests of EPs' (n = 21) knowledge of geriatric syndromes and attitudes toward older adults, and by a retrospective pre-post analysis of 100 records of patients aged 70 years or more. Six EPs were purposively sampled and interviewed after completion of the education program. The program significantly improved EPs' geriatric knowledge. EPs indicated that the program improved their ability and attentiveness to recognize frailty and geriatric syndromes. The program also significantly improved EPs' attention for the older patient's social history and circumstances (P = 0.04) but did not have a significant effect on medical decision making. EPs valued especially the case-based teaching and indicated that the interactive setting helped them to better understand and retain knowledge. Combined quantitative and qualitative data suggest that EPs benefit from geriatric emergency teaching. Future enhancement and evaluation of the geriatric education program is needed to confirm benefits to clinical practice and patient outcomes.

Studies on aging and migration often note a 'language barrier' for older migrants when communicating in a (medical) second language (L2) context. Yet how a limited L2 proficiency impacts the aging process of migrant adults has, so far, not been systematically investigated. This question is important given that having a limited L2 proficiency may pose immediate drawbacks on one's ability to maintain independence. Through a combination of qualitative interviews and quantitative language and cognitive measures, this study investigates if and under which circumstances a 'language barrier' may be detrimental for the aging process of a group of older female Turkish migrants in the Netherlands. Findings suggest that a limited L2 proficiency reciprocally fuels feelings of L2 insecurity, which impacts the formation of social relationships in the L2, feelings of belonging and lower wellbeing levels. A firm embedding in an L1 network positively impacts wellbeing levels, yet results in a heavy dependence on others in L2 situations. We conclude that limited L2 skills may steer the aging process in a detrimental direction for those older migrants who lack a social support network in the L1 and cannot communicate effectively in the L2.

Background: The ageing of people with intellectual disabilities, involving consequences like dementia, creates a need for methods to support care staff. One promising method is Dementia Care Mapping (DCM). This study examined the effect of DCM on job satisfaction and care skills of ID-care staff. Methods: We performed a quasi-experimental study in 23 group homes for older people with intellectual disabilities in the Netherlands. Among staff, we assessed job satisfaction and care skills as primary outcomes and work experience measures as secondary outcomes (N = 227). Results: Dementia Care Mapping achieved no significantly better effect than care as usual (CAU) for primary outcomes on job satisfaction (MWSS-HC) and working skills (P-CAT). Effect sizes varied from -0.18 to -0.66. We also found no differences for any of the secondary outcomes. Conclusion: Dementia Care Mapping does not increase job satisfaction and care skills of staff caring for older people with intellectual disabilities. This result differs from previous findings and deserves further study.

Participatory research actively engages participants in some or all stages of the research process -- from deciding on scope and problem statement to actively collecting data to disseminating results and effecting change. Considering the shifting roles of participants and researchers in participatory ageing research, to the academic, participatory research becomes a venture into project and people management, local politics, consultancy and community building. First, we present a literature overview of the promises and pitfalls of participatory research. Then, drawing on a university initiated participatory study involving older people as co-researchers in a neighbourhood in Groningen, the Netherlands, we discuss the shifting roles and expectations of all of those involved in the participatory research process. We conclude that a central question that requires continuous negotiation in the participatory research process is: what's in in for whom?

This article focuses on research ethics in highly intimate research with possible impact on life and death. In order to stimulate an open-ended dialogue about research ethics, we reflect on four ethical challenges that came up during our research into older people with a wish to die. Drawing on our experiences, we discuss (1) the possibly confirming influence of our research on the death wish (moral experience of whether or not to disregard responsibility); (2) the suggested duty to intervene (moral experience of whether or not to compromise the person's autonomy); (3) the researcher's authority and power over the data (moral experience of threatening a person's self-narrative) and (4) the dilemma of intimacy (moral experience of encountering the tragic). For guidance in addressing these challenges, we draw upon work on research ethics from phenomenological and care ethics scholars, as well as from those writing about relational ethics in health research. We suggest that being open about ethical uneasiness is important, because in most cases of a grey area, there are only open-ended answers needing an enquiring mind, rather than clear and fixed guidelines. Acknowledgement of ethical uneasiness and open-ended reflexivity are indispensable to constitute a morally good research practice.

Most of the studies of the causes of visual impairment have been population-based studies. These population-based studies provide important information on the incidence and prevalence of "theoretical" eye problems in a community. However, not all those who are visually impaired, from a theoretical point of view, consider themselves as such and hence will not visit an ophthalmologist or accept the offer of low vision counseling. Others are unaware of the possibilities of rehabilitation or are not able to come to these clinics because of health problems, mental difficulties, or other reasons (Munoz et al., 1999). This discrepancy between population-based studies and daily practice makes it difficult to develop strategies to offer low vision services to those who need them. In addition, little is known about the changes in patterns of visual impairment over time. Therefore, there is still a place for hospital-based or patient-based studies of the incidence and etiology of visual impairment. The aim of this study was to determine changes, over time, in the incidence and etiology of visual impairment in persons aged 50 and older who visited an eye clinic for an incurable age-related eye disease and who accepted an offer of rehabilitation. The participants were all the patients of the Department of Ophthalmology of the Elkerliek Hospital, Helmond, the Netherlands.

The purpose of this paper was to analyse the core of the quality of life, intended as a complex construct with specific and transversal features. The approach to this issue, by linking it to the great emergency of disability in adulthood, pushes the analysis into deep conceptual pedagogical reflections, which lead the authors' initial reflections to focus on the theoretical framework related to the quality of life model and subsequently on the identification of some areas of intervention as a tangible application of the quality of life model. New perspectives and innovative potentials for the quality of life of adults with disability are investigated to reach new awareness, which can also be applied in different life contexts. The paper mentions meaningful trajectories, also from the international scene, aiming to guarantee significantly oriented life trajectories.

We present three statistical methods for causal analysis in life course research that are able to take into account the order of events and their possible causal relationship: a cross-lagged model, a latent growth model (LGM), and a synthesis of the two, an autoregressive latent trajectories model (ALT). We apply them to a highly relevant causality question in life course and health inequality research: does socioeconomic status (SES) affect health (social causation) or does health affect SES (health selection)? Using retrospective survey data from SHARELIFE covering life courses from childhood to old age, the cross-lagged model suggests an equal importance of social causation and health selection; the LGM stresses the effect of education on health growth; whereas the ALT model confirms no causality. We discuss examples, present short and non-technical introduction of each method, and illustrate them by highlighting their relative strengths for causal life course analysis.

Universities of applied sciences in Europe face the challenge of preparing students in health and social care for working with older people and contributing to the innovations needed in light of the ageing of society, along with changes in the health and social care systems in many countries. Dealing with the special needs of older people and the increasing burden of chronic diseases requires specific competencies for health and social care professionals, as well as an integrated approach to health and social care. Research has found that many educational programs lack adequate preparation for students in health and social care when it comes to the correct competences. To identify the competences needed for all health and social care professionals in Europe, who work with older people, the European Later Life Active Network (ELLAN) has conducted research and developed a verified competence framework. This "European core competences framework for health and social care professionals working with older people" describes roles and competences that students in health and social care programs need to learn in order to provide good care and support for older people. Within the ELLAN consortium, 26 universities of applied sciences from 25 European countries collaborated in this research and development process. The framework has been verified by two Delphi rounds among a group of 21 experts and a group of 21 researchers from 19 countries. The framework includes awareness of diversity and different cultural backgrounds. This makes it a useful document for educational purposes all over Europe.

Although psychiatric problems are less prevalent in old age within the general population, it is largely unknown whether this extends to individuals with autism spectrum disorders (ASD). We examined psychiatric symptoms and disorders in young, middle-aged, and older adults with and without ASD (N[subscript max] = 344, age 19-79 years, IQ > 80). Albeit comparable to other psychiatric patients, levels of symptoms and psychological distress were high over the adult lifespan; 79 % met criteria for a psychiatric disorder at least once in their lives. Depression and anxiety were most common. However, older adults less often met criteria for any psychiatric diagnosis and, specifically, social phobia than younger adults. Hence, despite marked psychological distress, psychiatric problems are also less prevalent in older aged individuals with ASD.

We investigated the effects of age on proactive and reactive cognitive control in a large population sample of 809 individuals, ranging in age between 5 and 97 years. For that purpose, we used an anticue paradigm, which required a consistent remapping of cue location and response hand: Left-sided cues required right-hand responses and vice versa. After a random preparation interval of 100-850 ms, these anticues were followed by a target stimulus, which prompted a response with the index or middle finger of 1 of 2 hands. A neutral control condition involved uninformative cues, indicating all 4 possible response locations. The primary outcome measure was the difference between neutral and anticue reaction time (RT). Negative values indicated RT costs of the anticue, relative to the neutral condition, reflecting reactive cognitive control. Positive values indicated RT benefits, reflecting proactive cognitive control. Results were twofold. First, the switch from RT costs to benefits took place at longer preparation intervals in the youngest and oldest age groups than in the intermediate age groups. Second, irrespective of preparation interval, anticue performance followed an inverted U-shaped trajectory as a function of age, with a relatively steep improvement during childhood and adolescence, relative stability between 26 and 60 years, and a slightly accelerating decline into old age. Both patterns of results suggest an age-related transition from a primarily reactive, to a primarily proactive mode of cognitive control in early life and back again from a primarily proactive, to a primarily reactive mode of control in later life.

The aim of this study is to assess the reach and effectiveness of an integrated community-based intervention designed to promote physical activity and healthy eating among older adults in a socioeconomically disadvantaged community in the Netherlands. The intervention was evaluated with a controlled pre-post quasi-experimental design, with 430 randomly selected older adults participating in the intervention group and 213 in a control group at baseline. The intervention included a local media campaign and environmental approaches (e.g. community involvement) and was implemented during a 3-month high-intensity period, followed by a 6-month low-intensity one. Levels of physical activity and fruit and vegetable consumption were assessed at baseline and at 3 and 9 months after baseline. At the follow-up measurements, the intervention had reached respectively 68 and 69% of the participants in the intervention group. No significant differences were found between the intervention group and the control group in changes to any outcome except for transport-related PA at 3 and 9 months follow-up. The systematically developed community-based intervention reached a relatively large proportion of the participants, but had only small effects on the levels of physical activity and healthy eating in older adults in the short and medium term.

Gifted elders (those who are both gifted and senior citizens) are one of the world's greatest untapped and unrecognized resources. Their needs are too-often neglected in today's world. Spending time with a gifted grandparent, or with a retired teacher, coach, or mentor, can be a win-win for all. However, that time can be even more productive if seniors' gifts are clearly recognized, if their social-emotional needs are addressed, and if families get actively involved with their giftedness. Social-emotional needs include self-revelation, perceptiveness, purpose-driven actions, self-development, self-worth, and interpersonal growth. Families can help by facilitating connections with people who understand them, promoting social and recreational activities, and helping maintain the identities of all gifted persons, including those with cognitive impairments such as dementia. Sidebars discuss how gifted elders can nurture their own social-emotional growth, how to mentor the next generation of gifted, and new programs for gifted seniors in the Netherlands.

Complex behavior change interventions need evidence regarding the effectiveness of individual components to understand how these interventions work. The objective of this study was to identify the least and most promising behavior change techniques (BCTs) within the Dutch intervention "A Matter of Balance" (AMB-NL) aimed at concerns about falls in old age as an example. After the identification of 27 BCTs within AMB-NL, an online two-round Delphi survey among 16 international experts was conducted to reach consensus on the least and most promising BCTs. The level of consensus and the level of importance of BCTs were determined. In total, 23 of the 27 (>85%) BCTs identified reached consensus. Most promising BCTs were goal setting (behavior), graded tasks and behavioral practice/rehearsal. Information about health consequences, salience of consequences and information about emotional consequences were considered least promising. These outcomes provide a first but important step in the evidence building process regarding the effectiveness of BCTs in a complex intervention.

In order to discover an effective treatment for dementia it is necessary to include dementia patients in clinical research trials. Dementia patients face an increased risk to lose the capacity to consent to research participation, and research possibilities with incompetent participants are legally strictly limited. One solution is for patients to consent to research through an advance research directive (ARD) whilst still competent. In order to explore whether such a directive would be useful and valuable in practice we conducted a qualitative study (13 interviews). We explored the opinions and arguments of researchers in the field of dementia, aiming to map the possibilities and constraints of ARDs. It was argued that a positive ARD could be valuable to discuss research participation with proxies, and patients with a negative ARD will be excluded from research trials. However, it is argued that an ARD cannot replace the informed consent procedure, and in practice proxy dissent will overrule written consent. The practical use of these directives is thus limited, as most researchers will not comply with positive directives.

A psychoeducational face-to-face training program (Keep Your Brain Fit!) was developed to support the working population in coping with age-related cognitive changes and taking proactive preventive measures to maintain cognitive health. A feasibility study was conducted to test the training program presented in a workshop format. Participants completed an online questionnaire immediately after the workshop and three weeks later. The questionnaire assessed participants' appreciation of the workshop and evaluation of subjective cognitive functioning. 155 men and women between 40 and 65 years old (mean age: 53.8) participated in the workshops. The results showed the participants' appreciation of the knowledge they gained by participating in the workshop. Participation reduced negative emotions toward cognitive functioning in 69% of the participants, and almost 50% indicated that they were better able to cope with cognitive challenges. This psychoeducational program may offer a valuable contribution to the coping strategies of the aging workforce. Adjustments were made based on participants' evaluations, and the program was made suitable for online use in order to reach a broader audience.

Worldwide demographic change means that the responsibility for an aging population will fall to younger generations. This narrative literature review comprises an international examination of what has been published about children's views of older people between 1980 and 2011. Sixty-nine academic articles were inductively analyzed, and the emerging themes were ageism, contact with older people, children's media, children's perceptions of older people, intergenerational studies, children's perceptions of older people's health conditions, and culture, ethnicity, and worldwide studies. Reports about children's views were influenced by research methods, the children's familiarity with whom they were being asked to describe, their prior relationships with grandparents and other significant older people, and their stage of development. Eighty percent of the articles were based on American research and were often guided by a concern about ageism. Although children adopt stereotypes, they do not appear to be ageist. Research needs to include a wider geographical and cultural spread of children, children's understandings of the lived experiences of older people, and an exploration of the effects of culture, faith, and socioeconomic status on children's views if it is to underpin effective education that equips the next generation to humanely support the older populations of the future.

Objective: The aim of the current study was to compare obese and nonobese type 2 diabetes patients at baseline and after participating in an existing self-management intervention (i.e., "Beyond Good Intentions") on cognitive, self-care, and behavioral measures to examine whether both groups are equally prepared and able to adopt self-management approaches. Methods: A total of 94 type 2 diabetes patients were included, of whom 64 (59% male) completed the study. The final sample consisted of 27 obese (33% male) and 37 nonobese (78% male) patients. The intervention comprised one individual and four group sessions and aimed to improve self-management behavior by enhancing proactive coping skills (i.e., setting concrete goals, identifying barriers, coping with difficult situations, action planning, and progress evaluation). Cognitive (i.e., proactive coping, self-control, self-efficacy), self-care (i.e., adherence to lifestyle recommendations), and behavioral (i.e., diet, exercise) measures were assessed at baseline and after completing the intervention. Results: At baseline, obese patients reported to possess lower cognitive skills and lower adherence to lifestyle recommendations compared with nonobese patients. The intervention was effective in improving cognitive skills, self-care activities, as well as dietary and exercise behaviors. Improvements were equal for obese and nonobese patients. However, obese patients were more likely to drop out. Conclusions: Although obese type 2 diabetes patients were found to possess limited skills at baseline compared with nonobese patients, the self-management course proved to be equally effective for both groups.

This study investigated perceptions of love across the lifespan using Sternberg's triangular theory of love, which distinguishes between passion, intimacy, and commitment. The study aimed to (a) investigate the psychometric properties of the short Triangular Love Scale (TLS-short) in adolescents and adults (see Appendix), and (b) track age and gender differences in the three love components of the TLS-short in a sample of 12- to 88-year-olds (N = 2791). The three-factor structure of the TLS-short was confirmed in both the adolescent and adult sample. Adolescents (12-17 years) reported lower levels of all love components compared to young adults (18-30 years). Late adults (50+) reported lower levels of passion and intimacy, but similar levels of commitment compared to young (18-30 years) and middle adults (30-50 years). Gender differences in the perceptions of all three love components were present but less sizeable than suggested in popular accounts and earlier academic research.

Background: Epidemiological information on age-related cardiovascular disease in people with intellectual disability (ID) is scarce and inconclusive. We compared prevalence and incidence of cerebrovascular accident and myocardial infarction over age 50 in a residential population with ID to that in a general practice population. Method: Lifetime prevalences after age 50 were similar in both populations: 5.7% (95% CI 4.0-8.1%) in persons with ID and 4.4% (95% CI 3.1-6.0%) in the general population (Pearson chi-square 1.17, "P" = 0.279). Incidence per gender was similar between cohorts (men "P" = 0.86, women "P" = 0.36). There was no difference in incidence rates between the ID and control groups [relative risk = 1.5 (95% CI 0.9-2.4)]. Conclusion: Prevalence and incidence of myocardial infarction and cerebrovascular accident in ageing persons with ID do not appear different from those in the general population. It has to be taken into account that underdiagnosis and selection bias towards a more disabled group may have lead to underestimation of age-related cardiovascular morbidity, and the higher age and underrepresentation of Down syndrome to overestimation.

Older people with an intellectual disability (ID) have been shown to have similar to increased cardiovascular risks as compared to the general population. Peripheral arterial disease (PAD), atherosclerosis distal from the aortic bifurcation, is associated with increased cardiovascular morbidity and mortality. The prevalence of PAD has not been investigated in this population. Therefore, the aim of the present study was to determine the prevalence of PAD in older people with ID in The Netherlands, the rate of prior diagnoses, and correlations with participant characteristics, and to compare the prevalence with PAD in the general Dutch population. 771 people aged 50 years and over participated in ankle-brachial index (ABI) measurement as part of a multi-centre cross-sectional study (HA-ID study). PAD was defined as an ABI less than 0.9. After excluding those, who met the exclusion criteria, 629 participants remained. PAD was present in 20.7% of the participants and 97% had not been diagnosed before. People with higher age, smokers and people who lived in central settings, walked with support and were more dependent in activities of daily living were more at risk of PAD. Prevalence of PAD is higher than in the general population (17.4% of 562 eligible participants with ID, as compared to 8.1% of 917 Dutch participants of the PANDORA study, a pan-European study into the prevalence of PAD) through all age groups. Because the high prevalence of PAD implies a serious health risk for older people with ID, we recommend that ankle-brachial index measurement is to be routinely performed as part of the cardiovascular risk management in this group. (Contains 3 tables.)

Objective: We review all available controlled outcome studies of solution-focused brief therapy (SFBT) to evaluate evidence of its effectiveness. Method: Forty-three studies were located and key data abstracted on problem, setting, SFBT intervention, design characteristics, and outcomes. Results: Thirty-two (74%) of the studies reported significant positive benefit from SFBT; 10 (23%) reported positive trends. The strongest evidence of effectiveness came in the treatment of depression in adults where four separate studies found SFBT to be comparable to well-established alternative treatments. Three studies examined length of treatment and all found SFBT used fewer sessions than alternative therapies. Conclusion: The studies reviewed provide strong evidence that SFBT is an effective treatment for a wide variety of behavioral and psychological outcomes and, in addition, it may be briefer and therefore less costly than alternative approaches. (Contains 6 tables and 1 figure.) [A list of SFBT Outcome Studies is included.]

Although physical fitness is relevant for well-being and health, knowledge on the feasibility of instruments to measure physical fitness in older adults with intellectual disability (ID) is lacking. As part of the study Healthy Ageing with Intellectual Disabilities with 1,050 older clients with ID in three Dutch care services, the feasibility of 8 physical fitness tests was expressed in completion rates: box and block test, response time test, Berg balance scale, walking speed, grip strength, 30-s chair stand, 10-m incremental shuttle walking test, and the extended modified back saver sit and reach test. All tests had moderate to good feasibility in all subgroups, except for the participants with profound ID (all tests), severe ID (response time test and Berg balance scale), and wheelchair users (all tests that involve the legs). We conclude that the 8 tests are feasible to measure physical fitness in most older adults with ID.

Understanding the role of social policies in intergenerational transfers from old to young people is especially important in times of population aging. This paper focuses on the influences of social expenditures and social services on financial support and on practical help from older parents to their adult children based on the first two waves from the Survey of Health, Ageing and Retirement in Europe (SHARE, "N" = 60,250 dyads from 13 European countries). Multilevel models showed that social policy plays an important role for intergenerational transfer patterns: The more public assistance was provided to citizens, the more likely parents supported their adult children financially and practically, but this support was less intense in terms of money and time given. Thus, the analyses support the specialization hypothesis that posits a division of labor between family and state for downward intergenerational transfers. (Contains 3 tables, 3 figures, and 1 note.)

Purpose of the Study: We aimed to investigate whether social capital (obtaining support through indirect ties such as from neighbors) and social cohesion (interdependencies among neighbors) within neighborhoods positively affect the well being of older adults. Design and Methods: This cross-sectional study included 945 of 1,440 (66% response rate) independently living older adults (aged [greater than or equal] 70 years) in Rotterdam. We fitted a hierarchical random effects model to account for the hierarchical structure of the study design: 945 older adults (Level 1) nested in 72 neighborhoods (Level 2). Results: Univariate analyses showed that being born in the Netherlands, house ownership, education, income, social capital of individuals, neighborhood security, neighborhood services, neighborhood social capital, and neighborhood social cohesion were significantly related to the well being of older adults. Multilevel analyses showed that social capital of individuals, neighborhood services, neighborhood social capital, and neighborhood social cohesion predicted the well being of older adults. Single and poor older adults reported lower well being than did better off and married older adults. However, the effects of marital status and income were mediated by neighborhood services, social capital, and social cohesion. Neighborhood services, social capital, and social cohesion may act as buffer against the adverse effects of being single and poor on the well being of older adults. Implications: The results of this study support the importance of social capital of individuals, as well as social capital within the neighborhood and social cohesion within the neighborhood for well being of older adults. The well being of older adults may also be enhanced through the improvement of quality of neighborhood services. (Contains 4 tables.)

Background: The Actiwatch is increasingly being used to investigate sleep. The aim of this study was to investigate which sensitivity setting of the Actiwatch is most suitable to detect sleep disturbance in older adults with intellectual disability (ID). Method ;Two Actiwatch types were compared to polysomnography (PSG) in 10 older adults with mild ID, using a 1-min epoch-to-epoch comparison. Outcome measures were sleep detection percentage, wake detection percentage, and overall accuracy of both Actiwatches, and several sleep parameters. Results: The high sensitivity setting of the Actiwatch appeared most suitable to detect sleep disturbance in older adults with ID (wake detection percentage = 54.6%, sleep detection percentage = 89.7%). Sleep parameters calculated using the high sensitivity setting corresponded well to PSG outcomes. Outcomes were similar for both Actiwatches. Conclusions: We recommend using the high sensitivity setting of the Actiwatch for clinical evaluation of sleep, and for epidemiological research in older adults with ID.

Background: Healthy Ageing is a complex intervention aimed at reducing the prevalence of loneliness among elderly Dutch people. Purpose: This study aimed to assess how mass media communication materials, information meetings, and psychosocial courses were received by elderly people at high risk of loneliness. Methods: Face-to-face interviews with 17 independently living elderly persons at increased risk of loneliness were conducted. They provided information about factors in?uencing attention to and acceptability of the content of the intervention components. Interviews were audiotaped, transcribed, and analyzed with Atlas. Results: The mass media communication materials were not successful in attracting attention because interviewees' expectations about the communication channels differed from what was provided, the perceived personal relevance of the message was low, and the presentation was not attractive. The content of the intervention components was not well received because the objectives and components did not connect with the priority group's perception of their environment. Discussion: This study showed that the classical health education approach with one-way communication did not succeed in reaching the priority group. Translation to Health Education Practice: To select appropriate theoretical methods and practical strategies, such as using storytelling and personal invitation, we recommend involvement of the priority group. (Contains 2 tables.)

Introduction: The pilot study reported here determined the effectiveness of a multidisciplinary group rehabilitation program, Visually Impaired Elderly Persons Participating (VIPP), on psychosocial functioning. Methods: The single-group pretest-posttest pilot study included 29 persons with visual impairments (aged 55 and older) who were referred to a low-vision rehabilitation center. The VIPP intervention (20 weekly meetings) consisted of four components (practical training; education, social interaction, counseling, and training in problem-solving skills; individual and group goal setting; and a home-based exercise program). Psychosocial adaptation to vision loss, helplessness, self-efficacy, mental health, and fear of falling were used as indicators of psychosocial functioning and were assessed at the baseline, halfway, immediately after completion of the intervention, and at the six-month follow-up. Results: Directly after the intervention, the participants' adaptation to vision loss (ES = 0.57), self-efficacy (ES = 0.50), and mental health (ES = 0.39) improved compared to the baseline. Moreover, helplessness and a generic and vision-specific fear of falling decreased (ES = 0.26, ES = 0.20, and ES = 0.24, respectively). The six-month follow-up measure indicated improved adaptation to vision loss (ES = 0.54), a lesser feeling of helplessness (ES = 0.53), better mental health (ES = 0.22), and a lesser vision-specific fear of falling (ES = 0.27). In contrast, a decrease in self-efficacy (ES = 0.14) and an increase in the generic fear of falling (ES = 0.18) were found. Discussion: The tentative conclusion of this small-scale pilot study is that the VIPP program benefits psychosocial functioning in both the short and long term. Implications for practitioners: The study showed that low-vision rehabilitation centers could implement multidisciplinary group rehabilitation programs, such as VIPP, to improve the psychosocial functioning of elderly people who are visually impaired. (Contains 3 tables and 1 figure.)

This study measures physical activity levels in a representative population-based sample of older adults (aged [greater than or equal to]50 years) with intellectual disabilities. For this, the steps/day of all 1050 participants of the Healthy Ageing and Intellectual Disabilities study (HA-ID; a study conducted among three Dutch healthcare providers in 2009-2010), were measured with a pedometer. Largely due to physical limitations (n = 103), walking speed less than 3.2 km/h (n = 252), limited understanding or non-cooperation (n = 233), only 257 of the group were able to participate in valid measurements with pedometers. Of these 257 participants, only 16.7% (95% CI 12.2-21.3) complied with the guideline of 10,000 steps/day, 36.2% (95% CI 30.3-42.1) took 7500 steps/day or more, and 39% (95% CI 32.6-44.5) was sedentary (less than 5000 steps/day). Because the measured sample was the more functionally able part of the total sample, this result is likely to be a considerable overestimation of the actual physical activity levels in this population. This realistic study shows that physical activity levels are extremely low in adults aged 50 years and over with intellectual disabilities. Focus on lifetime promotion of physical activity in this specific, but rapidly growing population, is recommended. (Contains 4 tables and 1 figure.)

Overweight and obesity are major health problems associated with increased cardiovascular disease risk, which is not sufficiently studied in people with intellectual disability yet. The present study was part of the Healthy Ageing in Intellectual Disability (HA-ID) study. The aim of this study was to establish (1) the prevalence of overweight, obesity and body fat percentage in older people with intellectual disability (ID) through measurement of Body Mass Index (BMI), waist circumference, waist-to-hip ratio (WHR) and skin fold thickness, and compare this with prevalence of overweight and obesity in the general population, and (2) the association of overweight and obesity with participant and treatment characteristics (gender, age, level of ID, Down syndrome, autism, independent living, smoking, (instrumental) activities of daily living ((I)ADL), physical activity and use of atypical antipsychotic medication) using regression analyses. In this cross-sectional study 945 persons, aged 50 and over with borderline to profound ID, living in central settings, in community settings and independently were included. Overweight and obesity were highly prevalent, with more obesity (26%) than in the general Dutch older population (10%) as measured by BMI, and 46-48% obesity as measured by waist circumference and WHR respectively. Women, people with Down syndrome, higher age, less severe ID, autism, people who are able to eat independently, preparing meals and doing groceries independently, people with physical inactivity and use of atypical antipsychotics were significantly more at risk of being overweight or obese. This merits specific actions by policy makers and clinical practice to improve health outcomes. (Contains 4 tables.)