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W Rietkerk,1 DL Gerritsen,2 BJ Kollen,1 CS Hofman,3 K Wynia4,†, JPJ Slaets,5,6 SU Zuidema1 1Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 2Department of Primary and Community Care and Radboud Alzheimer Centre, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; 3Department of Innovation and Research, Vilans, Centre of Expertise on Long-Term Care, Utrecht, the Netherlands; 4Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 5Faculty of Medical Sciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; 6Leyden Academy On Vitality And Ageing, Leiden, the Netherlands†K Wynia passed away on September 23, 2019Correspondence: W RietkerkDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, Postbus 196, Groningen 9700 AD, the NetherlandsTel +31 6 515 38759Email w.rietkerk@umcg.nlBackground: Older adults and care professionals advocate a more integrated and proactive care approach. This can be achieved by proactive outpatient assessment services that offer comprehensive geriatric assessments to better understand the needs of older adults and deliver person-centered and preventive care. However, the effects of these services are inconsistent. Increased involvement of the older adult during the assessment service could increase the effects on older adult’s well-being.Methods: We studied the effect of an assessment service (Sage-atAge) for community-dwelling frail adults aged ≥65 years. After studying the local experiences, this service was adapted with the aim to increase participant involvement through individual goal setting and using motivational interviewing techniques by health-care professionals (Sage-atAge+). Within Sage-atAge+, when finishing the assessment, a “goal card” was written together with the older adult: a summary of the assessment, including goals and recommendations. We measured well-being with a composite endpoint consisting of health, psychological, quality of life, and social components. With regression analysis, we compared the effects of the Sage-atAge and Sage-atAge+ services on the well-being of participants.Results: In total, 453 older adults were eligible for analysis with a mean age of 77 (± 7.0) years of whom 62% were women. We found no significant difference in the change in well-being scores between the Sage-atAge+ service and the original Sage-atAge service (B, 0.037; 95% CI, −0.188 to 0.263). Also, no change in well-being scores was found even when selecting only those participants for the Sage-atAge+ group who received a goal card.Conclusion: Efforts to increase the involvement of older adults through motivational interviewing and goal setting showed no additional effect on well-being. Further research is needed to explore the relationship between increased participant involvement and well-being to further develop person-centered care for older adults.Keywords: outpatient assessment service, well-being, comprehensive geriatric assessment, motivational interviewing, goal setting, person-centered care

Objective: To determine, by expert consensus using a Delphi procedure, a minimum reporting set of study variables for fetal growth restriction (FGR) research studies.Methods: A panel of experts, identified based on their publication record as lead or senior author of studies on FGR, was asked to select a set of essential reporting study parameters from a literature-based list of variables, utilizing the Delphi consensus methodology. Responses were collected in four consecutive rounds by online questionnaires presented to the panelists through a unique token-secured link for each round. The experts were asked to rate the importance of each parameter on a five-point Likert scale. Variables were selected in the three first rounds based on a 70% threshold for agreement on the Likert-scale scoring. In the final round, retained parameters were categorized as essential (to be reported in all FGR studies) or recommended (important but not mandatory).Results: Of the 100 invited experts, 87 agreed to participate and of these 62 (71%) completed all four rounds. Agreement was reached for 16 essential and 30 recommended parameters including maternal characteristics, prenatal investigations, prenatal management and pregnancy/neonatal outcomes. Essential parameters included hypertensive complication in the current pregnancy, smoking, parity, maternal age, fetal abdominal circumference, estimated fetal weight, umbilical artery Doppler (pulsatility index and end-diastolic flow), fetal middle cerebral artery Doppler, indications for intervention, pregnancy outcome (live birth, stillbirth or neonatal death), gestational age at delivery, birth weight, birth-weight centile, mode of delivery and 5-min Apgar score.Conclusions: We present a list of essential and recommended parameters that characterize FGR independent of study hypotheses. Uniform reporting of these variables in prospective clinical research is expected to improve data quality, study consistency and ultimately our understanding of FGR. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background: Evidence on the progress of disease severity in Multiple Sclerosis (MS) is generally limited in scope.Objectives: To examine the course of a broad spectrum of MS-related disabilities and quality of life (QOL) in relation to disease severity, and responsiveness of the Multiple Sclerosis Impact Profile (MSIP).Methods: The mortality rate was calculated after checking the national population register for vital status of the initial cohort. We performed a longitudinal study among 245 patients with MS attending the Groningen MS Center in the Netherlands. We assessed these patients in 2004 and 2009 using a postal survey including the MSIP to evaluate disabilities, the World Health Organization Quality of Life-Abbreviation version (WHOQOL-BREF) to evaluate QOL, and the ambulation question of the Expanded Disability Status Scale (EDSS) to evaluate disease severity. Responsiveness of the MSIP was estimated using standardized response mean (SRM).Results: Increase of disability in the MSIP disability domains and loss of QOL were most prevalent and pronounced in patients with EDSS 0 to < 4.5 in 2004. MSIP and QOL scores were remarkably stable in the higher disease severity groups. Mortality rates were highest (24%) in patients with EDSS ≥ 7 to < 10 in 2004. SRM indices for the MSIP ranged between 0.26 and 0.56.Conclusions: Prominent increases in multiple aspects of disability and loss of QOL occur especially in the early stages in MS. Health care interventions may lead to health and QOL gains, in particular when offered to patients in the first stage of the MS process. Responsiveness was sufficient for nine of the 11 MSIP domains. [ABSTRACT FROM AUTHOR]

Objective. The subjective dimension of disability, the perception of disability, is a dimension missing from the International Classification of Functioning, Disability and Health (ICF), and from health-related quality of life (HRQOL) instruments. However, it is a highly relevant dimension for clinical practice as perceived disability may identify care needs. We therefore developed a measure for this subjective dimension of disability in multiple sclerosis (MS) and examined the contribution of this dimension to QOL. Method. A measure named theMultiple Sclerosis Impact Profile-Disability Perception (MSIP-DP) was developed to reflect a person's perception of disabilities reported using the original MSIP-disability (MSIP-D) items. MS patients (n=530) completed bothMSIP sections, the medical outcome study short form questionnaire (SF-36), the World Health Organisation Quality Of Life-BREF (WHOQOL-BREF) and questions concerning disease severity. The contribution of disability perception (DP) to QOL in MS was estimated using hierarchical multiple regression analyses after controlling forMS severity. Results. Confirmative factor analysis confirmed the hypothesised disability perception domains that correspond with the related disability domains in the MSIP. DP scales yielded sufficient reliability. DP explained a unique and substantial part of the variance in QOL, particularly the perception of impairments in mental functions. Discussion. Results indicated that the subjective dimension of functioning and health operationalised in the MSIP-DP is a relevant concept in explaining QOL in MS. In clinical practice psychological interventions addressing a patient's perception of disability, particularly of impairments in mental functioning, may contribute to QOL. [ABSTRACT FROM AUTHOR]

BACKGROUND: Financial constraints and quality requirements demand that interventions selected are most effective. A previous systematic review of the effectiveness of the patient advocacy case management model was not found. OBJECTIVE: The objective of this study was to evaluate the effects of patient advocacy case management on service use and healthcare costs for impaired older people or adults with a chronic somatic disease living in the community. METHODS: A literature search was conducted in Medline, CINAHL, and Cochrane databases. Included were English-language randomized controlled trials evaluating service use and costs of the patient advocacy case management model for people with a chronic somatic disease or for impaired older people living in the community. RESULTS: Eight relevant studies were identified and included after evaluation of methodological quality. All studies concerned frail or impaired older people, and one study also included people with a somatic chronic disease. In none of the studies was evidence found for clinically relevant increase of service use and costs, whereas in two studies, it was reported that patient advocacy case management led to decreased service use and to savings in costs. DISCUSSION: Patient advocacy case management does not increase service use and costs and was effective in decreasing service use and costs in two studies. These conclusions are an indication for quality improvement through the combination of its organizational benefits. Therefore, there should be more priority given to further implementation of patient advocacy case management for those with chronic illness and impaired older people. Nursing can play an important role in this development. [ABSTRACT FROM AUTHOR]

Purpose. The aim of this study was to develop and test the structure of the Multiple Sclerosis Impact Profile (MSIP), and to evaluate its reliability and validity within a large group of MS patients. Method. Data were obtained from a postal survey of 377 patients attending the Groningen MS centre of the university hospital and 153 patients from the MS patients' association. Results. Factor analysis showed that the MSIP comprised domains representing the four components of the International Classification (ICF). The body functions component comprised two factors, which we divided into three scales: 'muscles and muscle movement functions' (MMF), 'excretion and reproductive functions' (ERF) and 'mental functions' (MF). The activities component comprised one factor, which we divided into two scales: 'basic movement functions' (BMF) and 'activities of daily living' (ADL). The participation component comprised one factor: 'participation in life situations' (PLS). The environmental factors component comprised one factor: 'environmental factors' (EF). Four clinically relevant 'symptom' items were added to the questionnaire as single items. The MISP scales yielded sufficient to good internal consistency coefficients. Analysis of the convergent, divergent and known-groups validity indicated that the MSIP measures the physical, psychological and social impact of MS and discriminates between categories of course of disease and disease severity. Conclusion. The MSIP seems to be a reliable and valid ICF-based outcome measure that covers a broad range of clinically relevant aspects of health. ICF can play an important role in measurement development and improvement of a unified and standard language in clinical practice and research. [ABSTRACT FROM AUTHOR]

Purpose. The aim of this study was to determine ICF items indicating health problems for patients with a chronic neurological disorder such as multiple sclerosis, Parkinson's disease and neuromuscular disease.Method. A Delphi study using three disease-specific panels composed of patients and proxies, medical and non-medical health professionals (N = 98). Panels were asked to select items from the International Classification of Functioning, Disability and Health (ICF) reflecting relevant disease-specific health problems. Items appraised as relevant by the panel members were compared with items in established measures namely: the Minimal Record of Disability (MRD) and the Disability and Impact Profile (DIP).Results. Sixty-eight ICF items were considered to be the most relevant, and belonged to four ICF domains. No significant differences were found between the appraisal of items by patients/proxies and health professionals. Agreement across the disease panels appeared to be (very) strong. Differences between the three disease-specific panels were found for the 'Body Functions and Structures' domain: consensus was reached by extension of the inclusion criteria. The ICF-item selection covers almost all items of the established measures. The largest contrast was shown in the item selection for the 'participation' and 'environmental factors' domains.Conclusions. Selected items indicate a broader scope in studying health problems compared with widely used health status measures in neurology, especially for the ICF domains 'Participation' and 'Environmental Factors'. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is a common and significant problem in older adults. Insight into factors underlying malnutrition is needed to develop strategies that can improve the nutritional status. Compromised intestinal integrity caused by gut wall hypoperfusion due to atherosclerosis of the mesenteric arteries in the aging gastrointestinal tract may adversely affect nutrient uptake. The presence of compromised intestinal integrity in older adults is not known. The aim of this study is to provide a proof-of-concept that intestinal integrity is compromised in older adults during daily activities., Methods: Adults aged ≥75 years living independently without previous gastrointestinal disease or abdominal surgery were asked to complete a standardized walking test and to consume a standardized meal directly afterwards to challenge the mesenteric blood flow. Intestinal fatty acid-binding protein (I-FABP) was measured as a plasma marker of intestinal integrity, in blood samples collected before (baseline) and after the walking test, directly after the meal, and every 15 min thereafter to 75 min postprandially., Results: Thirty-four participants (median age 81 years; 56% female) were included. Of the participants, 18% were malnourished (PG-SGA score ≥ 4), and 32% were at risk of malnutrition (PG-SGA score, 2 or 3). An I-FABP increase of ≥50% from baseline was considered a meaningful loss of intestinal integrity and was observed in 12 participants (35%; 8 females; median age 80 years). No significant differences were observed in either baseline characteristics, walking test scores, or calorie/macronutrient intake between the groups with and without a ≥ 50% I-FABP peak., Conclusion: This study is first to indicate that intestinal integrity is compromised during daily activities in a considerable part of older adults living independently., (© 2021. The Author(s).)

Purpose: Care for older adults should preferably be provided in a person-centred way that includes goal planning. The aim of the present cohort study is to gain an insight into the results of goal planning, in a person-centred care setting for community-living older adults., Materials and Methods: Within Embrace, a person-centred and integrated care service, older adults set goals with the aim to improve health-related problems. For every goal, they rated severity scores ranging from 0 (no problem) to 10 (extremely severe): a baseline score, a target score and, within one year, an end score to evaluate these goals. The differences between baseline and end scores (goal progress) and target and end scores (goal attainment), and the percentage of goals attained were calculated and compared between health-related domains (i.e., mental health, physical health, mobility, and support)., Results: Among 233 older adults, 836 goal plans were formulated of which 74% (95% Confidence Interval: 71-77) were attained. Goals related to physical health were the most likely to be attained and goals for mobility and pain the least likely., Conclusions: Older adults are able to attain health-related goals through collaborative goal planning. We recommend future integrated care programmes for older adults to incorporate goal-planning methods to achieve person-centred care.IMPLICATIONS FOR REHABILITATIONOlder adults experiencing frailty or complex care needs and receiving individual support within an integrated care setting are able to formulate and attain goals using goal planning with severity scores.Goal plans of community-living older adults mostly aim at improving health-related problems concerning physical health, mobility, or support.Goals related to physical health are the most likely to be attained, while goals for mobility and pain are the least likely to be attained.

Introduction: Integrated care has been suggested as a promising solution to the disparities in access and sustained high quality long-term care emerging in Europe's ageing population. We aim to gain a better understanding of context-specific barriers to and facilitators of implementation of integrated care by doing a retrospective assessment of seven years of Embrace. This Dutch integrated person-centred health service for older adults was based on two evidence-based models (the Chronic Care Model and the Kaiser Permanente Triangle). Despite successful deployment the programme ended in 2018. In this case study we assess the impact of the programme based on past evaluations, reflect on why it ended, lessons learned and ideas to take forward., Discussion: The majority of health outcomes were positive and the perceived quality of care improved, albeit no clear-cut savings were observed, and the costs were not balanced across stakeholders. The Embrace payment model did not support the integration of health services, despite reforms in long-term care in 2015., Key Lessons: Enabling policy and funding are crucial to the sustained implementation of integrated person-centred health services. The payment model should incentivize the integration of care before the necessary changes can be made at organizational and clinical levels towards providing proactive and preventive health services., Competing Interests: One of the co-authors (KW) has been involved in the intervention and evaluations of Embrace. The other authors have not been involved in the intervention or evaluations used in this study. Three authors (SH, ML, EB) were involved in the European ACT@Scale project. They had no active involvement in the Embrace programme., (Copyright: © 2020 The Author(s).)

Objective: To assess the prevalence, severity, and change in health-related problems in a sample of older adults who received individual care and support from Embrace, for the whole sample, per subgroup based on complexity of care needs and frailty, and for those who had at baseline a health-related problem., Design: A pretest-posttest study with assessments at baseline and after 12 months., Setting: Community., Participants: Older adults aged 75 years and older (N=136) who are frail (n=56) or who have complex care needs (n=80)., Intervention: Participants received care and support by Embrace, a person-centered and integrated care service for community-living older adults supporting them to age in place. A multidisciplinary team provided care and support, with intensity depending on the older adults' risk profile., Main Outcome Measure: Health-related problems as perceived by older adults and measured with the Geriatric International Classification of Functioning, Disability and Health Core Set., Results: Health-related problems were related to 6 coherent clusters: (1) Mental Functions; (2) Physical Health; (3) Mobility; (4) Personal Care; (5) Nutrition; and (6) Support. The most prevalent and most severe problems at baseline were related to Mental Functions and Mobility. Changes in the prevalence of problems after 12 months varied. Severity scores decreased or remained stable, except for Mobility items which showed a varying changing pattern in participants with complex care needs. Prevalence and severity of problems for those with a problem at baseline decreased after 12 months. Frail participants with a problem had higher baseline severity scores than those with complex care needs experiencing a problem, but differences in changes between individuals who are frail and those with complex care needs were small., Conclusions: The results are encouraging and may indicate that individual, person-centered and integrated care and support from Embrace offers a route to counteracting the decline in physical, cognitive and social functioning associated with aging., (Copyright © 2019 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)