Lilian L. Peters

Construct validity of the Groningen Frailty Indicator established in a large sample of home-dwelling elderly persons: Evidence of stability across age and gender.

BACKGROUNDnThe primary objective of the present study was to evaluate the validity of the Groningen Frailty Indicator (GFI) in a sample of Dutch elderly persons participating in LifeLines, a large population-based cohort study. Additional aims were to assess differences between frail and non-frail elderly and examine which individual characteristics were associated with frailty.nnnMETHODSnBy December 2012, 5712 elderly persons were enrolled in LifeLines and complied with the inclusion criteria of the present study. Mann-Whitney U or Kruskal-Wallis tests were used to assess the variability of GFI-scores among elderly subgroups that differed in demographic characteristics, morbidity, obesity, and healthcare utilization. Within subgroups Kruskal-Wallis tests were also used to examine differences in GFI-scores across age groups. Multivariate logistic regression analyses were performed to assess associations between individual characteristics and frailty.nnnRESULTSnThe GFI discriminated between subgroups: statistically significantly higher GFI-median scores (interquartile range) were found in e.g. males (1 [0-2]), the oldest old (2 [1-3]), in elderly who were single (1 [0-2]), with lower socio economic status (1 [0-3]), with increasing co-morbidity (2 [1-3]), who were obese (2 [1-3]), and used more healthcare (2 [1-4]). Overall age had an independent and statistically significant association with GFI scores. Compared with the non-frail, frail elderly persons experienced statistically significantly more chronic stress and more social/psychological related problems. In the multivariate logistic regression model, psychological morbidity had the strongest association with frailty.nnnCONCLUSIONnThe present study supports the construct validity of the GFI and provides an insight in the characteristics of (non)frail community-dwelling elderly persons participating in LifeLines.

Oral health status and need for oral care of care-dependent indwelling elderly: from admission to death

ObjectivesThe objective of this study is to assess oral health and oral status of elderly patients newly admitted to a nursing home from admission until death.Materials and methodsOral health, oral status, need for dental care, cooperation with dental treatment, and given dental care were assessed by two geriatric dentists in all new long-stay patients (nxa0=xa0725) admitted to a nursing home between January 2009 and December 2013. All patients were followed from admission until death or until they left the nursing home.ResultsAt admission, dementia patients were significantly older than somatic patients; median [IQR] ages were, respectively, 85 [79–89] and 81 [76–87] (pxa0=xa00.001). In addition, edentulous patients were significantly older than patients with remaining teeth, 83 [79–89] versus 80 [74–86] (pxa0=xa00.001) years. Thirty percent of the admitted patients died within 12xa0months after admission. A small minority (20%) of the patients had their own teeth. In this group, poor oral hygiene (72%), caries (70%), and broken teeth (62%) were frequently observed. Edentulous patients were significantly more cooperative with treatment than patients with remaining teeth (64 versus 27%). Finally, significantly less professional dental care was given to edentulous patients when compared to patients with remaining teeth (median 90 [IQR 60–180] versus 165 [75–375] min).ConclusionWhen compared to edentulous elderly patients, patients with remaining teeth were younger at admittance, were more often non-cooperative, and had a poorer oral health and higher need for dental care.Clinical relevanceIt is important that health care workers ensure adequate oral health and dental care to frail elderly, especially for elderly with remaining teeth.

Elderly with remaining teeth report less frailty and better quality of life than edentulous elderly: a cross‐sectional study

OBJECTIVEnTo assess oral status and self-reported oral health in community-living elderly and to determine differences between relevant subgroups of oral status (remaining teeth, edentulous, implant-retained overdentures) and case complexity (robust, frail, complex care needs).nnnSUBJECTS AND METHODSnIn this cross-sectional descriptive study, 1325 Dutch community-living elderly (≥75xa0years of age) were asked to complete validated questionnaires on frailty, activities of daily living (ADL), complexity of care needs, and QoL. Data on oral status, self-reported oral health, dental care, general health, and medication use were assessed. Differences between relevant subgroups were determined.nnnRESULTSnData of 1026 (77%) elderly (median 80xa0years, IQR 77-84) were analyzed: 39% had remaining teeth, 51% were edentulous, and 10% had implant-supported overdentures. Elderly with complex care needs (nxa0=xa0225, 22%) and frail elderly (nxa0=xa0217, 21%) were more often edentulous and reported more oral problems than robust elderly (nxa0=xa0584, 57%). Elderly persons with remaining teeth were less frail, had better QoL and ADL, and used fewer medicines than edentulous elderly. Elderly with implant-supported overdentures performed better on frailty and QoL than edentulous elderly with conventional dentures.nnnCONCLUSIONnCommunity-living elderly commonly suffer from oral health problems, in particular elderly with complex care needs. QoL, ADL, and general health are higher among community-living elderly with remaining teeth and implant-supported overdentures than in edentulous elderly.

Perceptions of nearly graduated fourth year midwifery students regarding a ‘good midwife’ in the Netherlands

OBJECTIVEnMidwifery students have the challenge to learn to be autonomous and capable midwives to ensure a safe and emotionally satisfying experience for mothers (to be) and their babies. They have to develop and acquire knowledge and skills for practice, and they have to adopt and internalize the values and norms of the midwifery profession in order to socialize as a midwife.In this study we explored conceptualisations of good midwives among nearly graduated final year midwifery students as a result of their professional socialization process.nnnDESIGNnA cross-sectional study consisting of an onexa0open-ended question was undertaken. Data was analyzed qualitatively, inductively and deductively by using Halldorsdottirs theory of the primacy of a good midwife.nnnSETTINGnOne of three midwifery academies in the Netherlands in July 2016 were included.nnnPARTICIPANTSnAll midwifery students (N=67)xa0in their final year were included.nnnFINDINGSnStudent midwives gave broad interpretations of the features of a good midwife. Three themes - next to the themes already conceptualised by Halldorsdottir - were revealed and mentioned by nearly graduated Dutch midwifery students. They added that a good midwife has to have specific personal characteristics, organizational competences, and has to promote physiological reproductive processes in midwifery care.nnnKEY CONCLUSIONSnStudents views are broad and deep, reflecting the values they take with them to real midwifery practice. The results of this study can serve as an indicator of the level of professional socialization into the midwifery profession and highlight areas in which changes and improvements to the educational program can be made.

Health and quality of life differ between community living older people with and without remaining teeth who recently received formal home care : A cross sectional study

ObjectiveTo assess oral health, health, and quality of life (QoL) of care-dependent community-living older people with and without remaining teeth who recently received formal home care.Materials and methodsFor this cross-sectional observational study, community-living older people (≥u200965xa0years), who recently (<u20096xa0months) received formal home care, were interviewed with validated questionnaires and underwent an oral examination. Oral health, general health, medicines usage, frailty (Groningen Frailty Indicator), cognition (Minimal Mental State Examination), QoL (RAND 36), and oral health-related QoL (Oral Health Impact Profile-14) were assessed.ResultsOne hundred three out of 275 consecutive eligible older people (median age 79 [IQR (Inter Quartile Range) 72–85xa0years] participated in the study. Thirty-nine patients had remaining teeth and 64 were edentulous. Compared with edentulous older people, older people with remaining teeth scored significantly better on frailty, QoL, physical functioning, and general health. No significant differences were seen in cognition. Dental and periodontal problems were seen in more than half of the patients with remaining teeth. Two third of the edentulous patients did not visit their dentist regularly or at all.ConclusionsCare-dependent home-dwelling older people with remaining teeth generally were less frail, scored better on physical functioning and general health and had better QoL than edentulous older people. Dental and periodontal problems were seen in approximately 50% of the elderly.Clinical relevanceNotwithstanding their common dental problems, frailty, health, and QoL are better in home-dwelling older people with remaining teeth. To maintain this status, we advise not only dentists, but also health care workers and governments, to encourage people to maintain good oral health.

Assessment of Biopsychosocial Complexity and Health Care Needs: Measurement Properties of the INTERMED Self-Assessment Version

Objective The INTERMED Self-Assessment questionnaire (IMSA) was developed as an alternative to the observer-rated INTERMED (IM) to assess biopsychosocial complexity and health care needs. We studied feasibility, reliability, and validity of the IMSA within a large and heterogeneous international sample of adult hospital inpatients and outpatients as well as its predictive value for health care use (HCU) and quality of life (QoL). Methods A total of 850 participants aged 17 to 90 years from five countries completed the IMSA and were evaluated with the IM. The following measurement properties were determined: feasibility by percentages of missing values; reliability by Cronbach &agr;; interrater agreement by intraclass correlation coefficients; convergent validity of IMSA scores with mental health (Short Form 36 emotional well-being subscale and Hospital Anxiety and Depression Scale), medical health (Cumulative Illness Rating Scale) and QoL (Euroqol-5D) by Spearman rank correlations; and predictive validity of IMSA scores with HCU and QoL by (generalized) linear mixed models. Results Feasibility, face validity, and reliability (Cronbach &agr; = 0.80) were satisfactory. Intraclass correlation coefficient between IMSA and IM total scores was .78 (95% CI = .75–.81). Correlations of the IMSA with the Short Form 36, Hospital Anxiety and Depression Scale, Cumulative Illness Rating Scale, and Euroqol-5D (convergent validity) were −.65, .15, .28, and −.59, respectively. The IMSA significantly predicted QoL and also HCU (emergency department visits, hospitalization, outpatient visits, and diagnostic examinations) after 3- and 6-month follow-up. Results were comparable between hospital sites, inpatients and outpatients, as well as age groups. Conclusions The IMSA is a generic and time-efficient method to assess biopsychosocial complexity and to provide guidance for multidisciplinary care trajectories in adult patients, with good reliability and validity across different cultures.

Mode of birth and medical interventions among women at low risk of complications: A cross-national comparison of birth settings in England and the Netherlands

Objectives To compare mode of birth and medical interventions between broadly equivalent birth settings in England and the Netherlands. Methods Data were combined from the Birthplace study in England (from April 2008 to April 2010) and the National Perinatal Register in the Netherlands (2009). Low risk women in England planning birth at home (16,470) or in freestanding midwifery units (11,133) were compared with Dutch women with planned home births (40,468). Low risk English women with births planned in alongside midwifery units (16,418) or obstetric units (19,096) were compared with Dutch women with planned midwife-led hospital births (37,887). Results CS rates varied across planned births settings from 6.5% to 15.5% among nulliparous and 0.6% to 5.1% among multiparous women. CS rates were higher among low risk nulliparous and multiparous English women planning obstetric unit births compared to Dutch women planning midwife-led hospital births (adjusted (adj) OR 1.89 (95% CI 1.64 to 2.18) and 3.66 (2.90 to 4.63) respectively). Instrumental vaginal birth rates varied from 10.7% to 22.5% for nulliparous and from 0.9% to 5.7% for multiparous women. Rates were lower in the English comparison groups apart from planned births in obstetric units. Transfer, augmentation and episiotomy rates were much lower in England compared to the Netherlands for all midwife-led groups. In most comparisons, epidural rates were higher among English groups. Conclusions When considering maternal outcomes, findings confirm advantages of giving birth in midwife-led settings for low risk women. Further research is needed into strategies to decrease rates of medical intervention in obstetric units in England and to reduce rates of avoidable transfer, episiotomy and augmentation of labour in the Netherlands.

Peri-implant health in people aged 75 and over with an implant-retained overdenture in the mandibula

The number of elderly patients with an implant-retained overdenture in the mandibula is increasing. There is, however, insufficient information on how these elderly people are functioning with their overdenture and on their peri--implant health. Therefore, a study was carried out among a group of people aged 75 and over who had been provided with an implant-retained overdenture in a general dental office, measuring their ability to manage independently, their general health and peri-implant health. The study revealed a high degree of ability to manage independently, despite the health problems affecting many over 75. The patients rated their prosthetic overdentures with an average grade of 8.9 ± 1.1. Plaque around the implant (73%) and bleeding on probing (68%) were frequently seen. However, progressive peri-implant bone loss was seldom seen. No relationship was evident between plaque-scores and the ability to manage independently. Except for oral hygiene instruction and/or professional cleaning of peri-implants, no serious interventions were necessary. It was concluded that this group of elderly people, provided with an implant-retained mandibular overdenture, are functioning well. Plaque around the implant and bleeding on probing are often present but progressive peri-implant bone loss is rare.

Impact of a Nurse-Led Health Promotion Intervention in an Aging Population: Results From a Quasi-Experimental Study on the “Community Health Consultation Offices for Seniors”

Objective: The study evaluated the nurse-led intervention “Community Health Consultation Offices for Seniors (CHCO)” on health-related and care needs–related outcomes in community-dwelling older people (⩾60 years). Method: With a quasi-experimental design, the CHCO intervention was evaluated on health-related and care needs–related outcomes after 1-year follow-up. Older people who received the intervention were frail, overweight, or were smoking. The comparison group received care as usual. In both groups, similar data were collected on health status, falls and fractures, and care needs. In the intervention group, additional data were collected on biometric measures and health-related behavior. Results: The intervention group and the care-as-usual group included 403 seniors and 984 seniors, respectively. Health-related outcomes, behaviors, and biometric measures, remained stable. After 1 year, care needs increased for both groups, but at a lower rate for the care-as-usual group. Discussion: The CHCO intervention showed no significant improvement on health-related outcomes or stability in care needs–related outcomes.

The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population-based cohort study

Abstract Background Spontaneous vaginal birth rates are decreasing worldwide, while cesarean delivery, instrumental births, and medical birth interventions are increasing. Emerging evidence suggests that birth interventions may have an effect on childrens health. Therefore, the aim of our study was to examine the association between operative and medical birth interventions on the childs health during the first 28 days and up to 5 years of age. Methods In New South Wales (Australia), population‐linked data sets were analyzed, including data on maternal characteristics, child characteristics, mode of birth, interventions during labor and birth, and adverse health outcomes of the children (ie, jaundice, feeding problems, hypothermia, asthma, respiratory infections, gastrointestinal disorders, other infections, metabolic disorder, and eczema) registered with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification codes. Logistic regression analyses were performed for each adverse health outcome. Results Our analyses included 491 590 women and their children; of those 38% experienced a spontaneous vaginal birth. Infants who experienced an instrumental birth after induction or augmentation had the highest risk of jaundice, adjusted odds ratio (aOR) 2.75 (95% confidence interval [CI] 2.61‐2.91) compared with spontaneous vaginal birth. Children born by cesarean delivery were particularly at statistically significantly increased risk for infections, eczema, and metabolic disorder, compared with spontaneous vaginal birth. Children born by emergency cesarean delivery showed the highest association for metabolic disorder, aOR 2.63 (95% CI 2.26‐3.07). Conclusion Children born by spontaneous vaginal birth had fewer short‐ and longer‐term health problems, compared with those born after birth interventions.