Sil Aarts

Co-presence of multimorbidity and disability with frailty: an examination of heterogeneity in the frail older population

BACKGROUND Frailty is often associated with multimorbidity and disability. OBJECTIVES We investigated heterogeneity in the frail older population by characterizing five subpopulations according to quantitative biological markers, multimorbidity and disability, and examined their association with mortality and nursing home admission. DESIGN Observational study. PARTICIPANTS Participants (n=4,414) were from the population-based Age Gene/Environment Susceptibility Reykjavik Study. MEASUREMENTS Frailty was defined by ≥ 3 of five characteristics: weight loss, weakness, reduced energy levels, slowness and physical inactivity. Multimorbidity was assessed using a simple disease count, based on 13 prevalent conditions. Disability was assessed by five activities of daily living; participants who had difficulty with one or more tasks were considered disabled. Differences among frail subpopulations were based on the co-presence of multimorbidity and disability. Differences among the following subpopulations were examined: 1) Non-frail (reference group); 2) Frail only; 3) Frail with disability; 4) Frailty with multimorbidity; 5) Frail with disability and multimorbidity. RESULTS Frailty was present in 10.7% (n=473). Frailty was associated with increased risk for mortality (OR 1.40; 95% CI 1.15-1.69) and nursing home admission (OR 1.50; 95% CI 1.16-1.93); risks differed by subpopulations. Compared to the non-frail, the frail only group had poorer cognition and increased inflammation levels but did not have increased risk for mortality (OR 1.40; 95% CI 0.84-2.33) or nursing home admission (OR 1.01; 95% CI 0.46-2.21). Compared to the non-frail, the other frail subpopulations had significantly poorer cognition, increased inflammation levels, more white matter lesions, higher levels of calcium, glucose and red cell distribution width and increased risk for mortality and nursing home admission. CONCLUSIONS The adverse health risks associated with frailty in the general older adult population may primarily be driven by increased disease burden and disability.

The relation between social network site usage and loneliness and mental health in community-dwelling older adults

Loneliness is expected to become an even bigger social problem in the upcoming decades, because of the growing number of older adults. It has been argued that the use of social network sites can aid in decreasing loneliness and improving mental health. The purpose of this study was to examine whether and how social network sites usage is related to loneliness and mental health in community‐dwelling older adults.

The Essential Elements for a Nursing Home According to Stakeholders from Healthcare and Technology: Perspectives from Multiple Simultaneous Monodisciplinary Workshops

Technology and architectural solutions are needed as a means of support in future nursing homes. This study investigated how various monodisciplinary groups of stakeholders from healthcare and technology envision the nursing home of the future and which elements are necessary for its creation. Moreover, differences in needs and interests between the various stakeholders were considered. This qualitative study gathered data via 10 simultaneous sticky note brainstorm sessions with 95 professional stakeholders, which resulted in 1459 quotes in five categories that were clustered into themes and processed into word clouds. The stakeholders prioritized the needs of the resident and placed the most importance on the fact that a nursing home is primarily a place to live in the final stages of ones life. A mix of factors related to the quality of care and the quality of the built environment and technology is needed. Given the fact that there are differences in what monodisciplinary groups of stakeholders see as an ideal nursing home, multidisciplinary approaches should be pursued in practice to incorporate as many new views and stakeholder needs as possible.

The importance of effect sizes

KEY MESSAGE: •  Statistical significance testing alone is not the most adequate manner to evaluate if there is indeed a clinically relevant effect •  Effect sizes should be added to significance testing •  Effect sizes facilitate the decision whether a clinically relevant effect is found, helps determining the sample size for future studies, and facilitates comparison between scientific studies

Exploring innovative solutions for quality of life and care of bed-ridden nursing home residents through codesign sessions

Bed-ridden nursing home residents are in need of environments which are homelike and facilitate the provision of care. Design guidance for this group of older people is limited. This study concerned the exploration and generation of innovative environmental enrichment scenarios for bed-ridden residents. This exploration was conducted through a combination of participatory action research with user-centred design involving 56 professional stakeholders in interactive work sessions. This study identified numerous design solutions, both concepts and products that are available on the marketplace and that on a higher level relate to improvements in resident autonomy and the supply of technological items and architectural features. The methodology chosen can be used to explore the creative potential of stakeholders from the domain of healthcare in product innovation.

Origins and consequences of technology acquirement by independent-living seniors: towards an integrative model

BackgroundLiving independently can be challenging for seniors. Technologies are expected to help older adults age in place, yet little empirical research is available on how seniors develop a need for technologies, how they acquire these technologies, and how these subsequently affect their lives. Aging is complex, dynamic and personal. But how does this translate to seniors’ adoption and acceptance of technology? To better understand origins and consequences of technology acquirement by independent-living seniors, an explorative longitudinal qualitative field study was set up.MethodsHome visits were made to 33 community-dwelling seniors living in the Netherlands, on three occasions (2012–2014). Semi-structured interviews were conducted on the timeline of acquirements, and people and factors involved in acquirements. Additionally, participants were interviewed on experiences in using technologies since acquirement. Thematic analysis was employed to analyze interview transcripts, using a realist approach to better understand the contexts, mechanisms and outcomes of technology acquirements.ResultsFindings were accumulated in a new conceptual model: The Cycle of Technology Acquirement by Independent-Living Seniors (C-TAILS), which provides an integrative perspective on why and how technologies are acquired, and why these may or may not prove to be appropriate and effective, considering an independent-living senior’s needs and circumstances at a given point in time. We found that externally driven and purely desire-driven acquirements led to a higher risk of suboptimal use and low levels of need satisfaction.ConclusionsTechnology acquirement by independent-living seniors may be best characterized as a heterogeneous process with many different origins, pathways and consequences. Furthermore, technologies that are acquired in ways that are not congruent with seniors’ personal needs and circumstances run a higher risk of proving to be ineffective or inappropriate. Yet, these needs and circumstances are subject to change, and the C-TAILS model can be employed to better understand contexts and mechanisms that come into play.

The opinions of radiographers, nuclear medicine technologists and radiation therapists regarding technology in health care: a qualitative study

New technology is continuously introduced in health care. The aim of this study was (1) to collect the opinions and experiences of radiographers, nuclear medicine technologists and radiation therapists regarding the technology they use in their profession and (2) to acquire their views regarding the role of technology in their future practice.

Evidence-based practice in de dagelijkse praktijk

SamenvattingMevrouw Van Heijnen is 69 jaar en heeft diabetes mellitus type 2. Ze heeft een voetulcus. Bij binnenkomst in de praktijk geeft mevrouw aan dat uw wondbehandeling (drukvrij leggen met behulp van vilt) volgens haar niet werkt. Ze wil dan ook iets anders proberen. U bent verbaasd; uw methode bij wondbehandeling wordt juist door veel cliënten in uw praktijk gewaardeerd. Als u hierover later met een vakgenoot in gesprek raakt, geeft deze aan dat zij een andere wondbehandeling hanteert. Die is volgens haar effectief gebleken in een wetenschappelijk onderzoek. U begint te twijfelen; wat is nu de beste optie voor uw cliënt

De t-toets en de analysis of variance, ANOVA

SamenvattingBij toetsende statistiek wordt met behulp van een statistische berekening een hypothese getoetst. Bijvoorbeeld om te bepalen of het verschil tussen groepen op toeval berust, of niet. De keuze welke statistische toets van toepassing is op de gestelde onderzoeksvraag, is afhankelijk van verscheidene factoren, zoals het meetniveau van de variabelen, de (on)afhankelijkheid van de data (onafhankelijke groepen zoals man vs. vrouw, of afhankelijke data, zoals voormeting vs. nameting bij dezelfde patiënten) en de normaliteit van de data. Dit artikel zal dieper ingaan op een van de meest gebruikte toetsen in de statistiek: de t-toets en de ANOVA (analysis of variance). Het basisidee van een t-toets en de ANOVA is na te gaan of gemiddelden van groepen gelijk zijn of van elkaar verschillen. Om een t-toets of ANOVA te kunnen uitvoeren, dient de afhankelijke variabele, de uitkomstmaat, van ratio- of intervalniveau te zijn.

Leer wetenschappelijke artikelen snel en efficiënt lezen

SamenvattingWetenschappelijke publicaties kennen een vaste structuur, bestaande uit een samenvatting, inleiding, beschrijving van de gebruikte methode, de resultaten en een paragraaf ‘discussie’. Hierdoor kunt u snel, selectief en efficiënt lezen.