Tinie Kardol

Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis

INTRODUCTION Frailty is one of the most important concerns regarding our aging population. Evidence grows that the syndrome is linked to several important health outcomes. A general overview of frailty concepts and a comprehensive meta-analysis of their relation with negative health outcomes still lacks in literature, making it difficult for health care professionals and researchers to recognize frailty and the related health risks on the one hand and on the other hand to appropriately follow up the frailty process and take substantiated action. Therefore, this study aims to give an overview of the predictive value of the main frailty concepts for negative health outcomes in community-dwelling older adults. METHODS This review and meta-analysis assembles prospective studies regarding the relation between frailty and any potential health outcome. Frailty instruments were subdivided into frailty concepts, so as to make comprehensive comparisons. Odds ratios (ORs), hazard ratios (HRs), and relative risk (RR) scores were extracted from the studies, and meta-analyses were conducted in OpenMeta Analyst software. RESULTS In total, 31 articles retrieved from PubMed, Web of Knowledge, and PsycInfo provided sufficient information for the systematic review and meta-analysis. Overall, (pre)frailty increased the likelihood for developing negative health outcomes; for example, premature mortality (OR 2.34 [1.77-3.09]; HR/RR 1.83 [1.68-1.98]), hospitalization (OR 1.82 [1.53-2.15]; HR/RR 1.18 [1.10-1.28]), or the development of disabilities in basic activities of daily living (OR 2.05 [1.73-2.44]); HR/RR 1.62 [1.50-1.76]). CONCLUSION Overall, frailty increases the risk for developing any discussed negative health outcome, with a 1.8- to 2.3-fold risk for mortality; a 1.6- to 2.0-fold risk for loss of activities of daily living; 1.2- to 1.8-fold risk for hospitalization; 1.5- to 2.6-fold risk for physical limitation; and a 1.2- to 2.8-fold risk for falls and fractures. The analyses presented in this study can be used as a guideline for the prediction of negative outcomes according to the frailty concept used, as well as to estimate the time frame within which these events can be expected to occur.

The discovery of deliberation. From ambiguity to appreciation through the learning process of doing Moral Case Deliberation in Dutch elderly care

In the field of bioethics a trend can be noticed toward deliberative and collective forms of moral reflection among practitioners. Moral Case Deliberation (MCD) is an example of this development and currently introduced in an increasing number of health care organizations in the Netherlands, including elderly care. The purpose of this article is to evaluate the process of implementation of MCD focusing on the learning experiences of practitioners over time. The article is grounded in a naturalistic evaluation of the implementation of MCD in two elderly care institutions between 2006 and 2012. Methods included interviews, participant observations and focus groups. The results indicate that gaining experience with MCD brought about a learning process in which both the learning of competence for reflection and deliberation (e.g. an exploratory attitude) and experiencing the benefits (e.g. relief of moral distress) were key elements. We conclude that doing ethics is the best way to motivate practitioners to engage in moral deliberations on the work floor. Gaining practical experience should be explicitly stimulated bottom-up and facilitated top-down.

RESPONSIBILITIES IN ELDERLY CARE: MR POWELL'S NARRATIVE OF DUTY AND RELATIONS

In Western countries a considerable number of older people move to a residential home when their health declines. Institutionalization often results in increased dependence, inactivity and loss of identity or self-worth (dignity). This raises the moral question as to how older, institutionalized people can remain autonomous as far as continuing to live in line with their own values is concerned. Following Walkers meta-ethical framework on the assignment of responsibilities, we suggest that instead of directing all older people towards more autonomy in terms of independence, professional caregivers should listen to the life narrative of older people and attempt to find out how their personal identity, relations and values in life can be continued in the new setting. If mutual normative expectations between caregivers and older people are not carefully negotiated, it creates tension. This tension is illustrated by the narrative of Mr Powell, a retired successful public servant now living in a residential home. The narrative describes his current life, his need for help, his independent frame of mind, and his encounters with institutional and professional policies. Mr Powell sees himself as a man who has always cared for himself and others, and who still feels that he has to fulfil certain duties in life. Mr Powells story shows that he is not always understood well by caregivers who respond from a one-sided view of autonomy as independence. This leads to misunderstanding and an underestimation of his need to be noticed and involved in the residential community.

Identifying frailty risk profiles of home-dwelling older people: focus on sociodemographic and socioeconomic characteristics

Abstract Objectives: This paper investigates risk profiles of frailty among older people, as these are essential for detecting those individuals at risk for adverse outcomes and to undertake specific preventive actions. Frailty is not only a physical problem, but also refers to emotional, social, and environmental hazards. Methods: Using data generated from the Belgian Ageing Studies, a cross-sectional study (n = 28,049), we tested a multivariate regression model that included sociodemographic and socioeconomic indicators as well as four dimensions of frailty, for men and women separately. Results: The findings indicated that for both men and women, increased age, having no partner, having moved house in the previous 10 years, having a lower educational level and having a lower household income are risk characteristics for frailty. Moreover, when looking at the different frailty domains, different risk profiles arose, and gender-specific risk characteristics were detected. Discussion: This paper elaborates on practical implications, and formulates a number of future research recommendations to tackle frailty in an aging society. The conclusion demonstrates the necessity for a thorough knowledge of risk profiles of frailty, as this will save both time and money and permit preventive actions to be more individually tailored.

Refining the push and pull framework: identifying inequalities in residential relocation among older adults

ABSTRACT Older people consider moving home when there is a discrepancy between actual and desired living conditions. This study builds on the classic push and pull framework described in the early work of Lee and Wiseman by identifying whether or not individual differences among older people can be predictive for certain push and pull reasons (such as housing, health, neighbourhood and social contact). On the basis of data from the Belgian Ageing Studies (N = 35,402), it was found that 13.9 per cent of older respondents had moved in the last ten years (N = 4,823). An analysis of the movers revealed inequalities in the reasons for moving in later life and raises the question of whether a relocation is voluntary (being able to move) or involuntary (being forced to move). Respondents with lower household incomes and poor mental health were significantly more likely to have moved because of stressors pushing them out of their previous dwelling, whereas older people with higher household incomes or home-owners were mainly pulled towards a more attractive environment.

Detecting frail, older adults and identifying their strengths: results of a mixed-methods study

BackgroundThe debate on frailty in later life focuses primarily on deficits and their associations with adverse (health) outcomes. In addition to deficits, it may also be important to consider the abilities and resources of older adults. This study was designed to gain insights into the lived experiences of frailty among older adults to determine which strengths can balance the deficits that affect frailty.MethodsData from 121 potentially frail community-dwelling older adults in Flemish-speaking Region of Belgium and Brussels were collected using a mixed-methods approach. Quantitative data were collected using the Comprehensive Frailty Assessment Instrument (CFAI), Montreal Cognitive Assessment (MoCA), and numeric rating scales (NRS) for quality of life (QoL), care and support, meaning in life, and mastery. Bivariate analyses, paired samples t-tests and means were performed. Qualitative data on experiences of frailty, frailty balance, QoL, care and support, meaning in life, and mastery were collected using semi-structured interviews. Interviews were subjected to thematic content analysis.ResultsThe “no to mild frailty” group had higher QoL, care and support, meaning in life, and mastery scores than the “severe frailty” group. Nevertheless, qualitative results indicate that, despite being classified as frail, many older adults experienced high levels of QoL, care and support, meaning in life, and mastery. Respondents mentioned multiple balancing factors for frailty, comprising individual-level circumstances (e.g., personality traits, coping strategies, resilience), environmental influences (e.g., caregivers, neighborhood, social participation), and macro-level features (e.g., health literacy, adequate financial compensation). Respondents also highlighted that life changes affected their frailty balance, including changes in health, finances, personal relationships, and living situation.ConclusionThe findings indicate that frailty among older individuals can be considered as a dynamic state and, regardless of frailty, balancing factors are important in maintaining a good QoL. The study investigated not only the deficits, but also the abilities, and resources of frail, older adults. Public policymakers and healthcare organizations are encouraged to include these abilities, supplementary or even complementary to the usual focus on deficits.

Moreel beraad in de verpleeghuiszorg: methodisch spreken over goede zorg

SamenvattingDeze bijdrage gaat over de praktijk en theorie van moreel beraad en over moreel beraad-projecten in de zorgpraktijk. In het kort wordt uitgelegd wat moreel beraad is, met welke doelen het kan worden ingezet, en vanuit welke theoretische ethiekopvatting moreel beraad door de Moreel Beraad Groep van het VUmc wordt vormgegeven. Aan de hand van een moreel beraad-project in de ouderenzorg wordt vervolgens een korte moreel beraad-casus beschreven.

Leren voor en door ouderen: succes verzekerd!

SamenvattingWil leren voor ouderen succesvol zijn dan zal de leeromgeving aan een aantal voorwaarden moeten voldoen. De consortia van de Europese projecten SMARTE (Strenghts for Mastering Ageing by Realising Tools in Europe) en GUTS (Generations Using Training for Social inclusion in 2020) hebben een leermodel ontwikkeld dat handvatten biedt om het leren voor en door ouderen in de praktijk te brengen. In het project GUTS zijn 10 leeromgevingen in 5 landen ontwikkeld waar ouderen en jongeren samen aan de slag gaan. Vraag is hoe zo’n leeromgeving eruit zou kunnen zien.

Dementia Care in Nursing Homes Requires a Multidisciplinary Approach

Dementia care in nursing homes involves care for very frail and disabled older residents, suffering from complex problems in various domains of life. These problems require an integrated approach, focusing on the resident as a human being with a disease who needs high-quality professional care which contributes to his or her quality of life and also supports the family and other informal caregivers. To enable an integrated approach, multidisciplinary teamwork is necessary. Offering care from a multidisciplinary approach puts challenges on the organization of care, more specifically on the share each healthcare professional gets in the care process, on the related mutual agreements between different healthcare professionals and on their mutual communication. In the near future, more attention must be paid as well to the equal role that residents and family caregivers themselves may play in this process of multidisciplinary care.