Tijdschrift Voor Gerontologie en Geriatrie

Published by Bohn Stafleu van Loghum
Print ISSN: 0167-9228
Publications
To describe and calculate Home Care Quality Indicators from data of the European Aged in Home Care (ADHOC) project. With due regard for risk factors, home care agencies at country level have been compared with each other on quality of care. The indicators of Home Care quality of care (HCQIs) are calculated based on methods that have been developed in the US and Canada. The values of these QIs are risk adjusted on the basis of odds ratios of covariates resulting from logistic regression analysis on the ADHOC sample. To enhance the comparison of QIs between countries we have used the method of percentile thresholds and QI aggregate sum measure related to those. Risk adjusted values of 22 Home Care Quality Indicators differed considerably between home care agencies in the eleven European countries that participated in ADHOC. The QI aggregate showed which countries probably had the best home care and which had the worst. There are quality indicators available, derived from data of the Resident Assessment Instrument for Home Care, with which quality of care between home care agencies in and across nations can be adequately compared. Examples of this type of indicator are: social isolation, inadequate pain control, failure to improve in impaired locomotion in the home.
 
In this article, a report is provided of results from the Longitudinal Aging Study Amsterdam (LASA). LASA is a study on determinants and consequences of changes in daily functioning. In this article, the focus is on changes in physical functioning. From longitudinal data, it is observed that many older people experience function loss, especially at higher ages. A host of factors are associated with function loss, such as chronic diseases, cognitive decline, depressive complaints, socio-economic status, and life style. A few of these factors are causal, others are characteristics of groups with raised chances of function loss. From trend analyses, it is apparent that the prevalence of functional limitations is not fixed, but varies over time. The LASA study shows that this prevalence is increasing. In view of the absolute and relative rise of the number of older people in the population, it is of great importance to realise a lower prevalence of function loss and a delay of function loss to older ages. Based on the findings presented, some suggestions for this are given. Also, some directions for future research are described.
 
According to current dementia guidelines from 2005 (CBO) functional brain imaging by PET-scan of the brain has no place in the analysis of a dementia syndrome. Differential diagnosis between Alzheimer disease and other causes of dementia remains important because there are differences in natural course and treatment. Here we present three patients aged 62, 71 and 68 years with dementia syndrome who were assessed at an outpatient memory clinic. After geriatric assessment and subsequent brain MRI the etiology of the dementia remained unclear. In all three patients the etiology became clear after using a 18 FDG PET-scan of the brain. We conclude that 18 FDG PET imaging of the brain has added value in the analysis of dementia syndrome with an unclear etiology after initial analysis.
 
Why are there in the Netherlands two geriatric disciplines and how have the professions of clinical geriatricians and nursing home practitioners been developed? Only written sources have been used for the research: articles, annual reports, archives of scientific associations and umbrella organisations. For the elderly chronic patients increasingly less space was available in hospitals after 1945. These patients obstructed circulation in this institution, which focused more on treatment rather than nursing. Although everyone acknowledged the need for more medical attention for this old age group, there was a lot of opposition against the development of special geriatric units in hospitals. Other specialists agreed that they could effectively treat the elderly patient and felt no need for a geriatrician. Contrary to the geriatric units in hospitals, the development of nursing homes flourished. In these facilities, the nursing home medicine evolved and, as opposed to geriatrics in hospitals, less resistance was encountered. The system of registration of medical specialists made it impossible to recognise only one geriatrician, since they worked in both hospitals as well as in nursing homes. The professional development of nursing home practitioners and clinical geriatricians was delayed partly as a result of the general hesitation of the KNMG in acknowledging new medical disciplines and as a result of internal domain discussions.
 
Recently day care facilities are available for psychogeriatric patients. With a national survey we tried to get insight into how and where in 1979 the day care facilities for psychogeriatric patients in The Netherlands were functioning. The data collected revealed that this type of care is yet only on a small scale -- and not evenly spread out over the country -- available. The ratio of nursing home beds and of day-care places per thousand of the population of 65 years and older varies from province to province. A description is given of the organization of the day-care facility, the staffing and the coordination of the treatment offered. About half of the patients who finished the day-treatment in 1979 after a period of five to six months of care, were admitted to an intramural health service. We have tried to find reasons for this. Poor contact between the staff of the day-care facility and others like the general practitioner and the social psychogeriatric outpatient service might be a reason, the capacity of nursing home beds another.
 
The Dutch Central Board for the homes of the aged did a good job with her advice on this subject. The problems are rightly summed up and it made a lot of valuable recommendations. It is to be regretted, however, that these problems almost exclusively are considered from the viewpoints of the official bodies, institutions and existing systems. About the well-being, wishes and needs of the elderly involved in the process of admission to the one or the other institute, is spoken too little. Especially within the area between the boundaries of the different facilities their own well-being must be decisive.
 
The report under discussion suggests examination of psychogeriatric clients undertaken by a psychiatrist with the help of the current medical diagnostic apparatus. The report is criticized as the psychiatric approach is too much emphasized. This emphasis does not correspond with the current practice in the Dutch psychogeriatric care. The problems of psychogeriatrics are not to be found in the field of diagnostics, but rather in the lack of ambulatory services. The disadvantageous implications of the proposals for the client and the policy as to psychogeriatrics are discussed.
 
The British Council's Course 'Psychogeriatrics' at the University of Nottingham reflects the state and development of the internationally acknowledged psychiatry of old age in Britain. This article describes the contents of the course in terms of epidemiology, organization, diagnosis and treatment, with special attention to aspects of education and research. It concludes with a remark on the identity of the subject, stating that psycho-geriatrics has its emphasis in training and research rather than being a medical subspecialty.
 
This article is in Dutch language. An inventory of the current gerontological research in the Netherlands has been made by the Steering Committee for Research on Aging (SOOM). The results are compared with data of 1977. In terms of effort in man-years (MY) the research has almost tripled. The investment in current research was 192 MY versus 71 in 1977. In biomedical research 49 MY were spent vs. 23 in 1977; in medical 60 vs. 19 in 1977; in social medical 8 (this category was not used in 1977); and in behavioral and social research 37 and in applied social 38 vs. 29 for all social gerontological research in 1977. 50% of all research is conducted by projects, 44% by projects within a program and 5% in programs, in which however a quarter of the total MY is spent. Applied social research is mainly project-bound (66%), biology only for 28%. The average duration of the research varies from 4.5 years (biology) to 1.5 years (applied social research). Almost 60% of the current research is carried out within universities. 5 of them invest more than 5 MY in gerontological research. In 70% of the university research the university contributes more or less financially. In (medical)biological gerontology the central and peripheral nervous system is the most frequently studied subject (especially dementia). In medical gerontology dementia is the main subject; and in social gerontology home care and extra- and intramural care.
 
Government, scientists and health care workers show an increasing interest in dementia and memory defects. It is unclear, however, whether the general public has acquired more access to the increased knowledge in this field. This is important to know because many people seem to worry about memory dysfunctions or about a possible dementia. An analysis of newspaper articles over a period of 3 years (March 1987 until March 1990) shows that the number of newspaper articles on memory has decreased. On the other hand, the average number of articles on dementia has increased from 11 per month in the first year to 25 and 28 in the second and third year. In these articles, most attention is given to research on dementia and to health care services for dementia patients. The number of articles on general aspects of dementia remained practically unchanged, although these articles in particular have an important informative function. In national newspapers, the attention for the six different themes is unequally divided. The themes 'general aspects of dementia', 'health care services' and 'research on dementia' have a relatively high impact. Finally, it appears that the same headline of an article can evoke different emotional reactions in a group of judges. Taking the results of this research into account, the authors argue that more health education activities should be directed at memory defects and dementia. Furthermore they conclude that a more systematic evaluation of these activities is necessary.
 
This paper describes major points of a study on the future of dementia in the period 1990-2010. By means of a literature review and consultation of experts in a Delphi-study exploratory scenarios and a target-setting scenario were constructed. The paper delineates the exploratory reference-scenario, which includes the most probable processes and developments according to the majority of the experts. Furthermore necessary measures and strategies are described to increase the quality of care to demented elderly in the next twenty years.
 
Because the Dutch population has a growing number of older people, an increasing burden on mental health services is expected. To facilitate policy making for the future, it is important to know what changes there have been in use of mental health services by elderly in the past. This study investigates changes in the use of mental health services by older adults in the period 1990-2004. Information about the use of mental health services by older adults was retrieved from the Dutch Psychiatric Case Registers. Population size in these register areas and the unit costs of the different mental health services were taken into account. In total there was an increase in the number of older adults that used mental health services in the period mentioned above. The costs, however, showed a decrease, which was caused by the decrease of expensive inpatient care and the increase of less expensive outpatient care. This was mainly the case until 2002. From this year on the ratio between inpatient and outpatient care stabilized. Deinstitutionalization of mental health care for older adults was shown in the period 1990-2002. This means that expensive inpatient care is partly replaced by less expensive outpatient care. As a consequence more older adults can be treated with no rise in costs. Since 2002 deinstitutionalization came to a halt. Because a growing number of older adults will be using mental health services in the future, new forms of outpatient care should be explored.
 
Self-perceived health describes how a person perceives his or her own health. It is a widely used measure of health status. The aim of this study is to investigate the stability of self-perceived health between 1992/'93 and 2002/'03 of men and women aged 55-64 and to what extent a possible shift can be explained by demographic factors, lifestyle factors and objective health. Data of two age-, sex- and region-stratified samples are used from the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study in a population-based sample of older persons in the Netherlands. Self-perceived health is defined by the answer to the following question: How would you rate your health in general? with possible answers: 1 = excellent, 2 = good, 3 = fair, 4 = sometimes good/sometimes poor and 5 = poor. In the analyses, answers 4 and 5 are combined because of the small number of answers in the category 'poor'. The difference in self-perceived health between the two cohorts is tested using the chi2-test. Multinomial regression analyses are used to examine which cohort and/or period factors are responsible for the cohort difference. The youngest cohort rated more excellent and poor health than the oldest, and less good and fair health. The youngest cohort had a higher prevalence of chronic illness, functional limitation and depressive symptoms, which negatively affected self-perceived health. The cohort and period factors do not significantly contribute to the explanation of the cohort difference. There is a small shift in self-perceived health over time. In comparison with the oldest cohort the self-perceived health of the youngest improved, taken the deteriorated objective health of the youngest cohort into account.
 
This study focuses on the residents of three ecclesiastical homes for the elderly in 19th century. The Hague. These homes took in poor members of the church who were at least 60 years old. Most of the elderly who resided in these homes had received poor relief prior to admission. The main reason to request admission was that they were no longer able to independently run a household. Most of the residents were well past the age of 60 upon entering the home, women generally being a few years older than men. There were no significant gender differences in duration of residence. The female age at death was a few years higher than for males. The health of the residents appeared to be worse than that of the total elderly population of The Hague, resulting in a higher death rate. In general, residents had independently run a household prior to admission.
 
In the second half of the nineteenth century poor relief of the church was especially directed at the elderly. Firstly, this is clear from the existence of almshouses and the so-called old people's homes. Secondly, in allocating poor relief age played an important role. Permanent outdoor relief was supplied from the age of fifty. This article will portray this nineteenth century permanent outdoor relief. A group of 239 permanently endowed people will be analyzed on the basis of parish registers of the Evangelical-Lutheran church in Amsterdam. This specific group (orphanages, almshouses, old people's homes and boarders will not be considered) consisted largely of elderly people.
 
The aging of the Dutch population will lead to a larger demand for housing for the elderly. But this is not the only effect the aging population will have on the housing market. Till the year 2000 the group of households in the reduction stage will grow substantially. These households experience a reduction in size because children leave their parents' home or one of the partners dies. These households behave quite differently on the housing market than younger households. Simulation models have been developed to analyse both growth and composition of the group of older households and their behaviour on the housing market till the year 2000. The result show that the housing needs of the elderly in the future differ widely from those of the present cohorts.
 
This article describes the most important aspects of these guidelines. The guidelines are composed of two complementary lines of care. The first line focusses on the basic nutritional care in nursing homes and the second specifically on the patient with nutritional problems. The purpose is to help nursing homes in formulating a sensible and patient-centred nutritional policy; and to realize alertness on nutritional problems in patients, so that necessary interventions can be undertaken in time. Attention is also paid to the importance of an adequate implementation of the guidelines.
 
The oral health status of residents in Dutch nursing homes is rather poor, especially of those depending on caregivers for their oral health care. Moreover, when care dependency is rising, the provision of good oral health care becomes more difficult. With more elderly people still having (parts of) their natural teeth, the need for good oral health care is increasing even more. Therefore a specific guideline was developed. The ultimate aim of the guideline "Oral health care for dependent residents in long term care facilities" is to improve the oral health of nursing home residents. Oral health care needs to be incorporated in daily nursing home care routine and in the integral care plan of every resident. Attention is given to the importance of an adequate implementation of this guideline as well as to the necessity of research evaluating the effects of it's implementation.
 
Public pension (AOW), supplementary pensions and care-arrangements together constitute the important financial arrangements for the elderly in the Netherlands. The ageing process jeopardizes them all, although the uncertainty about the future development of supplementary pensions is huge. The problems with the care provision will probably be bigger than those for the public pension, because other factors (like age-dependent use of care and insufficient growth of labour productivity in the care sector) add to the growth of expenses due to the rising share of elderly persons in the population. Therefore, contributions of the elderly will be necessary, collectively or individually. A growing standard of living, shifting the criteria for an acceptable minimum standard, both in income and care, sets a major problem. The consequences of changes in the standard of living and in the perception of acceptable minimal standards are explored in three scenarios. If the standard of living does not grow much (scenario 1), future elderly persons will be more prosperous compared to younger individuals and their capacity to contribute to the growing expenses for care will grow. If however the standard of living grows strongly (scenario 2 and 3), future elderly persons will impoverish compared to younger adults. Furthermore, their ability to pay will diminish. This is even more so the case, as in this situation the prices of care will be higher. If the public pension becomes the most important component in the pension system, the incomes of most retired people will be near a relatively high social minimum level. However, if supplementary pensions become most important, the differences in wealth within the retired population will be marked.
 
'AGING WELL' IN THE 21TH CENTURY: A PSYCHOSOCIAL PERSPECTIVE: Aging well refers to retaining or restoring well-being in the face of various age-related changes in later life. This process is influenced by the quality of social relationships and active adaptation to loss and change. According to recent studies from the Longitudinal Aging Study Amsterdam, more older adults are maintaining relationships with friends, colleagues and other non-kin longer. Greater diversity in their social networks contributes to happiness and morale, and provides protection against anxiety, depression and loneliness. There is also a slight increase in mastery and in cognitive functioning among new cohorts of older adults. These developments promote adaptation to declines in health and loss of the partner. These improvements are found less frequently among those with lower education, lower incomes, and/or small networks. Several interventions have proven to be effective for these disadvantaged groups: a visiting service for widows and widowers and two self-management interventions for chronically ill or physically vulnerable older adults.
 
Cognitive and emotional problems are common after stroke and screening is essential. In this paper a new screening instrument is presented and its usability is investigated. A group of stroke patients (N = 69) were interviewed using the new instrument, the CLCE-24, six months post stroke. Moreover extensive neuropsychological testing was conducted (including MMSE/CAMCOG). Patients, relatives and assessors (a psychologist) were positive about its use. The interview with the CLCE-24 took 11.1 minutes on average (5-35 minutes). Eighty percent of the patients had complaints; 73% had cognitive problems, while 51% had emotional problems. Patients with at least one complaint on the CLCE-24 scored lower on the MMSE (t=2.5; p = 0.01) and the CAMCOG (t= 2.5; p= 0.02) compared to patients without complaints. The CLCE-24 can be applied by professionals in primary care for identification of cognitive and emotional complaints after stroke. Further research and implementation in clinical practice and the stroke service is recommended.
 
The GIP-28 is the shortened version of the 82-item Behavior Rating Scale for Psychogeriatric Inpatients. Originally it was meant and psychometrically evaluated for use in psychogeriatric and elderly psychiatric inpatients. We supposed that the GIP-28 might be useful to detect psychosocial and cognitive problems in residents of homes for the elderly. It was therefore tested in 15 residential homes (n = 949). The instrument consists of three, factor-analytically derived, scales: 'Apathy', 'Cognition' and 'Affect'. These three principal components were also identified in the data of the inhabitants of the residential homes. Internal consistency of the scales, as measured with Cronbach's Alpha is .75, .66, .80 respectively. Construct validity of the GIP-28 is satisfactory: the correlation between the Affect scale and the GDS was .36 and between the Cognition scale and the MMSE was -.36. The GIP-28 was associated with another observation scale for care needs (r = .54). The GIP-28 can be used to detect mental health problems in the population of residential homes. However, it is neither meant nor suited to replace psychiatric diagnostic procedures.
 
This study reports on a new rating scale, the short version (GIP-28) of the Dutch Behavioral Rating Scale for Geriatric Inpatients (GIP). Only a limited number of items was needed to adequately describe GIP variance in two patient samples (n = 2196 and n = 126). Based on previous results factor analysis produced three factors: 'apathy', 'cognitive' and 'affective' symptoms. This led to the construction of new subscales which showed significant differences between persons in different patient settings. Elderly patients with a cognitive disorder or schizophrenia/mood disorder according to DSM-IV criteria, were correctly classified in almost 80% of the cases. We conclude that the GIP-28 is equivalent to the GIP and describes aspects of apathy and cognitive and affective symptoms in elderly patients. A compact rating scale like this might best be used in (routine) screening of cognitive and noncognitive behavioral problems. It may also prove useful for outpatient purposes.
 
The overall health status of the population is often measured by RAND-36 item Health Survey. In 2012, Fontys and partners started a longitudinal field study in the Netherlands. This study is aimed at identifying factors that influence the use of technology by elderly individuals in order to increase independent living. A total of 50 participants aged 70 years or older, are interviewed every eight months, for a total of four years. In addition, participants are asked to fill in several questionnaires. One questionnaire that is (partly) included is the Dutch version of the RAND-36, which includes the statement; "I am as healthy as anybody I know". Some participants who find themselves healthier than other people they know (want to) fill in an answer that indicates that they find themselves less healthy than others (e.g. "I am not as healthy as anybody, I am healthier so I answer 'definitely false'"). Hence, the Dutch version of this RAND-36 statement can lead to an underestimation of the overall health status of Dutch elderly individuals.
 
Well known, but also less frequent or deviant features of epilepsy of late onset (beginning after 60) are discussed. Main groups of disturbances causing or resulting in seizures and related to epilepsy are mentioned. Diagnostic tools are given and guidelines with special points of attention are considered.
 
Friendship serves several important functions which contribute to well being in later life. The companionate function of friendship contributes to positive well being under normal circumstances. Friendship also provides social support during stressful events, such as loss of the partner, thus reducing negative well being. In addition to supporting socialization in new situations, friends serve a sustaining function; that is, they help sustain continuity of meaning of self and life experiences from the communal perspective of values and norms developed over the years. Various studies show that friendship is more important for older women than older men; women are more likely to maintain friendships until late in life and benefit from their friendships in adaptation to loss of the partner. A course was developed to assist older women in improving the quality or quantity of their friendships, to help them improve their well being. The course is based on a self-help method and the principles of feminist therapy. A model describing four phases in which relational competence is important in friendship also forms the basis for the course. Disorders in friendship can be understood and influenced in terms of a cognitive perspective, aimed at customary thoughts on self, others and relationships. An evaluation study of the eleven participants in the first course demonstrates a significant decline in loneliness a year after the course as finished, as well as relevant improvements in the quality or quantity of friendships among several participants. The changes appear to be independent of the women's adult attachments styles, which influence their orientation in friendship. The conclusion is that the friendship course supports socially active lonely women, whose loneliness is not too extreme.
 
Nowadays people speak of the 'new' generation of young old who would be healthier and more socially active compared to the earlier generation. Using data from the Longitudinal Aging Study Amsterdam it was examined to what degree this is a realistic image. The study compared the social participation level of 55-64 year olds in 1992 and the same age group in 2002, and aimed to explain the differences from cohort differences in four determinants of participation: level of education, labour participation, health and partner status. Descriptive analyses showed that the younger cohort was more actively involved in voluntary organisations and participated more often in cultural and leisure activities compared to the older cohort. In addition, the younger cohort was more highly educated, yet reported more functional disabilities, and more often hold paid jobs compared to the older cohort. No cohort differences were found with respect to the proportion of married persons. Logistic regression analyses showed that the higher level of social participation of the younger cohort was mainly due to the higher level of education, but that this effect was reduced by the larger disability of the younger cohort. Job and partner status did not explain the cohort differences in social participation. It is concluded that the current young old are more socially active and higher educated than their predecessors. Their (somewhat) worse health status, however, asks for a more nuanced image of the 'new' young old.
 
In The Netherlands no detailed information about alcohol consumption among older persons (55 years and older) is available. Therefore we investigated the prevalence and determinants of alcohol consumption with data from the Longitudinal Aging Study Amsterdam. The results show that 13.4% of persons of 55 years and older are heavy drinkers (male >3 glasses per day, female >2 glasses per day). Most heavy drinkers are younger than 75 years of age, and in this age group more female (22.2%) than male (14.8%) are heavy drinkers. 13% of all participants frequently drinks 6 or more glasses in a short period of time (binge drinking). In the age group of 55-65 years alcohol consumption has considerably increased over a period of ten years. This increase is stronger among females than among males. When people grow older alcohol consumption decreases, which seems associated with a decline in physical or psychological health and/or cognitive decline. Heavy and binge drinking is associated with younger age, higher education and income, and may be strongly related to their social lifes.
 
In this article an exploratory study into a national exercise program for people of 55 years and older is reported. In order to gain more insight in the various characteristics of the participants, a questionnaire was completed by a sample of 839 persons. The studied aspects are background characteristics, medical characteristics, characteristics of daily activities, risk behaviour, way of acquaintance with and motive for participation in the program. The results of the research are, if possible, compared with a reference group. A comparison between the participants of the various types of the movement program, shows similarities on the dimensions ADL-problems and bad health. Differences are found on the dimensions gender, age and education. The conclusion is that the choice of the type of the movement program is probably made on the ground of these three characteristics. The comparison between the participants of the exercise program and the reference group shows that a selection within the population of people of 55 years and older is very likely. The majority of the participants is 65 to 74 years old (43%), female (80%) and of low educational level (85%). Positive differences in favour of the exercise participants are found on the variables hypertension, medicine usage. ADL problems and risk behaviour (smoking and drinking). It is, however, unclear whether these differences are the result of an effect of the program or the result of selection in the program population. A combination of these two factors is also not ruled out. An effect-study can give more evidence for one of the factors involved.
 
This study aimed to examine the 12-month and lifetime prevalence rates of pure and comorbid mental disorders (mood, anxiety and alcohol disorders) in Belgian home-dwelling elderly. A representative random sample of 665 non-instutionalized older adults (60+) from Belgium was interviewed in 2000 and 2001. DSM-IV disorders were assessed by interviewers trained to use a revised version of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) of the World Health Organization. Twenty percent of the respondents reported a lifetime history of at least one mental disorder; 5% met criteria for a a mental disorder in the past twelve months. Mood and anxiety disorders were the most common mental disorders. Almost 5% of the respondents reported suicidal ideation in their lifetime, while 0.22% had suicidal ideation in the past twelve months preceding the interview. Mental disorders are not uncommon in the Belgian home-dwelling elderly. The results of this study imply that in 2000-2001 at least five percent of the older adults living in the community had at least one mental disorder. Two in thousand older adults reported suicidal ideations in the 12 months preceding the interview.
 
Alcohol abuse and addiction in The Netherlands among the older adults aged 65 and over has increased in the last decade. Outreaching care is important as most of the elderly do not receive the care they need. We discuss the detoxification and group therapy of an elderly alcoholic. Issues that will be discussed are potential risks and choices that need to be made.
 
In the period 1967-1981, 102 patients older than 70 years were treated for a colorectal carcinoma. The average delay was 6.5 months. Obstruction as initial symptom was seen in only 8% of the cases. The resection rate was 85%. The postoperative mortality rate was 6% for patients who underwent a resection. For all patients the postoperative mortality rate was 8%. Surgery for colorectal carcinoma in the elderly is well tolerated, and a resection should be pursued as long as the general condition permits.
 
The aim of this study was to determine the prevalence of orthostatic (OH) and postprandial hypotension (PPH) in Dutch elderly patients admitted to a medical ward and to explore patient characteristics associated with OH and PPH: symptoms, medications and comorbidity. We studied 50 patients, mean age 78.8 years, 68% female. Orthostatic hypotension (OH) was defined as a decrease of systolic blood pressure (BP) > or = 20 or diastolic > or = 10 mm Hg after 3 minutes of standing. To diagnose postprandial hypotension (PPH) BP was measured sitting before and 30 minutes after the start of patient's noon meal, the same criteria were applied. We registered changes in BP, pulse rate, complaints, reason for hospitalization, medication and comorbidity: hypertension, diabetes mellitus and Parkinson(ism). We found OH in 24% of the patients, PPH was diagnosed more frequently: in 34%. 10% had both, but there were no relations between OH and PPH. In none of the patients OH and PPH were measured before our assessment. Pulse rate increased respectively 8 and 3/min. With OH and PPH. Both subjective and objective complaints were significantly associated with OH, where as only subjective non-specific complaints were associated with PPH. Objective complaints were very rare in PPH. OH and PPH were not significantly associated with medication use and comorbidity. PPH and OH are common in hospitalized elderly patients. OH is more often symptomatic than PPH. We found no relationship with medication use or comorbidity. According to research literature, however, OH and PPH are associated with higher morbidity, mortality and possibly cognitive decline. Therapeutic measures must be considered, especially in the presence of comorbidity such as significant carotid artery occlusion.
 
This study is based on the outcomes of the program "Privacy In Nursing Homes" that has been initiated by the Dutch Department of Health in the late 90's. In this study, personnel of 74 nursing homes were asked to reflect on the way they treat residents. The attitudes of personnel were measured with a questionnaire that contains 80 propositions about their behaviour towards residents. The propositions can be reduced to five factors: kindness, structural environment, control, freedom to choose, and respect. First, we give the general results on these five factors. After that we give insight in the correlations between the five different aspects of treatment and the results of regression analysis. The general conclusion is that the behaviour towards residents in nursing homes at the beginning of the 21st Century is far from optimal. Residents most notably lack personal freedom and control over their received care and their way of living. This result is especially worrying because client conformed care has been an important point of attention for some time now. Another important conclusion is that the care for residents has a positive relation with the mangement policy of an organization and so, it is possible to improve the care.
 
Using data from a 2002 representative survey of Flemish 75-year olds (N = 1457), the aim of the present study is to identify the structures in and causes of subjective well-being. The analyses reveal the great importance of good health. Respondents with a good physical and mental condition, who have a great deal of functional mobility and independence, do feel much better. Secondly, findings indicate that respondents who faced the loss of their partner, experience lower well-being. This explains the found gender differences. Women have lower perceived quality of life, mainly because of their greater susceptibility to widowhood. Furthermore, missing the former job and work role also contributes to lower levels of well-being. Finally, respondents who can cope financially, who feel satisfied with their social contacts and who spend their time in an active way, have higher personal well-being.
 
In this study we have examined for which ADL and mobility activities simple technical aids, including housing adaptations, can replace formal home care. A representative group of 498 single, independently living elderly persons, aged 75 years or older, were interviewed orally. Many elderly interviewees (81.5%) had difficulties performing instrumental activities of daily living. Approximately one third of them received professional home care. We did not include technical aids for household activities in our study, since the distinction between technical aids and consumer products is unclear, and it was impossible to include all consumer products in our study. About 20% of the 120 elderly persons who had difficulties with personal care, received home care, especially in dressing and bathing. Only 5% of the elderly people with mobility problems (N = 208) got home care for mobility activities; most of them used technical aids or informal helpers. This means that stimulation of more mobility aids will not decrease the need for home care. Technical aids are very important for elderly people, but there are hardly any possibilities for replacing home care by the implementation of more technical aids.
 
Sociodemographic Characteristics of the Respondents in the Qualitative and the Quantitative Research 
In this paper we describe the results of a project, in which occupational therapists visited 83 independently living, single, elderly people (clients of organisations providing care) and advised them about technical aids. Subsequently some technical aids were provided. The intervention group received, on average, three out of five advised technical aids. The effect of this intervention was an increase in the use of technical aids (people used, on average, two technical aids more at the end of the project), which means that the provided technical aids were being used. This effect was stronger in the group of the 75-84 old persons than in the above 85 year old ones. This effect led to a change in people's attitudes towards technical aids: at the beginning of the project 80% of the elderly believed technical aids could help them to remain independent and at the end this percentage was 90%. There was a slight, non-significant, decrease in the number of hours home help (from 5,4 to 4,7 hours per week). However, we were unable to ascertain an effect on the percentage of elderly using community care or waiting for institutional care. This may have been due to the heterogeneity of the intervention, the small research population and the relatively short intervention period. Elderly should be assessed as being in need of technical aids at an earlier stage.
 
CREUTZFELDT-JAKOB DISEASE IN A PERSON OVER THE AGE OF 80: Creutzfeldt-Jakob disease is a rare neurodegenerative disease that can occur in four forms. The sporadic form, the familial form, the iatrogenic form and variant Creutzfeldt-Jakob disease. The sporadic form is seen in about 1 per million people per year and is associated with rapidly progressive cognitive decline, psychiatric and neurological symptoms. The diagnosis and counseling of patients is a major challenge because of the complex and heterogeneous presentation, especially if the presentation differs from the standard. In this article we describe a diagnostic struggle regarding an elderly patient.
 
Using the micro-simulation method an estimate is made of the costs of six facilities for the elderly in 1991. The estimate is based on three factors: the use of facilities, the price of facilities and the income of the elderly. The latter is important because some of the facilities are income-tested. Changes in the income position of the elderly affect the contribution of the public sector in total expenses and the contribution of the users of the facilities. The income of the elderly is also an important prerequisite for a policy for the aged which is aimed at shifting the care for the elderly from within institutions to facilities outside institutions and to self-help. Three different versions have been calculated: a basic version, assuming a constant level of provision of facilities; a trend version extrapolating past trends in the use of facilities, and a policy version, assuming that the shift of care from within institutions to facilities outside institutions and self-help will be realised in 1991. According to the basic version expenses for the six facilities in 1991 will amount to 4,7 milliard guilders more than in 1981. Compared with the outcome of the basic variant, the trend version shows a reduction of expenses in 1991 of 150 million guilders, and according to the policy version 1,1 milliard lower.
 
In a group of 34 psychogeriatric patients (mean age 79 years) the prevalence of hypovitaminosis D was found to be 82%, taking 30 nmol/l as cut-off for calcidiol. We found 47% of the whole group to be severely deficient having values lower than 20 nmol/l. Results of related test are presented and discussed. Patient were treated with oral calcium and vitamin D3 medication. Origin, presentation and risks of hypovitaminosis D, including muscle weakness and the aggravating role of low calcium intake, are discussed with special attention to psychogeriatric patients. Suppletion of vitamin D and calcium is suggested for this patient group.
 
In this explorative study, 20 demented and 20 non-demented elderly adults were tested with the Amsterdam Dementia Screening test (ADS3) and the Wechsler Memory Scale-Revised (WMS-R). Subjects were recruited from a nursing home. The ADS3 appeared to be a feasible instrument for the patient groups investigated here: 87.5% of the demented and non-demented patients were classified correctly. A combination of the ADS3 and the WMS-R led to a correct prediction of 97.5% of the individuals in the two groups investigated. Education appeared to have an effect on performance on the ADS3, whereas age and gender did not. As expected, a strong linear relationship between the ADS3 and the WMS-R was found. However, since data about reliability, validity and norms of the WMS-R are still under investigation, definite conclusions about the concurrent validity cannot be made yet.
 
This study evaluated some psychometric qualities of the Dutch short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-N). The score profile on the short form IQCODE-N was comparable in two outpatient populations. Short form and regular IQCODE-N are equivalent, as they were highly correlated (r = 0.97). However, using IQCODE-N cut-off scores the short form appeared to be more strict in defining 'decline'. A moderately high correlation was found between informant ratings and dementia screening tests CST (r = -0.47) and ADS (r = -0.46). Informant ratings were not influenced by patient's age or level of education. The short form IQCODE-N describes cognitive change in everyday activities of elderly patients and can be an efficient rating scale for clinical assessment of dementia.
 
The risks of operative treatment of abdominal aortic aneurysm are considerably smaller in elective circumstances than after rupture of the aneurysm. The risk of a ruptured aneurysm is higher than the indicated percentage in the literature, because this only reflects the operative mortality. Possibly almost 65% of the patients with a rupture of an abdominal aortic aneurysm die at home or during transport to the hospital. In the absence of valid contra-indications to surgery, elective operative treatment should be considered, also in the elderly patient.
 
Top-cited authors
Jos F M de Jonghe
  • DC Klinieken
Dorly J H Deeg
  • Amsterdam University Medical Center
Miel W Ribbe
  • Institute for Health and Care Research
Rolf Saan
  • Martini Ziekenhuis
Dik Bakker
  • University of Amsterdam