Tijdschrift voor gerontologie en geriatrie
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Tijdschr Gerontol Geriatr · Apr 2009
[Trends in the utilization of Dutch mental health services by older adults between 1990-2004].
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. ⋯ 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.
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Tijdschr Gerontol Geriatr · Dec 2008
[End-of-life with dementia in Dutch antroposofic and traditional nursing homes].
Every year more than 20,000 people with dementia die in Dutch nursing homes and this number steadily increases. Therefore, the importance of good end-of-life care for these patients including physical, psychosocial and spiritual care is evident. Although the training standards for Dutch nursing home physicians and nurses share a common standard, the philosophy of a nursing home may affect end-of-life care strategies for the residents. ⋯ The anthroposophic nursing homes had significant higher scores on the 'Symptom Management' ((32.9 (SD 7.5) versus 26.9 (SD 9.5)), and 'Comfort Assessment in Dying' scales (34.0 (SD 3.9) versus 30.8 (SD 5.8)) and on its subscale Well Being (7.7 (SD 1.2) versus 6.7 (SD 2.1)). Our results suggest that death with dementia was more favourable in anthroposophic nursing homes than in regular homes. The results inform further prospective studies on nursing homes how this and other philosophies are translated into daily nursing home practice, including decision making in multi-disciplinary teams, family consultation, and complementary non-pharmacological therapies.
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Nursing homes (NH) are less well studied than hospices or hospitals as a setting for terminal care. The aim of this study is to identify the direct causes and underlying diseases of the terminal phase in Dutch nursing homes. ⋯ Providing good and timely palliative care to elderly patients in Dutch nursing homes is a major medical and societal challenge. In this study, the terminal phase of the mainly non-cancer patients is difficult to predict, and once diagnosed, little time is left.
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Tijdschr Gerontol Geriatr · Dec 2008
[Evaluation of units for short-term terminal care in nursing homes].
The Units for short-term terminal care in 10 nursing homes were evaluated in terms of (a) meeting minimum care requirements for organisation, personnel and expertise and (b) changes in outcomes in patients. Interview with staff members show that 69% of the care requirements were met. Requirements for expertise development were better met (77%), and requirements for personnel and team were met less well (58%). ⋯ We conclude that the minimum care requirements should be revised, taken into account the way the requirements are used in daily practise. The data seem to point at good quality of care. We advise a repetition of the last evaluation in 2003.
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Tijdschr Gerontol Geriatr · Feb 2008
[Prediction of functional decline in elderly patients discharged from the accident and emergency department].
The aim of this study is to investigate the predictive validity of 5 screening tools with respect to functional decline in older persons discharged from the Accident & Emergency Department. ⋯ Sensitivity and negative predictive value are the most important parameters for screening tools. Hence, our study suggests that the ISAR instrument is the most appropriate instrument to predict functional decline in ambulatory older persons admitted to the emergency department. The ISAR can easily be integrated in nursing records and can be systematically employed in older persons at the emergency department.