[Experiences, wishes and needs of patients with regard to patient participation during geriatric rehabilitation]. / Ervaringen, wensen en behoeftes van patiënten ten aanzien van patiëntparticipatie tijdens geriatrische revalidatie.

Person-centered care is the result of shared goal setting and monitoring progress during rehabilitation in geriatric rehabilitation care (GR). It requires active patient involvement. Collaboration between health care professionals and patients is valuable in formulating goals and contributes to person-centered care. With this study we investigate how active participation is implemented in practice, what wishes GR patients have and what tools are needed for this. For this purpose, cross-sectional semi-structured interviews were conducted with 23 GR patients for 1 year. The research shows that patients want to be actively approached and supported by professionals for active patient participation. The extent to which and the way in which this is done are different, requiring a flexible approach that considers the needs and possibilities of the patient and his environment. Recommendations for practice have been formulated based on this study.

[What words do older people use regarding ageing and frailty: a Delphi study]. / Welke woorden ouderen gebruiken als het gaat om ouder worden en kwetsbaarheid: een Delphi-studie.

BACKGROUND: Frailty is a term widely and increasingly used in describing a condition of individuals experiencing multiple problems in one or more domains of human functioning, physical, psychological, and/or social. Frailty is a common condition among older people. Yet, it seems older people barely use this term. This study aims to answer the following research questions: which words are used in the Dutch literature and which words do older people recognize and use in describing ageing and frailty? METHOD: The method was twofold, 1) a study of Dutch grey literature and 2) a Delphi procedure. This process involved collecting terms from the literature after which the words were presented to a Delphi panel of older people (>70 years, N=30). The procedure consisted of three rounds in which the panellists were asked whether they recognized or used the terms. The panellists had the opportunity to add terms to the already existing words on the lists. RESULTS: A total of 187 terms were submitted to the Delphi panel. After analysis, 69 words were retained that were recognized or used by older people. The terms were subdivided into different categories. The category frailty is not included in the final list of terms, due to the panel members' lack of regocnition and use. CONCLUSION: This study shows which alternative terms can be used in written and oral communication about themes such as frailty and ageing with older people.

Validation of the Dutch version of the quick mild cognitive impairment screen (Qmci-D).

BACKGROUND: Differentiating mild cognitive impairment (MCI) from dementia is important, as treatment options differ. There are few short (<5 min) but accurate screening tools that discriminate between MCI, normal cognition (NC) and dementia, in the Dutch language. The Quick Mild Cognitive Impairment (Qmci) screen is sensitive and specific in differentiating MCI from NC and mild dementia. Given this, we adapted the Qmci for use in Dutch-language countries and validated the Dutch version, the Qmci-D, against the Dutch translation of the Standardised Mini-Mental State Examination (SMMSE-D). METHOD: The Qmci was translated into Dutch with a combined qualitative and quantitative approach. In all, 90 participants were recruited from a hospital geriatric clinic (25 with dementia, 30 with MCI, 35 with NC). The Qmci-D and SMMSE-D were administered sequentially but randomly by the same trained rater, blind to the diagnosis. RESULTS: The Qmci-D was more sensitive than the SMMSE-D in discriminating MCI from dementia, with a significant difference in the area under the curve (AUC), 0.73 compared to 0.60 (p = 0.024), respectively, and in discriminating dementia from NC, with an AUC of 0.95 compared to 0.89 (p = 0.006). Both screening instruments discriminated MCI from NC with an AUC of 0.86 (Qmci-D) and 0.84 (SMMSE-D). CONCLUSION: The Qmci-D shows similar,(good) accuracy as the SMMSE-D in separating NC from MCI; greater,(albeit fair), accuracy differentiating MCI from dementia, and significantly greater accuracy in separating dementia from NC. Given its brevity and ease of administration, the Qmci-D seems a useful cognitive screen in a Dutch population. Further study with a suitably powered sample against more sensitive screens is now required.

Cross-Cultural Equivalence of De Jong Gierveld Loneliness Scale Among Older Native and Diasporic Chinese Adults.

BACKGROUND AND OBJECTIVES: Loneliness is prevalent among older adults and known to be detrimental to mental health. The objective of this study was to determine the psychometric properties of the Chinese 6-item De Jong Gierveld Loneliness Scale (DJGLS) in the older native and diasporic Chinese community. RESEARCH DESIGN AND METHODS: Participants were recruited from a local community in urban Tianjin, China and urban Chinese communities of older adults in the Netherlands. Scale properties, including reliability, were calculated with Cronbach's alpha and multiple-group confirmatory factor analysis to examine the 2-dimensional structure of the scale and the cross-cultural equivalence between both countries. Item response analysis was employed to plot the relationships between the item response and expected total scale score. RESULTS: A total of 193 older adults from China and 135 older adults from the Netherlands were included. The Cronbach's alphas were 0.68 (China) and 0.71 (the Netherlands). The DJGLS's 2-dimensional structure was validated by the goodness of fit and the factor loadings. Cross-cultural equivalence was demonstrated with the multiple-group confirmatory analysis. In addition, sufficient discriminative power of the individual items was demonstrated by item response analysis in both countries. DISCUSSION AND IMPLICATIONS: This study is the first to provide a detailed item behavior analysis with an item response analysis of the DJGLS. In conclusion, the findings of this study suggest that the DJGLS has an adequate and similar item and scalar equivalence for use in Chinese populations.

The PRECIS-2 tool has good interrater reliability and modest discriminant validity.

OBJECTIVES: PRagmatic Explanatory Continuum Indicator Summary (PRECIS)-2 is a tool that could improve design insight for trialists. Our aim was to validate the PRECIS-2 tool, unlike its predecessor, testing the discriminant validity and interrater reliability. STUDY DESIGN AND SETTING: Over 80 international trialists, methodologists, clinicians, and policymakers created PRECIS-2 helping to ensure face validity and content validity. The interrater reliability of PRECIS-2 was measured using 19 experienced trialists who used PRECIS-2 to score a diverse sample of 15 randomized controlled trial protocols. Discriminant validity was tested with two raters to independently determine if the trial protocols were more pragmatic or more explanatory, with scores from the 19 raters for the 15 trials as predictors of pragmatism. RESULTS: Interrater reliability was generally good, with seven of nine domains having an intraclass correlation coefficient over 0.65. Flexibility (adherence) and recruitment had wide confidence intervals, but raters found these difficult to rate and wanted more information. Each of the nine PRECIS-2 domains could be used to differentiate between trials taking more pragmatic or more explanatory approaches with better than chance discrimination for all domains. CONCLUSION: We have assessed the validity and reliability of PRECIS-2. An elaboration study and web site provide guidance to help future users of the tool which is continuing to be tested by trial teams, systematic reviewers, and funders.