Trends across 20 years in multiple indicators of functioning among older adults in the Netherlands.

BACKGROUND: Monitoring of trends in functioning of older adults provides indispensable information for health care policy. This study examined trends in multiple indicators of functioning among Dutch older adults across a period of 20 years. METHODS: Data from the Longitudinal Aging Study Amsterdam were used. We included 10 870 observations of 3803 respondents aged 64-84 years across seven waves (1992-12) and 931 observations of 603 respondents aged 85-94 years across four waves (2001-12). At each wave, 8 indicators of functioning were measured: multimorbidity, severe functional limitations, depression, anxiety, cognitive impairment, physical inactivity, loneliness and social isolation. In addition, a sum score (range: 0-8) of these indicators was calculated, with a score of ≥5 indicating 'multiple problems.' Trends in functioning over time were assessed using Generalized Estimating Equation analyses. RESULTS: In the 64-84-years-olds, the prevalence of multimorbidity increased over time [OR(year) = 1.06, 95% CI = 1.05-1.06], whereas the prevalence of the other indicators decreased [i.e. cognitive impairment, physical inactivity (in women) and loneliness (in women)] or remained stable [i.e. severe functional limitations, depression, anxiety, physical inactivity (in men), loneliness (in men) and social isolation]. In the 85-94-year-olds, the prevalence of severe functional limitations increased over time [OR(year) = 1.08, 95% CI = 1.02-1.13], whereas the prevalence of the other indicators remained stable. In both age groups, the prevalence of 'multiple problems' remained stable. CONCLUSION: Unfavorable trends were observed in multimorbidity among 64-84-years-olds and in severe functional limitations among 85-94-year-olds. Favorable trends were found in cognitive impairment, physical inactivity (in women) and loneliness (in women) among 64-84-years-olds.

Neighbourhood social inclusion from the perspective of people with intellectual disabilities: Relevant themes identified with the use of photovoice.

BACKGROUND: Earlier studies show that to gain more understanding of the concept of social inclusion, the views and experiences of people with intellectual disabilities are needed. The aim of this study was to investigate their perspective on neighbourhood social inclusion from an ecological point of view. METHOD: We carried out a photovoice study with 18 people with intellectual disabilities in three neighbourhoods in the Netherlands. Participants took photographs in their neighbourhood they considered relevant, and these photographs were discussed during an interview. RESULTS: Six themes emerged from qualitative analysis: attractiveness of the neighbourhood, social contacts in the neighbourhood, activities in the neighbourhood, social roles in the neighbourhood, independence and public familiarity. CONCLUSIONS: As regards neighbourhood social inclusion, participants were often focused on small and informal activities and situations. Public familiarity proved very important. Framing the concept of neighbourhood social inclusion within an ecological approach may help to better understand processes of social inclusion.

Photovoice in research involving people with intellectual disabilities: A guided photovoice approach as an alternative.

BACKGROUND: In studies involving people with intellectual disabilities, photovoice is increasingly used to include the voice of participants. Analysing existing literature, the present authors found that photovoice was used in various forms with different outcomes. These studies describe both obstructing and facilitating factors. The present authors designed a more standardized approach of photovoice and developed an alternative strategy: "guided photovoice." METHOD: The "guided photovoice" approach was tested on fourteen participants with intellectual disabilities. The outcomes of the approach were evaluated. RESULTS: The effectiveness of the approach varied with the participants' capabilities and needs. Some participants were talked more while taking photographs, others told their story easily during the interviews. The use of follow-up questions was helpful to deepen the interview. CONCLUSIONS: A more standardized, guided photovoice approach is a helpful addition to the various options for using photovoice; it is important to decide which approach best fits the needs and capabilities of the participants.

Living apart (or) together-neighbours' views and experiences on their relationships with neighbours with and without intellectual disabilities.

BACKGROUND: Neighbours play an important role in the social inclusion of people with intellectual disabilities. Neighbouring in general might help understand the social interactions between neighbours with and without intellectual disabilities. Our study focuses on gaining insight into neighbouring patterns and how people with intellectual disabilities fit in them. METHOD: 26 interviews were conducted with 29 neighbours of people with intellectual disabilities on their norms and behaviours towards neighbours with and without disabilities. RESULTS: Four patterns were identified: feeling an outsider, fleeting contacts, individualized neighbourliness and sense of community. DISCUSSION: Participants perceived neighbours with intellectual disabilities as different: they are difficult to approach and show inappropriate behaviour. The groups shared most general perceptions, but there were differences. The first two groups mostly had fleeting encounters, whereas the last groups seemed more open to communal activities and assisting neighbours. In enhancing social inclusion, staff should be aware of these neighbouring patterns.

The Longitudinal Aging Study Amsterdam: cohort update 2016 and major findings.

The Longitudinal Aging Study Amsterdam (LASA) is an ongoing longitudinal study of older adults in the Netherlands, which started in 1992. LASA is focused on the determinants, trajectories and consequences of physical, cognitive, emotional and social functioning. The study is based on a nationally representative sample of older adults aged 55 years and over. The findings of the LASA study have been reported in over 450 publications so far (see www.lasa-vu.nl ). In this article we describe the background and the design of the LASA study, and provide an update of the methods. In addition, we provide a summary of the major findings from the period 2011-2015.

Testing evolutionary theories of discriminative grandparental investment.

This study tests two evolutionary hypotheses on grandparental investments differentiated by the child's sex: the paternity uncertainty hypothesis and the Trivers-Willard hypothesis. Data are from two culturally different countries: the Dutch Longitudinal Aging Study Amsterdam (n=2375) and the Chinese Anhui Survey (n=4026). In the Netherlands, grandparental investments are biased towards daughters' children, which is in accordance with the paternity uncertainty hypothesis. But in China, grandparental investments are biased towards sons' children, which is in conflict with the paternity uncertainty hypothesis. This study found no support for the Trivers-Willard hypothesis. These results raise doubts over the relevance of paternity uncertainty as an explanation of a grandparental investment bias towards daughters' children that is often found in Western populations. The results suggest that discriminative grandparental investments are better understood as the outcome of cultural prescriptions and economic motives.

When grandmothers matter.

In a recent issue of this journal, Herndon discussed the grandmother hypothesis and its implications for studies on cognitive ageing. According to this hypothesis, the long post-reproductive life span in human females is an adaptive mechanism that evolved to maximize female fitness by investing resources in the care of their grandchildren rather than by continuing to reproduce themselves. From this, Herndon deduces that special cognitive robustness to be maintained until after the age of menopause must have co-evolved because grandmothers can only exert the beneficial effect if their cognitive abilities remain intact. He therefore pleas to compare cognitive ageing in humans with other primates, especially chimpanzees, because they lack a long post-reproductive life span and would therefore not have evolved this cognitive robustness. Here, we question the important role of grandmothers in our evolutionary past, first because of the different family structures during this time and second because of the low number of females that actually lived to experience a post-reproductive lifespan. We also show that in a population that reflects our evolutionary past, grandmothers do not have an important role for child survival. Finally, we react on the implications for the study of cognitive ageing as put forward by Herndon.

A Healthy Lifestyle in Old Age and Prospective Change in Four Domains of Functioning.

Objective: The aim of this article is to study the associations between healthy lifestyle in old age and decline in physical, psychological, cognitive, and social functioning. Method: A population-based sample of 3,107 Dutch men and women aged 55 and 85 years (1992/1993; Longitudinal Aging Study Amsterdam) was used with five 3-yeary follow-up examinations. Lifestyle score, based on smoking status, alcohol consumption, physical activity, and body mass index (BMI), ranged from 0 (unhealthy) to 4 (healthy). Outcomes included gait speed, depressive symptoms, cognitive status, and social contacts. Results: Persons with a healthy lifestyle had a 10.6% slower decline in gait speed (0.04 m/s, 95% confidence interval [CI] = [0.03, 0.05]), 10.8% slower increase in depressive symptoms (-1.07 [-1.70, -0.44]), a 1.8% slower decline in cognitive functioning (0.47 [0.23, 0.70]), and a 4.9% slower decline in social contacts (0.58 [0.01, 1.15]) compared with persons with no or one healthy lifestyle factor. Discussion: A healthy lifestyle benefits physical, psychological, cognitive, and social functioning up to very old age.

Participation narratives of Third Age adults: Their activities, motivations and expectations regarding civil society organisations.

Third Age adults leaving the labour market are not only armed with broad experience and multiple competencies but also find themselves free of professional obligations while still physically sound. The general theory of Third Age of Laslett sheds a new light on characteristics of ageing adults and their role in society. They are able to engage in society in ways inaccessible to previous generations of older adults. According to Laslett, combining a myriad personal strengths and being free of professional obligations they are challenged to make Third Age a time of personal development by making choices of engagement and civic contribution. To enlighten these issues, this qualitative study focuses on how and under what conditions 23 Third Agers invest their strengths in unpaid societal and social participation. Their narratives reveal three types of involvement: holistic, inhibited and social consumerist. The holistic pattern and, to a lesser extent, the inhibition pattern meet the expectations of Laslett about the Third Age. The social consumerist pattern, on the other hand, rather refers to disengagement. These observations imply that to facilitate the societal engagement and social participation of this population, civil society organisations need to rethink their goals, activities and procedures.

Information and Communication Technologies to Support Chronic Disease Self-Management: Preconditions for Enhancing the Partnership in Person-Centered Care.

OBJECTIVE: In order to alleviate the pressure on health care systems exerted by the growing prevalence of chronic diseases, information and communication technologies (ICT) are being introduced to enable self-management of chronic diseases by supporting partnerships between patients and health care professionals. This move towards chronic disease self-management is accompanied by a shift in focus on integrating the patient with his or her perceptions on the chronic disease as a full-fledged partner into the health care system. This new perspective has been described as "person-centered care" (PCC). To date, information and communication technologies only partially build on the principles of PCC. This paper examines the preconditions of ICT to enable a person-centered approach to chronic disease management. METHODS: Using cancer treatment as a case study for ICT-enabled PCC, we conducted a comparative analysis of thirteen scientific studies on interventions presented as ICT-enabled PCC for cancer treatment, to answer the research question: What are the preconditions of ICT-enabled PCC in chronic disease management? Based on the intended and actual outcomes, we distilled in several analytic steps the preconditions of ICT-enabled PCC for chronic disease self-management. RESULTS: We distinguished four user-related preconditions of ICT-enabled PCC: (shared) decision making, personalized ICT, health-related quality of life, and efficiency. CONCLUSIONS: We argue that these four preconditions together can improve people's self-management of chronic diseases by strengthening the partnership between the patient and the healthcare professional. Moreover, the study revealed a discrepancy between intended and reported actual outcomes in terms of realizing person-centered care.

The Trade-Off between Female Fertility and Longevity during the Epidemiological Transition in the Netherlands.

Several hypotheses have been put forward to explain the relationship between women's fertility and their post-reproductive longevity. In this study, we focus on the disposable soma theory, which posits that a negative relationship between women's fertility and longevity can be understood as an evolutionary trade-off between reproduction and survival. We examine the relationship between fertility and longevity during the epidemiological transition in the Netherlands. This period of rapid decline in mortality from infectious diseases offers a good opportunity to study the relationship between fertility and longevity, using registry data from 6,359 women born in The Netherlands between 1850 and 1910. We hypothesize that an initially negative relationship between women's fertility and their longevity gradually turns less negative during the epidemiological transition, because of decreasing costs of higher parities. An initially inversed U-shaped association between fertility and longevity changes to zero during the epidemiological transition. This does suggest a diminishing environmental pressure on fertility. However, we find no evidence of an initial linear trade-off between fertility and post-reproductive survival.

Socioeconomic status determines sex-dependent survival of human offspring.

BACKGROUND AND OBJECTIVES: In polygynous societies, rich men have many offspring through the marriage of multiple wives. Evolutionary, rich households would therefore benefit more from sons, and according to the Trivers-Willard hypothesis, parents invest more in offspring of the sex that has the best reproductive prospects. We determined the sex differences in number of offspring, sex ratio of offspring, offspring survival and offspring weight in rich and poor households in a polygynous population. METHODOLOGY: We studied a population of 28 994 individuals in Northern Ghana during an 8-year prospective follow-up. We determined the fertility rate for both men and women, sex ratio of 3511 newborn offspring and offspring survival in 16 632 offspring up to reproductive age (≤18 years). Also, we collected 9842 weight measurements of 1470 offspring up to the age of 3 years from growth charts of local clinics. RESULTS: In rich households, men have a lifetime number of 6.0 offspring, while for women this was 3.1. In line with evolutionary predictions, the male:female sex ratio was higher in rich households (0.52; poor households 0.49), sons had lower mortality in rich households (hazard ratio male versus female 1.06, P = 0.64; poor households: hazard ratio male versus female 1.46, P = 0.01) and sons also had higher weights in rich households (P = 0.008). CONCLUSIONS AND IMPLICATIONS: In rich households, men have higher reproductive prospects in this polygynous society and, in line with Trivers-Willard, we registered more sons in rich households, sons had lower mortality and higher weights, maximizing the reproductive output in this society.

How Grandparents Matter: Support for the Cooperative Breeding Hypothesis in a Contemporary Dutch Population.

Low birth rates in developed societies reflect women's difficulties in combining work and motherhood. While demographic research has focused on the role of formal childcare in easing this dilemma, evolutionary theory points to the importance of kin. The cooperative breeding hypothesis states that the wider kin group has facilitated women's reproduction during our evolutionary history. This mechanism has been demonstrated in pre-industrial societies, but there is no direct evidence of beneficial effects of kin's support on parents' reproduction in modern societies. Using three-generation longitudinal data anchored in a sample of grandparents aged 55 and over in 1992 in the Netherlands, we show that childcare support from grandparents increases the probability that parents have additional children in the next 8 to 10 years. Grandparental childcare provided to a nephew or niece of childless children did not significantly increase the probability that those children started a family. These results suggest that childcare support by grandparents can enhance their children's reproductive success in modern societies and is an important factor in people's fertility decisions, along with the availability of formal childcare.

Socio-economic status by rapid appraisal is highly correlated with mortality risks in rural Africa.

Socio-economic status is an important determinant of health and survival in rural Africa and necessitates a practical and valid instrument to implement in health studies. Our objective was to investigate the validity of the rapid appraisal method to assess socio-economic status and its ability to identify individuals at risk. Among 1573 households in rural northern Ghana, we calculated the Demographic Health Survey (DHS) wealth index and conducted two rapid appraisal methods: self-reported wealth and interviewer-reported wealth. In addition we followed the 25,184 participants from these households for survival with a mean follow-up of 3.9 years, during which 885 participants died. The DHS wealth index was moderately correlated to self-reported wealth (Spearman's rho 0.59, P<0.001) and interviewer-reported wealth (Spearman's rho 0.75, P<0.001). Mortality risks were significantly higher for people with lower than average self-reported wealth [hazard ratio (HR) 1.30 (95% CI 1.11-1.51)] and lower interviewer-reported wealth [HR 1.40 (95% CI 1.21-1.62)]. Mortality risks were lower for people with higher self-reported wealth [HR 0.81 (95% CI 0.32-2.03)] and higher interviewer-reported wealth [HR 0.84 (95% CI 0.58-1.21)]. Similar discriminative mortality risks were assessed when using tertiles of the DHS wealth index (Ptrend<0.001).

Adaptive strategies after health decline in later life: increasing the person-environment fit by adjusting the social and physical environment.

Following the press-competence model (PCM) of Lawton and associates, we tested two expectations as to the adaptations older adults make to their socio-physical environment following health decline: (1) depending on the change in their functional limitations, older adults use adaptive strategies ranging from mobilizing informal care to moving into a residential setting; (2) the more people succeed in realizing suitable adaptations, the higher their wellbeing, measured as depressive symptoms, after a health decline. Data come from two waves of a longitudinal study among Dutch people aged 60-85 and living independently at baseline (Longitudinal Aging Study Amsterdam, LASA). The 819 respondents with a decline in self-reported functional disability within 3 years time were selected for analysis. Results of multivariate logistic and regression analyses show that (1) all adaptive strategies under study occur in response to health decline; (2) mobilization of informal care and moving to a care setting alleviates the negative effect of health decline on depressive symptoms. Furthermore, mobilization of professional home care was associated with more depressive symptoms independent of health decline, whereas adjustment of the home had no effect on depressive symptoms. We argue that some support was found for Lawton's PCM, but that evidence can be improved by studying more closely which adaptive strategies alleviate the environmental stress induced by specific physical disabilities.