[Towards proactive and personalised care for the elderly]. / Op weg naar een proactieve en persoonsgerichte ouderenzorg.

The Netherlands, like other Western countries, shows an obvious demography of aging, which is associated with many challenges. People age differently, after all. Some remain vital until very old age, while others become frail and disabled much earlier in life. Because of the indicated demographic trend, morbidity is expected to increase and with it, the number of older people needing care. 'Aging in place' has become a central phenomenon in healthcare policies. This means that older people should be empowered to lead a meaningful life in their own living environment as long as possible, even when they are frail and care dependent. Therefore, in the future, most care for older people will actually occur at home. This article aims to present a meaningful care model for the older people. Starting from the 'definition discussion' about frailty and a revaluation of the concept of' resilience, a basis will be provided for a sustainable, proactive and personalised elderly care, close to the living environment of older people, in which dentists and other oral health professionals play an important role as well.

[Oral health in older adults, a challenge? Determinants of oral health in older adults.] / Mondzorg bij ouderen: een uitdaging? Determinanten voor mondgezondheid bij ouderen.

Current data show many older adults to have poor oral health, deteriorating even more when they become frail or care dependent. In order to achieve a structural and sustained improvement of this situation, it is necessary to have a clear view of the factors determining oral health in older adults, such as (endogenous (biological, lifestyle), environmental determinants and determinants associated with the organisation of healthcare. The various determinants show oral health in older adults is the result of thecombined effects of very diverse factors and for that reason, a solution will have to be based on a multidisciplinary approach, also involving people outside of clinical care. To promote good oral health over the full course of life, it is important to invest in a good start in life, that helps accumulate oral health gains, and at the same time it is essential to adapt the healthcare system and prevention strategies to the individual's needs in order to make oral care effective for the full course of life.

[Detection and prevention in later life: risk profiles for physical, psychological, social and environmental frailty.] / Detectie en preventie van kwetsbaarheid: Op zoek naar risicoprofielen voor fysieke, psychische, sociale en omgevingskwetsbaarheid.

In order to provide proactive care and support for older people attention is needed for the prevention of frailty among older adults. Subsequently, accurate case finding of those who are more at risk of becoming frail is crucial to undertake specific preventive actions. This study investigates frailty and risk profiles of frailty among older people in order to support proactive detection. Hereby, frailty is conceived not only as a physical problem, but also refers to emotional, social, and environmental hazards. Using data generated from the Belgian Ageing Studies (N = 21,664 home-dwelling older people), a multinomial logistic regression model was tested which included socio-demographic and socio-economic indicators as well as the four dimensions of frailty (physical, social, psychological and environmental). Findings indicate that for both men and women having moved in the previous 10 years and having a lower household income are risk factors of becoming multidimensional frail. However, studying the different frailty domains, several risk profiles arise (e. g. marital status is important for psychological frailty), and gender-specific risk groups are detected (e. g. non-married men). This paper elaborates on practical implications and formulates a number of future research recommendations to tackle frailty in an ageing society.

[Cooperation between nursing homes and intellectual disability care services : State of affairs in Flanders]. / Samenwerking tussen woonzorgcentra en voorzieningen voor personen met verstandelijke beperkingen : Een stand van zaken in Vlaanderen.

Considering the increasing life expectancy of people with intellectual disabilities (ID), the importance of cooperation between services for people with ID and elderly care services has been stressed in Flanders and the Netherlands, as well as internationally. However, the prevalence, intensity and content of such a cooperation are yet unknown. In order to gain information to address this issue, an online-survey was delivered to directors of all nursing homes in Flanders (n = 781). 229 surveys were completed.In more than 75% of the nursing homes, people with ID were among the residents over the past decade. However, at the same time a lack of expertise has been identified as a barrier to provide them optimal care and support. Hence, the respondents point out that a cooperation with ID care services could be beneficial. Nevertheless, those partnerships only arose in a quarter of the nursing homes so far, primarily for the purpose of exchange of expertise. Intersectoral multidisciplinary consultations and intersectoral care team consultations have been taking place as well, be it mainly in the context of a persons' transition from an ID care service to a nursing home. Until now, radical cooperations which involve an exchange of staff, seem to be rather rare.

The relationship between impulsivity and craving in alcohol dependent patients.

RATIONALE: Impulsivity and craving are both associated with higher relapse rates and a worse prognosis in patients with a substance use disorder, but the relationship between these two phenomena has been largely ignored in the field of alcohol use disorders. OBJECTIVES: The primary aim of this study was to investigate the relationship between different dimensions of impulsivity and different forms of self-reported craving. Additionally, the influence of the severity of alcohol dependence on impulsivity, craving, and on their relationship was exploed. METHODS: Impulsivity and craving levels were investigated in 87 abstinent alcohol-dependent (AD) patients using a broad range of self-report questionnaires and behavioral impulsivity measures. Alcohol use was measured by means of the timeline followback method. RESULTS: Higher scores of emotional craving (Alcohol Urge Questionnaire-AUQ) were significantly related to higher self-reported impulsivity (Barratt Impulsiveness Scale, version 11) and to higher cognitive impulsivity (information sampling task). Additionally, exploratory analyses suggest that these relationships are more pronounced in severe AD patients compared to less severe AD patients. No significant relationships were found between emotional craving (AUQ) and motor impulsivity (stop signal task) or delay discounting and between obsessive-compulsive craving (Obsessive Compulsive Drinking Scale) and measures of impulsivity. CONCLUSIONS: Emotional craving is related to self-reported impulsivity and to cognitive impulsivity. These relationships seem to be more pronounced in AD patients with severe alcohol dependence. Further research is needed to explore the effect of this relationship on treatment outcome and relapse.

The halo-shoulder brace and the mandibular-shoulder brace as postoperative supports following spinal fusion.

Bracing of the cervical spine in patients with rheumatoid arthritis, ankylosing spondylitis and instability due to metastases poses special problems. Because of asymmetry, a tender bony or cutaneous swelling or tender skin, difficulties arise in fitting a mass-produced brace. In order to overcome these difficulties a carefully moulded made-to-measure halo-shoulder brace and also a mandibular-shoulder brace were developed. The halo-shoulder brace (a halo connected with 4 rods to a shoulder girdle) provides an effective means of postoperatively controlling the unstable cervical spine until the graft unites. The brace is well tolerated by the patient and facilitates early postoperative mobility. The mandibular-shoulder brace (a similar shoulder girdle with a mandibular and an occipital part), also well tolerated by the patient, is used after the halo-shoulder brace during consolidation of the graft and also to support the neck in patients who for other reasons require a collar but who cannot tolerate a normal readymade appliance. The manufacture of the braces, their effectiveness and a series of 13 patients are described.