Contact patterns of older adults with and without frailty in the Netherlands during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, social distancing measures were imposed to protect the population from exposure, especially older adults and people with frailty, who have the highest risk for severe outcomes. These restrictions greatly reduced contacts in the general population, but little was known about behaviour changes among older adults and people with frailty themselves. Our aim was to quantify how COVID-19 measures affected the contact behaviour of older adults and how this differed between older adults with and without frailty. METHODS: In 2021, a contact survey was carried out among people aged 70 years and older in the Netherlands. A random sample of persons per age group (70-74, 75-79, 80-84, 85-89, and 90 +) and gender was invited to participate, either during a period with stringent (April 2021) or moderate (October 2021) measures. Participants provided general information on themselves, including their frailty, and they reported characteristics of all persons with whom they had face-to-face contact on a given day over the course of a full week. RESULTS: In total, 720 community-dwelling older adults were included (overall response rate of 15%), who reported 16,505 contacts. During the survey period with moderate measures, participants without frailty had significantly more contacts outside their household than participants with frailty. Especially for females, frailty was a more informative predictor of the number of contacts than age. During the survey period with stringent measures, participants with and without frailty had significantly lower numbers of contacts compared to the survey period with moderate measures. The reduction of the number of contacts was largest for the eldest participants without frailty. As they interact mostly with adults of a similar high age who are likely frail, this reduction of the number of contacts indirectly protects older adults with frailty from SARS-CoV-2 exposure. CONCLUSIONS: The results of this study reveal that social distancing measures during the COVID-19 pandemic differentially affected the contact patterns of older adults with and without frailty. The reduction of contacts may have led to the direct protection of older adults in general but also to the indirect protection of older adults with frailty.

Taking care of older caregivers who lose control: The association between mastery and psychopathology.

OBJECTIVE: In Europe there is a growing number of informal caregivers above 55 years of age, some of whom experience high levels of psychological distress. Our aim is to investigate the prevalence of psychological distress and its association with perceived mastery among elderly informal caregivers. METHODS: In a large representative random sample of citizens from four cities in the Netherlands, we compared psychological distress among older and younger informal caregivers. Next, we selected informal caregivers aged 55 years and older (n = 2663). Mastery was measured by means of the Pearlin Mastery Scale and psychological distress by means of the Kessler psychological distress scale (K10). We presented weighted percentages and conducted multivariate logistic regression analyses. RESULTS: The prevalence of psychological distress was 41.9% among elderly informal caregivers, as opposed to 52.6% among younger informal caregivers. Among the older informal caregivers there was an association between insufficient sense of mastery and psychological distress (OR = 21.3; 95% CI = 12.8-35.5), which persisted after correction for covariates (OR = 4.9; 95% CI = 2.8-8.6). CONCLUSION: The association between insufficient sense of mastery and psychological distress in elderly caregivers is strong. Mastery should be considered a point of engagement for preventive interventions on caregiver distress.

Ethnic differences in functional limitations: a comparison of older migrants and native Dutch older population.

BACKGROUND: Although the older migrants population in Europe is expected to grow substantially in the coming years, there is little information about their health status and particularly functional limitations. This study examined the association of ethnicity and mobility, hearing and visual limitations in comparison to the general population in the Netherlands, and whether relevant characteristics explained the potential differences between older migrants and non-migrants. METHODS: Secondary data analysis of 12 652 subjects 55 years and older who participated in the health survey in the four largest Dutch cities. To establish limitations in vision, hearing and mobility, the Organization for Economic Co-operation and Development (OECD) questionnaire was used. Logistic regression analysis was used to examine the association between limitations and ethnic background, subsequently adjusting for demographic and socio-economic characteristics and relevant health- and lifestyle-related factors. RESULTS: Older migrants had higher prevalences of functional limitations. The age- and- gender adjusted ORs were 2 to 8-fold compared with older non-migrants. After adjusting for socioeconomic status and health-and lifestyle indicators, Moroccan, Turkish and Surinamese migrants still had increased ORs for visual limitations [ORs (95% CI), respectively: 2.48 (1.49-4.14), 3.08 (1.75-5.41) and 1.97 (1.33-2.91)] compared with the Dutch. For mobility limitations, only the Turkish migrants had an OR twice as high (2.19; 1.08-4.44) as the non-migrants. No significant differences were found between Antillean/Aruban migrants and non-migrants. CONCLUSIONS: Important ethnic inequalities exist in various functional limitations, particularly in vision. These results underline the importance of tailored preventive interventions in older migrants to detect and prevent these limitations at an early stage.

Contextual factors that shape uptake of COVID-19 preventive measures by persons of Ghanaian and Eritrean origin in the Netherlands: A focus group study.

OBJECTIVES: To explore the contextual factors that shape uptake of COVID-19 preventive measures, in specific migrant and ethnic minority populations, with a focus on migration-related, sociocultural and socioeconomic conditions. DESIGN: A qualitative design, consisting of three online focus group discussions. SETTING: This study was conducted amongst smaller, albeit substantial, migrant and minority ethnic populations in the Netherlands. PARTICIPANTS: A total of 25 participants (12 male; 13 female) of Ghanaian and Eritrean origin, purposively sampled to ensure diversity within groups, with regards to sex, age, educational level, occupation, household size and length of stay in the Netherlands. Focus group discussions were held online, therefore, experience in the use of video conferencing software was a prerequisite. RESULTS: Participants' awareness and knowledge of COVID-19 and COVID-19 preventive measures was shaped by migration-related factors, such as limited Dutch proficiency, by access to understandable information and interference of misinformation. Participants' engagement by COVID-19 preventive measures was subject to COVID-19 threat appraisal and the ease with which complex behavioural messages could be translated to individual situations. Lastly, a strong social norm to keep with cultural and religious practices, and limited opportunity for preventive behaviour in the work and home context hinder the uptake of preventive behaviour following a decision to act according to measures. CONCLUSIONS: Migration-related, sociocultural, and socioeconomic factors shape uptake of COVID-19 preventive measures amongst persons of Ghanaian and Eritrean origin in The Netherlands. To ensure equitable uptake our results suggest the importance of timely spread of multilingual information tailored to literacy needs; as well as, education and modelling delivered through online platforms and by leading figures in respective communities; and, regulations to ensure continued access to financial and material resources to minimise negative spill-over effects and exacerbation of inequality.

Ethnic Differences in Fall Risk Among Community-Dwelling Older People in the Netherlands.

OBJECTIVE: This study measures the prevalence of falls and fear of falling among a population sample aged ≥65 years from different ethnic minorities living in the Netherlands, and examines whether ethnicity contributed to the differences in fall risk. METHOD: We analyzed data from 8,892 Dutch, Moroccan, Turkish, and Surinamese participants. Descriptive statistics and multiple regression analyses were conducted with falls and fear of falling as the dependent variable and ethnicity as the independent variable. RESULTS: Moroccan, Turkish, and Surinamese older adults had a significantly higher odds ratio (OR) for fear of falling than their Dutch counterparts (OR = 2.13, 95% confidence interval [CI] = [1.05, 4.31]; OR = 2.09, 95% CI = [1.07, 4.09]; and OR = 2.49, 95% CI = [1.53, 4.03], respectively). The association between ethnicity and falling disappeared after controlling for socio-demographic and health characteristics. DISCUSSION: Dutch minority older adults were at higher risk for fear of falling than their Dutch counterparts. The study underlines the need for targeting culture-sensitive interventions.

A longitudinal study on determinants of HPV vaccination uptake in parents/guardians from different ethnic backgrounds in Amsterdam, the Netherlands.

BACKGROUND: Human papillomavirus (HPV) vaccination coverage in the Netherlands is low (~60%) compared to other childhood vaccinations (>90%), and even lower among ethnic minorities. The aim of this study was to explore the possible impact of ethnicity on the determinants of both HPV vaccination intention and HPV vaccination uptake among parents/guardians having a daughter that is invited for the HPV vaccination. METHODS: In February 2014, parents/guardians living in Amsterdam were invited to complete a questionnaire about social-psychological determinants of their decision making process regarding the HPV vaccination of their daughter and socio-demographic characteristics. This questionnaire was sent approximately one month before the daughter was scheduled to receive her first HPV vaccine dose. Their daughters' HPV vaccination status was retrieved from the national vaccination database. We distinguished four ethnic groups: Dutch (NL), Surinamese, Netherlands Antillean, and Aruban (SNA), Middle-Eastern and North-African (MENA), and Other. To assess the impact of determinants on both intention and uptake, linear and logistic regression analyses were used respectively. Missing data were imputed using multiple imputation by chained equation. RESULTS: In total 1,309 parents/guardians participated (33% participation rate). In all groups we found the mothers' intention to be the strongest predictor of their daughters' HPV vaccination uptake. Explained variance of uptake was highest in the NL-group (pseudo-R2:0.56) and lower in the other ethnic groups (pseudo-R2 varied between 0.23 and 0.29). The lower explained variance can be attributed to the relative large proportion of participants with a positive intention that finally did not go for vaccination in the SNA-group (11%) and MENA-group (30%). Explained variance (R2) of intention varied between 0.66 and 0.77 across ethnic groups, and was best explained by the proximal social-psychological determinants. The strength of association of these determinants with both intention and uptake were largely similar across ethnic groups. CONCLUSION: We conclude that the same determinants should be targeted in the different ethnic groups, although the mode of delivery of the intervention needs to be tailored to the different cultural backgrounds. Further research is needed to explain the observed discrepancy between intention and uptake, especially among parents/guardians in the non-Dutch groups.

The prevalence and impact of risk factors for ethnic differences in loneliness.

BACKGROUND: Previous studies have demonstrated that loneliness is more frequently present in citizens of ethnic minority groups than in natives. The current study investigates whether ethnic differences in emotional and social loneliness between Moroccan, Turkish, Surinamese and Dutch adults living in the Netherlands are due to ethnic differences in the presence and/or impact of an array of possible risk factors, such as partnership, health and socioeconomic status. METHODS: The data were collected in 2012 as a part of a general health questionnaire of the Public Health Services in the four major cities of the Netherlands, containing 20.047 Dutch, 1.043 Moroccan, 1.197 Turkish and 1.900 Surinamese respondents. RESULTS: Structural equation models showed that ethnic differences in emotional and social loneliness can be ascribed to ethnic differences in the prevalence and impact of several risk factors. Main findings were that all three ethnic minority groups reported feeling less healthy and more discriminated against than the Dutch group, which was related to increased loneliness. Perceived financial difficulties and people in the neighbourhood not getting along had more impact on feelings of loneliness for the Turkish group than loneliness for the other ethnic groups. Furthermore, members of the Turkish group were found more at risk to feel anxious or depressed, which was in turn related to increased loneliness. CONCLUSIONS: Policy makers are encouraged to develop multifaceted prevention strategies concerning those risk factors that are most changeable, thereby focusing per risk factor on those ethnic groups for which it is an important contribution to loneliness.

Intensified preventive care to reduce cardiovascular risk in healthcare centres located in deprived neighbourhoods: a randomized controlled trial.

BACKGROUND: We examined the effectiveness of a structured collaboration in general practice between a practice nurse, a peer health educator, the general practitioner (GP) and a GP assistant in providing intensified preventive care for patients at high risk of developing cardiovascular diseases. DESIGN: A randomized controlled trial in three healthcare centres (18 GPs) in deprived neighbourhoods of two major Dutch cities. METHODS: Two hundred seventy-five high-risk patients (30-70 years) from various ethnic groups were randomized to intervention (n=137) or usual care group (n=138). We determined group differences in outcomes [10-year absolute risk (Framingham risk equation), blood pressure, lipids and body mass index] at 12-month follow-up. RESULTS: The 10-year absolute risk was reduced by 1.76% (standard error: 0.81) in intervention and by 2.27% (standard error: 0.69) in usual care group; the difference in mean change was 0.88% [95% confidence interval: -1.16 to 2.93]. In both groups significant reductions were observed in the following individual risk factors: total cholesterol, total cholesterol/high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, with no relevance between group differences. CONCLUSION: The cardiovascular risk profile of intervention and control patients improved after 1-year follow-up. However, no extra effect of the structured preventive care on the risk for cardiovascular diseases was achieved.

Different distribution of cardiovascular risk factors according to ethnicity: a study in a high risk population.

This study compares the distribution of cardiovascular risk factors in different ethnic groups at high risk of developing cardiovascular diseases within general practices. A total of 430 patients (179 Dutch, 126 Turks, 50 Surinamese, 23 Moroccans, 23 Antilleans and 29 from other ethnic groups) were included in the study. Data collection consisted of questionnaires and physical and clinical examinations. 54% was female. The mean age was 53.1 (sd 9.9) years. There were important ethnic differences in the distribution of cardiovascular risk factors. Compared to the Dutch, ethnic minorities had significantly greater odds of being diabetic (OR = 3.2-19.4); but were less likely to smoke (OR = 0.10-0.53). Turkish individuals had a lower prevalence of hypercholesterolemia but were 2.4 times more likely to be obese than the Dutch. Hypertension was very common in all ethnic groups and no significant ethnic differences were found. These findings provide additional evidence of the need for tailored interventions for different ethnic groups in general practices.

Process evaluation of an intensified preventive intervention to reduce cardiovascular risk in general practices in deprived neighbourhoods.

BACKGROUND: A RCT, conducted to examine the effectiveness of a structured collaboration in general practice to provide intensified preventive care in patients at high cardiovascular risk yielded no effect in the total group but differences across healthcare centres and ethnic groups become apparent. We conducted a process evaluation to explain these differences. METHODS: We assessed the reach of the target group and whether key intervention components (individual educational sessions, structured team meetings, and risk assessments) were performed as planned (maximum score for protocol completion is 11). RESULTS: The reach was initially 91%, but only a minority of patients completed the intervention activities as planned. The average score of the number of intervention components was low (5.66 out of 11 (sd 2.8)) and varied between centres (4.84 to 7.40) and ethnic groups (4.89 to 7.38), with team meetings as the least implemented activity conform plan. CONCLUSION: This study indicates that adding a practice nurse and a peer health educator to the general practice did not seem to result in the desired collaboration between the healthcare personnel. Further research is needed to investigate the reasons behind the low participation rate of the patients in the intervention.

No evidence for marked ethnic differences in accuracy of self-reported diabetes, hypertension, and hypercholesterolemia.

OBJECTIVE: To assess whether the accuracy of self-reported diabetes, hypertension, and hypercholesterolemia in high-risk groups differs according to ethnicity. STUDY DESIGN AND SETTING: We analyzed data of 430 patients at high risk of cardiovascular disease from different ethnic origin, including Turkish, Surinamese, and Dutch. Risk factors based on self-reports were compared with data from medical records and with a gold standard based on clinical measurements. Proportions of concordance between self-reports and other methods and kappa statistics (kappa) were determined by ethnicity. RESULTS: Concordance between self-reports and other data sources was highest in diabetes and lowest for hypercholesterolemia. Agreement of self-reports was substantial to almost perfect for diabetes (kappa: 0.84-0.76), substantial to moderate for hypertension (kappa: 0.63-0.51), and moderate for hypercholesterolemia (kappa: 0.55-0.48). There was no statistically significant association between ethnicity and concordance, except for self-reporting of diabetes among Surinamese vs. Dutch indigenous patients (odds ratio=0.37; 95% confidence interval: 0.14-0.97). CONCLUSION: There are no marked ethnic differences in the accuracy of self-reports of diabetes, hypertension, and hypercholesterolemia in high-risk populations. Larger studies including multiple ethnic groups are needed to confirm these findings.