Carolien H. M. Smits

Background: General practitioners (GPs) are advised to offer advance care planning (ACP) to people with dementia (PWD). In a randomized controlled trial, an educational intervention for GPs aimed at initiating and optimizing ACP proved to be effective. During the intervention most GPs were accompanied by their practice nurse (PN). To provide insights into the intervention’s successful components and what could be improved, we conducted a process evaluation and explored implementation, mechanisms of impact and contextual factors. Methods: We used the Medical Research Council guidance for process evaluations. Implementation was explored identifying reach and acceptability. We performed descriptive analyses of participants’ characteristics; selection, inclusion and intervention attendance; a GP post-intervention survey on initiating ACP; a post intervention focus group with trainers of the intervention. Mechanisms of impact were explored identifying adoption and appropriateness. We used: participants’ intervention ratings; a GP post-intervention survey on conducting ACP; ACP documentation in PWD’s medical files; post-intervention interviews with PWD/FC dyads. All data was used to identify contextual factors. Results: The intervention was implemented by a small percentage of the total Dutch GP population invited, who mostly included motivated PWD/FC dyads with relatively little burden, and PWD with limited cognitive decline. The mechanisms of impact for GPs were: interactively learning to initiate ACP with training actors with a heterogeneous group of GPs and PNs. For PWD/FCs dyads, discussing non-medical preferences was most essential regarding their SDM experience and QoL. Some dyads however found ACP stressful and not feasible. Younger female GPs more often initiated ACP. Male PWD and those with mild dementia more often had had ACP. These characteristics and the safe and intimate training setting, were important contextual facilitators. Conclusion: We recommend Interventions aimed at improving ACP initiation with PWD by GPs to include interactive components and discussion of non-medical preferences. A safe environment and a heterogeneous group of participants facilitates such interventions. However, in practice not all FC/PWD dyads will be ready to start. Therefore, it is necessary to check their willingness when ACP is offered.

Two Dutch undergraduate programs in applied gerontology have teamed up with older volunteers to educate students in collaborating with older adults in the field of age-friendly service development. The research question of this study was: What are the motives and meanings of the older volunteers concerning their participation in an undergraduate program? An explorative descriptive qualitative design was used to study the motives and meanings of the older volunteers through semi-structured interviews (n = 11) and a focus group interview (n = 4). Two themes and nine categories emerged: (1) Personal norms and values (categories: responsible life attitude, contribution, self-determination), (2) Personal gain (categories: intergenerational education, personal development, staying healthy, pleasure, feeling appreciated, feeling connected). Personal norms and values and personal gains are meaningful to older volunteers in applied gerontology education. Universities should respect these when designing measures for improving participation methods.

Background: The Care for Better Region program was developed to achieve sustainable care improvement focusing on fall prevention. Key ingredients involved improvement teams developing and implementing a falls reduction plan, Practice Development; facilitation of improvement teams by lecturers and undergraduate health care students; an implementation phase. This study evaluates the impact of this program on: (1) the number of falls incidents, and (2) the sustainability of care improvement practice.Methods: A realist evaluation design was used. Nine improvement teams participated in the Care for Better Region program. Staff members registered falls incidents in two measurement cycles in the participating teams (N = 143 older adults) and in a control group (N = 93). Data collection on improvement sustainability involved participative observations, interviews, logs of students and lecturer coaches, minutes and evaluations.Results: The falls incidents on the participating wards decreased over 12 months from 13.3% to 1.4%. At the control wards they stabilized. Sustainability of improvement practice: (1) Involvement of improvement teams was enhanced by measurements of falls incidents. However, involvement of ward staff was difficult to accomplish; (2) Students, lecturer coaches and project leaders of the improvement teams learned how to involve stakeholders, implement project management, and how to prevent falls incidents; (3) Network facilitation was promoted by the central meetings. The project leaders’ meetings continued after the project; (4) Students facilitated the improvement teams. The change of students after six and twelve months inspired the teams to renew their focus.Conclusions: This exploratory realist evaluation study shows how the Care for Better Region program improved sustainability of falls incidents reduction. The program also had a positive impact on the sustainability of improvement practice. Nursing education should focus on the development of innovation and facilitation skills in students. Nursing practice may improve by interdisciplinary collaboration with undergraduate health care education in care improvement programs.

The population of the Netherlands is aging, although it is still relatively young in comparison with the population of most other European countries. As Dutch society transitions from a welfare state to a society based more on individual responsibility, the increasingly well-educated and financially well-off elderly people wish to exert more control over their own lives. Research and education in the field of aging have grown rapidly over the past few decades, along with variety in research focus and methodology. In addition, funding organizations nowadays stress the importance of participation of older adults in research studies and the usability of research findings to society. Thus, academic and applied research is expected to thrive and contribute to the autonomy, health, and well-being of Dutch elders, while also providing insight into physical, mental, social, and financial aspects of aging. Thanks to these insights, public debate is focusing not only on the costs of health care and pensions but also on older generations’ autonomy and contributions to society.