Robbert Huijsman

Background: Perceived community environment is important for shaping older people's participation in their communities and for their well-being. Social cohesion and social belonging are two important yet distinct dimensions of perceived community environment that may influence support-behaviour and well-being in different ways. However, previous studies often treated both belonging and support behaviour as components of social cohesion. As a result, the associations between social cohesion and belonging with support provision behaviors and well-being among community-dwelling older people remains underexplored. This study aims at addressing this gap. Methods: A longitudinal survey study design was employed. Data were collected among community-dwelling older people in the Netherlands across two waves with a six-month interval ( N = 675). Multivariate linear auto-regressions and cross-lagged panel models (CLPMs) were used to explore the longitudinal associations among support provision, social cohesion, social belonging, and well-being. Sensitivity analyses using change-score regressions were conducted to assess robustness at the intra-individual level. Results: We found that support provision, social cohesion, and social belonging were all positively associated with follow-up well-being. Cross-lagged analyses revealed distinct longitudinal relationships that, social cohesion at T0 was positively associated with increased support provision at T1, whereas social belonging at T0 was not. Sensitivity analyses confirmed that within-person increases in cohesion were associated with increases in support provision, while changes in belonging were not positively related to support changes. Conclusions: Our study offers a new understanding of how the community environment may influence older people's support behaviors. Findings suggest that social cohesion and social belonging play distinct roles in relation to support provision among older people. Practices aimed at facilitating mutual support and well-being may need to take specific roles of different dimensions of community environment into account.

Background: Although dementia research agendas increasingly prioritize dissemination and implementation (D&I) of research findings, there is still limited understanding of the role and activities of dementia research funders. Implementation science literature offers theories, frameworks and tools to integrate diverse stakeholder perspectives, supporting the translation of research evidence into practice and policy. This study identifies and categorizes the D&I strategies and related challenges, faced by public and private dementia research funders in the Netherlands. This study aims to provide evidence that clarifies the roles of public and private dementia research funders and offers guidance for planning and executing dementia research D&I. This study contributed to evidence and perspectives generated outside the traditional clinical settings, which are essential to advance implementation science. Methods: Semi-structured qualitative interviews were conducted with 20 individuals, selected through purposive snowball sampling. Respondents involved representatives of three public and four private funding agencies in the Netherlands. Interviews were conducted in-person or virtually, audio-recorded and transcribed verbatim. Data extraction and data analysis were conducted using an iterative abductive thematic coding approach on the basis of the methodology of Timmermans and Tavory. Results: The strategies and related challenges of public and private funders of dementia research were clustered into three themes: “dissemination”, “implementation support” and “research ecosystem capacity-building”. Strategies for dissemination and implementation support were facilitated through brokering knowledge and providing financial incentives, procedural guidance and action mandates. Public and private funders contributed significantly to research ecosystem capacity-building through strategies such as establishing research consortium models, implementation training programs and professional connective networks. Results suggested that both types of funders are guided by distinct value systems and contribute different resources and expertise to the D&I process. Collaborative capacity between public and private funders was hindered by D&I role ambiguity and conflicting value systems, which emphasizes the lack of insights in how and when to engage each type of funder in D&I. Conclusions: This study provides contextual insight into the opportunities to invest in developing D&I professional competencies and leveraging strategic public–private partnerships to optimize D&I processes. Future research could develop this research ecosystem concept to overcome persistent contextual D&I challenges.

Older adults residing in nursing home (NH) settings are at risk of loneliness, a complex and multi-dimensional concept that adversely affects health. To effectively identify and address loneliness, it is crucial to enhance the understanding of the social, psychological, cultural, and environmental factors associated with loneliness. A scoping review was conducted to examine the current evidence. Thematic analysis was employed to identify factors influencing (dimensions of) loneliness, which were ranked on proximity to loneliness. Based on 38 research papers, 27 factors related to loneliness were identified, of which 13 were sufficiently representative. A minority of these factors were directly linked to the social, emotional and existential dimensions of loneliness. The most frequently mentioned factors were categorised into the domains of health and functioning, stress-coping, social contact, and relationship quality. Loneliness is best addressed within the immediate social environment of NH settings, and staff play a crucial role in fostering a sense of belonging. Moreover, residents' experiences and needs regarding loneliness and its dimensions must be thoroughly assessed and discussed, particularly for those suffering from dementia. Furthermore, our review emphasises the urgent need for comprehensive, inclusive, and consistent research on loneliness in NH settings.

Background: Integrated care is enhanced by integration on system, organizational, professional, and clinical levels including functional and normative integration. Many studies have been done on functional integration on these different levels, less studies focus on how normative integration takes place. In this study, we focus on the question: what differences in frames of refence must be addressed to establish consensus on appropriate care for People with Multiple Problems? Methods: A mixed-method Delphi study was carried out in which professionals and managers regularly involved in care for people with multiple problems (PWMPs) worked towards consensus on appropriate care delivery through the assessment of 15 vignettes representing real trajectories of PWMPs. Results: No consensus on appropriate care delivery was reached on any of the 15 vignettes. Five differences in perspective explained the dissensus: 1) an individual versus a systemic perspective on the client; 2) a focus on self-expressed needs of clients or professionally assessed (normative) needs; 3) client-directed or caregiver-directed care; 4) client as victim of circumstances or responsible for circumstances; 5) a focus on barriers or opportunities. Conclusions: In general, panelists agreed that care for PWMPs should be integrated. However, the further integrated care was to be operationalized in practice the greater the dissensus between panelists emerged. To understand how these differences in perspectives may be overcome to provide care for PWMPs normative integration needs to be studied during actual processes of care delivery.

Dementia is one of the leading causes of death and disability among citizens and a societal challenge because of aging worldwide. As dementia has physical, psychological, social, material, and economic impacts, both research and care practice require many disciplines to develop and implement diagnostics, medical and psychosocial interventions, and support, crossing all domains of housing, public services, care, and cure. Notwithstanding large research efforts, much knowledge about mechanisms, interventions, and needs’ based care pathways is still lacking. To cope with these challenges in research and practice, this paper is the first to question how generalist and specialist orientations can be unfolded. In the Netherlands, all dementia professors (N = 44) at eight Dutch academic centers have been interviewed. Qualitative analyses revealed three subgroups of dementia professors, one with a generalist orientation, one adhering to specialist approaches, and a third group that pleas for mixed orientations, with some differences between research and care practice. Each group has arguments for its generalist/specialist vision, but the synthesis suggests a paradigm of personalized and integrated dementia care, aimed at the individual in his own living environment. Sustainable strategies to cope with dementia require (inter)national programs and strong collaboration to build multi- and interdisciplinarity within and between research and practice.

Purpose: This study examines the theoretical and empirical relationships between LM&SS, human resource management (HRM), climate for LM&SS and outcomes (employee well-being and performance) in hospitals. As part of this research, the authors examine the interplay between “hard” and “soft” practices for LM&SS and “soft” HR practices.Design/methodology/approach: A cross-sectional, multisite survey study covering all internal service units at all eight Dutch university hospitals was conducted (42 units, N = 218 supervisors, N = 1,668 employees), and multivariate multilevel regression analyses were performed.Findings: A systems approach involving “soft” LM&SS practices that are specifically HR-related has a positive effect (β is 0.46) on a climate for LM&SS. A climate for LM&SS is not related to perceived performance or employee health. It is, however, positively related to employee happiness and trusting relationships (both βs are 0.33). We did not find that a climate for LM&SS had a mediating effect.Research limitations/implications: This study shows that a balanced approach involving both “hard” and “soft” factors is crucial to achieving the desired breadth and depth of LM&SS adoption at the macro, meso, and micro levels. The authors found that a climate for LM&SS positively affects employee well-being in hospitals.Practical implications: In their attempt to create mutual gains for both their organization and their employees, hospitals that adopt LM&SS should foster a climate for LM&SS by embracing a balanced approach consisting of both “hard” and “soft” practices, thereby internalizing LM&SS at the macro, meso, and micro levels.Originality/value: This is one of the first studies to examine in-depth the impact of “hard” and “soft” LM&SS on both employee well-being (subdivided into different components) and performance in healthcare, as well as the role of “soft” HRM in this relationship. Linking LM&SS, HRM and outcomes to a climate for LM&SS is relatively a new approach and has led to a deeper understanding of the mechanisms underpinning the internalization of LM&SS in healthcare.

Older persons are vulnerable to depression SFduring the ageing process. Financial resources and social participation are expected to have an impact on depressive symptoms. This study investigated the relationship between financial support from children and depression among Chinese older persons, as well as the mediating effect of social participation in this relationship. Data from 7163 participants aged 60 and above were extracted from wave 2015 and 2018 of the China Health and Retirement Longitudinal Survey (CHARLS). A multivariate regression analysis was performed on both cross-sectional data and two-wave longitudinal data to test our hypotheses. The results revealed that financial support from children was negatively associated with depressive symptoms in both the short-term and the long-term. In addition, this relationship was partially mediated by social participation in the short-term association and fully mediated by social participation in the long-term, where financial support was positively related to social participation, and social participation was negatively associated with depressive symptoms. This study offers an in-depth insight into the relationship between financial support from children and depression among Chinese older persons. Policies and initiatives to stimulate social participation should be promoted to improve older persons’ mental health.

Cooperation is key to provide integrated dementia care. However, different kinds of (personal and organisational) interests will affect collaboration in integrated dementia care (IDC) networks. Hence, it is crucial to understand how interests influence relations in IDC-networks in order to shape future policies. A sequential mixed methods single case study design was used, in three phases: a Social Network Analysis (SNA) based on data from questionnaires (n = 24–26), explorative interviews with network partners (n = 14) and a focus group with network coordinators (n = 7) to explore the conceptual generalisability of the single case of the IDC-network. The SNA revealed that highly connected organisations were often established care organisations that deliver case management, while smaller care organisations or welfare organisations tend to be less connected. Care-related, strategic, and financial interests influence participation of organisations in the IDC-network, while personal intrinsic motivations determine a representative’s contribution to the network. Especially conflicting interests strongly influence the network structure. We conclude that conflicting interests in IDC-networks stand in the way of reaching the collective goal of an IDC-network, i.e., optimising the wellbeing of people with dementia and their informal caregivers in the region. Thus, IDC-networks should act to manage, resolve and prevent disputes arising from conflicting interests.

Background: Neuropsychiatric symptoms occur frequently in many nursing home residents with dementia. Despite the availability of multidisciplinary guidelines, neuropsychiatric symptoms are often inadequately managed. Three proven effective methods for managing neuropsychiatric symptoms were integrated into a single intervention method: the STIP-Method, a personalized integrated stepped-care method to prevent and treat neuropsychiatric symptoms. The STIP-Method comprises 5 phases of clinical reasoning to neuropsychiatric symptoms and 4 stepped-care interventions and is supported with a web application. Objective: This study aims to identify the facilitators and barriers in the implementation of the STIP-Method in nursing homes. Methods: A mixed methods design within a participatory action research was used to implement the STIP-Method in 4 facilities of 2 Dutch nursing home organizations. In total, we aimed at participation of 160-200 persons with dementia and expected an intervention fidelity of 50% or more, based on earlier studies regarding implementation of effective psychosocial interventions to manage neuropsychiatric symptoms. All involved managers and professionals were trained in the principles of the STIP-Method and in using the web application. An advisory board of professionals, managers, and informal caregivers in each facility supported the implementation during 21 months, including an intermission of 6 months due to the COVID-19 pandemic. In these 6-weekly advisory board meetings, 2 researchers stimulated the members to reflect on progress of the implementation by making use of available data from patient records and the web application. Additionally, the 2 researchers invited the members to suggest how to improve the implementation. Data analysis will involve (1) analysis of facilitators and barriers to the implementation derived from verbatim text reports of advisory board meetings to better understand the implementation process; (2) analysis of patient records in accordance with multidisciplinary guidelines to neuropsychiatric symptoms: personalized, interdisciplinary, and proactive management of neuropsychiatric symptoms; (3) evaluation of the web application in terms of usability scores; (4) pre- and postimplementation analysis of patient records and the web application to evaluate the impact of the STIP-Method, such as changes in neuropsychiatric symptoms and informal caregiver burden. Results: We enrolled 328 persons with dementia. Data collection started in July 2019 and ended in December 2021. The first version of this manuscript was submitted in October 2021. The first results of data analysis are expected to be published in December 2022 and final results in June 2023. Conclusions: Our study may increase understanding of facilitators and barriers to the prevention and treatment of neuropsychiatric symptoms in nursing home residents with dementia by implementing the integrated STIP-Method. The need for well-designed implementation studies is of importance to provide nursing homes with optimal tools to prevent and treat neuropsychiatric symptoms.