Cees M. P. M. Hertogh

Background: The growing aging population and staff shortages are placing pressure on Dutch nursing homes (NHs). These challenges have led to an increased interest in digital health technologies. Among these are wearable devices that allow for remote continuous monitoring of vital signs. An example is the Healthdot (smartQare), a wearable electronic device that continuously monitors heart rate, respiratory rate, and physical activity. In the context of acute respiratory infections (ARIs) in NHs, where initial symptoms can go unnoticed, continuous monitoring may aid in early recognition, timely intervention, and reduce staff workloads. However, little is known about how health care professionals perceive the use of continuous vital signs monitoring devices, such as the Healthdot, for this cause in NHs. Objective: This study aims to explore the perspectives of healthcare professionals on the use of the Healthdot for early detection and monitoring of ARIs in NHs, to inform potential future implementation. Methods: Semistructured interviews were conducted with 20 physicians, nurses, and certified nursing assistants from 4 NHs and 1 acute geriatric community hospital located in a NH. Interview transcripts were thematically analyzed to identify themes regarding their perspectives on the use of the Healthdot for monitoring ARIs in this setting. Results: Five main themes were identified that related to the appropriate use of the Healthdot for NH clients and health care professionals: alignment of Healthdot use and NH clients’ treatment policies, balancing safety and freedom, impact of the Healthdot on work processes, supporting rather than replacing care, and possible use during pandemics and in the future. Additionally, several preconditions for the use of the Healthdot were identified, including its usability, a support base among care staff, adequate training and guidance, communication with NH clients and their relatives, and a clear policy regarding its use. Conclusions: Given the complexity of care in NHs, where clinical care is typically balanced against quality of life and a homelike environment, physicians generally expressed reserved attitudes toward the Healthdot, highlighting the need to consider multiple factors in its implementation. Care staff were generally positive about the device. Nevertheless, tailored assessment for each individual NH client remains essential, balancing treatment goals, safety, autonomy, and person-centered care. Additionally, clear communication and alignment between health care professionals in this setting are crucial, specifically regarding their expectations of the Healthdot’s role in care processes. This study offers practical guidance that may inform future implementation efforts of continuous vital sign monitoring devices in NHs.

This explorative study investigates the content of physical fitness training and changes in physical fitness and functioning in the current practice of orthopedic geriatric rehabilitation (GR) in the Netherlands. The content of physical fitness training was analyzed in 48 patients from 11 orthopedic GR wards, comparing it to general guidelines for older adults. Endurance, muscle strength, and functioning were measured at admission and discharge. Correlations between training volume and change in endurance, knee-extensor muscle strength, and physical functioning were assessed. Training characteristics varied substantially among individuals. Compared to guidelines, endurance time and intensity were low, and muscle strength training volume was low to moderate. Significant improvements (17.7-41.4%) in muscle strength and all measures of physical functioning were observed. Pain highly affected endurance outcomes in the majority of the patients. Patients not limited by pain showed no change in endurance. Only resistance training volume of the affected leg moderately correlated with change in muscle strength. Physical fitness training content varied and was generally low in intensity compared to guidelines. Its relation to fitness and functioning was limited. Future efforts should focus on improving training strategies and developing a valid measure of endurance.

Purpose: Geriatric rehabilitation is intended for older adults with vulnerability, comorbidity, and acute functional impairments. To explore and evaluate referral criteria, this study followed hospital patients referred for rehabilitation in nursing homes. Design: Exploratory, retrospective cohort study. Methods: Participants were community living before acute hospitalization and referred for geriatric rehabilitation between January 15 and May 15, 2019. Data were collected at hospital admission, hospital discharge, and discharge from rehabilitation-oriented care. Outcome measure was the final discharge destination. Results: Out of 87 hospital patients referred for rehabilitation (mean age = 76.3 years, SD = 10.7), 73 received rehabilitation-oriented post-acute care and 60 (82.2%) returned home after rehabilitation. Premorbid functional status was regained by 45 (61.6%) participants and mobility by 40 (54.8%). Independent baseline mobility, no complications during post-acute care, fewer cognitive symptoms, and multidomain vulnerability were associated with discharge destination after rehabilitation. Clinical Relevance to Rehabilitation Nursing: A multidomain assessment can make vulnerability applicable in referral decisions and induce tailored individual rehabilitation programs. Conclusion: This study explored the case-mix characteristics of hospital patients following rehabilitation trajectories. No frailty measures were available; vulnerability was refined into physical, cognitive, and social components. Careful assessment of vulnerability can support personalized referral decision-making.

To explore interrelations between cognitive, physical, affective, and daily functioning, quality of life and white matter hyperintensities (WMH) in a geriatric memory clinic sample. Participants received brain imaging, comprehensive geriatric assessment and neuropsychological evaluation including measurements of cognitive, physical, affective, and daily functioning and health-related quality of life. Data was analyzed using multiple linear regressions and network analysis using (moderated) mixed graphical models. The total sample included 932 patients (age: 79.6 ± 6.0, 49% women). In regression analyses, severe WMH (Fazekas 3) was associated with decreased cognitive (attention/speed, language) and physical functioning, more apathy symptoms and more (instrumental) activities of daily living dependency (All β's -0.40 to -0.24). Within the network analysis, daily functioning was directly associated with memory, attention/speed, and gait speed, while quality of life was associated with gait speed and affective functioning. WMH had no direct network associations with domains of functioning. Cognitive, physical, and affective changes associated with severe WMH co-occur with decreased daily functioning and lower quality of life in a geriatric memory clinic sample. However, relationships between domains of functioning are independent of WMH. This warrants a holistic and symptom-based approach in clinical care and post-diagnostic support.

The aim of this explorative, qualitative study is to identify factors that potentially influence the execution of physical fitness training in inpatient orthopedic geriatric rehabilitation (GR), from the perspectives of patients, their relatives and professionals. In GR wards of skilled nursing facilities in the Netherlands, semi-structured interviews were held with triads of patients, their relatives and responsible nurses, and focus groups with members of the multidisciplinary teams. Verbatim reports were analyzed according to the framework method. We found twelve categories of barriers and facilitators related to characteristics of the patients, their family, staff, training program and organization. The barriers and facilitators found largely correspond with those found for participation in exercise in related settings, but also show important differences. This overview of barriers and facilitators enables multidisciplinary teams to design improvements at the level of the organization and interventions, as well as at the level of the individual training program, tailoring it to the patient's circumstances and needs. Further research should focus on weighing these barriers and facilitators to develop a feasible guidance for daily practice, as well as testing their effect on the adherence to existing physical fitness training guidelines.

Background: Antibiotics are often inappropriately prescribed for urinary tract infections (UTIs) in nursing home (NH) residents. Research emphasises the importance of prescribing antibiotics only if there are UTI‐related signs and symptoms (S&S). However, for many NH residents it is challenging to find out whether such S&S are present, for example due to cognitive disorders.Objectives: To provide insight into the assessment of UTI‐related S&S in NH residents with impaired awareness or ability to communicate S&S, and to develop supportive tools for the observation of UTI‐related S&S in this subgroup of NH residents, by nursing staff.Methods: We performed a practice‐based study using mixed methods. Data of 295 cases of suspected UTI were analysed to determine how often UTI‐related S&S were ‘not assessed/non‐assessable’ in residents with and without dementia. Barriers and facilitators in observing UTI‐related S&S in NH residents with impaired awareness or ability to communicate S&S were derived from interviews and focus groups with nursing staff. Literature review, focus group data, additional telephone interviews and questionnaires with nursing staff were used in a step‐by‐step process, including pilot testing, to develop supportive tools for the observation of UTI‐related S&S.Results: UTI‐related S&S were assessable in the majority of NH residents with dementia. The proportion ‘not assessed/non‐assessable’ S&S in residents with dementia increased with increasing severity of dementia. In residents with very severe dementia, up to 58% of the S&S were ‘not assessed/non‐assessable’. Knowing the resident, working methodologically, and being sufficiently skilled to interpret observations in residents facilitate the assessment of UTI‐related S&S. Insights acquired during the different study elements resulted in the development of an observation checklist and a 24‐h observation tool.Conclusions: The more NH residents have impaired awareness of ability to communicate S&S, the more difficult it seems to be to assess UTI‐related S&S. The observation checklist and 24‐h observation tool developed in the current study may support nursing staff in their observation of UTI‐related S&S in this group of NH residents.

Background: Nurses are consistently present throughout the rehabilitation of older patients but are apprehensive about performing goal‐centred care in the multidisciplinary team.Objectives: The aim of this review was to explore working interventions on setting goals and working with goals designed for nurses in geriatric rehabilitation, and to describe their distinctive features.Methods: We performed a scoping review. We searched MEDLINE and CINAHL through August 4, 2021. Search terms related to the following themes: nurses, rehabilitation, geriatric, goal and method. We used snowballing to find additional. From the selected studies, we systematically extracted data on means, materials and the nursing role and summarized them in a narrative synthesis, using intervention component analysis.Results: The study includes 13 articles, describing 11 interventions which were developed for six different aims: improving multidisciplinary team care; increasing patient centredness; improving disease management by patients; improving the psychological, and emotional rehabilitation; increasing the nursing involvement in rehabilitation; or helping patients to achieve goals. The interventions appeal to four aspects of the nursing profession: assessing self‐care skills incorporating patient's preferences; setting goals with patients, taking into account personal needs and what is medically advisable; linking the needs of the patient with multidisciplinary professional treatment and vice versa; and thus, playing an intermediate role and supporting goal achievement.Conclusions: The interventions show that in goal‐centred care, the nurse might play an important unifying role between patients and the multidisciplinary team. With the support of nurses, the patient may become more aware of the rehabilitation process and transfer of ownership of treatment goals from the multidisciplinary team to the patient might be achieved. Not many interventions were found meant to support the nursing role. This may indicate a blind spot in the rehabilitation community to the additional value of its contribution.

Objectives To present an overview of effectiveness and training characteristics of physical training on aerobic fitness, compared with alternative or no training, in adults aged over 65 years with various health statuses, providing a basis for guidelines for aerobic training of vulnerable older adults that can be used in geriatric rehabilitation. Design An umbrella review of systematic reviews that included both randomised controlled trials and other types of trials. Data sources MEDLINE, Embase, CINAHL and the Cochrane Library were searched on 9 September 2019. Eligibility criteria for selecting studies We included systematic reviews reporting on physical training interventions that are expected to improve aerobic fitness, presenting results for adults aged 65 years and older, describing at least one of the FITT-characteristics: Frequency, Intensity, Time or Type of exercise, and measuring aerobic fitness at least before and after the intervention. Data extraction and synthesis Two independent reviewers extracted the data and assessed the risk of bias. A narrative synthesis was performed. Results We included 51 papers on 49 reviews. Positive effect of training on aerobic fitness was reported by 33 reviews, 11 reviews remained inconclusive and 5 reviews reported no effect. Training characteristics varied largely. Frequency: 1–35 sessions/week, Intensity: light–vigorous, Time: Conclusion Physical fitness training can be effective for vulnerable older adults. Exercise characteristics from current existing guidelines are widely applicable, although lower frequencies and intensities are also beneficial. For some conditions, adjustments are advised. PROSPERO registration number CRD42020140575.

Study Objective To provide an overview of patients' needs concerning goal‐setting, and indications of how those needs can be met by nurses. Methods A narrative review. Pubmed and Cinahl were searched through March 1, 2020 for: patients' experiences concerning goal‐setting and the role of nursing in rehabilitation. Additional articles were found through snowballing. A total of 22 articles were reviewed on patients' experiences, and 12 on the nursing role. Results Patients need to be prepared for collaborating in goal‐setting and to receive an explanation about their part in that process. The multiplicity of disciplines may cloud patients' understanding of the process. The nurse's planning of the rehabilitation process should be aimed at resolving this issue. Goals need to be meaningful, and patients need support in attaining them. The interpretive, integrative, and consoling functions of Kirkevold's nursing role are suitable to meet these needs. Conclusions Both the literature about patients' needs regarding goal‐setting and the nursing role make clear that the way nurses work in rehabilitation can gain in clarity. Strengthening the role of nurses will improve the goal‐setting process for patients. Interprofessional collaboration, clear work procedures, continuity of care, time and trust, and the physical environment all are important to reinforce this role.