Health behaviours and well-being among older adults with a Surinamese migration background in the Netherlands.

BACKGROUND: This study aims to identify the relationships between health behaviours (healthy diet, physical activity, not smoking and social activity) and well-being among older adults with a Surinamese background. METHODS: Community-dwelling older adults (≥ 70 years) with a Surinamese background living in Rotterdam, the Netherlands, were identified by the municipal register. A survey study was conducted to assess background information, health behaviours (healthy diet, physical activity, not smoking and social activity) and well-being. Multiple regression analyses were performed to assess the relationships of health behaviours with well-being while controlling for background characteristics. RESULTS: Average age of participants was 76.2 (4.9) years, slightly more than half of them were female (54.2%). Almost half of the participants had a low-income level (49.6%). More than half of the participants met the Dutch guidelines of fruit intake (63.0%) and vegetable intake (62.8%). Less than half of the participants met the guidelines of fish intake (40.9%) and physical activity (39.8%). The majority of the participants were non-smokers (87.9%). Most of the participants had daily contact with family/friends (90.9%) and slightly more than half of the participants visited family/friends often (53.6%). Looking at the health behaviours, a positive relationship was found between eating enough fruit (ß = .109; p ≤ 0.05) and vegetables (ß = .135; p ≤ 0.01), physical activity (ß = .164; p ≤ 0.001) and often visiting family/friends (ß = .158; p ≤ 0.001) with well-being. CONCLUSION: This study suggests that next to traditional health behaviours also social activity is an essential health behaviour for the well-being of older Surinamese adults. Research about health promotion should expand its focus by including social activity as health behaviour.

Views of patients with obesity on person-centred care: A Q-methodology study.

INTRODUCTION: To better accommodate patients with obesity, the adoption of a person-centred approach to healthcare seems to be imperative. Eight dimensions are important for person-centred care (PCC): respect for patients' preferences, physical comfort, the coordination of care, emotional support, access to care, the continuity of care, the provision of information and education, and the involvement of family and friends. The aim of this study was to explore the views of patients with obesity on the relative importance of the dimensions of PCC. METHODS: Q methodology was used to study the viewpoints of 21 patients with obesity on PCC. Respondents were asked to rank 31 statements about the eight dimensions of PCC by level of personal significance. Using by-person factor analysis, distinct viewpoints were identified. Respondents' comments made while ranking were used to verify and refine the interpretation of the viewpoints. RESULTS: Five distinct viewpoints were identified: (1) 'someone who listens in an unbiased manner', (2) 'everything should run smoothly', (3) 'interpersonal communication is key', (4) 'I want my independence', and (5) 'support for myself and my loved ones'. Viewpoint 1 was supported by the largest number of respondents and explained the most variance in the data, followed by viewpoint 3 and the other viewpoints, respectively. CONCLUSION: Our findings highlight the need for tailored care in obesity treatment and shed light on aspects of care and support that are most important for patients with obesity. PATIENT CONTRIBUTION: Our sample consisted of patients. Patients were also involved in the development of the statement set through pilot testing.

Are self-management abilities beneficial for frail older people's cognitive functioning?

BACKGROUND: Self-management abilities seem to be important for the cognitive functioning of older people, especially those who are frail. We investigated relationships between broad self-management abilities (initiative taking, investment behavior, resource variety, resource multifunctionality, self-efficacy, and positive frame of mind) and cognitive functioning among frail older people while controlling for background characteristics (sex, age, marital status, and educational level). METHOD: Survey data were collected from mid-2014 to mid-2015 from community-dwelling frail older people residing in North Brabant, the Netherlands. We measured cognitive functioning with the 12-item Mini-Mental State Examination (MMSE-12) and self-management abilities with the short version of the Self-Management Ability Scale (SMAS-S). RESULTS: In total, 588 of 834 potential participants were willing to participate (70.5% response rate). The mean age was 82.33 ± 5.19 and the majority (68.5%) of respondents were female. About one-third (38.4%) of respondents had low educational levels and 61.7% lived alone. Mean MMSE-12 and SMAS-S scores were 9.68 ± 2.10 and 3.70 ± 0.88, respectively. Bivariate analyses showed that all six self-management abilities were related positively to cognitive functioning. Multivariate analyses with adjustment for background characteristics (sex, age, marital status, and educational level) showed that cognitive functioning was associated positively with initiative taking (ß = 0.23, p = 0.030) and investment behavior (ß = 0.24, p = 0.030) among community-dwelling frail older people. CONCLUSIONS: This study clearly showed that a repertoire of broad self-management abilities is related to cognitive functioning among community-dwelling frail older people. Initiative taking and investment behavior seem to be especially important. These findings are of interest in a time of populational aging and an increasing number of older people dealing with cognitive problems. Preventive investments in (older) people's self-management abilities are expected to be beneficial for their cognitive functioning in the long term.

Behaviour change interventions to promote health and well-being among older migrants: A systematic review.

BACKGROUND: Whether behaviour change interventions are effective for the maintenance of older migrants' health and well-being is uncertain. A systematic review was conducted to assess evidence for the capacity of behaviour change techniques (BCTs) to promote the health and well-being of older migrants. METHODS: Electronic databases (Cochrane CENTRAL, Embase, Ovid MEDLINE and Web of Science) were searched systematically to identify relevant randomised controlled trials, pre-post studies and quasi-experimental studies published before March 2021. Additional articles were identified through citation tracking. Studies examining BCTs used to promote the health and/or well-being of older migrants were eligible. Two independent reviewers used the Behaviour Change Technique Taxonomy version 1 to extract data on BCTs. Data on intervention functions (IFs) and cultural adaption strategies were also extracted. Intervention contents (BCTs, IFs, culture adaption strategies) were compared across effective and ineffective interventions according to health and well-being outcome clusters (anthropometrics, health behaviour, physical functioning, mental health and cognitive functioning, social functioning and generic health and well-being). RESULTS: Forty-three studies (23 randomised controlled trials, 13 pre-post studies and 7 quasi-experimental studies) reporting on 39 interventions met the inclusion criteria. Thirteen BCTs were identified as promising for at least one outcome cluster: goal-setting (behaviour), problem-solving, behavioural contract, self-monitoring of behaviour, social support (unspecified), instruction on how to perform the behaviour, information about health consequences, information about social and environmental consequences, demonstration of the behaviour, social comparison, behavioural practice/rehearsal, generalisation of a target behaviour and addition of objects to the environment. Three BCTs (instruction on how to perform the behaviour, demonstration of the behaviour, and social comparison) and two IFs (modelling and training) were identified as promising for all outcome clusters. CONCLUSIONS: Thirteen distinct BCTs are promising for use in future interventions to optimise health and well-being among older migrants. Future research should focus on the effectiveness of these BCTs (combinations) in various contexts and among different subgroups of older migrants, as well as the mechanisms through which they act. Given the scarcity of interventions in which cultural adaption has been taken into account, future behavioural change interventions should consider cultural appropriateness for various older migrant (sub)groups. TRIAL REGISTRATION: PROSPERO CRD42018112859.

Age-friendly communities and well-being realization among older native and immigrant populations in the Netherlands: a theory-guided study protocol.

BACKGROUND: With rapid population aging, policy makers and service providers are becoming increasingly aware of the importance of building and maintaining age-friendly communities. Clearly, "age-friendly" relates to the impact of context on people's well-being. But how? What is an age-friendly community, and does that differ for native and immigrant older people? Up until now, how native and immigrant older people in the Netherlands perceive community age-friendliness, and whether and how age-friendly communities help them realize well-being, remains unknown which limits opportunities to develop appropriate interventions. This article presents a study protocol to identify, theoretically and empirically, how and under what conditions age-friendly communities help native and immigrant older people in the Netherlands realize well-being. We present a theory-guided approach to elucidate differences in neighborhood age-friendliness and requirements for age-friendly community development between native Dutch and immigrant older people. Good interventions are built on good theory. The proposed research will add to theory building by systematically examining what older people get from their neighborhoods and the conditions that influence well-being realization, including the role of individual and neighborhood resources. We posit that physical and social well-being realization will be enhanced in age-friendly communities that support realization of multiple well-being needs and development of solidarity within and between groups in the neighborhood via cross-cutting sharing arrangements. METHODS: We present a mixed-methods design among native and immigrant older people (Turkish, Surinamese and Moroccan) consisting of: (i) Q-studies (combining in-depth interview-based and quantitative analyses); (ii) a pilot survey study; (iii) a main survey study in Rotterdam, the Hague, Utrecht, and Amsterdam; and (iv) focus groups. DISCUSSION: By exploring truly new ground in the field of age-friendly communities, the results of the proposed research will provide new empirical evidence, advance theory, and be helpful for the development of interventions aimed at improving age-friendliness and well-being for native and immigrant older populations, thereby contributing to resolving the societal challenges of caring for and supporting older people in the community.

Age-friendly neighbourhoods and physical activity of older Surinamese individuals in Rotterdam, the Netherlands.

BACKGROUND: Age-friendly neighbourhoods seem to promote physical activity among older individuals. Physical activity is especially important for chronically ill individuals. In the Netherlands, older Surinamese individuals are more likely to have chronic diseases than are their native Dutch counterparts. This study examined relationships of neighbourhood characteristics with physical activity among older Surinamese individuals in Rotterdam, the Netherlands. METHODS: Of 2749 potential participants, 697 (25%) community-dwelling older (age ≥ 70 years) Surinamese individuals living in Rotterdam, the Netherlands, completed a questionnaire on personal and neighbourhood characteristics between March and June 2020. Correlation and multilevel regression analyses were performed to identify associations between missing neighbourhood characteristics for ageing in place and physical activity. RESULTS: Scores for the neighbourhood domains communication and information (r = -0.099, p ≤ 0.05), community support and health services (r = -0.139, p ≤ 0.001), and respect and social inclusion (r = -0.141, p ≤ 0.001), correlated negatively with participants' PA. In the multilevel analysis, overall missing neighbourhood characteristics to age in place scores were associated negatively with physical activity (p ≤ 0.05). CONCLUSION: This study showed the importance of age-friendly neighbourhoods for physical activity among older Surinamese individuals in Rotterdam, the Netherlands. Our findings suggest that the neighbourhood plays an important role in supporting older individuals' leading of physically active lifestyles. Further research is needed to support the development of interventions to create age-friendly neighbourhoods.

Easier Said Than Done: Healthcare Professionals' Barriers to the Provision of Patient-Centered Primary Care to Patients with Multimorbidity.

Patient-centered care (PCC) has the potential to entail tailored primary care delivery according to the needs of patients with multimorbidity (two or more co-existing chronic conditions). To make primary care for these patients more patient centered, insight on healthcare professionals' perceived PCC implementation barriers is needed. In this study, healthcare professionals' perceived barriers to primary PCC delivery to patients with multimorbidity were investigated using a constructivist qualitative design based on semi-structured interviews with nine general and nurse practitioners from seven general practices in the Netherlands. Purposive sampling was used, and the interview content was analyzed to generate themes representing experienced barriers. Barriers were identified in all eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, emotional support, family and friends, continuity and transition, and coordination of care). They include difficulties achieving mutual understanding between patients and healthcare professionals, professionals' lack of training and education in new skills, data protection laws that impede adequate documentation and information sharing, time pressure, and conflicting financial incentives. These barriers pose true challenges to effective, sustainable PCC implementation at the patient, organizational, and national levels. Further improvement of primary care delivery to patients with multimorbidity is needed to overcome these barriers.

Associations of Social Cohesion and Socioeconomic Status with Health Behaviours among Middle-Aged and Older Chinese People.

Background: An understanding of factors associated with health behaviours is critical for the design of appropriate health promotion programmes. Important influences of social cohesion, education, and income on people's health behaviours have been recognised in Western countries. However, little is known about these influences in the older Chinese population. Objective: To investigate associations of social cohesion and socioeconomic status (SES) with health behaviours among middle-aged and older adults in China. Methods: We used data from the World Health Organization's Study on Global AGEing and Adult Health. Logistic regression and multivariate linear regression were performed. Results: Participants who reported greater social cohesion were more likely to have adequate vegetable and fruit (VF) consumption, be socially active, and less likely to smoke daily, but were not physically more active; participants with lower education levels were less likely to have adequate VF consumption and be socially active, and more likely to smoke daily; higher incomes were associated with decreased odds of daily smoking, increased odds of adequate VF consumption, increased likelihood to be socially active, but also less likelihood to have sufficient physical activity (PA). Associations of social cohesion and SES with health behaviours (smoking, PA, and VF consumption) differed between men and women. Discussion: Our findings are an essential step toward a fuller understanding of the roles of social cohesion and SES in protecting healthy behaviours among older adults.

Positive and negative ageing perceptions account for health differences between older immigrant and native populations in the Netherlands.

BACKGROUND: This study assessed the extent to which persistent differences in self-rated health (SRH) between older immigrants and natives are attributable to negative and positive ageing perceptions. METHODS: The study was conducted with three population groups in Rotterdam, the Netherlands: native Dutch people aged ≥70 years (n = 1150), Turkish immigrants aged ≥65 years (n = 680) and Moroccan immigrants aged ≥65 years (n = 292). To assess participants' internal ageing representations, we used the short Aging Perceptions Questionnaire, which distinguishes negative (consequences, chronic and cyclical timeline awareness, and emotional representations) and positive (positive consequences, positive and negative control) dimensions and has been validated in native and immigrant populations. We analysed differences in ageing perceptions between immigrants and natives and the associations of ageing perceptions with SRH. We used Karlson-Holm-Breen decomposition to assess ageing perceptions' mediation of the relationship between migration background and SRH. RESULTS: Older immigrants had stronger negative and weaker positive ageing perceptions (excepting the positive consequences of ageing) than did Dutch natives. Ageing perceptions mediated the relationship between migration background and SRH. SRH differences between Turkish immigrants and native Dutch older persons were explained mainly by differences in negative consequences and cyclical timeline awareness. SRH differences between Moroccan immigrants and native Dutch older persons were attributable mainly to differences in negative consequences and positive control. CONCLUSIONS: Differences in positive and negative ageing perceptions between older immigrants and natives in the Netherlands largely explained SRH differences between these population groups.

The Need for Co-Creation of Care with Multi-Morbidity Patients-A Longitudinal Perspective.

BACKGROUND: Primary care delivery for multimorbid patients is complex, due to single disease-oriented guidelines, complex care needs, time constraints and the involvement of multiple healthcare professionals. Co-creation of care, based on the quality of communication and relationships between healthcare professionals and patients, may therefore be valuable. This longitudinal study investigates the relationships of co-creation of care to physical and social well-being and satisfaction with care among multimorbid patients in primary care. METHODS: In 2017 and 2018, longitudinal surveys were conducted among multimorbid patients from seven primary care practices in Noord-Brabant, the Netherlands (n = 138, age = 73.50 ± 9.99). Paired sample t-tests and multivariate regression analyses were performed. (3) Results: Co-creation of care improved significantly over time (t = 2.25, p = 0.026), as did social well-being (t = 2.31, p = 0.022) and physical well-being (t = 2.72, p = 0.007) but not satisfaction with care (t = 0.18, p = 0.858). Improvements in co-creation of care from T0 to T1 were associated with social well-being (B = 0.157, p = 0.002), physical well-being (B = 0.216, p = 0.000) and satisfaction with care (B = 0.240, p = 0.000). (4) Conclusions: Thus, investment in co-creation of care by primary care practices may lead to better outcomes for multimorbid patients.

Self-management of patients with advanced cancer: A systematic review of experiences and attitudes.

BACKGROUND: Patients with advanced cancer are increasingly expected to self-manage. Thus far, this topic has received little systematic attention. AIM: To summarise studies describing self-management strategies of patients with advanced cancer and associated experiences and personal characteristics. Also, to summarise attitudes of relatives and healthcare professionals towards patient self-management. DESIGN: A systematic review including non-experimental quantitative and qualitative studies. Data were analysed using critical interpretive synthesis. Included studies were appraised on methodological quality and quality of reporting. DATA SOURCES: MEDLINE, Embase, Cochrane Central, PsycINFO, CINAHL, Web of Science and Google Scholar (until 11 June 2019). RESULTS: Of 1742 identified articles, 31 moderate-quality articles describing 8 quantitative and 23 qualitative studies were included. Patients with advanced cancer used self-management strategies in seven domains: medicine and pharmacology, lifestyle, mental health, social support, knowledge and information, navigation and coordination and medical decision-making (29 articles). Strategies were highly individual, sometimes ambivalent and dependent on social interactions. Older patients and patients with more depressive symptoms and lower levels of physical functioning, education and self-efficacy might have more difficulties with certain self-management strategies (six articles). Healthcare professionals perceived self-management as desirable and achievable if based on sufficient skills and knowledge and solid patient-professional partnerships (three articles). CONCLUSION: Self-management of patients with advanced cancer is highly personal and multifaceted. Strategies may be substitutional, additional or even conflicting compared to care provided by healthcare professionals. Self-management support can benefit from an individualised approach embedded in solid partnerships with relatives and healthcare professionals.

Views of professionals and volunteers in palliative care on patient-centred care: a Q-methodology study in the Netherlands.

BACKGROUND: Patients with palliative care needs, require support with their physical needs, but also with their emotional, spiritual and social needs. Patient-Centred Care (PCC) may help organizations to support these patients according to their needs and so improve the quality of care. PCC has been shown to consist of eight dimensions, including for instance access to care and continuity of care, but these eight dimensions may not be equally important in all care settings and to all patients. Furthermore, the views of those involved in care provision may affect the choices they make concerning care and support to patients. Therefore, insight into how professionals and volunteers involved in palliative care delivery view PCC is important for understanding and improving the quality of care in the palliative sector. METHODS: This study was conducted in the palliative care setting (hospices and hospitals) in the Netherlands. Views on palliative care were investigated using the Q-methodology. Participants were asked to rank 35 statements that represented the eight dimensions of PCC in palliative care settings, and to explain their ranking during a follow-up interview. Ranking data were analysed using by-person factor analysis. Interview materials were used to help interpret the resulting factors. RESULTS: The analysis revealed two distinct viewpoints on PCC in palliative care: 'The patient in the driver seat', particularly emphasizing the importance of patient autonomy during the last phase of life, and 'The patient in the passenger seat', focussed on the value of coordination between professionals, volunteers and patients. CONCLUSIONS: The most distinguishing aspect between views on PCC in palliative care concerned control; a preference for the patient in the driver's seat versus shared decision-making by a team consisting of patient, professionals and volunteers. Different types of care and support may be most adequate to satisfy the different needs and preferences of patients with either of these views.

Acculturation is associated with older Turkish immigrants' self-management abilities.

BACKGROUND: The few previous studies investigating acculturation and self-management have suggested that increased participation in (or adaptation to) the host culture is associated with better health and disease management. However, research on the relationship between acculturation strategies (attachment to the Dutch and Turkish cultures) and broader self-management abilities among older Turkish immigrants in the Netherlands is lacking. This study aimed to investigate this relationship in this population. METHODS: Turkish immigrants aged > 65 years and residing in Rotterdam, the Netherlands (n = 2350), were identified using the municipal register. In total, 680 respondents completed the questionnaire (32% response rate). RESULTS: The average age of the respondents was 72.90 (standard deviation, 5.02; range, 66-95) years and 47.6% of respondents were women. The majority (80.3%) of respondents reported having low educational levels. Women, single individuals, less-educated respondents, and those with multimorbidity experienced lower levels of attachment to the Dutch culture and reported poorer self-management abilities. Slightly stronger relationships were found between self-management and attachment to the Dutch culture than attachment to the Turkish culture. Multimorbidity negatively affected the self-management abilities of older Turkish people living in the Netherlands. CONCLUSIONS: The study findings indicate that especially attachment to the Dutch culture matters for the self-management abilities of older Turkish immigrants in the Netherlands. Given the high prevalence of multimorbidity in this population, investment in their self-management abilities is expected to be beneficial. Special attention is needed for women, single individuals, less-educated people, and those with multimorbidity. Interventions aiming to better integrate these groups into Dutch society are also expected to be beneficial for their self-management abilities.

Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons.

BACKGROUND: The article reports on the cost-effectiveness of the proactive, integrated primary care program Finding and Follow-up of Frail older persons (FFF) compared with usual primary care for community-dwelling frail older persons in the Netherlands. METHODS: This study had a matched quasi-experimental design (pretest and posttest). The economic evaluation was performed from a healthcare perspective with a time horizon of 12 months. The target population consisted of community-dwelling frail older persons aged ≥ 75 years in the FFF intervention group (11 general practitioner (GP) practices) and in the control group receiving usual care (4 GP practices). The effectiveness measures for the cost-effectiveness and cost-utility analyses were subjective well-being (Social Production Function Instrument for the Level of well-being short; SPF-ILs) and QALYs (EuroQol; EQ-5D-3L), respectively. Costs were assessed using resource use questionnaires. Differences in mean effectiveness between groups were assessed using univariate, multilevel and propensity score matched analyses, with and without imputation of missing values. Differences in costs were assessed using Mann-Whitney U-tests and independent samples t-tests. Bootstrapping was performed, and predicted incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were depicted on cost-effectiveness planes. RESULTS: The various analyses showed slightly different results with respect to differences in estimated costs and effects. Multilevel analyses showed a small but significant difference between the groups for well-being, in favor of the control group. No significant differences between groups in terms of QALYs were found. Imputed data showed that mean total costs were significantly higher in the intervention group at follow-up. CONCLUSION: Proactive, integrated care for community-dwelling frail older persons as provided in the FFF program is most likely not a cost-effective initiative, compared with usual primary care in the Netherlands, in terms of well-being and QALYs over a 12-month period.

Quality of primary care delivery and productive interactions among community-living frail older persons and their general practitioners and practice nurses.

BACKGROUND: Although there is evidence with respect to the effectiveness of Chronic Care Model (CCM)-based programs in terms of improved patient outcomes, less attention has been given to the effect of high-quality care on productivity of patient-professional interactions, especially among frail older persons. The aim of our study was therefore to examine whether frail community-dwelling older persons' perspectives on quality of primary care according to the dimensions of the CCM are associated with the productivity of the patient-professional interactions. METHODS: Our study was part of a large-scale evaluation study with a matched quasi-experimental design to compare outcomes of frail community-dwelling older persons that participated in a proactive, integrated primary care approach based on (elements of) the CCM and those that received usual primary care. Frail older persons' perceptions of quality of care were assessed with the Patient Assessment of Chronic Illness Care Short version (PACIC-S). Productive interactions with general practitioners (GPs) and practice nurses were assessed using a relational coproduction instrument. Measurements were performed at baseline (T0) and 12 months thereafter (T1). In total, 232 frail older persons were participating in the intervention group at T0 and matched to 232 frail older persons in the control group. At T1, 182 persons were in the intervention group and 176 in the control group. RESULTS: Paired sample t-tests showed significant improvements in overall quality of care, the majority of underlying quality of care items, and productive interactions within the intervention group and control group over time. Multilevel analyses revealed that productive interaction with the GP and practice nurse at T1 was significantly related to perceived productive interaction with them at T0, the perceived quality of primary care at T0, and the change in perceived quality of primary care over time (between T0 and T1). CONCLUSIONS: Frail community-dwelling older persons' perspectives on quality of primary care were associated with perceived productivity of their interactions with the GP and practice nurse in both the intervention group and the control group. We found no significant differences in overall perceived quality of care and perceived patient-professional interaction between the intervention group and control group at baseline and follow-up. In times of population aging it is necessary to invest in high-quality care delivery for frail older persons and productive interactions with them.

Enabling and disabling behaviors in the social environment are associated with physical Activity of older people in the Netherlands.

BACKGROUND: Although research clearly shows that physical activity has significant health benefits and contributes to the prevention of chronic disease onset, the vast majority of the world's population is insufficiently physically active, and the prevalence of insufficient physical activity is greatest in the population of older adults. The social environment may play an important role in shaping health behaviors, we however, lack knowledge regarding the exact influence of the social environment on older persons' physical activity levels. This research therefore aims to identify the relationships of physical activity to enabling and disabling behaviors in the social environment among older people in the Netherlands. METHODS: Participants were randomly sampled from the Rotterdam municipality register and stratified by age group (70-74, 75-79, 80-84, and ≥ 85 years) and neighborhood (district). Of 2798 respondents, 1280 (46%) returned filled-in questionnaires. The Perceived Social Influence on Health Behavior (PSI-HB) instrument was used to assess the degree to which individuals' health behavior is influenced by those around them. Respondents were additionally asked about enabling and disabling behaviors in their social environments and how many days per week they were physically active. Physical activity scores ranged from 0 (not being physically active for 30 min a day at all during the week) to 7 (being physically active every day of the week). Respondents with a score of ≥5 were considered to be physically active and those with a score of < 5 as physically inactive. RESULTS: Results revealed that increasing age significantly contributed to physical inactivity within this older population. Lower educational level significantly decreased the odds of physical activity. After controlling for background characteristics results show enabling behaviors and utilitarian social influence significantly increased the odds of physical activity while disabling behaviour of the social environment contributed to physical inactivity. No significant associations were found with perceived social influence aspects value-expressive influence and informational influence. CONCLUSION: Actual enabling and disabling behaviors of actors in older people's social environments seem relevant for their physical activity levels, in positive and negative ways. In promoting active aging, consideration of the role of the social environment and ensuring that it is supportive of older people's physical activity are important.

Influence of the organizational environment on challenging behaviour in people with intellectual disabilities: Professionals' views.

BACKGROUND: We examined the influence of the organizational environment on challenging behaviour in people with intellectual disabilities to increase understanding of the quality of support services for people with intellectual disabilities. METHOD: Twenty-one professionals and managers from four specialized Dutch disability service organizations were interviewed. Data were analysed with a grounded theory approach, using Bronfenbrenner's ecological theory as a sensitizing frame. RESULTS: The organizational environment (i.e., vision, values, sufficient resources) is related via the support service (i.e., providing stability, constant awareness) to residents' challenging behaviour and is also linked directly to challenging behaviour (e.g., living environment, values). Organizations are restricted by national regulations, negative media attention and changing societal values, which negatively influence quality of support. CONCLUSIONS: The creation of a supportive organizational environment for staff, who in turn can provide quality support services to residents with demanding care needs, was found to prevent challenging behaviour in people with intellectual disabilities.

Aging perceptions matter for the well-being of elderly Turkish migrants, especially among the chronically ill.

BACKGROUND: Research on cultural ideology with respect to aging perceptions leading to poorer health and well-being is necessary to improve the quality and effectiveness of (preventive) healthcare delivery in reaching immigrant elderly people and delivering care tailored to their needs. Despite the potential benefits of positive aging perceptions on well-being, there is a lack of empirical quantitative research on aging perceptions among elderly Turkish migrants. Therefore, the current study aimed to identify the importance of aging perceptions for the well-being of Turkish elderly in Rotterdam. METHODS: The current research is a large-scale quantitative study aimed at investigating the contribution of aging perceptions to well-being among elderly Turkish migrants in Rotterdam. All Turkish people aged > 65 years were identified using the Rotterdam municipal register and invited to participate in the study. In total, 680 Turkish respondents returned completed questionnaires (32% response rate). RESULTS: The average respondent age was 72.90 (SD, 5.02) (range, 66-95) years and approximately half of the respondents (47.6%) were women. The majority of the respondents was of a low education (80.3%) and reported a low income level (83.4%). The mean number of chronic diseases among study participants was 2.68 (SD, 1.87) (range, 0-10). Being female (p ≤ 0.01), being single (p ≤ 0.01), having a low education level (p ≤ 0.01) and number of chronic diseases (p ≤ 0.001) were negatively associated with well-being. In addition, negative perceptions on aging were negatively associated with well-being while positive perceptions on aging were positively associated with well-being. Stepwise regression analyses showed a mediating effect of perceptions of aging on the relationship between the number of chronic diseases and the well-being of study participants. CONCLUSIONS: Aging perceptions, especially perceived consequences of aging (both positive and negative), feelings of control (both positive and negative), and emotional representations are important to the well-being of Turkish elderly residing in the Netherlands. These results indicate the importance of the development of interventions in the perceptions on aging in the elderly Turkish population in Western Europe.

The importance of health behaviours and especially broader self-management abilities for older Turkish immigrants.

Background: This study aims to identify the relationships between health behaviours, self-management abilities, physical health, depressive symptoms and well-being among Turkish older immigrants. Methods: A total of 2350 older Turkish migrants aged > 65 years residing in Rotterdam, the Netherlands were identified using the municipal register of which 680 respondents completed the questionnaires (response rate of 32%). Results: Average age of the respondents was 72.90 (standard deviation 5.02) (range 66-95) years and about half of them were women (47.6%). The majority of respondents reported having a low education (80.3%), low income level (83.4%), is chronically ill (90.6%), overweight (86.5%) and about half obese (46.0%). More than half of the respondents eat enough fruit (58.2%) and vegetables per week (55.3%). About a third of the respondents smoke (33.5%) and 43.0% can be considered to be physically active. Looking at the health behaviours a weak positive relationship was found between eating enough vegetables and well-being (ß = 0.14; P = 0.017). In addition, weak relationships were found between physical activity and depressive symptoms (ß = -0.16; P = 0.007), smoking and depressive symptoms (ß = 0.16; P = 0.009) and self-management abilities and physical health (ß = 0.17; P = 0.015). Strongest relationships were found between self-management abilities and depressive symptoms (ß = -0.39; P < 0.001) and self-management abilities with overall well-being (ß = 0.49; P < 0.001). Conclusions: From this study, we can conclude that next to health behaviours broader self-management abilities to maintain overall well-being are important for Turkish older people. Interventions to improve self-management abilities may help Turkish older people better deal with function losses and chronic diseases as they age further.

Evaluating an integrated primary care approach to improve well-being among frail community-living older people: A theory-guided study protocol.

BACKGROUND: A major challenge in primary healthcare is the substantial increase in the proportion of frail community-dwelling older persons with long-term conditions and multiple complex needs. Consequently, a fundamental transformation of current models of primary care by means of implementing proactive integrated care is necessary. Therefore, an understanding of the effects of integrated primary care approaches and underlying mechanisms is essential. This article presents the design of a theory-based evaluation of an integrated primary care approach to improve well-being among frail community-living older adults, which is called "Finding and Follow-up of Frail older persons" (FFF). First, we present a theoretical model to facilitate a sound theory-guided evaluation of integrated primary care approaches for frail community-dwelling older people. The model incorporates interrelated elements of integrated primary care approaches (e.g. proactive case finding and self-management support). Efforts to improve primary care should integrate these promising components to assure productive patient-professional interactions and to improve well-being. Moreover, cognitive and behavioral components of healthcare professionals and patients are assumed to be important. Second, we present the design of the study to evaluate the FFF approach which consists of the following key components: (1) proactive case finding, (2) case management, (3) medication review, (4) self-management support, and (5) working in multidisciplinary care teams. METHODS: The longitudinal evaluation study has a matched quasi-experimental design with one pretest and one posttest (12 month follow-up) and is conducted in the Netherlands between 2014 and 2017. Both quantitative and qualitative methods are used to evaluate effectiveness, processes, and cost-effectiveness. In total, 250 frail older persons (75 years and older) of 11 GP (general practitioner) practices that implemented the FFF approach are compared with 250 frail older patients of 4 GP practices providing care as usual. In addition, data are collected from healthcare professionals. Outcome measures are based on our theoretical model. DISCUSSION: The proposed evaluation study will reveal insight into the (cost)effectiveness and underlying mechanisms of the proactive integrated primary care approach FFF. A major strength of the study is the comprehensive evaluation based on a theoretical framework. The quasi-experimental design presents some challenges.