The association between frailty and quality of life when aging in place.

BACKGROUND AND OBJECTIVES: Advanced age is often associated with frailty, which in turn is associated with low quality of life. This study explores to what extent multidimensional frailty is associated with multidimensional quality of life. MATERIAL AND METHODS: A cross-sectional survey study was conducted in a sample of 336 Flemish older people aging in place. Data were collected between 2014 and 2016 using two multidimensional self-reporting instruments; the Comprehensive Frailty Assessment Instrument to assess frailty and the World Health Organization Quality of Life Instrument-Short Version to assess quality of life. Bivariate analyses were used to explore the relationship between quality of life, associated factors of quality of life and frailty. RESULTS: The mean age of the respondents was 74.9 years and 71.7% were woman. An inverse correlation was found between frailty and quality of life (r = -.683) and the corresponding subdomains. Nevertheless, some respondents perceived their quality of life as high, although they were defined as mild to high frail. Further analysis indicated that neither socio-demographic factors nor being ill contributed to quality of life. DISCUSSION AND IMPLICATIONS: Psychological frailty contributed the most to quality of life. However, the results indicate that frailty does not inevitably leads to a lower quality of life and that other factors, besides frailty, play an important role in determining quality of life. Knowledge about these factors and their mutual relationship can help policymakers and services in providing client-centered care to increase or maintain the quality of life of people aging in place.

The quality of life of older people aging in place: a literature review.

PURPOSE: In order to cope with the challenges that are the result of an aging population, policies and services promote keeping elders in the community and letting them age in place rather than sending them to specialized institutions. Aging in place refers to the option where people can stay in their homes as they age. This policy option, however, poses various challenges and may also threaten the quality of life of the aging. A literature review was performed on the quality of life of older people aging in place to determine whether the actual assessment of quality of life can be used within aging in place. METHODS: Web of Science, PubMed, CINAHL, Sociological Abstracts and Social Science Research Network were searched for publications on "Ag(e)ing in place" AND "Quality of life." RESULTS: Although assessment is crucial to a policy pursuing a good quality of life, literature reveals that it is seldom performed. Only a small part of the studies report on the assessment of quality of life, including the instruments used and the results. The findings also indicate that there is no consensus on the definition of quality of life or its domains structures. CONCLUSION: As no existing instrument assessing the quality of life of older people aging in place could be identified, such a tool should be developed, because any policy towards this growing group of people should be complemented by an evaluation.

Disability Policy Evaluation: Combining Logic Models and Systems Thinking.

Policy evaluation focuses on the assessment of policy-related personal, family, and societal changes or benefits that follow as a result of the interventions, services, and supports provided to those persons to whom the policy is directed. This article describes a systematic approach to policy evaluation based on an evaluation framework and an evaluation process that combine the use of logic models and systems thinking. The article also includes an example of how the framework and process have recently been used in policy development and evaluation in Flanders (Belgium), as well as four policy evaluation guidelines based on relevant published literature.

Evidence and Evidence-Based Practices: Are We There Yet?

The purpose of this article is to move the field of intellectual and closely related developmental disabilities (IDD) towards a better understanding of evidence and evidence-based practices. To that end, we discuss (a) different perspectives on and levels of evidence, (b) commonly used evidence-gathering strategies, (c) standards to evaluate evidence, (d) the distinction between internal and external validity, and (e) guidelines for establishing evidence-based practices. We also describe how the conceptualization and use of evidence and evidence-based practices are changing to accommodate recent trends in the field.

Substance use among individuals with intellectual disabilities living independently in Flanders.

BACKGROUND: Over the past decades, there has been increased scientific and clinical interest in substance use among individuals with intellectual disabilities (ID). Despite raised interest and awareness in the topic, lack of supportive data on prevalence and risk factors highlights the need for ongoing research. The aims of this cross-sectional multicenter study were to examine the nature and extent of substance use in individuals with ID living independently, to investigate group differences in substance use and related problems, and to explore the role of substance-related knowledge and attitudes in substance use behaviors. METHOD: Participants were 123 individuals with mild to moderate ID receiving support from independent living services. Data were gathered by means of a structured interview strategy (i.e. the Substance Use and Misuse in Intellectual Disability-Questionnaire; SumID-Q). RESULTS: Findings revealed that rates of lifetime use of licit and illicit substances were higher than those found in earlier studies among individuals with ID and the general population. While cannabis use was the only illicit substance reported, current tobacco and alcohol use were shown to be highly prevalent (48%-45.5%). Rates for the latter were similar to earlier studies among community samples of individuals with ID. In contrast to our hypotheses, few group differences in substance use behaviors were observed. Male gender was associated with age of onset of alcohol and tobacco use and tobacco use-related problems, while younger age was found to be associated with lifetime use of cannabis. No evidence was found regarding the role of knowledge; however, smokers and alcohol users rated tobacco and alcohol use more positively. CONCLUSION: This study demonstrated that individuals with ID living independently use a wide range of licit and illicit substances and present divergent levels and patterns of substance use. Notwithstanding the role of personal choice in substance use, more research is needed to better understand the nature and extent of substance use and related problems, as well as the role of substance-related knowledge and attitudes in individuals with ID.

Scale of emotional development-Short.

BACKGROUND: Intellectual disability (ID) is often accompanied by delays in emotional development (ED) that may result in challenging behavior. Insight into emotional functioning is crucial for appropriate diagnostic assessment in adults with ID. However, few standardized assessment instruments are available. AIMS: The aim of this study was to develop a short, psychometrically sound instrument for assessing levels of ED in individuals with ID: The Scale of Emotional Development - Short (SED-S), which can be applied to adults. METHODS AND PROCEDURES: The Scale for ED - Revised2 (SED-R2) was taken as a point of departure. In a first step, the validity and observability of the items (N=556) in the SED-R2 were assessed by 30 experts from Germany, Belgium, and The Netherlands. The SED-S was then constituted in a consecutive consensus process, in which items to be included were selected based on their assessments and subsequently rephrased, and in which the structure and method of administering the new scale were agreed upon. OUTCOMES AND RESULTS: The SED-S consists of 200 binary items describing five levels of emotional functioning (reference ages: 0-12 years) within eight domains: Relating to His/Her Own Body, Relating to Significant Others, Dealing with Change - Object Permanence, Differentiating Emotions, Relating to Peers, Engaging with the Material World, Communicating with Others, and Regulating Affect. CONCLUSIONS AND IMPLICATIONS: The SED-S offers an empirical-based, practical tool to assessing ED in adults with ID. Further research will be needed to meet the requirements of a standardized diagnostic instrument.

The Portuguese version of personal outcomes scale: a psychometric validity and reliability study.

This article presents the results of a pilot study to evaluate the psychometric properties of the Escala Pessoal de Resultados (EPR), the Portuguese version of the Personal Outcomes Scale (POS), to assess quality of life (QOL) in people with intellectual disability (ID) in Portugal. We present the adaptation and validation processes of the EPR. Data were collected from 1,264 adults with intermittent and limited levels of support needs and respective proxies. Results of the research are discussed in requisites of the validity and reliability. The different coefficients illustrate that this scale may be a useful addition to the QOL assessment in Portuguese people with ID.

Does performance management affect nurses' well-being?

AIM: This article focuses on employee performance-management practices in the healthcare sector. We specifically aim to contribute to a better understanding of the impact of employee performance-management practices on affective well-being of nurses in hospitals. Theory suggests that the features of employee-performance management (planning and evaluation of individual performances) predict affective well-being (in this study: job satisfaction and affective commitment). METHODS: Performance-management planning and evaluation and affective well-being were drawn from a survey of nurses at a Flemish hospital. Separate estimations were performed for different aspects of affective well-being. RESULTS: Performance planning has a negative effect on job satisfaction of nurses. Both vertical alignment and satisfaction with the employee performance-management system increase the affective well-being of nurses; however, the impact of vertical alignment differs for different aspects of affective well-being (i.e. job satisfaction and affective commitment). CONCLUSION: Performance-management planning and evaluation of nurses are associated with attitudinal outcomes. The results indicate that employee performance-management features have different impacts on different aspects of well-being.

Quality of life assessment in intellectual disabilities: the Escala Pessoal de Resultados versus the World Health Quality of Life-BREF.

The aim of this study is to compare the applications of the Escala Pessoal de Resultados (EPR) and the World Health Quality of Life-BREF (WHOQOL-BREF) in quality of life (QOL) assessment of people with intellectual disabilities (ID). A total of 216 adults with ID were assessed (age ranging from 18 to 64 years; 128 people were diagnosed with mild, and 88 with moderate ID). The two scales were administered to each person to obtain their perception about their QOL. Statistically significant correlations (weak to moderate) were observed between both scales. The EPR and the WHOQOL-BREF demonstrated adequate reliability, construct, and discriminant validity in our sample. However, the group of adults with moderate ID scored higher on the WHOQOL-BREF than on the EPR. Results indicated that the two assessment instruments aim to evaluate different measures, and seem to be not interchangeable.

An evidence-based approach to organization evaluation and change in human service organizations evaluation and program planning.

The work described in this article focuses primarily on how human service organizations can use an evidence-based, self-assessment approach to organization evaluation to facilitate continuous quality improvement and organization change. Real-life examples are presented, strengths and challenges discussed, and future conceptual and measurement issues identified.

Quality of life in persons with intellectual disabilities and mental health problems: an explorative study.

The field of intellectual disability (ID) is strongly influenced by the Quality of Life paradigm (QOL). We aimed at investigating whether or not the QOL paradigm also applies to clients with ID and cooccurring mental health problems. This paper aims at stimulating a debate on this topic, by investigating whether or not QOL domains are universal. Focus groups with natural and professional network members were organized to gather qualitative data, in order to answer two questions: (1) Are the QOL dimensions conceptualized in the model of Schalock et al. applicable for persons with ID and mental health problems? (2) What are indicators relating to the above-mentioned dimensions in relation to persons with ID and mental health problems? The results offer some proof for the assumption that the QOL construct seems to have universal properties. With regard to the second question, the study revealed that the natural and professional network members are challenged to look for the most appropriate support strategies, taking specific indicators of QOL into account. When aspects of empowerment and regulation are used in an integrated manner, the application of the QOL paradigm could lead to positive outcomes concerning self-determination, interdependence, social inclusion, and emotional development.

The use of evidence-based outcomes in systems and organizations providing services and supports to persons with intellectual disability.

This article describes how evidence-based outcomes (EBOs) can be used to improve clinical, managerial, and policy decisions. As a component of evidence-based practices, EBOs are defined as measures obtained from the assessment of quality of life-related indicators that are based on a cross-culturally validated quality of life conceptual and measurement model, have utility in that they can be used for multiple purposes, and have robustness in reference to reliability and validity of the assessment strategy employed. A 5-component EBO model is described that provides a framework for the activities involved in selecting, developing, and implementing evidence-based outcomes. Three international examples based on the reliable, valid, and standardized assessment of individual quality of life outcomes are presented that demonstrate how EBOs can be used to improve clinical, managerial, and policy decision making. The article concludes with a discussion of guidelines for developing and using EBOs, and the challenges involved in their use.

The influence of supports strategies, environmental factors, and client characteristics on quality of life-related personal outcomes.

The concept of quality of life (QOL) is increasingly being used as a support provision and outcomes evaluation framework in the field of intellectual disability (ID). The present study used a hierarchical multiple regression research design to determine the role that available supports strategies, environmental factors, and client characteristics play in assessed quality of life-related personal outcomes. Data were collected in Arduin Foundation in The Netherlands. Participants were 186 individuals with an intellectual disability. Results indicated that QOL-outcomes were significantly impacted by the availability of support strategies, living arrangement, status of employment and level of ID.

Person-centered planning: analysis of research and effectiveness.

Person-centered planning is a well known and widely used approach to individual program planning in the field of intellectual and developmental disabilities. Its purpose is to develop collaborative supports focused on community presence, community participation, positive relationships, respect, and competence. Because there is little research on its effectiveness, our purpose here was to (a) review the current status of effectiveness research; (b) describe its effectiveness in terms of outcomes or results; and (c) discuss the effectiveness of person-centered planning in relation to evidence-based practices. Analyzed studies suggest that, overall, this planning has a positive, but moderate, impact on personal outcomes for this population. The body of evidence provided in this review is weak with regard to criteria for evidence-based research.