The complex nature of boundary work in arts and health: a reflective journey in a social design project.

BACKGROUND: There is an increased interest in the role artists can play in care for older people. This momentum comes with the need to closer investigate the nature of boundary work of creative professionals in arts and health projects. METHODS: We conducted a responsive evaluation to provide a thick description of the boundary work involved in ENCOUNTER#9, an intergenerational arts project taking place within an older person care setting. RESULTS: Boundary work proved to be rewarding, yet messy and unruly. Although the lead artist had carefully planned and prepared the project and gained a broad commitment, not everything went according to plan. This led to friction and all involved put effort into adjusting goals and expectations. CONCLUSION: We add to the conceptualisation of boundary work in arts and health by showing that it takes place on different levels: personal, relational, organisational and public.

Toward Age-Friendly Policies: Using the Framework of Age-Friendliness to Evaluate the COVID-19 Measures from the Perspectives of Older People in the Netherlands.

Protective measures that were taken during the COVID-19 pandemic, targeted older people as an at-risk group. The objective of this article is to investigate how older people in the Netherlands experienced the mitigation measures and whether these measures endorse and promote the idea of an age-friendly world. The WHO conceptual framework of age-friendliness, which consists of eight areas, has been used for a framework analysis of 74 semi-structured interviews with older Dutch adults, that were held during the first and the second wave of the pandemic. The results of the analysis indicate that the areas of social participation, respect and inclusion were affected most, and the measures concerning communication and the health services were experienced as age-unfriendly. The WHO framework is a promising tool for assessment of social policies, and we suggest its further development for this purpose.

Collective Prevention of Non-Communicable Diseases in an Ageing Population with Community Care.

The Dutch population is rapidly ageing, and a growing number of people are suffering from age-related health problems such as obesity, cardiovascular diseases and diabetes. These diseases can be prevented or delayed by adapting healthy behaviours. However, making long-lasting lifestyle changes has proven to be challenging and most individual-based lifestyle interventions have not been effective on the long-term. Prevention programs focused on lifestyle should involve the physical and social context of individuals, because the (social) environment plays a large role in both conscious and unconscious lifestyle choices. Collective prevention programmes are promising strategies to mobilize the potential of the (social) environment. However, little is known about how such collective prevention programs could work in practice. Together with community care organization Buurtzorg, we have started a 5 year evaluation project to study how collective prevention can be practised in communities. In this paper, we discuss the potential of collective prevention and explain the methods and goals of our study.

Good Care during COVID-19: A Narrative Approach to Care Home Staff's Experiences of the Pandemic.

Due to its major impact on Dutch care homes for older people, the COVID-19 pandemic has presented care staff with unprecedented challenges. Studies investigating the experiences of care staff during the COVID-19 pandemic have shown its negative impact on their wellbeing. We aimed to supplement this knowledge by taking a narrative approach. We drew upon 424 personal narratives written by care staff during their work in a Dutch care home during the COVID-19 pandemic. Firstly, our results show that care staff have a relational-moral approach to good care. Residents' wellbeing is their main focus, which they try to achieve through personal relationships within the triad of care staff-resident-significant others (SOs). Secondly, our results indicate that caregivers experience the COVID-19 mitigation measures as obstructions to relational-moral good care, as they limit residents' wellbeing, damage the triadic care staff-residents-SOs relationship and leave no room for dialogue about good care. Thirdly, the results show that care staff experiences internal conflict when enforcing the mitigation measures, as the measures contrast with their relational-moral approach to care. We conclude that decisions about mitigation measures should be the result of a dialogic process on multiple levels so that a desired balance between practical good care and relational-moral good care can be determined.

The Value of Active Arts Engagement on Health and Well-Being of Older Adults: A Nation-Wide Participatory Study.

An emerging body of research indicates that active arts engagement can enhance older adults' health and experienced well-being, but scientific evidence is still fragmented. There is a research gap in understanding arts engagement grounded in a multidimensional conceptualization of the value of health and well-being from older participants' perspectives. This Dutch nation-wide study aimed to explore the broader value of arts engagement on older people's perceived health and well-being in 18 participatory arts-based projects (dance, music, singing, theater, visual arts, video, and spoken word) for community-dwelling older adults and those living in long term care facilities. In this study, we followed a participatory design with narrative- and arts-based inquiry. We gathered micro-narratives from older people and their (in)formal caregivers (n = 470). The findings demonstrate that arts engagement, according to participants, resulted in (1) positive feelings, (2) personal and artistic growth, and (3) increased meaningful social interactions. This study concludes that art-based practices promote older people's experienced well-being and increase the quality of life of older people. This study emphasizes the intrinsic value of arts engagement and has implications for research and evaluation of arts engagement.

How young adults view older people: Exploring the pathways of constructing a group image after participation in an intergenerational programme.

In recent years, a multitude of intergenerational contact programmes and interventions has emerged to counteract ageism among young adults. Research on these programmes and its supposed effect on ageism often start from the assumption that intergenerational contact follows a largely linear process in which a high level of encounters, in the right setting, decreases ageism and negative stereotyping. The purpose of this article is to critically examine this assumption by focussing on the underlying process of intergenerational contact, rather than examining the positive or negative outcome. Using in-depth interviews with 35 young adults, we found that although conditions and mediating factors during the contact do play a role in the outcome of intergroup contact, the process of contact is rather varied and does not follow a linear path. The results reveal that whether or not a positive contact experience translates into a changed group image of older people is related to the positioning of such experience within the young adults' personal frame of reference. We found that this has to do with the young adults having diverse and both positive and negative previous experiences, their grandparent-grandchild relationship, stories from others and personal characteristics. With this study, we point to the complexity of intergenerational contact and highlight potential pathways leading to varying group images of 'the old'.

Coping of Older Adults in Times of COVID-19: Considerations of Temporality Among Dutch Older Adults.

OBJECTIVES: Globally, mitigation measures during the coronavirus disease 2019 (COVID-19) pandemic have focused on protecting older adults. Earlier disaster studies have shown the importance of including older peoples' voices to prevent secondary stressors, yet these voices have received little attention during this pandemic. Here, we explore how Dutch older adults view this crisis and cope with measures to contribute to our understanding of coping of older adults in general and during disaster situations more specifically. METHOD: Qualitative study using semistructured telephone interviews with 59 diverse older adults aged 54-95 throughout the Netherlands. RESULTS: Older adults typify this crisis as ungraspable, disrupting their daily and social lives. Despite filling their lives with activities, they experience loss or lack of purpose. They try to follow measures to decrease infection risk and gain control, and use problem- and emotion-focused coping strategies. Emotion-focused strategies used were interpreting their personal vulnerability, self-enhancing comparisons, acceptance, and distraction. In the latter 2 strategies, the temporary nature of measures was emphasized. DISCUSSION: Older adults describe this crisis consistently with earlier findings from disaster studies. They use known coping strategies, but emphasize the duration in relation to their expectation of temporality. This underscores a dynamic, processual approach toward coping that incorporates temporal dimensions such as duration and order. Our findings stress the importance of acknowledging heterogeneity among older adults and adjusting communication about mitigation measures to decrease insecurity and increase resonance. This may make COVID-19 mitigation measures more manageable and age-responsible and allow older adults to start living again.

Correction: Intergenerational transmission of child maltreatment using a multi-informant multi-generation family design.

[This corrects the article DOI: 10.1371/journal.pone.0225839.].

Intergenerational transmission of child maltreatment using a multi-informant multi-generation family design.

In the current study a three-generational design was used to investigate intergenerational transmission of child maltreatment (ITCM) using multiple sources of information on child maltreatment: mothers, fathers and children. A total of 395 individuals from 63 families reported on maltreatment. Principal Component Analysis (PCA) was used to combine data from mother, father and child about maltreatment that the child had experienced. This established components reflecting the convergent as well as the unique reports of father, mother and child on the occurrence of maltreatment. Next, we tested ITCM using the multi-informant approach and compared the results to those of two more common approaches: ITCM based on one reporter and ITCM based on different reporters from each generation. Results of our multi-informant approach showed that a component reflecting convergence between mother, father, and child reports explained most of the variance in experienced maltreatment. For abuse, intergenerational transmission was consistently found across approaches. In contrast, intergenerational transmission of neglect was only found using the perspective of a single reporter, indicating that transmission of neglect might be driven by reporter effects. In conclusion, the present results suggest that including multiple informants may be necessary to obtain more valid estimates of ITCM.

Estimating the Heritability of Experiencing Child Maltreatment in an Extended Family Design.

Child-driven genetic factors can contribute to negative parenting and may increase the risk of being maltreated. Experiencing childhood maltreatment may be partly heritable, but results of twin studies are mixed. In the current study, we used a cross-sectional extended family design to estimate genetic and environmental effects on experiencing child maltreatment. The sample consisted of 395 individuals (225 women; Mage = 38.85 years, rangeage = 7-88 years) from 63 families with two or three participating generations. Participants were oversampled for experienced maltreatment. Self-reported experienced child maltreatment was measured using a questionnaire assessing physical and emotional abuse, and physical and emotional neglect. All maltreatment phenotypes were partly heritable with percentages for h2 ranging from 30% (SE = 13%) for neglect to 62% (SE = 19%) for severe physical abuse. Common environmental effects (c2) explained a statistically significant proportion of variance for all phenotypes except for the experience of severe physical abuse (c2 = 9%, SE = 13%, p = .26). The genetic correlation between abuse and neglect was ρg = .73 (p = .02). Common environmental variance increased as socioeconomic status (SES) decreased (p = .05), but additive genetic and unique environmental variances were constant across different levels of SES.

The Experience of Aging and Perceptions of "Aging Well" Among Older Migrants in the Netherlands.

BACKGROUND AND OBJECTIVES: In this study, we examine the experience of aging and subjective views of what it means to age well among older adults with a migrant background in the Netherlands. We embed the study within the successful aging debate and tackle two of its most persistent critiques: the failure to adequately include subjective views in the definition of aging well and the failure to recognize that the process of aging is culturally determined. RESEARCH DESIGN AND METHODS: The research draws on qualitative data collected through eight focus-group discussions with the six largest migrant groups in the Netherlands, namely Indo-Dutch and Moluccans, and migrants with Western, Surinamese, Antillean, Turkish, and Moroccan background. RESULTS: The study findings show that in general older migrants experience aging more positively than commonly assumed. Nevertheless, some negative aspects of aging were also mentioned. These together with fears about the future underpin participants' perceptions about aging well. Key aspects of successful aging include remaining healthy, independent, and engaged. Differences between and within groups exist in the meaning given to these concepts and the extent to which other specific aging-related wishes were mentioned. These differences are rooted in participants' experiences of the migration event, employment history, and their current socioeconomic conditions. DISCUSSION AND IMPLICATIONS: We conclude that the life course perspective is essential in understanding migrants' aging process and their views on successful aging, and suggest that policies and interventions which promote disease prevention and tackle social exclusion will be beneficial for older adults with a migration background.

Do psychosocial factors modify the negative association between disability and life satisfaction in old age?

CONTEXT: Many assume that having poor physical health in old age lowers life satisfaction, but in fact there are large differences in life satisfaction among older people who experience disability. OBJECTIVE: To investigate whether psychosocial factors modify the negative association between disability and life satisfaction in older people and whether these differ across the life course. DESIGN: Cross sectional study. SETTING: 66,561 community-dwelling Survey of Health, Ageing, and Retirement in Europe (SHARE) participants aged 50-106 with a mean age of 67.8 ± 9.9 (SD) years from 17 European countries and Israel. METHODS: Psychosocial factors included depression (EURO-D scale), perceived loneliness, having a spouse, having children, contact with children, and participation in social activities. Disability was assessed by limitations in (Instrumental) Activities of Daily Living ((I)ADL) and life satisfaction by Cantril's ladder. We also ran the analyses with the Control Autonomy Self-realization Pleasure (CASP-12) Index, a normative measure of quality of life. We used multiple linear regressions to estimate associations and proportion of variance explained. RESULTS: The variance in life satisfaction that could be attributed uniquely to ADL and IADL disability was 0.17% and 0.33% respectively (both p < 0.001). The impact of (I)ADL disabilities on life satisfaction was strongest at age 50 and gradually decreased with increasing age (p trend < 0.001). Mental health explained more variance; 5.75% for depressive symptoms and 2.50% for loneliness and for social resources this ranged from 0.09% to 0.47% (all p < 0.001). While disability has a negative effect on life satisfaction, the effect was not stronger in older persons who were depressed, neither in those who felt lonely nor in those without social resources. Similar outcomes were found when using CASP-12 as the explained variable. CONCLUSION: The impact of (I)ADL disabilities on life satisfaction in community-dwelling older people decreases with age. These associations are not affected by psychosocial factors and these patterns cannot be explained by people changing their norms and values.

Parents' experiences of childhood abuse and neglect are differentially associated with behavioral and autonomic responses to their offspring.

Although childhood maltreatment has been shown to compromise adaptive parental behavior, little is known what happens in terms of physiological regulation when parents with a history of childhood maltreatment interact with their offspring. Using a sample of 229 parents (131 women), the present study examined whether childhood maltreatment experiences are associated with parents' behavioral and autonomic responses while resolving conflict with their offspring. Self-reported experienced child maltreatment was measured using a questionnaire assessing abuse and neglect. Parents (Mage  = 52.7 years, rangeage  = 26.6-88.4 years) and their offspring (Mage  = 24.6 years, rangeage  = 7.5-65.6 years) participated in a videotaped parent-offspring conflict interaction task. Parental warmth, negativity, and emotional support were coded. In addition, their pre-ejection period and respiratory sinus arrhythmia were measured as indicators of underlying sympathetic and parasympathetic nervous system reactivity, respectively. Findings demonstrated that experiences of abuse and neglect were associated with behavioral and physiological responses in different ways. Separating these two types of maltreatment in research and in clinical practice might be important.

The genetic and environmental etiology of child maltreatment in a parent-based extended family design.

Child maltreatment has been associated with various cumulative risk factors. However, little is known about the extent to which genetic and environmental factors contribute to individual differences between parents in perpetrating child maltreatment. To estimate the relative contribution of genetic and environmental factors to perpetrating maltreatment we used a parent-based extended family design. Child-reported perpetrated maltreatment was available for 556 parents (283 women) from 63 families. To explore reporter effects (i.e., child perspective on maltreatment), child reports were compared to multi-informant reports. Based on polygenic model analyses, most of the variance related to the perpetration of physical abuse and emotional neglect was explained by common environmental factors (physical abuse: c2 = 59%, SE = 12%, p = .006; emotional neglect: c2 = 47%, SE = 8%, p < .001) whereas genetic factors did not significantly contribute to the model. For perpetrated emotional abuse, in contrast, genetic factors did significantly contribute to perpetrated emotional abuse (h2 = 33%, SE = 8%, p < .001), whereas common environment factors did not. Multi-informant reports led to similar estimates of genetic and common environmental effects on all measures except for emotional abuse, where a multi-informant approach yielded higher estimates of the common environmental effects. Overall, estimates of unique environment, including measurement error, were lower using multi-informant reports. In conclusion, our findings suggest that genetic pathways play a significant role in perpetrating emotional abuse, while physical abuse and emotional neglect are transmitted primarily through common environmental factors. These findings imply that interventions may need to target different mechanisms dependings on maltreatment type.

[Health and wellbeing of older migrants in the Netherlands: A narrative literature review]. / Gezondheid en welbevinden van oudere migranten in Nederland: Een narratieve literatuurstudie.

In the past few years there has been a growing attention for older migrants, but the question of what we actually know about this group of people remains open. This article strives to fill this knowledge lacuna by presenting an overview of current research findings on health and wellbeing. In total 104 publications were taken into account in this literature review, including 69 articles published in (inter)national journals and 35 reports. The results show that a great deal of research is dedicated to the three largest groups of non-western migrants - Surinamese, Turkish and Moroccan older adults - and health-related themes such as health status and healthcare utilization and quality. Interest in the field of wellbeing is, on the other hand, still rather small. Furthermore, there seems to be little attention to diversity on the current research agenda, although prior research has shown relatively large differences between migrant groups. Based on this literature review, we conclude with a plea for more explanatory research, which goes beyond country of origin and socio-economic status.

When Contact Is Not Enough: Affecting First Year Medical Students' Image towards Older Persons.

CONTEXT: Many medical schools have initiated care internships to familiarize their students with older persons and to instil a professional attitude. OBJECTIVE: To examine the impact of care internships on the image that first-year medical students have of older persons and to explore the underlying concepts that may play a role in shaping this image. DESIGN: Survey before and after a two-week compulsory care internship using the Aging Semantic Differential (ASD; 32 adjectives) and the Attitudes toward Old People (AOP; 34 positions) questionnaires. PARTICIPANTS: Before and after a care internship involving interpersonal contact, 252 and 244 first-year medical students at the Leiden University Medical Centre (LUMC) in the academic year 2012-2013 participated. METHOD: Descriptive statistics, analyses of variance, and principal component analysis were used; clusters of adjectives and positions were reduced into concepts to examine dominant patterns of views. Changes in image were investigated as mean differences of the total and concept scores. RESULTS: Both the ASD and the AOP questionnaires showed a poor general image of older persons that significantly worsened after the care internship (p < 0.01). The percentage of students considering over 75 years as being old increased from 17.2% to 31.2% (p < 0.01) and those who thought they would find as much satisfaction in care for older as for younger patients decreased from 78.5% to 62.1% (p < 0.001). Exploratory principal component analysis showed particularly low scores on 'comportment' and 'pleasurable interaction' whereas the scores on 'personality traits' and 'habitual behaviour' significantly deteriorated (both p < 0.001). These patterns were irrespective of the student's gender and previous contact experience. CONCLUSION: Medical schools should carefully consider care internships to ensure that students do not worsen their views on older patients, which may occur due to inadequate contact depth and quality within a rather unsupportive context.

How is Change in Physical Health Status Reflected by Reports of Nurses and Older People Themselves?

BACKGROUND: Self-rated health is assumed to closely reflect actual health status, but older people's shifting norms and values may influence this association. We investigated how older people's change in self-ratings, in comparison to their retrospective appreciation and change in nurse ratings, reflect functional decline and mortality risk. METHODS: A representative sample of 85-year olds from a middle-sized city in the Netherlands, excluding those with severe cognitive dysfunction, was followed for 6 years. Participants and a research nurse annually provided ratings of health, and participants retrospectively appreciated their annual change in health. Functional status was assessed with the Groningen Activity Rating Scale and all were followed for vital status. RESULTS: Functional decline was reflected by all reports of change in health (all p < .001). When incongruent, change in nurse-ratings reflected functional decline better than change in self-ratings but retrospective appreciation reflected functional decline best (p < .001 vs change in self-ratings and p < .05 vs change in nurse-ratings). Mortality risk was only reflected by retrospective appreciation (p < .01). CONCLUSIONS: Retrospective appreciation of health by older people is superior to change in self-ratings and nurse-ratings in reflecting change in physical health, possibly because similar norms and values are applied in the assessment. The nurse's norms, like the norms of older people, may shift with the ageing of the researched cohort. Asking people to retrospectively appreciate their change in health is a valuable addition to usual enquiries in practice and research.

Being Active, Engaged, and Healthy: Older Persons' Plans and Wishes to Age Successfully.

OBJECTIVES: This study took an emic multidimensional approach on successful aging and examined what older people consider important to age successfully by asking them about their plans and wishes (PWs). Associations between participants' demographics, health status, working life, social contacts, life satisfaction, and their PWs were investigated. METHOD: An online questionnaire was completed by 649 older individuals (55-90 years). Conceptual content analysis was performed to identify important categories in PWs. Quantitative analyses were conducted to examine associations between PWs and participants' characteristics. RESULTS: Most mentioned PWs were related to activities, engagement with life, and health. Seventy-four participants (11.4%) expressed no PWs. Multivariate analysis revealed that having PWs was most strongly related to participants' life satisfaction. Older individuals with a higher life satisfaction indicated significantly more often to have PWs than individuals with a lower life satisfaction. DISCUSSION: The majority of older people desire an active, engaged, and healthy life. PWs were variable and personal, which endorses an emic, multidimensional approach to successful aging. Knowledge on what older individuals find important in their lives and what they want to achieve can assist older individuals in setting and attaining their goals toward aging well.

Impact of physical and mental health on life satisfaction in old age: a population based observational study.

BACKGROUND: It is widely assumed that poor health lowers life satisfaction when ageing. Yet, research suggests this relationship is not straightforward. This study investigated how older people evaluate their life when facing disease and disabilities. METHODS: The Leiden 85-plus Study, a prospectively followed cohort of a cohort of a middle-sized city in the Netherlands, all aged 85 years, that was age-representative of the general population, was used. Those with severe cognitive dysfunction were excluded (n = 501). Comorbidities, physical performance, cognitive function, functional status, residual lifespan, depressive symptoms and experienced loneliness were measured during home visits. Life satisfaction was self-reported with Cantril's ladder. All analyses were performed using regression analysis. RESULTS: Participants reported high life satisfaction (median 8 out of 10 points) despite having representative levels of disease and disability. Comorbidity, low cognitive function, and residual lifespan as markers of health were not associated with life satisfaction. Poor physical performance and low functional status were weakly but significantly associated with lower life satisfaction (p < 0.05 respectively p < 0.001), but significance was lost after adjustment for depressive symptoms and perceived loneliness. Depressive symptoms and perceived loneliness were strongly related to lower life satisfaction (both p < 0.001), even after adjustment for physical health characteristics. CONCLUSION: Poor physical health was hardly related to lower life satisfaction, whereas poor mental health was strongly related to lower life satisfaction. This indicates that mental health has a greater impact on life satisfaction at old age than physical health, and that physical health is less relevant for a satisfactory old age.

Associations of Various Health-Ratings with Geriatric Giants, Mortality and Life Satisfaction in Older People.

Self-rated health is routinely used in research and practise among general populations. Older people, however, seem to change their health perceptions. To accurately understand these changed perceptions we therefore need to study the correlates of older people's self-ratings. We examined self-rated, nurse-rated and physician-rated health's association with common disabilities in older people (the geriatric giants), mortality hazard and life satisfaction. For this, we used an age-representative population of 501 participant aged 85 from a middle-sized city in the Netherlands: the Leiden 85-plus Study. Participants with severe cognitive dysfunction were excluded. Participants themselves provided health ratings, as well as a visiting physician and a research nurse. Visual acuity, hearing loss, mobility, stability, urinal and faecal incontinence, cognitive function and mood (depressive symptoms) were included as geriatric giants. Participants provided a score for life satisfaction and were followed up for vital status. Concordance of self-rated health with physician-rated (k = .3 [.0]) and nurse-rated health (k = .2 [.0]) was low. All three ratings were associated with the geriatric giants except for hearing loss (all p < 0.001). Associations were equal in strength, except for depressive symptoms, which showed a stronger association with self-rated health (.8 [.1] versus .4 [.1]). Self-rated health predicted mortality less well than the other ratings. Self-rated health related stronger to life satisfaction than physician's and nurse's ratings. We conclude that professionals' health ratings are more reflective of physical health whereas self-rated health reflects more the older person's mental health, but all three health ratings are useful in research.