In 1998 waren er circa 75 zogeheten “zorgboerderijen”. Tegenwoordig zijn dat er meer dan 900. Er wordt verondersteld dat zorgboerderijen een positieve invloed hebben op de gezondheid van diverse doelgroepen. Tot op heden is daar echter weinig wetenschappelijk onderzoek naar gedaan. In dit proefschrift worden enkele van de weinige wetenschappelijke onderzoeken naar de gezondheidseffecten van zorgboerderijen beschreven. In deze onderzoeken stond de doelgroep thuiswonende dementerende ouderen centraal. Ongeveer 10% van de zorgboerderijen in Nederland biedt dagverzorging aan deze doelgroep. Op basis van dit proefschrift werd geconcludeerd dat zorgboerderijen beter dan reguliere instellingen voor dagverzorging in staat zijn om dementerende ouderen een afwisselend en divers dagverzorgingsprogramma aan te bieden. Ook stimuleren zorgboerderijen de voedselconsumptie van dementerende ouderen meer dan reguliere instellingen voor dagverzorging. Zorgboerderijen en reguliere instellingen voor dagverzorging lijken echter even effectief te zijn in het voorkomen van een significante afname van het cognitief functioneren, het emotioneel welbevinden en de functionele status, evenals in het voorkomen van een significante toename van het aantal gedragsproblemen.In the Netherlands an increasing number of farms combine agricultural production with care services for people with care needs. It is generally believed that these green care farms (GCFs) have beneficial effects on the health status of a diversity of target groups. At present, empirical studies testing this hypothesis are scarce. The main objective of the studies described in this thesis was to gain insight into the potential benefits of day care at GCFs for community‐dwelling older dementia patients. Day care at GCFs was therefore compared with day care at regular day care facilities (RDCFs). In view of the differences between both day care types regarding the day care setting and day care program it was hypothesized that they would differ in their effects on the health status of dementia patients. In two cross‐sectional studies it was tested to what extent the day program of dementia patients at GCFs differed from those at RDCFs. It appeared that at GCFs, dementia patients were (physically) more active, participated in more diverse activities, were more outdoors, and had more opportunities to perform activities in smaller groups than those at RDCFs. It was tested whether these differences resulted into different effects for five domains of health: dietary intake, cognition, emotional well‐being, behaviour, and functional performance. In a comparative cross‐sectional study dietary intake of dementia patients attending day care at GCFs or RDCFs was recorded both at home and during their time at the day care facility. The study showed that dementia patients attending day care at GCFs had significantly higher intakes of energy, carbohydrate, and fluid than their counterparts attending day care at RDCFs. In a cohort study, rates of change during 1 year in cognitive functioning, emotional well‐being, behavioural symptoms, and functional performance were compared between dementia patients attending day care at GCFs and RDCFs. Functioning in these domains remained rather stable and no differences were observed between subjects from GCFs and RDCFs. In the cohort study, also caregiver burden of family caregivers of these dementia patients was assessed. Caregivers’ quality of life, emotional distress, and feelings of competence remained rather stable in family caregivers of dementia patients from both day care settings. In conclusion, the present work has shown that GCFs exceeded RDCFs in offering older dementia patients a diverse day program and in stimulating their dietary intake. The latter may result into a better preserved nutritional status in dementia patients attending day care at GCFs than in those attending day care at RDCFs. GCFs and RDCFs were equally effective in preventing significant decrease of cognitive functioning, emotional well‐being, and functional performance and in preventing significant increase of the number of behavioural symptoms. Both day care types further prevented significant increase of caregiver burden. Day care at GCFs is a new and valuable addition to the present care modalities for community‐dwelling older dementia patients and their caregivers
In the Netherlands, there is a growing need for collective housing for older people to bridge the gap between ageing-in-place and institutional care facilities. Participation of older people in the concept and design phases is important to tune the market supply to the needs of (future) residents, yet social entrepreneurs find it challenging to involve older people. This commentary explores various ways older people can participate in the development of new housing initiatives. The ladder of citizen participation is applied to explore different roles that (future) residents could play with levels of influence varying from non-participation to citizen power. Considerations for meaningful participation are discussed, in order to show how collaborations can be formed between (future) residents and decision makers.
Objective: To evaluate the relationship between presence and nature of co-morbidity and quality of care for diabetes patients enrolled in diabetes disease management programmes provided by care groups.Methods: We performed an observational study within eight Dutch diabetes care groups. Data from patient record systems of care groups and patient questionnaires were used to determine quality of care. Quality of care was measured as provision of the recommended diabetes care, patients’ achievement of recommended clinical outcomes and patients’ perception of coordination and integration of care.Results: 527 diabetes patients without and 1187 diabetes patients with co-morbidity were included. Of the co-morbid patients, 7.8% had concordant co-morbid conditions only, 63.8% had discordant co-morbid diseases only and 28.4% had both types of conditions. Hardly any differences were observed between patients with and without co-morbidity in terms of provided care, achievement of clinical outcomes and perceived coordination and integration of care.Conclusions: Our study implies that care groups are able to provide similar quality of diabetes care for diabetes patients with and without co-morbidity. Considering the expected developments regarding additional disease management programmes in care groups, it is of importance to monitor quality of care, including patient experiences, for all chronic diseases. It will then become clear whether accountable provider-led organisations such as care groups are able to ensure quality of care for the increasing number of patients with multiple chronic conditions.
The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)
Scholars are increasingly challenging traditional definitions of adventure and risk-focused theories of adventure motivations and benefits. Adventure research has often lacked robust theoretical explanations of how positive outcomes are achieved. In addition, traditional adventure perspectives are largely disconnected from emerging research examining links between nature, health, and psychological wellbeing. Recent studies suggest that basic psychological needs and natural settings may be critical mechanisms through which adventure fosters psychological wellbeing. In response to these issues and developments, this chapter first explores how adventure could be redefined in terms of the unique, rather than inherently higher, risks it affords. It then explores how outdoor adventure outcomes may be better understood in relation to eudaimonic wellbeing outcomes, and suggests key psychological mechanisms, such as basic psychological needs and nature contact, through which these outcomes may be facilitated. The chapter concludes by proposing a conceptual framework to guide future research on adventure and wellbeing.
The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)
Abstract Background Countries are adapting their health and social care systems to better meet the needs of growing populations with (multiple) chronic conditions. To guide this process, assessment of the ‘patient experience’ is becoming increasingly important. For this purpose, the Person‐Centred Coordinated Care Experience Questionnaire (P3CEQ) was developed in the United Kingdom, and translated into several languages. Aim This study aimed to assess the internal and construct validity of the Dutch P3CEQ to capture the experience of person‐centred coordinated care of people with chronic conditions in the Netherlands. Participants and Methods Adults with chronic conditions ( N = 1098) completed the Dutch P3CEQ, measures of health literacy and patient activation, and reported the use and perceived quality of care services. Data analysis included Principal Component and reliability analysis (internal validity), analysis of variance and Student's T ‐tests (construct validity). Results The two‐component structure found was pretty much the same as in the UK validation study. Sociodemographic correlates also resembled those found in the United Kingdom. Women, persons who were less educated, less health‐literate or less activated experienced less person‐centred coordinated care. P3CEQ scores correlated positively with general practitioner performance scores and quality ratings of the total care received. Conclusion The Dutch P3CEQ is a valid instrument to assess the experience of person‐centred coordinated care among people with chronic conditions in the Netherlands. Awareness of inequity and more attention to communication skills in professional training are needed to ensure that care professionals better recognize the needs of women, lower educated or less health‐literate persons, and improve their experiences of care. Patient Contribution The P3CEQ has been developed in collaboration with a range of stakeholders. Eighteen persons with (multiple) chronic conditions participated as patient representatives and codesign experts in (four) codesign workshops. Other patient representatives participated in cognitive testing of the English‐language instrument. The usability of the P3CEQ to capture the experience of person‐centred coordinated care of older persons has been examined by interviewing 228 older European service users, including 13 living in the Netherlands, as part of the SUSTAIN project. More than a thousand persons with chronic conditions participated in the validation study of the Dutch P3CEQ.
Earlier studies suggest that green care farms (GCFs) are a valuable addition to other dementia care services. We explored which lessons from GCFs could be implemented by regular long-term care institutions (RLTCIs) and which barriers and facilitators were expected. First, key lessons were identified by secondary data analysis addressing the following issues: 1. Aligning care with preferences and needs of people with dementia; 2. Making active use of stimulating elements in the care environment and 3. Implementing a different care philosophy and vision. Second, semi-structured interviews (n=33) were conducted with professionals from RLTCIs and GCFs. Barriers and facilitators were identified at three interrelated levels; context (financial, organizational, social, professional), dementia care setting and client group. At GCFs, a holistic, integrated way of working was implemented in everyday care compared with a more task-oriented approach in regular care. These results may inspire care institutions to develop more person-centered dementia care environments.
