Background Population aging is occurring worldwide. As a result, frailty and disability are in the full interest of practice, policy, and science. An increase in healthcare utilization is an adverse outcome of frailty and disability. Objective The aim of the present study was the prediction of six indicators of healthcare utilization by frailty and disability measures. The six indicators of healthcare utilization of interest were: use of informal care, number of visits to a general practitioner, hospital admission, receiving nursing care, receiving personal care, and contacts with (health)care professionals. Methods We used a sample of 484 people that was randomly drawn from the municipality of Roosendaal (the Netherlands), a municipality with 78,000 inhabitants. A subset of people who completed the Tilburg Frailty Indicator (TFI) at baseline and the Groningen Activity Restriction Scale (GARS) questionnaires was used with a nine-year followup. We used generalized estimation equations (GEE) to predict the six indicators with the frailty measures (physical, psychological, and social scores) and disability measures (ADL and IADL scores). We also performed GEE analyses adjusted for age, gender, and multimorbidity from part A of the TFI at baseline. Results The significant predictors were different for each indicator. However, the physical frailty score, the ADL score, and the IADL score often emerged as significant predictors. These three variables predicted several indicators of healthcare utilization: use of informal care, number of visits to a general practitioner, hospital admission, receiving nursing care, receiving personal care, and contacts with (health)care professionals. The social score was found to be significant for the indicator use of disciplines. Conclusions In conclusion, our study showed that in particular physical frailty, and ADL and IADL disability predicted healthcare utilization in community-dwelling people aged 75 years or older. It is important that care and welfare professionals pay attention to physical frailty and both ADL and IADL disability aiming to diminish frailty and disability and preventing intensive healthcare utilization and related costs. Future research will have to focus on more representative Dutch municipalities in order to get a more reliable and accurate picture of the disciplines used by people with frailty and disability.

Background: Approximately 4 years ago a new concept of learning in practice called the 'Learning and Innovation Network (LIN)' was introduced in The Netherlands. To develop a definition of the LIN, to identify working elements of the LIN in order to provide a preliminary framework for evaluation, a concept analysis was conducted. Method: For the concept analysis, we adopted the method of Walker and Avant. We searched for relevant publications in the EBSCO host portal, grey literature and snowball searches, as well as Google internet searches and dictionary consults. Results: Compared to other forms of workplace learning, the LIN is in the centre of the research, education and practice triangle. The most important attributes of the LIN are social learning, innovation, daily practice, reflection and co-production. Often described antecedents are societal developments, such as increasing complexity of work, and time and space to learn. Frequently identified consequences are an attractive workplace, advancements of expertise of care professionals, innovations that endorse daily practice, improvement of quality of care and the integration of education and practice. Conclusions: Based on the results of the concept analysis, we describe the LIN as 'a group of care professionals, students and an education representatives who come together in clinical practice and are all part of a learning and innovation community in nursing. They work together on practice-based projects in which they combine best practices, research evidence and client perspectives in order to innovate and improve quality of care and in which an integration of education, research and practice takes place'. We transferred the outcomes of the concept analysis to an input-throughput-output model that can be used as a preliminary framework for future research.

Quality of life is a relevant health outcome for older persons; quality of life predicts adverse outcomes such as institutionalization and premature death. The aim of this cross-sectional study was to determine the associations of disability in activities in daily living (ADL) and instrumental activities of daily living (IADL) on the physical and mental dimensions of quality of life. A sample of 377 Dutch people aged 75 years and older completed ‘the Senioren Barometer’, a web-based questionnaire. This questionnaire contained the Groningen Activity Restriction Scale (GARS) for measuring ADL and IADL and the Short-Form Health Survey (SF-12) for measuring the two quality of life dimensions. After controlling for the background variables, all disability items together explained 35.0% of physical quality of life and 28.2% of mental quality of life, with both p-values <0.001. Only ADL item “stand up from sitting in a chair”, and IADL items “do “heavy” household activities” and “do the shopping” were negatively associated with both quality of life dimensions, after controlling for all the variables in the model. This study showed that disability in ADL and IADL is negatively associated with quality of life in older people aged 75 years and older. Therefore, it is important for healthcare professionals (e.g. nurses, general practitioners, physiotherapists) to carry out interventions aiming to prevent and diminish disability or the adverse outcomes of disability such as a lower quality of life. In order to be effective these interventions should be inexpensive, feasible, and easy to implement.

Background: Postprocedural complications after elective cardiac interventions include hematomas and infections. Telemedical wound assessment using mobile phones with integrated cameras may improve quality of care and help reduce costs. Aims: We aimed to study the feasibility of telemedical wound assessment using a mobile phone. The primary aim was the number of patients who were able to upload their pictures. Secondary aims were image interpretability, agreement between nurse practitioners, and patient evaluation of the intervention. Methods: This is a prospective study of all consecutive patients who underwent an elective cardiac intervention. Patients were instructed to photograph their wound or puncture site after hospital discharge and upload the pictures to a secure email address 6 days after hospital discharge. Received photos were assessed by 2 nurse practitioners. The intervention was evaluated using a peer-reviewed questionnaire and photo assessment scheme. Results: In total, 46 eligible patients were included in the study, with 5 screen failures (eg, clinical stay ≥ 6 days) and 1 patient lost to follow-up. Thirty-three of 40 patients (83%) were able to upload their pictures. Smartphone users were more successful in uploading their pictures compared with feature phone users (93% vs 55%, P < .01). Eighty-eight percent of the clinical pictures were interpretable. The interobserver variability had an agreement between 93% and 97%. Conclusions: Patients are able to take and upload the mobile clinical photos to the secure email address, and the vast majority was interpretable. Smartphone users were more successful than feature phone users in uploading their pictures. The interobserver variability was good.

This study aims to evaluate the role of frailty as a predictor of adverse health outcomes in elderly users of Primary Health Care services in Rio de Janeiro, Brazil. Between 2013 and 2015, a study was conducted with 958 individuals aged ≥60 years users of the Family Health Strategy in the city of Rio de Janeiro, to assess the predictive validity of the Brazilian version of the Tilburg Frailty Indicator (TFI) to fall, fracture, hospitalization, functional dependence and death, in a follow-up period of six months. The characteristics of the study population were described and the incidences of the outcomes were estimated. The risk of each adverse outcome was calculated according frailty status. The follow-up was performed for 635 individuals (66.3% of total sample). The study population was predominantly female (65.1%), mean age=70.5 (SD=8.1). At the end of the follow-up, 35 (5.7%) lost functional capacity in basic activities of daily living (ADL) and 157 (25.9%) in instrumental activities of daily living (IADL), 67 (10.9%) experienced hospitalization, 60 (9.8%) suffered fall and 9 (1.5%) fracture, and 18 (2.9%) died. There was a higher risk of functional dependence in ADL (OR= 3.01 CI95% 1.45–6.27) and in IADL (OR= 1.50 CI95% 1.04–2.16), fall (OR= 2.08 CI95% 1.21–3.58) and death (OR= 3.35 CI95% 1.18–9.53) for frail when compared to non-frail elderly. Frailty assessed by the TFI is a good predictor of adverse health outcomes among elderly users of primary care services in Brazil, and would be an alternative tool for monitoring the health conditions.

Geriatrische revalidatiezorg (GRZ) is kortdurende, geïntegreerde multidisciplinaire zorg, gericht op herstel van functioneren en maatschappelijke participatie bij relatief laag belastbare ouderen. Gezien de complexe zorgvragen van geriatrische cliënten dienen verpleegkundigen (NLQF 4 en 6) en verzorgenden (NLQF 3) (in het vervolg verpleegkundigen genoemd) over voldoende en juiste competenties te beschikken om klinisch relevante signalen te herkennen, op juiste waarde in te schatten en effectief aan te pakken. Verpleegkundigen ervaren echter een grote mate van handelingsverlegenheid en geven aan moeite te hebben om multidisciplinaire communicatie en samenwerking structureel vorm te geven. Dit onderzoek geeft inzicht in de wijze waarop verpleegkundigen hun rol in het GRZ-proces ervaren in relatie tot handelingsverlegenheid. Daarnaast is inzichtelijk gemaakt hoe cliënten en mantelzorgers hun eigen inbreng in het GRZ-proces ervaren.

Although an increasing number of studies consider frailty as a multidimensional phenomenon, frailty is still often conceptualized and measured as a merely medical or physical concept. In this international symposium with four presenters from Belgium and the Netherlands, we address the importance of a multidimensional approach to frailty. Several frailty domains will be discussed thoroughly and attention will be given to balancing factors in frailty. The first presenter will focus on cognitive frailty and its relationship with other frailty domains. Our second presenter will discuss the results of in-depth analyses of socio-demographic factors and their connection with psychological frailty. Thereafter, the third presenter will illustrate why and how the environmental domain is related to frailty. Despite its importance, research regarding environmental factors (e.g. (bad) housing condition) is still lacking. Finally, our last presenter will discuss balancing factors in frailty, as frailty cannot be considered as only an individual attribute of deficits, but might be considered as a balance between deficits and resources. Our discussant, Robbert Gobbens from the Netherlands, will reflect on the presentations.

BACKGROUND:Postprocedural complications after elective cardiac interventions include hematomas and infections. Telemedical wound assessment using mobile phones with integrated cameras may improve quality of care and help reduce costs.AIMS:We aimed to study the feasibility of telemedical wound assessment using a mobile phone. The primary aim was the number of patients who were able to upload their pictures. Secondary aims were image interpretability, agreement between nurse practitioners, and patient evaluation of the intervention.METHODS:This is a prospective study of all consecutive patients who underwent an elective cardiac intervention. Patients were instructed to photograph their wound or puncture site after hospital discharge and upload the pictures to a secure email address 6 days after hospital discharge. Received photos were assessed by 2 nurse practitioners. The intervention was evaluated using a peer-reviewed questionnaire and photo assessment scheme.RESULTS:In total, 46 eligible patients were included in the study, with 5 screen failures (eg, clinical stay ≥ 6 days) and 1 patient lost to follow-up. Thirty-three of 40 patients (83%) were able to upload their pictures. Smartphone users were more successful in uploading their pictures compared with feature phone users (93% vs 55%, P < .01). Eighty-eight percent of the clinical pictures were interpretable. The interobserver variability had an agreement between 93% and 97%.CONCLUSIONS:Patients are able to take and upload the mobile clinical photos to the secure email address, and the vast majority was interpretable. Smartphone users were more successful than feature phone users in uploading their pictures. The interobserver variability was good.

The Tilburg frailty indicator (TFI) is a self-report measurement instrument which integrates the physical, psychological and social domains to assess frailty in older adults. The aim of this study was the adaptation of the TFI to a German version and testing of the psychometric properties. This study surveyed 210 individuals aged 64-91 years living at home. The mean age of participants was M = 75.3 +/- 5.7 years with 62 % females. The internal consistency was tested with Cronbach's alpha. The test-retest reliability was calculated after 20 weeks. The German TFI was validated using alternative measures for assessment of the quality of life, e.g. Eurohis-QoL-8 and short form health survey (SF-12), the patient health questionnaire (PHQ), the geriatric anxiety inventory short form (GAI-SF), the social support scale (F-Soz-U-K-14) and the resilience scale (RS-11). The internal consistency was acceptable with a value for Cronbach's alpha of 0.67. The test-retest reliability was good after 5 months alpha = 0.87 (physical domain r = 0.85, psychological domain r = 0.75 and social domain r = 0.84). The inter-item correlations ranged between -aEuro parts per thousand 0.06 and 0.57. Correlations with alternative frailty measures showed good convergent and divergent validity. This study showed acceptable psychometric properties of the German adaptation of the TFI which was found to be age and frailty sensitive. The results of the validity of the TFI support the three domains integrated in the frailty score. Further application and testing of the German TFI in primary care and clinical settings are suggested to consolidate the findings.

This cross-sectional study clarified the association between service utilization patterns and frailty in older adults living at home, certified in the lowest care level under Japan's Long-Term Care (LTC) system.We tested 710 participants who completed in-home assessments.We measured participants' multidimensional frailty using the Tilburg Frailty Indicator (TFI), handgrip strength, body mass index, depression, and cognitive function.LTC service utilization patterns were classified into five patterns: (1) using home aid services only, (2) using daycare

BACKGROUND:In the last decade, studies on frailty have become increasingly frequent in the literature on aging, and also the number of available questionnaires regarding frailty has increased over the years. Therefore, the choice of which questionnaire to use is becoming more difficult.OBJECTIVE:The aim of this study was to assess the psychometric properties of the Polish version of the Tilburg Frailty Indicator (TFI), an instrument that identifies frailty in the elderly population.DESIGN:Setting, and Participants. The study was carried out in a community-based setting in Wrocław, Poland. Nurses and doctors (general practitioners) administered the TFI in primary care facilities. Participants included a sample of 212 community dwelling elderly aged 60 or older (mean age:70.6 SD≥7.16).MEASUREMENTS:The validation (assessment of face validity, content validity) was carried out in accordance with the literature. The Tilburg Frailty Indicator (TFI) consists of two different parts. One part addresses the potential determinants of frailty and the other specifically addresses the components of frailty, covering its physical, psychological and social domains. Scale reliability was estimated using two methods: Cronbach's alpha, measuring the scale's internal consistency, and the test-retest method, determining the scale's absolute stability. To assess test-retest reliability, the same group was re-interviewed by the same observer within 10-14 days of the first interview.RESULTS:The test-retest reliability showed a high level of agreement for all items of the instrument, with values ranging from 96 to 100%. The Cronbach's Alpha internal consistency was 0.74.CONCLUSION:The Polish version of the TFI proved to be a valid and reproducible tool for assessment of Frailty Syndrome for the Polish population. We would recommend to be used as the screening tool to assess frailty.

Introduction: Due to the aging population and the governmental policy to substitute institutional care with home care, more community care nurses are needed in the Netherlands. In addition, new competences, for instance regarding promoting self-management and multidisciplinary collaboration, are required according to the new national professional profile of nurses. However, several aspects might hinder the education about these competences. Not all lecturers of the nursing schools currently have much experience in home care, and particularly the community care nurses already working in practice do not always have much experience with guiding student nurses in their internships. Therefore, collaboration and exchange between community care nurses and nursing lecturers is needed. Ten learning communities involving lecturers of nursing schools (bachelor level) and community care nurses, spread across the Netherlands, started in 2015 with learning communities to exchange knowledge and experiences and to enhance the new competences that are required. Aim: The aim of this symposium, organized by evaluators and project leaders involved in the learning communities, is to give an impression of the realization and the activities of the learning communities. For instance, it is discussed how learning communities promote new competences and leadership roles of community care nurses.

Hoe kwetsbaar zijn de patiënten binnen de geriatrische revalidatiezorg en in welke mate bepaalt die kwetsbaarheid hoe het na ontslag met deze ouderen thuis zal gaan? Binnen verpleeghuizen van Laurens (Rotterdam) is hiernaar onderzoek gedaan met behulp van de Tilburg Frailty Indicator (TFI), een screeningsinstrument voor kwetsbaarheid.

The Tilburg frailty indicator (TFI) is a self-report measurement instrument which integrates the physical, psychological and social domains to assess frailty in older adults. The aim of this study was the adaptation of the TFI to a German version and testing of the psychometric properties.