University of Groningen
Perspectives on health and health promotion in community-dwelling older people
Marcus-Varwijk, Anne Esther
DOI:
10.33612/diss.171365999
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Publication date:
2021
Link to publication in University of Groningen/UMCG research database
Citation for published version (APA):
Marcus-Varwijk, A. E. (2021). Perspectives on health and health promotion in community-dwelling older
people: a mixed-methods study. University of Groningen. https://doi.org/10.33612/diss.171365999
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Aging population
Research shows a significant global increase in the number of older adults. In 2015, the total number of people aged 65 years and over counted 617 million, representing 8.5% of the total world population. By 2050, the number of people aged 65 and over is expected to increase to 1.6 billion people, representing almost 17% of the entire world population (An Aging World, 2015). For the Netherlands, people aged 65 years and over represented approximately 19% of the total Dutch population in 2018 (17.18 million inhabitants), and this percentage is estimated to increase to 26% by 2040.2
Worldwide, the increased proportion of people of 65 years and over is explained by declining fertility rates and increased life expectancy.3
Socioeconomic improvements, such as safer living and working conditions, more access to safe water and nutrition, safer means of transportation, and better hygienic conditions have all contributed to the increased life expectancy.4 Today’s older people have invested in, and contributed to, the
many socioeconomic, technical and achievements, from which all generations now benefit.
Life expectancy has also increased because of better access to higher standards of medical care. For example, younger generations experience significant health benefits because of better prenatal and perinatal care.5 Older people
also benefit from higher standards of care, enhanced treatment options, and technological developments.6 In addition, disease prevention and health
promotion strategies have enabled people to live longer lives. For example, health promotion and disease prevention initiatives to prevent smoking have contributed to decreases in the number of people smoking, thereby increasing life expectancy.7
Aging, disease, disabilities and frailty
As life expectancy is expanding, years lived with chronic diseases, frailty and disability are also increasing in the later years of older people’s lives.8 As
people age, the risk of developing most diseases increases gradually (such as heart disease, diabetes).3 The number of people affected by multiple chronic
diseases (multimorbidity) increases significantly with higher age.9 The biological
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aging process, indicating biological losses in vitality, begins with physiological deterioration, leading to the development of diseases, disabilities and functioning loss, a state of frailty, and death.10,11 Older adults living with chronic diseases,
disabilities, and frailty experience difficulties in maintaining their daily functioning and active engagement, often resulting in complex care needs.12
Scholars’ definitions of frailty vary. Most would agree that frailty indicates a state of vulnerability regarding the future occurrence of adverse health outcomes such as falls, hospitalization or severe loss of functioning in one or more domains.13-16
In this dissertation, we adopt the multidimensional construct of frailty, in which frailty comprises more than only the physical domain, including the psychological, social, cognitive, and environmental domains.17-22
Living a long life in the best health possible
An assumption could be that if people were given the choice, most would like to live their lives as long as possible in the best health possible and live happy and independent lives, without needing care from others. However, many older people live with one or more chronic diseases or disabilities, and are in need of care.8 Where life expectancy has increased worldwide, the number of
years living in the best health possible has not increased correspondingly.10,23
Therefore, one of the greatest challenges is answering the questions of how to increase the number of years living in the best health possible, compressing morbidity and disability, and delaying frailty.
Aging and health
Promoting healthy aging and disease and disability prevention for older adults should be an essential item on the (inter)national agenda of policymakers,24 that
could contribute to an increase in the numbers of years living in the best health possible. What does “healthy aging” encompass? The definition of the term “healthy aging” is a nuanced one.6 Descriptions of the term healthy aging are
diverse, and many other terms are closely linked to the concept, such as active aging, aging well and successful aging. We want to note that the meaning and description of healthy and active aging varies according to the population being asked. For example, a study by Karlin & Weil (2016) investigating the perceptions
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of healthy and active aging of people aged 50 years and over from six very diverse countries (Italy, the United States, Thailand, South Africa, Botswana, and Saudi Arabia) show that the concept of healthy and active aging varies considerably based on cultural norms and beliefs related to aging.25 In addition, ideas on
healthy and active aging might change over time.26 In general, many organizations,
policymakers and researchers use the World Health Organization’s definitions on healthy and active aging. The World Health Organization27 describes healthy
aging as the process of developing and maintaining the functional ability that enables
well-being in older age. The comprehensive WHO vision on aging and health is
illustrated in Figure 1.28 In addition, healthy aging is linked to the biopsychosocial
model, which means that healthy aging consists of interacting biological,
psychological, and social elements.29,30
In the late 1990s, the WHO adopted the term “active aging,” explicitly to recognize
the factors in addition to health care that affect how individuals and populations age.31 The concept indicates that older people continue to participate socially,
economically, culturally, spiritually, and are active members in civil society.32
Figure 2 shows the determinants of active aging as illustrated by the.33
Adopting healthy lifestyles
In general, behavioral determinants refer to the adoption of healthy lifestyles and being actively involved in one’s own care at all stages of the life course. Health-related behaviors, such as keeping a healthy diet, being physically active, not smoking, and moderate to no alcohol use, are important factors in maintaining well-functioning and good health.34-39 Research has shown positive effects of
healthy lifestyles on health expectancy and healthy life expectancy.6 A
well-known large longitudinal study, The Alameda County Study, followed the behavior of 6,928 people over 20 years.40 This study showed that people who maintained
healthy lifestyles (e.g., avoiding smoking, regular exercise, moderate alcohol consumption, average weight status, sleeping 7-8 hours a night) were living longer and more years without disabilities.40,41 Another study by Jacob et al. (2016)
followed community-dwelling older adults aged 65 years and over (n=5,248) from 1989 to 2015, investigating whether several lifestyle factors (smoking, alcohol consumption, physical activity, diet, body mass index (BMI), social networks, and social support) could compress the period living with disabilities.42 This
13
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Figure 2. The determinants of active aging33
study showed that, for example, walking longer distances and a high-quality diet compressed years living with disabilities.42 Adopting healthy lifestyles in
older age enables and supports older people to maintain independence and prevent functional decline and decelerates the progression of disease.35,36,43,44
For example, studies have shown that people aged 60 years and over who have adopted a healthier diet, increased the length of time they lived and improved their quality of life.45-48 Existing research recognizes that quitting smoking at
older ages is beneficial for one’s health. Studies show that smokers who quit after the age of 65 increased their length of time living as well as living years in good health.49,50 There is also evidence showing that it is never too late to begin new
exercise routines in older age because the benefits of regular physical activity significantly improve overall health,51,52 and improvements in cognition are also
shown.53
Gender
Culture
Active
ageing
Social determinants Behavioural determinants Ergonomic determinants Physical environment Health and social services Personal determinants15
Health promotion and disease prevention targeting older people
with augmented risks of adverse health outcomes
Given the potential of adopting healthy lifestyles in older age, health promotion and preventive interventions that consider the aging population are urgently needed. Health promotion is described as enabling older people to increase control
over, and to improve, their health.54 Disease prevention could be described as
follows: For A (where A can be an individual or a collective) to prevent disease in
B (where B can be an individual or a collective), is for A to intentionally try to stop, eliminate or postpone the emergence or development of those (kinds of) internal processes and states that typically cause (manifest) ill health, or of future ill health and premature death, in B.55 While the concepts differ, in practice health promotion
and disease prevention are mostly integrated.55 In this dissertation, the focus will
be on health promotion and disease prevention, targeting community-dwelling older people with augmented risks of adverse health outcomes in one or more domains. Older people with augmented risks of adverse health outcomes could be described as high-risk groups. Many health promotion and disease prevention interventions do not yet reach those older people who would most need the intervention.50 Detecting risks and reaching older people with high risks at an
early stage could be beneficial to prevent the situation becoming worse. If frailty could be detected at an early stage, appropriate medical care, health promotion, and disease-preventing interventions could lead to improvements in daily functioning and health-related behaviors, and possibly delay the onset of disease in the older population with augmented risks.16,56-58
The role of nurses
Interventions take place in a range of settings and may be led by different disciplines such as the General Practitioner, geriatrics, physiotherapists or nurses. In this dissertation, we examine the role of nurses who provide health promotion and disease prevention interventions, specifically. For decades, nurses have been involved in disease prevention and health promotion programs.59-61 Due to demographic changes, including the increased aging
population, nurses are increasingly involved in interventions aiming to improve or maintain daily functioning in community-dwelling older people.62 Nurses
are trained to use a holistic approach that considers the multiple facets (biopsychosocial) of the experienced health by older people.
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Not long ago, the Canadian Medical Education Directives for Specialists (CanMEDS) theoretical framework, including the seven roles of the CanMEDS were adjusted to the nursing profession and implemented for the bachelor nurse curricula in the Netherlands.63 The roles of Communicator, Collaborator, and
Health Advocate are particularly suitable to promote health and improve or maintain daily functioning in community-dwelling older people.64 The CANMEDs
roles are described in much detail in the “Bachelor of Nursing 2020”.63 Below,
I will summarize relevant aspects of the Communicator, Collaborator, and Health Advocate roles that are related to this dissertation. Firstly, the role of Communicator is focused on a way of communicating from a person-centered perspective.65 Nurses are active listeners, are able to communicate in an open and
respectful way. Moreover, they have knowledge of communication techniques, accompanied by a deeper knowledge of the underlying theoretical framework or model applied for these techniques. Secondly, in their role as Collaborator, nurses build a personal relationship based on trust66 and equality. Nurses are also team
players as they work in multidisciplinary teams. For example, nurses who work in the communities are able to refer to the General Practitioner if necessary.60,67
Thirdly, as Health Advocates, nurses improve the health and well-being of older people, whereby improving health involves disease prevention, health promotion (including the promotion of healthy lifestyles), and health protection.68 In their
role as Health Advocate, nurses are trained to use systematic client assessments in which deterring factors could be registered in an early phase, and could be acted upon.60,69 Nurses work with older people to address the determinants of
health that are relevant to them and collaboratively search for openings to adopt healthy behaviors.68
Nurse-led health promotion and disease prevention interventions
for community-dwelling older people: a challenging field of study
Despite the potential benefits of adapting a healthy lifestyle, it is not easy to get older people commit to changing their lifestyles and maintaining this.70After participating in health promotion or disease prevention interventions, participants often relapse in their former habits after the intervention has stopped.71,72 Since behavior change and the care needs of older people can
be quite complex, there is a great challenge in finding effective nurse-led interventions. Moreover, little is known about the effectiveness of nurse-led
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health promotion and disease prevention interventions in frail community-dwelling older people that also contribute to health-related behavior in the long term.73 The best interventions to prevent or reduce the level of frailty in order
to maintain functional status and healthy lifestyles, and enable older people to live at home as long as possible are, therefore, currently unclear.74 Studies on
nurse-led preventive home visits, or nurse-led case management programs for community-based older people have showed various outcomes.67 For example,
in Spain, a nurse-led case management delivery model for home care did improve functional abilities in older people.75 On the other hand, a Dutch study
failed to show evidence for the effectiveness of an interdisciplinary primary care approach (where the General Practitioner and practice nurse collaborated closely) to reduce disability and prevent functional decline in community-dwelling frail older people.76
Evaluating nurse-led health promotion and disease prevention
interventions for community-dwelling older people
An answer to the question of what effective components of health promotion and disease prevention nurse-led interventions in daily practice might look like, is of great relevance, and has not yet been found.77-79 Since the working
elements for effective nurse-led health promotion and disease prevention interventions for community-dwelling older adults are as yet unclear, more evaluation research is needed to find out what the working elements include. Promising elements for health promotion and disease prevention for older people may be found in a person-centered approach. Even though there is no consensus on the definition of a person-centered approach, there are six prominent domains found in a review on person-centered care.80 These
domains include: holistic or whole-person care, respect and value, choice, dignity,
self-determination, and purposeful living.80 In theory, and in compliance with the
CANMEDs roles described before, Motivational interviewing (MI) and Shared decision-making (SDM) are suitable communication approaches to accomplish person-centered care when behavior change and choosing between options are needed.81 Several studies have reported that communication approaches
used in health promotion and disease prevention interventions should match the older person’s specific needs and include older people’s own beliefs and
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priorities concerning their health and well-being.82,83 SDM, in the context of
this dissertation, could be described as the process of nurses and older adults working together towards informed preferences regarding health-related (behavior) options, based on the older adult’s values and the best evidence available.84 Stiggelbout et al (2015) introduced the following four steps that
include SDM:
1.
the professional informs the patient that a decision is to be made and that the patient’s opinion is important;2.
the professional explains the options and their pros and cons;3.
the professional and the patient discuss the patient’s preferences and the professional supports the patient in deliberation;4.
the professional and patient discuss the patient’s wish to make the decision, they make or defer the decision, and discuss follow-up.85MI is a counselling style aimed at partnership to search for the older adults’ own conviction for the need to change and the development of confidence to make a change.86 The MI spirit, as they call it, embodies the elements: empathy,
partnership, evocation, and compassion.87 Still, even with efforts to educate
nurses in SDM and MI, implementing the effective elements of these approaches has proved difficult in practice.81 Solely evaluating interventions on effectiveness
does not offer the comprehensive perspective that is needed to gain more insight in the working elements, such as effective communication approaches. Evaluating the extent to which an intervention is being implemented as intended (called treatment fidelity) gives insight into how interventions are implemented in practice. Thus, treatment fidelity could give insight into the extent to
which nurses effectively use communication approaches in performing health promotion and disease-prevention programs.
Moreover, investigating the views and experiences of older adults regarding health, well-being, and functioning is not always optimally understood by nurses. Nurses tend to act from their own perspectives and do not always succeed in working from, or even recognizing, the older adults’ perspective on healthy aging.88 Additionally, health services are often based on the health professionals’
assessment of a person’s functioning and health, instead of considering the older adults’ own experiences about their functioning and health.89 Therefore, more
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research is needed to elicit older adults’ views and perspectives on healthy aging and their experiences in participating in health promotion practices and disease prevention interventions.90,91
The community health consultation offices for older adults
In practice, there are innovative interventions developed by care institutions or health insurers who aim to contribute to preventing or reducing the level of frailty with a view to maintaining functional status, improving healthy lifestyles, and enabling older people to live at home for as long as possible. In this context, the research team were asked to evaluate an existing nurse-led intervention, called the Community Health Consultation Offices (CHCO) that reached out to community-dwelling people of 60 years and over with augmented risks of adverse health outcomes. Please see the text box below for a description of the CHCO intervention.
The context: The Community Health Consultation Offices for Older Adults
The original idea of setting up consultation offices for older adults was published in a Vision document by the National Centre of Expertise for Long-term Care in the Netherlands.92 The WHO’s active aging
model,33 the life course perspective,93,94 and Prochaska & DiClemente’s
transtheoretical model95 were used as an underlying theoretical
framework for the intervention: the Community Health Consultation Offices for Older Adults (CHCO intervention).
This Vision document was used as a frame of reference for a protocolled nurse-led intervention in the northern and eastern parts of the
Netherlands as executed by Zilveren Kruis Achmea (the largest health insurance company in the region), and the home care association (Evean/ Icare), as started in 2009. This modified and protocolled version of the CHCO intervention reached out to community-dwelling people of 60 years and over, with augmented risks of adverse health outcomes. Community health nurses were trained to perform the consultations for older people, including a workshop in MI.
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Older people were eligible for participation in the CHCO intervention without a financial contribution, in a two-step selection procedure. First, members of the home care association (Evean/Icare) and those who were also insured by the health insurance company (Zilveren Kruis Achmea) received an informational letter about the CHCO intervention. The letter explained that only older people at risk would be invited and, therefore, a postal questionnaire was included. The questionnaire contained questions about smoking, current weight and height, and the Groningen Frailty Indicator (GFI). The GFI consists of fifteen items, detecting frailty in a multidimensional way.96 Older adults who completed
the questionnaire and sent it to the home care organization by regular mail were screened for participation with a second selection round. In the second phase of the procedure, older people were considered at risk and, therefore, eligible to receive the CHCO intervention if they conformed with at least one of the following inclusion criteria:37,38,57 (I) frailty (GFI
>3), (II) overweight (<70 years, BMI >25 kg/m² and/or >70 years, BMI>30 kg/m²), (III) currently smoking, and (IV) interested in participating. Those eligible and interested in participating received an (I) an invitation to the nurse’s office in the area where they lived, or the community health nurse visited their homes if necessary, and, (II) a comprehensive questionnaire about their health and well-being, which they were asked to bring along to their meeting with the community health nurse.
During the first consultation, the community health nurse talked to the older person about the comprehensive questionnaire and checked that all items were completed. Also, biometric measurements were executed to contribute to the overall comprehensive assessment of the health and well-being of the older participant. Based on the comprehensive assessment, the nurse gave tailored advice and could refer to the General Practitioner, all aiming to enhance the older persons’ health and well-being. Next, the nurse and the older participant could plan a new appointment, a follow-up consultation after about three months or an appointment after a year.
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Aims and scope
This study will contribute to the existing body of knowledge on whether
components of health promotion and disease prevention interventions targeting community-dwelling older adults with augmented risks of adverse health outcomes work or do not work, such as the Community Health Consultation Offices for older adults as described before. In addition, we want to note that the personal views and experiences of the target group, the community-dwelling older adults, regarding healthy aging are often underexposed in studies. However, knowledge about these personal views and experiences of community-dwelling older people can contribute to the development of health promotion and disease prevention interventions in which interventions match the views and experiences of the target group, the older adults themselves. We have come to the following research aims:
1.
to evaluate a nurse-led health promotion and disease-preventiveintervention for community-dwelling older people with augmented risks of adverse health outcomes from various research perspectives, namely:
a. investigating whether a minimal intervention by the Community Health Consultation Offices (CHCO), targeting community-dwelling older people with augmented risks, could improve older people’s health and stabilize care-related outcomes (Chapter 2, quantitative);
b. exploring the experiences and views of older people participating in a (nurse-led) health promotion and disease prevention intervention
(Chapters 3&4, qualitative);
c. evaluating the extent to which the nurses used MI within the Community Health Consultation Offices for older adults with augmented risks of adverse health outcomes (Chapter 5, quantitative).
2.
to gain insight into the views and experiences of community-dwelling older adults regarding healthy aging in general (Chapters 3&4, qualitative). We conducted a parallel mixed-method design, collecting and analyzing both quantitative and qualitative data concurrently in order to achieve the aims of this study, since mixed-methods in healthcare research is especially valuable giving justice to all the diverse perspectives involved in the phenomena
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being studied.97,98 In the General Discussion (Chapter 6), findings from both
the quantitative and qualitative studies are integrated and interpreted, along with a discussion. Next, methodological considerations are addressed. Finally, implications and recommendations for research, practice, education, and policy are discussed. The findings of this study may well have an impact on the competences of nurses, including their knowledge, skills, and attitudes in the field of health promotion and disease prevention.
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References
1. Beattie BL, Whitelaw N, Mettler M, Turner D. A vision for older adults and health promotion. American journal of health promotion : AJHP 2003; 18(2): 200-4.
2. Stoeldraijer L, Van Duin C, Huisman C. Bevolkingsprognose 2017–2060: 18, 4 miljoen inwoners in 2060. Centraal Bureau voor de Statistiek: The Hague, The Netherlands 2017: 1-19.
3. Shah K. Disease, Disability, and Frailty with Increasing Age. Healthy Aging: Springer; 2019: 9-14.
4. Mathers CD, Stevens GA, Boerma T, White RA, Tobias MI. Causes of international increases in older age life expectancy. Lancet (London, England) 2015; 385(9967): 540-8.
5. Kristine Husøy O, Solomon T, Kjell Arne J, Kristiane Tislevoll E, Ole Frithjof N, Ingrid M. Prioritizing child health interventions in Ethiopia: modeling impact on child mortality, life expectancy and inequality in age at death. PLoS ONE, 2012.
6. Friedman SM. The Interface Between Healthy Aging, Longevity, Disease, and Disability. Healthy Aging: Springer; 2019: 23-9.
7. Thun MJ, Apicella LF, Henley SJ. Smoking vs other risk factors as the cause of smoking-attributable deaths: confounding in the courtroom. Jama 2000; 284(6): 706-12.
8. Coll P. Healthy Aging : a Complete Guide to Clinical Management. Cham, Switzerland: Springer; 2019.
9. Fabbri E, An Y, Zoli M, et al. Aging and the burden of multimorbidity: associations with inflammatory and anabolic hormonal biomarkers. The journals of gerontology Series A, Biological sciences and medical sciences 2015; 70(1): 63-70.
10. Crimmins EM. Lifespan and Healthspan: Past, Present, and Promise. The Gerontologist 2015; 55(6): 901-11.
11. Fried LP, Tangen CM, Walston J, et al. Frailty in Older Adults: Evidence for a Phenotype. JOURNALS OF GERONTOLOGY SERIES A 2001; 56(Part 3): M146-M57.
12. Fried LP, Bandeen-Roche K, Williamson JD, et al. Functional Decline in Older Adults: Expanding Methods of Ascertainment. The Journals of Gerontology: Series A 1996; 51A(5): M206-M14.
13. Ferrucci L. Editorial. An Exciting Thought. JOURNALS OF GERONTOLOGY SERIES A 2005; 60(1): 56.
14. Fulop T, Larbi A, Witkowski JM, et al. Aging, frailty and age-related diseases. Biogerontology 2010; 11(5): 547-63.
15. Rockwood K, Stadnyk K, MacKnight C, McDowell L, Hébert R. A brief clinical instrument to classify frailty in elderly people. Lancet (British edition) 1999; 353(9148): 205-6.
16. Slaets JP. Vulnerability in the elderly: frailty. Med Clin North Am 2006; 90(4): 593-601.
17. Bergman H, Ferrucci L, Guralnik J, et al. Frailty: An emerging research and clinical paradigm - Issues and controversies. J Gerontol Ser A-Biol Sci Med Sci 2007; 62(7): 731-7.
18. Peters LL, Boter H, Buskens E, Slaets JP. Measurement properties of the Groningen Frailty Indicator in home-dwelling and institutionalized elderly people. Journal of the American Medical Directors Association 2012; 13(6): 546-51.
25
19. Peters LL, Boter H, Slaets JP, Buskens E. Development and measurement properties of the self assessment version of the INTERMED for the elderly to assess case complexity. Journal of psychosomatic research 2013; 74(6): 518-22.
20. Peters LL, Burgerhof JG, Boter H, Wild B, Buskens E, Slaets JP. Predictive validity of a frailty measure (GFI) and a case complexity measure (IM-E-SA) on healthcare costs in an elderly population. Journal of psychosomatic research 2015; 79(5): 404-11.
21. Schuurmans H, Steverink N, Lindenberg S, Frieswijk N, Slaets JP. Old or frail: what tells us more? The journals of gerontology Series A, Biological sciences and medical sciences 2004; 59(9): M962-5.
22. Walston J, Hadley EC, Ferrucci L, et al. Research Agenda for Frailty in Older Adults: Toward a Better Understanding of Physiology and Etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. Journal of the American Geriatrics Society 2006; 54(6): 991-1001.
23. Beard JR, Officer A, de Carvalho IA, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet (London, England) 2016; 387(10033): 2145-54.
24. Rowe JW, Fulmer T, Fried L. Preparing for Better Health and Health Care for an Aging Population. Jama 2016; 316(16): 1643-4.
25. Karlin NJ, Weil J. Healthy Aging in a Global Context: Comparing Six Countries. Ageing International 2017; 42(1): 1-22.
26. Phelan EA, Anderson LA, LaCroix AZ, Larson EB. Older adults’ views of “successful aging”--how do they compare with researchers’ definitions? J Am Geriatr Soc 2004; 52(2): 211-6.
27. WHO. What is healthy ageing? https://www.who.int/ageing/healthy-ageing/en/ (accessed 10 05 2020 2020).
28. WHO. Healthy Ageing Infographic. 2015. https://www.who.int/ageing/events/world-report-2015-launch/healthy-ageing-infographic.jpg?ua=1 (accessed 10 05 2020 2020).
29. Benson JJ, Sloan S, Halt AK. Human relationships and healthy aging. Healthy Aging: Springer; 2019: 319-28.
30. Borrell-Carrió F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med 2004; 2(6): 576-82.
31. Kalache A, Kickbusch I. A global strategy for healthy ageing. World health : published for the non-technical reader by the World Health Organization 1997; 50(4): 4.
32. Fernández-Ballesteros Ro, Robine JM, Walker A, Kalache A. Active Aging: A Global Goal. Current Gerontology and Geriatrics Research 2013; 2013: 1-4.
33. WHO. Active ageing: a policy framework. 2002. https://www.who.int/ageing/ publications/active_ageing/en/.
34. Collaborators GBDA. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (London, England) 2018; 392(10152): 1015-35.
35. Hubbard RE, Lang IA, Llewellyn DJ, Rockwood K. Frailty, body mass index, and abdominal obesity in older people. The journals of gerontology Series A, Biological sciences and medical sciences 2010; 65(4): 377-81.
2
6
36. Hubbard RE, Searle SD, Mitnitski A, Rockwood K. Effect of smoking on the
accumulation of deficits, frailty and survival in older adults: A secondary analysis from the Canadian study of health and aging. J Nutr Health Aging 2009; 13(5): 468-72.
37. Kojima G, Iliffe S, Walters K. Smoking as a predictor of frailty: a systematic review. Bmc Geriatr 2015; 15.
38. Peters LL, Boter H, Burgerhof JG, Slaets JP, Buskens E. Construct validity of the Groningen Frailty Indicator established in a large sample of home-dwelling elderly persons: Evidence of stability across age and gender. Exp Gerontol 2015.
39. Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med 2002; 22(4): 267-84.
40. Wiley JA, Camacho TC. Life-style and future health: Evidence from the Alameda County study. Preventive Medicine 1980; 9(1): 1-21.
41. Wingard DL, Berkman LF, Brand RJ. A multivariate analysis of health-related practices: a nine-year mortality follow-up of the Alameda County Study. American journal of epidemiology 1982; 116(5): 765-75.
42. Jacob ME, Yee LM, Diehr PH, et al. Can a Healthy Lifestyle Compress the Disabled Period in Older Adults? Journal of the American Geriatrics Society 2016; 64(10): 1952-61.
43. Macera CA, Cavanaugh A, Bellettiere J. State of the Art Review Physical Activity and Older Adults. American Journal of Lifestyle Medicine 2017; 11(1): 42-57.
44. Timmermans EJ, Huisman M, Kok AAL, Kunst AE. Smoking Cessation and 16-year Trajectories of Functional Limitations Among Dutch Older Adults: Results from the Longitudinal Aging Study Amsterdam. The Journals of Gerontology: Series A 2018; 73(12): 1722-8.
45. Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. Jama 2004; 292(12): 1433-9.
46. Peel NM, McClure RJ, Bartlett HP. Behavioral determinants of healthy aging. American Journal of Preventive Medicine 2005; 28(3): 298-304.
47. van Baak MA, Visscher TLS. Public health success in recent decades may be in danger if lifestyles of the elderly are neglected. Am J Clin Nutr 2006; 84(6): 1257-8.
48. Villareal DT, Miller BV, Banks M, Fontana L, Sinacore DR, Klein S. Effect of lifestyle intervention on metabolic coronary heart disease risk factors in obese older adults. Am J Clin Nutr 2006; 84(6): 1317-23.
49. Østbye T, Taylor DH. The effect of smoking on years of healthy life (YHL) lost among middle‐aged and older Americans. Health Services Research 2004; 39(3): 531-52.
50. Taylor AH, Cable NT, Faulkner G, Hillsdon M, Narici M, Van Der Bij AK. Physical activity and older adults: a review of health benefits and the effectiveness of interventions. Journal of Sports Sciences 2004; 22(8): 703-25.
51. Hamer M, Lavoie KL, Bacon SL. Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing. British Journal of Sports Medicine 2014; 48(3): 239-43.
52. McPhee JS, French DP, Jackson D, Nazroo J, Pendleton N, Degens H. Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology 2016; 17(3): 567-80.
2
7
53. Lautenschlager NT, Cox KL, Flicker L, et al. Effect of Physical Activity on Cognitive Function in Older Adults at Risk for Alzheimer Disease: A Randomized Trial. Jama 2008; 300(9): 1027-37.
54. WHO. Health promotion: a discussion document on the concept and principles: summary report of the Working Group on Concept and Principles of Health Promotion, Copenhagen, 9-13 July 1984: Copenhagen: WHO Regional Office for Europe, 1984.
55. Tengland P-A. Health Promotion or Disease Prevention: A Real Difference for Public Health Practice? Health Care Analysis 2010; 18(3): 203-21.
56. Ng TP, Feng L, Nyunt MSZ, et al. Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial. The American Journal of Medicine 2015; 128(11): 1225-36.e1.
57. Stegeman I, Kraaijenhagen R, Bossuyt P. [Integrated risk profiling allows prevention and early intervention]. Nederlands tijdschrift voor geneeskunde 2009; 154: A1906-A.
58. Vina J, Rodriguez-Manas L, Salvador-Pascual A, Tarazona-Santabalbina FJ, Gomez-Cabrera MC. Exercise: the lifelong supplement for healthy ageing and slowing down the onset of frailty. Journal of Physiology-London 2016; 594(8): 1989-99.
59. Goodman C, Davies SL, Dinan S, See Tai S, Iliffe S. Activity promotion for community-dwelling older people: a survey of the contribution of primary care nurses. Br J Community Nurs 2011; 16(1): 12-7.
60. Kemppainen V, Tossavainen K, Turunen H. Nurses’ roles in health promotion practice: an integrative review. Health Promotion International 2013; 28, Issue 4: 490–501.
61. Whitehead D. Health promotion in nursing: a Derridean discourse analysis. Health Promotion International 2011; 26(1): 117-27.
62. Smit LC, Schuurmans M, Blom J, et al. Unravelling complex primary-care programs to maintain independent living in older people: a systematic overview. Journal of Clinical Epidemiology 2018; 96: 110-9.
63. Lambregts J, Grotendorst A, van Merwijk C. Bachelor of Nursing 2020: een toekomstbestendig opleidingsprofiel 4.0: Springer; 2016.
64. Huizenga P, Gobbens RJJ, Finnema EJ, Roodbol PF. Application of nursing roles in the care for older people, based on the CanMEDS. Journal of Advanced Nursing 2016; 72: 48.
65. McCormack B, McCance TV. Development of a framework for person‐centred nursing. Journal of advanced nursing 2006; 56(5): 472-9.
66. Hupcey JE, Miller J. Community dwelling adults’ perception of interpersonal trust vs. trust in health care providers. Journal of clinical nursing 2006; 15(9): 1132-9.
67. Iliffe S. Community-based interventions for older people with complex needs: time to think again? Age and ageing 2016; 45(1): 2-3.
68. Frank J, Snell L, Sherbino J, Editors. CanMEDS 2015 Physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada 2015.
69. Borglin G, Jakobsson U, Edberg A-K, Hallberg IR. Self-reported health complaints and their prediction of overall and health-related quality of life among elderly people. International Journal of Nursing Studies 2005; 42(2): 147-58.
70. Resnick B, Spellbring AM. Understanding what motivates older adults to exercise. Journal of gerontological nursing 2000; 26(3): 34-42.
71. Robison J, Rogers MA. Adherence to exercise programmes. Sports Medicine 1994; 17(1): 39-52.
28
72. van der Bij AK, Laurant MGH, Wensing M. Effectiveness of physical activity interventions for older adults: a review1 American Journal of Preventive Medicine 2002; 22(2): 120-33.
73. Walters ME, Reijneveld SA, van der Meulen A, Dijkstra A, de Winter AF. Effects of a training program for home health care workers on the provision of preventive activities and on the health-related behavior of their clients: A quasi-experimental study. International Journal of Nursing Studies 2017; 74: 61-6.
74. Puts MT, Toubasi S, Atkinson E, et al. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a protocol for a scoping review of the literature and international policies. BMJ open 2016; 6(3): e010959.
75. Morales-Asencio JM, Gonzalo-Jiménez E, Martin-Santos FJ, et al. Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study. BMC Health Services Research 2008; 8(1): 193.
76. Metzelthin SF, van Rossum E, de Witte LP, et al. Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial. Bmj 2013; 347.
77. Beswick AD, Rees K, Ayis S, et al. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. The Lancet 2008; 371(9614): 725-35.
78. Butler CC, Simpson SA, Hood K, et al. Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial. Bmj 2013; 346: f1191.
79. Tappenden P, Campbell F, Rawdin A, Wong R, Kalita N. The clinical effectiveness and cost-effectiveness of home-based, nurse-led health promotion for older people: a systematic review. Health Technol Assess 2012; 16(20): 1-72.
80. Kogan AC, Wilber K, Mosqueda L. Person-Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review. Journal of the American Geriatrics Society 2016; 64(1): e1-e7.
81. Elwyn G, Dehlendorf C, Epstein RM, Marrin K, White J, Frosch DL. Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems. Ann Fam Med 2014; 12(3): 270-5.
82. Cooper RS. Using public health indicators to measure the success of hypertension control. Hypertension (Dallas, Tex : 1979) 2007; 49(4): 773-4.
83. Kuh D, Shlomo YB. A life course approach to chronic disease epidemiology: Oxford University Press; 2004.
84. Elwyn G, Frosch D, Thomson R, et al. Shared Decision Making: A Model for Clinical Practice. Journal of General Internal Medicine 2012; 27(10): 1361-7.
85. Stiggelbout AM, Pieterse AH, De Haes JC. Shared decision making: Concepts, evidence, and practice. Patient Educ Couns 2015; 98(10): 1172-9.
86. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change: Guilford Press; 2002.
87. Miller WR, Rollnick S. Motivational interviewing: helping people change. 3rd ed. ed. New York, NY: Guilford Press; 2013.
88. Derksen RE, Brink-Melis WJ, Westerman MJ, Dam JJ, Seidell JC, Visscher TL. A local consensus process making use of focus groups to enhance the implementation of a national integrated health care standard on obesity care. Fam Pract 2012; 29 Suppl 1: i177-i84.
29
89. Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Quality & safety in health care 2006; 15(5): 307-10.
90. Behm L, Ivanoff SD, Zidén L. Preventive home visits and health – experiences among very old people. BMC public health 2013; 13(1): 1-10.
91. Butler M, Talley KMC, Burns R, et al. Values of Older Adults Related to Primary and Secondary Prevention. Evidence Synthesis Rockville, MD: Agency for Healthcare Research and Quality 2011.
92. Bakker E, Jaspers N, Kraakman M, Visser G. Consultatiebureau voor Ouderen. Visiedocument. Utrecht, The Netherlands: Kenniscentrum Ouderen, Vilans, 2008.
93. Braveman P, Barclay C. Health disparities beginning in childhood: a life-course perspective. Pediatrics 2009; 124 Suppl 3: S163-75.
94. Mayer KU. New Directions in Life Course Research. Annual Review of Sociology 2009; 35(1): 413-33.
95. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 1983; 51(3): 390-5.
96. Steverink N, Slaets J, Schuurmans H, Van Lis M. Measuring frailty. Development and testing of the Groningen Frailty Indicator (GFI). The Gerontologist 2001; 41(1): 236.
97. Östlund U, Kidd L, Wengström Y, Rowa-Dewar N. Combining qualitative and
quantitative research within mixed method research designs: a methodological review. Int J Nurs Stud 2011; 48(3): 369-83.
98. Shorten A, Smith J. Mixed methods research: expanding the evidence base. Evidence-based nursing 2017; 20(3): 74-5.
