Pre-medical students from New York visit Leyden Academy

Pre-medical students from New York visit Leyden Academy

Today Leyden Academy welcomed a small delegation pre-medical students from Union College in New York. The students are currently touring the US, Canada, the UK and the Netherlands for an impression of how health care is structured in the various countries. In our country, the tour included amongst others visits to hospitals, a health centre, a centre specialising in physical and mental disabilities and an interview with a general practitioner. The goal is to provide students with an exposure to the different types of systems alongside an emphasis on teaching them how to compare and analyse the strengths and weaknesses of each model. Some issues are looked into in depth, such as how each system deals with decisions about allocating resources, regulating and managing costs, dealing with end of life issues, and supporting programs to improve public health.

At Leyden Academy, some of these topics were discussed. PhD candidate Miriam Verhage provided the students with an introduction to the mission and research projects of Leyden Academy as well as on the structure and financing of health care in the Netherlands. Miriam also gave a brief insight on the future of the Dutch method of care, on the impact of COVID-19 and on the care for vulnerable older populations.
The topic of the presentation of Lucia Thielman, researcher at Leyden Academy, was ‘Care for older people in a transitioning society’. In recent years the Netherlands has transitioned from a welfare state to a participation state. Within this transition care for older adults has changed from care provided in nursing homes to care provided at home. In addition, care is now more often being provided by informal providers in collaboration with formal care provides such as the primary care doctor.
Furthermore, the students got to experience what it feels like to be old, by wearing the ‘ageing suit’. Including shaky hands, unsteady feet and limited eyesight due to glaucoma or diabetic retinopathy, depending on the glasses you choose. A true eye-opener…

Enjoying Life Approach on location: Between dream and deed

Enjoying Life Approach on location: Between dream and deed

On May 10, 2022, the conference ‘Enjoying Life Approach on location’ took place in Arnhem (in the Netherlands), as a completion of the eponymous project. Marieke Braks, director of long-term care at VGZ and host of the conference, said that the first steps in the project started with a cup of coffee and that she is proud of what has been achieved since then, with all those involved. Tineke Abma, director of Leyden Academy and professor of Elderly Participation at the Leiden University Medical Center, then discussed good care and care ethics: 1) it is very personal, 2) it is a reciprocity, in coordination with residents and relatives, and 3) it starts with attention and insight into wishes and desires.
In addition to ‘attention’, according to Theo van Uum, director of Long-term Care at the Ministry of Health, Welfare and Sport, ‘trust’ is also a key word. He finds the Enjoying Life Approach an inspiration that puts the elderly in control, and he believes the scalability of the approach is promising. However he indicated, we must be aware of, on the one hand, the growing number of people with dementia (from 300,000 to approximately 500,000 in 2040 in the Netherlands) and, on the other hand, the shortage on the labour market.
After the plenary part, the participants discussed in various workshops subjects related to person-oriented care.

“Two years ago I mainly focused on carrying out the care tasks. Everything has changed since we focus on person-oriented care. That has done a lot to my job satisfaction. Even though we have a route, it no longer feels like a list I have to work through. I just enjoy doing it now.” – Employee

Book about person-oriented care
As a result of the project, a book (in the Dutch language) has been made, packed with striking photos, experiences, stories and practical tips. Tineke indicated that she is pleased with the fact that the project has been anchored in practice. She handed over the first copies to elderly care employees Wendy van der Ven and Gwendolyn Graven and asked them for a reflection on their experiences with the Enjoying Life Approach. Wendy: “You ‘see’ each other and share with each other. You need each other and everyone is valuable; residents, relatives, and employees.” Gwendolyn: “It is a process, it is never finished. You have to get to know each other and give each other space, even when you face dilemmas.”

“Last summer it was my birthday. The nurses bought a present, which they let my mother give to me. I thought that was so wonderful. My mother really feels at home at the care facility. The care employees and the residents have really become family to her. I’m not the most important person to her anymore. And I don’t mind at all.” – Relative

A film with love
What we can’t express in words, needs to be experienced. That’s why we made a short film ‘With love’ (also in Dutch), which premiered at the conference. ‘With love’ follows Piet and Annemarie and her Bernard, and shows the person behind the resident: attention gives recognition. In the film you can see that employees provided a hook-up bed, so that Bernard can stay with his wife every now and then. And Piet gets emotional by a Doodle board that a care worker made for him after a pleasant conversation and a dance.

“I think it’s important that have good contact with the nursing staff. That you can rely on them and that they keep to their promise.” – Resident

Action research
Implementing the Enjoying Life Approach in practice is not easy: there are sometimes (practical) objections between dream and deed. From 2019 to 2021, the action research focused on the training and coaching of employees as well as the redesign of the electronic client file, work processes and accountability frameworks at two elderly care organisations.
The research was supervised by Leyden Academy and supported by the care offices of Menzis and VGZ, the Ministry of Health, Welfare and Sport, the Dutch Healthcare Authority, the Health Care and Youth Inspectorate, and the KIK-V program of the National Health Care Institute.

“We had a lady who absolutely did not want to be showered. Every time it was a fight. The family could hardly believe it. The son was invited to attend once. It turned out that Mrs. did not want a stranger to help her in the shower, but that she enjoyed it when her children did it. From then on the children helped her shower. For them it was a nice way to make contact, for the staff it was a relief.” – Manager

Everyone thrives in an inclusive age-friendly society

Everyone thrives in an inclusive age-friendly society

The Netherlands Scientific Council for Government Policy (WRR) recently put a magnifying glass on elderly care in four countries: Japan, England, Germany and Denmark. One of the researchers is Tineke Abma, professor of Participation of Older People at the Leiden Medical University Centre and Executive-Director of Leyden Academy on Vitality and Ageing. What lessons can be learned from this research?

Why research in these four countries?
Tineke Abma: “These are countries with a similar demographic structure as in the Netherlands: an increasing group of older people and a shrinking younger working population that can take care of older people. In addition, these are countries that differ in the way in which they have organized healthcare. England is market oriented. Denmark is an egalitarian society where mainly local governments direct long-term care. Germany has a hybrid model just like us. Here, both the government as well as the market determine care, and the civil society plays an important role. Japan is interesting because it is a ‘super-aged society’ like no other country. No fewer than 86,000 people of 100 years and older live there. The respect with which older people are traditionally treated also makes that country interesting.”

Three dimensions of sustainability
The issues facing us as an ageing society in the field of elderly care are complex and difficult to solve, Abma emphasizes. One of the most important conclusions that she and her fellow researchers draw is: when you develop policy, you have to keep an eye on the balance between three dimensions that play a role. These concern:

  • Financial sustainability: will healthcare remain affordable for society and for individual citizens?
  • Personnel sustainability and quality of care: is there sufficient care personnel, and is the staff qualified to take care of the well-being of older people?
  • Societal sustainability: is there support and trust for health care policy?

England
Abma: “There should not be one of those three dimensions dominating the policy for long-term care. Then things can go wrong, as in England where the financial dimension has come to dominate. This leads to a disbalance compared to the other countries. In England there is no broad societal support for the long-term care policy, on the contrary we saw a lot of social outrage and discontent regarding the long-term care policy. For regular and acute healthcare, the English people are insured through taxes and the National Health Service. That is well arranged. But long-term and social care, has for a large part being been privatized. People have to take out additional insurance for this, but a majority of the population doesn’t know that. This leads to a situation wherein older people out of necessity stay longer at home to save costs, resulting in a situation where they do not receive the care needed, or end up in hospital when a crisis occurs. Another consequence is that if they have to be admitted to a nursing home, many of them have to sell their house. Kings Fund College referred to the situation as ‘The road to nowhere,’ because the problem has been known for more over than thirty years. Politicians have promised to resolve the issue but nothing has happened yet..”

Denmark
England is therefore not a shining example for the Netherlands. Denmark is, says Abma. This brings her to a second important conclusion: the importance of developing a global long-term vision for long-term care for the older population. “Denmark has had a law since 1891 stipulating that care is provided locally in the community. Community care is grounded in the notion of ‘ageing in place’, and community care includes physical care as well as prevention, domestic care and social care. This long-term vision ensures stability and societal sustainability, because for over a decade Denmark followed the principles of community care. New policies are always in line with the underlying vision of ageing in place, such as the home visits and reablement program, and therefore recognizable for the general population. Moreover, the values on which the community care policy is based are in line with the values of the egalitarian and democratic culture of the Danish country. One of their remarkable features for working women is the good childcare and professional support for the older population which is provided. Informal care is therefore kept to the minimum.”

The Netherlands
Abma disapproves of the situation in the Netherlands, compared to the Scandinavian country. She recalls the great transition of 2015. The Exceptional Medical Expenses Act (AWBZ) disappeared from one moment to another, without a careful and proper preparation and information and communication to the general population. The Long-term Care Act came into being, as well as the Health Insurance Act and the Social Support Act. Abma: “It was a shame, of course, to phase out all those nursing and care homes, without at the same time investing in care and support in the local community. That is happening now, but we are very late with that. The challenge we face right now is how to facilitate the local collaboration between healthcare providers and social care and support services in order to attend well to the needs of the older population.”

Supermarket
“It is therefore extremely important to invest massively in local care and support networks to foster ageing in place. This should be in joint collaboration with the local communities, mobilizing their sources of resilience. Also, we should acknowledge that healthcare alone cannot resolve the challenges we face. This is a societal issue, and we need everyone in our society to develop a sustainable future, such as social workers, housing corporations, and all kinds of services older people need in order to thrive.” Abma also emphasizes the importance of unexpected coalitions in this regard, for example the collaboration between care, welfare and business companies. “The local supermarket for example can be of importance by keeping an eye on older people and jointly building up local communities. One may also think of social designers and artists who want to contribute and develop a sense of belonging in a community.”

Men and cars
The point is that our society is not designed for older people, according to the professor. “It is mainly geared to dynamic, young and fit people, and productive work. Just look at the infrastructure. It’s based on the husband taking the car going to work. Why are the sidewalks so narrow everywhere? That is residual space in this view. While wide sidewalks are important for older people, but also for children and people with disabilities. Everyone thrives in an inclusive age-friendly society.” Looking through the lens of age-friendliness may help to re-envision our society as a place for human flourishing.

Step by step
The future of care for the older population and of policy making is a complex and wicked issue, as Abma stated earlier. It is wicked, because many stakeholders are involved, with different interests and visions; the multiple dimensions, including ethical, political, economic and cultural dimensions; the entanglement with other issues like the emancipation of women, economic crises, political destabilization, migration; and because much is uncertain, hard to predict and out of control. That is not to say that it should paralyze us; that we no longer know where to start. In a complex society like ours we should not want to make master plans as if everything can be predicted and controlled. Such a strategy simply does not fit the nature of our postmodern situation. This does not mean that we can do nothing at all, or follow a laissez faire strategy. “It is much more wise and sensible to give up the high ambitions and notions of full control, and start with relatively small actions, with small wins. Starting by building relationships of trust with community partners, mobilizing their sources of strengths, and by learning-by-doing, building in feedback loops. In this way we learn step by step how we can shape an inclusive society.”

Community
The point is that our society is also similar to the one in England where the emphasis is on the individual, Abma adds. “We still think too much in terms of: ‘there is an individual client who has a problem, a solution has to be found.’ It is much wiser to learn to think in terms of relationships, networks and communities, and to stimulate social cohesion. There are so many sources of resilience in the community, and people who are willing to contribute to society, just because it makes them feel being meaningful.”

The Dutch version of this interview was published in the magazine ‘MOVISIES’ in March 2022.

Care for elderly people with a migration background in Amsterdam: A future perspective

Care for elderly people with a migration background in Amsterdam: A future perspective

In Amsterdam, the number of seniors who need care is increasing rapidly. A large part of this growth is taking place among older people with a migration background. This group of seniors is not only getting older and more in need of care, but is also increasingly diverse. This demographic development brings important questions: How great will the demand for care be in the near future? And how can we meet the diverse care wishes and needs of older people with a migration background?

Large diversity
At the moment there are many (culture) specific facilities aimed at different target groups; think, for example, of small-scale living for seniors with a Surinamese background or daytime activities for seniors with Turkish or Moroccan descent. There are good reasons (such as language and religion) that make culture-specific care desirable. However, research and mirror discussions show that all kinds of bottlenecks are experienced in meeting expectations, needs and wishes in this culture-specific care. Moreover, the wishes and needs of older people with a migrant background are just as different as those of older people born in the Netherlands. There is also great diversity within equal migrant groups, in which other characteristics (such as education and income) can play a more decisive role.

Quantitative and qualitative research
We investigated the (future) demand for care with the help of register data from Statistics Netherlands. This shows that the demand for long-term care among older people with a migration background will increase in the future. The strongest increase is expected in the demand for long-term care that falls within a mix of personal budget, full package at home and modular package at home.

We also talked to 66 people with a migration background about their ideas about care, now and in the future. They indicate that they consider it important that the quality of care is good, for example when it comes to care-technical actions, cleaning and hygiene and the supply of (diverse) food. They find it essential that care is person-oriented and relational. Language must be taken into account and there must be room for religion. In the future, they want to live independently at home as long as possible. If that is no longer possible, the wishes are diverse: ranging from (paid) informal care to home care to a stay in a nursing home.

Intervention and knowledge dissemination
After this first phase (research), we will develop a concept intervention (phase 2) and test it in five locations of the participating healthcare organizations (phase 3). Finally, in phase 4, we will permanently place the information and skills obtained in care and support, and make them accessible to everyone. We hope that this will improve care provision in situations in which cultural differences play a role, and that the quality of care and satisfaction will increase.

Would you like to know more about this research project? Please contact Nina Conkova at conkova@leydenacademy.nl.

Healthcare Clowning International Meeting: 20-22 April, the Hague

Healthcare Clowning International Meeting: 20-22 April, the Hague

The Healthcare Clowning International Meeting (HCIM) brings together all the people who are part of the life-changing picture of healthcare clowning, who connect worlds, connect people and change spaces.

20-22 April 2022,  the Fokker Terminal in The Hague

We find ourselves in an extraordinary moment in time. We are more aware than ever how important human contact and connection are to our wellbeing. This meeting aims to nurture and strengthen this vital work.
Experts from all over the world look into the world of healthcare clowning. HCIM will approach the field from different angles including: impact and our role in  society, the art of clowning, innovation and online opportunities and fundraising.

From Leyden Academy, professor Tineke Abma is a keynote speaker and Barbara Groot en Lieke de Kock are panelists.

Below a short interview of moderator Laura Koppenberg with keynote speaker Christopher Bailey (Lead of Arts & Health at the World Health Organization). He explains how clowns create a magic space where connection is possible. How they see people where they emotionally are and take them on an amazing journey, wherever it might lead.

 

More information or registration? Go to www.hcim2021.com.

Good care during COVID-19: care home staff’s experiences

Good care during COVID-19: care home staff’s experiences

“I was emotionally very affected by the despair of a resident who had to be isolated in his room. I found it difficult to be confronted with such visible suffering. Especially since there wasn’t much I could do besides lend an ear and be physically present. I sat in the office and cried for a while afterwards.”

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 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 first year of the COVID-19 pandemic (March 2020-Januari 2021). We published our findings on 13 February 2022 in the article ‘Good Care during COVID-19: A Narrative Approach to Care Home Staff’s Experiences of the Pandemic’ in the International Journal of Environmental Research and Public Health.

Obstructions to relational-moral good care
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.

“A resident is standing at the window. Her husband has come to wave to her from outside. As a result of the corona restrictions, no visitors are allowed. The resident gestures to her husband: ‘come upstairs.’ I explain to her that that’s not possible. ‘Then I’ll go to him.’ I tell her that’s not possible either. ‘You are so mean’, she tells me.”

Recommendation
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 article ‘Good Care during COVID-19: A Narrative Approach to Care Home Staff’s Experiences of the Pandemic’ by Marleen Dohmen, Charlotte van den Eijnde, Lucia Thielman, Jolanda Lindenberg, Josanne Huijg, and Tineke Abma was published on 13 February 2022 in the International Journal of Environmental Research and Public Health, Special Issue Nursing and COVID-19.

Online lecture Professor Taichi Ono: “Cherish longevity!”

Online lecture Professor Taichi Ono: “Cherish longevity!”

How does Japan deal with a super-aging society, and the sustainability of elderly care? And how do older people in Japan experience the COVID-19 crisis? On Thursday 20 January 2022, we hosted an online lecture exploring these topics and exchanging experiences and points of view between Japan and the Netherlands.

Professor Taichi Ono of Japan’s National Graduate Institute for Policy Studies (GRIPS) shared his views on the organization and challenges of Japanese elderly care, and provided an overview of how Japanese older people are coping with the COVID-19 pandemic. Professor Tineke Abma, executive director of Leyden Academy, introduced both topics from a Dutch perspective. During and after the lecture, there was a lively interaction with the 25 participants, divided evenly from Japan and The Netherlands.

Mindset change
Professor Ono had a clear message for the participants: “We have to change our mindset, and cherish longevity from the bottom of our hearts.” In his final slides, he introduced the interesting notion of Kyou-Dou, the idea of work and encouragement, to stay active in longer life. Not just for the paycheck, but for fulfilment in life and well-being.

Fruitful exchange
Professor Abma concluded that we can learn a lot from Japan, as they are in the forefront of dealing with the demographic challenges and opportunities of an aging population. “I think this webinar has shown how fruitful it can be to set up an international exchange between countries that are dealing with (super) ageing societies, how they can inspire each other, and how we can learn lessons from each other.”

Global perspective
For an in-depth, global view on older people in the COVID-19 crisis, please read the recent International Longevity Centre (ILC) Global Alliance publication Protecting the human rights of older persons: Challenges to the human rights of older people during and after COVID-19. The report offers valuable insights into the impact of the pandemic across 16 countries in the ILC Global Alliance, including ‘country snapshots’ of Japan (p.27) and The Netherlands (p.29). In The Netherlands, the ILC-network is represented by the Leyden Academy.

You can (re-)watch the full online session (1:47:00) below.

Challenges to the human rights of older people during and after COVID-19

Challenges to the human rights of older people during and after COVID-19

Globally, COVID-19 has led to debilitating effects and posed significant human rights challenges for older persons. Healthcare measures and societal responses to COVID-19 have impacted older persons mental and physical wellbeing, amplified ageism, and heightened the risks of elder abuse.

In the report ‘Protecting the human rights of older persons: Challenges to the human rights of older people during and after COVID-19’, ILC Global Alliance present insights into the impacts of the pandemic across 16 countries in the ILC-Global Alliance, amongst others the Netherlands. Pandemic measures that were meant to physically safeguard older persons have in turn created human rights challenges for them. The initial stringent lockdowns in the community and no visitations imposed in nursing homes have negative impacts on institutionalised and community-dwelling older persons. Many older persons were socially isolated which aggravated their mental health and quality of life and accelerated their functional decline during the pandemic. Additionally, the pandemic has impacted socioeconomic conditions. Older persons across the world, particularly those residing in developing nations, are subjected to greater hardships as they suffer from starvation and experience a slew of human rights issues ranging from age discrimination to elder abuse. Older persons will need additional help.

COVID-19 may have taken our attention, but now it is time to double down on our efforts to promote ways in which older persons can remain strong and age well, and to rebuild and strengthen the social and physical supports that can enable them to have the best possible quality of life.

Click here to download the report.

Research on older people and low literacy

Research on older people and low literacy

In Europe alone, 80 million individuals have low literacy (lack of basic skills), and among those aged 55+ the percentage of low literates is highest. In The Netherlands, there are about 2.5 million adults with low literacy skills, including approximately 700.000 people over 65 years old. These individuals are at higher risk of adverse health outcomes due to a magnification of disadvantage such as lower social economic status, difficulty accessing and interpreting information, limited access to (e-)health solutions, and so on. Many have difficulty adhering to a healthy lifestyle, and have negative learning experiences leading to low confidence and disengagement from learning activities.

In the Netherlands, Leyden Academy researches the experiences, needs and desires of older people with low literacy skills. We also coordinate the European project ‘LOLit: Low Literacy at play’, training citizens with low literacy using the principle of ‘meaningful play’. In an innovative co-created training, we develop 6 thematic sessions. These blended social gatherings innovatively nudge knowledge and skills (such as basic digital and literacy skills), supported by peer-coaching that aims to increase (e-)health literacy. This project is a cooperation of Leyden Academy and the University of Copenhagen (Denmark) and the University of Coimbra (Portugal). The programme will be organized in 2022 in the Netherlands (Leiden and Rotterdam) for approximately 60 attendees, and in Copenhagen and Coimbra for 40 attendees.

The project LOLit: Low Literacy at play is supported by Erasmus+. For more information, please contact Jolanda Lindenberg or Miriam Verhage.

Inaugural lecture David van Bodegom: Vitality in an ageing population

Inaugural lecture David van Bodegom: Vitality in an ageing population

On November 11, 2021, our colleague David van Bodegom delivered his inaugural lecture as professor of ‘Vitality in an ageing population’ at the Leiden University Medical Center, Department of Public Health and Primary Care. The chair was established by Leyden Academy.

Healthy ageing
According to David, the key to healthy and vital ageing lies in our living environment. He therefore argues in favour of changing our living environment in the fight against lifestyle-related disorders instead of making individual citizens feel guilty. “So-called ‘aging diseases’ such as type 2 diabetes, obesity and cardiovascular disease are a huge problem in the Netherlands. While they can partly be prevented or remedied with a healthy lifestyle,” says David. But in an environment where we sit in our office for hours and have access to unhealthy food at any time of the day, healthy behaviour is difficult to maintain, according to David. “Our environment makes us sick, so we have to deal with that.”

The environment guides choices
David illustrates by means of a personal example that the offer in the environment guides our choices. “Since there is a bowl of apples next to the coffee machine at work, I eat a lot more apples. Not because I want to or because someone told me to, but simply because it’s there. So if we change our environment, our behaviour will follow naturally. In this way it is more pleasant and more promising to maintain a healthy lifestyle.”

Beyond the consulting room
Healthcare is just not geared up for this yet, David notes. “Prescribing medicines pays more in the current system than discussing a healthy lifestyle with the patient.” Fortunately, he sees that there is a movement in this area. “I notice especially among young doctors and medical students that lifestyle is becoming increasingly important. They look beyond the consulting room.” The National Prevention Agreement and the inclusion of combined lifestyle interventions in the basic healthcare package are also steps in the right direction, according to the professor. “But we have not won the battle yet.”

Peer coaching
To promote the vitality of older persons, David and colleagues at Leyden Academy founded the Vitality Club. These are groups of older neighbours who exercise together a few times a week, entirely on their own initiative and therefore without professional supervision. “These clubs are a great success. Participants come to participate for their health, but keep coming back for the fun. This shows that the social aspect is important. The elderly coach each other to stay healthy.” The next step is to investigate whether this form of peer coaching also works for people with type 2 diabetes. In an initiative in Leiden a lifestyle program was recently set up for this purpose. “We are going to investigate whether such an alternative referral process can yield health benefits and can relieve the burden on healthcare in a sustainable way.”

Health gain
In the coming years, David and his colleagues want to take the movement in lifestyle medicine even further. “There is still much to be gained in health for older persons. To make this happen, we need to shift our focus from the individual to the population.”