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Background Older people with multifaceted care needs often require treatment and complex care across different settings. However, transitional care is often inadequately managed, and older people and their informal caregivers are not always sufficiently heard and/or supported in transitional care decision‐making. Objective To explore older people's and informal caregivers' experiences with, views on, and needs concerning empowerment in transitional care decision‐making. Methods A qualitative descriptive study was conducted in the TRANS‐SENIOR consortium's collaborative research using semistructured in‐depth interviews between October 2020 and June 2021 in Flanders, Belgium. A total of 29 people were interviewed, including 14 older people and 15 informal caregivers who faced a transition from home to another care setting or vice versa. Data were analysed according to the Qualitative Analysis Guide of Leuven. Findings Five themes were identified in relation to the participant's experiences, views and needs: involvement in the decision‐making process; informal caregivers' burden of responsibility; the importance of information and support; reflections on the decision and influencing factors. Conclusions Overall, older people and informal caregivers wished to be more seen, recognised, informed and proactively supported in transitional care decision‐making. However, their preferences for greater involvement in decision‐making vary and are affected by several factors that are both intrinsic and extrinsic. Therefore, healthcare systems might seek out age‐tuned and person‐centred empowerment approaches focusing on older people's and informal caregivers' empowerment. For future studies, we recommend developing specific strategies for such empowerment. Patient or Public Contribution Older persons' representatives were involved in designing the TRANS‐SENIOR programme of research, including the current study. Healthcare professionals and nursing care directors were involved in the study design and the selection and recruitment of participants.

Background According to some studies, interventions can prevent or delay frailty, but their effect in preventing adverse outcomes in frail community-dwelling older people is unclear. The aim is to investigate the effect of an intervention on adverse outcomes in frail older adults. Methods A systematic review and meta-analysis of Medline, Embase, the Cochrane Library, and Social Sciences Citation Index. Randomized controlled studies that aimed to treat frail community-dwelling older adults, were included. The outcomes were mortality, hospitalization, formal health costs, accidental falls, and institutionalization. Several sub-analyses were performed (duration of intervention, average age, dimension, recruitment). Results Twenty-five articles (16 original studies) were included. Six types of interventions were found. The pooled odds ratios (OR) for mortality when allocated in the experimental group were 0.99 [95% CI: 0.79, 1.25] for case management and 0.78 [95% CI: 0.41, 1.45] for provision information intervention. For institutionalization, the pooled OR with case management was 0.92 [95% CI: 0.63, 1.32], and the pooled OR for information provision intervention was 1.53 [95% CI: 0.64, 3.65]. The pooled OR for hospitalization when allocated in the experimental group was 1.13 [95% CI: 0.95, 1.35] for case management. Further sub-analyses did not yield any significant findings. Conclusion This systematic review and meta-analysis does not provide sufficient scientific evidence that interventions by frail older adults can be protective against the included adverse outcomes. A sub-analysis for some variables yielded no significant effects, although some findings suggested a decrease in adverse outcomes. Trial registration Prospero registration CRD42016035429 .

Background The debate on frailty in later life focuses primarily on deficits and their associations with adverse (health) outcomes. In addition to deficits, it may also be important to consider the abilities and resources of older adults. This study was designed to gain insights into the lived experiences of frailty among older adults to determine which strengths can balance the deficits that affect frailty. Methods Data from 121 potentially frail community-dwelling older adults in Flemish-speaking Region of Belgium and Brussels were collected using a mixed-methods approach. Quantitative data were collected using the Comprehensive Frailty Assessment Instrument (CFAI), Montreal Cognitive Assessment (MoCA), and numeric rating scales (NRS) for quality of life (QoL), care and support, meaning in life, and mastery. Bivariate analyses, paired samples t-tests and means were performed. Qualitative data on experiences of frailty, frailty balance, QoL, care and support, meaning in life, and mastery were collected using semi-structured interviews. Interviews were subjected to thematic content analysis. Results The “no to mild frailty” group had higher QoL, care and support, meaning in life, and mastery scores than the “severe frailty” group. Nevertheless, qualitative results indicate that, despite being classified as frail, many older adults experienced high levels of QoL, care and support, meaning in life, and mastery. Respondents mentioned multiple balancing factors for frailty, comprising individual-level circumstances (e.g., personality traits, coping strategies, resilience), environmental influences (e.g., caregivers, neighborhood, social participation), and macro-level features (e.g., health literacy, adequate financial compensation). Respondents also highlighted that life changes affected their frailty balance, including changes in health, finances, personal relationships, and living situation. Conclusion The findings indicate that frailty among older individuals can be considered as a dynamic state and, regardless of frailty, balancing factors are important in maintaining a good QoL. The study investigated not only the deficits, but also the abilities, and resources of frail, older adults. Public policymakers and healthcare organizations are encouraged to include these abilities, supplementary or even complementary to the usual focus on deficits.

ObjectiveThe aim of the present study is to describe a stepwise approach to study which contextual factors might moderate the effect of healthcare interventions and to test feasibility of this approach within the D-SCOPE project.DesignExploratory case study.SettingIn the D-SCOPE project, a complex intervention by means of home visits was set up to improve access to tailored care in three municipalities (Ghent, Knokke-Heist and Tienen).MethodsOne designed and tested an approach including five steps: (1) a theoretical/conceptual discussion of relevant contextual factor domains was held; (2) a search was done to find appropriate web-based public datasets which covered these topics with standardised information; (3) a list of all identified contextual factors was made (inventory); (4) to reduce the long list of contextual factors, a concise list of most relevant contextual factors was developed based on the opinion of two independent reviewers and (5) a nominal grouping technique (NGT) was applied.ResultsThree public web-based datasets were found resulting in an inventory of 157 contextual factors. After the selection by two independent reviewers, 41 contextual factors were left over and presented in a NGT which selected 10 contextual factors. The NGT included seven researchers, all familiar with the D-SCOPE intervention, with various educational backgrounds and expertise and lasted approximately 1 hour.ConclusionThe present study shows that a five-step approach is feasible to determine relevant contextual factors that might affect the results of an intervention study. Such information may be used to correct for in the statistical analyses and for interpretation of the outcomes of intervention studies.NCT03168204

Background Frail community-dwelling older adults, whom might experience problems regarding physical, cognitive, psychological, social and environmental factors, are at risk for adverse outcomes such as disability, institutionalization and mortality. People in need of help do not always find their way to care and support services and are left undetected. The aim of the D-SCOPE project is to detect frail community-dwelling older adults who previously went unnoticed and to improve their access to care and support. Goal is to increase their frailty-balance, quality of life, meaning in life, life satisfaction, mastery, community inclusion and ageing well in place. Methods/design The study is a prospective, longitudinal randomized four-armed controlled trial with follow-up at 6 months. The study group aims to include 900 community-dwelling older adults aged 60 years and over from 3 municipalities in Flanders (Belgium). While selecting the study group, risk profiles for frailty will be taken into account. Participants will be randomly selected from the census records in each municipality. Data will be collected prospectively at baseline (T0) and at follow-up, 6 months after baseline (T1). At baseline, participants who are at least mild frail on one of the 5 domains of frailty (CFAI-plus) or feel frail based on the subjective assessment of frailty will be randomly assigned to (1) the study group or (2) the control group. A mixed method design with the inclusion of quantitative and qualitative data analyses will be used to evaluate the efficacy and experiences of the detection and prevention program on frailty. Discussion The study will contribute to an innovative vision concerning the organization of care and support, and a timely and accurate detection and support of community-dwelling older adults at risk for frailty. Trial registration This trial was registered at ClinicalTrials.gov, on May 26, 2017, identifier: NCT03168204 .

This paper aims to give an overview of the different sources of income and the expenditures of community-dwelling older adults and to what extent they can make ends meet to explore the affordability of care and support at home. Despite research on the affordability of residential care, evidence on the cost of ‘ageing in place’ is still missing. 173 questionnaires were gathered within a non-random sample of community-dwelling older adults (60+). Both frequencies and bivariate tests (to explore whether there are certain risk groups with low incomes and high expenditures) were performed on the data. Results indicate the variety of income sources, the necessity of financial compensations to make ends meet and that especially older women and older tenants are at risk for facing financial difficulties. Also, this research indicates that ‘ageing in place’, especially for older adults with care needs, is not always affordable and can be a challenge within our ageing society.

Purpose Timely detection of multidimensional frailty is important to prevent further negative outcomes. Perspectives of general practitioners (GPs) or informal caregivers might serve as a first, global screener to identify older people in need of a more extended assessment. Therefore, we aimed to investigate whether proxy assessments are associated with older people’s self-reported environmental, physical, psychological, social and overall frailty. Methods A cross-sectional study was conducted on 78 community-dwelling people aged 60 years and over, their GPs ( n  = 57) and informal caregivers ( n  = 50). Self-reported frailty was assessed with the Comprehensive Frailty Assessment Instrument. GPs and informal caregivers rated each frailty domain and overall frailty on a scale of 0 (not frail at all) to 10 (severely frail). Associations between proxy scores and self-reported frailty were examined by correlation analyses. Results Significant low to moderate associations were found between (1) self-reported physical frailty and physical frailty scores given by the GPs ( r  = 0.366, p  ≤ 0.01) and informal caregivers ( r  = 0.305, p  ≤ 0.05), and (2) self-reported psychological frailty and psychological frailty scores given by the GPs ( r  = 0.230, p  ≤ 0.05) and informal caregivers ( r  = 0.254, p  ≤ 0.05). No significant associations were found between proxy scores and self-reported environmental, social and overall frailty. Conclusions Global proxy scores as short, subjective screeners for detecting frailty cannot completely replace self-reported frailty. Nonetheless, low to moderate correlations were found for physical and psychological frailty ratings, suggesting that proxy scores might be of value as a first sign of something being wrong for these domains.

Most older people wish to age in place, for which functional status or being able to perform activities of daily living (ADLs) is an important precondition. However, along with the substantial growth of the (oldest) old, the number of people who develop limitations in ADLs or have functional decline dramatically increases in this part of the population. Therefore, it is important to gain insight into factors that can contribute to developing intervention strategies at older ages. As a first step, this systematic review was conducted to identify risk and protective factors as predictors for developing limitations in ADLs in community-dwelling people aged 75 and over. Four electronic databases (CINAHL (EBSCO), EMBASE, PsycINFO and PubMed) were searched systematically for potentially relevant studies published between January 1998 and March 2016. After a careful selection process, 6,910 studies were identified and 25 were included. By far most factors were examined in one study only, and most were considered risk factors. Several factors do not seem to be able to predict the development of limitations in ADLs in people aged 75 years and over, and for some factors ambiguous associations were found. The following risk factors were found in at least two studies: higher age, female gender, diabetes, hypertension, and stroke. A high level of physical activity and being married were protective in multiple studies. Notwithstanding the fact that research in people aged 65 years and over is more extensive, risk and protective factors seem to differ between the 'younger' and 'older' olds. Only a few risk and protective factors in community-dwelling people aged 75 years and over have been analysed in multiple studies. However, the identified factors could serve both detection and prevention purposes, and implications for future research are given as well.

To gain insights into vulnerable lifecourses and give a voice to those often underrepresented in quantitative research, this study examines the life stories (past, present and future) of 19 financially excluded older adults using an adapted version of McAdams’ life-story interview scheme. Although these life stories demonstrate an accumulation of many disadvantages and an uncertain future because of current financial situations, the stories also reflect the generativity, resilience, coping strategies and agency of financially excluded older adults. We demonstrate how the experienced lifecourse is built around both negative and positive turning points and transitions which go beyond the classical education–work–retirement triumvirate, and how socio-cultural life scripts are used as a framework to build one's own life story in order to achieve continuity. The discussion highlights the potential for deploying the life-story method as a qualitative resource for providing individualised care.

AimThis paper aims to identify barriers that frail community-dwelling older adults experience regarding access to formal care and support services.BackgroundUniversal access to healthcare has been set by the World Health Organisation (WHO) as a main goal for the post-2015 development agenda. Nevertheless, regarding access to care, particular attention has to be paid to the so-called vulnerable groups, such as (frail) older adults.MethodsBoth inductive and deductive content analyses were performed on 22 individual interviews with frail, community-dwelling older adults who indicated they lacked care and support. The coding scheme was generated from the conceptual framework ‘6A’s of access to care and support’ (referring to work of Penchansky and Thomas, 1981; Wyszewianski, 2002; Saurman, 2016) and applied on the transcripts.FindingsResults indicate that (despite all policy measures) access to a broad spectrum of care and support services remains a challenge for older people in Belgium. The respondents’ barriers concern: ‘affordability’ referring to a lot of Belgian older adults having limited pensions, ‘accessibility’ going beyond geographical accessibility but also concerning waiting lists, ‘availability’ referring to the lack of having someone around, ‘adequacy’ addressing the insufficiency of motivated staff, the absence of trust in care providers influencing ‘acceptability’, and ‘awareness’ referring to limited health literacy. The discussion develops the argument that in order to make care and support more accessible for people in order to be able to age in place, governments should take measures to overcome these access limitations (eg, by automatic entitlements) and should take into account a broad description of access. Also, a seventh barrier (a seventh A) within the results, namely ‘ageism’, was discovered.