Author: leydenacademy

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.

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.

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
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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.

“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.

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.

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 six 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, the University of Copenhagen (Denmark) and the University of Coimbra (Portugal). The programme will be organised 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.

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.”

How does healthcare work in Denmark, what does it cost and how has the Danish healthcare system withstood the ‘stress test’ of the COVID pandemic, compared to the Netherlands? Rudi Westendorp, professor of Geriatric Medicine at the University of Copenhagen and member of the Danish Outbreak Management Team, discussed this with the students and alumni of our executive course ‘Good life, good care for the elderly’ on 15 October 2021.

About thirty administrators and policy makers from (elderly) care were gathered in the Faculty Club of Leiden University. The annual study trip to Scandinavia could not take place due to the corona measures, so Professor Westendorp was asked to place Dutch healthcare in an international perspective. The former director of Leyden Academy, who has been working and living in Copenhagen since 2015, made it immediately clear that Danish care is organized very efficiently: he showed his personal pass, were caregivers provide all necessary information and which gives him access to care everywhere.

Make sure to dream
The Danish healthcare system is equally efficient in its management. The country is divided into five regions with one director above them, with the power to persevere. There is one centrally controlled GGD. Long-term care is provided by the 96 municipalities, which are given a lot of freedom to fulfil their task transparently and following the quality requirements. Very logical, Westendorp thinks, also for the Netherlands: “In Rotterdam you need something different than in East Groningen”. Healthcare costs are lower in Denmark (approximately 12% of GDP compared to more than 14% in the Netherlands) and the population benefits: Danes give their lives an average of 8 and this rating increases as people get older. Westendorp: “This is actually the care we dream of in the Netherlands… but which we will never get.”

Corona as a stress test
You can also measure the quality of a care system by the extent to which it is shock-resistant. Westendorp calls the COVID pandemic a ‘stress test’. And here too, according to him, Denmark performs better. The ICs coped well with the rush and there is no delayed care. Nor has there been any excess mortality in Denmark; Neighbouring Norway even records under-mortality, because influenza barely got a foothold there due to the corona measures. How is it that COVID in the Netherlands has claimed so many more victims among the older population? Food for thought, according to Westendorp.

A deal is a deal
Various causes were suggested from the discussions at the tables. Are the Danes healthier than us? No, says Westendorp, “they smoke and drink like heretics”. Is it because the country is less populated? Nonsense: one in three Danes lives in Copenhagen, an urban area with 2 million people. The professor eventually relieved the audience of the tension: it is mainly due to the discipline of sticking to measures. Don’t be under any illusions, there was a lot of heated debate in Denmark too. But if 80% of Danes agree on the right way, then that’s the decision, and the other 20% also agree. Westendorp: “The Dutch often think: ‘I’ll decide for myself’. Danes keep to the agreements, and people won’t deviate from this. So there are no implementation problems.”

We before me
This is also the main reason for Westendorp’s conclusion that we will never receive the “dreamed” Danish care in the Netherlands. A deal is a deal and we before me, that is simply ingrained in the Danish national character and not in ours. Danes wore face masks en masse because you don’t have to think about infecting someone else. The Dutch wore the masks reluctantly, mainly to protect themselves. It elicits Westendorp’s statement that “every country gets the COVID epidemic as an expression of the culture that prevails there”.  Yet there is hope, because, according to the professor, both countries share the collective will to properly arrange health care and to help each other in times of disaster and misery. “We essentially want the same thing, only we have lost our way in the implementation in the Netherlands. Why the market forces and fragmentation, why don’t we organize it as a public matter?” Westendorp wonders. To end on a positive note: “We can rebuild this and hold government accountable from the bottom up.”

What is the impact of arts engagement on the quality of life of older people? Together with Amsterdam UMC and supported by ZonMw, we conducted a 2-year research project. We recently published our findings in a special issue of scientific journal International Journal of Environmental Research and Public Health. Please click here for the open access article ‘The Value of Active Arts Engagement on Health and Well-Being of Older Adults: A Nation-Wide Participatory Study’.

An emerging body of research indicates that active arts engagement can enhance older adults’ health and experienced well-being, but scientific evidence is still fragmented. There is a research gap in understanding arts engagement grounded in a multidimensional conceptualization of the value of health and well-being from older participants’ perspectives. This Dutch nation-wide study aimed to explore the broader value of arts engagement on older people’s perceived health and well-being in 18 participatory arts-based projects (dance, music, singing, theater, visual arts, video, and spoken word) for community-dwelling older adults and those living in long term care facilities. In this study, we followed a participatory design with narrative- and arts-based inquiry. We gathered micro-narratives from older people and their (in)formal caregivers (n = 470).

The findings demonstrate that arts engagement, according to participants, resulted in (1) positive feelings, (2) personal and artistic growth, and (3) increased meaningful social interactions. This study concludes that art-based practices promote older people’s experienced well-being and increase the quality of life of older people. This study emphasizes the intrinsic value of arts engagement and has implications for research and evaluation of arts engagement.

The article ‘The Value of Active Arts Engagement on Health and Well-Being of Older Adults: A Nation-Wide Participatory Study’ by Barbara de Groot, Lieke de Kock, Yosheng Liu, Christine Dedding, Janine Schrijver, Truus Teunissen, Margo van Hartingsveldt, Jan Menderink, Yvonne Lengams, Jolanda Lindenberg, and Tineke Abma was published in Augustus 2021 in the International Journal of Environmental Research and Public Health.

For more information, please contact Lieke de Kock or visit the project website www.kunstindezorg.com.