Amsterdam Study Research Articles

Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL)

Loneliness has a significant influence on both physical and mental health. Few studies have investigated the possible associations of loneliness with mortality risk, impact on men and women and whether this impact concerns the situation of being alone (social isolation), experiencing loneliness (feeling lonely) or both. The current study investigated whether social isolation and feelings of loneliness in older men and women were associated with increased mortality risk, controlling for depression and other potentially confounding factors. In our prospective cohort study of 4004 older persons aged 65-84 years with a 10-year follow-up of mortality data a Cox proportional hazard regression analysis was used to test whether social isolation factors and feelings of loneliness predicted an increased risk of mortality, controlling for psychiatric disorders and medical conditions, cognitive functioning, functional status and sociodemographic factors. At 10 years follow-up, significantly more men than women with feelings of loneliness at baseline had died. After adjustment for explanatory variables including social isolation, the mortality hazard ratio for feelings of loneliness was 1.30 [95% confidence interval (CI) 1.04-1.63] in men and 1.04 (95% CI 0.90-1.24) in women. No higher risk of mortality was found for social isolation. Feelings of loneliness rather than social isolation factors were found to be a major risk factor for increasing mortality in older men. Developing a better understanding of the nature of this association may help us to improve quality of life and longevity, especially in older men.

Ethnicity and thrombolysis in ischemic stroke: a hospital based study in Amsterdam

BackgroundEthnic differences have been reported with regard to several medical therapies. The aim of this study was to investigate the relation between ethnicity and thrombolysis in stroke patients.MethodsRetrospective single-centre study. Patients admitted with an ischemic stroke between 2003 and 2008 were included. Ethnicity was determined by self-identification and stratified into white and non-white (all other ethnicities). The main outcome measure was the difference in thrombolysis rate between white and non-white patients. Logistic regression analysis was used to identify potential confounders of the relation between ethnicity and thrombolysis.Results510 patients were included, 392 (77%) white and 118 (23%) non-white. Non-white patients were younger (median 69 vs. 60 years, p < 0.001), had a higher blood pressure at admission (median systolic 150 vs. 160 mmHg, p = 0.02) and a lower stroke severity (median NIHSS 5 vs. 4, p = 0.04). Non-white patients were significantly less often treated with thrombolysis compared to white patients (odds ratio 0.34, 95% CI 0.17-0.71), which was partly explained by a later arrival at the hospital. After adjustment for potential confounders (late arrival, age, blood pressure above upper limit for thrombolysis, and oral anticoagulation use), a trend towards a lower thrombolysis rate in non-whites remained (adjusted odds ratio 0.38, 95% CI 0.13 to 1.16).ConclusionsNon-white stroke patients less often received thrombolysis than white patients, partly as a result of a delay in presentation. In this single centre study, potential bias due to hospital differences or insurance status could be ruled out as a cause. The magnitude of the difference is worrisome and requires further investigation. Modifiable causes, such as patient delay, awareness of stroke symptoms, language barriers and treatment of cardiovascular risk factors, should be addressed specifically in these ethnic groups in future stroke campaigns.

Seroprevalence and Determinants of Eight High-Risk Human Papillomavirus Types in Homosexual Men, Heterosexual Men, and Women: A Population-Based Study in Amsterdam

To determine differences in the seroprevalence of high-risk human papillomavirus (hrHPV) types between men having sex with men (MSM), heterosexual men and women, we analyzed seroprevalence and risk factors for 8 hrHPV in the general population of Amsterdam, the Netherlands. We interviewed 1349 inhabitants aged ≥17 years and tested sera for antibodies against L1 capsid proteins of 8 hrHPV using Luminex-based multiplex serology. Risk factors for hrHPV were determined by multivariate Poisson analysis. Seroprevalences for 8 hrHPV ranged from 13.1% for HPV-45 to 31.4% for HPV-35. Seropositivity for HPV-16 and HPV-18 was more common in women and MSM than in heterosexual men. HPV-16 and -18 were more common in subjects also having antibodies against other hrHPV types (prevalence rate ratio [PRR], 2.12, 95% confidence interval [CI] 1.52-2.97; and PRR, 2.00; 95% CI, 1.43-2.81, respectively) and/or herpes simplex virus type 2 (PRR, 1.69; 95% CI, 1.32-2.16; and PRR, 1.47; 95% CI, 1.13-1.92, respectively). HPV-18 was more common in persons with a history of sexually transmitted infections (STI) (PRR, 1.64; 95% CI, 1.20-2.25). HPV-35, -45, and -58 were more common in non-European ethnic groups. Prevalence of 8 hrHPV antibodies was high in the Amsterdam population, especially in MSM.

Three-year course of clinical symptomatology in young people at ultra high risk for transition to psychosis

The investigation into the course of ultra high risk (UHR) symptomatology of those patients who eventually do not meet the psychosis-threshold criteria within the 3-year timeframe of the study. The course of UHR symptoms, GAF score and employment status was investigated in 57 patients who did not make a transition to psychosis and who were examined within the Dutch Prediction of Psychosis Study in Amsterdam, the Netherlands. At the 3-year follow-up, 75% of the patients who did not make a transition to psychosis had remitted from UHR status. With a Generalized Estimation Equation Model it was shown that this group recovered from positive (F = 52.7, P < 0.0001), negative (F = 24.3, P < 0.0001), disorganization (F = 14.4, P < 0.0001) and general symptoms (F = 25.0, P < 0.0001) within the timeframe of the study. In addition, the level of global functioning and likelihood of having a job and/or education significantly improved. The largest improvements occurred within the first year. UHR symptoms did not re-occur after improvement. With the current UHR criteria, a large percentage of the included subjects appear to have transitory complaints and dysfunctioning. A refinement of the UHR criteria may diminish the chance of including 'false positives' in future UHR studies.

Involuntary Admission of Emergency Psychiatric Patients: Report From the Amsterdam Study of Acute Psychiatry

This brief report presents initial data from the Amsterdam Study of Acute Psychiatry (ASAP-I) about factors associated with the decision to admit patients compulsorily (involuntarily) to emergency psychiatric services in the Amsterdam region of the Netherlands. The study was a prospective cohort study of 1,970 consecutive patients who came into contact with the Psychiatric Emergency Service Amsterdam. A history of more than 14 outpatient contacts the previous year was associated with a low risk of compulsory admission (OR=.3). An involuntary admission in the previous five years was associated with a higher risk (OR=3.7). Referral by a general practitioner was associated with a low risk compared with referral by police (OR=2.4) or by mental health services (OR=2.3). The hypothesis that outpatient treatment may help to prevent compulsory admission found some support in this study. More research is needed to understand the mechanisms of the associations so that an intervention study can be developed to test this hypothesis.

Involuntary Admission of Emergency Psychiatric Patients: Report From the Amsterdam Study of Acute Psychiatry

Involuntary Admission of Emergency Psychiatric Patients: Report From the Amsterdam Study of Acute Psychiatry

The Amsterdam Studies of Acute Psychiatry - II (ASAP-II): a comparative study of psychiatric intensive care units in the Netherlands

BackgroundThe number of patients in whom mental illness progresses to stages in which acute, and often forced treatment is warranted, is on the increase across Europe. As a consequence, more patients are involuntarily admitted to Psychiatric Intensive Care Units (PICU). From several studies and reports it has become evident that important dissimilarities exist between PICU's. The current study seeks to describe organisational as well as clinical and patient related factors across ten PICU's in and outside the Amsterdam region, adjusted for or stratified by level of urbanization.Method/DesignThis paper describes the design of the Amsterdam Studies of Acute Psychiatry II (ASAP-II). This study is a prospective observational cohort study comparing PICU's in and outside the Amsterdam region on various patient characteristics, treatment aspects and recovery related variables. Dissimilarities were measured by means of collecting standardized forms which were filled out in the framework of care as usual, by means of questionnaires filled out by mental health care professionals and by means of extracting data from patient files for every consecutive patient admitted at participating PICU's during a specific time period. Urbanization levels for every PICU were calculated conform procedures as proposed by the Dutch Central Bureau for Statistics (CBS).DiscussionThe current study may provide a deeper understanding of the differences between psychiatric intensive care units that can be used to promote best practice and benchmarking procedures, and thus improve the standard of care.

MAURO ZONTA, Hebrew Scholasticism in the Fifteenth Century: A History and Source Book (Amsterdam Studies in Jewish Thought 9).

MAURO ZONTA, Hebrew Scholasticism in the Fifteenth Century: A History and Source Book (Amsterdam Studies in Jewish Thought 9).

Children of Immigrants in Schools in New York and Amsterdam: The Factors Shaping Attainment

Background/ContextThis article considers the ways in which school systems in New York City and Amsterdam have shaped the educational trajectories of two groups of relatively dis-advantaged immigrant youth: the children of Dominican immigrants in New York and the children of Moroccan immigrants in Amsterdam. It describes the salient features of the two educational systems and the ways in which they structure opportunity for children of immigrants. In terms of public policy, the United States and the Netherlands have taken quite different approaches toward the integration of immigrant students: The Netherlands actively seeks to integrate students and provides additional funds and special programs, whereas the United States has taken a more laissez-faire approach.Purpose/Objective/Research Question/Focus of StudyThe article analyses available data on young second-generation Moroccan and Dominican youth and their school careers in two cities: New York and Amsterdam. It aims to look at the influence of institutional arrangements and the way that the educational system facilitates or hampers the educational integration of two highly disadvantaged groups.Research DesignThe article is based on available data on the Moroccan population in Amsterdam and the Dominican population in New York. This includes primarily the Dutch SPVA surveys and other local Amsterdam studies, and the Immigrant Second-Generation in Metropolitan New York (ISGMNY) study.Conclusions/RecommendationsBoth Moroccans in Amsterdam and Dominicans in New York show relatively low levels of educational attainment. Drawing on data from a number of studies of Moroccans in Amsterdam and on the ISGMNY study, the article shows that although differently structured, neither school system does an adequate job of serving disadvantaged immigrant students. It is interesting, however, that opportunities and impediments for the two groups are shaped differently and appear at different times in the school career. Successful practices in both countries show how extra investment of resources can increase equality of opportunity.

Plato . Ion or: On the Iliad. Edited with Introduction and Commentary (review)

Reviewed by: Plato. Ion or: On the Iliad. Edited with Introduction and Commentary Hardy Hansen Albert Rijksbaron . Plato. Ion or: On the Iliad. Edited with Introduction and Commentary. Amsterdam Studies in Classical Philology, 14. Leiden: Brill, 2007. Pp. xii, 285. $139.00. ISBN 978-90-04-16321-8. Albert Rijksbaron has produced an indispensible scholarly edition of Plato's Ion, with a new text based on a collation in situ of the primary manuscripts and a commentary whose "strong linguistic orientation" (x) and careful philology shed new light on nearly every line of the dialogue. In his extensive introduction, Rijksbaron argues (1-8) that Ion is closest in date to Republic and Phaedrus on the basis of numerous correspondences in technical and procedural terms between Ion and dialogues generally accepted as middle or late; he views Ion as an "integral . . . part" (13) of Plato's critique of poetry. He argues cogently that the title as given in the mss. is correct and thus prints Ἴων ἢ περὶ Ἰλιάδος at both the beginning and the end. To the three primary mss. (T, W, F), he adds S (codex Venetus Marcianus graecus 189), whose value as a primary witness has not been generally recognized by recent editors. An excursus (37-48) deals with the problems posed by the quotations from Homer and presents judicious arguments for choosing when to print a reading different from the Homer mss. (e.g., 537a8: αὐτὸς δέ . . . κλινθῆναι [38 and n.92]) and when to favor Homer (e.g., 538d1: ὄρουσεν [45]). Rijksbaron makes valuable critical observations passim on editions ranging from the Aldine (52-57) to that of Henri Estienne (254-55) to Burnet's OCT, while scrupulously crediting earlier work throughout. As for the commentary, a brief review can only touch on a few of the many places where Rijksbaron advances our understanding of the text. One of the best notes is on the very first phrase of Ion, τὸν Ἴωνα χαίρειν (530a1). Rijksbaron notes the rarity of the article with proper names in Plato outside of "turn-taking scenes" in narrated dialogues and his unique use here of the accusative + infinitive as a command. Socrates' tone is very (ironically) formal and honorific. [End Page 355] At 530d9, when Socrates says that he will make time later to listen to Ion, the mss. present a choice between ἀκροᾶσθαι and ἀκροάσασθαι. In an appendix (261-69, one of three dealing in detail with textual questions), Rijksbaron surveys the uses of both infinitives of this verb in prose writers and notes that the aorist infinitive of ἀκροάομαι is not otherwise attested in Plato. As for σχολή + infinitive, elsewhere the aorist only appears when the whole expression is negated (e.g., "I don't have time to . . ."). He therefore prints ἀκροᾶσθαι, which "presents the listening as an unbounded action"; Socrates "is not interested in anything in particular" which Ion may have to say (269). See the good discussion of the force of the imperfect and aorist indicatives in the contrafactual conditions at 540d5-6 and 540d7-e2, and the note on the pragmatic difference between the present and aorist infinitives of ἐξηγέομαι at 531b7-9. In several places Rijksbaron rescues the text by defending an ms. reading. At 532b4 he prints, with most mss., αὐτὸς ὁμολογεῖ, "he [Ion] himself agrees," instead of the ὁμολογῇ ("you yourself agree") of Burnet and many other editors, which has no ms. authority; elsewhere in Plato the middle of ὁμολογέω has reciprocal meaning. At 533c8 he prints ἄρχομαι . . . ἀποφαινόμενος with TWSF, rejecting ἔρχομαι, which Cobet and subsequent editors had adopted. Rijksbaron's grasp of Plato's idiom is evident in his extensive note on 535b1, where he prints Ἔχε δή· τόδε μοι εἰπέ with the first imperative separate and, in its context, somewhat rude. Also good are his remarks on word order, e.g., on the phrase σὺ . . . ἢ τῶν μάντεων τις τῶν ἀγαθῶν (531b6): "the order places the emphasis on τῶν μάντεων, or rather, in pragmatic terms, it turns τῶν μάντεων into the contrastive Focus of the question, on a par with σύ" See 538b5-6, where Rijksbaron chooses the reading περὶ ἑτέρων καὶ ἐπιστήμη πραγμάτων ἐστίν "because it is the only one which puts ἑτέρων in the Topic, and ἐπιστήμη in the Focus position." This is not an edition for beginners, but anyone who has taught Ion or who has tackled Ion while learning Greek will find Rijksbaron's work invaluable. He wears his considerable learning lightly and is always...

The Amsterdam Studies of Acute Psychiatry I (ASAP-I); A prospective cohort study of determinants and outcome of coercive versus voluntary treatment interventions in a metropolitan area

BackgroundThe overall number of involuntary admissions is increasing in many European countries. Patients with severe mental illnesses more often progress to stages in which acute, coercive treatment is warranted. The number of studies that have examined this development and possible consequences in terms of optimizing health care delivery in emergency psychiatry is small and have a number of methodological shortcomings. The current study seeks to examine factors associated with compulsory admissions in the Amsterdam region, taking into account a comprehensive model with four groups of predictors: patient vulnerability, social support, responsiveness of the health care system and treatment adherence.Methods/DesignThis paper describes the design of the Amsterdam Study of Acute Psychiatry-I (ASAP-I). The study is a prospective cohort study, with one and two-year follow-up, comparing patients with and without forced admission by means of a selected nested case-control design. An estimated total number of 4,600 patients, aged 18 years and over, consecutively coming into contact with the Psychiatric Emergency Service Amsterdam (PESA) are included in the study. From this cohort, a randomly selected group of 125 involuntary admitted subjects and 125 subjects receiving non-coercive treatment are selected for further evaluation and comparison.First, socio-demographic, psychopathological and network characteristics, and prior use of health services will be described for all patients who come into contact with PESA. Second, the in-depth study of compulsory versus voluntary patients will examine which patient characteristics are associated with acute compulsory admission, also taking into account social network and healthcare variables. The third focus of the study is on the associations between patient vulnerability, social support, healthcare characteristics and treatment adherence in a two-year follow-up for patients with or without involuntarily admittance at the index consultation.DiscussionThe current study seeks to establish a picture of the determinants of acute compulsory admissions in the Netherlands and tries to gain a better understanding of the association with the course of illness and patient's perception of services and treatment adherence. The final aim is to find specific patient and health care factors that can be influenced by adjusting treatment programs in order to reduce the number of involuntary admissions.

God image and mood in old age: Results from a community-based pilot study in the Netherlands

Religious involvement is frequently found to be associated with less depression in later life. The emotional aspects of religiousness, such as pertaining to the God–object relationship, have not received substantial attention in empirical research among older adults, and especially not in European samples. As part of a pilot study of the Longitudinal Aging Study Amsterdam, a small sample of older church-members (n = 60), aged 68–93, filled out a questionnaire, including the Questionnaire God Image on feelings to God and perceptions of God, two of the God Image Scales designed by Lawrence on perceptions of God, the brief positive and negative religious coping scale designed by Pargament, and items on hopelessness, depressive symptoms, and feelings of guilt. Feelings of discontent towards God correlated positively with hopelessness, depressive symptoms, feelings of guilt, and also with depressive symptoms assessed 13 years earlier; these findings pertained to Protestant participants in particular. Most facets of God image, positive, critical, and about punishment reappraisals, were associated with more feelings of guilt. A possible explanation for the most pervasive finding, that feelings of discontent towards God are related to depressive symptoms, is that both, throughout life, remain rooted in insecure attachment styles.

A new predictor for the onset of atrial fibrillation?

In this issue of the Netherlands Heart Journal, the results of a substudy of the PREVEND trial are published.1 This prospective registry of presumably healthy citizens of Groningen aims to establish the association between microalbuminuria and the emergence of renal and cardiovascular diseases.2 This general population based long-term study extends the series of previous large-scale epidemiological trials conducted in the Netherlands. We recall among them the 1970 Vlagtwedde study for epidemiological cardiology and ischaemic heart disease, the 1982 Zutphen study of diet and cardiovascular diseases, the 1997 Maastricht study of circulatory arrest and sudden death, the 1998 Amsterdam study of out-of-hospital cardiac arrest and the 1999 Rotterdam study of prolonged QT interval and mortality.

Management of recurrent rectal cancer: A population based study in greater Amsterdam

To analyze, retrospectively in a population-based study, the management and survival of patients with recurrent rectal cancer initially treated with a macroscopically radical resection obtained with total mesorectal excision (TME). All rectal carcinomas diagnosed during 1998 to 2000 and initially treated with a macroscopically radical resection (632 patients) were selected from the Amsterdam Cancer Registry. For patients with recurrent disease, information on treatment of the recurrence was collected from the medical records. Local recurrence with or without clinically apparent distant dissemination occurred in 62 patients (10%). Thirty-two patients had an isolated local recurrence. Ten of these 32 patients (31%) underwent radical re-resection and experienced the highest survival (three quarters survived for at least 3 years). Eight patients (25%) underwent non-radical surgery (median survival 24 mo), seven patients (22%) were treated with radio- and/or chemotherapy without surgery (median survival 15 mo) and seven patients (22%) only received best supportive care (median survival 5 mo). Distant dissemination occurred in 124 patients (20%) of whom 30 patients also had a local recurrence. The majority (54%) of these patients were treated with radio- and/or chemotherapy without surgery (median survival 15 mo). Twenty-seven percent of these patients only received best supportive care (median survival 6 mo), while 16% underwent surgery for their recurrence. Survival was best in the latter group (median survival 32 mo). Although treatment options and survival are limited in case of recurrent rectal cancer after radical local resection obtained with TME, patients can benefit from additional treatment, especially if a radical resection is feasible.

Vitamin D Receptor Gene Haplotype Is Associated with Body Height and Bone Size

Adult stature is a complex genetic trait. The vitamin D endocrine system has pleiotropic effects on several physiological processes, especially on skeletal metabolism. We recently identified promoter and 3'-untranslated region (UTR) haplotype alleles that influence vitamin D receptor (VDR) mRNA expression. We studied whether VDR gene variants contribute to the genetic variation in height. We studied VDR haplotype alleles and body height in two independent populations (n=7187). In a meta-analysis (n=14,157 from 27 studies and our current data), we evaluated the effect of the Bsm I polymorphism. Haplotypes of the linkage disequilibrium block 3 and block 5 were associated with body height differences with evidence for additive effects in the Rotterdam Study (P=0.00002) and the Longitudinal Aging Study Amsterdam study (P=0.001). Height differences between the extreme genotypes were 1.4 and 2.7 cm, respectively. The relationship was independent of age, gender, presence of vertebral fractures, and age-related height loss. In the Rotterdam population, we found the combined genotype to be associated with decreased vertebral area (P=0.03) and femoral narrow neck width (P=0.002). In the meta-analysis, subjects with the "BB" genotype were 0.6 cm (95% confidence interval, 0.2-1.1 cm) taller than those with the "bb" genotype (P=0.006). VDR gene variants are associated with differences in body height as evidenced by our study and by a meta-analysis. It remains for further studies to confirm whether the underlying mechanism of the association involves lower VDR expression in cells important for determining bone size.

Clinically defined vascular depression in the general population

Vascular depression is regarded as a subtype of depression, especially in, but not entirely restricted to, the elderly, characterized by a specific clinical presentation and an association with (cerebro)vascular risk and disease. It could have major implications for treatment if subjects at risk for such a depression could be easily identified by their clinical presentation in general practice. We studied the symptom profile of depression in subjects with and without vascular risk factors in two large Dutch community-based studies, the Rotterdam Study and the Amsterdam Study of the Elderly (AMSTEL). We could not confirm the specific symptom profile in depressed subjects with vascular risk factors in either of the two cohorts. Depressed subjects with vascular risk factors showed more loss of energy and more physical disability than those without vascular risk factors. However, presumed specific symptoms of vascular depression, namely psychomotor retardation and anhedonia, were not significantly associated with any of the vascular risk indicators. Loss of energy was significantly associated with myocardial infarction and peripheral arterial disease. In these two large community-based studies we identified some differences between vascular and non-vascular depressed subjects but found no evidence for a specific symptom profile of vascular depression as previously defined.

The influence of total mesorectal excision on local recurrence and survival in rectal cancer patients: A population‐based study in greater Amsterdam

To determine retrospectively in a population-based setting, the influence of the introduction of total mesorectal excision (TME) on local recurrence and survival in patients with rectal carcinoma. All rectal carcinomas diagnosed during 1988-1991 (979 patients, conventional surgery with blunt dissection of the rectum) and 1998-2000 (890 patients, TME resection) were selected from the Amsterdam Cancer Registry. For all patients who underwent a macroscopically radical resection in the absence of distant dissemination, information on the occurrence of local recurrent disease and distant metastasis was collected. The cumulative 5-year recurrence rate decreased significantly from 20% for patients diagnosed in 1988-1991 to 11% in 1998-2000. Stage (T-category, nodal status), period of diagnosis (conventional surgery vs. TME resection), radiotherapy, and chemotherapy were independent variables of local recurrence in multivariate analysis. There was a non-significant trend for improved 5-year relative survival for all rectal carcinoma cases from 52% (95% CI 48-55) for patients diagnosed in 1988-1991 to 59% (95% CI 55-63) in 1998-2000. A significant decrease in local recurrence and a trend for improved relative survival were observed. The broad introduction of TME and the shift towards preoperative radiotherapy are the most plausible explanations for these observations.

Prediction of Chlamydia trachomatis Infection: Application of a Scoring Rule to Other Populations

Active case finding is crucial to reduce transmission and consequences of Chlamydia trachomatis (CT) infections. We previously proposed the use of a prediction rule for CT infection for selective screening of high-risk individuals in a population. To support such an application, the prediction rule needs to be validated in other populations. We studied participants aged 15 to 29 years in a population-based study in Amsterdam (n = 1,788) and an outreach screening project among high-risk youth in Rotterdam (n = 172). Validity was indicated by discriminative ability (area under the receiver operating characteristic curve [AUC]) and by calibration, which was visualized in plots and tested with the Hosmer-Lemeshow (H-L) goodness-of-fit test. Cutoffs of predicted risk were examined for their effect on sensitivity and the fraction of participants that would need to be screened. Discriminative ability was reasonable both for the Amsterdam study (AUC 0.66; 95% confidence interval [CI], 0.58-0.74) and for the Rotterdam study (AUC 0.68; 95% CI, 0.58-0.79). The observed CT prevalence was lower than predicted in Amsterdam (H-L P = 0.02) and nonsignificantly higher in Rotterdam (H-L P = 0.20). By screening 77% of the Amsterdam population, 93% of the cases would have been detected, whereas in the Rotterdam study, no cases would be missed by screening 75%. The chlamydia prediction rule showed a reasonable external validity in two studies. These findings support the use of the rule as a tool for selective chlamydia screening, although only a limited fraction of participants can be excluded when a high sensitivity is required.

Effect of the Meeting Centres Support Program on informal carers of people with dementia: Results from a multi-centre study

Because of the complex nature of the problems that carers of persons with dementia encounter, several comprehensive support programs for carers were developed in the past decade. One such program is the Meeting Centres Support Program (MCSP) that integrates different types of support for persons with dementia and their carers, which have proved to be effective in practice and/or research. Within the framework of a study into the national implementation of the MCSP, it was investigated whether the positive effects found in carers that participated in the first Amsterdam Meeting Centres, were also achieved in other regions of The Netherlands. A pre-test–post-test control group design with matched groups was applied. In total, 94 carers in the MCSP in eight meeting centres and 34 carers of dementia patients who frequented regular psychogeriatric day care (PDC) in three nursing homes were included in the study. During the study period 23 carers of the MCSP group and 21 carers of the PDC group dropped out. At baseline and after seven months indicators of burden (psychological and psychosomatic symptoms, feelings of burden and time between start of support and institutionalization of the persons with dementia) were measured, as well as potential determinants of burden (sense of competence, coping strategies, experienced support, loneliness and the emotional impact of behaviour problems). Though on a group level no effect was found, either in psychological and psychosomatic symptoms or in the determinants of burden, a subgroup of carers who felt lonely (n = 22) at baseline benefited significantly more from the MCSP than from PDC in terms of psychological and psychosomatic symptoms. A majority of MCSP carers (82.1%) experienced less burden and more professional support. After seven months significantly fewer persons with dementia in the MCSP (4%) were institutionalized as compared to the patients in PDC (29%). Patients in the MCSP participated for a longer period of time before institutionalization. Although the effect on sense of competence of carers that was found in the Amsterdam study was not found in this multi-centre study, the effect on burden and delayed institutionalization of the person with dementia were confirmed. The integrated MCSP also proved more effective than PDC in decreasing psychological and psychosomatic symptoms in lonely carers. Further dissemination of the MCSP is therefore recommended.

Changes in Older Adult Loneliness

This study examines loneliness and its correlates—health, residential care, partner status, and network size—over a seven-year period among adults born between 1908 and 1937. The four waves of data are from the Dutch “Living Arrangements and Social Networks of Older Adults” and the “Longitudinal Aging Study of Amsterdam”programs. Data from at least two waves are available for 2,925 respondents. Results show that older adults generally become lonelier as time passes. The increase is greater for the oldest, the partnered, and those with a better functional capacity at baseline. Older adults who lose their partner by death show the greatest increase in loneliness. Not all older adults become more lonely: Improvement in functional capacity and network expansion lead to less loneliness. Entry into residential care does not affect loneliness. The longitudinal design provides new insights into factors that protect against loneliness compared to cross-sectional studies.