Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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    Hongerige veren
    Emous, R.A. van; Veldkamp, T. - \ 2009
    De Pluimveehouderij 39 (2009)2. - ISSN 0166-8250 - p. 36 - 37.
    moederdieren - ouderdom - verenkleed - ruien - energie - energieopname - pluimveevoeding - dierenwelzijn - dams (mothers) - old age - plumage - moulting - energy - energy intake - poultry feeding - animal welfare
    Omdat moederdieren op oudere leeftijd al snel kaal worden hebben ze veel meer energie nodig voor onderhoud. Dit heeft gevolgen voor het voeren, blijkt uit een (Animal Sciences Group) ASG-studie
    Food for the ageing population
    Raats, M.M. ; Groot, C.P.G.M. de; Staveren, W.A. van - \ 2008
    London : Woodhead Publishing (Woodhead publishing in food science, technology and nutrition ) - ISBN 9781845691936 - 652
    ouderenvoeding - ouderen - ouderdom - verouderen - elderly nutrition - elderly - old age - aging
    The world’s ageing population is increasing and food professionals will have to address the needs of older generations more closely in the future. This unique volume reviews the characteristics of the ageing population as food consumers, the role of nutrition in healthy ageing and the design of food products and services for the elderly. Chapters in Part one discuss aspects of the elderly’s relationship with food such as appetite and ageing, ageing and sensory perception, food and satisfaction with life, and the social significance of meals. The second part of the book reviews the role of nutrition in extending functionality into later years, with chapters on topics such as undernutrition and conditions such as Alzheimer's disease, bone and joint health and eye-related disorders. Concluding chapters address the issues of food safety and the elderly, designing new foods and beverages for the ageing and nutrition education programmes.
    Dietary patterns, biological risk factors and survival in elderly European men and women
    Knoops, K.T.B. - \ 2007
    Wageningen University. Promotor(en): Wija van Staveren; Daan Kromhout, co-promotor(en): Lisette de Groot. - [S.l.] : S.n. - ISBN 9789085046912 - 208
    dieet - risicofactoren - risicoschatting - mortaliteit - overleving - voedingstoestand - voeding - ouderen - ouderdom - verouderen - europa - diet - risk factors - risk assessment - mortality - survival - nutritional state - nutrition - elderly - old age - aging - europe
    Background: The percentage of the population aged 65 and over, which started to rise sharply in the last decades of the past century, is continuing to rise. However, up until now, little is known about dietary factors and diet-related biological factors in elderly in relation to survival in old age. Aim: The aim of this thesis is to investigate the associations between dietary patterns, diet-related biological risk factors and survival. Study population: Data from two prospective studies were used, the Healthy Ageing: a longitudinal study in Europe (HALE) and the Normative Aging Study (NAS). The HALE project which involves individuals enrolled in the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands, Elderly (FINE) studies, includes 1507 apparently healthy men and 832 women in 11 European Countries, aged 70 to 90 years at baseline and who were followed for 10 years. The NAS is a longitudinal study which started in 1963 by recruiting men, 21 to 80 years of age and free of heart disease and other major health problems, around Boston. Data collected in 1993 and later were used. Results: We observed that after fortification with folic acid, folate intake and plasma folate concentration increased significantly in three groups with different dietary patterns, derived by cluster analysis. Homocysteine tended to decrease in the group with a relatively high alcohol consumption, low fruit and vegetable dietary pattern in the NAS study. Dietary patterns defined by three European indexes were significantly associated with all-cause mortality in the HALE project. A Mediterranean type of diet was associated with an approximately 20 % lower mortality rates in both apparently healthy elderly and in post-myocardial infarction patients. Healthy lifestyle factors (moderate alcohol consumption, being physically active and non-smoking) were also inversely associated with all-cause mortality. Weight loss was significantly associated with increased all-cause mortality in the study centres of Northern Europe while weight gain was weakly associated with increased mortality in these centres in the FINE study. HDL-cholesterol was inversely associated with mortality from cardiovascular diseases and all-causes in the HALE project. Associations between HDL and mortality were strongest in women. Conclusion: A healthy diet is associated with lower mortality risk in elderly. Besides a healthy diet, it is important for elderly people to be physically active, use alcohol in moderation and quit smoking. It is also important to maintain constant body weight and to keep blood cholesterol at a desirable level, especially to keep HDL-cholesterol high.
    Determinants of cognitive decline in older European men
    Gelder, B.M. van - \ 2007
    Wageningen University. Promotor(en): Daan Kromhout, co-promotor(en): M.A.R. Tijhuis; S. Kalmijn. - [S.l.] : S.n. - ISBN 9789085046493 - 157
    cognitieve ontwikkeling - mentale vaardigheid - dieet - ouderen - ouderdom - mannen - europa - kenvermogen - sociale factoren - cognitive development - mental ability - diet - elderly - old age - men - europe - cognition - social factors
    In our ageing population, the number of persons with cognitive impairment, dementia and Alzheimer's disease still increase and cause many problems for the elderly themselves, their relatives and caregivers and for health care. Therefore, the need for preventive action is high. In this thesis we identified social, lifestyle and dietary risk factors for the postponement of cognitive impairment and decline in elderly European men.

    For the results presented in this thesis, data from theFinland,Italyand the Netherlands Elderly (FINE) Study were used. This prospective population-based cohort study was carried out between 1985 and 2000 among 2,285 Finnish, Italian and Dutch men bornbetween 1900 - 1920. Cognitive functioning was measured with the Mini-Mental State Examination (MMSE).

    In the FINE Study, cognitive functioning decreased on average with 1.5 points during the 10-year follow-up period. This decline was due to an age effect, but also to a period and birth cohort effect.

    Men who were married or who lived with others during five years had at least a two times smaller subsequent 10-year cognitive decline compared with men who lost a partner, who were unmarried, who started to live alone and who lived alone during these five years.

    Cognitive decline did not differ among men with a high or low duration of physical activity at baseline. However, men who participated in activities with at leasta medium-low intensity had a 1.8 to 3.5 times smaller cognitive decline compared with men who participated in activities with lowest intensity. Moreover, a decrease in duration or intensity of physical activity resulted respectively in a 2.6 or 3.6 times stronger cognitive decline than maintaining duration or intensity.

    Men who consumed coffee had a two times smaller 10-year cognitive decline than non-consumers. In addition, an inverse and J-shaped association between the number of cups of coffee per day consumed and 10-year cognitive decline was present, with the least decline for men consuming three cups of coffee per day.

    Fish consumers had significantly less 5-year subsequent cognitive decline than non-consumers. A linear trend was observed for the relation between the intake of the n-3 fatty acids EPA + DHA and cognitive decline. An average difference of about 380 mg/day in EPA + DHA intake was associated with a 1.1 points difference in cognitive decline.

    Men whose cognition decreased between 1990 and 1995 had a twofold higher risk of dying in the following five years compared with men whose cognition was stable. Mortality risk of men whose cognition improved between 1995 and 2000 was not different from men with a stable cognition.

    The associations between marital status, living situation and physical activity are strong and provide in combination with the existing literature enough evidence for justifying public health recommendations for postponing cognitive decline. However, our findings on coffee and fish consumption and on the intake of the fatty acids EPA + DHA in relation with cognitive functioning need confirmation in other studies.
    Milde vitamine B12 deficiëntie en het cognitief functioneren van ouderen : de effectiviteit van orale supplementen
    Eussen, S.J.P.M. - \ 2006
    Wageningen University. Promotor(en): Wija van Staveren; W.H.L. Hoefnagels, co-promotor(en): Lisette de Groot. - [S.l.] : S.n. - ISBN 9789085044314 - 142
    vitamine b12 - vitaminetekorten - mentale vaardigheid - verstandelijk gehandicapt - vitaminetoevoegingen - bijvoeding - ouderen - ouderdom - kenvermogen - vitamin b12 - vitamin deficiencies - mental ability - mental retardation - vitamin supplements - supplementary feeding - elderly - old age - cognition
    Cobalamin deficiency is common in older people and has been recognised as a possible cause for several clinical manifestations such as anaemia and cognitive impairment. Markers for cobalamin deficiency include increased concentrations of plasma total homocysteine (tHcy) and methylmalonic acid (MMA), and decreased concentrations of holotranscobalamin (holoTC). Cross sectional analysis in this thesis confirmed that impaired cognitive performance was associated with relatively unfavourable concentrations of markers for cobalamin status. These results are in line with findings from previous cross-sectional and prospective studies and suggest a role for cobalamin status in cognitive function, in particular because cobalamin deficiency is highly prevalent in old age. According to our recruitment activities it appeared that 26.6% of the older people had mild cobalamin deficiency, which we defined as low to low-normal cobalamin concentrations in combination with increased MMA concentrations. Normalizing mild cobalamin deficiency, defined as a decrease of respectively 80% to 90% of the estimated maximum reduction in plasma MMA concentrations, could be achieved by supplementing daily oral doses of 647 mg to 1032 mg crystalline cobalamin. The main purpose of our research was to investigate whether daily supplementation with such a high dose of oral cobalamin alone or in combination with folic acid has beneficial effects on cognitive function in people aged 70 years or older with mild cobalamin deficiency. We did this in a double-blind, placebo-controlled trial with a relatively large number of carefully selected participants, and an extensive assessment of cognitive function. In total, 195 individuals were randomized to receive either 1,000 μg cobalamin, or 1,000 μg cobalamin + 400 μg folic acid, or placebo for 24 weeks. Markers for cobalamin status and cognitive function were assessed before and after 24 weeks of treatment. Assessment of cognitive function included the domains of attention, construction, sensomotor speed, memory and executive function. Cobalamin status did not change in the placebo group, whereas oral cobalamin supplementation corrected mild cobalamin deficiency. Improvement in one domain (memory function) was observed in all treatment groups, and was greater in the placebo group than in the group who received cobalamin alone ( P = 0.0036). Oral supplementation with cobalamin alone or in combination with folic acid for 24 weeks was not associated with improvements in other cognitive functions. Blood collection after cessation of oral cobalamin supplementation showed that adequate cobalamin status may maintain for a period of up to 5 months after cessation. Despite the null finding of this trial, recent studies provide clues for future research in improving cognitive function.
    Nutritional care in old age: the effect of supplementation on nutritional status and performance
    Manders, M. - \ 2006
    Wageningen University. Promotor(en): Wija van Staveren; W.H.L. Hoefnagels, co-promotor(en): Lisette de Groot. - [S.l. ] : S.n. - ISBN 9789085043959 - 134
    ouderenvoeding - voedselsupplementen - bijvoeding - voedingstoestand - slechte voeding - ouderen - ouderdom - elderly nutrition - food supplements - supplementary feeding - nutritional state - malnutrition - elderly - old age
    Malnutrition is frequently observed in elderly people living in nursing homes and homes for the elderly. Anorexia resulting in inadequate dietary intake is often a cause of malnutrition. Malnutrition in old age affects several aspects of functioning. Earlier research has shown that a complete supplement improves nutritional status. These studies were however not sufficiently powerful to investigate an effect of such a supplement on functioning. Yet, positive results of a pilot study pointed in that direction. In this thesis we assumed that improving nutritional status by nutritional supplementation could lead to improvement in functioning, following improved total dietary intake, without affecting habitual intakes.

    In the current study residents of nursing homes and homes for the elderly were participating in a 24-week, randomised, double-blind, placebo-controlled intervention trial (n=176). They randomly received either a nutrient dense drink or a placebo drink twice a day in addition to their usual diet. Two packages of the nutrient dense drink contained 250 kcal and vitamins, minerals and trace elements at the level of 25 to 175% of the Dutch RDA. The placebo drink contained no energy and no vitamins and minerals.

    Using the complete supplement appeared to have a beneficial effect on dietary intake. The change in total energy intake was some 0.8 MJ/day higher in the supplement group than that in the control group (p=0.166). Moreover, a significantly favourable effect (p<0.001) was observed for the intake of vitamins and minerals. Hereby the supplement group did not appear to compensate their regular intakes for the energy content of the provided supplements. The positive effect on dietary intake was supported by changes in nutritional status, because markers of nutritional status of the intervention group compared favourably with those of the placebo group. These changes showed amongst others a positive effect of the intervention drink on body weight (1.6 kg difference in change; p=0.035), calf circumference (0.9 cm difference in change; p=0.048), and blood values (e.g. Hcy decreased from 16.8 to 11.2 μmol/L in the supplement group). In the study population no significant effect was found on functionality outcomes, including cognitive function, mood, physical performance and the ability to perform activities of daily living. However, a subgroup of participants with BMI at baseline below 24.4 kg/m 2 performed better on the cognitive subscale of the Alzheimer's Disease Assessment Scale (p=0.09), and its language sub score (p=0.01) after 24 weeks of intervention.

    To prevent serious malnutrition it is advocated to regularly weigh institutionalised elderly and use a short questionnaire for decreased appetite. With these instruments the development of malnutrition can be detected early and if indicated preventive action can be taken. Future research should be focused on efficient implementation of the used food supplement in every day practice. Nutrition policy should be focused on improvement of usual diet as well as temporarily providing nutritional supplements if indicated. From the findings of our intervention trial we conclude that the applied supplement is effective for counteracting the development of malnutrition in this population. Furthermore, the results of this trial suggest that it is effective as treatment for decreasing function in a subgroup of institutionalized elderly people with low BMI.
    Food perception and food liking with age
    Kremer, S. - \ 2006
    Wageningen University. Promotor(en): J.H.A. Kroeze; Kees de Graaf. - [S.l.] : S.n. - ISBN 9789085044185 - 155
    voedselvoorkeuren - eetpatronen - perceptie - smaak - sensorische evaluatie - ouderen - ouderdom - food preferences - eating patterns - perception - taste - sensory evaluation - elderly - old age
    The elderly population is rapidly growing worldwide. In sensory and nutrition research, age-associated losses in sensory function are believed to change the perception of food, to decrease food liking and consequently to decrease food intake of the elderly, although data in support of this line of assumptions are currently scarce. Consequently, there is a growing need to understand more about age related changes both in food perception and food liking. Therefore, the present thesis describes research on food perception, food liking and sensory acuity with increasing age. The results demonstrate that the elderly indeed perceive foods differently compared to the young, mainly as less intense in flavour and in creaminess/fattiness. However, their food liking is not reduced, despite these age-related changes in perception. It is concluded that decreased sensory acuity, although causing losses in perception of the elderly, is obviously not causing a reduced food liking and thus may not be the predominant reason for a diminished food intake.
    Acute respiratory infections in elderly people: the role of micronutrients and lifestyle
    Graat, J.M. - \ 2003
    Wageningen University. Promotor(en): Frans Kok; Evert Schouten. - [S.l.] : S.n. - ISBN 9789058089229 - 152
    ademhalingsziekten - influenza - verkoudheid - longontsteking - sporenelementen - vitaminen - vitamine e - levensstijl - ouderen - ouderdom - respiratory diseases - influenza - common cold - pneumonia - trace elements - vitamins - vitamin e - lifestyle - elderly - old age
    Acute respiratory infections are the most frequent of all infectious diseases. In popular speech common cold, flu (influenza), and pneumonia all denote acute respiratory infections. Elderly people show an increased risk of these infections and their complications. In The Netherlands about 2.000 elderly people die annually from influenza and influenza-related illness. Because the number of elderly people is growing rapidly worldwide, factors that could diminish the risk of theinfections,may have great public health importance.

    This thesis focuses on the effects of micronutrients and lifestyle on acute respiratory infections in 652 apparently healthy well-nourished elderly people of 60-95 years. Our 15-months randomized controlled trial showed that neither multivitamins-minerals in doses near the recommended dietary allowance nor 200mg of vitamin E had beneficial effects on the incidence and severity of acute respiratory infections. Incidence rate ratio (95% confidence interval) was 0.95 (0.75-1.15) in groups that received multivitamins-minerals and 1.12 (0.88-1.25) in groups that received vitamin E. Instead, we observed unfavorable effects of vitamin E on illness-severity. In the vitamin E compared to the no vitamin E group, illness-duration was 19 versus 14 days (p=0.02); no. of symptoms was six versus four (p=0.03); presence of fever was 37% versus 25% (p=0.009); and presence of activity-restriction was 52% versus 41% (p=0.02). Episodes of respiratory infection were self-assessed by means of a diary and substantiated by nurse telephone check, home-visits, and microbiology and serology testing in a subset. Infections turned out to be laboratory confirmed in 58% of the patients, whereas in only four percent of persons without symptoms of infection a pathogen was identified. Major pathogens in patients suffering from acute respiratory infection were rhinoviruses (32%), coronaviruses (17%), and influenzaviruses(7%).

    In addition, observational analyses were performed using the data of the trial. High plasma beta-carotene concentrations may reduce the incidence of acute respiratory infections, whereas alcohol consumption may increase the risk. Observational studies are however sensitive to bias and the influence of plasma carotenoids and lifestyle factors, i.e. alcohol consumption, smoking, and physical activity, on acute respiratory infections remain therefore subject to debate. Our main conclusion is that relatively healthy, well-nourished elderly people will not benefit from multivitamin-mineral and vitamin E supplementation in reducing acute respiratory infections.
    Impact of nutritional supplements on health indices in elderly people
    Wouters-Wesseling, W. - \ 2002
    Wageningen University. Promotor(en): W.A. van Staveren; J.G. Bindels; C.P.G.M. de Groot. - S.l. : S.n. - ISBN 9789058086815 - 159
    voedselsupplementen - ouderenvoeding - ouderen - ouderdom - gezondheid - maatregel op voedingsgebied - voedingsonderzoek - food supplements - elderly nutrition - elderly - old age - health - nutritional intervention - nutrition research

    Life expectancy in both the Western and non-western population has been increasing over the past centennial, due to improved hygiene, the discovery of medicines such as antibiotics and economic welfare. The consequence for society of this ageing of our population is an increased need for medical and social care and thus a burden of costs for health care. At the level of individual people an increased life expectancy is appealing, but only if accompanied by a preservation of a certain health status. Low intakes or plasma levels of nutrients have been related to several areas of physiological decline often observed in elderly people.

    This thesis describes the effects of provision of a complete nutritional supplement to elderly who are at risk for impaired nutritional status. Two studies in the population of psychogeriatric nursing home residents demonstrated that both short and longer-term use of a nutritional supplement was well accepted and tolerated in this target group. Furthermore, body weight and plasma levels of micronutrients increased upon supplementation.

    The results of a 6-months randomised placebo controlled intervention study in elderly living in homes for the elderly or sheltered housing are also reported. The effect of a nutritional supplement (containing macro- and micronutrients) or a non-energetic placebo on health indices was evaluated. The group receiving the supplement had significant improvements in plasma vitamin levels, weight, sleep, immune function, antioxidant levels and cognitive function. The objective for subjects to maintain intake from the regular diet was reached, and thus their total nutrient intake increased when using the supplement.

    In conclusion, the provision of a nutritional supplement can improve several health indices in elderly people who are at risk of nutritional deficiencies. Therefore, the strategy to improve health of elderly people should incorporate the option of providing nutritional supplements.

    Elder care, old-age security and social change in rural Yogyakarta, Indonesia = De zorg voor en bestaanszekerheid van ouderen tegen de achtergrond van sociale veranderingen in ruraal Yogyakarta, Indonesië
    Keasberry, I.N. - \ 2002
    Wageningen University. Promotor(en): A. Niehof. - S.l. : S.n. - ISBN 9789058087249 - 407
    ouderen - ouderdom - thuiszorg - gezondheidszorg - sociale zekerheid - platteland - indonesië - sociale verandering - elderly - old age - home care - health care - social security - social change - rural areas - indonesia

    This thesis describes the significance of the living conditions and care arrangements of older persons for their old-age security in the villages of Kebonagung (regency of Bantul) and Giriwungu (regency of Gunung Kidul) in the Special Region of Yogyakarta, Indonesia.

    The world population is ageing. The United Nations designated the year 1999 as 'The Year of the Older Person', thereby recognising and reaffirming that the global population is ageing at an unprecedented rate. This is also the case for the population of Indonesia. In 1996, the Indonesian archipelago counted about 206.3 million people of which two-thirds live on the island of Java. The proportion of older people is still small compared to that of Western countries, but is increasing at a remarkably high rate. The elderly population was projected to increase by 191 percent between 1996 and 2025. The Special Region of Yogyakarta, a province in the central part of Java, is a front-runner in the ageing process.

    In combination with demographic change, the processes of social and economic change are affecting the Indonesian society. Traditionally, Javanese children are obligated to take care of their parents, especially when their parents have stopped working. When Javanese people became old and were no longer heads of complete households, no longer had young children, and were no longer economically productive, they used to live with their children or siblings' children or grandchildren. In practice this often meant that the youngest child, preferably a daughter, stayed behind in the parental house and co-resided with the parents after marriage. The intergenerational relationships guaranteed the parents' care and support in their old age. However, we expect that these kinds of living arrangements are changing as a consequence of processes of social change and that this will also affect the elder care practices. Households and families that have always provided the support and care for the large majority of elderly people in Indonesia are becoming smaller. Members of families are living further apart as a consequence of increased mobility and migration. It is no longer self-evident that women are working at home or around the house, since the participation of women in paid labour is increasing. In the context of rapid social and economic change, traditional support mechanisms can no longer be fully relied upon for the care of older people. In the near future, Indonesian people will be less certain that their children will care for them in their old age.

    Older persons in Indonesia are as yet little studied and there is a lack of theoretical conceptualization on (elder) care in developing countries. To enable formulation of appropriate policies, it is, however, necessary to understand how elder care and support are arranged. The amount of literature on older persons in Indonesia is limited. Most of the studies use the decennial national censuses and intercensal surveys of the Indonesian Central Bureau of Statistics ( Biro Pusat Statistik ) and are not based on actual data collection, especially of qualitative data. The majority of the studies are about Java or the whole of Indonesia. They studied the subjects of demographic ageing, socio-economic conditions and well-being of older persons, nutritional health and institutional care. There are no comprehensive studies available that focus on older persons' living conditions, care arrangements and old-age security in rural Indonesia.

    The present study is part of the 'Household and family care for the elderly in an ageing society' project. The research project focuses on the issues of the socio-economic position of older people, the amount and kind of care and support needed by older people, the role of households, families and significant others in providing elder care, now and in the immediate future. The research project was set up with a comparative perspective towards rural and urban Yogyakarta on the one hand and rural Indonesia and a rural area in the Netherlands on the other hand. The different study areas share the common problem of the societal consequences of the ageing process. However, it was assumed that given the different demographic and socio-economic contexts, patterns of household and family care for older people as well as the socio-economic position of older people would differ.

    Developing countries in Asia offer a wide variety of cultural practices regarding care for and intergenerational relationships of older people. The Javanese have a bilateral kinship system that is generally characterised by the values of showing respect ( hormat ) and maintaining harmonious social appearances ( rukun ) towards older and senior relatives. The majority of the population adheres to Islam, a religion that emphasises intergenerational concern, kindness and mutual obligations, especially in matters of subsistence and general care.

    In Indonesia, rapid population growth is placing great strain on the government. However, the government provides limited special services for particular groups of older persons, and relies on private and charitable groups to assist in providing for the needy. Social security programmes are typically limited to government-employed individuals with complementary special welfare programmes for the impoverished and the impaired. To be able to anticipate future needs of older persons and to formulate appropriate policies, it is important to know more about the living conditions of older persons and their care arrangements with household members, kin, friends and neighbours. The former government of Suharto (1966-1998) acknowledged the problem of the 'low priority' given to ageing and having 'inadequate information' about older persons and the problems they experience.

    The present research seeks to address both the issue of inadequate information and knowledge, and the absence of theoretical conceptualization. Therefore, the research objective has a descriptive and a theoretical component. This research aims to:

    1. Gain insight into the lives of older persons, particularly regarding the care they provide themselves and receive from others at the micro-level (household-kin-community). Moreover, it aims to identify the transitions in elder care to be better able to anticipate the needs for elder care in Indonesia in the future.
    2. Develop a theoretical framework for care that will be applicable in Indonesia and countries of similar socio-economic and cultural setting. The theoretical framework starts from the assumptions and concepts found in the literature, which are adapted to and tested in the local situation.

    This thesis has a societal and practical relevance for policymakers, who are expected to develop programmes and social services to accommodate the problems of old age and improve the lives of older people in rural Indonesia. It has a scientific and theoretical relevance for researchers, who want to study older persons and elder care in developing countries from a comparative perspective.

    The central question of the research is as follows:

    How does social change affect older persons' lives, and what is the significance of care arrangements and support relations for old-age security?

    This question is broken down into a number of subsidiary questions, which will be dealt with in the following sections. Each research question will be answered by summarising the results of the research bearing on that point.

    Characteristics of older person's lives

    There is a need to know more about the living conditions of older persons, to know more about the socio-demographic, health and economic characteristics of the lives of older persons. The first research question was, therefore, more generally phrased as:

      1. How can the lives of older persons be characterised?
      2. Chapter 6 describes the socio-demographic status of persons aged fifty-five years and older, who live in the Javanese villages of Kebonagung and Giriwungu in the Special Region Yogyakarta, Indonesia. The age distribution of the sample shows a slightly irregular pattern with relatively few people under 60 years old and more than could be expected above the age of 75. The sex distribution is skewed with more women than men in each age group, except the age group of 70-74. The older persons are 69 years old on average and they have more female than male peers. Most older persons say that they are Muslim. However, in practice they combine Islam with animistic and Hinduistic elements in a syncretic belief system in which the slametan plays a central part. The majority of the older persons did not receive any schooling, because there was no school in the village when they were young, and schooling was a privilege for the happy few. Almost two-thirds of the older persons are married and one-third are widowed. Their marriages were often arranged by the parents on the basis of practical reasons. The majority of the older persons live with their spouse and/or others, who usually are child(ren), a child-in-law and/or grandchildren. In general, an elderly household consists of nearly five persons and is a three-generation household. Most older persons have three children still alive of whom at least one lives with them or in the same village.

        Chapter 7 describes the health characteristics of older persons. We measured the relatively objective health situation with scales for nutritional health and ability to perform the personal/instrumental activities of daily life. Most respondents have a moderate nutritional health and are usually able to perform the personal and instrumental activities of daily life. However, older persons could improve their health by adding more nutritional value and variation to their diet. Subjective health was measured by self-reports of physical and mental well-being, capacity of the senses, minor and chronic illnesses. In general, older persons are in good health, although they suffer from at least one minor illness and half of them suffer from a chronic illness. Most respondents can use all their sense organs; problems are mostly related to seeing and hearing.

        We only found a few cases of demented, bedridden or destitute persons. Although mental well-being is difficult to assess, we hypothesised possible reasons for the low prevalence of dementia. Indonesian people seldom reach the ages characterised by dependency and dementia. Besides, older persons continue to be useful around the house and farm, and, therefore, may retain the capability to perform (instrumental) activities. They gradually reduce their activities and do not abruptly stop working. People generally stay in their own houses and are mentally involved with (grand) children, which may prevent them from becoming estranged from their environment as would occur if they moved to an institution.

        Chapter 8 describes the resources and assets that determine the livelihood of older persons. Resources are the immediate means necessary for livelihood generation. Access to work, individual income, household income, food crops, (fruit) trees, and water sources are important for the satisfaction of older person's daily needs. About half of the older respondents spend most of their time on work from which they earn an income in cash or in kind. A quarter spent most of their time on household activities, and another quarter performed other activities at home. These people could be called retired. Here retirement stands for not spending most of the time on income-generating activities. We found that people retire at the average age of 64 years while the life expectancy at birth is 65 years. Hence, we may say that in the rural areas of the Special Region Yogyakarta older people tend to work until they die.

        The individual income of older persons is lower than the officially set mean value of basic daily needs. The elderly household income is higher than the official minimum wage for a standardised household of two adults and two children. However, the research data and formal standards are difficult to compare due to measurement differences concerning rural and urban environments, informal and formal work, income in cash and in kind, and household composition. Nevertheless, for three-quarter of the older persons in the research the individual income is sufficient for their daily needs. For one-quarter it is not sufficient because they have an uncertain income or many needs to fulfil.

        Assets consist of a wide range of tangible and intangible stores of values or claims to assistance that can be converted into money if necessary. Ownership of a house made of durable building materials, household items, fertile farmland, and livestock is important for meeting basic needs, and for additional resources in times of need. In Kebonagung the houses in which older persons live are made of better materials and have better facilities than in Giriwungu. More than half of the elderly households do not have access to enough farmland (corrected for type of irrigation) to meet their basic needs. Almost ten percent of the households are considered landless, and most of these are in Kebonagung. People in Kebonagung more often have income from sources other than agricultural production than in Giriwungu.

        Patterns of elder care

        We are primarily interested in the care arrangements and support network relations of older persons; specifically the care activities that older persons provide for themselves, that people in their personal network can provide for them, and the care they can provide for others. The care arrangement is defined as the totality of all settlements about the care and support activities between an older person and others. The support network relations are narrowed down to the supporting ties of the older person with household members, other kin, neighbours and friends, social organisations and neighbourhood groups. The individual care arrangements and support relations of older persons result in patterns of elder care. Hence, the second research question was phrased as:

      3. What patterns of elder care can be distinguished?
      4. Chapter 9 describes the living arrangements and daily care practices within elderly households. The availability, coresidence and proximity of children together make up the living arrangements of older persons. It does not mean that care and support is automatically provided to an older person when s/he lives with a child or has children living nearby. However, living with children indicates a possible source of care and support, and it influences the perspective and expectations of older persons with regard to support. Very few people have no children, but the majority of these childless people live with other relatives. The childless people who live alone are all women and, given the absence of a social security scheme, they are probably most vulnerable when they are in need of support. Most older persons live with or close to (some of) their children and hence apply for support from them. However, a large majority does not need help with the personal or instrumental activities of daily life, because they can still perform them without difficulty. The few persons who need help with the personal or instrumental activities, are mainly supported by a coresiding daughter. Although other studies report a preference of older parents for coresidence with a daughter, we only found a weakly significant confirmation of this hypothesis. We found that older mothers seem to prefer living together with a son. The distance at which children live from their parents does not seem to have implications for the daily care that parents receive. Most care is still provided by children, who live with the parents or live in the same village. However, we found some indication that respondents who have nobody near who can help, are reluctant to confess that they need help.

        Chapter 10 describes the relations of material, emotional and social support in and beyond the elderly household. Material support consists of money and material goods. Less than half of the older persons receives monetary support and only a quarter receive support in kind such as food or clothes. In general material support is received regularly: monetary support every three weeks and support in kind every ten days approximately. The main sources of financial support are sons. It is common practice that financial responsibilities and power are gradually transferred from the older persons to the younger persons in the extended household. We have hypothesised that migrated children would support their parents more by sending money home. Indeed, the proximity of children has implications for the financial care that parents receive. Parents with children living at a larger distance receive significantly higher yearly amounts of money than parents with children living nearby.

        Emotional support was operationalised as advice, trust and social contact exchanged outside the household. It was difficult to ask questions about advice and trust, because Javanese people do not easily talk about private matters. The responses to questions about social contact were easier to obtain. The majority of the older persons talked with neighbours and friends every other day. The different words for small talk ( omong-omong ), visiting for pleasure ( main, dolan ) and visiting a sick person ( besuk ) have different connotations and uses. We observed that children who live far away from their parents do not visit them regularly. Not even when the children live in Yogyakarta, which is only fifteen to twenty-five kilometres away from the study areas. They don't even return home at Lebaran at the end of the Fasting month ( Idul Fitri ), when children are expected to show respect to older persons and are expected to visit and bring presents to their parents.

        The social activities in which an older person participates constitute a social network and create a potential source of support. The social activities, which are most popular among older persons, are organised by the neighbourhood. The social networks of gotong royong (mutual assistance group), arisan dan simpan pinjam (saving and credit group), ronda (nights patrol group), Dasa Wisma (women's information group), pengajian (Koran recitation group) and lingkungan (social circle of direct neighbours) provide financial or labour support in a direct and reciprocal way. However, a person is only assured of support from these networks as long as at least one household member participates. Therefore, these social activities are not beneficial for the oldest people, who cannot participate anymore and who do not live together with a participating household member. Older persons who live alone, do not live with a child, or only have children living at a large distance are the most vulnerable to a lack of emotional and social support.

        Old-age security and livelihood strategies

        To be able to assess, act on and prevent problems with care for older persons, it is useful to have indicators for old-age security. Old-age security is defined as the relative state of security of older persons, which refers to their food security, health security, physical security, economic security and emotional security. We are interested in how secure older persons feel and what factors influence this security. Hence, the third research question was formulated as follows:

      5. What factors affect old-age security?
      6. Chapter 11 describes how we developed the old-age security scale, as an indicator of the older person's subjective feelings of security. We hypothesised that older women, female widows and the oldest persons will be more vulnerable to insecurity, but this was not confirmed. Gender, age or marital status have no effect on perceived old-age security. We also hypothesised that older persons will be less secure in Giriwungu than in Kebonagung. However, we found that it was just the other way around. This study shows that economic factors are less important than social factors for feelings of security of older persons. The main indicators proved to be the ability to perform the (instrumental) activities of daily life (IADL) and health. Besides, the economic asset of farmland acreage is a determinant of perceived old-age security.

        We assume that persons have strategies to provide for a secure and quiet old age. A livelihood strategy is defined as the ability to maintain and improve (old age) security while maintaining or enhancing the assets and resources on which households depend. The fourth research question was formulated as follows:

      7. What livelihood strategies secure old age?
      8. Chapter 11 describes the strategies of care arrangement, remarriage, moving house, support mobilisation and delayed property transfer. The care arrangement strategy of having many children to provide for a secure old age seems to have an effect on the perceived old-age security. However, the effect cannot be explained by the coresidence of the children. The effect can partly be explained by the care received for personal activities of daily life, which is usually provided within the elderly household or by non-coresiding children. We could not demonstrate the existence of a strategy of remarriage, house move or delayed property transfer. The strategy of mobilising monetary support or support in kind has no effect on perceived old-age security. Only the mobilisation of material support from other kin, and talks with non-coresiding children or neighbours/friends have an effect. These indicators seem more important than several objective indicators for the perceived old-age security. Older persons feel more secure when they live with an adult child, who can take care of them personally within the household and when they can talk frequently to children who live outside the household.

        Effects of social change

        It is assumed that care arrangements and support relations change under the influence of social change. When care arrangements and support relations of older persons change, this will affect the old-age security. As discussed in Chapter 2, social change is defined as a complex of interrelated natural, cultural, societal and individual transitions. Of all processes of social change, we assume that migration and longevity will have a major impact on familial elder care in rural areas. When young persons leave the village to seek work and a livelihood in a city, older persons stay behind without children who traditionally provided care in old age. When older persons live longer, they will generally need more care in the final stage of their lives. The last research question was, therefore, phrased as follows:

      9. How do processes of social change affect elder care and old-age security?

    To investigate the effects of social change older persons' lives, elder care and old-age security, a comparative element was included in the study design by the selection of two villages. The village of Kebonagung with low or no out-migration is more prosperous, but still has its main employment in agriculture along with other paid jobs. The village of Giriwungu with high emigration is poor and, because of its less fertile soils, has limited agricultural possibilities. We assumed that the impact of social change would be most noticeable in Giriwungu. Hence, we assumed that in Giriwungu the lives of older persons would be more negatively affected, older persons would be without traditional care providers and less secure in old age. However, the following results do not support the assumption that Giriwungu is the village experiencing a higher rate of emigration of younger persons than Kebonagung. In Kebonagung, older persons have smaller households, more often live alone, have no coresiding children and less often have a child living in the same village.

    In Giriwungu more older persons are still working. They are usually farmer, who gradually reduce their activities without having to stop working. In Kebonagung the activities of older persons are more evenly distributed between farm and other work. In Giriwungu elderly households cultivate a larger variation of crops and have more different types of livestock. In Kebonagung people have specialised in wet-rice cultivation and there are more landless people. Landless people who are dependent on cash income are more at risk when they become older and can no longer earn an income and provide for their own subsistence. In Giriwungu elderly households appear to invest more in agricultural stores of value, such as livestock and hardwood trees. In Kebonagung elderly households appear to invest in household items and housing quality. Although the household income in cash and in kind in Giriwungu is about half that of Kebonagung, farmland ownership (corrected for irrigation facilities) in Giriwungu is five times that of Kebonagung. Cassava is an important crop in Giriwungu. Although it has low monetary value, it is a buffer crop that is kept in the field and can always be eaten, which makes people in Giriwungu more food secure.

    We hypothesised that older persons would feel more secure in Kebonagung, because their children would not need to leave the village and, therefore, could still take care of their parents. Our hypothesis was mainly based on economic assumptions. However, contrary to our hypothesis, older persons in Giriwungu feel more secure because they live with at least one child, have children living in the same village and own more farmland. These factors are more important to the perceived old-age security than the negative factors of having a poor IADL capacity, more often needing IADL support and having to work hard as a farmer. These effects could not be ascribed to the impact of social change.

    A theoretical framework ofelder care

    The theoretical framework of this study is based on concepts known in literature, in particular Tronto's theory of care (1993). The theory starts from a broad definition of care: "On the most general level, we suggest that caring be viewed as a species activity that includes everything that we do to maintain, continue, and repair our 'world' so that we can live in it as well as possible . That world includes our bodies, our selves, and our environment, all of which we seek to interweave in a complex, life-sustaining web". Tronto distinguishes four analytically separate, but interconnected, phases in the caring process. These are caring about, taking care of, care-giving and care-receiving. These concepts are all verbs, to emphasise that care is an activity, a social practice. Tronto insists that the activity of caring is largely defined culturally, and will vary among different cultures.

    To enable the assessment of Tronto's theory of care in Indonesia and to study the issues of care in the field, we developed an analytical framework that consists of the older person's individual attributes, care arrangements, support relations, old-age security and livelihood strategies. The specific caring activities are operationalised by the personal activities of daily life (ADL), instrumental activities of daily life (IADL), monetary support, material support, emotional support and social support. These concepts of care activities are not culturally specific and therefore, applicable in any country. However, what is involved in the activity of caring, for example in instrumental care, has to be investigated empirically. The individual attributes affect old-age security directly and indirectly through the livelihood strategies that an older person has. Investing in relationships and building up care arrangements is a life-long practice, which will result in the provision of 'good care' and a secure old age. As such, it is a strategy that will enhance the chances of enjoying a supported old age.

    Dietary quality, lifestile factors and healthy ageing in Europe
    Haveman-Nies, A. - \ 2001
    Wageningen University. Promotor(en): W.A. van Staveren; C.P.G.M. de Groot. - S.l. : S.n. - ISBN 9789058085344 - 127
    dieetonderzoeken - levensstijl - ouderenvoeding - verouderen - ouderdom - mortaliteit - europa - nederland - diëten - ouderen - dietary surveys - diets - elderly - lifestyle - elderly nutrition - aging - old age - mortality - europe - netherlands

    Keywords: dietary quality, dietary patterns, lifestyle factors, smoking, physical activity, elderly, mortality, Mediterranean Diet Score, Healthy Diet Indicator, healthy ageing, self-rated health, functional status

    The contribution of diet and lifestyle factors to healthy ageing was investigated in European elderly, born between 1913 and 1918, of the SENECA study. First, the Mediterranean Diet Score (MDS), Healthy Diet Indicator (HDI), and cluster analysis were validated as measures of quality of dietary patterns in the SENECA study as well as the Framingham study. Cluster analysis, MDS, and HDI showed strong similarities in the classification of persons into dietary quality groups. High-quality diets were associated with nutritional status and health-related indicators. It is concluded that dietary quality can be assessed using diet scores as well as cluster analysis, the approaches being complementary.

    The relationships of the three lifestyle factors diet, physical activity, and smoking habits to survival and maintenance of health at old age were investigated, using Cox's proportional hazards analysis and logistic regression. Single unhealthy lifestyle behaviours were related to an increased mortality risk. For men, the mortality risk for a low-quality diet was 1.2 (95 percent confidence interval (CI): 0.9, 1.7), for inactivity 1.4 (95% CI: 1.1, 1.7), and for smoking 2.1 (95% CI: 1.6, 2.6). For women, the mortality risk for smoking was 1.8 (95% CI: 1.1, 2.7), for inactivity 1.8 (95% CI: 1.3, 2.4), and for a low-quality diet 1.3 (95% CI: 0.9, 1.8). The risk of death was increased for all combinations of two unhealthy lifestyle behaviours. Men and women with three unhealthy lifestyle behaviours had a three to four-fold increase in mortality risk. Self-rated health and functional status both declined in men and women with healthy and unhealthy lifestyle habits over a 10-year follow-up period, but the deterioration in health was delayed by the healthy lifestyle behaviours, non-smoking and physical activity. Inactive men had a 2.8 (90% CI: 1.3, 6.2) times increased risk for a decline in self-rated health and a 1.9 (90% CI: 0.9, 3.9) times increased risk to become dependent. Smoking men had a two-fold increased risk (90% CI: 1.0, 4.1) for a decline in self-rated health and a 2.2 (90% CI: 1.1, 4.5) times increased risk to become dependent. In women, inactivity was related to a 2.6 (90%CI: 1.4, 4.9) times increased risk to become dependent.

    In conclusion, a lifestyle characterised by non-smoking, physical activity and a high-quality diet contributes to healthy ageing. A healthy lifestyle at older ages is positively related to a reduced mortality risk and to a delay in the deterioration in health status. This postponement of the onset of major morbidity is likely to go together with a compressed cumulative morbidity. It is concluded that health promotion at older ages can contribute to healthy ageing.

    Zorg; wie doet er wat aan : een studie naar zorgarrangementen van ouderen
    Luijkx, K.G. - \ 2001
    Wageningen University. Promotor(en): A. Niehof; C. de Hoog. - S.l. : S.n. - ISBN 9789058084064 - 250
    ouderen - ouderdom - mensen - thuiszorg - gezondheidszorg - sociaal welzijn - nederland - platteland - elderly - old age - people - home care - health care - social welfare - rural areas - netherlands

    As a result of fertility decline and increasing life expectancy, the age structure of the Dutch population is changing, with a larger proportion and number of elderly persons and declining proportions and numbers of younger adults. Hence, the number of people in need of care is growing. While -at the same time- the number of people that can provide care declines and numerous independently living elderly are on waiting lists for professional care. Concerns about care for the elderly in the future prompted us to do research about the topic of care for independently living elderly. Given the rural orientation of Wageningen University the research was focused on rural elderly. The age groups included were persons aged 75 years and older. The following research questions were formulated:

    What is the picture of instrumental and social-emotional care for rural elderly, who still live independently and are aged 75 and older? Which characteristics of the elderly and which of the informal care givers influence the care that elderly receive? Which problems in the care of the elderly can arise in the future and how could these be solved?

    Data collection for this research proceeded in two stages. First, qualitative research was done to gain insight into the care for the elderly. Eleven elderly people and six informal carers ( mantelzorgsters ) were interviewed. In consequence of the qualitative research, the instrumental-care situation, the instrumental-care arrangement and the social-emotional-care arrangement were defined and hypotheses for the quantitative research were specified. For the quantitative research, the second stage of data collection, a survey was done among a random sample of people aged 75 years and over, stratified according to sex and marital status, living in seven rural municipalities in the Netherlands. We were able to analyse the cases of 465 elderly (response rate of 62,6%). Besides, interviews were conducted with 235 carers who give informal care to elderly persons from the sample. Below we will report about the main findings of the research.

    The instrumental-care situation

    The instrumental-care situation pictures the degree to which the elderly receive instrumental care from people beyond the own household. Elderly people in self-caring households care for themselves and in households consisting of more than one person for each other. Elderly people in cared-for households receive much care of people who are no household members. They themselves cannot do much. In between are elderly persons in households that just can manage ( redzaam ). These elderly care largely for themselves, but in addition receive substantial care from people beyond their own household. They receive more instrumental care than self-caring elderly and less than cared-for elderly. In the quantitative sample 27,5% of the people aged 75 years and over can be called self-caring, 50,1% managing and 22,4% cared-for.

    The quantitative research shows that the instrumental-care situation is significantly related to the variables of household composition, age and health indicators of the elderly. Elderly who live alone and older elderly receive more instrumental care from people who are no household member than elderly who share their household with someone else and younger elderly. At first sight the instrumental-care situation is not influenced by the sex of the elderly person. However, the female elderly in the sample are less healthy than the male elderly. Thus, for a comparison we have to control for health status. When women and men with a comparable health situation are compared, we can see that women receive less instrumental care than men. Besides, elderly who are less mobile receive more care than elderly who are more mobile.

    These results enable us to put the instrumental-care situation in a live course perspective. When people become older their health tends to decline. Thus, the three types of the instrumental-care situation can be seen as phases in the life course.

    Characteristics of informal carers are no predicting factors for the instrumental-care situation of elderly. When people give informal care it does not seem to matter whether they are woman or man and whether they are family or not. Furthermore, the quality of the relationship does not influence the amount of instrumental care elderly receive. The qualitative research has shown that children give informal care even when they experience the relationship with their parents not very positively. The obligations attached to kinship relations seem to be more important than the quality of the relationship.

    The instrumental-care arrangement

    The instrumental-care arrangement pictures the proportion of informal carers and professional carers in the care elderly receive. We defined the instrumental-care arrangement only for the elderly that just can manage. In comparison with the sample, the degree to which these elderly receive instrumental care varies less. The qualitative research shows that elderly who receive predominantly informal care refer to this care in terms of self-care. This way they emphasise that the care they receive from their daughter or son is closely to them. Elderly who receive predominantly formal care emphasis their feeling of independence in the care relationship. From a professional care giver they receive care, pay for it and do not further have a relationship with her. Because of this elderly experience this care, in comparison with informal care, less as a threat to their independence.

    Managing elderly with an informal safety net receive only or predominantly instrumental care of informal carers. Managing elderly with a formal safety net receive only or predominantly formal (professional) care. In the quantitative sample 36,0% of the managing elderly can be called managing with a informal safety net (18,0% of the sample) and 64,0% managing with a formal safety net (32,1% of the sample). The care they receive is diverse. Managing elderly with a formal safety net almost all are supported with the heavy tasks in the household such as vacuum cleaning and cleaning the windows. In comparison with the care managing elderly with an informal safety net, they receive fixed care. The care for elderly people with an informal safety net is more diverse and seems to be more adjusted to their individual needs and wishes.

    The quantitative research shows that the instrumental-care arrangement is significantly related to the normative values and characteristics of the social network of the elderly. Elderly who believe that children (in-law) ought to give informal care and elderly who think traditionally about sex roles have more often an informal safety net than elderly who have other normative values about these topics. Furthermore, elderly who have a social network that consist for more than half of children, elderly who have more children and elderly who have more children without paid employment receive more often predominantly informal care than elderly for whom this is not true.

    Characteristics that can not be influenced by the elderly such as their sex, their age and their health do not influence significantly the instrumental-care arrangement. This enables us to conclude that elderly choose for either informal or formal care.

    Like the instrumental-care situation, the instrumental-care arrangement is not predicted by characteristics of informal carers. These results also show that when people give informal care it does not matter whether they are woman or man and whether they are family or not. Furthermore, the instrumental-care arrangement is not significantly related to reciprocity. The qualitative research has shown that material reciprocity is important to informal carers because they experience it as an expression of appreciation. Especially the meaning and intention of material reciprocity seems to be important.

    The social-emotional-care arrangement

    The social-emotional-care arrangement pictures the degree to which the elderly receive social-emotional care and the proportion of kin and non-kin in this care process. Self-oriented elderly receive hardly any social-emotional care from people beyond the own household. Family-oriented elderly receive this type of care predominantly from family members who do not live in their household. They share the joyful and the more serious parts of social-emotional care with their children and other family members. Community-oriented elderly receive social-emotional care predominantly from non-kin. In comparison with the care for family-oriented elderly, the care for community-oriented elderly is more focused on the joyful parts. In the quantitative sample 19,6% of the elderly people can be called self-oriented, 36,3% family-oriented and 44,1% community-oriented.

    The quantitative research shows that the social-emotional-care arrangement is significantly related to several variables. Elderly women are more often family-oriented and elderly men are more often community-oriented. Also elderly whose social network consists for more than half of family members and elderly who have more children are more often family-oriented than elderly for whom this is not the case. Furthermore, health indicators are related to the social-emotional-care arrangement. Elderly who use more technical aids and elderly who cannot drive a car are more often family-oriented than elderly who use less technical aids and elderly who can drive a car.

    In contrast with instrumental care, characteristics of informal carers predict the social-emotional care elderly receive from people beyond the own household. Informal carers who say that the elderly appreciate the given care and informal carers who talk about their own problems with the elderly have more often a relationship with a community-oriented elderly than informal carers who do not experience immaterial reciprocity. Furthermore, informal carers who experience the care giving as a burden have more often a relationship with a family-oriented elderly than informal carers who do not experience it as a burden.

    Looking at the predicting factors for social-emotional care, we see that this care diverts from instrumental care. Social-emotional care is significantly related to the sex, the number of children and the health situation of the elderly, but also to characteristics of informal carers, such as immaterial reciprocity and the experienced burden. Furthermore, the results show that the relationships with family-oriented elderly are more experienced as relationships containing obligations than the relationships with community-oriented elderly. In comparison to community-oriented elderly, family-oriented elderly seem to have less to offer to their informal carers. They are in poorer health and give less social-emotional care to their informal carers. Because of their better health, community-oriented elderly are much more able to visit other people and seem to give more social-emotional care to others.


    Our research shows that family members are an important source of care for the elderly. When they provide instrumental care, this care is more adjusted to the individual needs and wishes of the elderly people than the care provided by formal (professional) carers. When they provide social-emotional care, this care also includes the more serious aspects of this care. Furthermore, our data show that the quality of the relationship is not significantly related to the care that informal carers provide. The qualitative research has shown that children care for their parents even when they experience the relationship with them as not very positively.

    Dietary patterns and health in the elderly : a north - south comparison in Europe
    Huijbregts, P.P.C.W. - \ 1997
    Agricultural University. Promotor(en): D. Kromhout; E.J.M. Feskens. - S.l. : Huijbregts - ISBN 9789054856436 - 141
    voedselhygiëne - voedingstoestand - consumptiepatronen - gezondheid - bevolking - ouderen - ouderdom - europa - food hygiene - nutritional state - consumption patterns - health - human population - elderly - old age - europe

    The aim of this thesis was to gain more insight into the role of dietary intake as a determinant of different aspects of health, e.g. cognitive function, functional status, self-rated health and mortality. Dietary patterns, obtained from cluster analysis or a healthy diet indicator (HDI), were used instead of single nutrients to investigate these associations. The results are based on different datasets. The largest part was performed in five population-based samples from three European countries participating in the Seven Countries Study: East and West Finland, Zutphen in The Netherlands, and Crevalcore and Montegiorgio in Italy. Around 1970, this dataset consisted of more than 3000 men aged 50-69 years. Around 1990 more than 1000 of the men aged 70-89 years participated in the follow-up. Another dataset used, comprised the information of 272 men and women aged 64-87 years in 1971, from a general practice in Rotterdam, The Netherlands.

    The first part of the thesis concerned the use and the comparison of cluster analysis and the healthy diet indicator. Using cluster analysis, groups with different dietary patterns can be discerned, which have different profiles of risk factors for cardiovascular diseases. Furthermore, an association was observed with 17-year all-cause mortality among men. The HDI, a score which is based on uniform cut-off values derived from recommendations of a WHO study group, appeared to be less dependent from the dataset under study. It was also associated with 17-year all-cause mortality in men but not in women.

    The remaining part of the thesis concerned the associations of dietary intake with several determinants of health status at old age in the combined datasets of Finland, Italy, and The Netherlands. Cross- sectional analysis of the dietary intake at old age (collected around 1990) indicated that the general patterns of dietary intake of the different cultures could still be recognised. A retrospective comparison with the dietary intake at middle age (around 1970) lead to the conclusion that since then, the dietary pattern of the Finnish and Dutch cohorts had changed slightly into the direction of a more healthy diet, e.g. less atherogenic, while the diet of the Italian men had remained Mediterranean. A healthy diet, as calculated by the HDI, was associated with a reduced 20-year allcause and cardiovascular mortality in the three different cultures. Furthermore, there was a tendency towards a better cognitive function among the elderly men with a better HDI in four out of five cohorts. Physical disabilities were accompanied by lower energy intake in elderly men in all three countries. This association was largely, but not completely, due to a lower physical activity. Self-rated health seemed to be a very culture dependent variable, since more than 80% of the elderly men in Finland felt moderately or not healthy, while this was only 20% and 10% in Italy and The Netherlands respectively. Only in Italy, a low self-rated health was associated with a lower energy intake. Since the studies on cognitive funtion, physical disabilities and self-rated health were designed crosssectional it cannot be decided whether the observed associations were causal or not.

    In conclusion, the studies presented in this thesis underline the importance of dietary intake in the maintenance of health at old age (e.g. mortality, cognitive function, functional status, self-rated health). Instead of calculating the associations of several health outcomes with single nutrients, a dietary pattern approach was used. The results of this international study on diet and health suggests that a healthy dietary pattern might have a beneficial effect on health status, but longitudinal studies are needed to confirm this assumption.

    Regular physical activity in old age : effect on coronary heart disease risk factors and well-being
    Schuit, A.J. - \ 1997
    Agricultural University. Promotor(en): F.J. Kok; E.G. Schouten. - S.l. : Schuit - ISBN 9789054857112 - 163
    gezondheidszorg - medische voorzieningen - sociale voorzieningen - therapie - sport - voedselhygiëne - voedingstoestand - consumptiepatronen - vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - ouderen - ouderdom - nederland - health care - medical services - social services - therapy - sport - food hygiene - nutritional state - consumption patterns - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - elderly - old age - netherlands

    Background. Regular physical activity is considered an important aspect of a healthy lifestyle. It may improve fitness, physical competence and may lower the risk of coronary heart disease (CHD). However, until now, data on the effects of regular exercise on CHD risk factors in elderly are limited, and there is a particular lack of data about the training effects on recently indicated risk factors, such as fibrinolytic and coagulation factors, and factors involved in the autonomic regulation of the heart.

    Methods . We have conducted a randomised, controlled intervention study, which addressed the effect of a 6 months training programme on 'classical' and 'new' CHD risk factors and well-being in 229 (intervention: 143 and control:86) apparently healthy, free- living elderly men and women (60-80 years).

    Results . Physical fitness (maximal exercise capacity) improved significantly in subjects of the intervention group (mean increase 14.1 Watt , 95%Cl: 10.1-18.1, +9%), compared to the controls. Among the classical CHD risk factors, only the reduction in serum triglyceride concentration in women was significant (-0.11 mmol/L, 95%Cl: -0.22-0.0, -7%). Blood pressure, high- and low density lipoprotein and total serum cholesterol concentration changed in a favourable direction, but not significantly from the control group. No effect of training on body weight and fasting insulin concentration was found. Among the new risk factors, the concentration of tissue type plasminogen activator (t-PA), a fibrinolytic factor, was significantly increased (+0.07 IU/mL, 95%Cl: 0.0-0.14,+11%) in subjects of the intervention group, while plasminogen activator inhibitor (PAI-1, inhibitor of fibrinolysis) was reduced, but not significantly different from the controls. These changes reflect an increase in fibrinolytic activity. However, fibrinogen concentration increased (+0.18 g/L 95%Cl 0.04-0.32,+6%). In addition, heart rate variability was increased and heart-rate- adjusted-QT interval was reduced in subjects of the intervention group (P<0.05). Both changes probably represent increase in parasympathetic activity and a more favourable autonomic regulation of the heart. Finally, physical self-efficacy was significantly improved in the subjects of the intervention group. Symptoms of depression were reduced, but not significantly different from the controls.

    Conclusion . Regular physical activity beneficially affected CHD risk factors, physical fitness and self-efficacy, which are important determinants of the quality of life and longevity in elderly. The magnitude of the benefits on CHD incidence remain unclear, since there is little information on the predictive value of the new risk factors in elderly. However, since elderly, in general, have advanced atherosclerosis and autonomic dysbalance, the improvements of these factors may be of particular importance in this age- group. In conclusion, our observations underline the importance of a public health policy aiming at stimulating regular physical activity in elderly people

    Changes in food patterns and health in Europeans in their 8th decade
    Schroll Bjoernsbo, K. - \ 1997
    Agricultural University. Promotor(en): W.A. van Staveren; C.P.G.M. de Groot. - S.l. : Schroll Bjoernsbo - ISBN 9789054857617 - 170
    voedselhygiëne - voedingstoestand - consumptiepatronen - gezondheid - bevolking - ouderen - ouderdom - europa - food hygiene - nutritional state - consumption patterns - health - human population - elderly - old age - europe
    Knowledge of specific food patterns of elderly people is important for relating diet to nutritional status and disease and for the identification of groups at risk of under- or over-consumption of specific nutrients. The standardised methodology employed in the SENECA surveys (Survey in Europe on Nutrition and the Elderly a Concerted Action) provided a unique opportunity to study cross-cultural differences in nutritional issues and lifestyle factors affecting health and performance of elderly people in Europe. This thesis explores food patterns in elderly Europeans and their impact on health. For the evaluation of the nutrient quality and the healthfulness of food patterns in elderly Europeans two approaches were applied: The Nutrient Adequacy Ratio, and a diet score, based on eight dietary components with a likely protective function for a number of chronic diseases. For a better insight in food patterns in addition to a conventional description, cluster analysis was employed.

    Food intake data from 1221 dietary histories recoded by the Eurocode system was used to identify specific food patterns within each of the SENECA towns. On the pooled level food patterns across centres emerged. Food patterns varied between and within European settings and the two types of variation appeared to be of the same magnitude.
    Food patterns were stable with age in 245 women from the Danish, Dutch, Swiss and Spanish SENECA towns. Minor changes attributable to period were, however, found. Also, foods contributing to the intake of specific nutrients were found to vary between SENECA towns. In addition to food choice, food handling affected the actual nutrient intake, and should, therefore, be considered in the nutritional evaluation of elderly people.
    Weight loss showed to be an indicator of poor health in Danish (n = 115) and Dutch (n = 12 1) elderly people, but energy intake as an intermediary factor could not be proven in this study. Nevertheless, a further analysis of the Danish data showed that, both quantity and quality of food intake matter in the prevention of disability in 115 elderly Danes.

    In conclusion, this thesis underlines the importance of food patterns of elderly people today for their ability to perform activities of daily living tomorrow. Inadequate nutrient intake appeared to result from a combination of low energy intake and unfavourable food patterns. Vulnerable groups of elderly people may gain from stimulation of physical activity and recommendations on nutritious foods.

    Coagulation factor 7 in elderly people : genetic disposition and diet
    Mennen, L.I. - \ 1997
    Agricultural University. Promotor(en): F.J. Kok; D.E. Grobbee; E.G. Schouten. - S.l. : S.n. - ISBN 9789054857433 - 112
    vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - voedselhygiëne - voedingstoestand - consumptiepatronen - genetische stoornissen - erfelijke ziekten - ouderen - ouderdom - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - food hygiene - nutritional state - consumption patterns - genetic disorders - hereditary diseases - elderly - old age
    In elderly people an increase in thrombotic tendency may lead to a increase in the risk of a coronary event. Coagulation factor VII affects this thrombotic tendency and has been recognised as a risk indicator for coronary heart disease. It is not known whether the level of factor VII can be influenced at older age. From studies in young subjects it is clear that dietary fat and the R/Q353 polymorphism (alleles R and Q) are the main determinants of factor VII. We studied the relation of factor VII with diet in elderly men and women, taking the R/Q353 polymorphism into account.

    In a cross-sectional study among 1158 elderly men and women (>55 y) factor VII coagulant activity (FVII:C) and total factor VII (FVIIt) were investigated in relation to serum-triglycerides, the R/Q353 polymorphism and the habitual diet. FVII:C was inversely associated with dietary fibre and protein and positively with saturated fat intake and serum-triglycerides. These associations were much stronger in subjects with the RR genotype compared to those carrying the Q allele; if the mean intake of dietary fibre would increase with 10 g a day, FVII:C would be expected to decrease with 7.6 % in elderly people homozygous for the R allele versus only 1.9 % decrease in those carrying the Q allele. FVIIt was inversely related to intake of dietary fibre and positively to serumtriglycerides, again the associations being stronger in subjects with the RR genotype. In a cross-over study among elderly women (>60 y, 35 RQ/QQ, 56RR) the postprandial response of activated factor VII (FVIIa) to several fat-rich (50 g) breakfasts was evaluated. The response of (FVIIa) was very similar for meals rich in palmitic acid, rich in stearic acid or rich in linoleic/linolenic acid with a ratio of 3:1 or 15:1. The increase in FVIIa ranged from 14.9 (95% CI: 10.6,19.2) IUmL after the stearic rich breakfast to 21.1 (16.6,25.6) IU/mL after the linoleic/linolenic 15:1 rich breakfasts. After the fat-free control breakfast FVIIa decreased with 8.7 (6.3,11.1) IU/mL. The mean absolute total response to the fatrich breakfasts combined was 37 IU/mL in subjects with the RR genotype and 16.1 IU/mL in subjects carrying the Q allele. Also the response relative to the fasting (FVIIa) level differed significantly between the genotype groups (RR: 42%, RQ/QQ: 32%). Serumtriglycerides concentration was not associated with FVIIa.

    In elderly people, factor VII is influenced by dietary fibre, total dietary fat and serumtriglycerides and not by fat type. The R/Q353 polymorphism strongly modifies these effects. This indicates that an increase in dietary fibre and a decrease in dietary fat intake may reduce the risk of a coronary event by reducing the level of factor VII particularly in elderly people with the RR genotype.

    Ouderen, zorg en welzijn: een pleidooi voor een vergelijkende benadering. (Elderly, care and well-being: a plea for a comparative approach).
    Niehof, A. - \ 1997
    Medische Antropologie 9 (1997)1. - ISSN 0925-4374 - p. 7 - 22.
    ouderen - geriatrie - sociaal welzijn - sociale zekerheid - sociologie - verwantschap - gezinnen - gezinsleven - gezinsstructuur - sociale antropologie - cultuur - cultuursociologie - sociale voorzieningen - welzijnsvoorzieningen - ouderdom - wereld - sociale zorg - sociale problemen - welzijn - sociaal onderzoek - vergelijkend onderzoek - sociaal werk - elderly - geriatrics - social welfare - social security - sociology - kinship - families - family life - family structure - social anthropology - culture - cultural sociology - social services - welfare services - old age - world - social care - social problems - well-being - social research - comparative research - social work
    Als gevolg van bevolkingsveroudering, optredend in zowel westerse als niet~westerse samenlevingen, treden er structurele veranderingen op in de aanratsverhoudingen tussen de verschillende leeftijdsgroepen. Dit is van invloed op het welzijn en de positie van ouderen. Het mondiale karakter van dit verschijnsel nodigt uit tot het hanteren van een vergelijkende benadering bij de bestudering ervan. Hiermee wordt geenDurkheimiaanse sociale morfologie van hele maatschappijen bedoeld, maar een vergelijking op het niveau van relevante instituties. In dit geval: huishouden, familie en verwantschap. De gevarieerde sociale en culturele context waarbinnen deze instituties functioneren, vertoont enkele voor vergrijzende samenlevingen specifieke kenmerken, zoals het ontstaan van een 'derde leeftijd(-sfase)'. De vergelijkende benadering zoafs hier voorgesleid vereist her terzijde schuiven van een aantal binaire opposities, zoals traditioneel tegenover modem, wesiers regenover niet-westers, publiek tegenover privé, en antropologie tegenover sociologie, omdat deze zijn voortgekomen uit een inmiddels verouderd moderniseringsparadigma. Zij vertroebelen in plaats van verhelderen onze blik. In de uitwerking van deze vergelijkende benadering voor het thema van ouderen en welzijn wordt met name aandacht besteedt aan de rol van verwantse/tapsrelaties en aan processen en typen van zorgverlening.
    Kwaliteitsaspecten van maaltijdsystemen : een vergelijkend onderzoek naar warme-, koelverse- en diepvriesmaaltijden voor ouderen
    Woerkum, M. van; Hobbelink, A. - \ 1996
    Wageningen : Wetenschapswinkel (Adviesbrief / Landbouwuniversiteit, Wetenschapswinkel 133)
    catering - centrale keukens - basisproducten - gemeenschapsontwikkeling - consumptiepatronen - borden - ouderen - voedsel - voedselhygiëne - voedselbereiding - voedingsmiddelen - gezondheidszorg - thuiszorg - thuisbezorgde maaltijden - ziekenhuiscatering - ziekenhuizen - huishoudens - keukens - maaltijden - Nederland - verpleeghuizen - voedingstoestand - ouderdom - overheidsdiensten - keukengerei - institutionele huishoudens - catering - central kitchens - commodities - community development - consumption patterns - dishes - elderly - food - food hygiene - food preparation - foods - health care - home care - home delivered meals - hospital catering - hospitals - households - kitchens - meals - Netherlands - nursing homes - nutritional state - old age - public services - cooking utensils - institutional households
    Prospective studies on coronary heart disease in the elderly : the role of classical and new risk factors
    Weijenberg, M.P. - \ 1996
    Agricultural University. Promotor(en): D. Kromhout; E.J.M. Feskens. - S.l. : Weijenberg - ISBN 9789090092096 - 161
    vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - epidemieën - epidemiologie - ouderen - ouderdom - nederland - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - epidemics - epidemiology - elderly - old age - netherlands
    In this thesis associations between biological risk factors and the occurrence of coronary heart disease in elderly persons are described. The focus is on classical (i.e. total and high density lipoprotein cholesterol and blood pressure) and some new (i.e. homocysteine, white blood cell count and serum albumin) biological risk factors. The studies are based on two Dutch cohorts. One is a cohort of 292 men and women, aged 64 to 87 years in 1971, from a general practice in Rotterdam, with a mortality follow-up of 17 years. The other is the Dutch cohort of the Seven Countries Study which consists of 939 men aged 64 to 84 years in 1985 from the town of Zutphen. The morbidity and mortality follow- up embraced five years.

    In general, the classical risk factors were important predictors of coronary heart disease occurrence in elderly people. Systolic blood pressure was a strong independent long-term predictor of coronary heart disease mortality in elderly women, but the long-term association was less clear in elderly men. Total cholesterol was also significantly associated with long-term mortality from coronary heart disease in elderly women, but in men the association tended to be inverted U -shaped, i.e. men with cholesterol levels in the median tertile of the cholesterol distribution had a higher risk than those with levels in the first and third tertile. Regarding the Zutphen study, the short-term associations with incidence of coronary heart disease were usually weaker than with mortality from the disease. Elevated systolic and diastolic blood pressure, and especially isolated systolic hypertension, were important short-term predictors of sudden cardiac death in elderly men. For mortality from coronary heart disease, which was not additionally recorded as sudden, U -shaped associations with systolic and diastolic blood pressure levels were observed, i.e. men with the lowest blood pressure levels and those with the highest blood pressure levels and using antihypertensive medication had the highest risk. Serum total cholesterol was related to short-term coronary heart disease mortality in elderly men. For incidence of the disease, an association was only observed in a subgroup of the population with serum albumin levels below the median. High density lipoprotein cholesterol was not predictive of mortality from coronary heart disease, but there appeared to be an association with the incidence of the disease.

    Concerning the new risk factors, serum homocysteine appeared to be associated with mortality from coronary heart disease in elderly men in the first one-and-a-half years of follow-up only. A strong association with mortality from cerebrovascular disease was observed in normotensive men. In addition, an association with an increased risk of cognitive impairment was suggested. Both white blood cell count and serum albumin were important predictors of coronary heart disease independent of the classical risk factors for coronary heart disease. The association with serum albumin could only partly be explained by baseline health status indicators.

    The experience obtained from the studies described in this thesis has made clear that elderly people are a heterogenous group with respect to risk factor levels as well as coronary heart disease risk. It would therefore be desirable to have a measure of susceptibility for coronary heart disease to identify elderly people who are at increased risk of the disease. Our studies suggest that white blood cell count and serum albumin, routine clinical blood chemistry values, may be useful in this respect in addition to the classical risk factors. Future studies should aim at assessing the effectiveness of a multifactorial approach of risk factor management on coronary heart disease and all-cause mortality as well as on quality of life in older men and women.

    Adviezen voor ouderen krijgen test in praktijk.
    Chin A Pow, M. ; Jong, N. de - \ 1996
    Voeding 57 (1996)9. - ISSN 0042-7926 - p. 26 - 28.
    cellen - consumptiepatronen - ouderen - voedsel - voedseladditieven - voedselsamenstelling - voedselhygiëne - voedingsmiddelen - voedingseducatie - voedingsinformatie - voedingstoestand - voedingswaarde - ouderdom - eigenschappen - kwaliteit - veroudering - cells - consumption patterns - elderly - food - food additives - food composition - food hygiene - foods - nutrition education - nutrition information - nutritional state - nutritive value - old age - properties - quality - senescence
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