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Article ; Online: Zijn de risicofactoren voor een coronaire hartziekte leeftijdsafhankelijk?

Peters, Mike J L / Beulens, Joline W J / Muller, Majon

2023 Volume 167

Abstract: There is a clear increase in cardiovascular risk with increasing age. However, in relative terms the contribution of individual cardiovascular risk factors such as BMI or blood pressure to the occurrence of cardiovascular disease weakens with age. ... ...

Title translation	Cardiovascular risk factors from an aging perspective.
Abstract	There is a clear increase in cardiovascular risk with increasing age. However, in relative terms the contribution of individual cardiovascular risk factors such as BMI or blood pressure to the occurrence of cardiovascular disease weakens with age. Whether these weaker associations are causal or driven by other confounding factors is unclear. If such associations are indeed causal, this would imply that cardiovascular risk factors require less intensive treatment with ageing. A recent study using mendelian randomization techniques confirmed that the causal relationship of cardiovascular risk factors with the occurrence of coronary artery disease weakens with age. In this article we discuss the possible contribution of mendelian randomization studies in studying casual relationships between cardiovascular risk factors and cardiovascular disease. We also comment on what the possible consequences are for cardiovascular risk management in older people in daily clinical practice.
MeSH term(s)	Humans ; Aged ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/genetics ; Risk Factors ; Coronary Artery Disease ; Aging ; Heart Disease Risk Factors ; Mendelian Randomization Analysis/methods ; Polymorphism, Single Nucleotide ; Genome-Wide Association Study
Language	Dutch
Publishing date	2023-01-04
Publishing country	Netherlands
Document type	English Abstract ; Journal Article
ZDB-ID	82073-8
ISSN	1876-8784 ; 0028-2162
ISSN (online)	1876-8784
ISSN	0028-2162
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Article ; Online: Ongeplande herhaalbezoeken van ouderen op de SEH.

van Dam, Carmen S / Muller, Majon / Nanayakkara, Prabath W

Nederlands tijdschrift voor geneeskunde

2023 Volume 167

Abstract: The majority of older patients' Emergency Department (ED) repeat visits are disease-related or caused by new complaints. Whether these repeat visits should and can be avoided is debated, given the vulnerability of this patient category. A proportion of ... ...

Title translation	Unplanned Emergency Department return visits by older patients.
Abstract	The majority of older patients' Emergency Department (ED) repeat visits are disease-related or caused by new complaints. Whether these repeat visits should and can be avoided is debated, given the vulnerability of this patient category. A proportion of patients still returns despite careful discharge planning. However, this number represents only a small fraction of the total of ED visits. In conclusion, this situation is likely to persist because the number of patients is growing, the problem is unpredictable and the care capacity is limited. For the small part that we can prevent, there is a shared responsibility for both the ED, but also for the entire care network due to the chronic nature of a large proportion of the complaints in the ED. Advance care planning is crucial in shifting to appropriate, timely and patient-centered care.
MeSH term(s)	Humans ; Advance Care Planning ; Emergency Room Visits ; Patient Discharge ; Patient-Centered Care ; Emergency Service, Hospital
Language	Dutch
Publishing date	2023-11-23
Publishing country	Netherlands
Document type	English Abstract ; Journal Article
ZDB-ID	82073-8
ISSN	1876-8784 ; 0028-2162
ISSN (online)	1876-8784
ISSN	0028-2162
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Article ; Online: Minding menopause in patients with cognitive impairment: a patient's perspective and reflections on clinical practice.

Thomas, Elias / Verdonk, Petra / Rhodius-Meester, Hanneke / Muller, Majon

BMC women's health

2023 Volume 23, Issue 1, Page(s) 591

Abstract: Many women experience impairment in cognitive function during perimenopause. These symptoms are often not attributed to perimenopause by women themselves, by family and friends, or by healthcare professionals. In this article, we present a case in which ... ...

Abstract	Many women experience impairment in cognitive function during perimenopause. These symptoms are often not attributed to perimenopause by women themselves, by family and friends, or by healthcare professionals. In this article, we present a case in which perimenopausal complaints were attributed to early dementia and discuss mechanisms contributing to the low level of awareness of perimenopausal symptoms amongst patients and clinicians. Stigma amongst women and healthcare professionals impairs the recognition of perimenopausal complaints, and consideration of treatment options by clinicians. We advocate raising awareness in patients and physicians with more education, and the incorporation of potential menopause-related symptoms in general clinical guidelines.
MeSH term(s)	Humans ; Female ; Menopause/psychology ; Perimenopause/psychology ; Educational Status ; Cognition ; Cognitive Dysfunction
Language	English
Publishing date	2023-11-10
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2050444-5
ISSN	1472-6874 ; 1472-6874
ISSN (online)	1472-6874
ISSN	1472-6874
DOI	10.1186/s12905-023-02770-w
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Article ; Online: Comment on: The association between neurohormonal therapy and mortality in older adults with heart failure with reduced ejection fraction.

Thomas, Gwen / Thijs, Abel / Muller, Majon

Journal of the American Geriatrics Society

2021 Volume 70, Issue 1, Page(s) 305

MeSH term(s)	Aged ; Heart Failure/drug therapy ; Humans ; Stroke Volume ; Ventricular Dysfunction, Left
Language	English
Publishing date	2021-10-09
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.17487
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Article ; Online: Is it time for Heart-Brain clinics? A clinical survey and proposition to improve current care for cognitive problems in heart failure.

Nijskens, Charlotte M / Thomas, Elias G / Rhodius-Meester, Hanneke F M / Daemen, Mat J A P / Biessels, Geert Jan / Handoko, M Louis / Muller, Majon

Clinical cardiology

2024 Volume 47, Issue 1, Page(s) e24200

Abstract: Background: Cognitive impairment is highly prevalent among patients with heart failure (HF). International guidelines on the management of HF recommend screening for cognitive impairment and tailored care for patients with cognitive impairment. However, ...

Abstract	Background: Cognitive impairment is highly prevalent among patients with heart failure (HF). International guidelines on the management of HF recommend screening for cognitive impairment and tailored care for patients with cognitive impairment. However, practical guidance is lacking. In this study, we explore cardiologists' perspective on screening and care for cognitive impairment in patients with HF. We give an example of a multidisciplinary Heart-Brain care pathway that facilitates screening for cognitive impairment in patients with HF. Methods: We distributed an online survey to cardiologists from the Dutch working groups on Geriatric Cardiology and Heart Failure. It covered questions about current clinical practice, impact of cognitive impairment on clinical decision-making, and their knowledge and skills to recognize cognitive impairment. Results: Thirty-six out of 55 invited cardiologists responded. Only 3% performed structured cognitive screening, while 83% stated that not enough attention is paid to cognitive impairment. More than half of the cardiologists desired more training in recognizing cognitive impairment and three-quarters indicated that knowing about cognitive impairment would change their treatment plan. Eighty percent agreed that systematic cognitive screening would benefit their patients and 74% wished to implement a Heart-Brain clinic. Time and expertise were addressed as the major barriers to screening for cognitive impairment. Conclusion: Although cardiologists are aware of the clinical relevance of screening for cognitive impairment in cardiology patients, such clinical conduct is not yet commonly practiced due to lack of time and expertise. The Heart-Brain care pathway could facilitate this screening, thus improving personalized care in cardiology.
MeSH term(s)	Humans ; Aged ; Heart Failure/complications ; Heart Failure/diagnosis ; Heart Failure/therapy ; Cardiology ; Surveys and Questionnaires ; Brain ; Cognition
Language	English
Publishing date	2024-01-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	391935-3
ISSN	1932-8737 ; 0160-9289
ISSN (online)	1932-8737
ISSN	0160-9289
DOI	10.1002/clc.24200
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Article ; Online: Comparing the stigma experiences and comfort with disclosure in Dutch and English populations of people living with dementia.

Bhatt, Jem / Kohl, Gianna / Scior, Katrina / Charlesworth, Georgina / Muller, Majon / Dröes, Rose-Marie

Dementia (London, England)

2023 Volume 22, Issue 7, Page(s) 1567–1585

Abstract: Objectives: People living with dementia can feel hesitant disclosing their diagnosis to social networks, partly due to stigma. Little attention has been paid to the measurement of disclosure decisions and stigma, and few standardised stigma tools have ... ...

Abstract	Objectives: People living with dementia can feel hesitant disclosing their diagnosis to social networks, partly due to stigma. Little attention has been paid to the measurement of disclosure decisions and stigma, and few standardised stigma tools have been validated in languages other than English. We investigated the psychometric properties of Dutch translations of three stigma measures, and explored the stigma experiences of Dutch and English people living with dementia as well as patterns and predictors of comfort with disclosure. Methods: Community-dwelling adults living with dementia in the Netherlands ( Results: Internal consistency was good to excellent for all measures in the Dutch sample. Small but significant differences were found between the Dutch and English samples on the total score of the Stigma Impact Scale and its subscale social isolation. Age was negatively associated with comfort disclosing to family, and desire for secrecy was negatively associated with comfort disclosing to both family and friends. Conclusions: The psychometric properties of the Dutch scales were satisfactory. Many people living with dementia would feel comfortable disclosing their diagnosis to family and friends, but stigma experiences can greatly affect this decision. Cross-cultural differences in stigma experiences in persons with dementia require further investigation.
MeSH term(s)	Adult ; Humans ; Disclosure ; Dementia ; Ethnicity ; Language ; Emotions
Language	English
Publishing date	2023-07-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2084045-7
ISSN	1741-2684 ; 1471-3012
ISSN (online)	1741-2684
ISSN	1471-3012
DOI	10.1177/14713012231188503
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Article: Diuretics, SGLT2 inhibitors and falls in older heart failure patients: to prescribe or to deprescribe? A clinical review.

van Poelgeest, Eveline P / Handoko, M Louis / Muller, Majon / van der Velde, Nathalie

European geriatric medicine

2023 Volume 14, Issue 4, Page(s) 659–674

Abstract: Purpose: Both heart failure and its treatment with diuretics or SGLT2 inhibitors increase fall risk in older adults. Therefore, decisions to continue or deprescribe diuretics or SGLT2 inhibitors in older heart failure patients who have fallen are ... ...

Abstract	Purpose: Both heart failure and its treatment with diuretics or SGLT2 inhibitors increase fall risk in older adults. Therefore, decisions to continue or deprescribe diuretics or SGLT2 inhibitors in older heart failure patients who have fallen are generally highly complex and challenging for clinicians. However, a comprehensive overview of information required for rationale and safe decision-making is lacking. The aim of this clinical review was to assist clinicians in safe (de)prescribing of these drug classes in older heart failure patients. Methods: We comprehensively searched and summarized published literature and international guidelines on the efficacy, fall-related safety issues, and deprescribing of the commonly prescribed diuretics and SGLT2 inhibitors in older adults. Results: Both diuretics and SGLT2 inhibitors potentially cause various fall-related adverse effects. Their fall-related side effect profiles partly overlap (e.g., tendency to cause hypotension), but there are also important differences; based on the currently available evidence of this relatively new drug class, SGLT2 inhibitors seem to have a favorable fall-related adverse effect profile compared to diuretics (e.g., low/absent tendency to cause hyperglycemia or electrolyte abnormalities, low risk of worsening chronic kidney disease). In addition, SGLT2 inhibitors have potential beneficial effects (e.g., disease-modifying effects in heart failure, renoprotective effects), whereas diuretic effects are merely symptomatic. Conclusion: (De)prescribing diuretics and SGLT2 inhibitors in older heart failure patients who have fallen is often highly challenging, but this clinical review paper assists clinicians in individualized and patient-centered rational clinical decision-making: we provide a summary of available literature on efficacy and (subclass-specific) safety profiles of diuretics and SGLT2 inhibitors, and practical guidance on safe (de)prescribing of these drugs (e.g. a clinical decision tree for deprescribing diuretics in older adults who have fallen).
MeSH term(s)	Aged ; Humans ; Accidental Falls/prevention & control ; Deprescriptions ; Diuretics/therapeutic use ; Heart Failure/drug therapy ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
Chemical Substances	Diuretics ; Sodium-Glucose Transporter 2 Inhibitors
Language	English
Publishing date	2023-02-03
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2556794-9
ISSN	1878-7657 ; 1878-7649
ISSN (online)	1878-7657
ISSN	1878-7649
DOI	10.1007/s41999-023-00752-7
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Article ; Online: Cost-effectiveness of the FindMyApps eHealth intervention vs. digital care as usual: results from a randomised controlled trial.

Neal, David P / Kucera, Matej / van Munster, Barbara C / Ettema, Teake P / Dijkstra, Karin / Muller, Majon / Dröes, Rose-Marie / Bosmans, Judith E

Aging & mental health

2024 , Page(s) 1–14

Abstract: Objectives: Despite growing interest, the cost-effectiveness of eHealth interventions for supporting quality of life of people with dementia and their caregivers remains unclear. This study evaluated the cost-effectiveness of the FindMyApps intervention, ...

Abstract	Objectives: Despite growing interest, the cost-effectiveness of eHealth interventions for supporting quality of life of people with dementia and their caregivers remains unclear. This study evaluated the cost-effectiveness of the FindMyApps intervention, compared to digital care-as-usual. FindMyApps aims to help people with dementia and their caregivers find and learn to use tablet apps that may support social participation and self-management of people with dementia and sense of competence of caregivers. Method: A randomised controlled trial (Netherlands Trial Register NL8157) was conducted, including people with mild cognitive impairment (MCI) or mild dementia and their informal caregivers (FindMyApps Results: In the FindMyApps group, caregiver SSCQ scores were significantly higher compared to care-as-usual Conclusion: FindMyApps is a cost-effective intervention for supporting caregivers' sense of competence. Further implementation of FindMyApps is warranted.
Language	English
Publishing date	2024-05-06
Publishing country	England
Document type	Journal Article
ZDB-ID	1474804-6
ISSN	1364-6915 ; 1360-7863
ISSN (online)	1364-6915
ISSN	1360-7863
DOI	10.1080/13607863.2024.2345128
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Article ; Online: Vascular cognitive impairment: When memory loss is not the biggest challenge.

van de Schraaf, Sara Aj / Smit, Merel F / Muller, Majon / Hertogh, Cees Mpm / Rhodius-Meester, Hanneke Fm / Sizoo, Eefje M

Dementia (London, England)

2023 Volume 23, Issue 1, Page(s) 152–171

Abstract: Objectives: Vascular cognitive impairment is the second most common type of cognitive impairment. Care needs of community-dwelling people with vascular cognitive impairment and their caregivers have not been thoroughly studied. Therefore, we aimed to ... ...

Abstract	Objectives: Vascular cognitive impairment is the second most common type of cognitive impairment. Care needs of community-dwelling people with vascular cognitive impairment and their caregivers have not been thoroughly studied. Therefore, we aimed to explore care needs of people with vascular cognitive impairment and their family caregivers. Design: A qualitative interview study. Setting and participants: Participants were purposefully sampled community-dwelling people with vascular cognitive impairment and their family caregivers. Methods: Interviews were audiotaped and transcribed verbatim. Analysis and data collection followed an iterative process, until data saturation was achieved. We conducted 18 interviews (nine people with vascular cognitive impairment and nine caregivers), concerning 13 unique people with vascular cognitive impairment. We analyzed the data using inductive thematic analysis following the Braun & Clark method. The study was reported in accordance with the COREQ criteria. Findings: Five themes were identified in the care needs reported by people with vascular cognitive impairment and family caregivers: (1) Specific information need with subtheme (1A) No memory problem, no dementia? (2) Being respected as a person, (3) Differing concerns about the future, (4) The roles of the caregiver and (5) Decisiveness from professional healthcare. Conclusions and implications: The care needs of people with vascular cognitive impairment and their caregivers were affected by (a lack of knowledge about) the characteristic symptoms of this condition. Participants equated cognitive impairment or dementia to memory loss ("Alzheimerization"), although memory loss was not their biggest challenge. People with vascular cognitive impairment and caregivers preferred resolute and decisive healthcare professionals. These professionals activate the person with vascular cognitive impairment who lacks initiative and diminishe role conflict of the caregiver. Care for people with vascular cognitive impairment and their caregivers could be improved by providing tailored information, promoting awareness of neuropsychiatric symptoms, particularly apathy, and by healthcare professionals providing more guidance in decision-making.
MeSH term(s)	Humans ; Dementia/psychology ; Cognitive Dysfunction/psychology ; Caregivers/psychology ; Memory Disorders ; Data Collection ; Qualitative Research
Language	English
Publishing date	2023-11-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2084045-7
ISSN	1741-2684 ; 1471-3012
ISSN (online)	1741-2684
ISSN	1471-3012
DOI	10.1177/14713012231214299
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Article ; Online: FindMyApps compared with usual tablet use to promote social health of community-dwelling people with mild dementia and their informal caregivers: a randomised controlled trial.

Neal, David P / Ettema, Teake P / Zwan, Marissa D / Dijkstra, Karin / Finnema, Evelyn / Graff, Maud / Muller, Majon / Dröes, Rose-Marie

EClinicalMedicine

2023 Volume 63, Page(s) 102169

Abstract: Background: FindMyApps is a tablet-based eHealth intervention designed to help people learn to use a tablet and find easy-to-use apps. This study evaluated the effectiveness of FindMyApps for supporting social health of people living with dementia, and ... ...

Abstract	Background: FindMyApps is a tablet-based eHealth intervention designed to help people learn to use a tablet and find easy-to-use apps. This study evaluated the effectiveness of FindMyApps for supporting social health of people living with dementia, and sense of competence of their informal caregivers. Methods: A single-centre, two-arm, non-blinded randomised controlled trial was conducted (Netherlands Trial Register NL8157). From 1st January 2020 to 31st July 2022, community-dwelling people in the Netherlands with a pre-established diagnosis of mild cognitive impairment (MCI) or dementia (Brief Cognitive Rating Scale 17-32), an informal caregiver and internet connection were allocated by block randomisation to receive FindMyApps or digital care-as-usual. Primary outcomes (measured at baseline and after three months) for people with dementia/MCI were self-management (Adult Social Care Outcomes Toolkit total score) and social participation (Maastricht Social Participation Profile frequency and diversity scores), and for caregivers, sense of competence (Short Sense of Competence Questionnaire total score). Between-group differences were tested by MANCOVA or ANCOVA (alpha = 0.05). Findings: 150 dyads were randomised (FindMyApps n = 76, care-as-usual n = 74). Follow-up data were available for 128 dyads (FindMyApps n = 64, care-as-usual n = 64), who were included in the analysis in the trial arm to which they were assigned. No harms of the intervention were identified. There were no statistically significant differences in outcomes for people with dementia/MCI at group level. Diagnosis and experiencing apathy appeared to be relevant effect modifiers of secondary outcomes (neuropsychiatric symptoms, positive affect, sense of belonging, and pleasurable activities). Caregivers who received FindMyApps had higher sense of competence at three months (F [1,123] = 7.01, p = 0.0092, η Interpretation: Overall we found no evidence that the FindMyApps intervention better supported social participation or self-management of people with MCI/dementia than digital care-as-usual. FindMyApps does seem to better support informal caregivers' sense of competence. For people with a diagnosis of mild dementia and older people, better tailored interventions, implementation and outcome measures may be needed. Funding: Marie Skłodowska Curie Actions Innovative Training Network H2020 MSCA ITN, grant agreement number 813196.
Language	English
Publishing date	2023-08-30
Publishing country	England
Document type	Journal Article
ISSN	2589-5370
ISSN (online)	2589-5370
DOI	10.1016/j.eclinm.2023.102169
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