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This review demonstrated, in accordance with other qualitative reviews, the weak evidence that supporting family caregivers could be beneficial. Although the rather small benefits of formal support, supporting family caregivers is an indispensable issue in dementia home care. Professional caregivers should keep in mind that family caregivers highly appreciate the intervention and that they feel less burdened or depressed in the short time follow up but that premature home care remains more rule than exception.

IntroductionOur current knowledge-based society and the many actualisations within the medical profession require a great responsibility of physicians to continuously develop and refine their skills. In this article, we reflect on some recent findings in the field of continuing education for professional doctors (continuing medical education, CME). Second, we describe the development of a CME from the Academic Center for General Practice (ACHG) of the KU Leuven.MethodsFirst, we performed a literature study and we used unpublished data of a need assessment performed (2013) in a selected group of general practitioners. Second, we describe the development of a proposal to establish a CME programme for general practitioners.ResultsCME should go beyond the sheer acquisition of knowledge, and also seek changes in practice, attitudes and behaviours of physicians. The continuing education offerings are subject to the goals of the organising institution, but even more to the needs and desires of the end user.ConclusionsIntegrated education is crucial to meet the conditions for efficient and effective continuing education. The ACHG KU Leuven decided to offer a postgraduate programme consisting of a combination of teaching methods: online courses (self-study), contact courses (traditional method) and a materials database.

SUMMARYObjectives To examine the evolution of quality of life (QOL) in demented subjects at base-line, one and 2 years later and to determine clinical variables associated with QOL. Method Longitudinal study of a cohort of 127 subjects living at home or in a long-term care institution. A QOL measure (Alzheimer Disease Related Quality of Life; ADRQL) was administered three times. In addition, several clinical instruments (MMSE, IADL, ADL and CDR/M) were also administered. Results ADRQL data analysis did not reveal significant modifications of QOL over the 2-year period, whereas results from clinical instruments showed a significant deterioration. On the group, the variations of ADRQL scores were limited, with some improvement after the first year followed by some deterioration after the second year. On the other hand, ADRQL scores fluctuated every year by at least 10 points for more than 50% of subjects. With dementia evolution, it was observed that the clinical variables were more strongly correlated with ADRQL scores and were more significant predictors. This varied from 5.9% (MMSE) in 2002 to 40.01% in 2004 (MMSE and CDR/M). Conclusions QOL did not develop in a strictly linear manner following the deterioration of clinical state. This suggests that the evolution of QOL is also determined by other variables relating to the physical and social environment of the patients. Their role seems particularly important for the mild to moderate stages of dementia.

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