Background: Undernutrition can negatively affect community-dwelling older adults' health and quality of life. Undernutrition management guidelines have been developed in the Netherlands for the primary care setting, however, the application of these guidelines remain unsatisfactory. The current study therefore aims to explore qualitatively the experiences of Dutch nutrition and care professionals and researchers with undernutrition awareness, monitoring, and treatment among community-dwelling older adults. Methods: We telephonically interviewed 22 Dutch nutrition and care professionals and researchers. Our semi-structured interview guide elicited answers that we audiotaped and transcribed verbatim. The interviews were coded using grounded theory and content analysis with the qualitative analysis software MAXQDA, after which the codes were categorized into themes. Results: The interviews resulted in six themes relevant to the topics of interest: undernutrition awareness, monitoring, and treatment. These were: (1) adverse changes in nutrition behaviour; (2) limited undernutrition awareness; (3) unclear monitoring responsibilities and procedures; (4) lack of awareness, time, and priority as monitoring barriers; (5) lack of treatment personalization and justification; (6) lack of timely treatment implementation and evaluation. Conclusions: The experts' experiences imply that undernutrition awareness is limited, among both older adults and care professionals. In addition, the interviewees are unclear about which professionals are responsible for monitoring and which monitoring procedures are preferred. The dietitians feel that they become involved too late, leading to decreased treatment effectiveness. In general, the interviewees desire a coherent and feasible allocation of responsibilities regarding undernutrition monitoring and treatment. This implies that the available guidelines on undernutrition management require more attention and facilitation.

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Background: Many older adults are at risk of undernutrition. Dietitians play a key role in the management and treatment of undernutrition, but older adults have difficulties to comply with dietetic recommendations. This qualitative study investigated which barriers older adults experience in adhering to treatment for undernutrition. Current dietetic practices and older adults' experiences were studied, and the potential to use protein-enriched regular products in undernutrition treatment was investigated. Methods: We interviewed 18 older adults who were under treatment for undernutrition, and 13 dietitians. Semistructured interview guides were used, and all interviews were audiotaped and transcribed verbatim. The interviews were coded with qualitative analysis software NVivo9, followed by content analysis to formulate main themes. Results: The interviews resulted in seven themes, which related to three main topics: barriers for treating undernutrition in older adults, current dietetic treatment, and new strategies to complement current treatment. Low awareness and a lack of knowledge regarding undernutrition, physical limitations, and loss of appetite were found to be major barriers for treating undernutrition in older adults. Dietitians said to focus mostly on increasing energy and protein intake by recommending the use of regular food products that fit the needs and habits of the patient, before prescribing oral nutritional supplements. Dietitians considered enriched regular products to be useful if they fit with the habits of older adults, the portion sizes were kept small, if products were easy to open and prepare, had good palatability, and were offered in a variety of taste and textures. Conclusions: Results from the interviews suggest that undernutrition awareness is low among older adults and they lack knowledge on how to manage undernutrition despite efforts taken by dietitians. Enriched regular products could enable older adults to better adhere to undernutrition treatment, provided that these products meet the needs and eating habits of older adults. If protein-enriched food products can replace regular, lowprotein variants, older adults do not need to consume more, but can adhere to their usual pattern while consuming more protein.

Virtual Coaches, also known as e-coaches, are a disruptive technology in healthcare. Indeed, among other usages, they might provide cost-effective solutions for increasing human wellbeing in different domains, such as physical, nutritional, cognitive, social, and emotional. This paper presents a systematic review of virtual coaches specifically aimed at improving or maintaining older adults' health in the aforementioned domains. Such digital systems assume various forms, from classic apps, to more advanced conversational agents or robots. Fifty-six articles describing a virtual coach for older adults and aimed at improving their wellbeing were identified and further analyzed. In particular, we presented how previous studies defined their virtual coaches, which behavioral change models and techniques they adopted and the overall system architecture, in terms of monitoring solutions, processing methods and modalities for intervention delivery. Our results show that few thorough evaluations of e-coaching systems have been conducted, especially regarding multi-domain coaching approaches. Through our analysis, we identified the wellbeing domains that should be addressed in future studies as well as the most promising behavior change models and techniques and coaching interfaces. Previous work illustrates that older adults often appreciate conversational agents and robots. However, the lack of a multidomain intervention approach in the current literature motivates us to seek to define future solutions.

Background A psychosocial dementia care programme for challenging behaviour (DEMBASE®) was developed in collaboration with a Swedish BPSD‐registry team for in‐home care services use in Japan. The programme consisted of a web‐based tool for the continued assessment of challenging behaviours and interdisciplinary discussion meetings. Effectiveness of the adapted programme was verified through a cluster‐randomised controlled trial. The Tokyo Metropolitan Government provided municipal funding to introduce the programme into daily practice beginning in April 2018. Objectives To investigate both facilitators and barriers associated with programme implementation. Design A secondary analysis of qualitative and quantitative data. Settings Data were collected in naturalistic long‐term care settings from April 2018 to March 2019. Participants A total of 138 professionals and 157 people with dementia participated in the programme. Methods Challenging behaviour in persons with dementia was assessed by professionals using a total Neuropsychiatric Inventory score. Data on expected facilitators and barriers were extracted for qualitative analysis from a debriefing meeting between professionals. Results Of the 157 persons with dementia, 81 (51.6%) received follow‐up behavioural evaluations by March 2019. The average level of challenging behaviour was significantly reduced for 81 persons from baseline to their most recent follow‐up evaluations. Facilitators included ‘programme available for care managers’, ‘visualised feedback on professionals’ work’, ‘affordable for providers and professionals’ and ‘media coverage’. Barriers included ‘professionals from different organisations’, ‘unpaid work’, ‘operation requirement for municipalities’ and ‘conflict with daily benefit‐oriented framework’. Conclusions A follow‐up evaluation was not fully achieved. Further strategies to address barriers may include the development of a benefit‐rewarding scheme for interdisciplinary discussion meetings, an e‐learning system capable of substituting training course portions and a cross‐municipality training course.