Wise, old and wonderful; the benefits of day-time activities for independently living frail elderly people

摘要

A rapidly ageing society lead to a significant increase of the number of frail elderly in the Netherlands. The last couple of years, government policy towards these vulnerable older people evolves rapidly due to a shrinking government budget and new concepts on civil society. As per 1 January 2015, the day-care provision has been transferred from AWBZ (Exceptional Medical Expenses Act, national level) to WMO (Social Support Act, local level). The reason for this is that municipalities can offer custom-made provisions and are in closer contact with the client. The aim is to facilitate the elderly people to live independently at home for a longer period. The transfer of the national AWBZ budget to the local executed WMO is coupled with a 25% cut. As a result, less elderly people will qualify for the indication of daytime activities. Aim of the research : The aim of this research is to gain an insight into the relation between daytime activities and the vulnerability of the elderly (65 and older). What could be the effects of the new policy (national and local) and is it necessary en to what extent to continue the offer of daytime activities and how.. Method of research : To investigate how vulnerable the participants with a somatic indication of the daytime activities are, we made use of the Tilburg Frailty Indication (TMI). This is a validated questionnaire, measuring frailty in the physical, social and psychological domains. 96 older adults participating in the daytime activities of the TMZ organization filled out the questionnaire. Based on their replies, we recruited 8 frail elderly for an in-depth interview to examine whether there is a relationship and if so, which one, between the day-care activities and the vulnerability of TMZ’s somatic elderly. It results in 8 portraits (stories) of frail elderly people who represent the target group. The outcome of these investigations, together with extensive literature search, led to the results mentioned below. Results : Both the literature search and the TFI indicate that vulnerable older people are mainly of old age, females, singles and groups with a low socio-economic status. The research shows that 88% of the people participating in the daytime activities are vulnerable, 86% are physically vulnerable, 70% socially vulnerable and 57% psychologically vulnerable. Compared with the national average of respectively 70%, 60% and 60% the research group is not significant deviant. From the interviews it became clear that day-care activities are very important to TMZ’s current clients. The main goal is to prevent them becoming isolated and to provide them with a meaningful way of spending the day. For those who are married (living together) the daytime activities provide respite for the informal caretaker. Day-care activities therefore are a powerful intervention to assure that vulnerable elderly people can continue living independently at home for a longer time. If there will be less or no day-care activities at all, it is likely that the frail elderly (and their partners) will become even more vulnerable, which will lead to more disabilities, (acute) admissions and deaths. This effect is diametrically opposed to the line of reasoning of the new WMO: to ensure for people to keep control over their own lives and to continue living independently at home for as long as possible. Recommendations : Day-care activities should be continued for the frail elderly living at home. 12,5% of the participants are not really frail. For the identification of frail older people, municipalities can make use of the TFI. Moreover, the TFI results may be used to determine which day-care activity is most appropriate. To continue to serve the current and future target group a new vision and policy of the supplier and the municipality is necessary. The organisation of the activities needs attention: more use of volunteers and integrating activities. Participants are willing to pay some financial contribution for food and transport. At national level, it is important for the government to provide sufficient knowledge and information regarding vulnerable older people before introducing a policy on the subject, such as regularly mapping the socio-economic characteristics of frail older people.