Dutch hospitals check 'vulnerability' of elderly patients before operating


Two Dutch hospitals have begun assessing the 'vulnerability' of patients over the age of 70 who are admitted to their emergency departments to determine their suitability for major operations and other far-reaching treatment, the NRC said on Monday. Doctors are using a short list of questions to determine if the elderly patient is fit enough to go through the procedure and will recover well. The questions cover issues such as medication, memory loss and whether or not the person concerned lives independently. The answers allow doctors to decide if a patient risks either dying or deteriorating when they are sent home after treatment. Leiden's LUMC teaching hospital and the Haga hospital in The Hague are pioneering the new system. It was developed after researchers noticed that 10% of the over 70s treated in the LUMC's A&E department died within three months and a further 20% were no longer able to live independently. 'We are talking mainly about serious operations with a large risk of complications,' Ronne Mairhu of the Haga hospital told NOS radio. 'Patients are often open to talking about it. The decision about whether to operate is always taken together with the patient and family members, Mairhu said. 'It often boils down to quality of life, not about prolonging life,' he said. If the system proves a success, it will be applied in other hospitals, Hanna Willems, chairwoman of the Dutch association for clinical geriatrics told the NRC. Last year, 800,000 people over the age of 65 ended up in an A&E department, and 530,000 of them were hospitalised. Chemotherapy Meanwhile, GroenLinks MP Corine Ellemeet on Monday launched a plan to improve care of the elderly which includes a call to involved specialist geriatric doctors in assessing whether people should be treated. 'Everyone has the right to be treated,' Ellemeet said. 'But you have to dare to ask if there are any gains to be made with an operation or chemotherapy. Geriatric specialists can determine if someone will benefit from medical treatment. People often deteriorate after a spell in hospital. Politicians, she said, are uneasy about tackling the issue because people will start talking about the elderly bearing the brunt of hospital cutbacks. 'This is not what we want at all,' she said. An honest approach to the risks associated with treatment would, she said, 'I think lead to many people passing on further treatment.' 4.5 million Last week, national statistics office CBS said 72% of the over-85s in the Netherlands still live in their own homes. There are some three million people over the age of 65 living in the Netherlands, but their number is set to grow to 4.5 million - or a quarter of the population - by 2040. The over-65s currently account for almost half of all spending on healthcare, but most of that goes on the small group who live in residential homes.  More >



Pensioners live longer in their own homes

The percentage of people over the age of 85 who are still living independently at home went up from 65% to 72% between 2012 and 1016, according to research by the Dutch healthcare authority NZa. The government has been actively encouraging people to stay at home since 2013, and the survey results show this is beginning have an effect, the NZa said. In particular, the government has introduced new health checks for admittance to a home. Now, almost half of care home residents have some form of dementia, compared with just 25% in 2012. There are some three million people over the age of 65 living in the Netherlands, but their number is set to grow to 4.5 million - or a quarter of the population - by 2040. The over-65s currently account for almost half of all spending on healthcare, but most of that goes on the small group who live in residential homes. Assets Finance ministry research earlier this month showed that today’s pensioners in the Netherlands have more disposable income than in the past and their assets have increased due to soaring house price. But even excluding home ownership, pensioners have more assets on average than the rest of the population. Dutch pensioners are also well off when compared with other countries. Just 2.6% of Dutch pensioners are said to be poor, compared with 8.2% of households in general.  More >



Menzis: pressure rising on health costs

Health insurance company Menzis booked after-tax earnings of €45.3m in 2017, down slightly on the €46.9m posted in the previous year the company said on Tuesday. Premium income inched up to €6.1bn from €6bn in 2016. But the company - one of the top four healthcare insurers in the Netherlands - hinted that premiums may have to increase in 2019, following similar statements by other healthcare insurers. Menzis relied on €69m of its reserves to keep premiums last year at their 2016 level. 'Despite the fact that we posted positive results, we saw more pressure on costs. We countered this partly by agreeing more long-term contracts with care providers,' said  CFO Frank Janssen. Menzis signed up 38,000 new clients in 2017. Menzies believes prevention and a healthy lifestyle are key to cost reduction, and has signed up 820,000 policyholders to its online health coach platform SamenGezond.  More >



Minister: end youth solitary confinement

Young people in secure accommodation should no longer be subjected to the 'trauma' of solitary confinement, health minister Hugo de Jonge has said. De Jonge wants to ban solitary confinement from 2021 as part of his plans to improve the youth care system, which are being presented to parliament on Monday, the NRC reported. In the meantime he said he would be discussing with institutions to cut the number of instances of children being placed in isolation rooms, an experience which can be 'traumatic' for the young person involved, said De Jonge. Experts estimate that solitary confinement is used several thousand times a year by institutions, either as a punishment measure, to protect the child or others around them, or because of a shortage of support staff. De Jonge said he also wants to improve the registration process for children in secure care facilities. In 2017 2,254 young people were treated in this way for behavioural problems that pose a danger to themselves or others. The action plan follows a re-evaluation of the Youth Care Act following concerns that the devolution of services to local authorities by the last government had not let to an improvement in quality. The health ministry and local councils have earmarked €108 million for improvements over the next three years.  More >



Bedtime battle: Dutch parents confused

As the daylight hours lengthen, Dutch parents are increasingly confused about what time they should ensure their kids are in bed, according to Dutch magazine Ouders van Nu. Editor Hilde Tholen told broadcaster NOS that peer pressure about watching television shows such as The Voice means children are trying to stay up longer. ‘From April to July, parents are more likely to look for advice on this on our website than in the winter,’ she reportedly said. ‘Bedtime is a very Dutch, also rather a German phenomenon. In other countries, children simply go to bed when they are tired.’ The Vereniging Kind en Slaap, an association of doctors who deal with child sleep issues, advised that parents should judge individual needs. ‘Always putting an infant to bed at 7pm isn’t good,’ chairperson and child neurologist Sigrid Pillen reportedly said. ‘The ideal bedtime can vary by half an hour from one child to another.’ She added that putting kids to bed too early doesn’t mean they are automatically better off. ‘They can spend hours protesting or lying awake, while a young lad who really wants to play football [late at night] might then sleep far better. 'A good guideline is: if you have to wake children in the morning, they aren’t getting enough sleep. If a child wakes up alone and feels good during the day, he or she is sleeping enough – even if peers are going to bed an hour earlier.’    More >