The work described in this thesis had two objectives, specifically focusing on people aged 70 years and older: first, we aimed to investigate the associations between several thrombosis-related... Show moreThe work described in this thesis had two objectives, specifically focusing on people aged 70 years and older: first, we aimed to investigate the associations between several thrombosis-related risk factors described in young and middle-aged populations and the risk of venous thrombosis (VT) in the elderly; second, we aimed to provide insight into several long-term consequences (i.e., health-related quality of life (HRQoL) and long-term risk of mortality) after a first VT at old age. Show less
Pulmonary embolism (PE) is a serious and sometimes life-threatening condition that refers to a blood clot that occludes the arteries of the lung. Despite all improvements over the past decades,... Show morePulmonary embolism (PE) is a serious and sometimes life-threatening condition that refers to a blood clot that occludes the arteries of the lung. Despite all improvements over the past decades, diagnosing PE is still a difficult process due to the non-specific symptoms, which can frequently overlap with symptoms of other cardiopulmonary diseases. Currently recommended diagnostic strategies for suspected acute PE consist of standardized assessment of the clinical pre-test probability (CPTP) using validated clinical decision rules (CDRs) and D-dimer testing. PE is considered safely ruled out in patients with a non-high CPTP and a normal D-dimer test. Imaging tests as computed tomography pulmonary angiography (CTPA) are required in the case of a high CPTP and/or abnormal D-dimer test to confirm the diagnosis. The first part of this thesis describes the challenges of diagnosing PE in general and in specific clinically relevant patient subgroups. Moreover, this part evaluates the diagnostic performance of non-invasive diagnostic strategies for suspected PE in specific relevant patient subgroups. The second part of this thesis focuses on venous thrombotic complications in hospitalized patients with COVID-19. Show less
Inflammatoire darmziekten (Inflammatory Bowel Disease, IBD) zijn chronische immuun-gemedieerde ziekten van het maag-darmstelsel. Het aandeel oudere patiënten met IBD, 65 jaar of ouder, wordt... Show moreInflammatoire darmziekten (Inflammatory Bowel Disease, IBD) zijn chronische immuun-gemedieerde ziekten van het maag-darmstelsel. Het aandeel oudere patiënten met IBD, 65 jaar of ouder, wordt groter. Het behandelen van deze groep is een uitdaging, omdat zij vaak andere ziekten (comorbiditeit) hebben en geriatrische aandoeningen zoals geheugenproblemen of verminderde spiermassa. Deze aandoeningen vallen onder het begrip kwetsbaarheid, en worden gemeten met een geriatrisch assessment.Dit proefschrift richt zich op het in kaart brengen van de huidige literatuur en behandeloverwegingen bij oudere patiënten met IBD, om daarna als een van de eersten bewijs te leveren voor het invoeren van (screening naar) comorbiditeit en kwetsbaarheid bij de behandeling van oudere patiënten met IBD.Allereerst wordt onderzocht welke factoren bijdragen aan behandelbeslissingen, door behandelaren te interviewen. Leeftijd en aspecten van kwetsbaarheid beïnvloeden behandelbeslissingen, maar behandelaren verschillen onderling in hoe ze deze aspecten gebruiken. Daarnaast liet een literatuur zoektocht zien dat het bewijs over de relatie tussen kwetsbaarheid en behandeluitkomsten schaars is.Ook wordt het verband tussen comorbiditeit en veiligheid van biologicals, medicijnen die ontstekingseiwitten of afweercellen remmen, onderzocht. De aanwezigheid van meer comorbiditeit geeft een hoger risico op bijwerkingen (infecties en ziekenhuisopnames), een hogere leeftijd geeft dat niet.Tenslotte wordt de prevalentie van kwetsbaarheid in een Nederlands cohort van oudere patiënten met IBD onderzocht. Bij ongeveer de helft was er kwetsbaarheid. Hoe kwetsbaarder, hoe hoger de IBD-ziekteactiviteit en de IBD-ziektelast. Kwetsbare patiënten hadden, onafhankelijk van hun leeftijd en IBD-ziekteactiviteit, een hogere kans op ziekenhuisopnames en infecties, maar ook op achteruitgang in zelfstandigheid en kwaliteit van leven. Show less
This thesis describes the PROMODE-study, which investigated in a pragmatic way whether a pro-active approach in primary care by screening for depressive symptoms, followed by an intervention offer... Show moreThis thesis describes the PROMODE-study, which investigated in a pragmatic way whether a pro-active approach in primary care by screening for depressive symptoms, followed by an intervention offer to persons of 75 years and over who screened positive, is (cost)effective to detect and relieve suffering from depressive symptoms at old age. We compared two screening methods regarding yield and costs. Furthermore, we found that scores of the 15-item Geriatric Depression Scale were higher when this screening questionnaire was self-administered than when interviewer-administered. In our intervention study, a cluster-randomised controlled trial, we found that the stepped-care intervention program was not (cost)effective compared with usual care in general practice, possibly due to a low uptake of the offered course being the main part of the intervention. In a qualitative study we explored the limiting and motivating factors for accepting course participation. This revealed that most persons were not (yet) prepared to accept the unsolicited intervention offer, although perceived needs to relieve depressive symptoms seemed to largely match the elements of the course. It is discussed that a more selective approach, aimed at high risk-groups and focussing on need for and readiness to accept help, might increase efficiency of a combined screening-intervention program. Show less
Aging of the brain was studied by comparing follow-up MRI scans in 554 persons aged 70-82 years. Mean interval time between these scans was three years and scans were looked for changes in cerebral... Show moreAging of the brain was studied by comparing follow-up MRI scans in 554 persons aged 70-82 years. Mean interval time between these scans was three years and scans were looked for changes in cerebral infarcts, white matter lesions, cerebral blood flow, and brain volume. Besides this, the preventive effect of pravastatin on these changes was studied. During the study time there was progression of cerebral infarcts, white matter lesions and there was decline of cerebral blood flow and progression of brain atrophy. Treatment with pravastatin 40 mg/daily did not have a protective effect on these changes. Show less
