ACTIVE AGEING: BIO-PSYCHO-
SOCIALE STRATEGIEËN
Prof. Dr. Ivan BAUTMANS
2022-2023
VUB
Nico Simons
,Inhoudsopgave
1. Gezond ouder worden: wat is het en waarom is lichaamsbeweging belangrijk? ...................................... 6
1.1 Inleiding ................................................................................................................................................. 6
1.2 Gezond ouder worden (Healthy Ageing)................................................................................................ 6
1.3 Kwetsbaarheid is de belangrijkste belemmering voor gezond ouder worden ....................................... 8
1.4 Anticiperen op kwetsbaarheid door het monitoren van handgreepspiervermoeidheid als biomarker
van de fysieke reserves van ouderen. ............................................................................................................... 11
1.5 Concepten ............................................................................................................................................ 12
1.5.1 Verschil tussen fysieke activiteit en fysieke oefening .......................................................................... 18
1.6 Feiten en cijfers .................................................................................................................................... 19
1.6.1 Onderliggende mechanismen .............................................................................................................. 19
1.7 Motivatie om te bewegen .................................................................................................................... 23
2. Depressie ............................................................................................................................................... 25
2.1 Inleiding ............................................................................................................................................... 25
2.2 Majeure depressieve stoornis .............................................................................................................. 25
2.3 Persistente depressieve stoornis (dysthymie) ...................................................................................... 27
2.4 Epidemiologie ...................................................................................................................................... 27
2.5 Depressie en dementie......................................................................................................................... 30
2.6 Stress diathese model .......................................................................................................................... 31
2.7 Risicofactoren ...................................................................................................................................... 32
2.8 Beschermende factoren ....................................................................................................................... 33
2.9 Effect risicofactoren ............................................................................................................................. 33
2.10 Risicogroepen ...................................................................................................................................... 34
2.11 Gevolgen .............................................................................................................................................. 34
2.12 Depressie en fysieke beperking ............................................................................................................ 34
2.13 Opsporen van depressie ....................................................................................................................... 35
2.13.1 Inleiding ........................................................................................................................................... 35
2.13.2 Verschillende niveaus om depressie op te sporen ........................................................................... 36
1
, 2.14 Behandeling ......................................................................................................................................... 43
2.14.1 Farmacotherapie ............................................................................................................................. 44
2.14.2 Psychotherapie ................................................................................................................................ 44
2.14.3 Electroconvulsie therapie (ECT) ....................................................................................................... 45
3. Suïcide ................................................................................................................................................... 46
3.1 Betekenis ............................................................................................................................................. 46
3.2 Letaliteit ............................................................................................................................................... 47
3.3 Attituden t.o.v. suïcide bij ouderen ...................................................................................................... 48
3.4 Risicofactoren ...................................................................................................................................... 49
3.5 Screening en behandeling suïcidaliteit ................................................................................................ 49
3.6 Samengevat ......................................................................................................................................... 50
4. Sarcopenie ............................................................................................................................................. 52
4.1 Begrip................................................................................................................................................... 52
4.2 Architecturale veranderingen .............................................................................................................. 55
4.3 Biomechanisch eigenschappen muscle tendon .................................................................................... 57
4.4 Bedrust................................................................................................................................................. 61
4.5 Malnutritie ........................................................................................................................................... 62
4.6 Ontsteking en cachexie ........................................................................................................................ 63
4.6.1 Acute ontsteking .................................................................................................................................. 65
4.6.2 Cachexie ............................................................................................................................................... 66
4.6.3 Epidemiologie en functionele impact van sarcopenie.......................................................................... 66
4.6.4 Sarcopenische obesitas ........................................................................................................................ 72
4.6.5 Antagonist muscle co-activation ......................................................................................................... 77
4.6.6 Dynapenie ............................................................................................................................................ 79
4.6.7 EWGSOP............................................................................................................................................... 80
4.6.8 Andere werkgroepen ........................................................................................................................... 88
4.7 Sarcopenie tegengaan ......................................................................................................................... 95
4.7.1 Weerstandstraining ............................................................................................................................. 95
2
, 4.7.2 Nieuwste bewijsmateriaal van strenght trainingstests bij kwetsbare ouderen ................................. 100
4.7.3 Voedingssupplementen ..................................................................................................................... 101
4.7.4 Weerstandstraining ........................................................................................................................... 102
4.7.5 Hoe organiseer je fitness voor senioren? ........................................................................................... 103
4.7.6 Individuele oefeningen voor thuis ...................................................................................................... 106
4.7.7 Belangrijk ........................................................................................................................................... 107
4.8 Spierzwakte in de acute situatie: oorzaken en oplossingen............................................................... 108
4.8.1 Oefenen in acute situaties om spierzwakte tegen te gaan ................................................................ 124
4.8.2 Voedingssupplementen ..................................................................................................................... 127
4.8.3 Samenvatting..................................................................................................................................... 128
5. Postural changes and functional performance at higher age ................................................................ 130
5.1 Inleiding ............................................................................................................................................. 130
5.2 Cervicale houdingsveranderingen bij veroudering ............................................................................ 130
5.3 Houdingsafwijkingen van de thoracale wervelkolom (Hyperkyfose) ................................................. 133
6. Ergotherapie ........................................................................................................................................ 158
6.1 Inleiding ............................................................................................................................................. 158
Doel ............................................................................................................................................................ 158
Historiek ..................................................................................................................................................... 158
Theoretisch kader ....................................................................................................................................... 158
Definitie ...................................................................................................................................................... 158
Activiteiten uit het dagelijkse leven ........................................................................................................... 158
Zelfzorg ....................................................................................................................................................... 158
Huishoudelijke activiteiten ......................................................................................................................... 159
Advanced activities of daily living............................................................................................................... 159
Behoefte pyramide ..................................................................................................................................... 159
Mentale beeld ............................................................................................................................................ 159
Betekenisvol handelen ............................................................................................................................... 160
Bewijs ......................................................................................................................................................... 160
Wat bij chronische aandoeningen? ............................................................................................................ 160
6.2 Op bewijs gebaseerd .......................................................................................................................... 161
Zoektermen ................................................................................................................................................ 161
6.3 Zinvolle activiteiten en kwaliteit van leven ........................................................................................ 161
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SOCIALE STRATEGIEËN
Prof. Dr. Ivan BAUTMANS
2022-2023
VUB
Nico Simons
,Inhoudsopgave
1. Gezond ouder worden: wat is het en waarom is lichaamsbeweging belangrijk? ...................................... 6
1.1 Inleiding ................................................................................................................................................. 6
1.2 Gezond ouder worden (Healthy Ageing)................................................................................................ 6
1.3 Kwetsbaarheid is de belangrijkste belemmering voor gezond ouder worden ....................................... 8
1.4 Anticiperen op kwetsbaarheid door het monitoren van handgreepspiervermoeidheid als biomarker
van de fysieke reserves van ouderen. ............................................................................................................... 11
1.5 Concepten ............................................................................................................................................ 12
1.5.1 Verschil tussen fysieke activiteit en fysieke oefening .......................................................................... 18
1.6 Feiten en cijfers .................................................................................................................................... 19
1.6.1 Onderliggende mechanismen .............................................................................................................. 19
1.7 Motivatie om te bewegen .................................................................................................................... 23
2. Depressie ............................................................................................................................................... 25
2.1 Inleiding ............................................................................................................................................... 25
2.2 Majeure depressieve stoornis .............................................................................................................. 25
2.3 Persistente depressieve stoornis (dysthymie) ...................................................................................... 27
2.4 Epidemiologie ...................................................................................................................................... 27
2.5 Depressie en dementie......................................................................................................................... 30
2.6 Stress diathese model .......................................................................................................................... 31
2.7 Risicofactoren ...................................................................................................................................... 32
2.8 Beschermende factoren ....................................................................................................................... 33
2.9 Effect risicofactoren ............................................................................................................................. 33
2.10 Risicogroepen ...................................................................................................................................... 34
2.11 Gevolgen .............................................................................................................................................. 34
2.12 Depressie en fysieke beperking ............................................................................................................ 34
2.13 Opsporen van depressie ....................................................................................................................... 35
2.13.1 Inleiding ........................................................................................................................................... 35
2.13.2 Verschillende niveaus om depressie op te sporen ........................................................................... 36
1
, 2.14 Behandeling ......................................................................................................................................... 43
2.14.1 Farmacotherapie ............................................................................................................................. 44
2.14.2 Psychotherapie ................................................................................................................................ 44
2.14.3 Electroconvulsie therapie (ECT) ....................................................................................................... 45
3. Suïcide ................................................................................................................................................... 46
3.1 Betekenis ............................................................................................................................................. 46
3.2 Letaliteit ............................................................................................................................................... 47
3.3 Attituden t.o.v. suïcide bij ouderen ...................................................................................................... 48
3.4 Risicofactoren ...................................................................................................................................... 49
3.5 Screening en behandeling suïcidaliteit ................................................................................................ 49
3.6 Samengevat ......................................................................................................................................... 50
4. Sarcopenie ............................................................................................................................................. 52
4.1 Begrip................................................................................................................................................... 52
4.2 Architecturale veranderingen .............................................................................................................. 55
4.3 Biomechanisch eigenschappen muscle tendon .................................................................................... 57
4.4 Bedrust................................................................................................................................................. 61
4.5 Malnutritie ........................................................................................................................................... 62
4.6 Ontsteking en cachexie ........................................................................................................................ 63
4.6.1 Acute ontsteking .................................................................................................................................. 65
4.6.2 Cachexie ............................................................................................................................................... 66
4.6.3 Epidemiologie en functionele impact van sarcopenie.......................................................................... 66
4.6.4 Sarcopenische obesitas ........................................................................................................................ 72
4.6.5 Antagonist muscle co-activation ......................................................................................................... 77
4.6.6 Dynapenie ............................................................................................................................................ 79
4.6.7 EWGSOP............................................................................................................................................... 80
4.6.8 Andere werkgroepen ........................................................................................................................... 88
4.7 Sarcopenie tegengaan ......................................................................................................................... 95
4.7.1 Weerstandstraining ............................................................................................................................. 95
2
, 4.7.2 Nieuwste bewijsmateriaal van strenght trainingstests bij kwetsbare ouderen ................................. 100
4.7.3 Voedingssupplementen ..................................................................................................................... 101
4.7.4 Weerstandstraining ........................................................................................................................... 102
4.7.5 Hoe organiseer je fitness voor senioren? ........................................................................................... 103
4.7.6 Individuele oefeningen voor thuis ...................................................................................................... 106
4.7.7 Belangrijk ........................................................................................................................................... 107
4.8 Spierzwakte in de acute situatie: oorzaken en oplossingen............................................................... 108
4.8.1 Oefenen in acute situaties om spierzwakte tegen te gaan ................................................................ 124
4.8.2 Voedingssupplementen ..................................................................................................................... 127
4.8.3 Samenvatting..................................................................................................................................... 128
5. Postural changes and functional performance at higher age ................................................................ 130
5.1 Inleiding ............................................................................................................................................. 130
5.2 Cervicale houdingsveranderingen bij veroudering ............................................................................ 130
5.3 Houdingsafwijkingen van de thoracale wervelkolom (Hyperkyfose) ................................................. 133
6. Ergotherapie ........................................................................................................................................ 158
6.1 Inleiding ............................................................................................................................................. 158
Doel ............................................................................................................................................................ 158
Historiek ..................................................................................................................................................... 158
Theoretisch kader ....................................................................................................................................... 158
Definitie ...................................................................................................................................................... 158
Activiteiten uit het dagelijkse leven ........................................................................................................... 158
Zelfzorg ....................................................................................................................................................... 158
Huishoudelijke activiteiten ......................................................................................................................... 159
Advanced activities of daily living............................................................................................................... 159
Behoefte pyramide ..................................................................................................................................... 159
Mentale beeld ............................................................................................................................................ 159
Betekenisvol handelen ............................................................................................................................... 160
Bewijs ......................................................................................................................................................... 160
Wat bij chronische aandoeningen? ............................................................................................................ 160
6.2 Op bewijs gebaseerd .......................................................................................................................... 161
Zoektermen ................................................................................................................................................ 161
6.3 Zinvolle activiteiten en kwaliteit van leven ........................................................................................ 161
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