O r i g i n a l People with dementia playing casual games on a tablet Preserving clients' quality of life (QoL) has become increasingly important in dementia care. Mood, engagement in pleasant activities, and the ability to perform activities of daily living (ADLs) are important factors that influence the QoL of people with dementia 1. Recent studies among residents of long-term care facilities who are living with dementia, confirm that activity involvement is beneficial for their QoL 2,3. One of the quality statements in the UK NICE quality standard 'Dementia: independence and wellbeing' states that people with dementia should be enabled to take part in leisure activities of their interest and choice 4. Dutch dementia care professionals acknowledge that people with dementia have a wide range of different interests and preferences for taking part in leisure activities 5. Professionals are willing to offer varying activities to people with dementia. However, due to lack of time and resources, they frequently feel themselves constrained to offer standard group activities rather than one-to-one activities. One of the dementia care professionals involved

Background: Meaning in life of older persons is related to well-being, health, quality of life, and “good life.” However, the topic is scarcely covered in nursing literature. Objective: The aim of this integrative review for nurses is to synthesize knowledge from scholarly literature to provide insight into how older persons find meaning in life, what are influencing circumstances, and what are their sources of meaning. The review serves as a starting point for including meaning in life of older persons as a major concern for nurses in their role as health promoters. Method: An integrative review was performed including empirical research literature and texts on theoretical perspectives. Ethical consideration: Researches agree with ethical codes for research of universities in the Netherlands. For literature reviews no additional procedures are necessary according to Dutch law. Findings: A total of 44 heterogeneous texts were included in this review. Finding meaning in life is challenging for older persons. Older persons find meaning through a developmental process, by creating and discovering. Meaning in life is found in connection with self and others. Health, living together, high socio-economic status, social relations, activities, and religion are associated with experiencing meaning in later life. The main source of meaning in life of older persons is human relationships. Other sources of meaning in life vary by age and culture. Discussion: The review provides insight into meaning in life of older persons. There are several gaps in knowledge: literature is culturally biased, research on discovery of meaning and daily meaning is limited, and research from a nursing perspective is lacking. In practice, nurses have many opportunities to attune to meaning in life of patients. Further development of competence and training are needed. Conclusion: Older persons find meaning in life through different processes. Meaning in life is associated with the circumstances old persons live in. Human relationship is the major source of meaning. The knowledge from this review is a necessary knowledge base for nurses to include meaning in life of older patients in care. Further research is needed to explore the role of nurses.

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Objective: To predict mortality with the Tilburg Frailty Indicator (TFI) in a sample of community-dwelling older people, using a follow-up of 7 years. Design: Longitudinal. Setting and Participants: 479 Dutch community-dwelling people aged 75 years or older. Measurements: The TFI, a self-report questionnaire, was used to collect data about total, physical, psychological, and social frailty. The municipality of Roosendaal (a town in the Netherlands) provided the mortality dates. Results: Total, physical, and psychological frailty predicted mortality, with unadjusted hazard ratios of 1.295, 1.168, and 1.194, and areas under the receiver operating characteristic curves of 0.664, 0.671, and 0.567, respectively. After adjustment for age and gender, the areas under the curves for total, physical, and psychological frailty were 0.704, 0.702, and 0.652, respectively. Analyses using individual components of the TFI show that difficulty in walking and unexplained weight loss predict mortality. Conclusions and Implications: This study has shown the predictive validity of the TFI for mortality in community-dwelling older people. Our study demonstrated that physical and psychological frailty predicted mortality. Of the individual TFI components, difficulty in walking consistently predicted mortality. For identifying frailty, using the integral instrument is recommended because total, physical, psychological, and social frailty and its components have proven their value in predicting adverse outcomes of frailty, for example, increase in health care use and a lower quality of life.

Older adults are a group of interest in healthcare and social care. The percentage of aged adults in population is growing worldwide, with a projected increase to 29% in high-income countries by 2030 (WHO, 2015). Most older adults age in place (WHO, 2015). Many of them receive help from family and professionals. In the Netherlands, where this study was conducted, more than 90% of