173 General discussion Informal caregivers The conceptualization of CRE includes informal caregivers being educated about the medical condition of their loved one, and to give attention to their coping ability, change of role, and grieving process. But above all, the informal caregiver is deployed as a team member who participates in the rehabilitation process. Involvement of informal caregivers in the rehabilitation of older adults leads to better rehabilitation outcomes and return home.10 The primary informal caregivers are often spouses and children, and their caring roles involve providing assistance with daily activities, including physical care, and provision of emotional support.11-13 Involving informal caregivers in the rehabilitation, and training and educating them in various aspects of the disease process such as recovery, interventions, and skills needed to care for their loved ones, has positive effects on the caregivers’ quality of live and ability to cope with burden.13,14 Despite the sufficient evidence for the positive effects of involving informal caregivers in the rehabilitation process, we should not forget they have an emotional bond with the rehabilitant. They are not only a functional partner in the rehabilitation process and the life afterwards, but also an emotional partner of the rehabilitant. So, in order to maintain their role as informal caregiver in the long term, they must also be given space to be this emotional partner to their loved one. Nudging Nudges are subtle changes in the way options are presented, designed to influence decisions in a predictable and healthy way and achieved by relying on wellknown decision-making tendencies.15 The last 15 years nudging is increasingly used in research into behavioral change, for example to stimulate sustainable and healthier food choices, organ donation, and to improve sleep, physical activity and sedentary behavior.16-19 Nudging is still a relatively new concept within geriatric medicine, which is why this theoretical concept was not included at the start of the CREATE study and was not presented as a topic to the participants of the qualitative studies of chapter 3 and 4. Even though nudging was not explicitly mentioned in the studies in this thesis, certain aspects of CRE can be seen as nudging and stimulate rehabilitants to participate more active in their rehabilitation process. The statements in the 7
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