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Svensson NH, Thorlund JB, Olsen PØ, Søndergaard J, Wehberg S, Andersen HS, Caserotti P, Thilsing T. The effect of exercise referral schemes and self-management strategies on use of prescription analgesics among community-dwelling older adults: registry linkage with randomised controlled trials. BMC Geriatr 2024; 24:641. [PMID: 39085817 PMCID: PMC11293001 DOI: 10.1186/s12877-024-05235-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Exercise referral schemes and self-management strategies have shown positive effects on patient-reported and objectively measured outcomes, such as increased functional capacity and physical activity level. However, the impact of these interventions on analgesic use remains uncertain. We hypothesised that exercise referral schemes, either utilised alone or in combination with self-management strategies, is more effective in reducing use of prescription analgesics compared with a self-management strategy only. SUBJECTS AND METHODS We utilised data from two completed randomised controlled trials, namely The Welfare Innovation in Primary Prevention (n = 121) and The SITLESS project (n = 338), and information from the national Danish health registries, including the National Prescription Registry. The two trials have investigated the effectiveness of interventions, which include exercise referral schemes and self-management strategies, on various aspects such as physical function and levels of physical activity among community-dwelling older adults. The studies were conducted in the period 2015-2020 and comprised older adults aged 65+ years, living in three different Danish municipalities. Participants were recruited through nationally regulated preventive home-visits. To estimate changes in use of prescription analgesics over time, a linear fixed effects regression model was applied. The outcome measure was the mean total yearly defined daily dose of analgesics. RESULTS All intervention groups showed a within-group increase in overall analgesic use, though not statistically significantly different from zero. There were no differences in estimated changes in mean total yearly defined daily dose when comparing the intervention groups to the group receiving the least extensive intervention (self-management strategies/control). The findings indicated that exercise referral schemes and self-management strategies, whether administrated individually or in combination, did not result in a reduction in analgesic use over time.
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Affiliation(s)
- Nanna Herning Svensson
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark.
| | - Jonas Bloch Thorlund
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Pia Øllgaard Olsen
- Department of Health, Culture and Development, Municipality of Tønder, Wegners plads 2, Tønder, 6270, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Helene Støttrup Andersen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Paolo Caserotti
- Centre for Active and Healthy Aging, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
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Johansen LW, Lausund H, Jøranson N. Health Professionals' Experiences with Health-Promoting Dialogues for Older Home-Dwellers-A Qualitative Study. Behav Sci (Basel) 2024; 14:464. [PMID: 38920796 PMCID: PMC11200546 DOI: 10.3390/bs14060464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/08/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Home-dwelling older people without healthcare services might develop vulnerability and health-related issues that should be detected proactively by service providers. Health-promoting measures directed towards the target group could facilitate living longer and better at home, as well as delay the need for healthcare services. One approach is through health-promoting dialogues between the municipality and healthcare professionals. This study aims to explore the experiences of healthcare professionals involved in health-promoting dialogues with home-dwellers aged over 75 years without health service decisions in Norway. Data were collected through three focus groups. Thematic analysis was applied to the data resulting in the emergence of one major theme, "challenging dialogues", comprising three sub-themes: "promote the individual's perspectives", "uncovering vulnerability", and "ambiguity of the dialogues". The health-promoting dialogue uses a resource perspective for the elderly to remain independent in old age and can reveal vulnerability and underlying needs. The purpose of the dialogue appears ambiguous for the target group, which leads to unclear service expectations and frequent rejections of the offer. Nevertheless, this health-promoting service has a clear purpose of identifying and meeting the needs of the target group in a broader sense during the ageing process.
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Affiliation(s)
| | | | - Nina Jøranson
- Faculty of Health Sciences, VID Specialized University, 0319 Oslo, Norway; (L.W.J.); (H.L.)
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Xiao F, Cao S, Xiao M, Xie L, Zhao Q. Patterns of home care and community support preferences among older adults with disabilities in China: a latent class analysis. BMC Geriatr 2023; 23:117. [PMID: 36869322 PMCID: PMC9983178 DOI: 10.1186/s12877-023-03830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/16/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Ageing in place is the preferred choice for most older adults worldwide. The role of the family as a core care resource has diminished as a result of changes in family structure, thus extending the responsibility for caring for older adults from within the family to outside it and requiring considerably more support from society. However, there is a shortage of formal and qualified caregivers in many countries, and China has limited social care resources. Therefore, it is important to identify home care patterns and family preferences to provide effective social support and reduce government costs. METHODS Data were obtained from the Chinese Longitudinal Healthy Longevity Study 2018. Latent class analysis models were estimated using Mplus 8.3. Multinomial logistic regression analysis was adopted to explore the influencing factors with the R3STEP method. Lanza's method and the chi-square goodness-of-fit test were used to explore community support preferences among different categories of families of older adults with disabilities. RESULTS Three latent classes were identified based on older adults with disabilities' characteristics (degree of disability, demand satisfaction), caregivers' characteristics (length of providing care, care performance) and living status: Class 1- mild disability and strong care (46.85%); Class 2- severe disability and strong care (43.92%); and Class 3- severe disability and incompetent care (9.24%). Physical performance, geographic region and economic conditions jointly influenced home care patterns (P < 0.05). Home visits from health professionals and health care education were the top two forms of community support that were most preferred by the older adults with disabilities' families (residual > 0). Families in the Class 3 subgroup preferred personal care support more than those in the other two subgroups (P < 0.05). CONCLUSION Home care is heterogeneous across families. Older adults' degrees of disability and care needs may be varied and complex. We classified different families into homogeneous subgroups to reveal differences in home care patterns. The findings can be used by decision-makers in their attempts to design long-term care arrangements for home care and to adjust the distribution of resources for the needs of older adults with disabilities.
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Affiliation(s)
- Feng Xiao
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Songmei Cao
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liling Xie
- Department of Nursing, First Branch of the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Relationship between physical frailty, nutritional risk factors and protein intake in community-dwelling older adults. Clin Nutr ESPEN 2022; 49:449-458. [DOI: 10.1016/j.clnesp.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
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5
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O'Halloran J, Oxholm AS, Pedersen LB, Gyrd-Hansen D. Home sweet home: GPs' response to an increase in the fee size for home visits. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:977-989. [PMID: 33839970 DOI: 10.1007/s10198-021-01302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
In many health care systems GPs receive fees for their services. Policymakers may use the size of these fees to try to incentivise GPs to provide more care. However, evidence is mixed on whether and how GPs respond to an increase in the fee size. This study investigates how GPs respond to an average increase of 150% in the fee for a high-effort and infrequent service such as a home visit due to patients' illness. We consider Danish GPs' provision of these visits to enlisted patients living outside of nursing homes. Using linear regressions with general practice fixed effects and a rich number of control variables, we estimate the association between GPs' provision of these home visits and the fee rise. On average, we find no association between the fee rise and GPs' provision of home visits. However, we find that GPs who previously provided the fewest home visits to eligible patients increase their provision by 13% after the fee rise compared to other GPs. This increase in visits is driven by more patients receiving multiple visits after the fee rise. We conclude that a fee rise may not yield a strong response in GPs' provision of high-effort and infrequent services such as home visits.
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Affiliation(s)
- Jamie O'Halloran
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense, Denmark.
| | - Anne Sophie Oxholm
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense, Denmark
| | - Line Bjørnskov Pedersen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense, Denmark
- Research Unit for General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
| | - Dorte Gyrd-Hansen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense, Denmark
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Kristiansen M, Nedergaard Jensen A, Norredam M, Srivarathan A. Targeting preventive home visits to older adults in disadvantaged communities: Perspectives of professionals. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1051-1060. [PMID: 32794327 DOI: 10.1111/hsc.13139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
This study explored the implementation of multidimensional preventive home visits targeted to older adults living in a disadvantaged community in Denmark. The intervention was adapted to include the following key components: involvement of community members in recruitment processes; a combination of individual and group-based dissemination; adaptation of materials to overcome language barriers; and diversity-sensitivity training for professionals. The study took place over 12 months between August 2016 and August 2017 and used various data sources: registry-based data, participant observations, combined with individual and focus group interviews with the target population (n = 22) and relevant health care professionals (n = 8). Here, we report on findings pertaining to implementation barriers and facilitators as seen from the perspective of professionals. Socioeconomic vulnerability was prominent, and uptake of health care services was low, indicating under-utilisation. Implementation facilitators and barriers were identified including potentials in nurturing local partnerships and proximity during recruitment; overcoming language barriers; offering diversity-sensitivity training for professionals; and a need for a more multidisciplinary, comprehensive scope of preventive visits for diverse older adults in disadvantaged communities. Thus, more focus on participatory, comprehensive and community-based health promotion are needed to ensure healthy ageing in the context of social inequality and ethnic diversity.
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Affiliation(s)
- Maria Kristiansen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Andrea Nedergaard Jensen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Abirami Srivarathan
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
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Older people living at home: experiences of healthy ageing. Prim Health Care Res Dev 2021; 22:e6. [PMID: 33658085 PMCID: PMC8060837 DOI: 10.1017/s1463423621000049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM The purpose of this study was to investigate how old persons perceived their life to be, how they viewed the ageing process and their need of health care and societal support. BACKGROUND The purpose of WHO's Healthy Ageing strategy and development of age-friendly environments is to support physiological and psychosocial changes in old persons by facilitating basic needs. Interventions to operationalize these needs in older people living at home are often developed from a professional perspective and to a small extent involves the perceptions, experience and expectations of the older persons. METHOD This qualitative study has an explorative design using focus group discussions to collect data. In all, 34 persons between 69 and 93 years of age participated in seven group discussions. The interviews were analyzed using inductive manifest content analysis. FINDINGS The main results suggest that most old persons enjoyed life and wished it to continue for as long as possible. Important was to sustain networks and to feel useful. Unexpected changes were described as threats and the need to use health care services was associated with illness and being dependent. The result is presented in three categories with sub-categories: 'Embracing life', 'Dealing with challenges' and 'Considering the future'.
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Vaarst J, Boyle E, Vestergaard S, Hvid LG, Strotmeyer ES, Glynn NW, Caserotti P. Does physical performance and muscle strength predict future personal and nursing care services in community-dwelling older adults aged 75+? Scand J Public Health 2021; 49:441-448. [PMID: 33467973 DOI: 10.1177/1403494820979094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIM The objective of this study was to investigate if grip strength or the short physical performance battery could predict the rate of receiving two different types of home care services: (a) personal care and (b) home nursing care for community-dwelling older adults aged 75+ years. METHODS A secondary data analysis of a prospective cohort study including 323 community-dwelling older adults. Measures of grip strength and the short physical performance battery were incorporated in a nationally regulated preventive home visit programme. Referral to personal and home nursing care were obtained from an administrative database with an average follow-up of 4.1 years. The rate of receiving the individual home care services and the study measures were determined using multivariable Cox proportional hazards models controlling for a priori selected covariates (age, sex, living status, obesity, smoking and prior use of home care). RESULTS The mean age was 81.7 years with 58.8% being women. The rate of receiving personal care differed between the short physical performance battery groups but not between the grip strength groups after adjusting for all covariates with hazard ratios (95% confidence intervals) of 1.90 (1.29-2.81) and 1.41 (0.95-2.08), respectively. The rate of receiving home nursing care differed between both the short physical performance battery and grip strength groups after adjusting for all covariates with hazard ratios of 2.03 (1.41-2.94) and 1.48 (1.01-2.16), respectively. CONCLUSIONS The short physical performance battery was associated with the rate of receiving both personal care and home nursing care. The short physical performance battery can be used to predict home care needs of community-dwelling older adults aged 75+ years.
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Affiliation(s)
- Jonathan Vaarst
- Department of Sports Science and Clinical Biomechanics and the Center for Active and Healthy Ageing, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Sonja Vestergaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Elsa S Strotmeyer
- Department of Epidemiology Pittsburgh, University of Pittsburgh, Pittsburgh, USA
| | - Nancy W Glynn
- Department of Epidemiology Pittsburgh, University of Pittsburgh, Pittsburgh, USA
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics and the Center for Active and Healthy Ageing, University of Southern Denmark, Odense, Denmark
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Fjell A, Cronfalk Seiger B, Hermann M, Rongve A, Aßmus J, Kvinge L, Seiger Å, Skaug K, Boström AM. Factors associated with self-rated health in a Norwegian population of older people participating in a preventive home visit program: a cross-sectional study. BMC Geriatr 2020; 20:323. [PMID: 32887555 PMCID: PMC7650279 DOI: 10.1186/s12877-020-01733-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/24/2020] [Indexed: 11/22/2022] Open
Abstract
Background Assessing self-rated health by preventive home visits of older people can provide information about the person’s well-being, quality of life and risk of developing illness. The aim of this study was to examine associations between self-rated health and factors related to demographics, lifestyle, health conditions and medical diagnoses by older people participating in a preventive home visit program. Methods A cross-sectional study including 233 participants (age 75–79) from three municipalities of Western Norway was conducted. Data were collected through preventive home visits performed by six nurses, using a questionnaire including self-rated health assessment and questions and tests related to demographics (e.g. education and housing), lifestyle (e.g. social activities, alcohol and smoking), health conditions (e.g. sensory impairment, pain and limited by disease) and medical diagnoses. Descriptive and inferential statistics including linear block-wise regression model were applied. Results The block-wise regression model showed that the variables Limited by disease and Pain were negatively associated with self-rated health and Use internet was positively associated. The model had a R2 0.432. The variable that contributed to largest change in the model was Limited by disease (R2 Change; 0.297, p-value< 0.001). Conclusions In the present study, being limited by disease and pain were strongly associated with poor self-rated health, indicating that these are important factors to assess during a preventive home visit. Also, digital competence (Use internet) was associated with a better self-rated health, suggesting that it could be useful to ask, inform and motivate for the use of digital tools that may compensate for or improve social support, social contact and access to health -related information.
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Affiliation(s)
- Astrid Fjell
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden. .,Department of health and caring sciences, Western Norway University of Applied Sciences, Bjørnsonsgate 45, 5528, Haugesund, Norway.
| | - Berit Cronfalk Seiger
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,Department of Nursing Science, Ersta Sköndal Bräcke University College, Huddinge, Sweden
| | - Monica Hermann
- Department of health and caring sciences, Western Norway University of Applied Sciences, Stord, Norway
| | - Arvid Rongve
- Department of Research and Innovation, Helse Fonna, Haugesund Hospital, Haugesund, Norway.,Inst. of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jörg Aßmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Lars Kvinge
- Department of health and caring sciences, Western Norway University of Applied Sciences, Stord, Norway
| | - Åke Seiger
- Department of Neurobiology, Care Sciences and Society, Division of Clinical geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Knut Skaug
- Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,Department of health and caring sciences, Western Norway University of Applied Sciences, Bjørnsonsgate 45, 5528, Haugesund, Norway.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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Rasmussen B, Nielsen CV, Uhrenfeldt L. Being active 1½ years after hip fracture: a qualitative interview study of aged adults' experiences of meaningfulness. BMC Geriatr 2020; 20:263. [PMID: 32727376 PMCID: PMC7391487 DOI: 10.1186/s12877-020-01666-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 07/22/2020] [Indexed: 01/29/2023] Open
Abstract
Background Being active is vital and a source of well-being. However, 18 months after hip fracture (HF), progress seems to have come to a halt. Aged adults may feel vulnerable, experiencing ongoing dependency and limited possibilities for socializing. How they experience the meaningfulness of being active during these circumstances is unknown. The aim of this study was to explore experiences of the meaningfulness of being active for aged adults 18 months after HF. Methods A phenomenological-hermeneutic methodology based on the philosophies of Heidegger and Gadamer was applied. Data were collected using individual interviews conducted in participants’ homes. The study was part of a longitudinal study, and three former interviews helped build trusting relationships with participants and focus the semi-structured interview guide. An existential theory of well-being and suffering considering health to be a balancing of mobility and dwelling was applied. Participants were nine aged adults 65 years or older with pre-fracture dependency included in the study 18 months earlier while still in hospital after HF. The interpretation was a process of analyzing data by moving between the parts and the whole as a means of gaining a deeper understanding and continuously testing pre-understandings. The analysis followed five steps: a) getting a sense of the whole b) delineating and condensing meaning units, c) interpreting meaning units, d) relating to study purpose, and e) developing themes and sub-themes. Results Two main themes emerged. The main-theme “Feeling the continuity of life “had four sub-themes: “Gratitude for present possibilities, ““Connected with earlier life-experience, ““Thoughtfully managing vulnerability, “and “Belonging with other people. “The main-theme “Feeling vulnerable “had two sub-themes: “Thwarted “and “Sad and regretting lost continuity in life.“. Conclusions Eighteen months after HF, aged adults seem to be struggling on their own to be active in meaningful ways. To maintain hope, relieve the strain in everyday life, and maintain a sense of safety and self-confidence, they may need help. However, to avoid suffering, there is a need to balance additional training and a struggle for progress with well-being experiences in terms of feeling gratitude, restoring a sense of normality, and feeling kinship with other people.
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Affiliation(s)
- Birgit Rasmussen
- Department of Physio and Occupational Therapy, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Bartholinsallé 2, 8000, Aarhus C, Denmark.,DEFACTUM, Aarhus, Central Denmark Region, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - Lisbeth Uhrenfeldt
- Faculty of Nursing and Health Science, Nord University, Universitetsalléen 11, 8049, Bodø, Norway
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Smith T, Fowler Davis S, Nancarrow S, Ariss S, Enderby P. Towards a theoretical framework for Integrated Team Leadership (IgTL). J Interprof Care 2019; 34:726-736. [PMID: 31750746 DOI: 10.1080/13561820.2019.1676209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study presents a framework for the leadership of integrated, interprofessional health, and social-care teams (IgTs) based on a previous literature review and a qualitative study. The theoretical framework for Integrated Team Leadership (IgTL) is based on contributions from 15 professional and nonprofessional staff, in 8 community teams in the United Kingdom. Participants shared their perceptions of IgT's good practice in relation to patient outcomes. There were two clear elements, Person-focused and Task-focused leadership behaviors with particular emphasis on the facilitation of shared professional practices. Person-focused leadership skills include: inspiring and motivating; walking the talk; change and innovation; consideration; empowerment, teambuilding and team maintenance; and emotional intelligence. Task-focused leadership behaviors included: setting team direction; managing performance; and managing external relationships. Team members felt that the IgTL should be: a Health or Social Care (HSC) professional; engaged in professional practice; and have worked in an IgT before leading one. Technical and cultural issues were identified that differentiate IgTL from usual leadership practice; in particular the ability to facilitate or create barriers to effective integrated teamworking within the organizational context. In common with other OECD countries, there are policy imperatives in England for further integration of health and social care, needed to improve the quality and effectiveness of care for older people with multiple conditions. Further attention is needed to support the development of effective IgTs and leadership will be a pre-requisite to achieve this vision. The research advances the understanding of the need for skilled interprofessional leadership practice.
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Affiliation(s)
- Tony Smith
- Centre for Leadership in Health and Social Care, Sheffield Hallam University, Sheffield, UK
| | - Sally Fowler Davis
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Susan Nancarrow
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Steven Ariss
- School of Health and Related Research, University of Sheffield Regent Court, Sheffield, UK
| | - Pam Enderby
- School of Health and Related Research, University of Sheffield Regent Court, Sheffield, UK
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Linderholm M, Törnvall E, Yngman-Uhlin P, Hjelm K. Self-rated health, lifestyle habits and risk assessment in 75-year-old persons attending preventive clinic visits with a nurse in primary health care: a cross-sectional study. Prim Health Care Res Dev 2019; 20:e88. [PMID: 32799984 PMCID: PMC6609977 DOI: 10.1017/s1463423619000136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/29/2018] [Accepted: 02/25/2019] [Indexed: 11/05/2022] Open
Abstract
AIM To describe self-rated health in relation to lifestyle and illnesses and to identify risk factors for ill health such as pressure ulcers, falls and malnutrition among 75-year-old participants in a new clinical routine involving health assessment followed by tailored one-to-one health promotion at preventive clinic visits to a nurse at primary health care centres (PHCC). BACKGROUND There is a rapidly growing ageing population worldwide. It is central to health policy to promote active and healthy ageing. Preventive clinic visits to a nurse in primary health care were introduced as a new clinical intervention in a region in Sweden to improve the quality of health for the older adults. DESIGN A quantitative cross-sectional population-based study. METHODS The sample consisted of 306 individuals in six primary health care centres in Sweden aged 75 years who attended preventive clinic visits to a nurse. Data were collected from March 2014 to May 2015 during structured conversations with a nurse based on self-administered questionnaires, clinical examinations, risk assessments and after the clinic visit existing register data were collected by the researcher. FINDINGS Participants experienced good self-rated health despite being overweight and having chronic illnesses. Daily exercise such as walking and housework was more common than aerobic physical training. The majority had no problems with mobility but reported anxiety, pain and discomfort and had increased risk of falls. CONCLUSION It is important to encourage the older adults to live actively and independently for as long as possible. The healthy older adults may benefit from the clinical intervention described here to support the individual's ability to maintain control over their health. Such supportive assessments might help the healthy older adult to achieve active ageing, reducing morbidity and preventing functional decline.
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Affiliation(s)
- Märit Linderholm
- Primary Health Care Centre Valdemarsvik, Region of Östergötland, Valdemarsvik, Sweden
- Doctoral student, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Eva Törnvall
- Management Department, Region of Östergötland, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Pia Yngman-Uhlin
- The Research and Development Unit, Region of Östergötland, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Katarina Hjelm
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
- Departement of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Tøien M, Bjørk IT, Fagerström L. An exploration of factors associated with older persons' perceptions of the benefits of and satisfaction with a preventive home visit service. Scand J Caring Sci 2017; 32:1093-1107. [PMID: 29250819 DOI: 10.1111/scs.12555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 11/29/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preventive home visits (PHVs) are healthcare services aimed at promoting the health of home-dwelling older people and to support their abilities to live independently. To enhance effectiveness, studies that explore older persons' experiences of PHVs are needed. OBJECTIVE To assess older persons' perceived benefits and opinions of a PHV service and explore associations between perceived benefits from PHV and relevant sociodemographic/health-related factors. THEORY The study was based on a comprehensive understanding of health, as including objective health/disease, subjective health/well-being and coping ability. METHODS A cross-sectional survey was administered during spring 2013 in a Norwegian municipality where nurses had offered annual PHVs to residents aged 75 years and older since 1999. We invited a stratified random sample of 393 PHV users to participate; of these, 161 volunteered. The main outcome variables in the questionnaire were perceived benefits from PHV. Logistic regression models were used to analyse the associations between each benefit and sociodemographic/health-related background variables. RESULTS Approximately 39% of the respondents reported that PHVs added to their feelings of safety; 66% reported support for ability to live at home; 72% reported support for having a good life, 83% were satisfied with the service, and 90% stated that PHVs are important for older people. Each benefit was associated with different sociodemographic/health-related factors. Support for feelings of safety increased with age. More support for living at home was associated with poor physical health and not living alone. Those without children perceived more support for a good life. Satisfaction with PHV increased with increasing scores on the Life Orientation Scale. Persons with poor mental health and those not living alone more often perceived PHV as important. CONCLUSIONS Annual, comprehensive PHVs to a general older population may support older persons' health and independence. Low response rate restricts the possibility to generalise the results.
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Affiliation(s)
- Mette Tøien
- Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway.,Department of Nursing Science, University of Oslo, Oslo, Norway
| | | | - Lisbeth Fagerström
- Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway.,Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
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Nursing care needs and services utilised by home-dwelling elderly with complex health problems: observational study. BMC Health Serv Res 2017; 17:645. [PMID: 28899369 PMCID: PMC5596938 DOI: 10.1186/s12913-017-2600-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 09/06/2017] [Indexed: 11/20/2022] Open
Abstract
Background In Norway, as in many Western countries, a shift from institutional care to home care is taking place. Our knowledge is limited regarding which needs for nursing interventions patients being cared for in their home have, and how they are met. We aimed at assessing aspects of health and function in a representative sample of the most vulnerable home-dwelling elderly, to identify their needs for nursing interventions and how these needs were met. Methods In this observational study we included patients aged 75+ living in their own homes in Oslo, who received daily home care, had three or more chronic diagnoses, received daily medication, and had been hospitalized during the last year. Focused attention and cognitive processing speed were assessed with the Trail Making Test A (TMT-A), handgrip strength was used as a measure of sarcopenia, mobility was assessed with the “Timed Up-and-Go” test, and independence in primary activities of daily living by the Barthel Index. Diagnoses and medication were collected from electronic medical records. For each diagnosis, medication and functional impairment, a consensus group defined which nursing service that the particular condition necessitated. We then assessed whether these needs were fulfilled for each participant. Results Of 150 eligible patients, 83 were included (mean age 87 years, 25% men). They had on average 6 diagnoses and used 9 daily medications. Of the 83 patients, 61 (75%) had grip strength indicating sarcopenia, 27 (33%) impaired mobility, and 69 (83%) an impaired TMT-A score. Median amount of home nursing per week was 3.6 h (interquartile range 2.6 to 23.4). Fulfilment of pre-specified needs was >60% for skin and wound care in patients with skin diseases, observation of blood glucose in patients taking antidiabetic drugs, and in supporting food intake in patients with eating difficulties. Most other needs as defined by the consensus group were fulfilled in <10% of the patients. Conclusions We identified a very frail group of home-dwelling patients. For this group, resources for home nursing should probably be used in a more flexible and pro-active way to aim for preserving functional status, minimize symptom burden, and prevent avoidable hospitalisations.
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Health team for the elderly: a feasibility study for preventive home visits. Prim Health Care Res Dev 2017; 18:242-252. [DOI: 10.1017/s1463423617000019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim was to describe the development, utilization and feasibility of a model of preventive home visits, in an urban and a rural municipality in Norway.
Background
Older people >65 years will rise significantly in coming years. Increased age is associated with risk of disability, illness and need for public health services. Preventive home visits is assumed to help older people to maintain their functional level longer, delaying disease and thus delaying the need for health care.
Method
Descriptive explorative design describing the development, utilization and feasibility of preventive home visits in two different settings. All 77-year-old persons living at home in an urban municipality and all 75 years and older in a rural municipality were invited to participate. A questionnaire including a substantial number of tests concerning; fall, nutrition, polypharmacy and cognitive impairment was used by Health Team Nurses as base for a risk assessment. Pilot studies were conducted to validate the questionnaire including an inter-rater reliability study of the risk assessment tool. A multiprofessional team, Health Team for the Elderly met each week to evaluate risk assessments and make recommendations to be sent to each respective general practitioner. Data were analysed using descriptive and inferential statistics. In total, 167 persons (109 from the urban municipality and 58 from the rural municipality) participated, corresponding to 60% of the approached individuals. The mean time for the visits was 108 minutes (SD 20). Missing data were identified for; Do you feel safe in your municipality (17.5%) and Are you looking forward to ageing (11.4%). In total, 36 persons (21.7%) were identified with increased risk for developing illness. We suggest that a structured model of preventive home visits and collaboration between highly specialized health care professionals are important factors for reliable health promoting risk assessments of elderly home dwellers.
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Kendall JC, Boyle E, Hartvigsen J, Hvid LG, Azari MF, Skjødt M, Caserotti P. Neck pain, concerns of falling and physical performance in community-dwelling Danish citizens over 75 years of age: A cross-sectional study. Scand J Public Health 2016; 44:695-701. [DOI: 10.1177/1403494816666414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: The aim of this study was to determine the associations between neck pain, concerns of falling and physical performance in older people. Methods: Cross-sectional study of 423 community-dwelling Danes aged 75 years and older. Measures consisted of self-reported neck pain, physical performance (Short Physical Performance Battery), self-reported psychological concerns related to falling (Falls Efficacy Scale International), depression (Major Depression Inventory), cognitive function (Mini Mental State Examination), self-reported low-back pain and self-reported history of falls. Associations between neck pain and fear of falling were determined using multivariable logistic regression modelling. Results: Bothersome neck pain that limits daily activities is significantly associated with concerns of falling (unadjusted odds ratio (OR) 3.29, 95% confidence interval (CI) 1.54–7.03) and impaired physical performance (unadjusted OR 2.26, 95% CI 1.09–4.69). However, these relationships became nonsignificant after adjusting for potential confounders. Bothersome neck pain and concerns of falling is attenuated by depression, and the relationship between bothersome neck pain and decreased physical performance is attenuated by concerns of falling, depression and previous history of falls. Conclusions: Bothersome neck pain in older people is associated with increased concerns of falling and decreased physical performance that are two known risk factors for falls in older people. However, these relationships are complicated by other variables, particularly depression.
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Affiliation(s)
- Julie C. Kendall
- Discipline of Chiropractic, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Lars G. Hvid
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Michael F. Azari
- Discipline of Chiropractic, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Mathias Skjødt
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- National Institutes of Health, National Institute on Aging, Bethesda, USA
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17
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Verhülsdonk S, Supprian T, Höft B. [Geriatric psychiatric home counseling for people with dementia and anosognosia : Results of a model project]. Z Gerontol Geriatr 2016; 50:219-225. [PMID: 26779708 DOI: 10.1007/s00391-015-1018-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/30/2015] [Accepted: 12/22/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lack of awareness of an illness (anosognosia) is a common symptom in dementia and has a significant impact on the course of the disease. It is associated with dysfunctional interaction with caregivers. Due to unawareness patients are not able to accept diagnostic procedures or medical treatment and refuse any kind of support. Thus, they are not integrated into psychosocial networks and medical support. This has a significant impact on patient-centered care in a domestic environment. In this article a model project with home visits to patients with dementia and anosognosia is described. METHOD A total of 55 home visits were carried out. The aim of this project was the integration into the existing healthcare services in order to safeguard the domestic environment. These visits focused on advice and information for the patients and their caregivers initiating the visits. Sociodemographic data of the patient cohort and the satisfaction of the caregiving relatives and general practitioners are presented. RESULTS Subjects with dementia were found to be in advanced stages of the disease, caring situations were complex and required assistance. Caregivers showed a substantial burden in accordance with previous reports. CONCLUSION New strategies are required to cope with anosognosia in patients with dementia and their caregivers. Even single home visits seem to be sufficient to initiate support for subjects with dementia and their relatives.
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Affiliation(s)
- Sandra Verhülsdonk
- Institutsambulanz Gerontopsychiatrie, LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Mooren Str. 5, Gebäude 14.99, 40225, Düsseldorf, Deutschland.
| | - T Supprian
- Institutsambulanz Gerontopsychiatrie, LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Mooren Str. 5, Gebäude 14.99, 40225, Düsseldorf, Deutschland
| | - B Höft
- Institutsambulanz Gerontopsychiatrie, LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Mooren Str. 5, Gebäude 14.99, 40225, Düsseldorf, Deutschland
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District nurses' experiences of preventive home visits to 75-year-olds in Stockholm: a qualitative study. Prim Health Care Res Dev 2015; 17:464-78. [PMID: 26621195 DOI: 10.1017/s1463423615000560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
UNLABELLED Aims This study had two aims: to describe the dialogue between district nurses (DNs) and older people in preventive home visits (PHVs) from the perspective of the DNs, and to identify barriers to and facilitators of this dialogue as perceived by the DNs. BACKGROUND The number of older people is rapidly increasing in all western countries, and as people's age increases, the probability that they will have multiple diseases also increases. Planned actions are therefore needed to promote health and prevent diseases among older people so they can remain in good health and live in their homes for as long as possible. In Sweden, PHVs to 75-year-olds by DNs are one such action. METHODS This qualitative study included five group interviews with 20 DNs. Data were analysed with qualitative content analysis. Findings DNs' experiences of barriers to and facilitators of a successful health dialogue were sorted into five domains. Together, these domains provided a systematic description of the interaction between the DN and the older person in the PHV. The domains included: establishing trustful contact, conducting a structured interview, making an overall assessment, proposing health-promoting activities and offering follow-up. The barriers and facilitators could be related to the older person, the DN or the home environment. The latent content of the interviews was evident in three themes that were related to the DNs' experiences of barriers and facilitators. These themes illustrated professional dilemmas that the DNs had to resolve to achieve the purpose of the PHV. The study demonstrates that the interaction between a DN and an older person in a PHV can be described as a complex social process in which the DN balances a personal and professional approach, combines a person-oriented and a task-oriented approach and employs both a salutogenic and pathogenic perspective.
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19
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Tøien M, Bjørk IT, Fagerström L. Older users' perspectives on the benefits of preventive home visits. QUALITATIVE HEALTH RESEARCH 2015; 25:700-712. [PMID: 25281240 DOI: 10.1177/1049732314553595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this article we explore older people's perspectives on the benefits of preventive home visits (PHVs), after long-term follow-up. PHVs are health services intended to promote older people's health and independence, prevent disease, and postpone functional decline. We applied an explorative and descriptive design and analyzed qualitative research interviews of 10 PHV users who had received multiple visits for at least 6 years. We sought manifest and latent content in our analysis. The participants reported benefits falling within four main categories: to feel safe, to manage everyday life, to live well, and to be somebody. Two latent themes emerged: living with an underlying, realistic concern about an uncertain future, and striving to maintain oneself as a person. The perceived benefits of PHVs differed significantly from the outcome measures commonly used in randomized, controlled trials. PHV interventions should have a longitudinal approach and support each person's current needs and valued goals.
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Affiliation(s)
- Mette Tøien
- Buskerud and Vestfold University College, Drammen, Norway
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20
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Stijnen MMN, Jansen MWJ, Duimel-Peeters IGP, Vrijhoef HJM. Nurse-led home visitation programme to improve health-related quality of life and reduce disability among potentially frail community-dwelling older people in general practice: a theory-based process evaluation. BMC FAMILY PRACTICE 2014; 15:173. [PMID: 25344322 PMCID: PMC4213477 DOI: 10.1186/s12875-014-0173-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 10/06/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Population ageing fosters new models of care delivery for older people that are increasingly integrated into existing care systems. In the Netherlands, a primary-care based preventive home visitation programme has been developed for potentially frail community-dwelling older people (aged ≥75 years), consisting of a comprehensive geriatric assessment during a home visit by a practice nurse followed by targeted interdisciplinary care and follow-up over time. A theory-based process evaluation was designed to examine (1) the extent to which the home visitation programme was implemented as planned and (2) the extent to which general practices successfully redesigned their care delivery. METHODS Using a mixed-methods approach, the focus was on fidelity (quality of implementation), dose delivered (completeness), dose received (exposure and satisfaction), reach (participation rate), recruitment, and context. Twenty-four general practices participated, of which 13 implemented the home visitation programme and 11 delivered usual care to older people. Data collection consisted of semi-structured interviews with practice nurses (PNs), general practitioners (GPs), and older people; feedback meetings with PNs; structured registration forms filled-out by PNs; and narrative descriptions of the recruitment procedures and registration of inclusion and drop-outs by members of the research team. RESULTS Fidelity of implementation was acceptable, but time constraints and inadequate reach (i.e., the relatively healthy older people participated) negatively influenced complete delivery of protocol elements, such as interdisciplinary cooperation and follow-up of older people over time. The home visitation programme was judged positively by PNs, GPs, and older people. Useful tools were offered to general practices for organising proactive geriatric care. CONCLUSIONS The home visitation programme did not have major shortcomings in itself, but the delivery offered room for improvement. General practices received useful tools to redesign their care delivery from reactive towards proactive care, but perceived barriers require attention to allow for sustainability of the home visitation programme over time.
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Affiliation(s)
- Mandy M N Stijnen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Maria W J Jansen
- Public Health Service South-Limburg, P.O. Box 2022, 6160, HA, Geleen, The Netherlands. .,Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Inge G P Duimel-Peeters
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands. .,Department of Patient and Care, Maastricht University Medical Centre, P.O. Box 5800, 6202, MD, Maastricht, The Netherlands.
| | - Hubertus J M Vrijhoef
- Tilburg School of Social and Behavioral Sciences, Scientific Centre for Care and Welfare (TRANZO), Tilburg University, P.O. Box 90153, 5000, LE, Tilburg, The Netherlands. .,Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore, 117597, Republic of Singapore.
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21
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Lagerin A, Carlsson AC, Nilsson G, Westman J, Törnkvist L. District nurses’ preventive home visits to 75-year-olds: An opportunity to identify factors related to unsafe medication management. Scand J Public Health 2014; 42:786-94. [DOI: 10.1177/1403494814550680] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aims: To investigate factors related to unsafe medication management among 75-year-olds during preventive home visits, and to describe the interventions district nurses used. Methods: An explorative study. During a 9- to 12-month period, 36 DNs used the Safe Medication Assessment (SMA) tool during preventive home visits to 75-year-olds who used at least one drug ( n=113). Results: One or more factors related to unsafe medication management were identified in 84% of the 75-year-olds. More than 40% used five or more drugs, and 34.5% reported symptoms potentially indicative of adverse effects of their drugs. Nearly 30% had prescribers from more than two medical units, and 7.1% of the older persons were appraised as having reduced cognitive ability. DNs intervened in more than two-thirds of the cases and used a variety of nursing care interventions to improve the safety of medication management. Conclusions: Preventive home visits seem to provide a unique opportunity to promote safe medication management. Several factors related to unsafe medication management were identified, and several different nursing care interventions were carried out to ensure safe medication management. Use of the SMA tool in preventive home visits seems to be advantageous in improving the safety of medication management among older persons.
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Affiliation(s)
- Annica Lagerin
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Axel C. Carlsson
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Public Health and Caring Sciences/Section of Geriatrics, Uppsala University, Uppsala, Sweden
| | - Gunnar Nilsson
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Jeanette Westman
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Lena Törnkvist
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Stijnen MMN, Van Hoof MS, Wijnands-Hoekstra IYM, Guldemond-Hecker Y, Duimel-Peeters IGP, Vrijhoef HJM, Jansen MWJ. Detected health and well-being problems following comprehensive geriatric assessment during a home visit among community-dwelling older people: who benefits most? Fam Pract 2014; 31:333-40. [PMID: 24736294 DOI: 10.1093/fampra/cmu015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Preventive home visits including comprehensive geriatric assessment for potentially frail older people are increasingly implemented in general practice. It remains unclear how to select older people who benefit most from it. OBJECTIVES To determine which community-dwelling older people benefit most from a comprehensive geriatric assessment by a practice nurse during a home visit in terms of detected problems. METHODS A cross-sectional study in 45 general practices in the Netherlands. Practice nurses visited 562 randomly selected older people (aged ≥ 75 years) and 1180 purposefully selected based on the following criteria: last visit to general practice >6 months ago; partner or child(ren) deceased within past 12 months; cognitive or psychosocial functioning unknown to GP; ≥2 chronic conditions; uses ≥5 medications and/or living alone. RESULTS Mean age of older people was 82.50 years, 65.50% was female. More problems were detected among women, higher age groups, those living alone and the less educated (all P < 0.001). Overall, more problems were detected in purposefully selected older people than in randomly selected older people (P < 0.001). Selection of older people with ≥2 chronic conditions and those using ≥5 medications resulted in more detected problems in general (both P < 0.05). CONCLUSION Although the findings are in favour of purposeful selection, observed differences in detected problems between the two selection procedures are relatively small. GPs should at least target older people with ≥2 chronic conditions, using ≥5 medications, being female, of an older age, living alone and the less educated.
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Affiliation(s)
- Mandy M N Stijnen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands,
| | - Maud S Van Hoof
- Primary Healthcare Organisation region 'Maastricht-Heuvelland' (ZIO), Maastricht, The Netherlands
| | | | - Yvonne Guldemond-Hecker
- Primary Healthcare Organisation region 'Oostelijk Zuid-Limburg/Parkstad' (HOZL), Heerlen, The Netherlands
| | - Inge G P Duimel-Peeters
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands, Department of Patient and Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hubertus J M Vrijhoef
- Tilburg School of Social and Behavioral Sciences, Scientific Centre for Care and Welfare (TRANZO), Tilburg University, Tilburg, The Netherlands, Saw Swee Hock School for Public Health, National University of Singapore, Singapore, Republic of Singapore
| | - Maria W J Jansen
- Academic Collaborative Centre for Public Health Limburg, Public Health Service Southern Limburg, Geleen, The Netherlands and Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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How do older persons understand the purpose and relevance of preventive home visits? A study of experiences after a first visit. Nurs Res Pract 2014; 2014:640583. [PMID: 24734175 PMCID: PMC3964832 DOI: 10.1155/2014/640583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to explore and describe older persons' experiences of their first Preventive Home Visit. Preventive Home Visits (PHV) are health services that aim to promote older persons' health, prevent functional decline, and reduce the need for comprehensive healthcare. The knowledge base to guide the design of effective PHV interventions is scarce. Studies that explore older persons' experiences of the first visit are essential, as compliance with the service is a prerequisite for positive outcomes. An explorative and descriptive design was applied. Qualitative research interviews with ten older persons who had received the first PHV the previous year were analysed with regard to manifest and latent content. The findings revealed that the understanding of the purpose of PHV varied. For some participants, the concepts and aims of health promotion and disease prevention were difficult to comprehend. The possibility to prepare for the visit was sought. All participants appreciated the service; the dialogue quality was good and a trusted municipal contact person provided security. To enhance compliance and ensure effective PHV, the invitation to the PHV service should include clearly stated aims and specific information about the first visit. An individualised, person-centred approach should be applied.
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Abstract
The ageing of European populations presents health, long-term care, and welfare systems with new challenges. Although reports of ageing as a fundamental threat to the welfare state seem exaggerated, societies have to embrace various policy options to improve the robustness of health, long-term care, and welfare systems in Europe and to help people to stay healthy and active in old age. These policy options include prevention and health promotion, better self-care, increased coordination of care, improved management of hospital admissions and discharges, improved systems of long-term care, and new work and pension arrangements. Ageing of the health workforce is another challenge, and policies will need to be pursued that meet the particular needs of older workers (ie, those aged 50 years or older) while recruiting young practitioners.
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Affiliation(s)
- Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK.
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25
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Stijnen MMN, Duimel-Peeters IGP, Jansen MWJ, Vrijhoef HJM. Early detection of health problems in potentially frail community-dwelling older people by general practices--project [G]OLD: design of a longitudinal, quasi-experimental study. BMC Geriatr 2013; 13:7. [PMID: 23331486 PMCID: PMC3570480 DOI: 10.1186/1471-2318-13-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 12/12/2012] [Indexed: 12/04/2022] Open
Abstract
Background Due to the ageing of the population, the number of frail older people who suffer from multiple, complex health complaints increases and this ultimately threatens their ability to function independently. Many interventions for frail older people attempt to prevent or delay functional decline, but they show contradicting results. Recent studies emphasise the importance of embedding these interventions into existing primary care systems and tailoring care to older people’s needs and wishes. This article presents the design of an evaluation study, aiming to investigate the effects and feasibility of the early detection of health problems among community-dwelling older people and their subsequent referral to appropriate care and/or well-being facilities by general practices. Methods/Design A longitudinal, quasi-experimental study is designed comparing 13 intervention practices with 11 control practices. General practices select eligible community-dwelling older people (≥ 75 years). Practice nurses from intervention practices (1) visit older people at home for a comprehensive assessment of their health and well-being; (2) discuss results with the GP; (3) formulate – if required – a care and treatment plan together with the patient; (4) refer patient to care and/or well-being facilities; and (5) monitor and coordinate care and follow-up. Control practices provide usual care and match the intervention practices on the presence of different primary care professionals within the practice. Primary outcome measures are health-related quality of life and disability. Additionally, attitude towards ageing, care satisfaction, health care utilisation, nursing home admission and mortality are measured. Some outcomes are assessed by means of a postal questionnaire (at baseline and after 6, 12, and 18 months follow-up), others through continuous registration over the 18-month period. A profound process evaluation will provide insight into barriers and facilitators for implementing the intervention protocol within general practices from both the patient and caregiver perspective. Discussion The proposed approach requires redesigning care delivery within general practices for accomplishing appropriate care for older people. A quasi-experimental design is chosen to closely resemble a real-life situation, which is desirable for future implementation after this innovation proves to be successful. Results of the effect and process evaluation will become available in 2013. Trial registration The Netherlands National Trial Register NTR2737
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Affiliation(s)
- Mandy M N Stijnen
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Sherman H, Forsberg C, Karp A, Törnkvist L. The 75-year-old persons' self-reported health conditions: a knowledge base in the field of preventive home visits. J Clin Nurs 2012; 21:3170-82. [DOI: 10.1111/j.1365-2702.2012.04314.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Helena Sherman
- Centre for Family Medicine (CeFAM), Karolinska Institutet; Huddinge; Sweden
| | - Christina Forsberg
- Division of Nursing, Department of Neurobiology, Care Science and Society (NVS); Karolinska Institutet; Huddinge; Sweden
| | - Anita Karp
- Aging Research Centre (ARC); Stockholm; Sweden
| | - Lena Törnkvist
- Centre for Family Medicine (CeFAM), Karolinska Institutet; Huddinge; Sweden
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van Kempen JAL, Robben SHM, Zuidema SU, Olde Rikkert MGM, Melis RJF, Schers HJ. Home visits for frail older people: a qualitative study on the needs and preferences of frail older people and their informal caregivers. Br J Gen Pract 2012; 62:e554-60. [PMID: 22867679 PMCID: PMC3404333 DOI: 10.3399/bjgp12x653606] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 01/08/2012] [Accepted: 03/08/2012] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND A number of studies have examined the effects of home visits and showed inconsistent results on physical functioning, institutionalisation, and mortality. Despite continuing interest from professionals in home visits for older people, reports on older people's needs and preferences for such visits are scarce. AIM This qualitative study aims to explore the views and needs of community-dwelling frail older people concerning home visits. DESIGN AND SETTING A qualitative study including interviews with frail older persons and their informal caregivers living in the area of Nijmegen, the Netherlands. METHOD Semi-structured interviews were conducted with frail older people and informal caregivers. A grounded theory approach was used for data-analysis. RESULTS Eleven frail older people and 11 informal caregivers were included. Most participants emphasised the importance of home visits for frail older people. They felt that it would give older people the personal attention they used to receive from GPs but miss nowadays. Most stated that this would give them more trust in GPs. Participants stated that trust is one of the most important factors in a good patient-professional relationship. Further, participants preferred home visits to focus on the psychosocial context of the patient. They stated that more knowledge of the psychosocial context and a good patient-professional relationship would enable the professional to provide better and more patient-centred care. CONCLUSION Patients' expectations of home visits are quite different from the actual purpose of home visiting programmes; that is, care and wellbeing versus cure and prevention. This difference may partly explain why the effectiveness of home visits remains controversial. Future studies on home visits should involve patients in the development of home visiting programmes.
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Affiliation(s)
- Janneke A L van Kempen
- Department of geriatric medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
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Yamada Y, Ekmann A, Nilsson CJ, Vass M, Avlund K. Are acceptance rates of a national preventive home visit programme for older people socially imbalanced?: a cross sectional study in Denmark. BMC Public Health 2012; 12:396. [PMID: 22656647 PMCID: PMC3403897 DOI: 10.1186/1471-2458-12-396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 06/01/2012] [Indexed: 11/28/2022] Open
Abstract
Background Preventive home visits are offered to community dwelling older people in Denmark aimed at maintaining their functional ability for as long as possible, but only two thirds of older people accept the offer from the municipalities. The purpose of this study is to investigate 1) whether socioeconomic status was associated with acceptance of preventive home visits among older people and 2) whether municipality invitational procedures for the preventive home visits modified the association. Methods The study population included 1,023 community dwelling 80-year-old individuals from the Danish intervention study on preventive home visits. Information on preventive home visit acceptance rates was obtained from questionnaires. Socioeconomic status was measured by financial assets obtained from national registry data, and invitational procedures were identified through the municipalities. Logistic regression analyses were used, adjusted by gender. Results Older persons with high financial assets accepted preventive home visits more frequently than persons with low assets (adjusted OR = 1.5 (CI95%: 1.1-2.0)). However, the association was attenuated when adjusted by the invitational procedures. The odds ratio for accepting preventive home visits was larger among persons with low financial assets invited by a letter with a proposed date than among persons with high financial assets invited by other procedures, though these estimates had wide confidence intervals. Conclusion High socioeconomic status was associated with a higher acceptance rate of preventive home visits, but the association was attenuated by invitational procedures. The results indicate that the social inequality in acceptance of publicly offered preventive services might decrease if municipalities adopt more proactive invitational procedures.
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Affiliation(s)
- Yukari Yamada
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Niemelä K, Leinonen R, Laukkanen P. A supportive home visit program for older adults implemented by non-professionals: Feasibility and effects on physical performance and quality of life at one year – A pilot study. Arch Gerontol Geriatr 2012; 54:e376-82. [DOI: 10.1016/j.archger.2011.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 10/04/2011] [Accepted: 10/07/2011] [Indexed: 12/17/2022]
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Voraussetzungen für ein neues Versorgungsmodell für ältere Menschen mit Multimorbidität. Z Gerontol Geriatr 2011; 44 Suppl 2:101-12. [DOI: 10.1007/s00391-011-0246-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kono A, Kanaya Y, Fujita T, Tsumura C, Kondo T, Kushiyama K, Rubenstein LZ. Effects of a Preventive Home Visit Program in Ambulatory Frail Older People: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2011; 67:302-9. [DOI: 10.1093/gerona/glr176] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Muller CA, Klaassen-Mielke R, Penner E, Junius-Walker U, Hummers-Pradier E, Theile G. Disclosure of new health problems and intervention planning using a geriatric assessment in a primary care setting. Croat Med J 2010; 51:493-500. [PMID: 21162161 PMCID: PMC3012401 DOI: 10.3325/cmj.2010.51.493] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 10/13/2010] [Indexed: 11/05/2022] Open
Abstract
AIM To determine the prevalence of health problems uncovered by a Standardized Assessment for Elderly Patients in a Primary Care Setting (STEP), to explore how often STEP uncovered conditions new to general practitioners (GP) and ascertain how often STEP results led GPs to plan further interventions. METHODS This descriptive, interim analysis was based on the data of 189 elderly patients (median age, 78 years; interquartile range [IQ], 74-81) and their 20 GPs collected in Hannover region, Germany, between June 2008 and April 2009. Study nurses in the practice setting applied the 44-item STEP instrument, based mainly on self-reporting, as well as a standardized patient interview. Subsequently, GPs indicated whether the problems were new to them, and whether they planned further action or health interventions on the basis of the problems identified by STEP. RESULTS A median of 11 health problems (IQ, 8-14) were uncovered per patient, of which a median of 2 (IQ, 1-4) were new to the GP and interventions were planned for a median of 2 problems (IQ, 0-4). Many of the identified health problems are typical of old age. The following health problems uncovered by STEP were often new to the GPs (percentages differ to numbers due to missing GP ratings): cognitive impairment (33 of 64 affected by this problem, 73%), missing or unknown immunization status (84 of 160, 55%), and recent chest pain (19 of 37, 53%). Alcohol misuse was new in all 4 affected patients (100%) and recent falls were new in 5 of 7 patients (83%). Interventions for affected patients were frequently planned for problems of immunization (for 83 patients of 160 reporting the problem, 57%), current anxiety (4 of 9, 50%), and chest pain (14 of 37, 44%). Moreover, further management was frequently planned for depression (10 of 29, 39%) and cognitive impairment (16 of 64, 38%). CONCLUSION Using a geriatric assessment in primary care discloses relevant heath problems and treatment needs that GPs may otherwise overlook.
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Affiliation(s)
- Christiane Annette Muller
- Christiane Muller, Institute of General Practice, Hannover Medical School, Carl-Neuberg Str.1, 30625 Hannover, Germany.
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Ekmann A, Vass M, Avlund K. Preventive home visits to older home-dwelling people in Denmark: are invitational procedures of importance? HEALTH & SOCIAL CARE IN THE COMMUNITY 2010; 18:563-571. [PMID: 20637042 DOI: 10.1111/j.1365-2524.2010.00941.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Since 1998 all municipalities in Denmark have been required by law to offer two annual preventive home visits to all home-dwelling citizens aged 75 or over. The influence of invitational procedures on acceptance rates has not been investigated. The aim of this study was to describe and investigate whether different invitational procedures were associated with first preventive home visit acceptance rates. The study was based on secondary analyses of data from the Danish Intervention Study on Preventive Home Visits. Data were collected from 1998 to 2002. Of the 4060 participants in the main study, 3245 reported receiving an offer for an identifiable preventive home visit, of whom 2399 (73.9%) provided complete data for the main analyses in the present study. Invitational procedures were categorised as: (1) a letter with a proposed date and time for the visit, (2) a visitor telephone call, and (3) a letter with encouragement to phone the visitor for appointment (letter without a proposed date). Covariates included sex, age, experience with preventive interventions, functional ability, self rated health, social relations and psychosocial characteristics. Statistical analyses included chi-square tests, and bi- and multivariable logistic regression analyses. Different invitational procedures were associated with first preventive home visit acceptance rates. Significantly more men (75.1%) than women (62.8%) declined the first preventive home visit regardless of the invitational procedure. Compared to 'letter with a proposed date', men had an odds ratio of 1.78 (95% CI: 1.16-2.74) for declining visits when 'telephone call' was used and an odds ratio 2.81 (95% CI: 1.79-4.40) when 'letter without a proposed date' was used as the invitational procedure. In women the odds ratios were 1.23 (95% CI: 0.91-1.68) and 1.87 (95% CI: 1.37-2.55), respectively.
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Affiliation(s)
- A Ekmann
- Danish Aging Research Centre (DARC), University of Aarhus, Odense and Copenhagen, Denmark.
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Johansson G, Eklund K, Gosman-Hedström G. Multidisciplinary team, working with elderly persons living in the community: a systematic literature review. Scand J Occup Ther 2010. [DOI: 10.3109/11038120902978096] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cutchin MP, Coppola S, Talley V, Svihula J, Catellier D, Shank KH. Feasibility and effects of preventive home visits for at-risk older people: design of a randomized controlled trial. BMC Geriatr 2009; 9:54. [PMID: 19958547 PMCID: PMC2797508 DOI: 10.1186/1471-2318-9-54] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 12/03/2009] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The search for preventive methods to mitigate functional decline and unwanted relocation by older adults living in the community is important. Preventive home visit (PHV) models use infrequent but regular visits to older adults by trained practitioners with the goal of maintaining function and quality of life. Evidence about PHV efficacy is mixed but generally supportive. Yet interventions have rarely combined a comprehensive (biopsychosocial) occupational therapy intervention protocol with a home visit to older adults. There is a particular need in the USA to create and examine such a protocol. METHODS/DESIGN The study is a single-blind randomized controlled pilot trial designed to assess the feasibility, and to obtain preliminary efficacy estimates, of an intervention consisting of preventive home visits to community-dwelling older adults. An occupational therapy-based preventive home visit (PHV) intervention was developed and is being implemented and evaluated using a repeated measures design. We recruited a sample of 110 from a population of older adults (75+) who were screened and found to be at-risk for functional decline. Participants are currently living in the community (not in assisted living or a skilled nursing facility) in one of three central North Carolina counties. After consent, participants were randomly assigned into experimental and comparison groups. The experimental group receives the intervention 4 times over a 12 month follow-up period while the comparison group receives a minimal intervention of mailed printed materials. Pre- and post-intervention measures are being gathered by questionnaires administered face-to-face by a treatment-blinded research associate. Key outcome measures include functional ability, participation, life satisfaction, self-rated health, and depression. Additional information is collected from participants in the experimental group during the intervention to assess the feasibility of the intervention and potential modifiers. Fidelity is being addressed and measured across several domains. DISCUSSION Feasibility indications to date are positive. Although the protocol has some limitations, we expect to learn enough about the intervention, delivery and effects to support a larger trial with a more stringent design and enhanced statistical power. TRIAL REGISTRATION ClinicalTrials.gov ID NCT00985283.
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Affiliation(s)
- Malcolm P Cutchin
- Division of Occupational Science, Department of Allied Health Sciences, University of North Carolina, Chapel Hill, North Carolina, USA.
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