1
|
Mouchaers I, Verbeek H, Kempen GIJM, van Haastregt JCM, Vlaeyen E, Goderis G, Metzelthin SF. Development and content of a community-based reablement programme (I-MANAGE): a co-creation study. BMJ Open 2023; 13:e070890. [PMID: 37648386 PMCID: PMC10471872 DOI: 10.1136/bmjopen-2022-070890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/19/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES As age increases, people generally start experiencing problems related to independent living, resulting in an increased need for long-term care services. Investing in sustainable solutions to promote independent living is therefore essential. Subsequently, reablement is a concept attracting growing interest. Reablement is a person-centred, holistic approach promoting older adults' active participation through daily, social, leisure and physical activities. The aim of this paper is to describe the development and content of I-MANAGE, a model for a reablement programme for community-dwelling older adults. DESIGN The development of the programme was performed according to the Medical Research Council framework as part of the TRANS-SENIOR international training and research network. A co-creation design was used, including literature research, observations, interviews, and working group sessions with stakeholders. SETTING AND PARTICIPANTS The interviews and working group sessions took place in the Dutch long-term home care context. Stakeholders invited to the individual interviews and working group sessions included care professionals, policymakers, client representatives, informal caregiver representatives, informal caregivers, and scientific experts. RESULTS The co-creation process resulted in a 5-phase interdisciplinary primary care programme, called I-MANAGE. The programme focuses on improving the self-management and well-being of older adults by working towards their meaningful goals. During the programme, the person's physical and social environment will be put to optimal use, and sufficient support will be provided to informal caregivers to reduce their burden. Lastly, the programme aims for continuity of care and better communication and coordination. CONCLUSION The I-MANAGE programme can be tailored to the local practices and resources and is therefore suitable for the use in different settings, nationally and internationally. If the programme is implemented as described, it is important to closely monitor the process and results.
Collapse
Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Hasselt, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke F Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| |
Collapse
|
2
|
Okamoto S, Sakamoto H, Kamimura K, Komamura K, Kobayashi E, Liang J. Economic effects of healthy ageing: functional limitation, forgone wages, and medical and long-term care costs. HEALTH ECONOMICS REVIEW 2023; 13:28. [PMID: 37162614 PMCID: PMC10170784 DOI: 10.1186/s13561-023-00442-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
This study aims to estimate the potential economic benefits of healthy ageing by obtaining estimates of the economic losses generated by functional limitations among middle-aged and older people. Utilising two data sources retrieved from nationally representative samples of the Japanese people, we analysed the association between functional limitation and economic indicators, including labour market outcomes, savings, investment, consumption, and unpaid activities among individuals aged ≥ 60. Using the estimated parameters from our micro-econometric analyses and the official statistics by the Japanese government and a previous study, we calculated the financial costs that can be averted if healthy ageing is achieved as foregone wages and formal medical/long-term care costs incurred by functional limitations. Our micro-econometric analyses found that functional limitation was associated with a 3% point increase in retirement probability, with a stronger association among those aged 60-69. Moreover, functional limitation was linked with higher total health spending and less active involvement in domestic work. Foregone wages generated by functional limitation were estimated to be approximately USD 266.4 million, driven mainly by individuals in their 60s. Long-term care costs, rather than medical care costs, for older people aged ≥ 85 accounted for most of the additional costs, indicating that the estimated medical and long-term costs generated by functional limitations were approximately USD 72.7 billion. Health interventions can yield economic benefits by preventing exits from the labour market due to health issues and reducing medical and long-term care costs.
Collapse
Affiliation(s)
- Shohei Okamoto
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae- cho, Itabashi-ku, Tokyo, 1730015, Japan.
- Institute of Global Health Policy Research, National Centre for Global Health and Medicine, Tokyo, Japan.
- Research Center for Financial Gerontology, Keio University, Tokyo, Japan.
| | - Haruka Sakamoto
- Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuki Kamimura
- Research Center for Financial Gerontology, Keio University, Tokyo, Japan
- Hirao School of Management, Konan University, Hyogo, Japan
| | - Kohei Komamura
- Research Center for Financial Gerontology, Keio University, Tokyo, Japan
- Faculty of Economics, Keio University, Tokyo, Japan
| | - Erika Kobayashi
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae- cho, Itabashi-ku, Tokyo, 1730015, Japan
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, Michigan, USA
- Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
3
|
Frailty and Types of Social Relationships Among Older Adults in 17 European Countries: A Latent Class Analysis. Arch Gerontol Geriatr 2022; 101:104705. [DOI: 10.1016/j.archger.2022.104705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022]
|
4
|
Mouchaers I, Verbeek H, Kempen GIJM, van Haastregt JCM, Vlaeyen E, Goderis G, Metzelthin SF. The concept of disability and its causal mechanisms in older people over time from a theoretical perspective: a literature review. Eur J Ageing 2022; 19:397-411. [PMID: 36052178 PMCID: PMC9424450 DOI: 10.1007/s10433-021-00668-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 01/25/2023] Open
Abstract
Ageing with a disability increases the risk of hospitalization and nursing home admission. Ageing in place interventions aiming to reduce disability are often not sufficiently effective and inadequately theory-based. There are many models available on disability, but it is unclear how they define disability, what their differences are, and how they evolved throughout the years. This paper aims to provide an overview of the evolution of these models and to elaborate on the causal mechanisms of disability. A literature review was conducted as part of the TRANS-SENIOR international training and research network. PubMed and Google Scholar were searched, and snowball sampling was applied to eligible publications. Data were extracted from the included publications, and a thematic analysis was performed on the retrieved data. Overall, 29 publications were included in the final sample. All included models arose from three original models and could be divided into two types: linear models and models on the interaction between the person and the environment. Thematic analysis led to three distinct evolutionary trends: (1) from a unidirectional linear path to a multidirectional nonlinear path, (2) from the consequences of disease towards the consequences of person-environment interaction, and (3) from disability towards health and functioning. Our findings suggest that by optimizing the use of personal as well as environmental resources, and focusing on health and functioning, rather than disability, an older person's independence and wellbeing can be improved, especially while performing meaningful daily activities in accordance with the person's needs and preferences.
Collapse
Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands ,Living Lab of Ageing and Long Term Care, Maastricht, the Netherlands ,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands ,Living Lab of Ageing and Long Term Care, Maastricht, the Netherlands
| | - Gertrudis I. J. M. Kempen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands ,Living Lab of Ageing and Long Term Care, Maastricht, the Netherlands
| | - Jolanda C. M. van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands ,Living Lab of Ageing and Long Term Care, Maastricht, the Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke F. Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands ,Living Lab of Ageing and Long Term Care, Maastricht, the Netherlands
| |
Collapse
|
5
|
Poplas Susič A, Klemenc-Ketiš Z, Blagus R, Ružić Gorenjec N. Factors that determine dependence in daily activities: A cross-sectional study of family practice non-attenders from Slovenia. PLoS One 2021; 16:e0245465. [PMID: 33481824 PMCID: PMC7822267 DOI: 10.1371/journal.pone.0245465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/30/2020] [Indexed: 12/05/2022] Open
Abstract
Background Independence in daily activities is defined as the ability to perform functions related to daily living, i.e. the capacity of living independently in the community with little or no help from others. Objective We focused on non-attenders as a subgroup of patients whose health status is not well known to family practice teams. Our goal was to estimate the prevalence of dependence and its severity level in the daily activities of patients, and to determine the factors that are associated with the occurrence of dependence. Design Cross-sectional observational study. Settings and participants Data was obtained in family medicine settings. Participants in the study were adults living in the community (aged 18 or over) who had not visited their chosen family physician in the last 5 years (non-attenders) and who were able to participate in the study. Through the electronic system, we identified 2,025 non-attenders. Community nurses collected data in the participants’ homes. The outcome measure was dependence in daily activities, assessed through eight items: personal hygiene; eating and drinking; mobility; dressing and undressing; urination and defecation; continence; avoiding hazards in the environment; and communication. Results The final sample consisted of 1,999 patients (98.7% response rate). The mean age was 59.9 (range 20 to 99). Dependence in daily activities was determined in 466 or 23.3% (95% CI: [21.5, 25.2]) of the patients. Older patients (over 60 years), with at least one chronic disease, increased risk of falling, moderate feelings of loneliness and a lower self-assessment of health were statistically significantly more likely to be dependent in their daily activities, according to our multivariate model. Conclusions A considerable proportion of family practice non-attenders were found to be dependent in daily activities, though at a low level. We identified several factors associated with this dependence. This could help to identify people at risk of being dependent in daily activities in the general adult population, and enable specific interventions that would improve their health status.
Collapse
Affiliation(s)
- Antonija Poplas Susič
- Ljubljana Community Health Centre, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- Ljubljana Community Health Centre, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia
- * E-mail:
| | - Rok Blagus
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Ružić Gorenjec
- Ljubljana Community Health Centre, Ljubljana, Slovenia
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
6
|
Saran A, White H, Kuper H. Evidence and gap map of studies assessing the effectiveness of interventions for people with disabilities in low-and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1070. [PMID: 37131970 PMCID: PMC8356326 DOI: 10.1002/cl2.1070] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background There are approximately 1 billion people in the world with some form of disability. This corresponds to approximately 15% of the world's population (World Report on Disability, 2011). The majority of people with disabilities (80%) live in low- and middle-income countries (LMICs), where disability has been shown to disproportionately affect the most disadvantaged sector of the population. Decision makers need to know what works, and what does not, to best invest limited resources aimed at improving the well-being of people with disabilities in LMICs. Systematic reviews and impact evaluations help answer this question. Improving the availability of existing evidence will help stakeholders to draw on current knowledge and to understand where new research investments can guide decision-making on appropriate use of resources. Evidence and gap maps (EGMs) contribute by showing what evidence there is, and supporting the prioritization of global evidence synthesis needs and primary data collection. Objectives The aim of this EGM is to identify, map and describe existing evidence of effectiveness studies and highlight gaps in evidence base for people with disabilities in LMICs. The map helps identify priority evidence gaps for systematic reviews and impact evaluations. Methods The EGM included impact evaluation and systematic reviews assessing the effect of interventions for people with disabilities and their families/carers. These interventions were categorized across the five components of community-based rehabilitation matrix; health, education, livelihood, social and empowerment. Included studies looked at outcomes such as, health, education, livelihoods, social inclusion and empowerment, and were published for LMICs from 2000 onwards until January 2018. The searches were conducted between February and March 2018. The EGM is presented as a matrix in which the rows are intervention categories (e.g., health) and subcategories (e.g., rehabilitation) and the column outcome domains (e.g., health) and subdomains (e.g., immunization). Each cell lists the studies for that intervention for those outcomes, with links to the available studies. Included studies were therefore mapped according to intervention and outcomes assessed and additional filters as region, population and study design were also coded. Critical appraisal of included systematic review was done using A Measurement Tool to Assess Systematic Reviews' rating scale. We also quality-rated the impact evaluation using a quality assessment tool based on various approaches to risk of bias assessment. Results The map includes 166 studies, of which 59 are systematic reviews and 107 impact evaluation. The included impact evaluation are predominantly quasiexperimental studies (47%). The numbers of studies published each year have increased steadily from the year 2000, with the largest number published in 2017.The studies are unevenly distributed across intervention areas. Health is the most heavily populated area of the map. A total of 118 studies of the 166 studies concern health interventions. Education is next most heavily populated with 40 studies in the education intervention/outcome sector. There are relatively few studies for livelihoods and social, and virtually none for empowerment. The most frequent outcome measures are health-related, including mental health and cognitive development (n = 93), rehabilitation (n = 32), mortality and morbidity (n = 23) and health check-up (n = 15). Very few studies measured access to assistive devices, nutrition and immunization. Over half (n = 49) the impact evaluation come from upper-middle income countries. There are also geographic gaps, most notably for low income countries (n = 9) and lower-middle income countries (n = 34). There is a fair amount of evidence from South Asia (n = 73) and Sub-Saharan Africa (n = 51). There is a significant gap with respect to study quality, especially with respect to impact evaluation. There appears to be a gap between the framing of the research, which is mostly within the medical model and not using the social model of disability. Conclusion Investing in interventions to improve well-being of people with disabilities will be critical to achieving the 2030 agenda for sustainable development goals. The EGM summarized here provides a starting point for researchers, decision makers and programme managers to access the available research evidence on the effectiveness of interventions for people with disabilities in LMICs in order to guide policy and programme activity, and encourage a more strategic, policy-oriented approach to setting the future research agenda.
Collapse
Affiliation(s)
| | | | - Hannah Kuper
- London School of Hygiene and Tropical Medicine (LSHTM)LondonUK
| |
Collapse
|
7
|
Niederstrasser NG, Rogers NT, Bandelow S. Determinants of frailty development and progression using a multidimensional frailty index: Evidence from the English Longitudinal Study of Ageing. PLoS One 2019; 14:e0223799. [PMID: 31665163 PMCID: PMC6821067 DOI: 10.1371/journal.pone.0223799] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/28/2019] [Indexed: 01/10/2023] Open
Abstract
Objective To identify modifiable risk factors for development and progression of frailty in older adults living in England, as conceptualised by a multidimensional frailty index (FI). Methods Data from participants aged 50 and over from the English Longitudinal Study of Ageing (ELSA) was used to examine potential determinants of frailty, using a 56-item FI comprised of self-reported health conditions, disabilities, cognitive function, hearing, eyesight, depressive symptoms and ability to carry out activities of daily living. Cox proportional hazards regression models were used to measure frailty development (n = 7420) and linear regression models to measure frailty progression over 12 years follow-up (n = 8780). Results Increasing age (HR: 1.08 (CI: 1.08–1.09)), being in the lowest wealth quintile (HR: 1.79 (CI: 1.54–2.08)), lack of educational qualifications (HR: 1.19 (CI: 1.09–1.30)), obesity (HR: 1.33 (CI: 1.18–1.50) and a high waist-hip ratio (HR: 1.25 (CI: 1.13–1.38)), being a current or previous smoker (HR: 1.29 (CI: 1.18–1.41)), pain (HR: 1.39 (CI: 1.34–1.45)), sedentary behaviour (HR: 2.17 (CI: 1.76–2.78) and lower body strength (HR: 1.07 (CI: 1.06–1.08)), were all significant risk factors for frailty progression and incidence after simultaneous adjustment for all examined factors. Conclusion The findings of this study suggest that there may be scope to reduce both frailty incidence and progression by trialling interventions aimed at reducing obesity and sedentary behaviour, increasing intensity of physical activity, and improving success of smoking cessation tools. Furthermore, improving educational outcomes and reducing poverty may also reduce inequalities in frailty.
Collapse
Affiliation(s)
- Nils Georg Niederstrasser
- School of Applied Social Sciences, De Montfort University, Leicester, England, United Kingdom
- * E-mail:
| | - Nina Trivedy Rogers
- Department of Epidemiology and Public Health, University College London, London, England, United Kingdom
| | - Stephan Bandelow
- Department of Physiology, Neuroscience and Behavioural Sciences, St. George’s University, St. George’s, Grenada
| |
Collapse
|
8
|
Wai JL, Yu DS. The relationship between sleep–wake disturbances and frailty among older adults: A systematic review. J Adv Nurs 2019; 76:96-108. [DOI: 10.1111/jan.14231] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/10/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Joyce Lok‐Tung Wai
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
| | - Doris Sau‐Fung Yu
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
| |
Collapse
|
9
|
Visser J, McLachlan MH, Maayan N, Garner P. Community-based supplementary feeding for food insecure, vulnerable and malnourished populations - an overview of systematic reviews. Cochrane Database Syst Rev 2018; 11:CD010578. [PMID: 30480324 PMCID: PMC6517209 DOI: 10.1002/14651858.cd010578.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Supplementary feeding may help food insecure and vulnerable people by optimising the nutritional value and adequacy of the diet, improving quality of life and improving various health parameters of disadvantaged families. In low- and middle-income countries (LMIC), the problems supplementary feeding aims to address are entangled with poverty and deprivation, the programmes are expensive and delivery is complicated. OBJECTIVES 1. To summarise the evidence from systematic reviews of supplementary feeding for food insecure, vulnerable and malnourished populations, including children under five years of age, school-aged children, pregnant and lactating women, people with HIV or tuberculosis (or both), and older populations.2. To describe and explore the effects of supplementary feeding given to people in these groups, and to describe the range of outcomes between reviews and range of effects in the different groups. METHODS In January 2017, we searched the Cochrane Database of Systematic Reviews, MEDLINE, Embase and nine other databases. We included systematic reviews evaluating community-based supplementary feeding, and concerning food insecure, vulnerable and malnourished populations. Two review authors independently undertook selection of systematic reviews, data extraction and 'Risk of bias' assessment. We assessed review quality using the AMSTAR tool, and used GRADEpro 'Summary of findings' tables from each review to indicate the certainty of the evidence for the main comparisons. We summarised review findings in the text and reported the data for each outcome in additional tables. We also used forest plots to display results graphically. MAIN RESULTS This overview included eight systematic reviews (with last search dates between May 2006 and February 2016). Seven were Cochrane Reviews evaluating interventions in pregnant women; children (aged from birth to five years) from LMIC; disadvantaged infants and young children (aged three months to five years); children with moderate acute malnutrition (MAM); disadvantaged school children; adults and children who were HIV positive or with active tuberculosis (with or without HIV). One was a non-Cochrane systematic review in older people with Alzheimer's disease. These reviews included 95 trials relevant to this overview, with the majority (74%) of participants from LMIC.The number of included participants varied between 91 and 7940 adults, and 271 and more than 12,595 children. Trials included a wide array of nutritional interventions that varied in duration, frequency and format, with micronutrients often reported as cointerventions. Follow-up ranged from six weeks to two years; three trials investigated outcomes at four to 17 years of age. All reviews were rated as high quality (AMSTAR score between eight and 11). The GRADE certainty ratings ranged from very low to moderate for individual comparisons, with the evidence often comprising only one or two small trials, thereby resulting in many underpowered analyses (too small to detect small but important differences). The main outcome categories reported across reviews were death, anthropometry (adults and children) and other markers of nutritional status, disease-related outcomes, neurocognitive development and psychosocial outcomes, and adverse events.Mortality data were limited and underpowered in meta-analysis in all populations (children with MAM, in children with HIV, and in adults with tuberculosis) with the exception of balanced energy and protein supplementation in pregnancy, which may have reduced the risk of stillbirth (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.39 to 0.94; 5 trials, 3408 women). Supplementation in pregnancy also improved infant birth weight (mean difference (MD) 40.96 g, 95% CI 4.66 to 77.26; 11 trials, 5385 participants) and reduced risk of infants born small-for-gestational age (RR 0.79, 95% CI 0.69 to 0.90; 7 trials, 4408 participants). These effects did not translate into demonstrable long-term benefits for children in terms of growth and neurocognitive development in the one to two trials reporting on longer-term outcomes. In one study (505 participants), high-protein supplementation was associated with increased risk of small-for-gestational age babies.Effects on growth in children were mixed. In children under five years of age from LMIC, one review found that supplementary feeding had a little or no effect on child growth; however, a more recent review in a similar population found that those who received food supplementation gained an average of 0.12 kg more in weight (MD 0.12 kg, 95% CI 0.05 to 0.18; 9 trials, 1057 participants) and 0.27 cm more in height (MD 0.27 cm, 95% CI 0.07 to 0.48; 9 trials, 1463 participants) than those who were not supplemented. Supplementary food was generally more effective for younger children (younger than two years of age) and for those who were poorer or less well-nourished. In children with MAM, the provision of specially formulated food improved their weight, weight-for-height z scores and other key outcomes such as recovery rate (by 29%), as well as reducing the number of participants dropping out (by 70%). In LMIC, school meals seemed to lead to small benefits for children, including improvements in weight z scores, especially in children from lower-income countries, height z scores, cognition or intelligence quotient tests, and maths and spelling performance.Supplementary feeding in adults who were HIV positive increased the daily energy and protein intake compared to nutritional counselling alone. Supplementation led to an initial improvement in weight gain or body mass index but did not seem to confer long-term benefit.In adults with tuberculosis, one small trial found a significant benefit on treatment completion and sputum conversion rate. There were also significant but modest benefits in terms of weight gain (up to 2.60 kg) during active tuberculosis.The one study included in the Alzheimer's disease review found that three months of daily oral nutritional supplements improved nutritional outcomes in the intervention group.There was little or no evidence regarding people's quality of life, adherence to treatment, attendance at clinic or the costs of supplementary feeding programmes. AUTHORS' CONCLUSIONS Considering the current evidence base included, supplementary food effects are modest at best, with inconsistent and limited mortality evidence. The trials reflected in the reviews mostly reported on short-term outcomes and across the whole of the supplementation trial literature it appears important outcomes, such as quality of life and cost of programmes, are not systematically reported or summarised.
Collapse
Affiliation(s)
- Janicke Visser
- Stellenbosch UniversityDivision of Human NutritionFrancie van Zijl DriveCape TownWestern CapeSouth Africa7505
| | - Milla H McLachlan
- Stellenbosch UniversityDivision of Human NutritionFrancie van Zijl DriveCape TownWestern CapeSouth Africa7505
| | - Nicola Maayan
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Paul Garner
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolMerseysideUKL3 5QA
| | | |
Collapse
|
10
|
Gobbens RJ. Associations of ADL and IADL disability with physical and mental dimensions of quality of life in people aged 75 years and older. PeerJ 2018; 6:e5425. [PMID: 30123720 PMCID: PMC6087617 DOI: 10.7717/peerj.5425] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background Quality of life is an important health outcome for older persons. It predicts the adverse outcomes of institutionalization and premature death. The aim of this cross-sectional study was to determine the influence of both disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) on physical and mental dimensions of quality of life. Methods A total of 377 Dutch people aged 75 years and older completed a web-based questionnaire. This questionnaire contained the Groningen Activity Restriction Scale (GARS) for measuring ADL and IADL and the Short-Form Health Survey (SF-12) for measuring quality of life. The SF-12 distinguishes two dimensions of quality of life, a physical and mental dimension. Results All ADL disability items combined and all IADL disability items combined explained a significant part of the variance of the physical and the mental dimension of quality of life. Only ADL item "stand up from sitting in a chair", and IADL items "do "heavy" household activities" and "do the shopping" were negatively associated with both quality of life dimensions after controlling for all the variables in the model. Discussion This study showed that disability in ADL and IADL is negatively associated with quality of life in older people. Therefore, it is important for health care professionals to carry out interventions aimed to prevent and diminish disability or the adverse outcomes of disability such as a lower quality of life. In order to be effective these interventions should be inexpensive, feasible, and easy to implement.
Collapse
Affiliation(s)
- Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
11
|
Machón M, Mateo-Abad M, Vrotsou K, Zupiria X, Güell C, Rico L, Vergara I. Dietary Patterns and Their Relationship with Frailty in Functionally Independent Older Adults. Nutrients 2018; 10:E406. [PMID: 29587356 PMCID: PMC5946191 DOI: 10.3390/nu10040406] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 01/03/2023] Open
Abstract
The impact of dietary patterns rather than single foods or nutrients on health outcomes is increasingly recognized. This cross-sectional study examines the dietary patterns of 527 non-institutionalized functionally independent older people aged ≥70 years from Gipuzkoa (Spain). Sociodemographic characteristics, health status, anthropometric measures and dietary data are collected. Multiple correspondence analysis (MCA) and cluster analysis are performed to identify dietary patterns and groups of individuals. Frequency of selected food items and compliance with food recommendations are included in the MCA. A high proportion of the sample population are overweight or obese, whereas only 3.3% are at risk of malnutrition (determined with the Mini Nutritional Assessment). Frail individuals (n = 130), measured with the Timed-Up and Go test are older, have a lower educational level, are more obese, present a poorer health status (more depressive symptoms, polypharmacy and falls, among others) and worse compliance with food recommendations than robust individuals (n = 392). Three groups of individuals are identified: cluster one (n = 285), cluster two (n = 194) and cluster three (n = 48). A gradient of increasing frailty and poorer health status is observed from cluster one to cluster three. The latter also shows the poorest dietary pattern, regarding dietary recommendations. The use of an easy-to-use tool to assess diet allows detection of differences among the three clusters. There is a need to increase awareness on the implementation of nutritional screening and a subsequent dietary assessment in primary care settings to provide nutritional care to elder, and moreover, frail individuals.
Collapse
Affiliation(s)
- Mónica Machón
- Unidad de Investigación de Atención Primaria-OSIs Gipuzkoa, Osakidetza, 20014 San Sebastián, Spain.
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 48902 Barakaldo, Spain.
- Instituto de Investigación Sanitaria Biodonostia, 20014 San Sebastián, Spain.
| | - Maider Mateo-Abad
- Unidad de Investigación de Atención Primaria-OSIs Gipuzkoa, Osakidetza, 20014 San Sebastián, Spain.
- Instituto de Investigación Sanitaria Biodonostia, 20014 San Sebastián, Spain.
- Kronikgune- Centro de Investigación en Cronicidad, 48902 Barakaldo, Spain.
| | - Kalliopi Vrotsou
- Unidad de Investigación de Atención Primaria-OSIs Gipuzkoa, Osakidetza, 20014 San Sebastián, Spain.
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 48902 Barakaldo, Spain.
- Instituto de Investigación Sanitaria Biodonostia, 20014 San Sebastián, Spain.
| | - Xabier Zupiria
- Centro de salud de Beraun, Osakidetza, 20100 Rentería, Spain.
| | - Carolina Güell
- Unidad de Investigación de Atención Primaria-OSIs Gipuzkoa, Osakidetza, 20014 San Sebastián, Spain.
- Centro de salud de Alza, Osakidetza, 20017 San Sebastián, Spain.
| | - Leonor Rico
- Unidad de Investigación de Atención Primaria-OSIs Gipuzkoa, Osakidetza, 20014 San Sebastián, Spain.
| | - Itziar Vergara
- Unidad de Investigación de Atención Primaria-OSIs Gipuzkoa, Osakidetza, 20014 San Sebastián, Spain.
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 48902 Barakaldo, Spain.
- Instituto de Investigación Sanitaria Biodonostia, 20014 San Sebastián, Spain.
| |
Collapse
|
12
|
Brown RT, Covinsky KE. Frailty as an Outcome in Geriatrics Research: Not Ready for Prime Time? Ann Intern Med 2018; 168:361-362. [PMID: 29310132 PMCID: PMC5840034 DOI: 10.7326/m17-3048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rebecca T Brown
- Division of Geriatrics, University of California, San Francisco, and San Francisco VA Medical Center, San Francisco, California (R.T.B., K.E.C.)
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, and San Francisco VA Medical Center, San Francisco, California (R.T.B., K.E.C.)
| |
Collapse
|
13
|
Santiago LM, Gobbens RJJ, van Assen MALM, Carmo CN, Ferreira DB, Mattos IE. Predictive validity of the Brazilian version of the Tilburg Frailty Indicator for adverse health outcomes in older adults. Arch Gerontol Geriatr 2018; 76:114-119. [PMID: 29494871 DOI: 10.1016/j.archger.2018.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/29/2018] [Accepted: 02/16/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aimed to determine the predictive value of the Brazilian Tilburg Frailty Indicator (TFI) for adverse health outcomes (falls, hospitalization, disability and death), in a follow-up period of twelve months. METHODS This longitudinal study was carried out with a sample of people using primary health care services in Rio de Janeiro, Brazil. At baseline the sample consisted of 963 people aged 60 years and older. A subset of all respondents participated again one year later (n = 640, 66.6% response rate). We used the TFI, the Katz's scale for assessing ADL disability and the Lawton Scale for assessing IADL disability. Falls, hospitalization and death were also assessed using a questionnaire. RESULTS The prevalence of frailty was 44.2% and the mean score of the TFI was 4.4 (SD = 3.0). There was a higher risk of loss in functional capacity in ADL (OR = 3.03, CI95% 1.45-6.29) and in IADL (OR = 1.51, CI95% 1.05-2.17), falls (OR = 2.08, CI95% 1.21-3.58), hospitalization (OR = 1.83, CI95% 1.10-3.06), and death (HR = 2.73, CI95% 1.04-7.19) for frail when compared to non-frail elderly, in the bivariate analyses. Controlling for the sociodemographic variables, the frailty domains together improved the prediction of hospitalization, falls and loss in functional capacity in ADL, but not loss in functional capacity in IADL. CONCLUSION The TFI is a good predictor of adverse health outcomes among elderly users of primary care services in Brazil and appears an adequate and easy to administer tool for monitoring their health conditions.
Collapse
Affiliation(s)
- Lívia Maria Santiago
- Federal University of Rio de Janeiro, Faculty of Medicine, Rua Rodolpho Paulo Rocco, 255/room 9E11, Cidade Universitária, Zip Code 21941- 913, Rio de Janeiro, RJ, Brazil; National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV, Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Groenelaan 7, 1186 AA, Amstelveen, The Netherlands; Department of General Practice, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Warandelaan 2, 90153, Tilburg University, Tilburg, The Netherlands; Department of Sociology, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands.
| | - Cleber Nascimento Carmo
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
| | - Daniele Bittencourt Ferreira
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
| | - Inês Echenique Mattos
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
14
|
Anthropometric Measures and Frailty Prediction in the Elderly: An Easy-to-Use Tool. Curr Gerontol Geriatr Res 2017; 2017:8703503. [PMID: 29358947 PMCID: PMC5735592 DOI: 10.1155/2017/8703503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/01/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose Anthropometry is a useful tool for assessing some risk factors for frailty. Thus, the aim of this study was to verify the discriminatory performance of anthropometric measures in identifying frailty in the elderly and to create an easy-to-use tool. Methods Cross-sectional study: a subset from the Multidimensional Study of the Elderly in the Family Health Strategy (EMI-SUS) evaluating 538 older adults. Individuals were classified using the Fried Phenotype criteria, and 26 anthropometric measures were obtained. The predictive ability of anthropometric measures in identifying frailty was identified through logistic regression and an artificial neural network. The accuracy of the final models was assessed with an ROC curve. Results The final model comprised the following predictors: weight, waist circumference, bicipital skinfold, sagittal abdominal diameter, and age. The final neural network models presented a higher ROC curve of 0.78 (CI 95% 0.74–0.82) (P < 0.001) than the logistic regression model, with an ROC curve of 0.71 (CI 95% 0.66–0.77) (P < 0.001). Conclusion The neural network model provides a reliable tool for identifying prefrailty/frailty in the elderly, with the advantage of being easy to apply in the primary health care. It may help to provide timely interventions to ameliorate the risk of adverse events.
Collapse
|
15
|
Gill TM, Williams CS. Evaluating Distinctions in the Assessment of Late-Life Disability. J Gerontol A Biol Sci Med Sci 2017; 72:1538-1546. [PMID: 28329106 DOI: 10.1093/gerona/glx022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/24/2017] [Indexed: 11/14/2022] Open
Abstract
Background By including categories for accommodations and reduced frequency, to supplement earlier classifications of difficulty and dependence, a new 5-category functional scale has the potential to distinguish finer gradations in disability but the hierarchical nature and advantages of this scale over alternative scales are uncertain. Methods Using data from the National Health and Aging Trends Study (N = 7,609), we conducted a series of: cross-sectional analyses that focused on the hierarchical consistency of responses in the 5-category scale; and longitudinal analyses that focused on predictive accuracy for mortality and functional dependence, comparing the 5-category scale with three simpler scales, having only three or four categories. Results Although there was considerable variability across the seven functional activities, the prevalence of inconsistencies in the hierarchy of the 5-category scale (eg, reports difficulty but no accommodations) was relatively high. In addition, the predictive accuracy of the 5-category scale for mortality and functional dependence was only modestly better than that of the two 3-category scales and was comparable to that of the 4-category scale. Finally, when evaluated as summative disability scores, there was little difference in predictive accuracy between the 5-category scale and three alternative scales. Conclusions Despite inconsistencies in its hierarchy, the 5-category scale is more effective in stratifying risk for mortality and functional dependence than the two 3-category scales but not the 4-category scale. When assessing changes over time, however, the addition of questions on accommodations and reduced frequency to those on difficulty and dependence, to form a summative disability score, offers little benefit and increases the burden of the assessment.
Collapse
Affiliation(s)
- Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Christianna S Williams
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
| |
Collapse
|
16
|
Viladrosa M, Casanova C, Ghiorghies AC, Jürschik P. [Effectiveness of physical exercise on fitness in frail older adults: A systematic review of randomised trials]. Rev Esp Geriatr Gerontol 2017. [PMID: 28641903 DOI: 10.1016/j.regg.2017.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Performing exercise to maintain a good physical condition is crucial to improve and prevent frailty in older adults. The aim of this review was to assess the beneficial effects of physical exercise on fitness in frail older adults. A thorough literature search of randomised clinical trials (RCT) in the last 15 years was performed on different electronic databases. The methodological assessment of studies was obtained using the PEDro scale. Ten RCT were included, providing a final sample of 1,130 individuals. Scores on the PEDro scale ranged from 5 to 8/10. Multicomponent training programs seem to be the best strategy to improve fitness outcomes. Further studies should be performed in order to optimise the design of supervised exercise programs, and further research is needed in hospital and institutionalised settings.
Collapse
Affiliation(s)
- Maria Viladrosa
- Departamento de Enfermería y Fisioterapia, Universitat de Lleida, Lleida, España; Hospital Universitari Arnau de Vilanova, Lleida España.
| | - Carles Casanova
- Departamento de Enfermería y Fisioterapia, Universitat de Lleida, Lleida, España
| | | | - Pilar Jürschik
- Departamento de Enfermería y Fisioterapia, Universitat de Lleida, Lleida, España
| |
Collapse
|
17
|
Sears NA, Blais R, Spinks M, Paré M, Baker GR. Associations between patient factors and adverse events in the home care setting: a secondary data analysis of two canadian adverse event studies. BMC Health Serv Res 2017; 17:400. [PMID: 28606073 PMCID: PMC5469013 DOI: 10.1186/s12913-017-2351-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 06/01/2017] [Indexed: 01/22/2023] Open
Abstract
Background Early identification of patients at who have a higher risk for the occurrence of harm can provide patient safety improvement opportunities. Patient factors contribute to adverse event occurrence. The study aim was to identify a single, parsimonious model of home care patient factors that, regardless of location and differences in home care program management and design factors, could provide a means of locating patients at higher and lower risk of harm. Methods Split modeling using secondary analyses of data from two recent Canadian home care patient safety studies was undertaken. Patient factors from the Minimum Data Set Resident Assessment Instrument (RAI) for Home Care and diagnoses consistent with ICD-10 and RAI-Mental Health assessment were used. Continuous and categorical measures of factors were considered. Adverse events were defined using World Health Organization taxonomy and measured on a dichotomous yes/no scale. Patient factors significantly associated (Pearson’s Chi Square, p ≤ .05) with the occurrence of adverse events in both earlier studies were entered in forward selection regression analyses to locate factors predictive of adverse event occurrence. Results Instrumental activities of daily living dependency and escalating co-morbidity counts are associated with patient vulnerability to adverse events. Conclusions Instrumental activities of daily living dependency and burden of illness, both easily identifiable early in the episode of care, are significantly associated with the risk of adverse event occurrence, however there is regional variability in the relationships.
Collapse
Affiliation(s)
- Nancy A Sears
- School of Baccalaureate Nursing, St. Lawrence College, Kingston, ON, Canada
| | - Régis Blais
- Department of Health Administration, Public Health Research Institute, Université de Montréal, PO Box 6128, Station Centreville, Montreal, Québec, H3C 3J7, Canada.
| | | | - Michèle Paré
- Public Health Research Institute, Université de Montréal, Montreal, Québec, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
18
|
Dedeyne L, Deschodt M, Verschueren S, Tournoy J, Gielen E. Effects of multi-domain interventions in (pre)frail elderly on frailty, functional, and cognitive status: a systematic review. Clin Interv Aging 2017; 12:873-896. [PMID: 28579766 PMCID: PMC5448695 DOI: 10.2147/cia.s130794] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Frailty is an aging syndrome caused by exceeding a threshold of decline across multiple organ systems leading to a decreased resistance to stressors. Treatment for frailty focuses on multi-domain interventions to target multiple affected functions in order to decrease the adverse outcomes of frailty. No systematic reviews on the effectiveness of multi-domain interventions exist in a well-defined frail population. OBJECTIVES This systematic review aimed to determine the effect of multi-domain compared to mono-domain interventions on frailty status and score, cognition, muscle mass, strength and power, functional and social outcomes in (pre)frail elderly (≥65 years). It included interventions targeting two or more domains (physical exercise, nutritional, pharmacological, psychological, or social interventions) in participants defined as (pre)frail by an operationalized frailty definition. METHODS The databases PubMed, EMBASE, CINAHL, PEDro, CENTRAL, and the Cochrane Central register of Controlled Trials were searched from inception until September 14, 2016. Additional articles were searched by citation search, author search, and reference lists of relevant articles. The protocol for this review was registered on PROSPERO (CRD42016032905). RESULTS Twelve studies were included, reporting a large diversity of interventions in terms of content, duration, and follow-up period. Overall, multi-domain interventions tended to be more effective than mono-domain interventions on frailty status or score, muscle mass and strength, and physical functioning. Results were inconclusive for cognitive, functional, and social outcomes. Physical exercise seems to play an essential role in the multi-domain intervention, whereby additional interventions can lead to further improvement (eg, nutritional intervention). CONCLUSION Evidence of beneficial effects of multi-domain compared to mono-domain interventions is limited but increasing. Additional studies are needed, focusing on a well-defined frail population and with specific attention to the design and the individual contribution of mono-domain interventions. This will contribute to the development of more effective interventions for frail elderly.
Collapse
Affiliation(s)
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Sabine Verschueren
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Heverlee, Belgium
| | - Jos Tournoy
- Department of Clinical and Experimental Medicine
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Evelien Gielen
- Department of Clinical and Experimental Medicine
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
19
|
Jover J, Abasolo L. Early intervention to restore function and maintain healthy trajectory. Best Pract Res Clin Rheumatol 2017; 31:275-288. [DOI: 10.1016/j.berh.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 10/31/2017] [Indexed: 01/13/2023]
|
20
|
Quality care provision for older people: an interview study with patients and primary healthcare professionals. Br J Gen Pract 2017. [PMID: 26212845 DOI: 10.3399/bjgp15x686065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In recent years, primary health care for the ageing population has become increasingly complex. AIM This study sought to explore the views and needs of healthcare professionals and older patients relating to primary care in order to identify focal areas for improving primary health care for older people. DESIGN AND SETTING This research was structured as a mixed interview study with focus groups and individual interviews. Participants were made up of primary healthcare professionals and older patients. Patients were recruited from five elderly care homes in a small city in the southern part of the Netherlands. METHOD All interviews were transcribed verbatim and analysed by two individual researchers applying constant comparative analysis. Data collection proceeded until saturation was reached. RESULTS Participants in the study agreed about the need for primary care for older patients, and showed sympathy with one another's perspectives. They did note, however, a number of obstacles hindering good healthcare provision. The major themes that arose were: 'autonomy and independence', 'organisational barriers', and 'professional expertise'. Participants generally noted that it is important to clarify differences in perspectives about good care between patients and healthcare professionals. CONCLUSION Effective primary care intervention for older patients requires mutual understanding of the expectations and goals of all parties involved. There are a number of important requirements, especially accessible patient information in the form of care plans; specialist training for nurses and GPs on complex care and multimorbidity; and training on discussing autonomy, goal setting, and shared care. Further improvement in health care for older people and its evaluation research should focus on these requirements.
Collapse
|
21
|
Morita M. [Factors related to the long-term prognosis of home-based medical care subjects]. Nihon Ronen Igakkai Zasshi 2016; 52:383-90. [PMID: 26700778 DOI: 10.3143/geriatrics.52.383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The purpose of this study is to identify the factors affecting long-term prognosis of home-based medical care subjects. METHODS We evaluated 290 subjects, who received home-based medical care between January 2012 and May 2015. We evaluated several aspects of the activities of daily living, such as the ability to walk, use of the toilet, self-feeding and self-administering of medications, as well as their cognition, activities, and abilities to communicate. The influence of these parameters on major adverse cardiovascular cerebrovascular events, non-cardiovascular, cerebrovascular events and the incidence of death was evaluated. RESULTS The mean age of the subjects was 83 years old and 38% of them were male: dementia or previous cerebral infarction was their main diagnosis. They required assistance for almost all activities of daily living except for feeding. Primary health concerns included 103 (37.0%) subjects had non-cardiovascular, cerebrovascular events, 63 subjects (21.7%) had pneumonia, and 48 subjects (16.6%) suffered major adverse cardiovascular cerebrovascular events, including 22 subjects (7.6%) with congestive heart failure. Sixty-one subjects (21.0%) died. The activities of daily living and cognition correlated strongly with non-cardiovascular, cerebrovascular events and death. CONCLUSION Our results indicated the activities of daily living and cognition strongly influence the occurrence of non-cardiovascular, cerebrovascular events and death in subjects receiving home-based medical care. Therefore, intervention should be targeted at improving these subjects' abilities to perform activities of daily living.
Collapse
Affiliation(s)
- Masaki Morita
- 2nd Department of Home Care Medicine, Saito Hospital
| |
Collapse
|
22
|
Vieira AI, Nogueira D, de Azevedo Reis E, da Lapa Rosado M, Vânia Nunes M, Castro-Caldas A. Hand tactile discrimination, social touch and frailty criteria in elderly people: A cross sectional observational study. Arch Gerontol Geriatr 2016; 66:73-81. [DOI: 10.1016/j.archger.2016.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/07/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
|
23
|
Mossello E, Profili F, Di Bari M, Bandinelli S, Razzanelli M, Salvioni A, Corridori C, Di Fiandra T, Francesconi P. Postal screening can identify frailty and predict poor outcomes in older adults: longitudinal data from INTER-FRAIL study. Age Ageing 2016; 45:469-74. [PMID: 27013497 DOI: 10.1093/ageing/afw048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/11/2016] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE identification of older individuals at risk for health-related adverse outcomes (HRAO) is necessary for population-based preventive interventions. Aim of this study was to improve a previously validated postal screening questionnaire for frailty in non-disabled older subjects and to test its prognostic validity in a vast sample of older community-dwellers. METHODS individuals aged 70+ underwent a mass postal screening. Physical frailty phenotype (PFP) was assessed in the unselected subsample of the first responders. After a 1-year follow-up, HRAO were recorded in the whole sample, including survival, access to Emergency Department, hospitalisation and Long-Term Care admission. RESULTS the questionnaire was mailed to 17,273 subjects, whose response rate was 55%. Among the first 1,037 responders without overt disability, the revised questionnaire was 75% sensitive and 69% specific for PFP (ROC 0.772). Non-disabled subjects who screened positive had a higher risk of HRAO in comparison with those who screened negative and similar to non-responders. Risk of adverse outcome was highest among disabled subjects. CONCLUSIONS a simple questionnaire delivered by mail has good accuracy in detecting PFP in non-disabled older subjects and is able to predict HRAO.
Collapse
Affiliation(s)
- Enrico Mossello
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Profili
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Mauro Di Bari
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefania Bandinelli
- Division of Geriatric Medicine, Azienda Sanitaria di Firenze, Florence, Italy
| | - Matilde Razzanelli
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Anna Salvioni
- Fiorentina Sud-Est Health District, Azienda Sanitaria di Firenze, Florence, Italy
| | - Carla Corridori
- Valdichiana Senese Health District, Unità Funzionale Segretariato Sociale, Azienda USL 7, Siena, Italy
| | - Teresa Di Fiandra
- Directorate General for Prevention, Italian Ministry of Health, Rome, Italy
| | - Paolo Francesconi
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Florence, Italy
| |
Collapse
|
24
|
Freitag S, Schmidt S. Prevention of frailty through narrative intervention. Soc Sci Med 2016; 160:120-7. [PMID: 27239902 DOI: 10.1016/j.socscimed.2016.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 03/18/2016] [Accepted: 05/13/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Frailty is a syndrome of increased vulnerability with adverse outcomes, increasing with age for elderly people. So far, intervention programs have mainly addressed the physical components of frailty. As biographical writing approaches have shown positive effects on cognition and health, the aim of this study is to investigate the effects of a biographical disclosure intervention on psychological frailty and health in older adults. METHODS In total, 198 elderly people (mean age = 75.1 years) were recruited and randomly assigned to four disclosure conditions: oral biographical disclosure, written structured and unstructured biographical disclosure, daily diary and a control group. Frailty was measured with the Tilburg Frailty Indicator, and physical and mental health were assessed with the Short Form (12-item) Health Survey. Measurements were assessed pre- and post-intervention, and at a three month follow-up. Mixed design ANOVAs with repeated measures, correlations and Wilcoxon tests were calculated. RESULTS The sample showed a frailty prevalence of 39.9% pre-intervention. Participants in the oral biographical disclosure, structured biographical writing, and daily diary groups showed improvements in their frailty and mental health, with small effect sizes. No effect for physical health was evident. People with high frailty symptoms and low mental health benefitted from the intervention. Frailty was negatively correlated with physical and mental health components. CONCLUSIONS The results of the intervention indicate a short-term positive effect on frailty and mental health in elderly people, who benefitted from the disclosure intervention in terms of improved mental health and lower frailty levels. Early frailty detection is therefore crucial in the treatment and care of older adults, and biographical disclosure approaches can help to maintain health at old age.
Collapse
Affiliation(s)
- S Freitag
- Ernst-Moritz-Arndt University Greifswald, Institute of Psychology, Department Health & Prevention, Robert-Blum-Str. 13, 17487 Greifswald, Germany.
| | - S Schmidt
- Ernst-Moritz-Arndt University Greifswald, Institute of Psychology, Department Health & Prevention, Robert-Blum-Str. 13, 17487 Greifswald, Germany
| |
Collapse
|
25
|
Artaud F, Singh-Manoux A, Dugravot A, Tzourio C, Elbaz A. Decline in Fast Gait Speed as a Predictor of Disability in Older Adults. J Am Geriatr Soc 2015; 63:1129-36. [DOI: 10.1111/jgs.13442] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fanny Artaud
- INSERM; Centre for Research in Epidemiology and Population Health; U1018, Epidemiology of Ageing and Age-Related Diseases; Villejuif France
- UMRS 1018; University Versailles St-Quentin; Versailles France
| | - Archana Singh-Manoux
- INSERM; Centre for Research in Epidemiology and Population Health; U1018, Epidemiology of Ageing and Age-Related Diseases; Villejuif France
- UMRS 1018; University Versailles St-Quentin; Versailles France
- Department of Epidemiology and Public Health; University College London; London UK
| | - Aline Dugravot
- INSERM; Centre for Research in Epidemiology and Population Health; U1018, Epidemiology of Ageing and Age-Related Diseases; Villejuif France
- UMRS 1018; University Versailles St-Quentin; Versailles France
| | - Christophe Tzourio
- INSERM U897; Neuroepidemiology Team; Bordeaux France
- University of Bordeaux; Bordeaux France
| | - Alexis Elbaz
- INSERM; Centre for Research in Epidemiology and Population Health; U1018, Epidemiology of Ageing and Age-Related Diseases; Villejuif France
- UMRS 1018; University Versailles St-Quentin; Versailles France
| |
Collapse
|
26
|
Metzelthin SF, van Rossum E, Hendriks MRC, De Witte LP, Hobma SO, Sipers W, Kempen GIJM. Reducing disability in community-dwelling frail older people: cost-effectiveness study alongside a cluster randomised controlled trial. Age Ageing 2015; 44:390-6. [PMID: 25566783 DOI: 10.1093/ageing/afu200] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/12/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND although proactive primary care, including early detection and treatment of community-dwelling frail older people, is a part of the national healthcare policy in several countries, little is known about its cost-effectiveness. OBJECTIVE to evaluate the cost-effectiveness of a proactive primary care approach in community-dwelling frail older people. DESIGN AND SETTING embedded in a cluster randomised trial among 12 Dutch general practitioner practices, an economic evaluation was performed from a societal perspective with a time horizon of 24 months. METHOD frail older people in the intervention group received an in-home assessment and interdisciplinary care based on a tailor-made treatment plan and regular evaluation and follow-up. Practices in the control group delivered usual care. The primary outcome for the cost-effectiveness and cost-utility analysis was disability and health-related quality of life, respectively. RESULTS multilevel analyses among 346 frail older people showed no significant differences between the groups regarding disability and health-related quality of life at 24 months. People in the intervention group used, as expected, more primary care services, but there was no decline in more expensive hospital and long-term care. Total costs over 24 months tended to be higher in the intervention group than in the control group (€26,503 versus €20,550, P = 0.08). CONCLUSIONS the intervention under study led to an increase in healthcare utilisation and related costs without providing any beneficial effects. This study adds to the scarce amount of evidence of the cost-effectiveness of proactive primary care in community-dwelling frail older people. TRIAL REGISTRATION Current Controlled Trials, ISRCTN 31954692.
Collapse
Affiliation(s)
- Silke F Metzelthin
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, Limburg the Netherlands
| | - Erik van Rossum
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, Limburg the Netherlands Centre of Research on Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, Limburg, the Netherlands Centre of Research on Technology in Care, Zuyd University of Applied Sciences, Heerlen, Limburg, the Netherlands
| | - Marike R C Hendriks
- Department of Human Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, Limburg, the Netherlands Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, North Holland, the Netherlands
| | - Luc P De Witte
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, Limburg the Netherlands Centre of Research on Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, Limburg, the Netherlands Centre of Research on Technology in Care, Zuyd University of Applied Sciences, Heerlen, Limburg, the Netherlands
| | - Sjoerd O Hobma
- Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg, the Netherlands
| | - Walther Sipers
- Orbis Medical Centre, Sittard-Geleen, Limburg, the Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, Limburg the Netherlands
| |
Collapse
|
27
|
Abasolo L, Leon L, Lajas C, Carmona L, Serra JA, Reoyo A, Rodriguez-Rodriguez L, Jover JÁ. An early intervention program for subacute physical disability related to musculoskeletal diseases in the elderly: a pilot study. Rheumatol Int 2015; 35:1183-91. [PMID: 25634768 DOI: 10.1007/s00296-015-3223-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
To evaluate the efficacy of a program for subacute physical disability due to musculoskeletal disorders (MSD) in the elderly. We carried out a randomized controlled evaluator-blinded intervention study in a health district (October 2005 to April 2008). Subjects older than 64, starting a subacute MSD episode of physical disability-defined as moderate disability or higher in the Rosser classification-and identified by general practitioners, were randomized into standard care or an early specific program. The program was carried out by rheumatologists following detailed proceedings. Efficacy was defined as the difference between groups in the duration of episodes-time from onset until an improvement larger than a point in the Rosser classification). Hazard ratios (HR) to recovery of the program over standard care were obtained from Cox regression analyses. One hundred and twenty-three patients were included, generating 244 episodes of subacute MSD. Mean duration of episodes was 5 months; 14.5 % of them were chronically disabled throughout follow-up. The program was associated with shorter duration of episodes compared with CG analyzing just the ended ones (p = 0.004). The HR to recovery between groups did not achieve statistical differences. Nevertheless, recovery rate at 12 months and HR from those with moderate physical disability at the inclusion period (Rosser disability level 4, n = 84) were superior in the IG (HR 1.9, p = 0.03; HR 1.93; p = 0.03 respectively). An early intervention program for subacute MSD-related disability in elderly has partial efficacy; the program benefited patients with moderate physical disability and after a year of follow-up.
Collapse
Affiliation(s)
- Lydia Abasolo
- Servicio de Reumatologia, Rheumatology Department, IdISSC, Hospital Clínico San Carlos, Calle Martín Lagos s/n, 28040, Madrid, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Gu D, Gomez-Redondo R, Dupre ME. Studying Disability Trends in Aging Populations. J Cross Cult Gerontol 2014; 30:21-49. [DOI: 10.1007/s10823-014-9245-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
29
|
Bindels J, Cox K, De La Haye J, Mevissen G, Heijing S, van Schayck OCP, Widdershoven G, Abma TA. Losing connections and receiving support to reconnect: experiences of frail older people within care programmes implemented in primary care settings. Int J Older People Nurs 2014; 10:179-89. [PMID: 25219530 DOI: 10.1111/opn.12066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The objective of this study was to evaluate whether care provided in the care programmes matched the needs of older people. BACKGROUND Care programmes were implemented in primary-care settings in the Netherlands to identify frail older people and to prevent further deterioration of health. DESIGN AND METHODS In total, 23 older people participated in in-depth interviews. Within this study, three older people participated as co-researchers; they gathered and analysed the data together with the academic researchers. Content analysis was used to analyse the data. RESULTS Two categories emerged from the data: 'Losing connections' and 'Receiving support to reconnect.' 'Losing connections' reflects the needs of older people and 'Receiving support to reconnect' reflects their experience and the appreciated aspects of the provided care. A relationship of trust with the practice nurse (PN) appeared to be an important aspect of care, as it fostered the sharing of feelings and issues other than physical or medical problems that could not be shared with the general practitioner. The PNs are experienced as connectors, who help to restore feelings of connectedness and older peoples' access to resources in the community. CONCLUSIONS The relationship with the PN was experienced as valuable because of the feelings of 'connectedness' it created. Through this connectedness, older people could discuss feelings of loneliness, depression and frustration in receiving and acquiring the appropriate resources and services with the PNs. Furthermore, the relationship with the PN helped the older people to gain access to other health professionals and services. IMPLICATIONS FOR PRACTICE The results imply that care for frail older people should include an awareness of the importance of the trusting relationship. Nurses can play a vital role in creating a trusting relationship and are able to bridge the gap between older people and other professionals and services.
Collapse
Affiliation(s)
- Jill Bindels
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Karen Cox
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Fontys University of Applied Sciences, School of Nursing, Eindhoven, The Netherlands
| | | | | | | | - Onno C P van Schayck
- CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Guy Widdershoven
- Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands
| | - Tineke A Abma
- Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
30
|
Cramm JM, Lee J. Smoking, physical activity and healthy aging in India. BMC Public Health 2014; 14:526. [PMID: 24884852 PMCID: PMC4047779 DOI: 10.1186/1471-2458-14-526] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 05/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To identify levels of physical inactivity and smoking and examine their relationships to health among older people in India. METHODS In 2010, Longitudinal Aging Study in India researchers interviewed 1,683 older adults in randomly sampled households with members aged ≥ 45 years in eight stratified districts in four states (90.9% response rate). We first used descriptive analyses to characterize older people in poor and good health. Differences between groups were established using chi-squared and t-tests. Multivariate logistic regression analyses were then performed to determine whether physical inactivity and smoking led to poor health while controlling for district of residence, caste, age, gender, marital status, and educational level. Regression analyses were also used to identify significant relationships between socio-demographic characteristics and health behaviors. RESULTS Larger proportions of older people in poor health were smokers (26.1% vs. 16.9%; p ≤ 0.001) and physically inactive (vigorous activities: 88.7% vs. 70.7%, p ≤ 0.001; moderate activities: 67.1% vs. 57.1%, p ≤ 0.01). Smoking (p ≤ 0.05) and lack of vigorous physical activity (p ≤ 0.001) increased the likelihood of poor health. Low educational level was significantly related to smoking and the lack of moderate physical activity (both p ≤ 0.001). Female gender decreased the likelihood of smoking. Male gender increased the likelihood of vigorous physical activity but decreased the likelihood of moderate physical activity. CONCLUSIONS Smoking and physical inactivity have important impacts on the health of older people in India. Policy attention is needed to improve these modifiable health behaviors.
Collapse
Affiliation(s)
- Jane Murray Cramm
- Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
| | | |
Collapse
|
31
|
Gramstad A, Storli SL, Hamran T. Exploring the meaning of a new assistive technology device for older individuals. Disabil Rehabil Assist Technol 2014; 9:493-8. [PMID: 24839989 DOI: 10.3109/17483107.2014.921249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Researching the outcomes of assistive technology devices (ATDs) for older clients is important to facilitate clinical decision-making. However, to understand the outcomes associated with ATDs, one must investigate the users' experiences and acknowledge the user as an active participant in diverse social contexts. PURPOSE To enhance understanding of the users' perspective regarding ATDs, this study aimed to investigate the meaning of the ATD for older individuals still living in their home environment. METHODS To provide descriptions of ATD experiences, older individuals who received a new ATD to compensate for their challenges in moving around, assist in self-care or both were recruited for the study. Participants were interviewed twice, with a few months between interviews, about their experience in using their new ATD. The interview transcripts were analyzed in a hermeneutical-phenomenological research approach. RESULTS The analysis revealed three recurring themes associated with the description of ATD experiences: "enabling performance and choice", "transformation from requiring assistance to assisting others", and "preparing for the future". CONCLUSION The results show that ATDs are used to enhance competence, mastery, control, self-worth, hope, and preparedness. The ATD service delivery should be client-centered and the client should be acknowledged as an active participant in producing change.
Collapse
Affiliation(s)
- Astrid Gramstad
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø , Tromsø , Norway and
| | | | | |
Collapse
|
32
|
Szanton SL, Wolff JW, Leff B, Thorpe RJ, Tanner EK, Boyd C, Xue Q, Guralnik J, Bishai D, Gitlin LN. CAPABLE trial: a randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: rationale and design. Contemp Clin Trials 2014; 38:102-12. [PMID: 24685996 DOI: 10.1016/j.cct.2014.03.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/18/2014] [Accepted: 03/21/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND As the population ages, it is increasingly important to test new models of care that improve life quality and decrease health costs. This paper presents the rationale and design for a randomized clinical trial of a novel interdisciplinary program to reduce disability among low income older adults based on a previous pilot trial of the same design showing strong effect. METHODS The CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial is a randomized controlled trial in which low income older adults with self-care disability are assigned to one of two groups: an interdisciplinary team of a nurse, occupational therapist, and handyman to address both personal and environmental risk factors for disability based on participants' functional goals, or an attention control of sedentary activities of choice. Both groups receive up to 10 home visits over 4 months. OUTCOMES The primary outcome is decreased disability in self-care (ADL). Secondary outcomes are sustained decrease in self care disability as well as improvement in instrumental ADLS, strength, balance, walking speed, and health care utilization. Careful cost tracking and analysis using intervention data and claims data will enable direct measurement of the cost impact of the CAPABLE approach. CAPABLE has the potential to leverage current health care spending in Medicaid waivers, Accountable Care Organizations and other capitated systems to save the health care system costs as well as improving low income older adults' ability to age at home with improved life quality.
Collapse
Affiliation(s)
- Sarah L Szanton
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States.
| | - J W Wolff
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - B Leff
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States
| | - R J Thorpe
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - E K Tanner
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States
| | - C Boyd
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States
| | - Q Xue
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States
| | - J Guralnik
- University of Maryland Medical School, United States
| | - D Bishai
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - L N Gitlin
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States
| |
Collapse
|
33
|
The Prediction of ADL and IADL Disability Using Six Physical Indicators of Frailty: A Longitudinal Study in the Netherlands. Curr Gerontol Geriatr Res 2014; 2014:358137. [PMID: 24782894 PMCID: PMC3982262 DOI: 10.1155/2014/358137] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/24/2014] [Indexed: 12/30/2022] Open
Abstract
Frailty is a predictor of disability. A proper understanding of the contribution of individual indicators of frailty in the prediction of disability is a requisite for preventive interventions. The aim of this study was to determine the predictive power of the individual physical frailty indicators: gait speed, physical activity, hand grip strength, Body Mass Index (BMI), fatigue, and balance, for ADL and IADL disability. The sample consisted of 505 community-dwelling persons (≥75 years, response rate 35.1%). Respondents first participated between November 2007 and June 2008, and a subset of all respondents participated again one year later (N = 264, 52.3% response rate). ADL and IADL disability were assessed by the Groningen Activity Restriction Scale. BMI was assessed by self-report, and the other physical frailty indicators were assessed with the TUG test (gait speed), the LAPAQ (physical activity), a hand grip strength test, the SFQ (fatigue), and the Four-test balance scale. All six physical frailty indicators were associated with ADL and IADL disability. After controlling for previous disability, sociodemographic characteristics, self-perceived lifestyle, and chronic diseases, only gait speed was predictive of both ADL and IADL disability, whereas there was a small effect of fatigue on IADL disability. Hence, these physical frailty indicators should be included in frailty assessment when predicting future disability.
Collapse
|
34
|
Cramm JM, Twisk J, Nieboer AP. Self-management abilities and frailty are important for healthy aging among community-dwelling older people; a cross-sectional study. BMC Geriatr 2014; 14:28. [PMID: 24602327 PMCID: PMC3975729 DOI: 10.1186/1471-2318-14-28] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 02/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to identify the relationships of self-management abilities and frailty to perceived poor health among community-dwelling older people in the Netherlands while controlling for important individual characteristics such as education, age, marital status, and gender. METHODS The cross-sectional study sample consisted of 869/2212 (39% response rate) independently living older adults (aged ≥70 years) in 92 neighborhoods of Rotterdam. In the questionnaires we assessed self-rated health, frailty using the Tilburg Frailty Indicator (TFI) and self-management abilities with the short version of the Self-Management Ability Scale (SMAS-S). We first used descriptive analysis to identify those in poor and good health. Differences between groups were established using chi-squared and t-tests. Relationships between individual characteristics, frailty, self-management abilities and poor health were investigated with correlation analyses. Multilevel logistic regression analyses were than performed to investigate the relationships of self-management abilities and frailty to health while controlling for age, gender, education, and marital status. The results of the multilevel regression analyses are reported as odd ratios. RESULTS Respondents in poor health were older than those in good health (78.8 vs. 77.2; p ≤ .001). A significantly larger proportion of older people in poor health were poorly educated (38.4% vs. 19.0%; p ≤ .001) and fewer were married (33.6% vs. 46.3%; p ≤ .001). Furthermore, older people in poor health reported significantly lower self-management abilities (3.5 vs. 4.1; p ≤ .001) and higher levels of frailty (6.9 vs. 3.3; p ≤ .001). Correlation analyses showed significant relationships between frailty, self-management abilities and poor health. Multilevel analyses showed that, after controlling for background characteristics, self-management abilities were negatively associated with poor health (p ≤ .05) and a positive relationship was found between frailty and poor health (p ≤ .05) among older people in the community. CONCLUSIONS Self-management abilities and frailty are important for healthy aging among community-dwelling older people in the Netherlands. Particularly vulnerable are the lower educated older adults. Interventions to improve self-management abilities may help older people age healthfully and prevent losses as they age further.
Collapse
Affiliation(s)
- Jane M Cramm
- Institute of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam 3000 DR, The Netherlands
| | - Jos Twisk
- Department of Methodology and Applied Biostatistics, Institute of Health Sciences, Faculty of Earth and Life Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anna P Nieboer
- Institute of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam 3000 DR, The Netherlands
| |
Collapse
|
35
|
Smets IHGJ, Kempen GIJM, Janssen-Heijnen MLG, Deckx L, Buntinx FJVM, van den Akker M. Four screening instruments for frailty in older patients with and without cancer: a diagnostic study. BMC Geriatr 2014; 14:26. [PMID: 24571290 PMCID: PMC3938903 DOI: 10.1186/1471-2318-14-26] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 02/17/2014] [Indexed: 12/27/2022] Open
Abstract
Background Frailty in older patients might influence treatment decisions. Frailty can be determined using a Comprehensive Geriatric Assessment (CGA), but this is time-consuming and expensive. Therefore we assessed the diagnostic value of four shorter screening instruments. Methods We tested the abbreviated CGA (aCGA), the Vulnerable Elders Survey-13 (VES-13), the Groningen Frailty Indicator (GFI) and the Geriatric 8 (G8). A full CGA including functional status, cognitive status, depression, nutrition and comorbidity was used as reference. A minimum of 85% for both sensitivity and specificity was predefined as acceptable. Data were collected through personal interviews by trained interviewers. We assessed people aged ≥ 70 years: 108 patients with recently diagnosed cancer recruited in hospitals and 290 without cancer recruited by general practitioners in the Netherlands and Belgium. Frailty was defined as having impairment in at least two domains of the full CGA. We used original cut-offs for the screening instruments and calculated sensitivity, specificity, positive and negative diagnostic values and the percentage classified as frail. Results Sensitivity of aCGA was 79% and 87% for patients with and without cancer; specificity was 59% and 64%. Sensitivity of VES-13 was 67% and 82% for patients with and without cancer; specificity was 70% and 79%. Sensitivity for GFI was 76% (in both groups) and specificity 73% (in both groups). Sensitivity for G8 was 87% and 75% for patients with and without cancer; specificity was 68% (in both groups). Conclusions No screening instrument was acceptable according to our predefined minimum of 85% for both sensitivity and specificity. The diagnostic value of the investigated instruments is rather poor and one could wonder about their additional value to clinical judgment.
Collapse
Affiliation(s)
- Ineke H G J Smets
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands.
| | | | | | | | | | | |
Collapse
|
36
|
Gramstad A, Storli SL, Hamran T. Older individuals' experiences during the assistive technology device service delivery process. Scand J Occup Ther 2014; 21:305-12. [DOI: 10.3109/11038128.2013.877070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
37
|
Bindels J, Cox K, Widdershoven G, van Schayck OCP, Abma TA. Care for community-dwelling frail older people: a practice nurse perspective. J Clin Nurs 2013; 23:2313-22. [DOI: 10.1111/jocn.12513] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Jill Bindels
- Department of Health Services Research; CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - Karen Cox
- Department of Health Services Research; CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
- School of Nursing; Fontys University of Applied Sciences; Eindhoven The Netherlands
| | - Guy Widdershoven
- Department of Medical Humanities; EMGO Institute for Health and Care Research; VU University Medical Centre; Amsterdam The Netherlands
| | - Onno CP van Schayck
- Department of General Practice; CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | - Tineke A Abma
- Department of Medical Humanities; EMGO Institute for Health and Care Research; VU University Medical Centre; Amsterdam The Netherlands
| |
Collapse
|
38
|
Metzelthin SF, van Rossum E, de Witte LP, Ambergen AW, Hobma SO, Sipers W, Kempen GIJM. Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial. BMJ 2013; 347:f5264. [PMID: 24022033 PMCID: PMC3769159 DOI: 10.1136/bmj.f5264] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To evaluate whether an interdisciplinary primary care approach for community dwelling frail older people is more effective than usual care in reducing disability and preventing (further) functional decline. DESIGN Cluster randomised controlled trial. SETTING 12 general practices in the south of the Netherlands PARTICIPANTS 346 frail older people (score ≥ 5 on Groningen Frailty Indicator) were included; 270 (78%) completed the study. INTERVENTIONS General practices were randomised to the intervention or control group. Practices in the control group delivered care as usual. Practices in the intervention group implemented the "Prevention of Care" (PoC) approach, in which frail older people received a multidimensional assessment and interdisciplinary care based on a tailor made treatment plan and regular evaluation and follow-up. MAIN OUTCOME MEASURES The primary outcome was disability, assessed at 24 months by means of the Groningen Activity Restriction Scale. Secondary outcomes were depressive symptomatology, social support interactions, fear of falling, and social participation. Outcomes were measured at baseline and at 6, 12, and 24 months' follow-up. RESULTS 193 older people in the intervention group (six practices) received the PoC approach; 153 older people in the control group (six practices) received care as usual. Follow-up rates for patients were 91% (n=316) at six months, 86% (n=298) at 12 months, and 78% (n=270) at 24 months. Mixed model multilevel analyses showed no significant differences between the two groups with regard to disability (primary outcome) and secondary outcomes. Pre-planned subgroup analyses confirmed these results. CONCLUSIONS This study found no evidence for the effectiveness of the PoC approach. The study contributes to the emerging body of evidence that community based care in frail older people is a challenging task. More research in this field is needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN31954692.
Collapse
Affiliation(s)
- Silke F Metzelthin
- Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P O Box 616, 6200 MD Maastricht, Netherlands
| | | | | | | | | | | | | |
Collapse
|
39
|
Ziden L, Haggblom-Kronlof G, Gustafsson S, Lundin-Olsson L, Dahlin-Ivanoff S. Physical Function and Fear of Falling 2 Years After the Health-Promoting Randomized Controlled Trial: Elderly Persons in the Risk Zone. THE GERONTOLOGIST 2013; 54:387-97. [DOI: 10.1093/geront/gnt078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
40
|
Bleijenberg N, ten Dam VH, Drubbel I, Numans ME, de Wit NJ, Schuurmans MJ. Development of a proactive care program (U-CARE) to preserve physical functioning of frail older people in primary care. J Nurs Scholarsh 2013; 45:230-7. [PMID: 23530956 DOI: 10.1111/jnu.12023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE Care for older patients in primary care is currently reactive, fragmented, and time consuming. An innovative structured and proactive primary care program (U-CARE) has been developed to preserve physical functioning and enhance quality of life of frail older people. This study describes in detail the development process of the U-CARE program to allow its replication. METHODS The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used as a theoretical guide for the design of the U-CARE program. An extended stepwise multimethod procedure was used to develop U-CARE. A team of researchers, general practitioners, registered practice nurses, experts, and an independent panel of older persons was involved in the development process to increase its feasibility in clinical practice. A systematic review of the literature and of relevant guidelines, combined with clinical practice experience and expert opinion, was used for the development of the intervention. FINDINGS Based on predefined potentially effective guiding components, the U-CARE program comprises three steps: a frailty assessment, a comprehensive geriatric assessment at home followed by a tailor-made care plan, and multiple follow-up visits. Evidence-based care plans were developed for 11 geriatric conditions. The feasibility in clinical practice was tested and approved by experienced registered practice nurses. CONCLUSIONS Using the MRC Framework, a detailed description of the development process of the innovative U-CARE program is provided, which is often missing in reports of complex intervention trials. Based on our feasibility-pilot study, the general practitioners and the registered practice nurses indicated that the U-CARE intervention is feasible in clinical practice. CLINICAL RELEVANCES The U-CARE program consists of promising components and has the potential to improve the care of older patients.
Collapse
Affiliation(s)
- Nienke Bleijenberg
- Rho Chi at Large, Nurse, Nursing Scientist, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
41
|
Bleijenberg N, Ten Dam VH, Steunenberg B, Drubbel I, Numans ME, De Wit NJ, Schuurmans MJ. Exploring the expectations, needs and experiences of general practitioners and nurses towards a proactive and structured care programme for frail older patients: a mixed-methods study. J Adv Nurs 2013; 69:2262-73. [DOI: 10.1111/jan.12110] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Nienke Bleijenberg
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Valerie Hester Ten Dam
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Bas Steunenberg
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Irene Drubbel
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Mattijs E. Numans
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Niek J. De Wit
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Marieke J. Schuurmans
- Department of Rehabilitation; Nursing Science and Sports Medicine; University Medical Center Utrecht; The Netherlands
| |
Collapse
|
42
|
Stijnen MMN, Jansen MWJ, Vrijhoef HJM, Duimel-Peeters IGP. Development of a home visitation programme for the early detection of health problems in potentially frail community-dwelling older people by general practices. Eur J Ageing 2013; 10:49-60. [PMID: 28804282 PMCID: PMC5549230 DOI: 10.1007/s10433-012-0251-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The integration within existing health care systems of preventive initiatives to maintain independent living among older people is increasingly emphasized. This article describes the development and refinement of the [G]OLD home visitation programme: an eight-step programme, including a comprehensive geriatric assessment, for the early detection of health and well-being problems among older people (≥75 years) by general practices. A single group post-test study using a mixed model design is performed to evaluate (a) the feasibility of the home visitation programme in general practice, (b) the practical usefulness of the geriatric assessment instrument, and (c) programme implementation with respect to reinventions introduced by general practitioners (GPs) and practice nurses (PNs). Within 3 months time, 22 PNs of 18 participating general practices visited 240 community-dwelling older people (mean age = 82.0 years; SD 4.2) who had not been in contact with their general practice for more than 6 months. Mean time investment of the programme per older person was 118.1 min (SD 27.0) for GPs and PNs combined. Evaluation meetings revealed that GPs and PNs considered the home visitation programme to be feasible in daily practice. They judged the geriatric assessment to be useful, although minor adjustments are needed (e.g., lay-out, substitution of tests). PNs often failed to register follow-up actions for detected problems in a care and treatment plan. Future training for PNs should address this issue. No reinventions were introduced that threatened fidelity of implementation. The findings are used to improve the home visitation programme before its evaluation in a large-scale controlled trial.
Collapse
Affiliation(s)
- Mandy M. N. Stijnen
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Maria W. J. Jansen
- Public Health Service South-Limburg, School for Public Health and Primary Care (CAPHRI), P.O. Box 2022, 6160 HA Geleen, The Netherlands
| | - Hubertus J. M. Vrijhoef
- Tilburg University, Scientific Centre for Care and Welfare (TRANZO), P.O. Box 90153, 5000 LE Tilburg, The Netherlands
| | - Inge G. P. Duimel-Peeters
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Patient & Care, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| |
Collapse
|
43
|
Cramm JM, Nieboer AP. Relationships between frailty, neighborhood security, social cohesion and sense of belonging among community-dwelling older people. Geriatr Gerontol Int 2012. [PMID: 23190426 DOI: 10.1111/j.1447-0594.2012.00967.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The relationships between frailty and neighborhood social resources and neighborhood quality among community-dwelling older people are poorly understood. We therefore enquired into these associations while controlling for important individual characteristics. METHODS Our cross-sectional study included 945 out of 1440 (66% response rate) community-dwelling older people (aged ≥ 70 years) in Rotterdam. The sample included approximately 430 older adults per district and was proportional with respect to neighborhood and age. Potential participants were mailed questionnaires, non-respondents were first sent a reminder, then asked by telephone and finally visited at home to complete the questionnaire. RESULTS Age, sex, marital status and level of education varied between the frail and non-frail. A significantly larger proportion of the frail was female (64.4% vs 48.0%; P ≤ 0.001), fewer were married (22.1% vs 48.4%; P ≤ 0.001) and the frail were, on average, older than the non-frail (78.8 vs 76.0 years; P ≤ 0.001). A significantly larger proportion of the frail were poorly educated (25.9% vs 18.6%; P ≤ 0.01). Multilevel regression analyses showed that older age (P<0.001) was associated with higher likelihood of frailty and marital status (P<0.001) with lower likelihood of frailty. Feeling more secure (P<0.001) and having a stronger sense of social cohesion and neighborhood belonging (P<0.05) seemed to protect against frailty. CONCLUSION The results of this study support the importance of feeling safe, social cohesion and a sense of belonging within the neighborhood. These findings could have important implications for efforts to reduce frailty of older people within communities.
Collapse
Affiliation(s)
- Jane M Cramm
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | | |
Collapse
|
44
|
Liebel DV, Friedman B, Watson NM, Powers BA. Which components of a primary care affiliated home visiting nurse program are associated with disability maintenance/improvement? Home Health Care Serv Q 2012; 31:155-80. [PMID: 22656915 DOI: 10.1080/01621424.2012.681550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A process evaluation of a primary care affiliated home visiting nurse intervention was performed to determine which intervention components were associated with disability maintenance/improvement. This secondary analysis (N = 238) used data recorded in intervention databases and patient interviews among community-dwelling elders with disability. Intervention components were examined in descriptive, correlational, bivariate, and logistic regression analyses. Results demonstrated that two structure components--physician-patient-family-nurse conference visits and intervention (education) materials--and three process components--disease management activities, goal setting, and medication management activities--were linked to maintaining/improving activities of daily living disability status. Confirmation of these findings may help home care nurses to delay disability worsening.
Collapse
Affiliation(s)
- Dianne V Liebel
- University of Rochester, School of Nursing, Rochester, New York 14642-8404, USA.
| | | | | | | |
Collapse
|
45
|
Frost H, Haw S, Frank J. Interventions in community settings that prevent or delay disablement in later life: an overview of the evidence. QUALITY IN AGEING AND OLDER ADULTS 2012. [DOI: 10.1108/14717791211264241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
46
|
Bleijenberg N, Drubbel I, Ten Dam VH, Numans ME, Schuurmans MJ, de Wit NJ. Proactive and integrated primary care for frail older people: design and methodological challenges of the Utrecht primary care PROactive frailty intervention trial (U-PROFIT). BMC Geriatr 2012; 12:16. [PMID: 22533710 PMCID: PMC3373372 DOI: 10.1186/1471-2318-12-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 04/25/2012] [Indexed: 01/20/2023] Open
Abstract
Background Currently, primary care for frail older people is reactive, time consuming and does not meet patients' needs. A transition is needed towards proactive and integrated care, so that daily functioning and a good quality of life can be preserved. To work towards these goals, two interventions were developed to enhance the care of frail older patients in general practice: a screening and monitoring intervention using routine healthcare data (U-PRIM) and a nurse-led multidisciplinary intervention program (U-CARE). The U-PROFIT trial was designed to evaluate the effectiveness of these interventions. The aim of this paper is to describe the U-PROFIT trial design and to discuss methodological issues and challenges. Methods/Design The effectiveness of U-PRIM and U-CARE is being tested in a three-armed, cluster randomized trial in 58 general practices in the Netherlands, with approximately 5000 elderly individuals expected to participate. The primary outcome is the effect on activities of daily living as measured with the Katz ADL index. Secondary outcomes are quality of life, mortality, nursing home admission, emergency department and out-of-hours General Practice (GP), surgery visits, and caregiver burden. Discussion In a large, pragmatic trial conducted in daily clinical practice with frail older patients, several challenges and methodological issues will occur. Recruitment and retention of patients and feasibility of the interventions are important issues. To enable broad generalizability of results, careful choices of the design and outcome measures are required. Taking this into account, the U-PROFIT trial aims to provide robust evidence for a structured and integrated approach to provide care for frail older people in primary care. Trial registration NTR2288
Collapse
Affiliation(s)
- Nienke Bleijenberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht CG 3584, The Netherlands.
| | | | | | | | | | | |
Collapse
|
47
|
Daniels R, van Rossum E, Beurskens A, van den Heuvel W, de Witte L. The predictive validity of three self-report screening instruments for identifying frail older people in the community. BMC Public Health 2012; 12:69. [PMID: 22269425 PMCID: PMC3293057 DOI: 10.1186/1471-2458-12-69] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 01/23/2012] [Indexed: 11/16/2022] Open
Abstract
Background If brief and easy to use self report screening tools are available to identify frail elderly, this may avoid costs and unnecessary assessment of healthy people. This study investigates the predictive validity of three self-report instruments for identifying community-dwelling frail elderly. Methods This is a prospective study with 1-year follow-up among community-dwelling elderly aged 70 or older (n = 430) to test sensitivity, specificity, and positive and negative predicted values of the Groningen Frailty Indicator, Tilburg Frailty Indicator and Sherbrooke Postal Questionnaire on development of disabilities, hospital admission and mortality. Odds ratios were calculated to compare frail versus non-frail groups for their risk for the adverse outcomes. Results Adjusted odds ratios show that those identified as frail have more than twice the risk (GFI, 2.62; TFI, 2.00; SPQ, 2,49) for developing disabilities compared to the non-frail group; those identified as frail by the TFI and SPQ have more than twice the risk of being admitted to a hospital. Sensitivity and specificity for development of disabilities are 71% and 63% (GFI), 62% and 71% (TFI) and 83% and 48% (SPQ). Regarding mortality, sensitivity for all tools are about 70% and specificity between 41% and 61%. For hospital admission, SPQ scores the highest for sensitivity (76%). Conclusion All three instruments do have potential to identify older persons at risk, but their predictive power is not sufficient yet. Further research on these and other instruments is needed to improve targeting frail elderly.
Collapse
Affiliation(s)
- Ramon Daniels
- Faculty of Health and Care, Zuyd University of Applied Sciences, PO Box 550, 6400 AN Heerlen, The Netherlands.
| | | | | | | | | |
Collapse
|
48
|
Gill TM, Gahbauer EA, Murphy TE, Han L, Allore HG. Risk factors and precipitants of long-term disability in community mobility: a cohort study of older persons. Ann Intern Med 2012; 156:131-40. [PMID: 22250144 PMCID: PMC3278794 DOI: 10.7326/0003-4819-156-2-201201170-00009] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Relatively little is known about why older persons develop long-term disability in community mobility. OBJECTIVE To identify the risk factors and precipitants for long-term disability in walking a quarter mile and driving a car. DESIGN Prospective cohort study from March 1998 to December 2009. SETTING Greater New Haven, Connecticut. PARTICIPANTS 641 persons, aged 70 years or older, who were active drivers or nondisabled in walking a quarter mile. Persons who were physically frail were oversampled. MEASUREMENTS Candidate risk factors were assessed every 18 months. Disability in community mobility and exposure to potential precipitants, including illnesses or injuries leading to hospitalization or restricted activity, were assessed every month. Disability that lasted 6 or more consecutive months was considered long-term. RESULTS 318 (56.0%) and 269 (53.1%) participants developed long-term disability in walking and driving, respectively. Seven risk factors were independently associated with walking disability and 8 were associated with driving disability; the strongest associations for each outcome were found for older age and lower score on the Short Physical Performance Battery. The precipitants had a large effect on long-term disability, with multivariate hazard ratios for each outcome greater than 6.2 for hospitalization and greater than 2.4 for restricted activity. The largest differences in absolute risk were generally observed in participants with a specific risk factor who were subsequently hospitalized. LIMITATIONS The observed associations may not be causal. The severity of precipitants was not assessed. The effect of the precipitants may have been underestimated because their exposure after the initial onset of disability was not evaluated. CONCLUSION Long-term disability in community mobility is common among older persons. Multiple risk factors, together with subsequent precipitants, greatly increase the likelihood of long-term mobility disability. PRIMARY FUNDING SOURCE National Institute on Aging, National Institutes of Health.
Collapse
Affiliation(s)
- Thomas M Gill
- Yale University School of Medicine, New Haven, Connecticut 06504, USA.
| | | | | | | | | |
Collapse
|
49
|
Risk factors and precipitants of long-term disability in community mobility: a cohort study of older persons. Ann Intern Med 2012. [PMID: 22250144 PMCID: PMC3278794 DOI: 10.1059/0003-4819-156-2-201201170-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Relatively little is known about why older persons develop long-term disability in community mobility. OBJECTIVE To identify the risk factors and precipitants for long-term disability in walking a quarter mile and driving a car. DESIGN Prospective cohort study from March 1998 to December 2009. SETTING Greater New Haven, Connecticut. PARTICIPANTS 641 persons, aged 70 years or older, who were active drivers or nondisabled in walking a quarter mile. Persons who were physically frail were oversampled. MEASUREMENTS Candidate risk factors were assessed every 18 months. Disability in community mobility and exposure to potential precipitants, including illnesses or injuries leading to hospitalization or restricted activity, were assessed every month. Disability that lasted 6 or more consecutive months was considered long-term. RESULTS 318 (56.0%) and 269 (53.1%) participants developed long-term disability in walking and driving, respectively. Seven risk factors were independently associated with walking disability and 8 were associated with driving disability; the strongest associations for each outcome were found for older age and lower score on the Short Physical Performance Battery. The precipitants had a large effect on long-term disability, with multivariate hazard ratios for each outcome greater than 6.2 for hospitalization and greater than 2.4 for restricted activity. The largest differences in absolute risk were generally observed in participants with a specific risk factor who were subsequently hospitalized. LIMITATIONS The observed associations may not be causal. The severity of precipitants was not assessed. The effect of the precipitants may have been underestimated because their exposure after the initial onset of disability was not evaluated. CONCLUSION Long-term disability in community mobility is common among older persons. Multiple risk factors, together with subsequent precipitants, greatly increase the likelihood of long-term mobility disability. PRIMARY FUNDING SOURCE National Institute on Aging, National Institutes of Health.
Collapse
|
50
|
Metzelthin SF, Daniels R, van Rossum E, de Witte LP, van den Heuvele WJA, Kempen GIJM. [The psychometric properties of three self-report screening instruments for identifying frail older people in the community]. Tijdschr Gerontol Geriatr 2011; 42:120-30. [PMID: 21834306 DOI: 10.1007/s12439-011-0022-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Frailty can lead towards serious adverse consequences, such as disability. With regard to prevention valid screening instruments are needed to identify frail older people. The aim was to evaluate and compare the psychometric properties of three screening instruments: the Groningen Frailty Indicator (GFI), the Tilburg Frailty Indicator (TFI) and the Sherbrooke Postal Questionnaire (SPQ). For validation purposes the Groningen Activity Restriction Scale (GARS) was added. METHODS A questionnaire was sent to 687 older people (> or = 70 years). (1) Agreement between instruments, (2) internal consistency, (3) cumulative scalability according to Mokken scale analysis and (4) construct validity were evaluated. RESULTS The response rate was 77%. Prevalence estimates of frailty ranged from 40% to 59%. The highest agreement was found between the GFI and TFI (Cohen's kappa = 0.74). Cronbach's alpha for the GFI, TFI and SPQ was 0.73, 0.79 and 0.26, respectively. The scalability of the three instruments was inadequate (Loevinger's H: 0.28, 0.30 and 0.09 for GFI, TFI and SPQ, respectively). Frailty scores correlated significantly with each other and with the GARS scores. CONCLUSION Especially the GFI and TFI seem to be useful to identify frail older people. Further research regarding their predictive validity is still needed.
Collapse
Affiliation(s)
- S F Metzelthin
- Vakgroep Verpleging en Verzorging, CAPHRI School for Public Health and Primary Care, Universiteit Maastricht
| | | | | | | | | | | |
Collapse
|