Health education: special issues for older adults

Free interactive counselling program in a mobile communication application for improving health education on indwelling ureteric stents after ureterorenoscopic lithotripsy: An observational study

Objective

This study examines the potential benefit of an interactive counselling program via a mobile application (app), which can instantly provide patients with the necessary information and correct response regarding their condition.

Methods

We designed a free ‘Ureteric Stent Interactive Program’ for patients receiving ureterorenoscopic lithotripsy and provided the program to interested patients. Patient data were collected from medical records and depending on whether patients used our program, they were divided into two groups: ‘program-user’ and ‘non-user’. The differences between the groups were analysed using Fisher’s exact tests.

Results

Of the 70 patients, 50 elected to use the program. The program-user group was significantly younger (<60 years: 74% vs 15%, P<0.001) and had higher education levels (40% vs 5%, P = 0.004). All 50 patients in the program-user group reported being satisfied (32%) or very satisfied (68%) with the program. Patients over 60 years were significantly more satisfied with program (35.5% vs 6.3%, P = 0.04).

Conclusions

Younger patients with high education levels were more likely to use the app and improve their health knowledge. Using the program resulted in high satisfaction, especially among older patients. This study demonstrates the benefits of interactive application for educating patients regarding their health.

Acceptability of a nurse-led, person-centred, anticipatory care planning intervention for older people at risk of functional decline: A qualitative study

BACKGROUND

As the population of older adults increases, the complexity of care required to support those who choose to remain in the community amplifies. Anticipatory Care Planning (ACP), through earlier identification of healthcare needs, is evidenced to improve quality of life, decrease aggressive interventions, and prolong life. With patient acceptability of growing importance in the design, implementation, and evaluation of healthcare interventions, this study reports on the acceptability of a primary care based ACP intervention on the island of Ireland.

METHODS

As part of the evaluation of a feasibility cluster randomized controlled trial (cRCT) testing an ACP intervention for older people at risk of functional decline, intervention participants [n = 34] were interviewed in their homes at 10-week follow-up to determine acceptability. The intervention consisted of home visits by specifically trained registered nurses who assessed participants' health, discussed their health goals and plans, and devised an anticipatory care plan in collaboration with participants' GPs and adjunct clinical pharmacist. Thematic analysis was employed to analyze interview data. The feasibility cRCT involved eight general practitioner (GP) practices as cluster sites, stratified by jurisdiction, four in Northern Ireland (NI) (two intervention, two control), and four in the Republic of Ireland (ROI) (two intervention, two control). Participants were assessed for risk of functional decline. A total of 34 patients received the intervention and 31 received usual care.

FINDINGS

Thematic analysis resulted in five main themes: timing of intervention, understanding of ACP, personality & individual differences, loneliness & social isolation, and views on healthcare provision. These map across the Four Factor Model of Acceptability ('4FMA'), a newly developed conceptual framework comprising four components: intervention factors, personal factors, social support factors, and healthcare provision factors.

CONCLUSION

Acceptability of this primary care based ACP intervention was high, with nurses' home visits, GP anchorage, multidisciplinary working, personalized approach, and active listening regarded as beneficial. Appropriate timing, and patient health education emerged as vital.

Health Knowledge Effects: An Integrated Community Health Promotion Platform

The Taiwanese government subsidizes healthcare providers offering preventive medicine to patients to help reduce the threats of chronic sickness and halt skyrocketing medical expenditures. Usually, nurses are the primary workers who perform community health promotion; however, because of the chronic shortage of working nurses, many Taiwan hospitals have closed wards and deferred the responsibility of promoting primary prevention. With a community health promotion platform integrating interactive response features and Web sites for community patients and hospital staff, a case hospital efficiently sustained the community health services. The objective of this study was to assess the impact of the integrated community health promotion platform for conducting education. Fifty-four patients/residents were invited to join a quasi-experiment of health education, and a follow-up survey was conducted to assess the acceptance of the community health promotion platform from both the experimental group of learners/users and the hospital staff. The results showed that the community health promotion platform was effective in improving participant health awareness. The experimental group outperformed the control group, with higher posttest scores and longer knowledge retention. Furthermore, users indicated a high acceptance of the community health promotion platform.

Ethnic comparison of weight loss in the Trial of Nonpharmacologic Interventions in the Elderly

OBJECTIVE

To compare weight loss in blacks and whites in the Trial of Nonpharmacologic Interventions in the Elderly (TONE).

RESEARCH METHODS AND PROCEDURES

TONE enrolled 421 overweight white and 164 overweight black adults, 60 to 79 years old, with blood pressure well-controlled on a single, antihypertensive drug. Drug therapy withdrawal was attempted 3 months after randomization to counseling for weight loss, sodium reduction, both weight loss and sodium reduction, or to usual care, with follow-up for 15 to 36 months after enrollment. Statistical procedures included repeated measures analysis of covariance and logistic and proportional hazards regression.

RESULTS

In the weight-loss condition, net weight change (in kilograms) was -2.7 in blacks and -5.9 in whites (p < 0.001; ethnic difference, p = 0.0002) at 6 months and -2.0 (p < 0.05) in blacks and -4.9 (p < 0.001) in whites at the end of follow-up (ethnic difference, p = 0.007). In weight/sodium, net weight change was -2.1 (p < 0.01) in blacks and -2.8 (p < 0.001) in whites at 6 months, and -1.9 in blacks and -1.7 in whites at the end of follow-up (p < 0.05; ethnic difference, p > 0.5). Exploratory analyses suggested a more favorable pattern of weight change in blacks than in whites from 6 months onward. There was no ethnic difference in blood pressure outcomes.

DISCUSSION

Whites lost more weight than blacks without, but not with, a concurrent focus on sodium reduction.

Medication compliance and older people: a review of the literature

The purpose of this paper is to critically review a select body of literature pertaining to medication compliance among older people. As there is a vast amount of literature on the topic, this review is selective to include (1) a critique of the more commonly cited compliance theories, (2) an analysis of the key variables influencing medication compliance among older people and (3) a critical evaluation of the literature which examines these phenomena. In addition, studies, which explore the benefits of Self-Administration of Medication Schemes, are the subject of particular scrutiny, by virtue of the fact that they address not only the education component but also the behavioural component of a well-organised patient education programme. The review is limited to material published in English since 1980 with the exception of the literature on compliance theories, which originated in previous decades. Key search terms including medication, compliance, older people, self-medication and education were used to derive the relevant material from the Medline and CINAHL databases. The literature was then critically reviewed using the criteria identified by Roe (1993) [Roe, B., 1993. Undertaking a critical review of the literature. Nurse Researcher 1(1), 35-46.] which emphasises the need for clarity in key areas such as research design, sample selection, research methods, results, discussion and conclusions. Empirical research which met this criteria was included in the review and in the main, this was found in academic rather than professional journals. The review concludes with a summary of the main points and a discussion of the implications for nursing practice, education and research.

Development of a health education programme for elderly with age-related macular degeneration: a focus group study

Age-related macular degeneration is a serious public health problem, and in most cases no cure exists. One available intervention is low vision rehabilitation, and there is a lack of programmes for the elderly. The purpose of this paper is to present the results of an evaluation of a group-based health education programme. This programme comprised six to eight 2-3 hour meetings, once a week, for persons with age-related macular degeneration. Each group consisted of four to six participants. The goal of the programme, which has its roots in the health belief model, was to sustain and restore the participants' performance of their daily activities. The tool used for process evaluation was focus group methodology, and eight focus groups were involved. Forty five persons, whose average age was 80 years, took part in the evaluation. The results indicated that the participants were, on the whole, pleased with the content of the programme. There were, however, some indications that they did not understand all the information provided. Social support, regained hope and meeting others with the same disease were reported as positive aspects of the health education programme. The importance of the group leader's role in guiding this health education programme was emphasised. Furthermore, with regard to the composition of the groups, the participants pointed out that it was important to consider variation in visual acuity, so as to provide different models for comparison, and whether both sexes should participate in all groups. Finally, several suggestions for improving the programme are put forward.

Interest in participation in a peer-led senior health education program

A study was made of the characteristics of older adults showing an interest in participating in a health education course given by peers. Determining the degree of interest in health education is important for assessing the impact on the target-population and evaluating the dissemination strategy. In the course 'Successful Aging' groups of older adults came together to discuss health related issues. The course was given by senior health educators aged 55 years and over from the peer group. To determine interest in the course answer cards were sent with a letter of invitation to all independently living inhabitants aged between 55 an 79 in a Dutch community. The rate of expressed interest in the course was 5.8%. Interest was highest among females in the 55-64 age group, the unmarried and those with low wellbeing. Males in the age group 65-79, females aged 75-79, those with a lower socio-economic status and the inactive were comparatively less interested. Subscription to the course was distinguished from mere interest in the course. From those who expressed interest, more people of low socio-economic status, with a reduced level of wellbeing, many physical limitations and poor self-efficacy actually subscribed. It is concluded that the health education program will be continued and that special attention will be paid to groups that showed lower levels of uptake. Involving intermediates from these groups in the course development is recommended.

Pilot study to enhance start-up of a multicenter nutrition intervention trial

Multicenter trials are important for answering questions that require large numbers of subjects. Such trials require standardized implementation of behavioral change programs across diverse populations, regions, and staff. Researchers involved with the Trial of Nonpharmacologic Interventions in the Elderly conducted a 17-week pilot study of their most complex intervention (combined weight and sodium reduction) before actual start-up of the main study. This allowed staff to rehearse implementing the program and to identify and address intervention and standardization issues. Registered dietitians in 4 US communities recruited 28 participants for the pilot study, using eligibility criteria similar to those for the main trial. Participant evaluations reflected high satisfaction with the program materials and overall approach. Minor protocol changes suggested by results of the pilot study were made easily in time for start-up of the main study. Reductions in weight and sodium intake were less than targeted but were sufficient to suggest that the intervention would be effective under optimal conditions. This partial achievement of goals in the pilot study underscored the need to allow for a learning curve, for without it standardization and outcomes of the main study would be compromised.

The extent of breast cancer screening in older women

Women 65 and older present a unique challenge to health professionals, particularly with respect to breast cancer screening. These women are at the highest risk for developing breast cancer; they represent 50% of all newly diagnosed breast cancers. This group represents 60% of the breast cancer deaths, however, demonstrating how serious a disease breast cancer is in the 65-and-older age group. Moreover, the 65-and-older population cohort is growing rapidly. By 2010, it is estimated that greater than 15% of the population will be older than 65, and, as is the case now, the majority of this group will be women. Therefore, preventing breast cancer deaths in older women is a very significant and pressing issue. Ironically, most studies have reported that screening for breast cancer is less widespread in women older than 65 than in those younger than 65. Regional surveys emphasize a number of barriers, some of which seem to be age-specific--a lower level of knowledge about the usefulness and benefit of mammography, particularly in the absence of symptoms; less of a sense of personal vulnerability; fewer screening recommendations from family, friends, or physicians; and more problems with access (cost, transportation). To improve breast cancer screening rates in older women, sound health education interventions are needed to improve knowledge of and belief and attitudes regarding mammography. These should be targeted not only to older women, but also to their physicians and/or primary care givers. In addition, specific attention should be given to those barriers that are particularly burdensome for the elderly: cost, transportation problems, and loss of mobility.

Evaluating written patient education materials

Evaluation, the last component in the process of patient education, is the most frequently omitted step in producing informative material. Yet, it is essential that program/material evaluation be conducted to determine the impact and success or failure of the program or material. It is vital to be aware of this need and possess knowledge about types of evaluation and those areas that must be included to provide a comprehensive evaluation.

Perceptions and behaviour among elderly hospital patients: description and explanation of age differences in satisfaction, knowledge, emotions and behaviour

In this study, it is first of all investigated whether elderly and younger hospital patients differ with respect to satisfaction with several aspects of their stay in the hospital, medical and hospital knowledge, emotional state, seeking information, discussing problems and engaging in self-care. Second, it is investigated whether age differences on these variables can be explained by demographic variables, previous hospitalization experience, information received and personality characteristics on which elderly and younger patients differ. Results show that compared to younger patients, elderly patients are more satisfied, have less knowledge and a smaller number of emotional problems and are less active during hospital admission. These differences covary with, a more positive assessment of the information received, a stronger level of external control, a higher level of social desirability and stronger feelings of gratitude among elderly patients. These results are in line with Taylor's concept of the 'good patient'. Finally, based on the findings, measures are suggested for health workers to promote the well-being of elderly hospital patients.