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Moore TL. Resilience of individuals with chronic illness who reside in low resource communities: a concept analysis. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100215. [PMID: 39005946 PMCID: PMC11245916 DOI: 10.1016/j.ijnsa.2024.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 07/16/2024] Open
Abstract
Background Chronic illness diagnosis while living in low resourced communities creates ongoing adversity in the process of adaptation. Resilience is an important phenomenon of study to improve health outcomes. The subject in this particular population has been poorly studied. Objective To conceptualize resilience of individuals with chronic illness who reside in low resource communities. Design Concept analysis. Data sources Seminal works and current studies were searched in PubMed (including Medline), Science Direct, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, Google Scholar, OVID, Ebsco, and the Cochrane Database. Qualitative and quantitative studies that investigated individual resilience of adults in the setting of chronic illness who reside in low resource communities were included. Exclusions included children with chronic illness and resilience of communities and populations. Methods Walker and Avant's method of concept analysis was utilized. The key elements for conceptualizing resilience in the setting of chronic illness who reside in low resource communities included defining attributes, antecedents and consequences of resilience identified from the literature search. Results Analysis revealed three defining attributes: (1) reflection, contemplation, and the will to live despite adversity through hope; (2) personal transcendence through action; and (3) continuous personal transcendence and maintenance. Antecedents and consequences of resilience in the setting of chronic illness who reside in low resource communities were described and outlined. Conclusions The conceptualization of resilience in the setting of chronic illness who reside in low resource communities is based on the defining attributes, antecedents, and consequences that resulted in a preliminary conceptual model. The model can be further tested in diverse populations to add to the existing knowledge on the subject, and develop interventions to foster resilience aimed to improve health outcomes and quality of life.
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Chavda VP, Balar PC, Vaghela DA, Dodiya P. Unlocking longevity with GLP-1: A key to turn back the clock? Maturitas 2024; 186:108028. [PMID: 38815535 DOI: 10.1016/j.maturitas.2024.108028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/05/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024]
Abstract
Traditionally known for managing blood sugar, GLP-1, a gut hormone, is emerging as a potential key to both lengthening lifespan and combating age-related ailments. While widely recognized for its role in blood sugar control, GLP-1 is increasingly recognized for its diverse effects on various biological pathways beyond glucose metabolism. Research across organisms and humans suggests that activating GLP-1 receptors significantly impacts cellular processes linked to aging. Its ability to boost mitochondrial function, enhance cellular stress resistance, and quell inflammation hints at its wider influence on aging mechanisms. This intricate interplay between GLP-1 and longevity appears to act through multiple pathways. One key effect is its ability to modulate insulin sensitivity, potentially curbing age-related metabolic issues like type 2 diabetes. Its neuroprotective properties also make it a promising candidate for addressing age-related cognitive decline and neurodegenerative diseases. Furthermore, preclinical studies using GLP-1 analogs or agonists have shown promising results in extending lifespan and improving healthspan in various model organisms. These findings provide a compelling rationale for exploring GLP-1-based interventions in humans to extend healthy aging. However, despite the exciting therapeutic prospects of GLP-1 in promoting longevity, challenges remain. Determining optimal dosages, establishing long-term safety profiles, and investigating potential adverse effects require comprehensive clinical investigations before we can confidently translate these findings to humans. This article emphasises the wide applicability of GLP-1.
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Affiliation(s)
- Vivek P Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L M College of Pharmacy, Ahmedabad 380008, Gujarat, India.
| | - Pankti C Balar
- Pharmacy Section, L M College of Pharmacy, Ahmedabad 380008, Gujarat, India
| | - Dixa A Vaghela
- Pharmacy Section, L M College of Pharmacy, Ahmedabad 380008, Gujarat, India
| | - Payal Dodiya
- Pharmacy Section, L M College of Pharmacy, Ahmedabad 380008, Gujarat, India
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Friedman C, VanPuymbrouck L. Environmental Modifications for People With Intellectual and Developmental Disabilities: A Policy Analysis of Medicaid Home- and Community-Based Services. Am J Occup Ther 2024; 78:7803205090. [PMID: 38767469 DOI: 10.5014/ajot.2024.050393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
IMPORTANCE Environmental modifications are targets for occupational therapy intervention because they support activities of daily living, self-efficacy, personal control, independence, and community living for people with intellectual and developmental disabilities (IDDs). OBJECTIVE To examine how environmental modifications were provided to people with IDDs through Medicaid home- and community-based services (HCBS) waivers across the United States in fiscal year (FY) 2021. DESIGN Using a mixed-methods policy analysis, we examined FY 2021 Medicaid HCBS 1915(c) waivers from across the United States to examine whether, and how, states provided environmental modifications to people with IDDs. RESULTS In FY 2021, 35 states projected spending $68.8 million on environmental modifications for 12,671 people with IDDs. The purpose of environmental modifications was most often to promote the health, welfare, and safety of people with IDDs (82.68%), and to promote their independence (69.29%). The most common examples of environmental modifications included ramps and/or lifts (70.08%), widening doorways and/or hallways (61.42%), bathroom modifications (58.27%), specialized electrical and/or plumbing for medical equipment (54.33%), and grab bars and/or handrails (53.54%). CONCLUSIONS AND RELEVANCE HCBS waiver data on environmental modifications for people with IDDs enhances an understanding of this funding source and provides a foundation of advocacy for occupational therapy practitioners to support people with IDDs with living, as well as aging, in the community rather than in institutions. An expansion of environmental modifications in HCBS for people with IDDs aligns with the aim of Medicaid HCBS waivers to promote community integration, self-determination, and independence, which are all benefits of environmental modifications. Plain-Language Summary: This study can help occupational therapy practitioners determine what funding sources are available in their state to help their clients with intellectual and developmental disabilities access environmental modifications. The findings can also help guide advocacy and lobbying efforts to expand access to environmental modifications.
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Affiliation(s)
- Carli Friedman
- Carli Friedman, PhD, is Director of Research, The Council on Quality and Leadership, Towson, MD;
| | - Laura VanPuymbrouck
- Laura VanPuymbrouck, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, Rush University, Chicago, IL
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Smith BM, Donohue PK, Seltzer RR. Family perspectives on provider conversations about housing needs for children with medical complexity. Child Care Health Dev 2024; 50:e13253. [PMID: 38529766 DOI: 10.1111/cch.13253] [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: 07/05/2023] [Revised: 12/19/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Children with medical complexity (CMC) have unique, and often unmet, housing needs that place them at risk for housing insecurity and poor health outcomes. Yet, little is known about how families with CMC discuss their housing needs with healthcare providers. We sought to understand: (1) how housing is currently discussed between CMC caregivers and healthcare providers, and (2) how CMC caregivers want such conversations to occur. METHODS From August to November 2020, we conducted semi-structured interviews with parents/guardians of CMC (<26 years old) in Maryland as part of a larger study to understand their housing experience. Four questions on communication with providers about housing were developed a priori and included in this analysis. Qualitative content analysis was applied to interview transcripts. RESULTS Among 31 completed interviews, most participants were female (90%), lived in single-family homes (68%) and were from a mix of neighbourhood types (urban 19%, suburban 58%, rural 22%). Their children ranged in age from 6 months to 22 years, had a mix of insurance types (public 65%, private 29%, both 6%) and nearly all required medical equipment or technology. Four themes emerged: (1) Current housing conversations are rare and superficial, (2) Ideal housing conversations would result in thoughtful care plans and concrete supports, (3) Frequency and initiation of housing conversations are best tailored to family preferences and (4) Value of housing conversations are limited by lack of provider knowledge and time. CONCLUSIONS Conversations about housing needs for CMC happen in limited ways with healthcare providers, despite a desire on the part of their caregivers. Such conversations can give meaningful insights into the family's specific housing challenges, allowing providers to appropriately tailor care plans and referrals. Future work is needed to capture provider perspectives, design CMC-specific housing screeners and develop interdisciplinary referral strategies.
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Affiliation(s)
- Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca R Seltzer
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
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Carcavilla-González N, Escalada San Adrián G, Minobes-Molina E, Pàmies-Tejedor S, Roncal-Belzunce V, Atarés-Rodríguez L, García-Navarro JA. A Paradigm Shift on Deinstitutionalization and Dementia Care: A Narrative Review. J Alzheimers Dis 2024; 99:829-841. [PMID: 38759003 DOI: 10.3233/jad-231180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer's disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.
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Affiliation(s)
- Nuria Carcavilla-González
- Department of Health Sciences, Public University of Navarra, Campus de Arrosadia, Pamplona, Spain
- Spanish Society of Geriatrics and Gerontology, Madrid, Spain
| | | | - Eduard Minobes-Molina
- Spanish Society of Geriatrics and Gerontology, Madrid, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Victoria, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Victoria, Spain
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Kiyoshi-Teo H, McMahon SK, Northup-Snyder K, Cohen DJ. Older People's Descriptions of Their Engagement in Fall Prevention. West J Nurs Res 2024; 46:10-18. [PMID: 37950361 DOI: 10.1177/01939459231211803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Evidence-based strategies to decrease fall rates are well established. However, little is understood about how older people engage in fall prevention strategies. Motivational Interviewing (MI) sessions aimed to facilitate individuals' engagement in fall prevention can be analyzed to learn what it means for older people to engage in fall prevention. Thus, the purpose of this study was to explore how older people describe their engagement in fall prevention. Participants in our parent project, MI for Fall Prevention (MI-FP), who received MI sessions were purposively selected for maximum variation in age, sex, fall risks, and MI specialist assigned. The first (of 8) MI sessions from 16 participants were recorded, transcribed, and analyzed using qualitative content analysis. Three researchers first deductively analyzed fall prevention strategies that participants described using an evidence-based fall prevention guideline as a reference. Then, we inductively analyzed the characteristics of these strategies and how participants engaged in them. Finally, we used the Capability, Opportunity, Motivation, Behavior (COM-B) model to organize our results about factors influencing engagement. We found (1) older adults engage in unique combinations of fall prevention strategies and (2) decisions about engagement in fall prevention strategies were influenced by multiple factors that were personal (e.g., who I am, capability, motivation, and opportunities). This study highlighted how fall prevention can be a life-long lifestyle decision for older people. Understanding older people's perspectives about engaging in fall prevention is essential to develop interventions to promote evidence-based fall prevention strategies in real-world settings.
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Affiliation(s)
- Hiroko Kiyoshi-Teo
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | | | | | - Deborah J Cohen
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
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Omaki E, Brown B, Shargo I, Moreno H, McKnight M, McDonald E, Stewart W, Shiang E, Norton RA, Shields WC. CHASE (Children's Housing Assessment for a Safe Environment): a protocol for the inspection and modification of injury risks in children's homes. Inj Epidemiol 2023; 10:47. [PMID: 37817290 PMCID: PMC10565964 DOI: 10.1186/s40621-023-00460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Decades of research and practice experience have led to an extensive body of evidence about effective home safety modifications. However, the benefits of safety modifications have not reached all segments of society. Poor quality housing in low-income neighborhoods, along with limited access to safety products and injury prevention information, can be significant barriers to child safety. METHODS This is a longitudinal study of 300 low-income families in Baltimore City and Baltimore County with children under 7 years of age who are referred from existing Green & Healthy Homes Initiative (GHHI) home visiting programs. Three home visits will be completed to assess home injury hazards using a previously developed tool, the Children's Housing Assessment for a Safe Environment (CHASE), and provide a Scope of Work that includes home modifications specific to the identified home injury hazards. An Assessor will also provide do-it-yourself education materials and injury prevention supplies to assist residents in completing the modifications. If the parent or caregiver is unable to complete the home modifications, a professional Housing Intervention Services team will complete the home modifications necessary to prevent injury in the home. This study will involve both quantitative and qualitative data analysis methods. Paired and regression analyses will be conducted to examine the maintenance of modifications and the variables associated with positive outcomes. A thematic analysis of staff and participant interviews will be used to identify perceived barriers and facilitators of successful program implementation. DISCUSSION Better data on residential injuries of children and an improvement in the overall surveillance of home injuries are necessitated. This study will set a strong foundation for a larger future study of health and cost effectiveness outcomes and will advance our understanding of the feasibility, costs, and potential benefits of addressing and preventing home injuries to children.
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Affiliation(s)
- Elise Omaki
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD, USA
| | - Brendan Brown
- Green and Healthy Homes Initiative, Baltimore, MD, USA
| | - Isabel Shargo
- Green and Healthy Homes Initiative, Baltimore, MD, USA
| | - Hector Moreno
- Green and Healthy Homes Initiative, Baltimore, MD, USA
| | | | - Eileen McDonald
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD, USA
| | - Wes Stewart
- Green and Healthy Homes Initiative, Baltimore, MD, USA
| | - Evelyn Shiang
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD, USA
| | | | - Wendy C Shields
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD, USA.
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Seo E, Lee S. Implications of Aging in Place in the Context of the Residential Environment: Bibliometric Analysis and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6905. [PMID: 37887643 PMCID: PMC10606307 DOI: 10.3390/ijerph20206905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023]
Abstract
The residential environment's impact on aging in place is a multidisciplinary field that draws from architecture, urban planning, gerontology, psychology, and sociology. This multidisciplinary nature makes it challenging to comprehensively understand the field and identify the connections and interactions among disciplines. A bibliometric analysis is crucial for exploring the field's intellectual structure, identifying interdisciplinary collaborations, and tracking the knowledge flow across disciplines and will facilitate cross-disciplinary dialogue, foster collaboration, and encourage research that integrates diverse perspectives. This study reviewed the literature on aging in place in the context of a residential environment, which required adapting theories and methodologies. It analyzed a dataset of 1500 publications retrieved from the Web of Science, applied performance analysis techniques, and utilized VOSviewer to visualize the intellectual structure and evolving research themes. The results emphasize the increasing strength of academic interest and the growing diversity of fields related to the topic. The findings are discussed in terms of productivity, collaboration, and research themes from the past to the future. The results provide a roadmap for researchers, policymakers, and practitioners worldwide who focus on aging in place and acknowledge the importance of considering the physical, social, and cultural aspects of an older adult's living environment.
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Affiliation(s)
| | - Sanghee Lee
- Department of Architecture, Kwangwoon University, Seoul 01897, Republic of Korea;
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Owusu B, Bivins B, Marseille BR, Baptiste D. Aging in place: Programs, challenges and opportunities for promoting healthy aging for older adults. Nurs Open 2023; 10:5784-5786. [PMID: 37246470 PMCID: PMC10416066 DOI: 10.1002/nop2.1872] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 05/30/2023] Open
Affiliation(s)
- Brenda Owusu
- Director of Adult‐Gerontology Primary Care Nurse Practitioner ProgramUniversity of Miami School of Nursing and Health StudiesCoral GablesFloridaUSA
| | - Balkys Bivins
- School of Nursing and Health StudiesUniversity of MiamiCoral GablesFloridaUSA
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Toto PE, Alchin T, Yanes C, Park J, Fields BE. Implementing CAPABLE With Care Partners Through an Area Agency on Aging: Identifying Barriers and Facilitators Using the Consolidated Framework for Implementation Research. THE GERONTOLOGIST 2023; 63:428-438. [PMID: 35797990 DOI: 10.1093/geront/gnac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Community Aging in Place, Advancing Better Living for Elders (CAPABLE) is an evidence-based intervention to promote aging in place. Although CAPABLE has been implemented in more than 40 community sites, wide variation in implementation exists. Guided by the Consolidated Framework for Implementation Research (CFIR), this study sought to determine key barriers and facilitators that may influence CAPABLE implementation with older adult and care partner dyads through an area agency on aging (AAA). RESEARCH DESIGN AND METHODS A formative evaluation was completed using qualitative data from the pilot of a Hybrid Trial Type 1 study implementing CAPABLE in an AAA. Multiple sources of data were collected, including 2 focus groups, field notes, a tracking log, and meetings with CAPABLE interventionists. Data were analyzed using a framework method and validated through a negative case analysis approach in NVivo 12 Pro. RESULTS Fourteen dyads enrolled in the pilot and 6 completed the CAPABLE intervention. Key themes aligned with 10 constructs from 5 domains of the CFIR. Facilitators included adaptability of the intervention, cost, networks and communication, and knowledge and belief of individuals. Barriers included intervention complexity, client needs and resources, and executing the planned process. DISCUSSION AND IMPLICATIONS Results enhance understanding of contextual factors that can influence the implementation of CAPABLE with care partners. Strategies to overcome barriers include simplifying recruitment materials and targeting older adults with recent onset of disability. The CFIR is a valuable resource for planning and evaluation of the implementation of evidence-based interventions to promote aging in place.
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Affiliation(s)
- Pamela E Toto
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tucker Alchin
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caylee Yanes
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Junha Park
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Beth E Fields
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Semeah LM, Orozco T, Wang X, Ahonle ZJ, Cowper-Ripley D, Ganesh SP, Wilson LK, Litt ER, Ahern JK, Santos Roman LM, Varma DS, Lee MJ, Novak JR, Jia H. Rural and Urban Home Modification Program Users: A Comparative Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:223-235. [PMID: 36727246 DOI: 10.1177/19375867221142627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand the sociodemographic, geographical, and clinical characteristics of rural veterans utilizing home modification (HM) healthcare services under the Home Improvement Structural Alterations (HISA) program, to compare these characteristics between rural and urban veteran users, to estimate the costs of HMs performed, and to present distance that users traveled to HISA-prescribing medical facilities within the Veterans Health Administration (VHA). BACKGROUND Accessible housing is in short supply. HMs allow veterans with disabilities (VWDs) to remain living at home rather than enter institutional-type settings. HISA is associated with decreased inpatient hospitalization rates and increased use of preventative healthcare via outpatient clinic visits. Home accessibility provides psychological benefits improving social interactions and interaction with the physical environment. METHODS This retrospective database study analyzes data from the National Prosthetics Patient Database and other medical datasets within the VHA. RESULTS Results provide a profile of and comparison between rural and urban veteran users. HISA users are substantially older compared to younger VWDs. The frequency of bathroom, railing, and wooden ramp HMs differed significantly between rural and urban users (p values < .001). Rural users traveled more miles than urban users to reach a prescribing facility. CONCLUSIONS Older adults and individuals with disabilities have unmet housing needs since accessible housing is in short supply. This HM healthcare service is helping to meet the housing accessibility needs of older veterans, VWDs, older adults, and people with disabilities, in general.
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Affiliation(s)
- Luz M Semeah
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Tatiana Orozco
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Xinping Wang
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | | | | | | | - Eric R Litt
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Justin K Ahern
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Deepthi Satheesa Varma
- University of Florida Department of Epidemiology and Health Policy Research, Gainesville, FL, USA
| | - Mi Jung Lee
- The University of Texas Medical Branch, Galveston, TX, USA
| | | | - Huanguang Jia
- U.S. Department of Veterans Affairs, Washington, DC, USA
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12
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Sheth S, Cogle CR. Home Modifications for Older Adults: A Systematic Review. J Appl Gerontol 2023; 42:1151-1164. [PMID: 36655622 DOI: 10.1177/07334648231151669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
While ≧10,000 Americans turn 65 years old every day, only 10% of American homes are "aging ready." Unsafe homes can exacerbate disability, lead to falls, and increase the likelihood of hospitalization. With increased investments in home and community-based services, public health stakeholders are considering home modifications to promote successful aging. While several home modification models exist, there is significant heterogeneity between models and no consensus on critical features. PubMed, EMBASE, and Web of Science were reviewed and twelve randomized controlled trials of home modifications for older adults were identified and evaluated for model structure, reported outcomes, and risk of bias. Overall, occupational therapist-driven home modifications supplemented with clinical, physical activity, and/or behavioral components saw the greatest success. This systematic review discusses the components of these models, highlights particularly effective and frequently used features, and the practice and research needed to create effective next-generation home modification models which promote healthy longevity.
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Affiliation(s)
- Sohum Sheth
- College of Medicine, 12233University of Florida, Gainesville, FL, USA
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Li J, Okoye S, Dwivedi P, Sciarratta L, Li M, Taylor J, Szanton SL. Promoting sleep in low-income older adults with disabilities: Comparing CAPABLE with a social engagement control. Geriatr Nurs 2022; 47:220-225. [PMID: 35944382 PMCID: PMC10167677 DOI: 10.1016/j.gerinurse.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
Sleep plays a vital role in older adults' health. The Community Aging in Place-Advancing Better Living for Elders (CAPABLE) trial, conducted in Maryland between 2012 and 2016, is a 5-month biobehavioral environmental intervention study to reduce functional disabilities in 300 low-income older adults. Individual and environmental factors impacting sleep were addressed in CAPABLE. This secondary data analysis was to test the preliminary effect of CAPABLE on actigraph-measured sleep, compared with a social engagement control in 73 CAPABLE participants with pretest-posttest actigraph data. Participants in this analysis were aged 75.8±7.5 years; 86.3% of them were females and 84.9% were Black/African Americans. Both CAPABLE intervention and social engagement control improved sleep efficiency and reduced sleep onset latency. The effect of CAPABLE on sleep was comparable to social engagement. These findings underline the importance of promoting physical function and maintaining social activity for sleep in low-income older adults with disabilities.
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Affiliation(s)
- Junxin Li
- Johns Hopkins University School of Nursing, Baltimore, United States.
| | - Safiyyah Okoye
- Johns Hopkins University School of Nursing, Baltimore, United States
| | - Pallavi Dwivedi
- Johns Hopkins University School of Nursing, Baltimore, United States
| | - Lena Sciarratta
- Johns Hopkins University School of Nursing, Baltimore, United States
| | - Mengchi Li
- Johns Hopkins University School of Nursing, Baltimore, United States
| | - Janiece Taylor
- Johns Hopkins University School of Nursing, Baltimore, United States
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, United States
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Spoelstra SL, Schueller M, Basso V, Sikorskii A. Results of a multi-site pragmatic hybrid type 3 cluster randomized trial comparing level of facilitation while implementing an intervention in community-dwelling disabled and older adults in a Medicaid waiver. Implement Sci 2022; 17:57. [PMID: 36028873 PMCID: PMC9419328 DOI: 10.1186/s13012-022-01232-5] [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] [Received: 01/07/2022] [Accepted: 08/14/2022] [Indexed: 01/28/2023] Open
Abstract
Background Evidence-based interventions that optimize physical function for disabled and older adults living in the community who have difficulty with daily living tasks are available. However, uptake has been limited, particularly in resource-constrained (Medicaid) settings. Facilitation may be an effective implementation strategy. This study’s aim was to compare internal facilitation (IF) versus IF and external facilitation (EF) on adoption and sustainability of an intervention in a Medicaid home and community-based waiver. Methods In a hybrid type 3 trial, waiver sites (N = 18) were randomly assigned to implement the intervention using a bundle of strategies with either IF or IF and EF. Adoption and sustainability were assessed via Stages of Implementation Completion (SIC) for each site. Clinician attitudes toward evidence-based practice and self-efficacy were evaluated among 539 registered nurses, social workers, and occupational therapists. Medicaid beneficiary outcomes of activities of daily living, depression, pain, falls, emergency department visits, and hospitalizations were evaluated in a sample of N = 7030 as reflected by electronic health records data of the Medicaid waiver program. Linear mixed-effects models were used to compare outcomes between trial arms while accounting for cluster-randomized design. Results The mean SIC scores were 72.22 (standard deviation [SD] = 16.98) in the IF arm (9 sites) and 61.33 (SD = 19.29) in the IF + EF arm (9 sites). The difference was not statistically significant but corresponded to the medium clinically important effect size Cohen’s d = 0.60. Clinician implementation outcomes of attitudes and self-efficacy did not differ by trial arm. Beneficiary depression was reduced significantly in the IF + EF arm compared to the IF arm (p = .04, 95% confidence interval for the difference [0.01, 0.24]). No differences between trial arms were found for other beneficiary outcomes. Conclusions Level of facilitation did not enhance capacity for adoption and sustainability of an evidence-based intervention in a Medicaid setting that cares for disabled and older adults. Improved beneficiary depression favored use of IF and EF compared to IF alone, and no differences were found for other outcomes. These findings also suggest level of facilitation may not have impacted beneficiary outcomes. Trial registration ClinicalTrials.gov, NCT03634033; date registered August 16, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01232-5.
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Affiliation(s)
- Sandra L Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, 301 Michigan St, Room C352, Grand Rapids, MI, 49504, USA.
| | - Monica Schueller
- Kirkhof College of Nursing, Grand Valley State University, 301 Michigan St, Room C352, Grand Rapids, MI, 49504, USA
| | - Viktoria Basso
- Statistics Department, Grand Valley State University, Grand Rapids, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, East Lansing, USA
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15
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Fields B, Yanes C, Ennis M, Toto P. Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program: Understanding the potential involvement of care partners. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1212-e1219. [PMID: 34355833 DOI: 10.1111/hsc.13529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/01/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
Older adults frequently turn to care partners for support to remain in their homes for as long as possible. Yet, many evidence-based home and community programs to support ageing in place do not formally involve care partners. This study sought to understand how to involve care partners in the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program. A qualitative descriptive study was conducted. Framework analysis of multiple sources of data, including descriptions from stakeholders (N = 24) and available CAPABLE resources, provided the basis for understanding how to involve care partners in the program. Considerations for involving care partners when initiating, delivering and following the program were generated; namely, providing older adults' choices while screening for the program, defining roles and sharing information in a collaborative manner and reinforcing knowledge and skills training. Embracing these considerations in geriatric practice and research efforts is likely to help care partners' ability to provide assistance, thus enabling older adults to remain in their homes for as long as possible. Providers can use findings to better involve and support care partners in their delivery of programs to older adults. Researchers should further develop and test a care partner-supported CAPABLE program.
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Affiliation(s)
- Beth Fields
- University of Wisconsin-Madison, Madison, WI, USA
| | | | - Molly Ennis
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Pamela Toto
- University of Pittsburgh, Pittsburgh, PA, USA
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16
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Abshire Saylor M, Pavlovic NV, DeGroot L, Jajodia A, de Hladek MC, Perrin N, Wolff J, Davidson PM, Szanton S. Strengths-building through life purpose, self-care goal setting and social support: Study protocol for Caregiver Support. Contemp Clin Trials Commun 2022; 28:100917. [PMID: 35602009 PMCID: PMC9118505 DOI: 10.1016/j.conctc.2022.100917] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/15/2022] [Accepted: 04/30/2022] [Indexed: 11/12/2022] Open
Abstract
Background For caregivers of people with heart failure, addressing a range of care recipient needs at home can potentially be burdensome, but caregivers may also gain meaning from caregiving. The Caregiver Support Program, a multicomponent strengths-based intervention, is designed to improve outcomes of heart failure caregivers. Objectives 1) Test the feasibility and gauge an initial effect size of the Caregiver Support Program to improve caregiver quality of life (primary outcome), and fatigue and burden (secondary outcomes) from baseline to 16 weeks, 2) test whether fatigue and caregiver burden are associated with objective measures of resilience (sweat inflammatory cytokines (Il-6 and IL-10) and self-reported resilience, 3) evaluate changes in heart rate variability, IL-6 and IL-10, pre- and post-intervention. Methods This is a single-blind, two group, waitlist control trial. Eligible caregivers are 1) ≥ 18 years, 2) English speaking, 3) live with the person with heart failure or visit them at least 3 days per week to provide care, 4) provide support for at least 1 instrumental activity of daily living (IADL), 5) live within a 1 h driving radius of the Johns Hopkins Hospital, and 6) the care-recipient has been hospitalized within the last 6 months. Trial participants are randomized into the immediate intervention (n = 24) or waitlist control group (n = 24). Data collection is at baseline, 16 weeks, and 32 weeks. Conclusion The Caregiver Support program has the potential to increase quality of life and decrease fatigue and caregiver burden for caregivers of people with heart failure and multiple co-morbidities.
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17
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The Behavioral Factors That Influence Person-Centered Social Care: A Literature Review and Conceptual Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074334. [PMID: 35410016 PMCID: PMC8998779 DOI: 10.3390/ijerph19074334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
The last decade has seen numerous policy reforms to emplace person-centered social care. Consequently, the public has been given more information, choice, and autonomy to decide how best they want to be cared for later in life. Despite this, adults generally fail to plan or prepare effectively for their future care needs. Understanding the behavioral antecedents of person-centered decision-making is thus critical for addressing key gaps in the provision of quality social care. To this end, we conducted a literature review of the psychological and health sciences with the aim of identifying the aspects that influence person-centered decision-making in social care. Using an established theoretical framework, we distilled nine behavioral factors―knowledge, competency, health, goal clarity, time discounting, familiarity, cognitive biases, cognitive overload, and emotion―associated with “Capability,” “Opportunity,” “Motivation,” and “Behavior” that explained person-centered decision-making in social care. These factors exist to different degrees and change as a person ages, gradually impacting their ability to obtain the care they want. We discuss the role of carers and the promise of shared decision-making and conclude by advocating a shift from personal autonomy to one that is shared with carers in the delivery of quality social care.
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18
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Vincenzo JL, Patton SK, Lefler LL, McElfish PA, Wei J, Curran GM. Older Adults' Perceptions and Recommendations Regarding a Falls Prevention Self-Management Plan Template Based on the Health Belief Model: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041938. [PMID: 35206125 PMCID: PMC8871905 DOI: 10.3390/ijerph19041938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 12/10/2022]
Abstract
Falls are the leading cause of fatal and non-fatal injuries among older adults. Self-management plans have been used in different contexts to promote healthy behaviors, but older adults’ perceptions of a falls prevention self-management plan template have not been investigated. Using mixed methods, we investigated older adults’ perceptions and recommendations of a falls prevention self-management plan template aligned with the Health Belief Model. Four focus groups (n = 27, average age 78 years) were conducted using semi-structured interview guides. Participants also ranked the written plan on paper with respect to each item by the level of importance, where item 1 was the most important, and 10 was the least important. Focus groups were transcribed and analyzed. Descriptive statistics were calculated for item rankings. Older adults felt that the plan would raise awareness and help them to engage in falls prevention behaviors. Participants recommended adding graphics and using red to highlight the risk of falling. Participants opined that ranking the items by level of importance was challenging because they felt all items were important. ‘What might happen to me if I fall’ was ranked as the most important item (average 2.6), while ‘How will I monitor progress’ was the least important (average = 6.6). Considering that older adults need support to engage in falls prevention, future research should investigate the impact of implementing an individually tailored falls prevention self-management plan on older adults’ engagement in falls prevention behaviors and outcomes of falls and injuries.
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Affiliation(s)
- Jennifer L. Vincenzo
- Department of Physical Therapy, College of Health Professions, University of Arkansas for Medical Sciences, Fayetteville, AR 72703, USA
- Correspondence:
| | - Susan K. Patton
- Department of Nursing, College of Education and Health Professions, University of Arkansas, Fayetteville, AR 72703, USA;
| | - Leanne L. Lefler
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Pearl A. McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Fayetteville, AR 72703, USA;
| | - Jeanne Wei
- Department of Geriatrics, Reynolds Institute on Aging, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
- Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114, USA
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19
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Liu M, Xue QL, Samuel L, Gitlin LN, Guralnik J, Leff B, Szanton SL. Improvements of Disability Outcomes in CAPABLE Older Adults Differ by Financial Strain Status. J Appl Gerontol 2022; 41:471-477. [PMID: 33267710 PMCID: PMC8169719 DOI: 10.1177/0733464820975551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Community Aging in Place-Advancing Better Living for Elders (CAPABLE) program reduces disability in low-income older adults. In this study, we used CAPABLE baseline and 5-month data to examine whether its effects in reducing activities of daily living (ADLs) and instrumental ADLs (IADLs) difficulties differed by participants' financial strain status. At baseline, participants with financial strain were more likely to report higher scores on depression (p < .001), have low energy (p < .001), and usually feel tired (p = .004) compared with participants without financial strain, but did not differ in ADL/IADL scores. Participants with financial strain benefited from the program in reducing ADL (relative risk [RR]: 0.61, 95% confidence interval [CI]: 0.43, 0.86) and IADL disabilities (RR: 0.69, 95% CI: 0.54, 0.87), compared with those with financial strain receiving attention control. Individuals with financial strain benefited more from a home-based intervention on measures of disability than those without financial strain. Interventions that improve disability may be beneficial for financially strained older adults.
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Affiliation(s)
- Minhui Liu
- Central South University Xiangya School of Nursing, Changsha, China
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Qian-Li Xue
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura Samuel
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Laura N. Gitlin
- Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania
| | - Jack Guralnik
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah L. Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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20
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Okoye SM, Spira AP, Perrin NA, Schrack JA, Han HR, Wanigatunga S, Nyhuis C, Szanton SL. Exterior housing conditions are associated with objective measures of poor sleep among low-income older adults with disabilities. Sleep Health 2021; 7:731-734. [PMID: 34629322 DOI: 10.1016/j.sleh.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the association of housing and neighborhood conditions with sleep among disadvantaged older adults. METHODS We used data from 136 low-income, predominantly Black older adults with disabilities. Predictors were indices of: interior housing conditions (eg, pests, tripping hazards); exterior housing conditions (eg, broken windows); and neighborhood disorder (eg, litter, vacant buildings). Outcomes were actigraphic total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). RESULTS In models adjusted for age, sex, education, living arrangement, comorbidities, and physical performance, each additional exterior housing problem was associated with 20.9-minutes less TST (95% confidence interval [CI]: -39.2, -2.6), 8.6-minutes more WASO (95% CI: 0.7, 16.5), and 2.3% lower SE (95% CI: -4.2, -0.4). The associations of interior housing conditions and neighborhood disorder with the sleep parameters were of smaller magnitude and not statistically significant. CONCLUSIONS Future studies should examine the effects of housing repair on sleep health.
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Affiliation(s)
- Safiyyah M Okoye
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA.
| | - Adam P Spira
- Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nancy A Perrin
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Jennifer A Schrack
- Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hae-Ra Han
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah Wanigatunga
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Casandra Nyhuis
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA
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21
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Arena SK, Wilson CM, Boright L, Peterson E. Impact of the HOP-UP-PT program on older adults at risk to fall: a randomized controlled trial. BMC Geriatr 2021; 21:520. [PMID: 34598692 PMCID: PMC8485496 DOI: 10.1186/s12877-021-02450-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/02/2021] [Indexed: 01/06/2023] Open
Abstract
Background Reduced falls and fall risks have been observed among older adults referred to the HOP-UP-PT (Home-based Older Persons Upstreaming Prevention-Physical Therapy) program. The purpose of this study was to describe outcomes of HOP-UP-PT program participants and then to compare these outcomes to non-participants. Methods Six Michigan senior centers referred adults ≥65 years who were at-risk for functional decline or falls. 144 participants (n = 72 per group) were randomized to either the experimental group (EG) or the control group (CG). Physical therapists (PTs) delivered physical, environmental, and health interventions to the EG over nine encounters (six in-person, three telerehabilitation) spanning seven months. The CG participants were told to continue their usual physical activity routines during the same time frame. Baseline and re-assessments were conducted at 0-, 3-, and 7-months in both groups. Descriptions and comparisons from each assessment encounter were analyzed. Results Participants ages were: EG = 76.6 (7.0) years and CG = 77.2 (8.2). Baseline measures were not significantly different apart from the Short Physical Performance Battery (SPPB) which favored the EG (P = 0.02). While no significant differences were identified in the survey outcomes or home environment assessments, significant differences in favor of the EG were identified in common fall risk indicators including the Timed Up and Go (P = 0.04), Four Test Balance Scale (P = 0.01), and the modified SPPB (P = 0.02) at the 3-month assessment visit. However, these differences were not sustained at the 7-month assessment as, notably, both groups demonstrated positive improvements in the Four Test Balance Score and SPPB. For individuals at a moderate/high fall risk at baseline, 47.8% of CG reported falling at seven months; whereas, only 6.3% of EG participants meeting the same criteria reported a fall after HOP-UP-PT participation. Conclusions A prevention-focused multimodal program provided by PTs in older adults’ homes proved beneficial and those with the highest fall risk demonstrated a significant decrease in falls. A collaboration between PTs and community senior centers resulted in upstreaming care delivery that may reduce both the financial and personal burdens associated with falls in an older adult population. Trial registration This study was retrospective registered at Clinical Trials.gov, TRN: NCT04814459 on 24/03/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02450-0.
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Affiliation(s)
- Sara K Arena
- Physical Therapy Program, Oakland University, School of Health Sciences, Human Health Bldg, 433 Meadowbrook Road, Rochester, MI, 48309-4401, USA.
| | - Christopher M Wilson
- Physical Therapy Program, Oakland University, School of Health Sciences, Human Health Bldg, 433 Meadowbrook Road, Rochester, MI, 48309-4401, USA
| | - Lori Boright
- Physical Therapy Program, Oakland University, School of Health Sciences, Human Health Bldg, 433 Meadowbrook Road, Rochester, MI, 48309-4401, USA
| | - Edward Peterson
- Henry Ford Health System, Department of Public Health Sciences, Detroit, MI, USA
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22
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Okoye SM, Szanton SL, Perrin NA, Nkimbeng M, Schrack JA, Han HR, Nyhuis C, Wanigatunga S, Spira AP. Objectively measured sleep and physical function: Associations in low-income older adults with disabilities. Sleep Health 2021; 7:735-741. [PMID: 34602384 DOI: 10.1016/j.sleh.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Late-life sleep health has been tied to physical function, but little is known about these associations among socially disadvantaged populations. DESIGN We determined cross-sectional associations of sleep with physical function in low-income, predominantly Black older adults with disabilities. PARTICIPANTS One hundred thirty-six older adults (mean age 76.0 years, 83.8% women, 82.4% Black). MEASUREMENTS Primary predictors were actigraphic total sleep time (TST), wake after sleep onset (WASO), and subjective sleep complaints. Outcomes were objective physical performance (Short Physical Performance Battery (SPPB)) and participant-reported difficulties in basic and instrumental activities of daily living (ADLs and IADLs). RESULTS In regression models adjusted for potential confounders, both longer TST and greater WASO were associated with lower SPPB scores and increased IADL difficulty. Participants with a mean TST in the longest (>7.5 hours) vs. intermediate (6.3-7.5 hours) tertile had 27% higher odds of additional IADL difficulty (incident rate ratio = 1.27, 95% confidence interval [CI] 1.03, 1.58). Each additional 10 minutes of WASO was associated with 0.13 point lower SPPB scores (B = -0.13, 95% CI -0.25, -0.01) and increased IADL difficulty (B = 0.02, 95% CI 0.0003, 0.04). Sex moderated the associations of WASO with IADL and ADL difficulties: associations were stronger for males. Subjective sleep complaints were not statistically significantly associated with function. CONCLUSIONS Among disabled, low-income, mostly Black older adults, objective measures of long sleep and greater WASO are associated with poorer physical function. Effect sizes for the associations were modest; however, findings may have important implications given the significant consequences of decreased function on quality of life and caregiving demands.
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Affiliation(s)
- Safiyyah M Okoye
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA.
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA
| | - Nancy A Perrin
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Manka Nkimbeng
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jennifer A Schrack
- Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hae-Ra Han
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Casandra Nyhuis
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah Wanigatunga
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adam P Spira
- Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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23
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Breysse J, Dixon S, Wilson J, Szanton S. Aging Gracefully in Place: An Evaluation of the Capability of the CAPABLE © Approach. J Appl Gerontol 2021; 41:718-728. [PMID: 34474609 DOI: 10.1177/07334648211042606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
As American adults live longer, society must prioritize effective strategies promoting safe aging-in-place and decreasing institutional health care costs. Social determinants of health, especially housing, critically influence older adult health, particularly for disadvantaged, low-income older adults. Johns Hopkins University developed Community Aging in Place-Advancing Better Living for Elders (CAPABLE©), a client-centered, home-based program to improve older adults' function and capacity to age in place. This evaluation studied CAPABLE's long-term effectiveness in four distinct locations in California, North Carolina, Pennsylvania, and Vermont. Seven months after CAPABLE, intervention group participants experienced greater improvements than the control group in activities of daily living limitations (2-point vs. 0.7-point improvement, p = .012), falls efficacy (8.9-point improvement vs. 0.1-point worsening, p = .012), depression (1.3-point improvement vs. 0.4-point worsening, p = .021), and pain (1.5-point improvement vs. 0.3-point worsening, p = .002). These results add to existing research on short-term effectiveness in urban locales, showing CAPABLE yields long-term health improvement for older adults in micropolitan and small urban locations, with different implementation organizations, housing stocks, and clients.
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Affiliation(s)
- Jill Breysse
- National Center for Healthy Housing, Columbia, MD, USA
| | - Sherry Dixon
- National Center for Healthy Housing, Columbia, MD, USA
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24
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Fields B, Rodakowski J, Jewell VD, Arthanat S, Park M, Piersol CV, Schepens Niemiec SL, Womack J, Mroz TM. Unpaid Caregiving and Aging in Place in the United States: Advancing the Value of Occupational Therapy. Am J Occup Ther 2021; 75:7505347010. [PMID: 34780633 PMCID: PMC8691185 DOI: 10.5014/ajot.2021.044735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Unpaid caregivers are often expected to help family members or friends overcome activity limitations and participation restrictions to successfully age in place. Caregivers assume multiple responsibilities, such as managing their own physical and psychosocial needs and navigating a complex health care system, and many feel ill equipped to fulfill the necessary health care responsibilities for their care recipients. Underprepared caregivers may cause poor outcomes for care recipients. Federal and state policy proposals call attention to the need to better support caregivers, especially as their numbers increase. Occupational therapy practitioners are well positioned to effectively engage caregivers as they navigate the health care system. The occupational therapy process looks broadly at the functional abilities, environmental contexts, and occupational demands that play a pivotal role in successful aging in place for clients and better outcomes for their caregivers. Now is the time to define occupational therapy's distinct value to this area.
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Affiliation(s)
- Beth Fields
- Beth Fields, PhD, OTR/L, BCG, is Assistant Professor, Department of Kinesiology, University of Wisconsin-Madison;
| | - Juleen Rodakowski
- Juleen Rodakowski, OTD, MS, OTR/L, FAOTA, is Associate Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Vanessa D Jewell
- Vanessa D. Jewell, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Sajay Arthanat
- Sajay Arthanat, PhD, OTR/L, ATP, is Professor, Department of Occupational Therapy, University of New Hampshire, Durham
| | - Melissa Park
- Melissa Park, PhD, is Associate Professor, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Catherine Verrier Piersol
- Catherine Verrier Piersol, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA
| | - Stacey L Schepens Niemiec
- Stacey L. Schepens Niemiec, PhD, OTR/L, is Associate Professor, T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Jennifer Womack
- Jennifer Womack, PhD, OTR/L, FAOTA, is Professor, Division of Occupational Science and Occupational Therapy, University of North Carolina at Chapel Hill
| | - Tracy M Mroz
- Tracy M. Mroz, PhD, OTR/L, is Assistant Professor, Department of Rehabilitation Medicine, University of Washington, Seattle
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Sheehan OC, Haley WE, Howard VJ, Huang J, Rhodes JD, Roth DL. Stress, Burden, and Well-Being in Dementia and Nondementia Caregivers: Insights From the Caregiving Transitions Study. THE GERONTOLOGIST 2021; 61:670-679. [PMID: 32816014 DOI: 10.1093/geront/gnaa108] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Few population-based studies have directly compared caregivers of persons with dementia to caregivers of persons with other disabilities (nondementia caregivers). We enrolled dementia and nondementia caregivers who were providing substantial and sustained care and compared these groups on measures of caregiver stressors, appraisals of burden, and well-being. RESEARCH DESIGN AND METHODS Caregivers (N = 251) who provided continuous care for at least 1 year and at least 5 h per week were recruited from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Caregivers reported on dementia caregiving status, stressors, burden, and well-being. RESULTS Forty-seven percent (n = 117) reported caring for a person with dementia. Dementia caregivers reported more stressors, providing more care for self-care and behavioral problems than nondementia caregivers. Dementia caregivers also reported higher appraisals of stress and burden, and more depressive symptoms, but did not differ from nondementia caregivers on mental and physical health quality of life. In multivariable-adjusted models, adjustment for the total number of care recipient problems attenuated differences between dementia and nondementia caregivers on burden and depression measures. DISCUSSION AND IMPLICATIONS Dementia and nondementia caregivers showed relatively few differences in indicators of overall well-being in this population-based sample, perhaps because both groups of caregivers in this study were providing substantial care. Dementia caregivers may require special assistance with dementia-specific problems such as behavioral problems. Clinical interventions and policy changes targeting highly burdened caregivers are needed to support them in allowing their care recipients to age in place at home.
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Affiliation(s)
- Orla C Sheehan
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
| | | | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Jin Huang
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
| | - J David Rhodes
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
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Views, experiences and attitudes of community-living older people towards the FIT-at-Home fall prevention programme: A qualitative interview study / Sichtweisen, Erfahrungswerte und Einstellungen von sturzgefährdeten Menschen im höheren Lebensalter zum FIT-at-Home-Sturzpräventionsprogramm: Eine qualitative Interviewstudie. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2021. [DOI: 10.2478/ijhp-2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
For older people, poor balance and strength as well as environmental hazards are a major risk factor for falls. A lifestyle-integrated home-based physical exercise training and home modification intervention were developed for older people at risk of falling.
Aim
This study aimed to examine older people's perceptions of the FIT-at-Home fall prevention intervention in order to further develop the intervention's content, procedures and mode of delivery.
Methods
We conducted semi-structured interviews with individuals who participated in the falls prevention programme using the problem-centred interview method. The interviews were analysed in a deductive-inductive approach following Mayring's qualitative content analysis.
Results
Seven themes emerging from the data described different facets of older people's perceptions towards the intervention. Findings suggested that the participants accepted the FIT-at-Home intervention. Overall, the individuals regard the intervention as feasible and practicable. From the older people's view, it was an advantage that the exercises could be implemented at any time without additional aids or equipment in-house and it was not necessary to visit the occupational therapy practice. Older people's experiences showed that feelings of success have a positive effect on the willingness to exercise. A perceived barrier influencing the implementation of exercises among older people was their own laziness, their general state of health and illnesses, their daily mood or meteor sensitivity.
Conclusion
The FIT-at-Home intervention comprising balance and strength exercises and home modification is feasible and acceptable for community-living older people. Older people's feedback will help us to further refine the intervention.
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Danto-Nocton E, Malone ML. Enhancing physician care of vulnerable older adults. J Am Geriatr Soc 2021; 69:1463-1465. [PMID: 33871875 DOI: 10.1111/jgs.17164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ellen Danto-Nocton
- Aurora UW Medical Group, Milwaukee, Wisconsin, USA.,Advocate Aurora Health, Milwaukee, Wisconsin, USA
| | - Michael L Malone
- Aurora UW Medical Group, Milwaukee, Wisconsin, USA.,Advocate Aurora Health, Milwaukee, Wisconsin, USA
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Bowling CB, Lee A, Williamson JD. Blood Pressure Control Among Older Adults With Hypertension: Narrative Review and Introduction of a Framework for Improving Care. Am J Hypertens 2021; 34:258-266. [PMID: 33821943 DOI: 10.1093/ajh/hpab002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/11/2020] [Accepted: 01/08/2021] [Indexed: 01/03/2023] Open
Abstract
Although antihypertensive medications are effective, inexpensive, and recommended by clinical practice guidelines, a large percentage of older adults with hypertension have uncontrolled blood pressure (BP). Improving BP control in this population may require a better understanding of the specific challenges to BP control at older age. In this narrative review, we propose a framework for considering how key steps in BP management occur in the context of aging characterized by heterogeneity in function, multiple co-occurring health conditions, and complex personal and environmental factors. We review existing literature related to 4 necessary steps in hypertension control. These steps include the BP measure which can be affected by the technique, device, and setting in which BP is measured. Ensuring proper technique can be challenging in routine care. The plan includes setting BP treatment goals. Lower BP goals may be appropriate for many older adults. However, plans must take into account the generalizability of existing evidence, as well as patient and family's health goals. Treatment includes the management strategy, the expected benefits, and potential risks of treatment. Treatment intensification is commonly needed and can contribute to polypharmacy in older adults. Lastly, monitor refers to the need for ongoing follow-up to support a patient's ability to sustain BP control over time. Sustained BP control has been shown to be associated with a lower rate of cardiovascular disease and multimorbidity progression. Implementation of current guidelines in populations of older adults may be improved when specific challenges to BP measurement, planning, treating, and monitoring are addressed.
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Affiliation(s)
- C Barrett Bowling
- U.S. Department of Veterans Affairs, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, North Carolina, USA
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Alexandra Lee
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Jeff D Williamson
- Department of Internal Medicine, Section on Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Mickler AK, Leff B, Eaton England A, Garrigues SK, Schuchman M, Perissinotto C, Ritchie CS, Harrison KL, Sheehan OC. Understanding the Daily Experiences and Perceptions of Homebound Older Adults and Their Caregivers: A Qualitative Study. J Appl Gerontol 2021; 40:1722-1732. [PMID: 33522364 DOI: 10.1177/0733464821990171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
More than 7.3 million older adults in the United States have difficulty leaving their homes or are completely homebound, yet little data exist on the experiences of homebound older adults and their caregivers. We conducted 30 semi-structured qualitative interviews with homebound older adults and caregivers recruited through home-based medical care practices in Baltimore and San Francisco. Thematic template analyses revealed that homebound older adults experience varying degrees of independence in activities of daily living, although their degree of dependence increases over time. Caregivers have a multifaceted, round-the-clock role. Both patients and caregivers experience burdens including social isolation and guilt. Navigating medical care and caregiving was further complicated by the complexity of the U.S. health care system; however, home-based medical care was viewed as a high-quality alternative to hospitals or nursing homes. Our findings suggest that providers and health care systems should expand the availability and accessibility of home-based care and improve caregiver support opportunities.
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Affiliation(s)
| | - Bruce Leff
- Johns Hopkins University, Baltimore, MD, USA
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30
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O'Connor M, Moriarty H, Schneider A, Dowdell EB, Bowles KH. Patients' and caregivers' perspectives in determining discharge readiness from home health. Geriatr Nurs 2021; 42:151-158. [PMID: 33444923 DOI: 10.1016/j.gerinurse.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 12/24/2022]
Abstract
There are no national, empirically derived clinical decision support tools to assist the interprofessional home health team in determining readiness for discharge from skilled home health. Eliciting patient and family caregiver perspectives around readiness for home health discharge is integral to developing tools that address their needs in this decision-making process. The purpose of this study was to describe the factors home health patients and their family caregivers perceive as critical when determining readiness for discharge from services. A qualitative descriptive study was conducted among skilled home health recipients and their family caregivers who were either recently discharged or recertified for additional care from two different Medicare-certified skilled home health agencies. Nine themes emerged: self-care ability, functional status, status of condition(s) and symptoms, presence of a caregiver, support for the caregiver, connection to community resources/support, safety needs of the home environment addressed, adherence to the prescribed regimen, and care coordination.
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Affiliation(s)
- Melissa O'Connor
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall #316, Villanova PA 19085, United States; Gerontology Interest Group, Villanova University, M. Louise Fitzpatrick College of Nursing, United States; NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, United States; Fellow, Betty Irene Moore Fellowships for Nurse Leaders and Innovators, United States.
| | - Helene Moriarty
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall #316, Villanova PA 19085, United States; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, United States; NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, United States
| | - Anne Schneider
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall #316, Villanova PA 19085, United States
| | - Elizabeth B Dowdell
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall #316, Villanova PA 19085, United States
| | - Kathryn H Bowles
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, United States; Center for Home Care Policy & Research, Visiting Nurse Service of New York, United States
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Zimbroff RM, Ritchie CS, Leff B, Sheehan OC. Home-Based Primary and Palliative Care in the Medicaid Program: Systematic Review of the Literature. J Am Geriatr Soc 2021; 69:245-254. [PMID: 32959375 PMCID: PMC11208066 DOI: 10.1111/jgs.16837] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES To describe the use of home-based medical care (HBMC) among Medicaid beneficiaries. DESIGN A systematic review of the peer-reviewed and gray literature of home-based primary care and palliative care programs among Medicaid beneficiaries including dual eligibles. SETTING HBMC including home-based primary care and palliative care programs. PARTICIPANTS Studies describing Medicaid beneficiaries receiving HBMC. MEASUREMENTS Three groups of studies were included: those focused on HBMC specifically for Medicaid beneficiaries, studies that described the proportion of Medicaid patients receiving HBMC, and those that used Medicaid status as a dependent variable in studying HBMC. RESULTS The peer-reviewed and gray literature searches revealed 574 unique studies of which only 16 met inclusion criteria. Few publications described HBMC as an integral care delivery model for Medicaid programs. Data from the programs described suggest the use of HBMC for Medicaid beneficiaries can reduce healthcare costs. The addition of social supports to HBMC appears to convey additional savings and benefits. CONCLUSION This systematic literature review highlights the relative dearth of literature regarding the use and impact of HBMC in the Medicaid population. HBMC has great potential to reduce Medicaid costs, and innovative programs combining HBMC with social support systems need to be tested.
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Affiliation(s)
- Robert M. Zimbroff
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Orla C. Sheehan
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Geriatric Medicine and Gerontology, Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
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32
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Park CM, Oh G, Lee H, Jung HW, Lee E, Jang IY, Kim DH. Multicomponent Intervention and Long-Term Disability in Older Adults: A Nonrandomized Prospective Study. J Am Geriatr Soc 2020; 69:669-677. [PMID: 33155305 DOI: 10.1111/jgs.16926] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES To evaluate the long-term association between a multicomponent intervention program and disability in socioeconomically vulnerable older adults. DESIGN This was a nonrandomized prospective intervention trial. SETTING The setting was a community. PARTICIPANTS Participants included older Koreans living alone or receiving government assistance from a low-income program. INTERVENTION The intervention was a 24-week multicomponent program compromising group exercise, nutritional supplementation, management of depression, deprescribing, and home hazard reduction (n = 187) versus usual care (n = 196). MEASUREMENTS The number of dependencies in 17 basic and instrumental activities of daily living was measured every 3 months for 30 months (range: 0-17; greater values indicated worse disability). Inverse probability weighting Poisson regression was used to model the number of dependencies to adjust for confounding bias and higher dropout rates of those with greater disability. RESULTS The study population had a mean age of 76 years, and 26% were men. During the 30-month follow up, 17 died (n = 8, intervention; n = 9, control), 62 (n = 16, intervention; n = 46, control) were institutionalized or received nursing home care, and 34 (n = 15, intervention; n = 19, control) were lost to follow up. After inverse probability weighting, the mean number of dependencies at baseline was 1.21 and 1.29 for the intervention group and the control group, respectively (P = .80). The intervention group had fewer dependencies than the control group, but the difference was attenuated over time: 1.08 versus 1.60 at 6 months (P = .04), 1.29 versus 1.87 at 12 months (P = .03), 1.62 versus 2.17 at 18 months (P = .06), 2.08 versus 2.51 at 24 months (P = .18), and 2.73 versus 2.90 at 30 months (P = .67). CONCLUSION A 24-week multicomponent intervention was associated with a slower progression of disability; however, the diminishing association from 24 months and beyond suggests that reassessment and intervention may be necessary. Due to a lack of randomization, our findings should be interpreted with caution.
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Affiliation(s)
- Chan Mi Park
- Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Gahee Oh
- Hebrew SeniorLife, Marcus Institute for Aging Research, Boston, Massachusetts, USA
| | - Heayon Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,PyeongChang Health Center and County Hospital, PyeongChang, Republic of Korea
| | - Dae Hyun Kim
- Hebrew SeniorLife, Marcus Institute for Aging Research, Boston, Massachusetts, USA.,Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Jeon YH, Krein L, Simpson JM, Szanton SL, Clemson L, Naismith SL, Low LF, Mowszowski L, Gonski P, Norman R, Gitlin LN, Brodaty H. Feasibility and potential effects of interdisciplinary home-based reablement program (I-HARP) for people with cognitive and functional decline: a pilot trial. Aging Ment Health 2020; 24:1916-1925. [PMID: 31345051 DOI: 10.1080/13607863.2019.1642298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To test feasibility and potential effects of the interdisciplinary Home-bAsed Reablement Program (I-HARP) that integrates evidence-based strategies and cognitive rehabilitation techniques into a dementia-specific, bio-behavioural-environmental intervention.Methods: A parallel-group randomised controlled pilot trial was conducted in Sydney, Australia, targeting community-dwelling people with amnestic mild cognitive impairment or mild/moderate stages of dementia and their carer (n = 18 dyads). I-HARP comprised: up to 12 home visits by registered nurse, occupational therapist, and psychologist, tailored to the individual client's needs; <A$1000 for home modification/assistive devices; and individual carer support, all provided over four months. Additional allied health services were recommended when necessary. Clients' daily activities, mobility, mood, caregiver burden, and quality of life were assessed at baseline, four months and 12 months. Semi-structured interviews were conducted with I-HARP participants post intervention.Results: Of 51 dyads who expressed interest in participation, 25 were eligible, with 76% consent rate (19/25 eligible dyads consented), and high adherence to the program (all nine intervention group participants completed and complied). Challenges included: need for better carer and allied health support, with more targeted recruitment points to speed up the process. The I-HARP group showed favourable effects across most outcomes at short-term (4 months) and longer-term (12 months) assessments. However, wide Confidence Intervals (CIs) point to the degree of uncertainty around interpretation of these results.Conclusion: The delivery of I-HARP, a dementia-specific reablement program and the trial design concerning randomisation, screening and consent procedures, were deemed feasible, acceptable and appropriate for the target population group. Building on the success and lessons from the pilot, a larger trial is currently underway.
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Affiliation(s)
- Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Luisa Krein
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Judy M Simpson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Population Ageing Research, The University of Sydney, Sydney, Australia
| | | | - Lindy Clemson
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, Charles Perkins Centre and School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre and School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Peter Gonski
- Division of Aged and Extended Care (Southcare), Sutherland Hospital, South Eastern Sydney Local Health District, Sutherland, Australia
| | | | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Henry Brodaty
- School of Psychiatry, UNSW Sydney, CHeBA (Centre for Healthy Brain Ageing) and Dementia Centre for Research Collaboration, Australia
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Granbom M, Nkimbeng M, Roberts LC, Gitlin LN, Taylor JL, Szanton SL. "So I am Stuck, but it´s OK": Residential Reasoning and Housing Decision-Making of Low-Income Older Adults with Disabilities in Baltimore, Maryland. ACTA ACUST UNITED AC 2020; 48:43-59. [PMID: 33731975 DOI: 10.1080/08882746.2020.1816782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Housing preferences and housing decision-making in later life are critical aspects of aging in place, which is a public health priority in many Western countries. However, few studies have examined the economic, social, and health factors that guide older adults' preferences and decisions about where to live, and even less so among older adults with low income or disabilities who may face greater barriers to aging in place. We sought to understand what housing decision-making and residential reasoning means for low-income older adult homeowners in Baltimore, Maryland. Using a grounded theory approach, we interviewed 12 adults with disabilities in June 2017 and February 2018. Our findings revealed how the strong desire to age in place turned into the realization that they had to age in place due to limited resources and options. The core category "shifting between wanting to age in place and having to age in place" was influenced by family needs, being a homeowner, the neighborhood, and coping at home. In conclusion, for low-income older adults with disabilities, it is important to acknowledge that sometimes aging in place may be equivalent to being stuck in place.
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Affiliation(s)
- Marianne Granbom
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD 21205, USA.,Department of Health Sciences, Lund University, 22100 Lund, Sweden
| | - Manka Nkimbeng
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD 21205, USA.,School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Laken C Roberts
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD 21205, USA
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD 21205, USA.,College of Nursing and Health Professions, Drexel University, Philadelphia, PA 19102, USA
| | - Janiece L Taylor
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD 21205, USA
| | - Sarah L Szanton
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD 21205, USA
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Liu M, Xue QL, Gitlin LN, Wolff JL, Guralnik J, Leff B, Szanton SL. Disability Prevention Program Improves Life-Space and Falls Efficacy: A Randomized Controlled Trial. J Am Geriatr Soc 2020; 69:85-90. [PMID: 32951215 DOI: 10.1111/jgs.16808] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/16/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the effects of a home-based disability prevention program on life-space and falls efficacy among low-income older adults. DESIGN Single-blind two-arm randomized controlled trial. SETTING Participants' homes. PARTICIPANTS Participants were low-income cognitively intact older adults (≥65 years old) with restricted daily activities. Our analytic sample for life-space (n = 194) and falls efficacy (n = 233) varied as the life-space measure was introduced 4 months after the trial began. INTERVENTION Up to six 1-hour home visits with an occupational therapist; up to four 1-hour home visits with a registered nurse; and up to $1,300 worth of home repairs, modifications, and assistive devices with a handyman, during a course of 4 months. MEASUREMENTS Life-space was measured by the Homebound Mobility Assessment; falls efficacy was measured using the 10-item Tinetti Falls Efficacy Scale at baseline and 5 months. RESULTS Participants were on average 75 years old, predominantly Black (86%) and female (85%-86%). Compared with participants in the control group, participants receiving the intervention were more likely to have improved versus decreased life-space in areas of bathroom (adjusted odds ratio (OR) = 3.95; 95% confidence interval (CI) = 1.20-12.97), front or back porch, patio, or deck (adjusted OR = 2.67; 95% CI = 1.05-6.79), stairs (adjusted OR = 4.09; 95% CI = 1.34-12.48), leaving the house for any reason other than for health care (adjusted OR = 2.40; 95% CI = 1.01-5.73), and overall life-space (adjusted OR = 2.15; 95% CI = 1.10-4.19). Participants who received the intervention also had an 11% improvement in falls efficacy in performing daily activities (exponentiated coefficient = 1.12; 95% CI = 1.04-1.21). CONCLUSION Life-space and falls efficacy were improved through a multicomponent, person-directed, home-based disability prevention intervention. Findings suggest that this intervention should be translated into different settings to promote independent aging.
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Affiliation(s)
- Minhui Liu
- Central South University Xiangya School of Nursing, Changsha, China.,Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura N Gitlin
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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36
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Owens OL, Beer JM, Revels AA, White K. The Lived Experiences of Older Low-Income African Americans Living Alone: Implications for Aging in Place in the United States. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/26892618.2020.1780662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Otis L. Owens
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Jenay M. Beer
- College of Public Health and School of Social Work, University of Georgia, Athens, GA, USA
| | - Asa A. Revels
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Kellee White
- School of Public Health, University of Maryland, College, MD, USA
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Bhattarai J'J, Bentley J, Morean W, Wegener ST, Pollack Porter KM. Promoting equity at the population level: Putting the foundational principles into practice through disability advocacy. Rehabil Psychol 2020; 65:87-100. [PMID: 32297777 PMCID: PMC7285891 DOI: 10.1037/rep0000321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Rehabilitation psychology is based on foundational principles that can guide us toward health equity among disabled and nondisabled communities. We summarize the literature on disparities in the disability community and underscore the urgency to address underlying inequities to eliminate disparities. We include examples of population-level interventions that promote equity in the disability community. We conclude with a call for a broader mission for rehabilitation psychologists based on the field's foundational principles, and outline emerging opportunities to widen our impact and advance equity. Our foundational principles, built on systems theory, call on rehabilitation psychologist to work at macrosystemic levels. As rehabilitation psychologists, we need to widen our focus from the micro (individual) to the macro (population) level. We need to bring the respect, dignity, and collaborative spirit that inspire our work with individuals to the broader community by advocating for structures and policies that promote equity for disabled persons. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Jacob Bentley
- Department of Clinical Psychology, Seattle Pacific University
| | - Whitney Morean
- Department of Clinical Psychology, Seattle Pacific University
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine
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Lipsitz LA. When I'm 84: What Should Life Look Like in Old Age? J Am Geriatr Soc 2020; 68:967-969. [PMID: 32150299 DOI: 10.1111/jgs.16408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 11/27/2022]
Abstract
Housing and the built environment are well-established social determinants of healthy longevity, yet no guidelines or standards exist for the design and construction of health-promoting environments, especially for older adults who are at risk for functional decline and frailty. To envision what should be included in the design of healthy communities, it may help to reverse-engineer what each of us would like our lives to look like in old age. In this special article, a geriatrician draws on his own personal aspirations and successful models of supportive community-based programs to suggest key factors that should be considered in the design of future living environments. These include healthy housing that can enable aging in place without social isolation and loneliness; engagement in meaningful and productive work; financial, physical, transportation, food, and housing security; and affordable high-quality home- and community-based healthcare. By conceptualizing what we would like our later years to look like, future leaders can be more deliberate in creating living environments that promote a long and productive health span. J Am Geriatr Soc 68:967-969, 2020.
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Affiliation(s)
- Lewis A Lipsitz
- Beth Israel Deaconess Medical Center, Hebrew SeniorLife, Boston, Massachusetts, USA
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Lette M, Ambugo EA, Hagen TP, Nijpels G, Baan CA, de Bruin SR. Addressing safety risks in integrated care programs for older people living at home: a scoping review. BMC Geriatr 2020; 20:81. [PMID: 32111170 PMCID: PMC7048120 DOI: 10.1186/s12877-020-1482-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/17/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Many older people live at home, often with complex and chronic health and social care needs. Integrated care programs are increasingly being implemented as a way to better address these needs. To support older people living at home, it is also essential to maintain their safety. Integrated care programs have the potential to address a wide range of risks and problems that could undermine older people's ability to live independently at home. The aim of this scoping review is to provide insight into how integrated care programs address safety risks faced by older people living at home - an area that is rather underexplored. METHODS Safety was conceptualised as preventing or reducing the risk of problems, associated with individual functioning and behaviour, social and physical environments, and health and social care management, which could undermine older people's ability to live independently at home. For this scoping review a systematic literature search was performed to identify papers describing integrated care programs where at least one intervention component addressed safety risks. Data were extracted on the programs' characteristics, safety risks addressed, and the activities and interventions used to address them. RESULTS None of the 11 programs included in this review explicitly mentioned safety in their goals. Nevertheless, following the principles of our conceptual framework, the programs appeared to address risks in multiple domains. Most attention was paid to risks related to older people's functioning, behaviour, and the health and social care they receive. Risks related to people's physical and social environments received less attention. CONCLUSION Even though prevention of safety risks is not an explicit goal of integrated care programs, the programs address a wide range of risks on multiple domains. The need to address social and environmental risks is becoming increasingly important given the growing number of people receiving care and support at home. Prioritising a multidimensional approach to safety in integrated care programs could enhance the ability of health and social care systems to support older people to live safely at home.
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Affiliation(s)
- Manon Lette
- Amsterdam Public Health research institute, Department of General Practice and Elderly Care Medicine, Amsterdam UMC - VU University Amsterdam, Amsterdam, the Netherlands. .,Centre for Nutrition, Prevention and Health Services research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Eliva A Ambugo
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Terje P Hagen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Giel Nijpels
- Amsterdam Public Health research institute, Department of General Practice and Elderly Care Medicine, Amsterdam UMC - VU University Amsterdam, Amsterdam, the Netherlands
| | - Caroline A Baan
- Centre for Nutrition, Prevention and Health Services research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Scientific Center for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, the Netherlands
| | - Simone R de Bruin
- Centre for Nutrition, Prevention and Health Services research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Müller C, Lautenschläger S, Dörge C, Voigt-Radloff S. A feasibility study of a home-based lifestyle-integrated physical exercise training and home modification for community-living older people (Part 2): the FIT-at-Home fall prevention program. Disabil Rehabil 2019; 43:1380-1390. [PMID: 31868030 DOI: 10.1080/09638288.2019.1700564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was conducted in a home-based context where trained occupational therapists delivered progressive physical exercise training and home modification intervention for preventing falls, namely the FIT-at-Home intervention. We assessed the feasibility of the intervention's content and mode of delivery from the occupational therapists' perspective as well as the feasibility of study procedures. METHODS We used a mixed-methods approach, which generated qualitative data from 14 OTs' after delivering the intervention via interviews and quantitative data of the study procedures via questionnaires and documentation sheets. RESULTS In total, 16 of the 17 older people completed the intervention. Of 9 recorded falls, no serious physical problems occurred. Qualitative data suggested that the intervention content and mode was feasible. Only minor adaptations to the program are needed based on the users' feedback. The main benefit was seen in the fact that simple exercises can be integrated into everyday life for older people with restricted mobility. CONCLUSION The FIT-at-Home intervention comprising lifestyle-integrated balance and strength exercises and home safety is feasible for occupational therapists to deliver. The findings will help to further refine the intervention and study procedures.Implications for rehabilitationFalling is a frequent and serious health problem for many community-living older people, and the incidence of injurious falls increases with advancing age.Home visiting programs comprising physical exercise training and home modification appear to be beneficial for older people with poor health, functional limitations, and limited mobility.This study indicates that it is feasible to introduce lifestyle-integrated balance and strength exercises, performed as part of daily routine for older people at risk of falling.Behavioural self-management strategies have the potential to improve the implementation of exercises during the course of rehabilitation treatment and afterward.
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Affiliation(s)
- Christian Müller
- Department of Occupational Therapy, University of Cooperative Education in Health Care and Welfare Saarland, Saarbrücken, Germany.,Department of Nursing Sciences, School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany
| | - Sindy Lautenschläger
- Department of Nursing Sciences, School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany
| | - Christine Dörge
- Department of Nursing Sciences, School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Centre of Geriatric Medicine and Gerontology Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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LaFave SE, Granbom M, Cudjoe TK, Gottsch A, Shorb G, Szanton SL. Attention control group activities and perceived benefit in a trial of a behavioral intervention for older adults. Res Nurs Health 2019; 42:476-482. [PMID: 31647125 PMCID: PMC6858509 DOI: 10.1002/nur.21992] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/30/2019] [Indexed: 11/11/2022]
Abstract
Researchers trialing behavioral interventions often use attention control groups, but few publish details on attention control activities or perceived benefit. Attention control groups receive the same dose of interpersonal interaction as intervention participants but no other elements of the intervention, to control for the benefits of attention that may come from behavioral interventions. Because intervention success is analyzed compared to control conditions, it is useful to examine attention control content and outcomes. The purpose of this study is to report on attention control visit activities and their perceived benefit in a randomized control trial. The trial tested an aging-in-place intervention comprised of a series of participant goal-directed visits facilitated by an occupational therapist, nurse, and handyman. The attention control group participants received visits from a lay person. We report on the number and length of visits received, types of visit activities that participants chose, and how much visit time was spent on each activity, based on the attention visitor's records. We report on participant perceptions of benefit based on a 10-item Likert-scale survey. The attention control group participants (n = 148) were cognitively intact, at least 65 years old, with at least one Instrumental Activities of Daily Living. Attention control group participants most often chose conversation (20.1% of visit time), and playing games (18.7%), as visit activities. The majority of attention control group participants (63.4%) reported "a great deal" of perceived benefit. Attention control group visits may be an appropriate comparison in studies of behavioral interventions for community-dwelling older adults.
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Affiliation(s)
- Sarah E. LaFave
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Marianne Granbom
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Department of Health Sciences, Lund University, Sweden
| | - Thomas K.M. Cudjoe
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Alex Gottsch
- Duke University Hospital, Durham, North Carolina
| | - Gerard Shorb
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sarah L. Szanton
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Müller C, Lautenschläger S, Dörge C, Voigt-Radloff S. Development of a lifestyle-integrated physical exercise training and home modification intervention for older people living in a community with a risk of falling (Part 1): the FIT-at-Home fall prevention program. Disabil Rehabil 2019; 43:1367-1379. [PMID: 31760814 DOI: 10.1080/09638288.2019.1661530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE In this paper, we report on the development and refinement of a progressive physical exercise training and home modification intervention for older people with a risk of falling located in Germany by using the United Kingdom's Medical Research Council framework. METHODS The process was iterative and six phases of development emerged: (1) establishing an intervention development group, (2) identifying the evidence on interventions, (3) identifying a theory to underpin the intervention, (4) designing the intervention components, (5) drafting the intervention manual and training course, and (6) piloting and refining of intervention components. RESULTS The result was an evidence-based, theory-informed, and user-endorsed intervention: FIT-at-Home. This intervention comprised nine individual sessions over 12 weeks and two follow-up booster sessions delivered by trained occupational therapists. A feasibility study demonstrated the acceptance and feasibility of intervention delivery. Users responses were generally favorable and included recommendations about the intervention manual, mode of delivery of the home hazard assessment, and producing a manual for older people. CONCLUSIONS We developed a feasible home-based lifestyle-integrated physical exercise training and home modification intervention for older people with a risk of falling by using a systematic approach. Implications include how this intervention could enrich occupational therapy fall prevention strategy in older people living at home.IMPLICATIONS FOR REHABILITATIONFalls in older people represent a major public health concern and occupational therapists in rehabilitation practice are encouraged to apply evidence-based interventions that reduce the risk of falls in older people living in a community.Many physical and environmental fall risks are modifiable by lifestyle changes such as physical exercise training, home safety assessment, and home modification. We developed a home-based balance and strength exercise training and home modification intervention that aims to improve strength, balance, and home safety.This study indicates that older people, at risk of falling, with functional limitations, and limited mobility, who participated in the FIT-at-Home intervention, felt that exercising at home suited them best.
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Affiliation(s)
- Christian Müller
- School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany.,University of Cooperative Education in Health Care and Welfare Saarland, Saarbrücken, Germany
| | - Sindy Lautenschläger
- School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany
| | - Christine Dörge
- School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisgau, Germany.,Centre of Geriatric Medicine and Gerontology Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Breisgau, Germany
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Zhou W, Oyegoke AS, Sun M. Adaptations for Aging at Home in the UK: An Evaluation of Current Practice. J Aging Soc Policy 2019; 32:572-589. [PMID: 31665986 DOI: 10.1080/08959420.2019.1685347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Housing adaptation is necessary to enable elderly people to live independently longer in their own homes. This study aims to review current housing adaptation practice in different parts of the UK and discuss the policy implications at national and local levels. It adopted a mixed-methods research strategy. First, a questionnaire survey was carried out with all 378 local authorities in England, Scotland, and Wales; 112 valid responses were received, representing a response rate of around 30%. Then, interviews and a focus group meeting were conducted with professionals involved in the adaptation process and older clients. The research findings showed that the current number of housing adaptations is relatively small in most local authorities, compared with the potential demand of an aging population. They also revealed some inconsistencies and deficiencies in the system, leading to ineffective and inefficient adaptation service process. These need to be addressed by local authorities in order to improve their adaptation systems and achieve better outcomes.
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Affiliation(s)
- Wusi Zhou
- School of Public Administration, Hangzhou Normal University , Hangzhou, China
| | | | - Ming Sun
- School of Architecture, Design and the Built Environment, Nottingham Trent University , Nottingham, UK
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Axmon A, Ekstam L, Slaug B, Schmidt SM, Fänge AM. Detecting longitudinal changes in activities of daily living (ADL) dependence: Optimizing ADL staircase response choices. Br J Occup Ther 2019. [DOI: 10.1177/0308022619853513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anna Axmon
- Epidemiology, Population studies, and Infrastructures at Lund University, Division of Occupational and Environmental Medicine, Lund University, Sweden
| | - Lisa Ekstam
- Department of Health Sciences, Lund University, Sweden
| | - Björn Slaug
- Department of Health Sciences, Lund University, Sweden
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Jordan K. Occupational Therapy in Primary Care: Positioned and Prepared to Be a Vital Part of the Team. Am J Occup Ther 2019; 73:7305170010p1-7305170010p6. [PMID: 31484019 DOI: 10.5014/ajot.2019.735002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Reilly's (1962) now deeply cherished statement that "man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health" (p. 1) was followed a few years later with a question to current and future occupational therapy practitioners. In 1966, Reilly asked how the profession would respond to the challenges of an expanding knowledge base, accelerating health care costs, and escalating regulatory burden. Visionary Wilma West, a contemporary of Reilly's, expanded on these themes by focusing on ways occupational therapy practitioners could leverage the breadth and depth of their practice to confront these challenges. These issues are now paramount in the primary care arena. An expanding body of literature, including the articles in a special section in this issue of the American Journal of Occupational Therapy, supports occupational therapy's role as a vital part of the solution to contemporary health care challenges. Occupational therapy practitioners are educationally prepared and successfully poised through policy to engage in evidence-based practice in the primary care environment.
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Affiliation(s)
- Katie Jordan
- Katie Jordan, OTD, OTR/L, is Professor of Clinical Occupational Therapy and Associate Chair of Clinical Occupational Therapy Services, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
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Jeon YH, Simpson JM, Low LF, Woods R, Norman R, Mowszowski L, Clemson L, Naismith SL, Brodaty H, Hilmer S, Amberber AM, Gitlin LN, Szanton S. A pragmatic randomised controlled trial (RCT) and realist evaluation of the interdisciplinary home-bAsed Reablement program (I-HARP) for improving functional independence of community dwelling older people with dementia: an effectiveness-implementation hybrid design. BMC Geriatr 2019; 19:199. [PMID: 31357949 PMCID: PMC6664757 DOI: 10.1186/s12877-019-1216-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A major gap exists internationally in providing support to maintain functional and social independence of older people with dementia living at home. This project evaluates a model of care that integrates evidence-based strategies into a person-centred interdisciplinary rehabilitation package: Interdisciplinary Home-bAsed Reablement Program (I-HARP). Two central aims are: 1) to determine the effectiveness of I-HARP on functional independence, mobility, quality of life and depression among people with dementia, their home environmental safety, carer burden and quality of life, and I-HARP cost-effectiveness; and 2) to evaluate the processes, outcomes and influencing factors of the I-HARP implementation. METHODS I-HARP is a 4-month model of care, integrated in community aged care services and hospital-based community geriatric services, and consists of: 1) 8-12 home visits, tailored to the individual client's needs, by an occupational therapist, registered nurse, and other allied health staff; 2) minor home modifications/assistive devices to the value of 60 years with mild to moderate dementia and his/her carer). During Phase I, I-HARP advisory group is established and training of I-HARP interventionists is completed, and the effectiveness of I-HARP is examined using a pragmatic RCT. Phase II, conducted concurrently with Phase I, focuses on the process evaluation of the I-HARP implementation using a realist approach. Semi-structured interviews with participants and focus groups with I-HARP interventionists and participating site managers will provide insights into the contexts, mechanisms and outcomes of I-HARP. DISCUSSION I-HARP is being evaluated within the real-world systems of hospital-based and community-based aged care services in Australia. Future directions and strategies for reablement approaches to care for community dwelling people living with dementia, will be developed. The study will provide evidence to inform key stakeholders in their decision making and the use/delivery of the program, as well as influence future systems-thinking and changes for dementia care. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTR N12618000600246 (approved 18/04/2018).
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Affiliation(s)
- Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, 88 Mallett Street – Building M02, Camperdown, Sydney, NSW Australia
| | - Judy M. Simpson
- Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | | | | | - Loren Mowszowski
- Brain and Mind Centre and School of Psychology, The University of Sydney, Sydney, Australia
| | - Lindy Clemson
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Sharon L. Naismith
- Brain and Mind Centre, Charles Perkins Centre and School of Psychology, The University of Sydney, Sydney, Australia
| | - Henry Brodaty
- CHeBA (Centre for Healthy Brain Ageing), School of Psychiatry, UNSW, Sydney, Australia
| | - Sarah Hilmer
- Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, St Leonards, NSW Australia
| | | | - Laura N. Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA USA
| | - Sarah Szanton
- Johns Hopkins School of Nursing, Johns Hopkins School of Public Health, Baltimore, MD USA
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Spoelstra SL, Schueller M, Sikorskii A. Testing an implementation strategy bundle on adoption and sustainability of evidence to optimize physical function in community-dwelling disabled and older adults in a Medicaid waiver: a multi-site pragmatic hybrid type III protocol. Implement Sci 2019; 14:60. [PMID: 31196137 PMCID: PMC6567613 DOI: 10.1186/s13012-019-0907-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022] Open
Abstract
Background In partnership with a state Medicaid home and community-based waiver program, this study tests implementation strategies for adoption and sustainability of an evidence-based intervention to support disabled and older adults who have difficulty with physical function and daily living tasks. A multi-level implementation strategy bundle will be directed at relationship, coalition, and team building; readiness to implement, leadership, and clinician attitude toward evidence assessments; intervention and facilitation training; interdisciplinary coordination; facilitation; and audit and feedback to support practice change. Methods Knowledge-to-Action model underpins this 2-arm, 3-year pragmatic mixed method randomized hybrid type III trial in 18 waiver program sites in Michigan. Data will be collected on sites, 775 clinicians (registered nurses, occupational therapists, social workers), and 15,000 disabled and older adults. Consolidated Framework for Implementation Research guides examination of site, clinician, and beneficiary characteristics; clinician attitude and self-efficacy; leadership and readiness to implement; and intervention impact on beneficiary outcomes. Sites will be randomized to either usual waiver care with internal facilitation of the bundle of implementation strategies or usual waiver care with both internal and external facilitation of the bundle. Primary outcomes are site-level adoption and sustainability over 12 months, and intervention effects on these outcomes are hypothesized to be mediated by clinicians’ attitude and self-efficacy. At the beneficiary level, by addressing the individual’s capabilities and home environment, the intervention is hypothesized to improve secondary outcomes of activities of daily living, pain, depression, falls, emergency department visits, and hospitalizations. Baseline site readiness and leadership and stages of implementation at 6 months will be explored as potential moderators. Linear mixed effects models will be used to test intervention effects on primary outcomes, with bias-correcting analytic strategy in mediation analyses. Generalized linear mixed effects modeling will be employed for the analysis of intervention effects on secondary outcomes. Discussion Synthesizing findings within and across the sites, we will specify how leadership, readiness for change, and level of facilitation enhance capacity for adoption and sustainability of an evidence-based intervention in an under-resourced Medicaid setting that cares for disabled and older adults. Trial registration ClinitalTrials.gov, NCT03634033. Registered 16 August 2018. Electronic supplementary material The online version of this article (10.1186/s13012-019-0907-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra L Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, 301 Michigan St, Room C352, Grand Rapids, MI, 49504, USA.
| | - Monica Schueller
- Kirkhof College of Nursing, Grand Valley State University, 301 Michigan St, Room C352, Grand Rapids, MI, 49504, USA
| | - Alla Sikorskii
- Departments of Psychiatry and Statistics and Probability, Michigan State University, East Lansing, USA
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Carnemolla P, Bridge C. Housing Design and Community Care: How Home Modifications Reduce Care Needs of Older People and People with Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111951. [PMID: 31159396 PMCID: PMC6604004 DOI: 10.3390/ijerph16111951] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/16/2022]
Abstract
The extent to which housing design can minimise levels of community caregiving has remained largely unmeasured. This paper reports the potential for home modifications to reduce caregiving in the peoples' homes, particularly older people and people with a disability. It contributes to new knowledge in understanding how housing can play a role in community caregiving and acknowledges the role of the built environment in managing care levels in ageing societies. This paper analyses self-reported care data from 157 Australian community care recipients (average age: 72 years) who had received home modifications within the past 6 months. A before/after comparison of care provided revealed that home modifications reduced hours of care provided by 42% per week. More detailed analysis revealed that the positive association of home modifications with care reduction is stronger with informal care (46% reduction) followed by formal care (16% reduction). These results suggest the role that home modifications, and housing design in general, play in reducing care needs in a community setting.
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Affiliation(s)
- Phillippa Carnemolla
- School of Built Environment, Faculty of Design, Architecture and Building, University of Technology Sydney, Harris St, Ultimo, NSW 2007, Australia.
| | - Catherine Bridge
- Faculty of Built Environment, University of New South Wales, Kensington, NSW 2052, Australia.
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Swarthout M, Bishop MA. Population health management: Review of concepts and definitions. Am J Health Syst Pharm 2019; 74:1405-1411. [PMID: 28887342 DOI: 10.2146/ajhp170025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The terms population health, population health improvement, and population health management are discussed. SUMMARY A key concept in defining population health activities is clearly delineating the population(s) of focus. The Institute for Healthcare Improvement's (IHI's) Triple Aim Initiative uses the term population health management to describe the work by healthcare organizations to improve outcomes for individual patients to maximize population health. The National Academy of Medicine favors the term population health improvement and uses this term to describe work to identify and improve aspects of or contributors to population health, expanding the focus beyond traditional healthcare delivery systems. As organizations like IHI and the National Academy of Medicine continue to focus on population health, the terms and definitions used to describe these activities will continue to evolve. CONCLUSION The use of consistent, clear definitions for population health activities is critical to the practice of pharmacy and healthcare delivery.
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Affiliation(s)
- Meghan Swarthout
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD .,Johns Hopkins Outpatient Pharmacy, Baltimore, MD.
| | - Martin A Bishop
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD
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50
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Kim H, Zhao YL, Kim N, Ahn YH. Home modifications for older people with cognitive impairments: Mediation analysis of caregivers' information needs and perceptions of fall risks. Int J Older People Nurs 2019; 14:e12240. [PMID: 31099499 DOI: 10.1111/opn.12240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/13/2019] [Accepted: 04/15/2019] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES The aims were to (a) identify how many older people with cognitive impairments are living in modified homes and (b) explore associated factors, and (c) examine the mediating effects that their caregivers' information needs and perceptions of fall risk and other factors. BACKGROUND Older people and their informal caregivers may consider implementing home modifications as an effective strategy for fall prevention. However, there is a lack of information on which older people's homes receive modifications and the various factors associated with such modifications among community-dwelling older people with cognitive impairments. DESIGN This cross-sectional and correlational study utilises a secondary data analysis. METHODS The data for this secondary analysis were taken from the 2015 National Online Survey of Caregivers, which includes information provided by 226 adult caregivers for older people with cognitive impairments. Descriptive analyses, hierarchical binary logistic regression and structural equation modelling were performed based on the Andersen and Newman framework of health services utilisation. RESULTS Overall, 46.5% of the older people lived in modified homes. Older people's impaired activities for daily living (ADLs), caregivers' information needs and perceptions of fall risk were all associated with home modifications (all p values<0.05). Caregivers' information needs mediated the relationship between impaired ADLs and home modifications (indirect effect = 0.026, p < 0.05), whereas the caregivers' perceptions of fall risk did not. CONCLUSIONS Older people with both cognitive and functional impairments are more likely to modify their home on behalf of care recipient's staying at home. Caregivers' information needs should thus be prioritized when considering home modifications to facilitate caring for older people with impaired ADLs. IMPLICATION FOR PRACTICE Nurses and other healthcare professionals should be prepared to offer appropriate information and comprehensive assessments of older people's conditions with regard to home modifications.
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Affiliation(s)
- Heejung Kim
- College of Nursing, Yonsei University, Seodaemun-gu, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Seodaemun-gu, Seoul, Korea
| | | | - Namhee Kim
- College of Nursing, Yonsei University, Seodaemun-gu, Seoul, Korea
| | - Yong Han Ahn
- Department of Architecture and Architectural Engineering, Hanyang University-ERICA, Ansan, Sangnok-gu, Korea
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