The effectiveness of a bibliotherapy in increasing the self-management ability of slightly to moderately frail older people

Instruments for measuring self-management and self-care in geriatric patients - a scoping review

Introduction

With demographic changes, prioritizing effective care for geriatric patients to maintain functionality, independence, and quality of life is crucial. Well-developed self-management or self-care abilities, which can be maintained and improved through interventions, are of the utmost importance. To implement these interventions tailored and effectively, a thorough assessment of the individual's self-management and self-care abilities is required.

Objective

This scoping review aimed to identify self-management and self-care instruments suitable for geriatric patients, their underlying theories and definitions of self-management and self-care, and their similarities and differences in item content.

Methods

A systematic search of the PubMed and CINAHL databases was conducted to identify retrievable full-text articles published in English in the medical and nursing fields since the 1970s, which were validated on a sample with an average age of at least 70 years, used generic rather than disease-specific items, and addressed the broad range of self-management and self-care abilities.

Results

Of the 20 included articles, six instruments were identified that were based on different theories and offered varying definitions of self-management or self-care. Despite these differences, all emphasize empowered individuals taking an active role in their care. Most address actual behavior and abilities referring to lifestyle factors and (anticipated) adjustment behavior. However, crucial aspects, such as psychological factors, (instrumental) activities of daily living, and social environment are not fully addressed in these instruments, nor are the types of execution to which the items refer, such as wants, feelings, confidence, or attitudes.

Conclusion

To fully understand how geriatric patients implement daily self-management or self-care, a combination of instruments covering the important factors of self-management and self-care and addressing multiple types of item execution, such as behaviors, abilities, wants, or attitudes, is recommended. This review provides the first comprehensive overview of self-management and self-care instruments suitable for geriatric patients.

A Sense of Control and Wellbeing in Older People Living with Frailty: A Scoping Review

A sense of control is important for supporting older people living with frailty to develop adaptive functioning to optimize wellbeing. This scoping review examined the literature on the sense of control and wellbeing in older people living with frailty within their everyday life and care service use. Nine databases were searched using the timeframe 2000 to 2021 to identify key ideas regarding control and wellbeing in older people with frailty. The review highlighted three major themes: a) Control as conveyed in bodily expressions and daily activities, b) Sense of control and influence of place of residence, and c) Control within health and social care relationships. Maintaining a sense of control is not only an internal feeling but is impacted by physical and social environments. Greater focus is needed on the nature of relationships between older people living with frailty and those who work alongside them, which support control and wellbeing.

Corrigendum: The interplay between quality of life and resilience factors in later life: a network analysis

[This corrects the article DOI: 10.3389/fpsyg.2021.752564.].

Are self-management abilities beneficial for frail older people's cognitive functioning?

Background

Self-management abilities seem to be important for the cognitive functioning of older people, especially those who are frail. We investigated relationships between broad self-management abilities (initiative taking, investment behavior, resource variety, resource multifunctionality, self-efficacy, and positive frame of mind) and cognitive functioning among frail older people while controlling for background characteristics (sex, age, marital status, and educational level).

Method

Survey data were collected from mid-2014 to mid-2015 from community-dwelling frail older people residing in North Brabant, the Netherlands. We measured cognitive functioning with the 12-item Mini-Mental State Examination (MMSE-12) and self-management abilities with the short version of the Self-Management Ability Scale (SMAS-S).

Results

In total, 588 of 834 potential participants were willing to participate (70.5% response rate). The mean age was 82.33 ± 5.19 and the majority (68.5%) of respondents were female. About one-third (38.4%) of respondents had low educational levels and 61.7% lived alone. Mean MMSE-12 and SMAS-S scores were 9.68 ± 2.10 and 3.70 ± 0.88, respectively. Bivariate analyses showed that all six self-management abilities were related positively to cognitive functioning. Multivariate analyses with adjustment for background characteristics (sex, age, marital status, and educational level) showed that cognitive functioning was associated positively with initiative taking (β = 0.23, p = 0.030) and investment behavior (β = 0.24, p = 0.030) among community-dwelling frail older people.

Conclusions

This study clearly showed that a repertoire of broad self-management abilities is related to cognitive functioning among community-dwelling frail older people. Initiative taking and investment behavior seem to be especially important. These findings are of interest in a time of populational aging and an increasing number of older people dealing with cognitive problems. Preventive investments in (older) people’s self-management abilities are expected to be beneficial for their cognitive functioning in the long term.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03353-4.

Positive Psychology in Therapeutic Songwriting for People Living with Late-Life Depression—An Intervention Protocol

(1) Background: An increasing number of people are living with late-life depression, yet non-pharmacological treatments to help manage symptoms are limited. Two interventions, positive psychology and music therapeutic songwriting, have independently led to decreased depressive symptoms and an improved wellbeing in older people over 65 years old. (2) Methods: This article describes the development of a therapeutic songwriting program for people living with late-life depression. Knowledge from positive psychology and therapeutic songwriting was combined to maximize the potential benefits. (3) Results: The intervention program has ten weekly 45 min sessions that incorporate elements from positive psychology into therapeutic songwriting. Using a three-song approach encompassing ongoing musical practices, different positive psychology interventions were incorporated to support the experiences associated with a flourishing life. The intervention protocol for older people presented here is distinct from previous deficit-orientated approaches in that it shifts the focus to positive experiences, resources, and the individual’s ability to decrease their own depressive symptoms and improve their wellbeing. (4) Discussion: This protocol presenting a therapeutic songwriting program meets the need to develop new non-pharmacological treatment options. However, further studies are needed to examine the feasibility and impact of the intervention program on late-life depression and wellbeing in older people.

Effects of Developmental Bibliotherapy on Subjective Well-Being of Older Adults Living in Nursing Homes: A Quasi-Experimental Study

The current study sought to create a developmental bibliotherapy material database (DBMD) and examine the effectiveness of developmental bibliotherapy on subjective well-being of older adults living in nursing homes. Based on the reading needs of older adults, we developed a DBMD, which included 327 materials with five themes: Health Care, Current Affairs and Politics, Historical Biographies, Geriatric Culture, and Psychological Adjustment. Fifty-four single materials were randomly selected from the DBMD to perform the intervention. This study used a quasi-experimental, single-group pre-/post-survey approach. Sixty-four older adults participated in the study for 6 weeks. Immediately before and after the intervention, older adults completed the Optimism-Pessimism Scale and Memorial University of Newfoundland Scale of Happiness. There were significant improvements in older adults' optimistic tendency and subjective well-being (p < 0.05). Reading materials in the DBMD promoted older adults' optimistic attitude toward life, reduced negative emotions, and improved subjective well-being. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

A healthy view? exploring the positive health perceptions of older adults with a lower socioeconomic status using photo-elicitation interviews

Purpose: The health perceptions of older adults with a lower socioeconomic status still seems to be unsettled. To gain more insight in these perceptions, 19 older adults were interviewed with the use of a photo-elicitation method.Methods: Participants reflected on ten photographs covering aspects of physical, social and mental health, and were also asked if and how they experience to have control over their health.Results: The results showed that the perception of health depended on the background of the participant, was experience-oriented and was mostly focused on the negative aspects of physical and mental health. Social contacts were an important contributor to well-being, especially when physical health declined. Although most participants seem hardly aware of having influence on their own health, several participants showed automatic self-management abilities.Conclusion: For participants who need more support to improve, or become more aware of their self-management abilities, interventions with an experience-oriented approach are needed.

The Interplay Between Quality of Life and Resilience Factors in Later Life: A Network Analysis

Age-related challenges and transitions can have considerable social, psychological, and physical consequences that may lead to significant changes in quality of life (QoL). As such, maintaining high levels of QoL in later life may crucially depend on the ability to demonstrate resilience (i.e., successful adaptation to late-life challenges). The current study set out to explore the interplay between several resilience factors, and how these contribute to the realization and maintenance of (different facets of) QoL. Based on the previous work, we identified behavioral coping, positive appraisal, self-management ability, and physical activity as key resilience factors. Their interplay with (various facets of) QoL, as measured with the WHOQOL-OLD, was established through network analysis. In a sample of community-dwelling older adults (55+; N=1,392), we found that QoL was most strongly (and directly) related to positive appraisal style and self-management ability. Among those, taking care of multifunctional resources (i.e., yielding various benefits at the same time) seemed to be crucial. It connected directly to "satisfaction with past, present, and future activities," a key facet of QoL with strong interconnections to other QoL facets. Our analysis also identified resilience factor(s) with the potential to promote QoL when targeted by training, intervention, or other experimental manipulation. The appropriate set of resilience factors to manipulate may depend on the goal and/or facet of QoL that one aims to improve.

A cross-sectional study investigating the relationships between self-management abilities, productive patient-professional interactions, and well-being of community-dwelling frail older people

Worldwide, the maintenance of well-being in ageing populations with associated frailty has become increasingly important. To maintain well-being during ageing, investment in frail older people’s self-management abilities and the fostering of productive interactions with healthcare professionals may lead to higher levels of well-being. The aim of this study was to investigate the relationships between community-dwelling frail older people’s self-management abilities, productive patient-professional interactions and well-being, while controlling for socio-demographic characteristics. This cross-sectional study included 588 community-dwelling frail older people (aged ≥ 75 years) from 15 general practitioner (GP) practices in the Netherlands. Well-being (Social Production Function Instrument for the Level of well-being short), productivity of interactions with GPs (relational coproduction instrument), and self-management abilities (Self-Management Ability Scale short) were measured during in-home face-to-face interviews by trained interviewers. Data were analysed using descriptive statistics, correlation analyses, and linear mixed-effects models. Significant relationships were detected between self-management abilities and the overall, social, and physical well-being of older people, and between productive interactions with GPs and overall and social well-being, but not physical well-being. In a time of ageing populations with associated frailty, investment in frail older people’s self-management abilities and the productivity of patient-professional interactions may be beneficial for this population’s well-being.

A systematic review and meta-analysis of psychological interventions to improve mental wellbeing

Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.

Inducing positive emotions to reduce chronic pain: a randomized controlled trial of positive psychology exercises

PURPOSE

Positive emotions have been found to be analgesic and can be induced by positive psychology exercises. This study tested if positive psychology exercises provide beneficial effects on pain, responses to pain, physical (pain interference), and emotional function.

METHODS

Randomized parallel-group controlled single-blinded superiority-trial including community-dwelling individuals with chronic pain secondary to spinal cord injury. Participants in the intervention group were instructed to practice 4 personalized positive psychology exercises for 8 weeks. Participants in the control group were asked to be mindful and write about current life events.

RESULTS

108 (64%) completed the study. At post-treatment, the intervention participants reported significant reductions in pain intensity and improvements in pain catastrophizing and pain control, relative to baseline. Both groups reported significant decreases in pain interference and negative emotions. Significant between-group differences emerged for pain intensity at post-treatment. At 3-months follow-up, improvements maintained for the intervention group and improvements in positive emotions reached statistical significance. Between-group differences were identified for pain intensity at post-treatment.

CONCLUSION

Positive psychology exercises represent a potential effective complementary treatment that result in benefits on pain which can be readily implemented into daily living. Trials designed with an inactive control condition should be conducted to further address efficacy.

TRIAL REGISTRATION

Swiss ethics committee (EKNZ 2014-317)/clinicaltrials.gov (NCT02459028) Registration date: Ethics approval 25.10.2014/Study start date: May 2015 URL of the record: https://clinicaltrials.gov/ct2/show/NCT02459028?term=NCT02459028&cntry=CH&draw=2&rank=1IMPLICATIONS FOR REHABILITATIONPain engenders negative emotions (e.g., fear, anger, sadness) which can negatively affect psychological, social, and physical function.Positive emotions have been found to be analgesic and can be induced by practicing positive psychology exercises.The findings of the current randomized controlled trial provide support for practicing positive psychology exercises (beyond the effects of pain medication intake), in particular on the reduction of pain intensity, but also in improving pain catastrophizing and pain control.The majority of the positive psychology exercises are brief and self-administered positive activities that have no known negative side effects nor financial cost, can be tailored to a person's preferences in activities and can be readily implemented into daily living with chronic pain, complementing standard treatment of pain.

POSITIVE PSYCHIATRY INTERVENTIONS IN GERIATRIC MENTAL HEALTH

PURPOSE OF REVIEW

Positive psychiatry shifts the focus of geriatric mental healthcare beyond studying disorders and psychopathology to studying factors that contribute to mental well-being and successful aging. An increasing number of interventional studies are using treatments that target modifiable positive psychosocial characteristics (PPCs) and study their impact on mental health. Here we provide an overview of the literature on positive psychiatry interventions using illustrative examples of interventions targeting social connectedness, meaning in life, wisdom, and resilience.

RECENT FINDINGS

There is growing evidence that PPCs are modifiable constructs that may be associated with improved well-being, physical health, and mental health outcomes.

SUMMARY

The preliminary evidence summarized in this narrative review indicates that positive psychiatry interventions targeting social connectedness, meaning in life, wisdom, and resilience can improve overall well-being and other positive health outcomes amongst older adults. The effect sizes of these interventions reported in RCTs and meta-analyses are typically small to medium, but occasionally large effect sizes are also reported. Current literature is restricted by heterogeneous methodology, limiting clinicians' abilities to extrapolate these principles of positive psychiatry into everyday practice. With the expanding body of evidence, positive psychiatry may have the potential to transform the landscape of geriatric mental health.

Meta-analyses of positive psychology interventions: The effects are much smaller than previously reported

For at least four decades, researchers have studied the effectiveness of interventions designed to increase well-being. These interventions have become known as positive psychology interventions (PPIs). Two highly cited meta-analyses examined the effectiveness of PPIs on well-being and depression: Sin and Lyubomirsky (2009) and Bolier et al. (2013). Sin and Lyubomirsky reported larger effects of PPIs on well-being (r = .29) and depression (r = .31) than Bolier et al. reported for subjective well-being (r = .17), psychological well-being (r = .10), and depression (r = .11). A detailed examination of the two meta-analyses reveals that the authors employed different approaches, used different inclusion and exclusion criteria, analyzed different sets of studies, described their methods with insufficient detail to compare them clearly, and did not report or properly account for significant small sample size bias. The first objective of the current study was to reanalyze the studies selected in each of the published meta-analyses, while taking into account small sample size bias. The second objective was to replicate each meta-analysis by extracting relevant effect sizes directly from the primary studies included in the meta-analyses. The present study revealed three key findings: (1) many of the primary studies used a small sample size; (2) small sample size bias was pronounced in many of the analyses; and (3) when small sample size bias was taken into account, the effect of PPIs on well-being were small but significant (approximately r = .10), whereas the effect of PPIs on depression were variable, dependent on outliers, and generally not statistically significant. Future PPI research needs to focus on increasing sample sizes. A future meta-analyses of this research needs to assess cumulative effects from a comprehensive collection of primary studies while being mindful of issues such as small sample size bias.

Pace and determinants of implementation of the self-management of well-being group intervention: a multilevel observational study

Background

When implementing an empirically supported intervention (ESI) arrays of influencing factors operate on the professional and organizational level, but so far dependency between these levels has often been ignored. The aim of this study is to describe the pace and identify determinants of implementation of the Self-Management of Well-being (SMW) group intervention while taking the dependency between professionals and organizations into account.

Methods

Pace of implementation was measured as the time between training of professionals and first use of the SMW intervention in months. Determinants of first use were derived from the Fleuren framework and assessed using web-based questionnaires and telephone interviews. First, univariate analyses, Fisher’s exact tests and t-tests, were performed to identify determinants of first use of the SMW intervention on the individual professional and the organizational level independently. Second, multilevel analyses were performed to correct for the dependency between professionals and organizations. Simple multilevel logistic regression analyses were performed with determinants found significant in the univariate analyses as independent variables, first use as dependent variable, professionals entered in the first level, and organizations in the second level.

Results

Forty-eight professionals from 18 organizations were trained to execute the SMW intervention. Thirty-two professionals achieved first use, at a mean pace of 7.5 months ± 4.2. Determinants on the professional level were ‘ownership’, ‘relative advantage’, ‘support from colleagues’ and ‘compatibility’. Determinants on the organizational level were ‘organizational size’ and ‘innovation-task orientation fit’. Multilevel analysis showed that ‘compatibility’, a factor on the professional level, was the only significant determinant contributing to first use in the multilevel model.

Conclusions

This implementation study revealed a strong dependency between professionals and organizations. Results showed that a majority of professionals used the SMW intervention in about 8 months. When the dependency between professionals and organization was taken into account, the professionals’ perception of compatibility was the only remaining determinant of implementation on the professional level. Organizational size and managers’ perception of ‘innovation-task orientation fit’ were determinants of implementation on the organizational level. It is advisable to discuss the compatibility between new and current tasks among managers and professionals before adopting a new intervention.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3891-x) contains supplementary material, which is available to authorized users.

The importance of health behaviours and especially broader self-management abilities for older Turkish immigrants

Background

This study aims to identify the relationships between health behaviours, self-management abilities, physical health, depressive symptoms and well-being among Turkish older immigrants.

Methods

A total of 2350 older Turkish migrants aged > 65 years residing in Rotterdam, the Netherlands were identified using the municipal register of which 680 respondents completed the questionnaires (response rate of 32%).

Results

Average age of the respondents was 72.90 (standard deviation 5.02) (range 66–95) years and about half of them were women (47.6%). The majority of respondents reported having a low education (80.3%), low income level (83.4%), is chronically ill (90.6%), overweight (86.5%) and about half obese (46.0%). More than half of the respondents eat enough fruit (58.2%) and vegetables per week (55.3%). About a third of the respondents smoke (33.5%) and 43.0% can be considered to be physically active. Looking at the health behaviours a weak positive relationship was found between eating enough vegetables and well-being (β = 0.14; P = 0.017). In addition, weak relationships were found between physical activity and depressive symptoms (β = −0.16; P = 0.007), smoking and depressive symptoms (β = 0.16; P = 0.009) and self-management abilities and physical health (β = 0.17; P = 0.015). Strongest relationships were found between self-management abilities and depressive symptoms (β = −0.39; P < 0.001) and self-management abilities with overall well-being (β = 0.49; P < 0.001).

Conclusions

From this study, we can conclude that next to health behaviours broader self-management abilities to maintain overall well-being are important for Turkish older people. Interventions to improve self-management abilities may help Turkish older people better deal with function losses and chronic diseases as they age further.

The emergence and utilisation of frailty in the United Kingdom: a contemporary biopolitical practice

Frailty has recently emerged as a dominant concept against a backdrop of media and governmental narratives that frame the growing ageing population as an economic threat to the current configuration of health care in the United Kingdom (UK). Despite frailty's popularity amongst geriatricians and policy makers, the concept faces resistance from other health-care professionals and older people themselves. This paper draws on the Foucauldian idea of biopower; by suggesting that the contemporary emergence and utilisation of frailty represents a biopolitical practice a number or critical observations are made. First, despite biomedical experts acknowledging ambiguities in the definition of frailty, the concept is presented as a truth discourse. This is driven by the ability of frailty measurements to predict risk of costly adverse outcomes; the capability of frailty scores to enumerate complex needs; and the scientific legitimacy frailty affords to geriatric medicine. Consequently, frailty has become pervasive, knowable and measurable. Second, the routine delineation between frail and robust objectifies older people, and can be said to benefit those making the diagnosis over those being labelled frail, with the latter becoming disempowered. Last, studies show that frailty is associated with increasing wealth inequalities in the UK; however, experts’ suggested management of frailty shifts the focus of responsibility away from ideologically driven structural inequalities towards the frail older person, attempting to encourage individuals to modify lifestyle choices. This neglects the association between lifestyle opportunities and socio-economic deprivation, and the impact of long-term poverty on health. These observations, set against the contemporary political climate of economic austerity, cuts to public services and rationalisation of health resources, bring the urgency of a critical consideration of frailty to the fore.

Self-management tasks to improve mobility and reduce fall risk are not leading to lower research participation in older adults

PURPOSE OF STUDY

The first aim is to evaluate, in a sub-study, the recruitment process of the Senior Step Study, which was an intervention study on the self-management of mobility and fall risk; the second aim is to explore the reasons mentioned by older people, from three different settings, for (not) participating.

METHODS

Subjects were community-dwelling older persons, residents of homes for the elderly, and older persons regularly visiting community centres. The effectiveness of different recruitment procedures was analysed for each setting separately. We also analysed reasons for accepting and declining participation between the settings.

RESULTS

The total inclusion rate was 27.9%. A personal initial approach (i.e., first contact was face-to-face or in a group meeting) did not improve the inclusion rate. More subjects consented to participate after an introductory meeting (which was planned after the first face-to-face contact) compared to persons not having one (p < 0.01). At different settings, subjects gave different reasons for participation. No differences were found in the reasons for refusing participation. Especially in homes for the elderly, people refused to participate because the research was too burdensome.

CONCLUSIONS

The inclusion rates in this study are comparable to other self-management studies with older people. An introductory meeting during which the study design and benefits of participating are explained and formal interim evaluations of the recruitment process may benefit recruitment. Recruiting older persons for self-management tasks is possible with the appropriate recruitment process, enabling more research on this increasingly important research topic.

The Effectiveness of a PRoactive Multicomponent Intervention Program on Disability in Independently Living Older People: A Randomized Controlled Trial

BACKGROUND

There is an increase in functional limitations and a decline in physical and mental well-being with age. Very few effective lifestyle interventions are available to prevent adverse outcomes such as disability in (pre-) frail older people. The effectiveness of an interdisciplinary multicomponent intervention program to prevent disability in older people in the community was tested.

METHOD

A randomized controlled trial (RCT) with a one-year follow-up was conducted in the Netherlands. Community-dwelling pre-frail older people aged 65 years and over were invited to participate. Frailty was measured with the Groningen Frailty Indicator (GFI) and categorized into non-frail (GFI=0), pre-frail (GFI = 1-3) and frail (GFI ≥ 4). The intervention program consisted of four components: a medication review, physical fitness, social skills, and nutrition.

OUTCOMES

The primary outcome was activity of daily living (ADL) measured with the Katz-6. Secondary outcomes were quality of life (SF-12) and healthcare consumption such as hospital admission, nursing home admission and primary care visits. Additional outcomes measured in the intervention group were physical fitness, Instrumental Activities of Daily Living (IADL), muscle strength, walking speed, functional capacity, mobility, feelings of depression and loneliness and nutritional status. The data were collected at baseline, after each intervention component and at a 12-month follow-up. An intention to treat analysis was used.

RESULTS

In total, there were 290 participants, and 217 (74.8%) completed the study. The mean age was 74 (SD: 7.2), most were pre-frail (59.9%), the majority were female (55.2%), and the individuals were not living alone (61.4%). After the 12-month follow-up, the median Katz-6 score did not change significantly between the two groups; adjusted Odds Ratio (OR) = 0.96 (95% Confidence Interval (CI): 0.39-2.35, p-value 0.92). No statistically significant differences were observed between the groups for quality of life and healthcare consumption. Among the participants in the intervention group, IADL (Friedman's test p <=0.04, X2 =6.50), walking speed (Friedman's test p <0.001, X2 =19.09) and functional capacity (Friedman's test p <0.001, X2 =33.29) improved significantly after the one-year follow-up. Right-hand grip strength improved immediately after completion of the intervention (Wilcoxon signed-rank test p=0.00, z= -3.39) but not after the 12-month follow-up.

CONCLUSION

The intervention program did not significantly improve daily functioning, quality of life and healthcare consumption among (pre) frail community-dwelling older persons at the one-year follow-up. Participants in the intervention group experienced improvements in walking speed, functional capacity and instrumental activities of daily living. More research is needed to better understand why may benefit and how to identify the target population.

Benefits of Well-Being Training in Healthy Older Adults

INTRODUCTION

Several studies have shown that psychological well-being (PWB) can be promoted through positive psychological interventions (PPIs). Although these interventions have shown promising results in clinical settings, only a few studies have investigated their effectiveness in older adults, and they have rarely considered an active control group. In addition, generalisation effects of the PWB training to quality of life (QoL) and to untrained cognitive abilities have never been considered.

OBJECTIVE

In this study, we evaluated the effectiveness of a six-session PWB intervention aiming specifically to improve PWB, and sought any transfer effects on an aspect related to PWB, QoL. Transfer effects on a high-level cognitive process, working memory (WM), were also investigated.

METHODS

Thirty-two older adults (61-82 years old) volunteered to take part in the study and were randomly assigned to either a training group or an active control group.

RESULTS

Only the trained group, once controlled for variability, reported larger gains in PWB and in WM performance after the training.

CONCLUSIONS

This pilot study suggests that PWB training can be effective in older adults, with a positive generalisation effect on cognition (WM). The discussion focuses on the need to develop PPIs tailored to older adults' needs and resources.

Interventions based on self-management of well-being theory: pooling data to demonstrate mediation and ceiling effects, and to compare formats

OBJECTIVES

Interventions based on self-management of well-being (SMW) theory have shown positive effects, but additional questions remain: (1) Are improvements in well-being, as induced by the interventions, mediated by improved self-management ability (SMA)? (2) Do the interventions show ceiling effects? (3) Is a particular format of SMW intervention (individual, group, or self-help) more effective?

METHOD

Data of three randomized controlled trials were pooled. The greater part of the sample (N = 445) consisted of single older females. A bootstrap analysis was performed to test for mediation. Regression analyses with interaction effects were performed to test for ceiling effects. Controlled and transformed effect sizes (proportion of maximum change) were calculated to compare formats.

RESULTS

There was a full significant mediation of well-being by SMA. A significant interaction (ceiling) effect was found on well-being, but not on SMA. The controlled effect sizes of the raw scores were small to medium (.04-.49), and were small to large after transformation (.41-.73). None of the intervention formats was more effective.

CONCLUSION

Support for SMW theory was found, i.e. increasing self-management ability lead to improved well-being. Some ceiling effect was found. We conclude that various SMW interventions formats can improve self-management abilities and well-being with medium effects.

The Impact of Audio Book on the Elderly Mental Health

Introduction

The growing elderly population calls mental health professionals to take measures concerning the treatment of the elderly mental disorders. Today in developed countries, bibliotherapy is used for the treatment of the most prevalent psychiatric disorders. Therefore, this study aimed to investigate the effects of audio book on the elderly mental health of Retirement Center of Shahid Beheshti University of Medical Sciences.

Methods

This experimental study was conducted on 60 elderly people participated in 8 audio book presentation sessions, and their mental health aspects were evaluated through mental health questionnaire (SCL-90-R). Data were analyzed using SPSS 24.

Results

Data analysis revealed that the mean difference of pretest and posttest of control group is less than 5.0, so no significant difference was observed in their mental health, but this difference was significant in the experimental group (more than 5.0). Therefore, a significant improvement in mental health and its dimensions have observed in elderly people participated in audio book sessions. This therapeutic intervention was effective on mental health dimensions of paranoid ideation, psychosis, phobia, aggression, depression, interpersonal sensitivity, anxiety, obsessive-compulsive and somatic complaints.

Conclusion

Considering the fact that our population is moving toward aging, the obtained results could be useful for policy makers and health and social planners to improve the health status of the elderly.

Sustaining program effectiveness after implementation: The case of the self-management of well-being group intervention for older adults

OBJECTIVE

The Self-Management of Well-being (SMW) group intervention for older women was implemented in health and social care. Our aim was to assess whether effects of the SMW intervention were comparable with the original randomized controlled trial (RCT). Furthermore, we investigated threats to effectiveness, such as participant adherence, group reached, and program fidelity.

METHODS

In the implementation study (IMP) 287 and RCT 142 women participated. We compared scores on self-management ability and well-being of the IMP and RCT. For adherence, drop-out rates and session attendance were compared. Regarding reach, we compared participants' baseline characteristics. Professionals completed questions regarding program fidelity.

RESULTS

No significant differences were found on effect outcomes and adherence between IMP and RCT (all p≥0.135). Intervention effect sizes were equal (0.47-0.59). IMP participants were significantly less lonely and more likely to be married, but had lower well-being. Most professionals followed the protocol, with only minimal deviations.

CONCLUSION

The effectiveness of the SMW group intervention was reproduced after implementation, with similar participant adherence, minimal changes in the group reached, and high program fidelity.

PRACTICE IMPLICATIONS

The SMW group intervention can be transferred to health and social care without loss of effectiveness. Implementation at a larger scale is warranted.

Validation of the Aging Perceptions Questionnaire Short on a sample of community-dwelling Turkish elderly migrants

Background

Aging perceptions have been found to be major contributors to health in old age. To quantitatively explore aging perceptions among elderly Turkish migrants, valid and reliable Turkish-language instruments are needed. The objective of the current study was to examine the construct validity and reliability of the Turkish-language version of the seven-dimension Aging Perceptions Questionnaire Short version (APQ-S) in a sample of community-dwelling elderly Turkish migrants in the Netherlands.

Methods

A questionnaire including the Turkish-language APQ-S was administered to 438 community-dwelling Turkish migrants aged 65–99 years who resided in Rotterdam, the Netherlands. The APQ-S includes 21 items in seven dimensions (timeline chronic and cyclical, consequence positive and negative, control positive and negative, and emotional representations). The questionnaire also contained items measuring well-being, physical and mental health-related quality of life, and number of chronic conditions.

Results

The latent factor model of the Turkish APQ-S was found to have an acceptable fit (root mean square error of approximation = .06; standardized root mean square residual = .07; comparative fit index = .90). Each indicator loaded significantly on its corresponding latent factor, and standardized factor loadings > .40 supported the convergent validity of the Turkish APQ-S dimensions. The APQ-S was also found to have acceptable construct validity in terms of its inter-factor structure and its expected associations with various health measures and age, gender, educational level, and marital status. Contrary to expectations, income level was not associated with any APQ-S dimension. With the exception of timeline cyclical (α = .56), each APQ-S dimension had acceptable reliability, with Cronbach’s alpha values ranging from .75 (timeline chronic) to .88 (control positive). Most APQ-S dimension scores differed significantly between elderly Turkish migrants and a general population of elderly Rotterdam residents, with Turkish elders having more negative and less positive aging perceptions.

Conclusion

The Turkish-language version of the APQ-S is a psychometrically valid and reliable instrument for the assessment of aging perceptions among elderly Turkish migrants. Further research is needed to gain insight into aging perceptions and their health and sociodemographic correlates in this population.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0619-7) contains supplementary material, which is available to authorized users.

Feasibility of repeated self-measurements of maximum step length and gait speed by community-dwelling older persons

OBJECTIVES

Self-management of mobility and fall risk can be important in fall prevention; however, it remains unstudied. Therefore, the current study assessed whether community-dwelling older persons were able to repeatedly self-assess maximum step length (MSL) and gait speed (GS) in their own home for a 6-month period, how these tests changed during this period and if these changes were related to falling.

DESIGN

This is a prospective study.

SETTING

This study was conducted at home.

PARTICIPANTS

A total of 56 community-dwelling older adults (24 women (43%), mean age 76.2 (SD 3.9) years) entered the study; of which, 45 completed the study.

METHODS

Participants performed MSL and GS once a week in their own home during a 6-month period.

PRIMARY AND SECONDARY OUTCOMES

Repeated MSL and GS measurements were the primary outcomes. Falls, self-management and mobility were the secondary outcomes.

RESULTS

Self-assessment of MSL and GS by older persons is feasible. Compliance of repeatedly self-measuring MSL and GS was good; the median number of weekly measurements was 23.0 (88%) and 21.0 (81%) for MSL and GS, respectively. Drop-outs showed less self-management abilities compared to the participants who completed the study (p=0.049). Linear mixed models showed a small significant improvement in MSL and GS over time (p<0.001), without an influence on falling.

CONCLUSIONS

Most community-dwelling older persons are able and willing to repeatedly assess their MSL and GS. Self-managing mobility and fall risk did not increase fall occurrence. The fact that older persons can be actively involved in their own healthcare is clinically relevant. Further studies are needed to examine the (cost-)effectiveness of self-management in fall prevention interventions.

Construct validity of the Groningen Frailty Indicator established in a large sample of home-dwelling elderly persons: Evidence of stability across age and gender

BACKGROUND

The primary objective of the present study was to evaluate the validity of the Groningen Frailty Indicator (GFI) in a sample of Dutch elderly persons participating in LifeLines, a large population-based cohort study. Additional aims were to assess differences between frail and non-frail elderly and examine which individual characteristics were associated with frailty.

METHODS

By December 2012, 5712 elderly persons were enrolled in LifeLines and complied with the inclusion criteria of the present study. Mann-Whitney U or Kruskal-Wallis tests were used to assess the variability of GFI-scores among elderly subgroups that differed in demographic characteristics, morbidity, obesity, and healthcare utilization. Within subgroups Kruskal-Wallis tests were also used to examine differences in GFI-scores across age groups. Multivariate logistic regression analyses were performed to assess associations between individual characteristics and frailty.

RESULTS

The GFI discriminated between subgroups: statistically significantly higher GFI-median scores (interquartile range) were found in e.g. males (1 [0-2]), the oldest old (2 [1-3]), in elderly who were single (1 [0-2]), with lower socio economic status (1 [0-3]), with increasing co-morbidity (2 [1-3]), who were obese (2 [1-3]), and used more healthcare (2 [1-4]). Overall age had an independent and statistically significant association with GFI scores. Compared with the non-frail, frail elderly persons experienced statistically significantly more chronic stress and more social/psychological related problems. In the multivariate logistic regression model, psychological morbidity had the strongest association with frailty.

CONCLUSION

The present study supports the construct validity of the GFI and provides an insight in the characteristics of (non)frail community-dwelling elderly persons participating in LifeLines.

Validation of the Dutch Aging Perceptions Questionnaire and development of a short version

BACKGROUND

Perceptions of aging have been found to independently contribute to various aspects of health and wellbeing in old age. Since valid and reliable perceptions of aging instruments are unavailable in Dutch, these associations have not yet been tested in the Netherlands. This study examined the reliability and construct validity of the Dutch-language version of the 7-dimension Aging Perceptions Questionnaire (APQ). Furthermore, in order to decrease the response burden, while retaining the APQ's original factor structure, a short version of the APQ (APQ-S) was developed as an alternative to the 5-dimension Brief APQ (B-APQ).

METHODS

A Dutch translated version of the APQ was administered to a large sample of community-dwelling elders in the Netherlands, aged 70 to 99 (n = 1280), alongside measures of wellbeing and physical functioning.

RESULTS

Confirmatory factor analyses confirmed the multidimensionality of the APQ. APQ scales were found to have good reliability and acceptable construct validity, yet several areas of localized strain were detected. These areas were addressed during item reduction, resulting in the 21-item APQ-S with an acceptable reliability and validity and a better overall model fit. While several notable differences were found, APQ-S results were largely comparable to that of the 5-dimension B-APQ.

CONCLUSION

With its multidimensional nature and acceptable psychometric properties, the Dutch language version of the APQ may prove to be an invaluable instrument to assess the seven perceptions of aging dimensions among older populations for geriatric research. However, use of a shortened version is advised, as these are less labor intensive and areas of localized strain are addressed. The choice between the APQ-S and the B-APQ should be based on theoretical and practical considerations concerning the dimensional structure most suitable for the study.

Self-management abilities and frailty are important for healthy aging among community-dwelling older people; a cross-sectional study

BACKGROUND

This study aimed to identify the relationships of self-management abilities and frailty to perceived poor health among community-dwelling older people in the Netherlands while controlling for important individual characteristics such as education, age, marital status, and gender.

METHODS

The cross-sectional study sample consisted of 869/2212 (39% response rate) independently living older adults (aged ≥70 years) in 92 neighborhoods of Rotterdam. In the questionnaires we assessed self-rated health, frailty using the Tilburg Frailty Indicator (TFI) and self-management abilities with the short version of the Self-Management Ability Scale (SMAS-S). We first used descriptive analysis to identify those in poor and good health. Differences between groups were established using chi-squared and t-tests. Relationships between individual characteristics, frailty, self-management abilities and poor health were investigated with correlation analyses. Multilevel logistic regression analyses were than performed to investigate the relationships of self-management abilities and frailty to health while controlling for age, gender, education, and marital status. The results of the multilevel regression analyses are reported as odd ratios.

RESULTS

Respondents in poor health were older than those in good health (78.8 vs. 77.2; p ≤ .001). A significantly larger proportion of older people in poor health were poorly educated (38.4% vs. 19.0%; p ≤ .001) and fewer were married (33.6% vs. 46.3%; p ≤ .001). Furthermore, older people in poor health reported significantly lower self-management abilities (3.5 vs. 4.1; p ≤ .001) and higher levels of frailty (6.9 vs. 3.3; p ≤ .001). Correlation analyses showed significant relationships between frailty, self-management abilities and poor health. Multilevel analyses showed that, after controlling for background characteristics, self-management abilities were negatively associated with poor health (p ≤ .05) and a positive relationship was found between frailty and poor health (p ≤ .05) among older people in the community.

CONCLUSIONS

Self-management abilities and frailty are important for healthy aging among community-dwelling older people in the Netherlands. Particularly vulnerable are the lower educated older adults. Interventions to improve self-management abilities may help older people age healthfully and prevent losses as they age further.

Medication management capacity in relation to cognition and self-management skills in older people on polypharmacy

OBJECTIVE

To determine the medication management capacity of independently living older people (≥75 years) on polypharmacy (≥ 5 medications) in relation to their cognitive- and self-management skills.

DESIGN

Cross-sectional study.

SETTING

Two homecare organizations in the Netherlands.

PARTICIPANTS

Homecare clients aged 75 and older on polypharmacy (N=95).

MEASUREMENTS

The primary outcome measure was medication management capacity, quantified as the number of 'yes' answers (range = 0-17) on the Medication Management Capacity (MMC) questionnaire. Other measures included self-management ability (assessed with the SMAS30) and cognitive skills (assessed with the clock drawing test).

RESULTS

Overall, 48.4% (n= 46) of the participants were able to manage their medication by themselves at home. About 40% of the participants were unable to state the names of their medications, even with the aid of a medication list, and about 25% reported having problems with opening medication packages. Correlations were found between self-management ability (Rs = 0.473; p < 0.001), cognitive skills (Rs = 0.372; p < 0.001), and age (Rs = 0.216; p < 0.005) and Medication Management Capacity score. Self-management ability and medication management support were significantly associated with medication management capacity.

CONCLUSION

A considerable proportion of independently living older people who receive home care and regularly use five or more medications lack the knowledge and skills needed to independently manage their own medications. Cognition and self management ability were related to medication management capacity. Self-management ability and medication management support were predictors of medication management capacity.

An evaluation of a Books on Prescription scheme in a UK public library authority

This article discusses an evaluation of a Books on Prescription (BOP) scheme in a UK public library authority. The research was carried out by Rebecca Furness and submitted as a dissertation for the MSc Information and Library Management to Northumbria University. The dissertation was supervised by Biddy Casselden at Northumbria University and was awarded a distinction. The dissertation identified areas for development for BOP schemes and made specific recommendations that could make the schemes more accessible, enabling significant numbers of people to lead more fulfilling lives. Because this study focuses on mental health and the role that UK public libraries have in supporting well-being, it is a good illustration of the wide-ranging nature of subjects welcomed for the Dissertations into practice feature.

An update on frailty diagnosis and management

Frailty as a clinical syndrome is becoming more widely recognized and current evidence shows the importance of early detection of pre-frail states with a potential for reversibility of poor outcomes. The purpose of this review is to present the latest literature on frailty since the last review in this journal in 2007, with a particular focus on interventions aimed at reversing the processes of frailty.

The relationship between self-management abilities, quality of chronic care delivery, and wellbeing among patients with chronic obstructive pulmonary disease in The Netherlands

Background

This cross-sectional study aimed to identify the relationship between quality of chronic care delivery, self-management abilities, and wellbeing among patients with chronic obstructive pulmonary disease (COPD).

Methods

The study was conducted in 2012 and included 548 (out of 1303; 42% response rate) patients with COPD enrolled in a COPD care program in the region of Noord-Kennemerland in The Netherlands. We employed a multilevel random-effects model (548 patients nested in 47 healthcare practices) to investigate the relationship between quality of chronic care delivery, self-management abilities, and patients’ wellbeing. In the multilevel analyses we controlled for patients’ background characteristics and health behaviors.

Results

Multilevel analyses clearly showed a significant relationship between quality of chronic care delivery and wellbeing of patients with COPD (P ≤ 0.001). When self-management abilities were included in the equation while controlling for background characteristics, health behaviors, and quality of chronic care delivery, these abilities were found to have a strong positive relationship with patients’ wellbeing (P ≤ 0.001). Low educational level, single marital status, and physical exercise were not significantly associated with wellbeing when self-management abilities were included in the equation.

Conclusion

Self-management abilities and the quality of chronic care delivery are important for the wellbeing of patients with COPD. Furthermore, self-management abilities acted as mediators between wellbeing and low educational level, single status, and physical exercise among these patients.

Relational coordination between community health nurses and other professionals in delivering care to community-dwelling frail people

AIMS

The first aim of this study was to investigate whether relational coordination is higher between primary care professionals and community health nurses than among other professionals. The second aim of this study was to investigate the relationship between different levels of relational coordination and primary care professionals' satisfaction with the care delivery of community health nurses.

BACKGROUND

Community health nursing is based on the notion that all activities should respond to frail people's needs in a coordinated way, together with other professionals. Relational coordination is therefore important for the effective health-care delivery by these nurses.

METHODS

This cross-sectional study was performed among 167 professionals (n = 323, response rate 52%) who regularly worked with community health nurses.

RESULTS

The results showed a higher degree of relational coordination with community health nurses than with other primary care professionals. Multilevel analyses revealed that professionals' satisfaction with the care delivered by community health nurses was influenced positively by relational coordination.

CONCLUSION

Enhancing relational coordination between community health nurses and other primary care professionals in the neighborhood may improve the delivery of care to community-dwelling frail people.

IMPLICATIONS FOR NURSING MANAGEMENT

Comprehensive care delivery to community-dwelling frail people requires strong connections between all health and social care professionals. Community health nurses may be an important factor in strengthening these connections.

Positive psychology interventions: a meta-analysis of randomized controlled studies

Background

The use of positive psychological interventions may be considered as a complementary strategy in mental health promotion and treatment. The present article constitutes a meta-analytical study of the effectiveness of positive psychology interventions for the general public and for individuals with specific psychosocial problems.

Methods

We conducted a systematic literature search using PubMed, PsychInfo, the Cochrane register, and manual searches. Forty articles, describing 39 studies, totaling 6,139 participants, met the criteria for inclusion. The outcome measures used were subjective well-being, psychological well-being and depression. Positive psychology interventions included self-help interventions, group training and individual therapy.

Results

The standardized mean difference was 0.34 for subjective well-being, 0.20 for psychological well-being and 0.23 for depression indicating small effects for positive psychology interventions. At follow-up from three to six months, effect sizes are small, but still significant for subjective well-being and psychological well-being, indicating that effects are fairly sustainable. Heterogeneity was rather high, due to the wide diversity of the studies included. Several variables moderated the impact on depression: Interventions were more effective if they were of longer duration, if recruitment was conducted via referral or hospital, if interventions were delivered to people with certain psychosocial problems and on an individual basis, and if the study design was of low quality. Moreover, indications for publication bias were found, and the quality of the studies varied considerably.

Conclusions

The results of this meta-analysis show that positive psychology interventions can be effective in the enhancement of subjective well-being and psychological well-being, as well as in helping to reduce depressive symptoms. Additional high-quality peer-reviewed studies in diverse (clinical) populations are needed to strengthen the evidence-base for positive psychology interventions.

Understanding older patients' self-management abilities: functional loss, self-management, and well-being

PURPOSE

This study aimed to increase our understanding of self-management abilities and identify better self-managers among older individuals.

METHODS

Our cross-sectional research was based on a pilot study of older people who had recently been admitted to a hospital. In the pilot study, all patients (>65 years of age) who were admitted to the Vlietland hospital between June and October 2010 were asked to participate, which led to the inclusion of 456 older patients at baseline. A total of 296 patients (65% response rate) were interviewed in their homes 3 months after admission. Measures included social, cognitive, and physical functioning, self-management abilities, and well-being. We used descriptive, correlations, and multiple regression analyses. In addition, we evaluated the mediation effect of self-management abilities on well-being.

RESULTS

Social, cognitive, and physical functioning significantly correlated with self-management abilities and well-being (all p ≤ 0.001). After controlling for background characteristics, multiple regression analysis indicated that social, cognitive, and physical functioning still related to self-management abilities (β = 0.17-0.25; all p ≤ 0.001). Older people with low levels of social, cognitive, and physical functioning were worse self-managers than were those with higher levels of functioning.

CONCLUSIONS

Self-management abilities mediate the relationship between social, cognitive, and physical functioning and well-being. Interventions to improve self-management abilities may help older people better deal with function losses as they age further.

The relationship between older adults' self-management abilities, well-being and depression

This study aimed to identify the relationship between self-management abilities, well-being and depression. Our study was conducted among older adults (>65 years of age) who were vulnerable to loss of function after hospital discharge. Three months after hospital admission, 296/456 patients (65 % response rate) were interviewed in their homes. The 30-item Self-Management Ability Scale was used to measure six self-management abilities: taking initiative, investing in resources for long-term benefits, taking care of a variety of resources, taking care of resource multifunctionality, being self-efficacious and having a positive frame of mind. Well-being was measured with the Social Production Function (SPF) Instrument for the Level of Well-being (SPF-IL) and Cantril's ladder. The Geriatric Depression Scale was used to assess depression. Correlation analyses showed that all self-management abilities were strong indicators for well-being (p < 0.001 for all). Regression analyses revealed that investing in resources for long-term benefits, taking care of a variety of resources, taking care of resource multifunctionality and being self-efficacious were associated with well-being. While no significant relationship was found between well-being and having a positive frame of mind or taking initiative, regression analyses revealed that these self-management abilities were related to depression. Investing in resources for long-term benefits and taking care of a variety of resources were significantly related to depression. This research showed that self-management abilities are related to well-being and depression among older adults. In addition, this study identified key self-management abilities for older adults who had recently been discharged from a hospital.

Self-management abilities, physical health and depressive symptoms among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes

OBJECTIVE

This study aimed to identify the predictive role of direct resources (educational level and marital status) and self-management abilities on physical health and depressive symptoms in patients with cardiovascular diseases (CVD), diabetes, or chronic obstructive pulmonary disease (COPD).

METHODS

Our cross-sectional questionnaire-based study included 1570 CVD patients, 917 COPD patients, and 412 patients with diabetes.

RESULTS

Physical health and depressive symptoms of COPD patients was lower than those of CVD and diabetic patients. Correlation analyses indicated that self-management abilities were strong indicators for physical health and depressive symptoms (all p<0.001). This relationship was strongest for depressive symptoms. Self-management abilities were related to educational level in all groups (all p<0.001). Regression analyses revealed that self-management abilities were strong predictors of physical health and depressive symptoms in all three patient groups (all p<0.001).

CONCLUSION

This research showed that self-management abilities are strong predictors of physical health and depressive symptoms.

PRACTICE IMPLICATIONS

Interventions that improve self-management abilities may counteract a decline in physical health and depressive symptoms. Such interventions may be important tools in the prevention of the loss of self-management abilities, because they may motivate people who are not yet experiencing serious problems.

The importance of neighborhood social cohesion and social capital for the well being of older adults in the community

PURPOSE OF THE STUDY

We aimed to investigate whether social capital (obtaining support through indirect ties such as from neighbors) and social cohesion (interdependencies among neighbors) within neighborhoods positively affect the well being of older adults.

DESIGN AND METHODS

This cross-sectional study included 945 of 1,440 (66% response rate) independently living older adults (aged ≥70 years) in Rotterdam. We fitted a hierarchical random effects model to account for the hierarchical structure of the study design: 945 older adults (Level 1) nested in 72 neighborhoods (Level 2).

RESULTS

Univariate analyses showed that being born in the Netherlands, house ownership, education, income, social capital of individuals, neighborhood security, neighborhood services, neighborhood social capital, and neighborhood social cohesion were significantly related to the well being of older adults. Multilevel analyses showed that social capital of individuals, neighborhood services, neighborhood social capital, and neighborhood social cohesion predicted the well being of older adults. Single and poor older adults reported lower well being than did better off and married older adults. However, the effects of marital status and income were mediated by neighborhood services, social capital, and social cohesion. Neighborhood services, social capital, and social cohesion may act as buffer against the adverse effects of being single and poor on the well being of older adults.

IMPLICATIONS

The results of this study support the importance of social capital of individuals, as well as social capital within the neighborhood and social cohesion within the neighborhood for well being of older adults. The well being of older adults may also be enhanced through the improvement of quality of neighborhood services.

Benefits of peer support in online Japanese breast cancer communities: differences between lurkers and posters

Background

Web 2.0 has improved interactions among peers on the Internet, especially for the many online patient communities that have emerged over the past decades. Online communities are said to be particularly beneficial peer support resources for patients with breast cancer. However, most studies of online patient communities have focused on those members who post actively (posters), even though there are many members who participate without posting (lurkers). In addition, little attention has been paid to the usage of online communities among non-English-speaking patients.

Objective

The present study explored the differences in peer support received by lurkers and posters in online breast cancer communities. It also examined the effects of such support on both groups’ mental health.

Methods

We conducted an exploratory, descriptive, cross-sectional, Web-based survey among members of four Japanese online breast cancer communities. In an online questionnaire, we asked questions regarding sociodemographics, disease-related characteristics, mental health, participation in online communities, and peer support received from those communities.

Results

Of the 465 people who accessed the questionnaire, 253 completed it. Of the respondents, 113/220 (51.4%) were lurkers. There was no significant difference between lurkers and posters with regard to sociodemographic variables. About half of the posters had been given a diagnosis of breast cancer less than a year previously, which was a significantly shorter period than that of the lurkers (P = .02). The 5 support functions extracted by factor analysis were the same for both posters and lurkers. These were emotional support/helper therapy, emotional expression, conflict, advice, and insight/universality. When the support scores were calculated, insight/universality scored highest for both posters and lurkers, with scores that were not significantly different between the two groups. Among the 5 support scores, emotional support/helper therapy and emotional expression were significantly higher among posters. For posters, emotional support/helper therapy and advice were negatively correlated with the anxiety subscale of the Hospital Anxiety and Depression Scale. Emotional expression, advice, and insight/universality were negatively correlated with the anxiety subscale for lurkers.

Conclusion

We found that posters felt they received more benefits from online communities than lurkers did, including emotional support, helping other patients, and expressing their emotions. Yet even lurkers were found to gain a certain amount of peer support through online communities, especially with regard to advice and insight/universality. The results demonstrate that participation in online communities—even as a lurker—may be beneficial to breast cancer patients’ mental health.

[The psychometric properties of three self-report screening instruments for identifying frail older people in the community]

BACKGROUND

Frailty can lead towards serious adverse consequences, such as disability. With regard to prevention valid screening instruments are needed to identify frail older people. The aim was to evaluate and compare the psychometric properties of three screening instruments: the Groningen Frailty Indicator (GFI), the Tilburg Frailty Indicator (TFI) and the Sherbrooke Postal Questionnaire (SPQ). For validation purposes the Groningen Activity Restriction Scale (GARS) was added.

METHODS

A questionnaire was sent to 687 older people (> or = 70 years). (1) Agreement between instruments, (2) internal consistency, (3) cumulative scalability according to Mokken scale analysis and (4) construct validity were evaluated.

RESULTS

The response rate was 77%. Prevalence estimates of frailty ranged from 40% to 59%. The highest agreement was found between the GFI and TFI (Cohen's kappa = 0.74). Cronbach's alpha for the GFI, TFI and SPQ was 0.73, 0.79 and 0.26, respectively. The scalability of the three instruments was inadequate (Loevinger's H: 0.28, 0.30 and 0.09 for GFI, TFI and SPQ, respectively). Frailty scores correlated significantly with each other and with the GARS scores.

CONCLUSION

Especially the GFI and TFI seem to be useful to identify frail older people. Further research regarding their predictive validity is still needed.

The reduction of disability in community-dwelling frail older people: design of a two-arm cluster randomized controlled trial

BACKGROUND

Frailty among older people is related to an increased risk of adverse health outcomes such as acute and chronic diseases, disability and mortality. Although many intervention studies for frail older people have been reported, only a few have shown positive effects regarding disability prevention. This article presents the design of a two-arm cluster randomized controlled trial on the effectiveness, cost-effectiveness and feasibility of a primary care intervention that combines the most promising elements of disability prevention in community-dwelling frail older people.

METHODS/DESIGN

In this study twelve general practitioner practices were randomly allocated to the intervention group (6 practices) or to the control group (6 practices). Three thousand four hundred ninety-eight screening questionnaires including the Groningen Frailty Indicator (GFI) were sent out to identify frail older people. Based on their GFI score (≥5), 360 participants will be included in the study. The intervention will receive an interdisciplinary primary care intervention. After a comprehensive assessment by a practice nurse and additional assessments by other professionals, if needed, an individual action plan will be defined. The action plan is related to a flexible toolbox of interventions, which will be conducted by an interdisciplinary team. Effects of the intervention, both for the frail older people and their informal caregivers, will be measured after 6, 12 and 24 months using postal questionnaires and telephone interviews. Data for the process evaluation and economic evaluation will be gathered continuously over a 24-month period.

DISCUSSION

The proposed study will provide information about the usefulness of an interdisciplinary primary care intervention. The postal screening procedure was conducted in two cycles between December 2009 and April 2010 and turned out to be a feasible method. The response rate was 79.7%. According to GFI scores 29.3% of the respondents can be considered as frail (GFI ≥ 5). Nearly half of them (48.1%) were willing to participate. The baseline measurements started in January 2010. In February 2010 the first older people were approached by the practice nurse for a comprehensive assessment. Data on the effect, process, and economic evaluation will be available in 2012.

TRIAL REGISTRATION

ISRCTN31954692.

The psychometric properties of three self-report screening instruments for identifying frail older people in the community

BACKGROUND

Frailty is highly prevalent in older people. Its serious adverse consequences, such as disability, are considered to be a public health problem. Therefore, disability prevention in community-dwelling frail older people is considered to be a priority for research and clinical practice in geriatric care. With regard to disability prevention, valid screening instruments are needed to identify frail older people in time. The aim of this study was to evaluate and compare the psychometric properties of three screening instruments: the Groningen Frailty Indicator (GFI), the Tilburg Frailty Indicator (TFI) and the Sherbrooke Postal Questionnaire (SPQ). For validation purposes the Groningen Activity Restriction Scale (GARS) was added.

METHODS

A questionnaire was sent to 687 community-dwelling older people (> or = 70 years). Agreement between instruments, internal consistency, and construct validity of instruments were evaluated and compared.

RESULTS

The response rate was 77%. Prevalence estimates of frailty ranged from 40% to 59%. The highest agreement was found between the GFI and the TFI (Cohen's kappa = 0.74). Cronbach's alpha for the GFI, the TFI and the SPQ was 0.73, 0.79 and 0.26, respectively. Scores on the three instruments correlated significantly with each other (GFI - TFI, r = 0.87; GFI - SPQ, r = 0.47; TFI - SPQ, r = 0.42) and with the GARS (GFI - GARS, r = 0.57; TFI - GARS, r = 0.61; SPQ - GARS, r = 0.46). The GFI and the TFI scores were, as expected, significantly related to age, sex, education and income.

CONCLUSIONS

The GFI and the TFI showed high internal consistency and construct validity in contrast to the SPQ. Based on these findings it is not yet possible to conclude whether the GFI or the TFI should be preferred; data on the predictive values of both instruments are needed. The SPQ seems less appropriate for postal screening of frailty among community-dwelling older people.

Interventions to prevent disability in frail community-dwelling older persons: an overview

This narrative review was conducted to provide an overview of the variety of interventions aimed at disability prevention in community-dwelling frail older persons and to summarize promising elements. The search strategy and selection process found 48 papers that met the inclusion criteria. The 49 interventions described in these 48 papers were categorized into 'comprehensive geriatric assessment', 'physical exercise', 'nutrition', 'technology', and 'other interventions'. There is a large diversity within and between the groups of interventions in terms of content, disciplines involved, duration, intensity, and setting. For 18 of the 49 interventions, significant positive effects for disability were reported for the experimental group. Promising features of interventions seem to be: multidisciplinary and multifactorial, individualized assessment and intervention, case management, long-term follow-up, physical exercise component (for moderate physically frail older persons), and the use of technology. Future intervention studies could combine these elements and consider the addition of new elements.

[Happy and healthy aging: well-being, resources and self-management abilities]

This article gives an overview of the research program directed by the author. First, the integrated theoretical framework of the program is presented, including sub-theories. The following assumptions are central to the program: (a) there are physical and social basic needs that, if not fulfilled, lead to deficits in well-being; (b) for the fulfilment of these basic needs both external resources and self-management abilities (internal resources) are needed; (c) self-management abilities and external resources mutually influence each other, which makes it possible to intervene. This theoretical basis allows the formulation of clear criteria for happy and healthy aging, and the derivation of the most important (social) conditions that influence the fulfilment of the basic needs. The article also presents the main empirical tests and intervention studies that have been executed, along with the first steps that have been taken to implement the interventions in practice. Recently, the program is focussing more on a lifespan perspective because important influences on happy and healthy aging often originate at younger ages. More insight in the life-span development of external resources and of self-management ability promises a better understanding of what happy and healthy aging is about and of what can be done to positively influence it.