1
|
Kokorelias KM, Grigorovich A, Harris MT, Rehman U, Ritchie L, Levy AM, Denecke K, McMurray J. Longitudinal Coadaptation of Older Adults With Wearables and Voice-Activated Virtual Assistants: Scoping Review. J Med Internet Res 2024; 26:e57258. [PMID: 39110963 PMCID: PMC11339587 DOI: 10.2196/57258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/14/2024] [Accepted: 06/26/2024] [Indexed: 08/25/2024] Open
Abstract
BACKGROUND The integration of smart technologies, including wearables and voice-activated devices, is increasingly recognized for enhancing the independence and well-being of older adults. However, the long-term dynamics of their use and the coadaptation process with older adults remain poorly understood. This scoping review explores how interactions between older adults and smart technologies evolve over time to improve both user experience and technology utility. OBJECTIVE This review synthesizes existing research on the coadaptation between older adults and smart technologies, focusing on longitudinal changes in use patterns, the effectiveness of technological adaptations, and the implications for future technology development and deployment to improve user experiences. METHODS Following the Joanna Briggs Institute Reviewer's Manual and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, this scoping review examined peer-reviewed papers from databases including Ovid MEDLINE, Ovid Embase, PEDro, Ovid PsycINFO, and EBSCO CINAHL from the year 2000 to August 28, 2023, and included forward and backward searches. The search was updated on March 1, 2024. Empirical studies were included if they involved (1) individuals aged 55 years or older living independently and (2) focused on interactions and adaptations between older adults and wearables and voice-activated virtual assistants in interventions for a minimum period of 8 weeks. Data extraction was informed by the selection and optimization with compensation framework and the sex- and gender-based analysis plus theoretical framework and used a directed content analysis approach. RESULTS The search yielded 16,143 papers. Following title and abstract screening and a full-text review, 5 papers met the inclusion criteria. Study populations were mostly female participants and aged 73-83 years from the United States and engaged with voice-activated virtual assistants accessed through smart speakers and wearables. Users frequently used simple commands related to music and weather, integrating devices into daily routines. However, communication barriers often led to frustration due to devices' inability to recognize cues or provide personalized responses. The findings suggest that while older adults can integrate smart technologies into their lives, a lack of customization and user-friendly interfaces hinder long-term adoption and satisfaction. The studies highlight the need for technology to be further developed so they can better meet this demographic's evolving needs and call for research addressing small sample sizes and limited diversity. CONCLUSIONS Our findings highlight a critical need for continued research into the dynamic and reciprocal relationship between smart technologies and older adults over time. Future studies should focus on more diverse populations and extend monitoring periods to provide deeper insights into the coadaptation process. Insights gained from this review are vital for informing the development of more intuitive, user-centric smart technology solutions to better support the aging population in maintaining independence and enhancing their quality of life. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/51129.
Collapse
Affiliation(s)
- Kristina Marie Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
| | - Alisa Grigorovich
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Recreation and Leisure Studies, Brock University, St Catherines, ON, Canada
| | - Maurita T Harris
- User Experience Design, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Umair Rehman
- Department of Computer Science, University of Western Ontario, London, ON, Canada
| | - Louise Ritchie
- Alzheimer Scotland Centre for Policy and Practice, University of West Scotland, Scotland, United Kingdom
| | - AnneMarie M Levy
- Lazaridis School of Business and Economics/Community Health, Wilfrid Laurier University, Brantford, ON, Canada
| | - Kerstin Denecke
- Institute for Medical Informatics, Bern University of Applied Sciences, Bern, Switzerland
| | - Josephine McMurray
- Lazaridis School of Business and Economics/Community Health, Wilfrid Laurier University, Brantford, ON, Canada
| |
Collapse
|
2
|
Ramli DB, Shahar S, Mat S, Ibrahim N, Tohit NM. The effectiveness of preventive home visits on resilience and health-related outcomes among community dwelling older adults: A systematic review. PLoS One 2024; 19:e0306188. [PMID: 38950029 PMCID: PMC11216600 DOI: 10.1371/journal.pone.0306188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/11/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND This research aimed to assess the effectiveness of preventive home visits (PHVs) in enhancing resilience and health-related outcomes among older adults living in the community. METHODS A comprehensive literature search was conducted in nine databases (PubMed, MEDLINE, CINAHL, Embase, Emcare, Web of Science (WOS), Scopus, PsycINFO and Cochrane Library. The search was undertaken between March 15 and 31, 2022 with subsequent updates performed on October 15, 2023 and April 10, 2024. This review also included grey literature sourced via Google, Google Scholar and backward citation searches. RESULTS Out of 5,621 records, 20 articles were found to meet the inclusion criteria with a total of 8,035 participants involved and the mean age ranged from 74.0 to 84.4 years. Using McMaster Critical Review Form for Quantitative Studies, we ascertained that the studies included in our analysis had moderate to high levels of quality. In addition to health-related outcomes, PHV interventions were also conducted to evaluate psychological effects (16 studies) and social outcomes (seven studies). Five studies conducted financial assessment to evaluate the costs of health and social care utilisation during PHV interventions. Regarding the results of the review, seven studies showed favourable outcomes, five indicated no effect and eight had equivocal findings. Only one study assessed resilience and determined that PHV had no effect on the resilience of the subjects. CONCLUSION This review found that the effectiveness of PHV interventions was uncertain and inconclusive. PHV interventions often prioritise health-related objectives. The incorporation of a holistic approach involving psychosocial health into PHV interventions is relatively uncommon. Due to the paucity of research on resilience as PHV outcome, we are unable to draw a conclusion on the effectiveness of PHV on resilience. Resilience should be prioritised as a psychological assessment in the future development of comprehensive PHV interventions, as it enables older adults to adapt, manage, and respond positively to adversities that may arise with age. Performing financial analysis such as costs and benefits analysis to incorporate the return on investment of PHV interventions is an added value for future research on this topic. CLINICAL TRIAL REGISTRATION PROSPERO registration number: CRD42022296919.
Collapse
Affiliation(s)
- Dayang Balkis Ramli
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Public Service Department, Prime Minister’s Office, Putrajaya, Malaysia
| | - Suzana Shahar
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Ibrahim
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noorlaili Mohd Tohit
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan, Bangi, Malaysia
| |
Collapse
|
3
|
Balqis-Ali NZ, Jawahir S, Chan YM, Lim AWY, Azlan UW, Shaffie SSM, Fun WH, Lee SWH. The impact of long-term care interventions on healthcare utilisation among older persons: a scoping review of reviews. BMC Geriatr 2024; 24:484. [PMID: 38831269 PMCID: PMC11145838 DOI: 10.1186/s12877-024-05097-9] [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: 03/07/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND As the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons. METHODS A scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE. RESULTS Thirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91, p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81, p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95, p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76, p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality. CONCLUSION The findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care.
Collapse
Affiliation(s)
- Nur Zahirah Balqis-Ali
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Suhana Jawahir
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia.
| | - Yee Mang Chan
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Amanda Wei-Yin Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Ummi Wahidah Azlan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Sal Sabila Mohd Shaffie
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Weng Hong Fun
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
- School of Pharmacy, Taylor's University Lakeside Campus Malaysia, Subang Jaya, Selangor, Malaysia
| |
Collapse
|
4
|
Wong AKC, Wong FKY, Chow KKS, Kwan DKS, Lau DYS, Lau ACK. A health-social service partnership programme for improving the health self-management of community-dwelling older adults: a hybrid effectiveness-implementation pilot study protocol. Pilot Feasibility Stud 2023; 9:184. [PMID: 37941087 PMCID: PMC10631147 DOI: 10.1186/s40814-023-01412-0] [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: 06/07/2022] [Accepted: 10/24/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The ageing population requires seamless, integrated health and social care services in the community to promote the health of older adults. However, inadequate financial resources, a lack of clear operational guidelines, and various organisational work cultures may affect the implementation quality and sustainability of these services. As a unique approach, this study seeks to examine the preliminary effects of a health-social partnership programme on the health self-management of community-dwelling older adults in Hong Kong. Additionally, the study seeks to ascertain key insights into the mechanisms and processes required to implement and sustain a self-care management programme in broader practice in community settings. METHODS This study will use a hybrid effectiveness-implementation design. During the 3-month programme, subjects in the intervention group will receive four Zoom video conference sessions and four telephone calls conducted by a health-social service team that will include a nurse case manager, community workers, general practitioners, a Chinese medicine practitioner, and social workers. Subjects in the control group will receive a monthly social telephone call from a trained research assistant to rule out the possible social effect of the intervention. The reach, effectiveness, adoption, implementation, and maintenance framework (i.e. RE-AIM framework) will be used to evaluate the implementation and effectiveness outcomes. Of the five dimensions included in the RE-AIM framework, only effectiveness and maintenance outcomes will be collected from both the intervention and control groups. The outcomes of the other three dimensions-reach, adoption, and implementation-will only be collected from subjects in the intervention group. Data will be collected pre-intervention, immediately post-intervention, and 3 months after the intervention is completed to evaluate the maintenance effect of the programme. DISCUSSION This programme will aim to enhance health-promoting self-care management behaviours in older adults dwelling in the community. This will be the first study in Hong Kong to use the hybrid effectiveness-implementation design and involve key stakeholders in the evaluation and implementation of a health self-management programme using a health-social service partnership approach. The programme, which will be rooted in the community, may be used as a model, if proven successful, for similar types of services. TRIAL REGISTRATION Clinicaltrials.gov, NCT04442867. Submitted 19 June 2020.
Collapse
Affiliation(s)
- Arkers Kwan Ching Wong
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Hong Kong.
| | - Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Hong Kong
| | | | | | | | - Avis Cheuk Ki Lau
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Hong Kong
| |
Collapse
|
5
|
Thompson S, Stickland MK, Wilund K, Gyenes GT, Bohm C. Exercise Rehabilitation for People With End-Stage Kidney Disease: Who Will Fill the Gaps? Can J Cardiol 2023; 39:S335-S345. [PMID: 37597748 DOI: 10.1016/j.cjca.2023.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
Exercise rehabilitation is a well established therapy for reducing morbidity and mortality and improving quality of life and function across chronic conditions. People with dialysis-dependent kidney failure have a high burden of comorbidity and symptoms, commonly characterised as fatigue, dyspnoea, and the inability to complete daily activities. Despite more than 30 years of exercise research in people with kidney disease and its established benefit in other chronic diseases, exercise programs are rare in kidney care and are not incorporated into routine management at any stage. In this review, we describe the mechanisms contributing to exercise intolerance in those with end-stage kidney disease and outline the role of exercise rehabilitation in addressing the major challenges to kidney care: cardiovascular disease, symptom burden, and physical frailty. We also draw on existing models of exercise rehabilitation from other chronic conditions to inform the way forward and challenge the status quo of exercise rehabilitation in both practice and research.
Collapse
Affiliation(s)
- Stephanie Thompson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | | | - Kenneth Wilund
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois, USA
| | - Gabor T Gyenes
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Clara Bohm
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
| |
Collapse
|
6
|
González-González E, Requena C. Self-care interventions of community-dwelling older adults: a systematic review and meta-analysis. Front Public Health 2023; 11:1254172. [PMID: 37876713 PMCID: PMC10593480 DOI: 10.3389/fpubh.2023.1254172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction The current notion of "care in old age" should be reconceptualized in the ageing societies of the 21st century. Currently, "being old" means that one is actively involved in their care and has the desire to retain control and independence. Objective Understand and analyze the efficacy of interventions in the physical and psychological self-care practices of healthy community-dwelling older people. Methodology Systematic review and meta-analysis. The guidelines of the PRISMA guide were followed. The methodological quality of the studies was checked using Cochrane Effective Practice and Organisation of Care criteria, and the search was performed between 2016 and 2021. Results Of the 1,866 evaluated, 8 studies met the criteria. The systematic review reveals that self-care interventions focus on physical health-related variables but not on psychological variables. The meta-analysis shows that interventions significantly improve physical health-related variables (care visits, hospital admission, medication, and gait speed). Conclusion Self-care training programs should include psychological variables to increase health and well-being in healthy older people.
Collapse
|
7
|
Ho L, Malden S, McGill K, Shimonovich M, Frost H, Aujla N, Ho ISS, Shenkin SD, Hanratty B, Mercer SW, Guthrie B. Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis. Age Ageing 2023; 52:afad132. [PMID: 37505991 PMCID: PMC10378722 DOI: 10.1093/ageing/afad132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND community-based complex interventions for older adults have a variety of names, including Comprehensive Geriatric Assessment, but often share core components such as holistic needs assessment and care planning. OBJECTIVE to summarise evidence for the components and effectiveness of community-based complex interventions for improving older adults' independent living and quality of life (QoL). METHODS we searched nine databases and trial registries to February 2022 for randomised controlled trials comparing complex interventions to usual care. Primary outcomes included living at home and QoL. Secondary outcomes included mortality, hospitalisation, institutionalisation, cognitive function and functional status. We pooled data using risk ratios (RRs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS we included 50 trials of mostly moderate quality. Most reported using holistic assessment (94%) and care planning (90%). Twenty-seven (54%) involved multidisciplinary care, with 29.6% delivered mainly by primary care teams without geriatricians. Nurses were the most frequent care coordinators. Complex interventions increased the likelihood of living at home (RR 1.05; 95% CI 1.00-1.10; moderate-quality evidence) but did not affect QoL. Supported by high-quality evidence, they reduced mortality (RR 0.86; 95% CI 0.77-0.96), enhanced cognitive function (SMD 0.12; 95% CI 0.02-0.22) and improved instrumental activities of daily living (ADLs) (SMD 0.11; 95% CI 0.01-0.21) and combined basic/instrumental ADLs (SMD 0.08; 95% CI 0.03-0.13). CONCLUSIONS complex interventions involving holistic assessment and care planning increased the chance of living at home, reduced mortality and improved cognitive function and some ADLs.
Collapse
Affiliation(s)
- Leonard Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen Malden
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kris McGill
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Michal Shimonovich
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Helen Frost
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Navneet Aujla
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Iris S-S Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Susan D Shenkin
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
- Ageing and Health Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stewart W Mercer
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
8
|
Ambagtsheer RC, Thompson MQ, Tucker GR, Schultz T, Beilby J, Visvanathan R. Does CGA Improve Health Outcomes in the Community? An Umbrella Review. J Am Med Dir Assoc 2023:S1525-8610(23)00297-9. [PMID: 37088103 DOI: 10.1016/j.jamda.2023.03.018] [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: 12/06/2022] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES To perform an umbrella review of systematic reviews with meta-analyses (MAs) examining the effectiveness of comprehensive geriatric assessment (CGA) delivered within community settings to general populations of community-dwelling older people against various health outcomes. DESIGN Umbrella review of MAs of randomized controlled trials (RCTs). SETTING AND PARTICIPANTS Systematic reviews with MAs examining associations between CGA conducted within the community and any health outcome, where participants were community-dwelling older people with a minimum mean age of 60 years or where at least 50% of study participants were aged ≥60 years. Studies focusing on residential care, hospitals, post-hospital care, outpatient clinics, emergency department, or patients with specific conditions were excluded. METHODS We examined CGA effectiveness against 12 outcomes: not living at home, nursing home admission, activities of daily living (ADLs) and instrumental ADLs (IADLs), physical function, falls, self-reported health status, quality of life, frailty, mental health, hospital admission, and mortality, searching the MEDLINE/PubMed, Cochrane Library, CINAHL, Embase databases from January 1, 1999, to August 10, 2022. AMSTAR-2 was used to assess the quality of included systematic reviews, including risk of bias. RESULTS We identified 10 MAs. Only not living at home (combined mortality and nursing home admission) demonstrated concordance between effect direction, significance, and magnitude. Significant effects were more typically observed in earlier rather than later studies. CONCLUSION AND IMPLICATIONS Given the widespread adoption of CGA as a component of usual care within geriatric medicine, the lack of strong evidence demonstrating the protective effects of CGA may be indicative of a cohort effect. If so, future RCTs examining CGA effectiveness are unlikely to demonstrate significant findings. Future studies of CGA in the community should focus on implementation and adherence to key components. TRIAL REGISTRATION Study protocol registered in PROSPERO 2020 CRD42020169680.
Collapse
Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Torrens University Australia, South Australia, Australia.
| | - Mark Q Thompson
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Adelaide Geriatrics Training & Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Graeme R Tucker
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia
| | - Timothy Schultz
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Flinders Health and Medical Research Institute, Flinders University, South Australia, Australia
| | - Justin Beilby
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Torrens University Australia, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Adelaide Geriatrics Training & Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| |
Collapse
|
9
|
Yous ML, Ganann R, Ploeg J, Markle-Reid M, Northwood M, Fisher K, Valaitis R, Chambers T, Montelpare W, Légaré F, Beleno R, Gaudet G, Giacometti L, Levely D, Lindsay C, Morrison A, Tang F. Older adults' experiences and perceived impacts of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP) for diabetes self-management in Canada: a qualitative descriptive study. BMJ Open 2023; 13:e068694. [PMID: 37019487 PMCID: PMC10083734 DOI: 10.1136/bmjopen-2022-068694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVES To assess the experiences and perceived impacts of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP) from the perspectives of older adults with diabetes and other chronic conditions. The ACHRU-CPP is a complex 6-month self-management evidence-based intervention for community-living older adults aged 65 years or older with type 1 or type 2 diabetes and at least one other chronic condition. It includes home and phone visits, care coordination, system navigation support, caregiver support and group wellness sessions delivered by a nurse, dietitian or nutritionist, and community programme coordinator. DESIGN Qualitative descriptive design embedded within a randomised controlled trial was used. SETTING Six trial sites offering primary care services from three Canadian provinces (ie, Ontario, Quebec and Prince Edward Island) were included. PARTICIPANTS The sample was 45 community-living older adults aged 65 years or older with diabetes and at least one other chronic condition. METHODS Participants completed semistructured postintervention interviews by phone in English or French. The analytical process followed Braun and Clarke's experiential thematic analysis framework. Patient partners informed study design and interpretation. RESULTS The mean age of older adults was 71.7 years, and the mean length of time living with diabetes was 18.8 years. Older adults reported positive experiences with the ACHRU-CPP that supported diabetes self-management, such as improved knowledge in managing diabetes and other chronic conditions, enhanced physical activity and function, improved eating habits, and opportunities for socialisation. They reported being connected to community resources by the intervention team to address social determinants of health and support self-management. CONCLUSIONS Older adults perceived that a 6-month person-centred intervention collaboratively delivered by a team of health and social care providers helped support chronic disease self-management. There is a need for providers to help older adults connect with available health and social services in the community. TRIAL REGISTRATION NUMBER ClinicalTrials.gov ID: NCT03664583; Results.
Collapse
Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Rebecca Ganann
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Maureen Markle-Reid
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Melissa Northwood
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kathryn Fisher
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Ruta Valaitis
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Tracey Chambers
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - William Montelpare
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - France Légaré
- VITAM Centre de recherche en santé durable, Université Laval, Quebec, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Ron Beleno
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Gary Gaudet
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Luisa Giacometti
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Deborah Levely
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Craig Lindsay
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Allan Morrison
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Frank Tang
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| |
Collapse
|
10
|
Barreira LF, Paiva A, Araújo B, Campos MJ. Challenges to Systems of Long-Term Care: Mapping of the Central Concepts from an Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1698. [PMID: 36767064 PMCID: PMC9914432 DOI: 10.3390/ijerph20031698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The ageing of the population poses urgent challenges to the health and social protection sectors, including the need for greater adequacy and integration of health care services provided to older people. It is considered necessary and urgent to understand the state-of-the-art of community-based models of care for older people in institutional care and at home. This study aims to map the concepts that politicians and providers need to address through an umbrella review as a review method. Articles describing the structuring aspects of care models appropriate to the needs in long-term care and systematic reviews or meta-analyses targeting people aged 65 years or more were considered. A total of 350 studies met the inclusion criteria and were included in the review. The results identified the need to contribute to effective and more efficient integration and articulation of all the stakeholders, based essentially on professional care at the patient's homes, focused on their needs using the available technologies, empowering patients and families. Eight categories emerged that addressed factors and variables involved in care models for the long-term care needs of institutionalised and home-based older people as a guarantee of accessibility to healthcare and to enhance the well-being and quality of life of patients and family caregivers.
Collapse
Affiliation(s)
- Luís Filipe Barreira
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho 1327, 4169-005 Porto, Portugal
- Instituto de Ciências da Saúde do Porto, Universidade Católica Portuguesa, R. de Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Abel Paiva
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal
| | - Beatriz Araújo
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho 1327, 4169-005 Porto, Portugal
- Instituto de Ciências da Saúde do Porto, Universidade Católica Portuguesa, R. de Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Maria Joana Campos
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal
| |
Collapse
|
11
|
Wong AKC, Wong FKY, Wong MCS, Chow KKS, Kwan DKS, Lau DYS. A community-based health-social partnership program for community-dwelling older adults: a hybrid effectiveness-implementation pilot study. BMC Geriatr 2022; 22:789. [PMID: 36207685 PMCID: PMC9542442 DOI: 10.1186/s12877-022-03463-z] [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: 05/17/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background A growing body of literature supports the efficacy of the health–social approach for the implementation of complex interventions to enhance self-care health management among community-dwelling older adults. However, there is little research on how interventions with this approach are implemented and disseminated in a real community setting. Methods This pilot study adopted an effectiveness–implementation hybrid design to 1) evaluate the effectiveness of a community-based Health–Social Partnership Program (HSPP) and 2) explore the reach, adoption, implementation, and maintenance of the HSPP in the community. Potential participants were recruited if they were aged 60 or above, owned a smartphone, and were cognitively competent. The participants received nurse-led case management with support from a social service team. Factors that hindered or facilitated the program delivery were examined to determine the implementation outcomes and sustained effects of the program. Data were collected at pre-intervention (T1), immediately post-intervention (T2), and 3 months post-intervention (T3). Results Ninety-two older adults joined and completed the program. The recruitment rate was 76.7%. A significant interaction effect was found for the mean self-efficacy scores from T1 to T2 (Wald χ2 = 12.28, p ≤ .001). Barriers to widespread program implementation included manpower shortage, lack of experienced staff, and unpredictable environment, whereas facilitators, as suggested by the older adults, providers, and community staff members, included regular communication between the research and service teams, recruitment of participants through community centers with the support of the research team, and seamless partnership among the health–social partnership team members. Strong implementation fidelity was achieved with zero attrition rate. Conclusion Most conventional randomized controlled trials investigating the effects of community-based programs have tended to control the contextual factors rather than incorporate the program in a real setting. This pilot study was the first to use a hybrid model to test the effectiveness and outcomes of HSPP implementation. The results imply that the program has a high potential sustainability in the real-life context. Trial registration This study was registered at clinicaltrials.gov (NCT04442867; date of first registration 23/06/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03463-z.
Collapse
Affiliation(s)
- Arkers Kwan Ching Wong
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Hong Kong.
| | - Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Hong Kong
| | - Martin Chi Sang Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | | |
Collapse
|
12
|
Osokpo OH, Lewis LM, Ikeaba U, Chittams J, Barg FK, Riegel BJ. Self-Care of African Immigrant Adults with Chronic Illness. Clin Nurs Res 2022; 31:413-425. [PMID: 34726102 PMCID: PMC8951348 DOI: 10.1177/10547738211056168] [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]
Abstract
This cross-sectional study aims to describe the self-care of adult African immigrants in the US with chronic illness and explore the relationship between acculturation and self-care. A total of 88 African immigrants with chronic illness were enrolled. Self-care was measured with the Self Care of Chronic Illness Inventory v3 and the Self-Care Self-Efficacy scale. Scores are standardized 0 to 100 with scores >70 considered adequate. Acculturation was measured using a modified standardized acculturation instrument and predefined acculturation proxies. The self-care scores showed adequate self-care, with the mean scores of 78.6, 77.9, and 75.6 for self-care maintenance, monitoring, and management. Self-care self-efficacy mean score was 81.3. Acculturation was not significantly associated with self-care. Self-care self-efficacy was a strong determinant of self-care maintenance (p < .0001), monitoring (p < .0001), and management (p < .0001). The perception of inadequate income was a significant determinant of poor self-care management (p = .03). Self-care self-efficacy and perceived income adequacy were better determinants of self-care than acculturation.
Collapse
Affiliation(s)
- Onome H. Osokpo
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Lisa M. Lewis
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Uchechukwu Ikeaba
- West Chester University of Pennsylvania, 25 University Avenue, West Chester, PA 19383
| | - Jesse Chittams
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Frances K. Barg
- University of Pennsylvania Perelman School of Medicine, 915 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Barbara J. Riegel
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| |
Collapse
|
13
|
Motamedi N, Taherian Z. Effect of a 12-week community-based intervention to improve social capital, quality of life, self-care, and health literacy among older people: A quasi-experimental trial. Adv Biomed Res 2022; 11:23. [PMID: 35720209 PMCID: PMC9201224 DOI: 10.4103/abr.abr_101_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/08/2021] [Accepted: 06/23/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction: The aim of this study was to assess the effect of a community-based intervention on social capital, quality of life, self-care, and health literacy among elderly. Materials and Methods: This quasi-experimental trial was conducted at two health-care centers in Isfahan, Iran, which assigned to the intervention and control groups. A total of 86 elderly (60 years or above) enrolled in the study. The intervention program consisted of 12 weekly group sessions with various health topics. Nine sessions held in the health-care center and three local tours in different locations of the neighborhood. The control group received routine care of health centers. Social capital, quality of life, self-care, and health literacy were assessed at baseline and 1 month after the intervention in two groups. Results: Mental component of quality of life (P = 0.026), self-care, and health literacy (P < 0.001) showed a significant increase in the intervention group compared to the control group at 1 month after the intervention. The total score of social capital and the dimensions of local community participation, social agency, feelings of security and trust, interactions with neighbors, and interactions with family and friends improved in the intervention group (P < 0.001). However, there was no significant difference in the dimensions of tolerance of diversity (P = 0.241) and value of life (P = 0.928). Conclusions: This community-based interventions with a variety of diverse and participatory components can be used as a strategy to promote the health of the elderly in primary health care.
Collapse
|
14
|
Lai FTT, Wong ELY, Tam ZPY, Cheung AWL, Lau MC, Wu CM, Wong R, Ma HM, Yip BHK, Yeoh EK. Association of volunteer-administered home care with reduced emergency room visits and hospitalization among older adults with chronic conditions: a propensity-score-matched cohort study. Int J Nurs Stud 2021; 127:104158. [DOI: 10.1016/j.ijnurstu.2021.104158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 09/17/2021] [Accepted: 12/10/2021] [Indexed: 11/15/2022]
|
15
|
Wong AKC, Bayuo J, Wong FKY. Investigating predictors of self-care behavior among homebound older adults: The role of self-efficacy, eHealth literacy, and perceived social support. J Nurs Scholarsh 2021; 54:278-285. [PMID: 34766694 DOI: 10.1111/jnu.12730] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/20/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE This study aimed to investigate the predictors of self-care behavior among homebound older adults using the Health Empowerment theory as a framework. DESIGN This was a cross-sectional, predictive correlational study. METHODS Sixty-eight participants were randomly selected from five Hong Kong community centers from May 21, 2020 through July 20, 2020. Self-care behaviors were assessed using the Chinese version of Partners in Health. Self-efficacy, eHealth literacy, and perceived social support were assessed as potential predictors of self-care behaviors. A multiple linear regression analysis was adopted to examine the predictive effects. RESULTS The age of the sample ranged from 61 to 85 years (mean = 71.7, SD = 6.0). Participants who reported having sufficient or more than sufficient financial resources had better self-care behaviors than those who claimed to have insufficient financial resources (F = 5.08, p = 0.009). Statistically significant correlations were found between the participants' eHealth literacy (r = 0.54, p < 0.001), perceived social support (r = 0.60, p < 0.001), and self-care behaviors. eHealth literacy (β = 0.13, p = 0.007) and perceived social support (β = 0.13, p < 0.001) were significant predictors of self-care behaviors. Collectively, the three variables accounted for 41% of the variances in self-care behaviors. CONCLUSIONS The findings in this study suggest that eHealth literacy and perceived social support are two key factors that predicted the self-care behaviors of this vulnerable population. CLINICAL RELEVANCE In this technological era, the use of eHealth, together with enhanced social support, can lead to better self-care among older adults, particularly those who are homebound.
Collapse
Affiliation(s)
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | |
Collapse
|
16
|
Kruisbrink M, Delbaere K, Kempen GIJM, Crutzen R, Ambergen T, Cheung KL, Kendrick D, Iliffe S, Zijlstra GAR. Intervention Characteristics Associated With a Reduction in Fear of Falling Among Community-Dwelling Older People: A Systematic Review and Meta-analysis of Randomized Controlled Trials. THE GERONTOLOGIST 2021; 61:e269-e282. [PMID: 32267498 PMCID: PMC8361503 DOI: 10.1093/geront/gnaa021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Fear of falling (FoF) is associated with decreased physical functioning and an increased fall risk. Interventions generally demonstrate moderate effects and optimized interventions are needed. Intervention characteristics, such as setting or delivery method may vary. We investigated which overarching intervention characteristics are associated with a reduction in FoF in community-dwelling older people. RESEARCH DESIGN AND METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) in community-dwelling older people without specific diseases was performed. Associations between intervention characteristics and standardized mean differences (SMD) were determined by univariate meta-regression. Sensitivity analyses were performed. RESULTS Data on 62 RCTs were extracted, 50 intervention groups were included in the meta-analysis. Most intervention characteristics and intervention types were not associated with the intervention effect. Supervision by a tai chi instructor (SMD: -1.047, 95% confidence interval [CI]: -1.598; -0.496) and delivery in a community setting (SMD: -0.528, 95% CI: -0.894; -0.161) were-compared to interventions without these characteristics-associated with a greater reduction in FoF. Holistic exercise, such as Pilates or yoga (SMD: -0.823, 95% CI: -1.255; -0.392), was also associated with a greater reduction in FoF. Delivery at home (SMD: 0.384, 95% CI: 0.002; 0.766) or with written materials (SMD: 0.452, 95% CI: 0.088; 0.815) and tailoring were less effective in reducing FoF (SMD: 0.687, 95% CI: 0.364; 1.011). DISCUSSION AND IMPLICATIONS Holistic exercise, delivery with written materials, the setting and tailoring potentially represent characteristics to take into account when designing and improving interventions for FoF in community-dwelling older people. PROSPERO international prospective register of systematic reviews, registration ID CRD42018080483.
Collapse
Affiliation(s)
- Marlot Kruisbrink
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands.,Neuroscience Research Australia, School of Public Health and Community Medicine, UNSW, Randwick, New South Wales, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, School of Public Health and Community Medicine, UNSW, Randwick, New South Wales, Australia.,Care and Public Health Research Institute, Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Gertrudis I J M Kempen
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands.,Neuroscience Research Australia, School of Public Health and Community Medicine, UNSW, Randwick, New South Wales, Australia
| | - Rik Crutzen
- Maastricht University, Care and Public Health Research Institute, Department of Health Promotion, Maastricht, the Netherlands
| | - Ton Ambergen
- Care and Public Health Research Institute, Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Kei-Long Cheung
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University, London, United Kingdom
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - G A Rixt Zijlstra
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands.,Neuroscience Research Australia, School of Public Health and Community Medicine, UNSW, Randwick, New South Wales, Australia
| |
Collapse
|
17
|
Regauer V, Seckler E, Grill E, Ippisch R, Jahn K, Bauer P, Müller M. Development of a complex intervention to improve mobility and participation of older people with vertigo, dizziness and balance disorders in primary care: a mixed methods study. BMC FAMILY PRACTICE 2021; 22:89. [PMID: 33980155 PMCID: PMC8117292 DOI: 10.1186/s12875-021-01441-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vertigo, dizziness and balance disorders (VDB) are common in older people and cause restrictions in mobility and social participation. Due to a multifactorial aetiology, health care is often overutilised, but many patients are also treated insufficiently in primary care. The purpose of this study was to develop a care pathway as a complex intervention to improve mobility and participation in older people with VDB in primary care. METHODS The development process followed the UK Medical Research Council guidance using a mixed-methods design with individual and group interviews carried out with patients, physical therapists (PTs), general practitioners (GPs), nurses working in community care and a multi-professional expert panel to create a first draft of a care pathway (CPW) and implementation strategy using the Consolidated Framework of Implementation Research and the Expert recommendations for Implementing Change. Subsequently, small expert group modelling of specific components of the CPW was carried out, with GPs, medical specialists and PTs. The Behaviour Change Wheel was applied to design the intervention´s approach to behaviour change. To derive theoretical assumptions, we adopted Kellogg´s Logic Model to consolidate the hypothesized chain of causes leading to patient-relevant outcomes. RESULTS Individual interviews with patients showed that VDB symptoms need to be taken more seriously by GPs. Patients demanded age-specific treatment offers, group sessions or a continuous mentoring by a PT. GPs required a specific guideline for diagnostics and treatment options including psychosocial interventions. Specific assignment to and a standardized approach during physical therapy were desired by PTs. Nurses favoured a multi-professional documentation system. The structured three-day expert workshop resulted in a first draft of CPW and potential implementation strategies. Subsequent modelling resulted in a CPW with components and appropriate training materials for involved health professionals. A specific implementation strategy is now available. CONCLUSION A mixed-methods design was suggested to be a suitable approach to develop a complex intervention and its implementation strategy. We will subsequently test the intervention for its acceptability and feasibility in a feasibility study accompanied by a comprehensive process evaluation to inform a subsequent effectiveness trial. TRIAL REGISTRATION The research project is registered in "Projektdatenbank Versorgungsforschung Deutschland" (Project-ID: VfD_MobilE-PHY_17_003910; date of registration: 30.11.2017).
Collapse
Affiliation(s)
- Verena Regauer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377 Munich, Germany
| | - Eva Seckler
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377 Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377 Munich, Germany
- German Centre for Vertigo and Balance Disorders, Ludwig-Maximilian University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Richard Ippisch
- Practice Centre Neurology, Psychiatry and Psychotherapy Germering, Josef-Kistler-Straße 10, 82110 Germering, Germany
| | - Klaus Jahn
- German Centre for Vertigo and Balance Disorders, Ludwig-Maximilian University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Schoen Clinic Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany
| | - Petra Bauer
- Faculty for Applied Health and Social Sciences, Development and Technology Transfer, Cen-Tre for Research, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Martin Müller
- Faculty for Applied Health and Social Sciences, Development and Technology Transfer, Cen-Tre for Research, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| |
Collapse
|
18
|
Wong AKC, Wong FKY, So C. Cost-effectiveness of a preventive self-care health management program for community-dwelling older adults: a randomised controlled trial. Age Ageing 2021; 50:440-446. [PMID: 32638995 DOI: 10.1093/ageing/afaa127] [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] [Received: 01/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the cost-effectiveness of a preventive self-care health management program for community-dwelling older adults as compared to usual care. DESIGN/INTERVENTION A cost-effectiveness analysis was executed alongside a randomised controlled trial. Nurse case managers provided interventions, including holistic assessment, empowerment of self-care, preventive health behaviours and self-efficacy with co-produced care planning, supported by nursing students. The control group received social control calls. PARTICIPANTS/SETTING Community-dwelling older adults were randomly assigned to the intervention (n = 271) or control (n = 269) group. The intervention was conducted in collaboration with 11 community centres under four non-government organisations in various districts of Hong Kong. MEASUREMENTS Cost and quality-adjusted life years (QALYs) were collected pre (baseline, 0 months) and post intervention (3 months) and 3 months after completion of the program (6 months). Incremental cost-effectiveness ratios between the groups were calculated, dividing the difference in cost by the difference in QALYs. RESULTS Analysis showed that the net incremental QALY gain was 0.0014 (3 months) and 0.0033 (6 months) when the intervention group was compared to the control group. The probability of being cost-effective at 6 months was 53.2% and 53.4%, based on the cost-effectiveness thresholds recommended by both the National Institute for Health and Clinical Excellence ($200,000/QALYs) and the World Health Organization (Hong Kong gross domestic product/capita, HK$381,780). CONCLUSIONS The results provide some evidence to suggest that the addition of a home-based, preventive self-care health management program may have effects on cost outcomes for community-dwelling older adults in Hong Kong.
Collapse
Affiliation(s)
| | - Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Ching So
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| |
Collapse
|
19
|
Wong AKC, Wong FKY, Chang KKP. A Proactive Mobile Health Application Program for Promoting Self-Care Health Management among Older Adults in the Community: Study Protocol of a Three-Arm Randomized Controlled Trial. Gerontology 2020; 66:506-513. [PMID: 32772019 DOI: 10.1159/000509129] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of mobile health (mHealth) has become common in recent years and is regarded as one of the most effective interventions for developing disease-specific management skills and establishing confidence in making preventive health behavior changes and accomplishing health-related goals among community-dwelling older adults. Most mHealth designs adopt a reactive care approach whereby health care professionals do not respond until they receive abnormal assessment results from the database or a message or signal from the client. The purpose of this study is to determine the effectiveness of a proactive mobile health application program with the support of a community health-social care team for older adults dwelling in the community on improving their self-care health management. METHODS This is a three-armed, randomized controlled trial. The study will be conducted in 7 community centers with an estimated sample size of 282 participants. The participants will be randomly assigned to mHealth with interactivity, mHealth, and control groups when they are (1) aged 60 or above, (2) complaining chiefly of pain, hypertension, or diabetes mellitus, (3) living within the service areas, and (4) smartphone users. Subjects in the mHealth with interactivity group will receive 2 main elements, the mHealth application and nurse case management supported by a social service team. The mHealth group will receive the mHealth application only. The primary outcome measure will be self-efficacy, and secondary outcomes will include self-management outcomes (pain score, blood pressure, capillary blood glucose), client outcomes (quality of life, depression), and health service utilization outcomes (institutionalization and health service utilization [general practitioner, outpatient clinic, emergency room, hospital admission]). Data will be collected before intervention, after intervention, and 3 months after intervention. DISCUSSION The incremental benefits of adding interactivity in the mHealth program have not been confirmed. This present study will add valuable information to the knowledge gap of whether mHealth with nurse interaction supported by a health-social partnership can improve self-care management among community-dwelling older adults.
Collapse
|
20
|
Dawson S, Kunonga P, Beyer F, Spiers G, Booker M, McDonald R, Cameron A, Craig D, Hanratty B, Salisbury C, Huntley A. Does health and social care provision for the community dwelling older population help to reduce unplanned secondary care, support timely discharge and improve patient well-being? A mixed method meta-review of systematic reviews. F1000Res 2020; 9:857. [PMID: 34621521 PMCID: PMC8482050 DOI: 10.12688/f1000research.25277.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background: This study aimed to identify and examine systematic review evidence of health and social care interventions for the community-dwelling older population regarding unplanned hospital admissions, timely hospital discharge and patient well-being. Methods: A meta-review was conducted using Joanna Briggs and PRISMA guidance. A search strategy was developed: eight bibliographic medical and social science databases were searched, and references of included studies checked. Searches were restricted to OECD countries and to systematic reviews published between January 2013-March 2018. Data extraction and quality appraisal was undertaken by one reviewer with a random sample screened independently by two others. Results: Searches retrieved 21,233 records; using data mining techniques, we identified 8,720 reviews. Following title and abstract and full-paper screening, 71 systematic reviews were included: 62 quantitative, seven qualitative and two mixed methods reviews. There were 52 reviews concerned with healthcare interventions and 19 reviews concerned with social care interventions. This meta-review summarises the evidence and evidence gaps of nine broad types of health and social care interventions. It scrutinises the presence of research in combined health and social care provision, finding it lacking in both definition and detail given. This meta-review debates the overlap of some of the person-centred support provided by community health and social care provision. Research recommendations have been generated by this process for both primary and secondary research. Finally, it proposes that research recommendations can be delivered on an ongoing basis if meta-reviews are conducted as living systematic reviews. Conclusions: This meta-review provides evidence of the effect of health and social care interventions for the community-dwelling older population and identification of evidence gaps. It highlights the lack of evidence for combined health and social care interventions and for the impact of social care interventions on health care outcomes. Registration: PROSPERO ID CRD42018087534; registered on 15 March 2018.
Collapse
Affiliation(s)
- Shoba Dawson
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Patience Kunonga
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Gemma Spiers
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Matthew Booker
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Ruth McDonald
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Ailsa Cameron
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Dawn Craig
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, UK, Newcastle, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Alyson Huntley
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
21
|
San-José A, Pérez-Bocanegra C, Agustí A, Laorden H, Gost J, Vidal X, Oropeza V, Romero R. Integrated health intervention on polypharmacy and inappropriate prescribing in elderly people with multimorbidity: Results at the end of the intervention and at 6 months after the intervention. Med Clin (Barc) 2020; 156:263-269. [PMID: 32593414 DOI: 10.1016/j.medcli.2020.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE To analyse the impact of an integrated health intervention focused on polypharmacy and inappropriate prescribing (IP) in elderly people with multimorbidity. MATERIAL AND METHODS Patients were referred for assessment and intervention from primary care or hospital to an interdisciplinary team composed of primary and hospital medical staff and nurses. Pharmacological assessment was centred on polypharmacy and IP using the STOPP/START criteria. Changes in polypharmacy and in IP were analysed at the end of the intervention and at 6 months. RESULTS One hundred consecutive patients (mean (SD) age 81.5(8.0) years, 54(54%) male) were analysed. Mean prescribed medicines at baseline was > 10. There were no significant changes at the end of the intervention and at 6 months. The proportion of patients with two or more STOPP criteria reduced from 37% at the beginning of the intervention to 18% at the end (p< .001), and the proportion of those with START criteria from 13% to 6% (p = .004). These differences persisted at 6 months. The number of STOPP and START criteria before the intervention was associated with a decrease in the STOPP and START criteria at the end of the intervention and at 6 months. A reduction in polypharmacy (p= .041) and in falls (p= .034) was observed at 6 months in those with a decrease in the STOPP criteria at the end of the intervention. CONCLUSIONS An integrated health intervention centred on polypharmacy and IP in elderly people improves inappropriate prescribing that persists beyond the intervention.
Collapse
Affiliation(s)
- Antonio San-José
- Geriatric Unit. Internal Medicine Service, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Carmen Pérez-Bocanegra
- Geriatric Unit. Internal Medicine Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Antonia Agustí
- Clinical Pharmacology Service, Vall d'Hebron University Hospital , Barcelona, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Helena Laorden
- Primary Care Centre Casernes. Catalan Institut of Health, Barcelona, Spain
| | - Jordi Gost
- Primary Care Centre Casernes. Catalan Institut of Health, Barcelona, Spain
| | - Xavier Vidal
- Clinical Pharmacology Service, Vall d'Hebron University Hospital , Barcelona, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Vanessa Oropeza
- Geriatric Unit. Internal Medicine Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Rosa Romero
- Primary Care Centre Casernes. Catalan Institut of Health, Barcelona, Spain
| |
Collapse
|
22
|
Britton E, Kindermann G, Domegan C, Carlin C. Blue care: a systematic review of blue space interventions for health and wellbeing. Health Promot Int 2020; 35:50-69. [PMID: 30561661 PMCID: PMC7245048 DOI: 10.1093/heapro/day103] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
There is increasing interest in the potential use of outdoor water environments, or blue space, in the promotion of human health and wellbeing. However, therapeutic nature-based practices are currently outpacing policy and the evidence base for health or wellbeing benefits of therapeutic interventions within blue space has not been systematically assessed. This systematic review aims to address the gap in understanding the impacts of blue space within existing interventions for targeted individuals. A systematic review was carried out, searching Google Scholar, SCOPUS, PubMed, etc. through to August 2017. Only blue space interventions were included that were specifically designed and structured with a therapeutic purpose for individuals with a defined need and did not include nature-based promotion projects or casual recreation in the outdoors. Thirty-three studies met the inclusion criteria and were assessed. Overall, the studies suggest that blue care can have direct benefit for health, especially mental health and psycho-social wellbeing. The majority of papers found a positive or weak association between blue care and health and wellbeing indicators. There was also some evidence for greater social connectedness during and after interventions, but results were inconsistent and mixed across studies with very few findings for physical health. This is the first systematic review of the literature on blue care. In summary, it has been shown that mental health, especially psycho-social wellbeing, can be improved with investment in blue spaces. Key areas for future research include improving understanding of the mechanisms through which blue care can improve public health promotion.
Collapse
Affiliation(s)
- Easkey Britton
- Whitaker Institute, National University of Ireland – Galway, Galway, Ireland
| | - Gesche Kindermann
- Whitaker Institute, National University of Ireland – Galway, Galway, Ireland
- Applied Ecology Unit, Centre for Environmental Science, National University of Ireland – Galway, Galway, Ireland
| | - Christine Domegan
- Whitaker Institute, National University of Ireland – Galway, Galway, Ireland
- J.E. Cairnes School of Business & Economics, National University of Ireland – Galway, Galway, Ireland
| | - Caitriona Carlin
- Whitaker Institute, National University of Ireland – Galway, Galway, Ireland
- Applied Ecology Unit, Centre for Environmental Science, National University of Ireland – Galway, Galway, Ireland
| |
Collapse
|
23
|
Levasseur M, Dubois MF, Filliatrault J, Vasiliadis HM, Lacasse-Bédard J, Tourigny A, Levert MJ, Gabaude C, Lefebvre H, Berger V, Eymard C. Effect of personalised citizen assistance for social participation (APIC) on older adults' health and social participation: study protocol for a pragmatic multicentre randomised controlled trial (RCT). BMJ Open 2018; 8:e018676. [PMID: 29605819 PMCID: PMC5884338 DOI: 10.1136/bmjopen-2017-018676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 01/16/2018] [Accepted: 02/01/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The challenges of global ageing and the growing burden of chronic diseases require innovative interventions acting on health determinants like social participation. Many older adults do not have equitable opportunities to achieve full social participation, and interventions might underempower their personal and environmental resources and only reach a minority. To optimise current practices, the Accompagnement-citoyen Personnalisé d'Intégration Communautaire (APIC), an intervention demonstrated as being feasible and having positive impacts, needs further evaluation. METHODS AND ANALYSIS A pragmatic multicentre, prospective, two-armed, randomised controlled trial will evaluate: (1) the short-term and long-term effects of the APIC on older adults' health, social participation, life satisfaction and healthcare services utilisation and (2) its cost-effectiveness. A total of 376 participants restricted in at least one instrumental activity of daily living and living in three large cities in the province of Quebec, Canada, will be randomly assigned to the experimental or control group using a centralised computer-generated random number sequence procedure. The experimental group will receive weekly 3-hour personalised stimulation sessions given by a trained volunteer over the first 12 months. Sessions will encourage empowerment, gradual mobilisation of personal and environmental resources and community integration. The control group will receive the publicly funded universal healthcare services available to all Quebecers. Over 2 years (baseline and 12, 18 and 24 months later), self-administered questionnaires will assess physical and mental health (primary outcome; version 2 of the 36-item Short-Form Health Survey, converted to SF-6D utility scores for quality-adjusted life years), social participation (Social Participation Scale) and life satisfaction (Life Satisfaction Index-Z). Healthcare services utilisation will be recorded and costs of each intervention calculated. ETHICS AND DISSEMINATION The Research Ethics Committee of the CIUSSS Estrie - CHUS has approved the study (MP-31-2018-2424). An informed consent form will be read and signed by all study participants. Findings will be published and presented at conferences. TRIAL REGISTRATION NUMBER NCT03161860; Pre-results.
Collapse
Affiliation(s)
- Mélanie Levasseur
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-France Dubois
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Johanne Filliatrault
- Research Centre, Institut universitaire de gériatrie de Montreal (CRIUGM), Montréal, Quebec, Canada
- School of Rehabilitation, Université de Montréal, Montréal, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Research Centre, Charles-Le Moyne Hospital, Université de Sherbrooke Longueuil Campus, Longueuil, Quebec, Canada
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Joanie Lacasse-Bédard
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
| | - André Tourigny
- Department of Social and Preventive Medicine, Laval University, Québec City, Quebec, Canada
- Institute on Aging and Seniors’ Social Participation, Saint-Sacrement Hospital, Québec City, Quebec, Canada
| | - Marie-Josée Levert
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada
| | - Catherine Gabaude
- French Institute of Transport, Development and Network Science and Technology (IFSTTAR), Marne-la-Vallée, France
| | - Hélène Lefebvre
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada
| | | | | |
Collapse
|