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Crocker TF, Lam N, Ensor J, Jordão M, Bajpai R, Bond M, Forster A, Riley RD, Andre D, Brundle C, Ellwood A, Green J, Hale M, Morgan J, Patetsini E, Prescott M, Ramiz R, Todd O, Walford R, Gladman J, Clegg A. Community-based complex interventions to sustain independence in older people, stratified by frailty: a systematic review and network meta-analysis. Health Technol Assess 2024; 28:1-194. [PMID: 39252602 PMCID: PMC11403382 DOI: 10.3310/hnrp2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Background Sustaining independence is important for older people, but there is insufficient guidance about which community health and care services to implement. Objectives To synthesise evidence of the effectiveness of community services to sustain independence for older people grouped according to their intervention components, and to examine if frailty moderates the effect. Review design Systematic review and network meta-analysis. Eligibility criteria Studies: Randomised controlled trials or cluster-randomised controlled trials. Participants: Older people (mean age 65+) living at home. Interventions: community-based complex interventions for sustaining independence. Comparators: usual care, placebo or another complex intervention. Main outcomes Living at home, instrumental activities of daily living, personal activities of daily living, care-home placement and service/economic outcomes at 1 year. Data sources We searched MEDLINE (1946-), Embase (1947-), CINAHL (1972-), PsycINFO (1806-), CENTRAL and trial registries from inception to August 2021, without restrictions, and scanned reference lists. Review methods Interventions were coded, summarised and grouped. Study populations were classified by frailty. A random-effects network meta-analysis was used. We assessed trial-result risk of bias (Cochrane RoB 2), network meta-analysis inconsistency and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation for network meta-analysis). Results We included 129 studies (74,946 participants). Nineteen intervention components, including 'multifactorial-action' (multidomain assessment and management/individualised care planning), were identified in 63 combinations. The following results were of low certainty unless otherwise stated. For living at home, compared to no intervention/placebo, evidence favoured: multifactorial-action and review with medication-review (odds ratio 1.22, 95% confidence interval 0.93 to 1.59; moderate certainty) multifactorial-action with medication-review (odds ratio 2.55, 95% confidence interval 0.61 to 10.60) cognitive training, medication-review, nutrition and exercise (odds ratio 1.93, 95% confidence interval 0.79 to 4.77) and activities of daily living training, nutrition and exercise (odds ratio 1.79, 95% confidence interval 0.67 to 4.76). Four intervention combinations may reduce living at home. For instrumental activities of daily living, evidence favoured multifactorial-action and review with medication-review (standardised mean difference 0.11, 95% confidence interval 0.00 to 0.21; moderate certainty). Two interventions may reduce instrumental activities of daily living. For personal activities of daily living, evidence favoured exercise, multifactorial-action and review with medication-review and self-management (standardised mean difference 0.16, 95% confidence interval -0.51 to 0.82). For homecare recipients, evidence favoured the addition of multifactorial-action and review with medication-review (standardised mean difference 0.60, 95% confidence interval 0.32 to 0.88). Care-home placement and service/economic findings were inconclusive. Limitations High risk of bias in most results and imprecise estimates meant that most evidence was low or very low certainty. Few studies contributed to each comparison, impeding evaluation of inconsistency and frailty. Studies were diverse; findings may not apply to all contexts. Conclusions Findings for the many intervention combinations evaluated were largely small and uncertain. However, the combinations most likely to sustain independence include multifactorial-action, medication-review and ongoing review of patients. Some combinations may reduce independence. Future work Further research is required to explore mechanisms of action and interaction with context. Different methods for evidence synthesis may illuminate further. Study registration This study is registered as PROSPERO CRD42019162195. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128862) and is published in full in Health Technology Assessment; Vol. 28, No. 48. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Thomas Frederick Crocker
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Natalie Lam
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Joie Ensor
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Magda Jordão
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ram Bajpai
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Matthew Bond
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Richard D Riley
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Deirdre Andre
- Research Support Team, Leeds University Library, University of Leeds, Leeds, West Yorkshire, UK
| | - Caroline Brundle
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Alison Ellwood
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Green
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Matthew Hale
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jessica Morgan
- Geriatric Medicine, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Eleftheria Patetsini
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Matthew Prescott
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ridha Ramiz
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Oliver Todd
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rebecca Walford
- Geriatric Medicine, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Gladman
- Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Inflammation and Recovery Sciences, University of Nottingham and Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Bajraktari S, Sandlund M, Zingmark M. Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context. ACTA ACUST UNITED AC 2020; 78:97. [PMID: 33072316 PMCID: PMC7556574 DOI: 10.1186/s13690-020-00480-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/06/2020] [Indexed: 01/09/2023]
Abstract
Background Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries. Methods This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O′Malley’s framework, and the Medical Research Council’s (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus. Results Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors. Conclusions All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are ‘Senior meetings’, ‘preventive home visits’ and ‘exercise interventions’ on its own or combined with other components.
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Affiliation(s)
- Saranda Bajraktari
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Magnus Zingmark
- Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.,Department of Epidemiology and Public Health, Umeå University, Umeå, Sweden
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Leandro TA, Alves AM, Pinheiro AKB, Araujo TLD, Quirino GDS, Oliveira DRD. Nurses' competencies in health promotion for homebound older people. Rev Bras Enferm 2019; 72:311-318. [PMID: 31826225 DOI: 10.1590/0034-7167-2018-0446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/27/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify competencies related to health promotion targeting homebound older people, as they appear in the literature. METHOD systematic review using the LILACS, Scopus, CINAHL, PubMed and Cochrane Library databases. The search was performed in November 2017. Selected articles were analyzed according to nine competency domains: enable change; advocate for health; mediate through partnership; communication; leadership; assessment; planning; implementation, and evaluation and research. RESULTS nine clinical trials were included. All health promotion competency domains were identified in the reviewed research interventions, performed with homebound older people. CONCLUSION studies showed that the employed treatments were beneficial for the homebound older population. Interventions based on health promotion competencies were positively identified, and are linked to an effective and high-quality health care practice.
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Patzelt C, Heim S, Deitermann B, Theile G, Krauth C, Hummers-Pradier E, Walter U. Reaching the Elderly: Understanding of health and preventive experiences for a tailored approach - Results of a qualitative study. BMC Geriatr 2016; 16:210. [PMID: 27931197 PMCID: PMC5146846 DOI: 10.1186/s12877-016-0374-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 11/23/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Often preventive measures are not accessed by the people who were intended to be reached. Programs for older adults may target men and women, older adults, advanced old age groups and/or chronically ill patients with specific indications. The defined target groups rarely participate in the conception of programs or in the design of information materials, although this would increase accessibility and participation. In the German "Reaching the Elderly" study (2008-2011), an approach to motivating older adults to participate in a preventive home visit (PHV) program was modified with the participatory involvement of the target groups. The study examines how older men and women would prefer to be addressed for health and prevention programs. METHODS Four focus groups (N = 42 participants) and 12 personal interviews were conducted (women and men in 2 age groups: 65-75 years and ≥ 76 years). Participants from two districts of a major German city were selected from a stratified random sample (N = 200) based on routine data from a local health insurance fund. The study focused on the participants' knowledge about health and disease prevention and how they preferred to be approached and addressed. Videos of the focus groups were recorded and analysed using mind mapping techniques. Interviews were digitally recorded, transcribed verbatim and subjected to qualitative content analysis. RESULTS A gender-specific approach profile was observed. Men were more likely to favor competitive and exercise-oriented activities, and they associated healthy aging with mobility and physical activity. Women, on the other hand, displayed a broader understanding of healthy aging, which included physical activity as only one aspect as well as a healthy diet, relaxation/wellness, memory training and independent living; they preferred holistic and socially oriented services that were not performance-oriented. The "older seniors" (76+) were ambivalent towards certain wordings referring to aging. CONCLUSIONS Our results suggest that gender-specific needs must be considered in order to motivate older adults to participate in preventive services. Age-specific characteristics seem to be less relevant. It is more important to pay attention to factors that vary according to the individual state of health and life situation of the potential participants.
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Affiliation(s)
- Christiane Patzelt
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Susanne Heim
- Formerly: Institute for General Practice, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Department of General Practice, University Medical Centre Göttingen, Humboldtallee 38, 37075, Göttingen, Germany
| | - Bernhilde Deitermann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Lower Saxony State Health Department, Division 4: Cancer Registry, Roesebeckstr. 4-6, 30449, Hannover, Germany
| | - Gudrun Theile
- Formerly: Institute for General Practice, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Department of Radiation Oncology/Centre of Palliative Care, University of Zürich and University Hospital of Zürich, Rämistraße 100, 8091, Zürich, Switzerland
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Eva Hummers-Pradier
- Formerly: Institute for General Practice, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Department of General Practice, University Medical Centre Göttingen, Humboldtallee 38, 37075, Göttingen, Germany
| | - Ulla Walter
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Marazzi MC, Inzerilli MC, Madaro O, Palombi L, Scarcella P, Orlando S, Maurici M, Liotta G. Impact of the Community-Based Active Monitoring Program on the Long Term Care Services Use and In-Patient Admissions of the Over-74 Population. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/aar.2015.46020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stall N, Nowaczynski M, Sinha SK. Systematic review of outcomes from home-based primary care programs for homebound older adults. J Am Geriatr Soc 2014; 62:2243-51. [PMID: 25371236 DOI: 10.1111/jgs.13088] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the effect of home-based primary care for homebound older adults on individual, caregiver, and systems outcomes. DESIGN A systematic review of home-based primary care interventions for community-dwelling older adults (aged ≥65) using the Cochrane, PubMed, and MEDLINE databases from the earliest available date through March 15, 2014. Studies were included if the house calls visitor was the ongoing primary care provider and if the intervention measured emergency department visits, hospitalizations, hospital beds days of care, long-term care admissions, or long-term care bed days of care. SETTING Home-based primary care programs. PARTICIPANTS Homebound community-dwelling older adults (N = 46,154). MEASUREMENTS Emergency department visits, hospitalizations, hospital bed days of care, long-term care admissions, long-term care bed days of care, costs, program design, and individual and caregiver quality of life and satisfaction with care. RESULTS Of 357 abstracts identified, nine met criteria for review. The nine interventions were all based in North America, with five emerging from the Veterans Affairs system. Eight of nine programs demonstrated substantial effects on at least one inclusion outcome, with seven programs affecting two outcomes. Six interventions shared three core program components: interprofessional care teams, regular interprofessional care meetings, and after-hours support. CONCLUSION Specifically designed home-based primary care programs may substantially affect individual, caregiver and systems outcomes. Adherence to the core program components identified in this review could guide the development and spread of these programs.
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Affiliation(s)
- Nathan Stall
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Poulsen T, Siersma VD, Lund R, Christensen U, Vass M, Avlund K. Educational intervention and functional decline among older people: The modifying effects of social capital. Scand J Public Health 2014; 42:295-303. [DOI: 10.1177/1403494813520353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: To analyse if social capital modifies the effect of educational intervention of home visitors on mobility disability. Earlier studies have found that educational intervention of home visitors has a positive effect of older peoples′ functional decline, but how social capital might modify this effect is still unknown. Methods: We used the Danish Intervention Study on Preventive Home Visits – a prospective cohort study including 2863 75-year-olds and 1171 80-year-olds in 34 Danish municipalities – to analyse the modifying effect of different aspects of social capital on the effect of educational intervention of home visitors on functional decline. The three measures of social capital (bonding, bridging, and linking) were measured at contextual level. Data was analysed with multivariate linear regression model using generalised estimating equations to account for repeated measurements. Results: We found that 80-year-olds living in municipalities with high bonding ( B=0.089, p=0.0279) and high linking ( B=0.0929; p=0.0217) had significant better mobility disability in average at 3-year follow up if their municipality had received intervention. Conclusions: With the unique design of the Danish Intervention Study on Preventive Home Visits and with theory-based measures of social capital that distinguish between three aspects of social capital with focus on older people, this study contributes to the literature about the role of social capital for interventions on mobility disability.
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Affiliation(s)
- Tine Poulsen
- Department of Public Health, University of Copenhagen, Denmark
| | | | - Rikke Lund
- Department of Public Health, University of Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Denmark
| | | | - Mikkel Vass
- Department of Public Health, University of Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Denmark
| | - Kirsten Avlund
- Department of Public Health, University of Copenhagen, Denmark
- Danish Aging Research Centre, University of Aarhus, Odense and Copenhagen, Denmark
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Ansai JH, Glisoi SFDN, Silva TOD, Ferreira FPC, Lunardi AC, Sera CTN. Evolução de desempenho físico e força de preensão palmar em idosos assistidos por um programa de assistência domiciliar interdisciplinar em um ano. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000200016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Com o aumento de morbidades no envelhecimento, há necessidade de serviços de saúde que prestem assistência aos idosos, como o atendimento domiciliar. Com o objetivo de analisar o desempenho físico e a força de preensão palmar (FPP) em idosos atendidos pelo Núcleo de Assistência Domiciliar Interdisciplinar, 19 idosos com capacidade de compreensão, independentes para marcha e sem descompensação de doença foram avaliados e reavaliados após um ano. A avaliação consistiu na coleta de dados clínicos e antropométricos nos registros de prontuários e desempenho físico (Short Physical Performance Battery-SPPB) e força de preensão palmar no domicílio do paciente. Compararam-se as avaliações (teste t pareado) e verificou-se associação entre índice de massa corporal (IMC), idade, SPPB e FPP (correlação de Pearson). Em um ano, houve piora significativa na FPP nos dois membros, velocidade de marcha e desempenho físico geral. O IMC, equilíbrio e força de membros inferiores (FMI) foram mantidos. Correlação inversa foi observada entre idade e variação de equilíbrio (r=-0,55) e direta entre FPP e marcha (r=0,48). As outras variáveis não apresentaram correlação significativa. Uma assistência mais específica e frequente traria benefícios para a independência e qualidade de vida dessa população, uma vez que os idosos têm elevada perda funcional e comorbidades.
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Stijnen MMN, Jansen MWJ, Vrijhoef HJM, Duimel-Peeters IGP. Development of a home visitation programme for the early detection of health problems in potentially frail community-dwelling older people by general practices. Eur J Ageing 2013; 10:49-60. [PMID: 28804282 PMCID: PMC5549230 DOI: 10.1007/s10433-012-0251-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The integration within existing health care systems of preventive initiatives to maintain independent living among older people is increasingly emphasized. This article describes the development and refinement of the [G]OLD home visitation programme: an eight-step programme, including a comprehensive geriatric assessment, for the early detection of health and well-being problems among older people (≥75 years) by general practices. A single group post-test study using a mixed model design is performed to evaluate (a) the feasibility of the home visitation programme in general practice, (b) the practical usefulness of the geriatric assessment instrument, and (c) programme implementation with respect to reinventions introduced by general practitioners (GPs) and practice nurses (PNs). Within 3 months time, 22 PNs of 18 participating general practices visited 240 community-dwelling older people (mean age = 82.0 years; SD 4.2) who had not been in contact with their general practice for more than 6 months. Mean time investment of the programme per older person was 118.1 min (SD 27.0) for GPs and PNs combined. Evaluation meetings revealed that GPs and PNs considered the home visitation programme to be feasible in daily practice. They judged the geriatric assessment to be useful, although minor adjustments are needed (e.g., lay-out, substitution of tests). PNs often failed to register follow-up actions for detected problems in a care and treatment plan. Future training for PNs should address this issue. No reinventions were introduced that threatened fidelity of implementation. The findings are used to improve the home visitation programme before its evaluation in a large-scale controlled trial.
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Affiliation(s)
- Mandy M. N. Stijnen
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Maria W. J. Jansen
- Public Health Service South-Limburg, School for Public Health and Primary Care (CAPHRI), P.O. Box 2022, 6160 HA Geleen, The Netherlands
| | - Hubertus J. M. Vrijhoef
- Tilburg University, Scientific Centre for Care and Welfare (TRANZO), P.O. Box 90153, 5000 LE Tilburg, The Netherlands
| | - Inge G. P. Duimel-Peeters
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Patient & Care, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
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One-year follow-up of non-institutionalized dependent older adults: mortality, hospitalization, and mobility. Can J Aging 2012; 31:357-61. [PMID: 22805052 DOI: 10.1017/s0714980812000244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Non-institutionalized dependent older adults present high morbidity and mortality, demand care from their families, and consume primary health care resources. To expand knowledge about this group, we conducted a population-based one-year prospective cohort study of 130 non-institutionalized dependent older persons (age 60 and older), stratified according to baseline mobility: independent walking (group A), use of walking aids (group B), and bedridden or confined to a wheelchair (group C). The outcomes analysed were death, hospitalization, and mobility disability. Total mortality was 8.5 per cent (p = .05). Overall hospitalization rate was 34.6 per cent; the main causes were stroke and pneumonia. After one year, there was a decline in the proportion of subjects classified as independent walking (57% vs. 43%; p = .03). We conclude that there was a high rate of mortality and hospitalization in this group of dependent older people, and an increase in disability after a one-year follow-up.
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How usual is usual care in pragmatic intervention studies in primary care? An overview of recent trials. Br J Gen Pract 2010; 60:e305-18. [PMID: 20594432 DOI: 10.3399/bjgp10x514819] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Because pragmatic trials are performed to determine if an intervention can improve current practice, they often have a control group receiving 'usual care'. The behaviour of caregivers and patients in this control group should be influenced by the actions of researchers as little as possible. Guidelines for describing the composition and management of a usual care control group are lacking. AIM To explore the variety of approaches to the usual care concept in pragmatic trials, and evaluate the influence of the study design on the behaviour of caregivers and patients in a usual care control group. DESIGN OF STUDY Review of 73 pragmatic trials in primary care with a usual care control group published between January 2005 and December 2009 in the British Medical Journal, the British Journal of General Practice, and Family Practice. Outcome measures were: description of the factors influencing caregiver and patients in a usual care control group related to an individual randomised design versus cluster randomisation. RESULTS In total, 38 individually randomised trials and 35 cluster randomised trials were included. In most trials, caregivers had the freedom to treat control patients according to their own insight; in two studies, treatment options were restricted. Although possible influences on the behaviour of control caregivers and control patients were more often identified in individually randomised trials, these influences were also present in cluster randomised trials. The description of instructions and information provided to the control group was often insufficient, which made evaluation of the trials difficult. CONCLUSION Researchers in primary care medicine should carefully consider the design of a usual care control group, especially with regard to minimising the risk of study-induced behavioural change. It is recommended that an adequate description of the information is provided to control caregivers and control patients. A proposal is made for an extension to the CONSORT statement that requires authors to specify details of the usual care control group.
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Hetlevik Ø, Gjesdal S. Norwegian GPs' participation in multidisciplinary meetings: a register-based study from 2007. BMC Health Serv Res 2010; 10:309. [PMID: 21078187 PMCID: PMC2999607 DOI: 10.1186/1472-6963-10-309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 11/15/2010] [Indexed: 11/12/2022] Open
Abstract
Background An increasing number of patients with chronic disorders and a more complex health service demand greater interdisciplinary collaboration in Primary Health Care. The aim of this study was therefore to identify factors related to general practitioners (GPs), their list populations and practice municipalities associated with a high rate of GP participation in multidisciplinary meetings (MDMs). Methods A national cross-sectional register-based study of Norwegian general practice was conducted, including data on all GPs in the Regular GP Scheme in 2007 (N = 3179). GPs were grouped into quartiles based on the annual number of MDMs per patient on their list, and the groups were compared using one-way analysis of variance. Binary logistic regression was used to analyse associations between high rates of participation and characteristics of the GP, their list population and practice municipality. Results On average, GPs attended 30 MDMs per year. The majority of the meetings concerned patients in the age groups 20-59 years. Psychological disorders were the motivation for 53% of the meetings. In a multivariate logistic regression model, the following characteristics predicted a high rate of MDM attendance: younger age of the GP, with an OR of 1.6 (95% CI 1.2-2.1) for GPs < 45 years, a short patient list, with an OR of 4.9 (3.2-7.5) for list sizes below 800 compared to lists ≥ 1600, higher proportion of psychological diagnosis in consultations (OR3.4 (2.6-4.4)) and a high MDM proportion with elderly patients (OR 4.1 (3.3-5.4)). Practising in municipalities with less than 10,000 inhabitants (OR 3.7 (2.8-4.9)) and a high proportion of disability pensioners (OR 1.6 (1.2-2.2)) or patients receiving social assistance (OR 2.2 (1.7-2.8)) also predicted high rates of meetings. Conclusions Psychological problems including substance addiction gave grounds for the majority of MDMs. GPs with a high proportion of consultations with such problems also participated more frequently in MDMs. List size was negatively associated with the rate of MDMs, while a more disadvantaged list population was positively associated. Working in smaller organisational units seemed to facilitate cooperation between different professionals. There may be a generation shift towards more frequent participation in interdisciplinary work among younger GPs.
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Affiliation(s)
- Øystein Hetlevik
- Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway.
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Garåsen H, Hendriksen C. Health care for the elderly--perspectives in relation to implementation of results from intervention studies in Norway and Denmark. Scand J Public Health 2009; 37:223-6. [PMID: 19406855 DOI: 10.1177/1403494809105025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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