Crossing cultures: health promotion for senior migrants in the Netherlands

Life Domains and Lifestyle of Older Adults Living in a Nursing Home: A Pilot Study

Although the preventive occupational therapy intervention program Lifestyle Redesign® has proven to be effective in maintaining and improving the health and quality of life of older adults, a similar program has not yet been culturally adapted to the Spanish population. As a preliminary step in developing a lifestyle intervention tailored to healthy Spanish older adults living in a nursing home (Lifestyle Choice; originally in Spanish "Elección de Estilo de Vida"), we aimed to identify and describe the life domains of this population and determine overlap with content areas addressed in the Lifestyle Redesign® program. An observational cross-sectional study was carried out using quantitative methods, including 30 healthy older adult residents in the "Virgen del Prado" nursing home in Talavera de la Reina (Toledo), based on the development of a questionnaire and a survey. Six life domains were identified: self-care, sleep and rest, mobility, personal safety, health maintenance, spirituality, and free time usage. The results of this study reveal important overlaps with content areas of Lifestyle Redesign®, suggesting that it may be feasible to develop a lifestyle intervention ("Elección de Estilo de Vida") tailored to the sociocultural features of the healthy Spanish population over 65 years old living in nursing homes.

Lifestyle Redesign® with independent living older adults in countries other than the USA

BACKGROUND

Health promotion services need to be developed to respond to the needs of an ageing population. Lifestyle Redesign^® (LR^®) is an occupational therapy intervention that has been addressed as cost-effective in the USA.

AIMS/OBJECTIVES

This scoping review aimed to identify how the LR^® has been implemented and what the results have been with older adults living independently in countries other than the USA.

MATERIAL AND METHODS

Sixteen studies were included. Quantitative results were interpreted through the numeric data and qualitative results through inductive thematic analysis.

RESULTS

The delivery of the LR^® shared both similarities and differences with the original LR^®, and the variations concerned interventions length, facilitators, and the outcome measures used. In the quantitative results, there was often a positive trend in intervention groups' health-related quality of life, mental health, and occupational performance; in qualitative results, there was improvement in self-esteem and possibilities in building new communities.

CONCLUSIONS AND SIGNIFICANCE

The original LR^® was often transferrable into cultural settings other than the USA and many positive outcomes in the health and well-being of older adults were addressed. However, to understand the feasibility and effectiveness of the LR^®, scientific research and publications need to be enhanced.

Feasibility of Lifestyle Redesign® for community-dwelling older adults with and without disabilities: Results from an exploratory descriptive qualitative clinical research design

INTRODUCTION

Although Lifestyle Redesign® has been shown to be effective in improving older adults' health and well-being, little is known about the feasibility of implementing this programme to develop meaningful and health-promoting routines of community-dwelling older adults in Canada. This study thus aimed to explore the feasibility of implementing a culturally-adapted 6-month version of Lifestyle Redesign® with community-dwelling older French-Canadians with and without disabilities.

METHODS

An exploratory descriptive qualitative clinical research design was used with 17 older adults living at home or in a seniors' residence, divided into two groups participating in Lifestyle Redesign®. Semi-structured interviews were conducted with participants and the occupational therapist who delivered the programme and recorded clinical notes.

FINDINGS

Participants were aged between 65 and 90; they were mainly women (n = 11; 64.7%), and seven (41.2%) had disabilities. The intervention was tailored to the participants' needs, interests, and capacities in each group (e.g. modules selected, number of individual sessions, and assistance of volunteer). Over the 6-month period, older adults participated in an average of about 25 group sessions with the occupational therapist and in four or five outings with their group (e.g. restaurant, market, and museum) and attended between 5 and 11 individual sessions with the occupational therapist. The most common reasons for missing group sessions were being ill, working, or having another appointment. Personal facilitators and barriers to participation in the intervention were mainly related to abilities, needs, spiritual life, and health. Environmental facilitators were mostly the regularity of the sessions, group, and external support, including human resources to deliver the intervention, whereas barriers were the residence's time restrictions and staff's attitudes, cost of some activities targeted in the programme, and transportation problems.

CONCLUSION

Lifestyle Redesign® is a feasible preventive occupational therapy intervention for community-dwelling older French-Canadians. These findings will guide future studies including large-scale clinical trials.

Professional competence in a health promotion program in the Netherlands

Health promotion for senior citizens ('seniors') is an increasingly important factor in health and welfare policy, having important implications for occupational therapy. The health promotion program 'Healthy and Active Aging' originated in the US, has been modified and adapted to the Dutch context and has been implemented in community contexts. This study aimed to generate an in-depth understanding of the Healthy and Active Aging program and to use this knowledge to inform professional practice. A naturalistic case study methodology was followed, using document analysis, observations, interviews and a group interview as data gathering methods. Data were analyzed and interpreted using narrative analyses. In this specific case, a small group of women joined the program. During 10 sessions, the participants explored the meaning of everyday activities for their self-perceived health and well-being. The key experience reported by the participants and professionals related to the positive ambience within the group, the emotional recognition among the participants and the responsive guidance of the professionals. This case showed how the framework of the program can be modified and tailored to the wishes and needs of the participating seniors. The group facilitators chose a subtle, responsive manner to support and motivate the participants.

Lifestyle differences between older migrants and non-migrants in 14 European countries using propensity score matching method

Objectives

We examine the differences in lifestyle between four groups of migrants—first generation of older migrants originating from one of the EU countries, Africa or the Middle East and second-generation older EU migrants—with non-migrants in their country of destination.

Methods

We use wave 5 of the SHARE data. To control for differences in socio-demographic characteristics, cultural factors and duration of stay in country of destination between migrants and non-migrants, we use propensity matching score analysis.

Results

Older migrants from Southern European countries are more likely to smoke than non-migrants in their country of origin. Older migrants originating from Africa and the Middle East are more likely to smoke than non-migrants in their country of destination. Some groups of second-generation older migrants are more likely to consume alcohol and to have lower levels of physical activity than non-migrants in their country of destination.

Conclusions

Our results show that differences in lifestyle between migrants and non-migrants exist, but they are not solely related to their migrant status. Cultural and socio-demographic characteristics also play a role.

Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries

Introduction

It is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries.

Methods

The SHARE dataset for individuals aged 50+ and their households, collected in 2010–2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model.

Results

We found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure.

Discussion

Our study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio-economic contexts, but also due to the specific characteristics of the different health systems. In view of the ageing of European populations, it will be crucial to strengthen the mechanisms for financial protection for older people with chronic diseases.