The Partners in Health scale for older adults: design and examination of its psychometric properties in a Dutch population of older adults

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

Introduction

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

Objective

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

Methods

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

Results

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

Conclusion

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

Pilot randomized controlled trial of a brief strategy to prevent suicide after discharge from residential addiction treatment

INTRODUCTION

Veterans are at greater risk for suicide and veterans with substance use disorder (SUD) have an even greater risk. Little research has looked into brief interventions to prevent suicide in this population in residential substance use treatment programs.

METHOD

We conducted a pilot, randomized controlled trial of a brief suicide prevention strategy called Veterans Affairs Brief Intervention and Contact Program (VA BIC) in patients participating in the Residential Recovery Center (RRC) SUD 28-day program and deemed at risk for suicide. We measured changes in symptoms at 1-, 3-, and 6-months. We looked at social connectedness, suicidal ideation, hopelessness, thwarted belongingness, perceived burdensomeness, and treatment engagement.

RESULTS

The study enrolled twenty patients. One participant withdrew immediately after baseline. We found that adherence to VA BIC components was high, as 100 % of patients (N = 10) completed 70 % or more of the VA BIC visits. Furthermore, 80 % of intervention group patients (N = 8) completed all VA BIC components. During the six-month follow-up, suicidal ideation improved in patients assigned to VA BIC, while it worsened in the standard care arm. Similarly, patients assigned to VA BIC reported a reduction in perceived burdensomeness over the six-month follow-up period while it worsened in the standard care arm. Additionally, VA BIC may modestly improve treatment engagement in the first month postdischarge.

CONCLUSION

We were able to recruit and enroll patients from a residential SUD treatment program into a clinical trial of the VA BIC intervention. Our preliminary results suggest that VA BIC may be useful in reducing suicidal ideation and perceived burdensomeness in patients who are discharged from residential SUD treatment programs and increasing treatment engagement. Future trials of VA BIC should determine whether VA BIC can reduce the risk of suicide in patients who are discharged from residential SUD treatment programs.

Determinants of emergency department utilisation by older adults in Singapore: A systematic review

INTRODUCTION

Adults aged ≥60 years contribute to disproportionately higher visits to the emergency departments (ED). We performed a systematic review to examine the reasons why older persons visit the ED in Singapore.

METHODS

We searched Medline, Embase and Scopus from January 2000 to December 2021 for studies reporting on ED utilisation by older adults in Singapore, and included studies that investigated determinants of ED utilisation. Statistically significant determinants and their effect sizes were extracted. Determinants of ED utilisation were organised using Andersen and Newman's model. Quality of studies was evaluated using Newcastle Ottawa Scale and Critical Appraisal Skills Programme.

RESULTS

The search yielded 138 articles, of which 7 were used for analysis. Among the significant individual determinants were predisposing (staying in public rental housing, religiosity, loneliness, poorer coping), enabling (caregiver distress from behavioural and psychological symptoms of dementia) and health factors (multimorbidity in patients with dementia, frailty, primary care visit in last 6 months, better treatment adherence). The 7 included studies are of moderate quality and none of them employed conceptual frameworks to organise determinants of ED utilisation.

CONCLUSION

The major determinants of ED utilisation by older adults in Singapore were largely individual factors. Evaluation of societal determinants of ED utilisation was lacking in the included studies. There is a need for a more holistic examination of determinants of ED utilisation locally based on conceptual models of health seeking behaviours.

Psychometric evaluation of the 8-item Altarum Consumer Engagement (ACE) Measure™ in community-dwelling adults in Singapore

BACKGROUND

A valid and reliable measure is essential to assess patient engagement and its impact on health outcomes. This study aimed to examine the psychometric properties of the 8-item Altarum Consumer Engagement Measure™ (ACE Measure) among English-speaking community-dwelling adults in Singapore.

METHODS

This cross-sectional study involved 400 randomly selected community-dwelling adults (mean age: 49.7 years, 50.0% were female, 72.3% were Chinese) who completed the English version of the 8-item ACE Measure independently. The item-level statistics were described. The internal consistency of the measure was measured by Cronbach alpha and item-rest correlations. Validity of the tool was assessed by 1) factorial validity using confirmatory factor analysis (CFA), 2) hypothesis-testing validity by correlating ACE subscales (Commitment and Navigation) with health-related outcomes, and 3) criterion validity against the Patient Activation Measure and Health Confidence Measure.

RESULTS

There was no floor or ceiling effect for Commitment and Navigation subscales, and the Cronbach alpha for each subscale was 0.76 and 0.54, respectively. The two-factor structure was confirmed by CFA. In general, Commitment and Navigation subscales were positively correlated with frequency of activity participation (rho = 0.30 - 0.33) and EQ-5D visual analog scale (rho = 0.15 - 0.30). Individuals who perceived better health than peers had higher subscale scores (p < 0.01). Each subscale score had moderate and positive correlations with activation score (rho = 0.48 - 0.55) and health confidence score (rho = 0.35 - 0.47).

CONCLUSIONS

The two-subscale ACE Measure demonstrated good construct validity in English-speaking Singapore community-dwelling adults. Evidence in internal consistency was mixed, indicating further investigation.

Personality Variables as Predictors of Health Services Consumption

Expenditure on healthcare and services can be a serious problem for public health. Personality variables should be included as indicators to be considered when studying the consumption of health resources and their planning. This study aims to identify the psychological and psychosocial variables that identify people who can be considered high consumers of health resources versus those who barely consume such resources. The sample was made up of a total of 1124 subjects; one half were men, and one half were women, all of legal age and residents in Spain. A battery of tests was created that included a questionnaire of sociodemographic variables and of healthcare consumption, as well as several psychological variables (Zimbardo Time Paradox Inventory, Multidimensional Locus of Control Scale, Psychological Reactance Scale, Coping Responses Inventory, self-efficacy scale applied to health, and the Symptom Checklist-90-R). The following variables of the model were significant predictors (p ≤ 0.05): a negative past, a fatalistic present, psychological cognitive reactance, behavioral coping, health self-efficacy, and the level of somatization. Data from the statistical analyses show how to create a psychological profile of people who are high consumers of healthcare resources that will allow for the creation of intervention programs in this regard.

Effectiveness of Theory-Based Health Information Technology Interventions on Coronary Artery Disease Self-Management Behavior: A Clinical Randomized Waitlist-Controlled Trial

Purpose

Secondary prevention of coronary artery disease, self‐management behavior, and blood pressure control are important to cardiovascular event prevention and promotion of quality of life (QOL), but they are underutilized. The purpose of this study was to investigate the effects of a self‐efficacy theory–based health information technology intervention implemented through blood control and patient self‐management.

Design

A clinical randomized waitlist‐controlled trial.

Methods

The study was conducted at a medical center in Taipei, Taiwan. A total of 60 subjects were randomly assigned to either the immediate intervention (experimental) group or the waitlist control group. The primary endpoint was systolic blood pressure at 3 months; secondary end points included self‐management behavior and QOL. Treatment for the immediate intervention group lasted 3 months, while the waitlist control group received routine care for the first 3 months, at which point they crossed over to the intervention arm and received the same intervention as the experimental group for another 3 months. Both groups were evaluated by questionnaires and physiological measurements at both 3 and 6 months postadmission. The results were analyzed using generalized estimating equations.

Results

Systolic blood pressure significantly improved for the intervention group participants at 3 months, when there was also significant improvement in self‐management behavior and QOL. There was no significant or appreciable effect of time spent in the waitlist condition, with treatments in the two conditions being similarly effective.

Conclusion

The use of a theory‐based health information technology treatment compared with usual care resulted in a significant improvement in systolic blood pressure, self‐management behavior, and QOL in patients with coronary artery disease.

Clinical Relevance

This treatment would be a useful strategy for clinical care of cardiovascular disease patients, improving their disease self‐management. It also may help guide further digital health care strategies during the COVID‐19 pandemic.

Predictors for self-management in older adults with type 2 diabetic nephropathy

AIM AND OBJECTIVES

To investigate factors related to self-management and predictors of self-management in older adult patients with type 2 diabetic nephropathy.

BACKGROUND

Diabetic patients suffer many comorbidities during their lifetime, and the process of self-management is complex. Self-management and an integrated care experience are extremely important for older adults with diabetic nephropathy.

DESIGN

A cross-sectional correlation design was adopted.

METHODS

A total of 123 older patients were enrolled in the study from June 2016 to November 2017. Data collection involved a demographic questionnaire, the Patients' Experience of Integrated Care Questionnaire and the Partners in Health Scale to measure the integrated care experience and self-management. Data analysis included descriptive statistics, independent t tests, Pearson product-moment correlation and multiple linear regression. The methods are consistent with the STROBE criteria (Data S1).

RESULTS

The results showed that the majority of the sample was female (56.9%). The average age was 77 years old. Stepwise regression analysis showed that re-admission during the past year (p < .001), physical function (p < .001) and integrated care experience (p < .001) are predictors of self-management in older adult patients with type 2 diabetic nephropathy and explained 42.8% of the variation in self-management behaviour.

CONCLUSION

The results can be used to enhance the awareness of clinicians of the importance of an integrated care experience and self-management among older patients with type 2 diabetic nephropathy. Clinicians also should pay attention to physical function and the integrated care experience to promote self-management.

RELEVANCE TO CLINICAL PRACTICE

Studies on the integrated care experience and self-management of diabetic neuropathy in older adults are limited in Taiwan. The results of this study provide valuable information to support the importance of integrated care among this specific population.

Factors associated with emergency room visits and hospitalisation amongst low-income public rental flat dwellers in Singapore

Background

In Singapore, a densely urbanised Asian society, more than 80% of the population stays in public housing estates and the majority (90%) own their own homes. For the needy who cannot afford home ownership, public rental flats are available. Staying in a public rental flat is associated with higher hospital readmission rates and poorer access to health services. We sought to examine sociodemographic factors associated with hospital admissions and emergency room visits amongst public rental flat residents.

Methods

We surveyed all residents aged ≥60 years in a public rental housing precinct in central Singapore in 2016. Residents self-reported their number of emergency room visits, as well as hospitalisations, in the past 6 months. We obtained information on residents’ sociodemographic characteristics, medical, functional and social status via standardised questionnaires. We used chi-square to identify associations between emergency room visits/hospitalisations and sociodemographic characteristics, on univariate analysis; and logistic regression for multivariate analysis.

Results

Of 1324 contactable residents, 928 participated in the survey, with a response rate of 70.1%. A total of 928 residents participated in our study, of which 59.5% were male (553/928) and 51.2% (476/928) were ≥ 70 years old. Around 9% (83/928) of residents had visited the emergency room in the last 6 months; while 10.5% (100/928) had been admitted to hospital in the past 6 months. On multivariable analysis, being religious (aOR = 0.43, 95%CI = 0.24–0.76) and having seen a primary care practitioner in the last 6 months (aOR = 0.46, 95%CI = 0.27–0.80) were independently associated with lower odds of emergency room visits, whereas loneliness (aOR = 1.96, 95%CI = 1.13–3.43), poorer coping (aOR = 1.72, 95%CI = 1.01–3.03) and better adherence (aOR = 2.23, 95%CI = 1.29–3.83) were independently associated with higher odds of emergency room visits. For hospitalisations, similarly poorer coping (aOR = 1.85, 95%CI = 1.12–3.07), better adherence (aOR = 1.69, 95%CI = 1.04–2.75) and poorer functional status (aOR = 1.85, 95%CI = 1.15–2.98) were all independently associated with higher odds of hospitalisations, whereas those who were religious (aOR = 0.62, 95%CI = 0.37–0.99) and those who were currently employed (aOR = 0.46, 95%CI = 0.37–0.99) had lower odds of being hospitalised.

Conclusion

In this public rental flat population, functional status, coping and adherence, and having a religion were independently associated with emergency room visits and hospitalisation. Residents who had seen a primary care practitioner in the last 6 months had lower odds of visiting the emergency room.

Effects of a population-based, person-centred and integrated care service on health, wellbeing and self-management of community-living older adults: A randomised controlled trial on Embrace

Objective

To evaluate the effects of the population-based, person-centred and integrated care service ‘Embrace’ at twelve months on three domains comprising health, wellbeing and self-management among community-living older people.

Methods

Embrace supports older adults to age in place. A multidisciplinary team provides care and support, with intensity depending on the older adults’ risk profile. A randomised controlled trial was conducted in fifteen general practices in the Netherlands. Older adults (≥75 years) were included and stratified into three risk profiles: Robust, Frail and Complex care needs, and randomised to Embrace or care as usual (CAU). Outcomes were recorded in three domains. The EuroQol-5D-3L and visual analogue scale, INTERMED for the Elderly Self-Assessment, Groningen Frailty Indicator and Katz-15 were used for the domain ‘Health.’ The Groningen Well-being Indicator and two quality of life questions measured ‘Wellbeing.’ The Self-Management Ability Scale and Partners in Health scale for older adults (PIH-OA) were used for ‘Self-management.’ Primary and secondary outcome measurements differed per risk profile. Data were analysed with multilevel mixed-model techniques using intention-to-treat and complete case analyses, for the whole sample and per risk profile.

Results

1456 eligible older adults participated (49%) and were randomized to Embrace (n(T0) = 747, n(T1) = 570, mean age 80.6 years (SD 4.5), 54.2% female) and CAU (n(T0) = 709, n(T1) = 561, mean age 80.8 years (SD 4.7), 55.6% female). Embrace participants showed a greater–but clinically irrelevant–improvement in self-management (PIH-OA Knowledge subscale effect size [ES] = 0.14), and a greater–but clinically relevant–deterioration in health (ADL ES = 0.10; physical ADL ES = 0.13) compared to CAU. No differences in change in wellbeing were observed. This picture was also found in the risk profiles. Complete case analyses showed comparable results.

Conclusions

This study found no clear benefits to receiving person-centred and integrated care for twelve months for the domains of health, wellbeing and self-management in community-living older adults.