1
|
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
|
2
|
Kasa AS, Traynor V, Drury P. Measuring the effects of nurse-led frailty intervention on community-dwelling older people in Ethiopia: a quasi-experimental study. BMC Geriatr 2024; 24:384. [PMID: 38689218 PMCID: PMC11061989 DOI: 10.1186/s12877-024-04909-2] [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] [Received: 01/02/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Despite the critical need, interventions aimed at frailty in sub-Saharan Africa are scarce, attributed to factors such as insufficient healthcare infrastructure, the pressing need to address infectious diseases, maternal and child health issues, and a general lack of awareness. Hence, the aim of this research was to develop, implement, and evaluate the effect of a nurse-led program on frailty and associated health outcomes in community-dwelling older individuals in Ethiopia. METHODS This study utilised a pre-test, post-test, and follow-up single-group quasi-experimental design. The main outcome measure was to determine changes in the frailty levels of older individuals living in communities at three different intervals: initially (T0), immediately after the intervention (T1), and 12 weeks following the intervention (T2). Secondary outcomes were the observed changes in daily living activities, nutritional status, depression levels, and quality of life (QOL), evaluated at each of these data collection points. To analyse changes in frailty and response variables over these periods, Friedman's ANOVA and Cochran's Q test were employed, setting the threshold for statistical significance at P < 0.05. RESULTS Sixty-six older people with a high adherence rate of 97% completed the intervention and the follow-up measurements. Participants had an average age of 66.7 ± 7.9 years, with females comprising 79.4% of the group. Notably, 12 weeks post-intervention, there was a marked decrease in frailty (χ2(2) = 101.05, p < 0.001) and depression scores (χ2(2) = 9.55, p = 0.008) compared to the baseline. However, the changes in depression, physical, mental, and environmental domains of QOL were not sustained for 12 weeks post-intervention. Study participants showed an improvement in nutritional status (χ2(2) = 25.68, p < 0.001), activity of daily living (χ2(2) = 6.00, p = 0.05), and global quality of life (χ2(2) = 20.64, p < 0.001). CONCLUSIONS The nurse-led intervention notably, 12 weeks post-intervention reduced frailty and depression. The intervention improved the nutritional status and some components of the quality of life of the participants. There is a need for further studies, especially with larger participant groups and stronger research designs such as randomized controlled trials (RCTs). TRIAL REGISTRATION ClinicalTrials.gov: NCT05754398 (03/03/2023).
Collapse
Affiliation(s)
- Ayele Semachew Kasa
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), NSW, Australia.
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), NSW, Australia
| | - Peta Drury
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), NSW, Australia
| |
Collapse
|
3
|
Crocker TF, Ensor J, Lam N, Jordão M, Bajpai R, Bond M, Forster A, Riley RD, Andre D, Brundle C, Ellwood A, Green J, Hale M, Mirza L, Morgan J, Patel I, Patetsini E, Prescott M, Ramiz R, Todd O, Walford R, Gladman J, Clegg A. Community based complex interventions to sustain independence in older people: systematic review and network meta-analysis. BMJ 2024; 384:e077764. [PMID: 38514079 PMCID: PMC10955723 DOI: 10.1136/bmj-2023-077764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To synthesise evidence of the effectiveness of community based complex interventions, grouped according to their intervention components, to sustain independence for older people. DESIGN Systematic review and network meta-analysis. DATA SOURCES Medline, Embase, CINAHL, PsycINFO, CENTRAL, clinicaltrials.gov, and International Clinical Trials Registry Platform from inception to 9 August 2021 and reference lists of included studies. ELIGIBILITY CRITERIA Randomised controlled trials or cluster randomised controlled trials with ≥24 weeks' follow-up studying community based complex interventions for sustaining independence in older people (mean age ≥65 years) living at home, with usual care, placebo, or another complex intervention as comparators. MAIN OUTCOMES Living at home, activities of daily living (personal/instrumental), care home placement, and service/economic outcomes at 12 months. DATA SYNTHESIS Interventions were grouped according to a specifically developed typology. Random effects network meta-analysis estimated comparative effects; Cochrane's revised tool (RoB 2) structured risk of bias assessment. Grading of recommendations assessment, development and evaluation (GRADE) network meta-analysis structured certainty assessment. RESULTS The review included 129 studies (74 946 participants). Nineteen intervention components, including "multifactorial action from individualised care planning" (a process of multidomain assessment and management leading to tailored actions), were identified in 63 combinations. For living at home, compared with no intervention/placebo, evidence favoured multifactorial action from individualised care planning including medication review and regular follow-ups (routine review) (odds ratio 1.22, 95% confidence interval 0.93 to 1.59; moderate certainty); multifactorial action from individualised care planning including medication review without regular follow-ups (2.55, 0.61 to 10.60; low certainty); combined cognitive training, medication review, nutritional support, and exercise (1.93, 0.79 to 4.77; low certainty); and combined activities of daily living training, nutritional support, and exercise (1.79, 0.67 to 4.76; low certainty). Risk screening or the addition of education and self-management strategies to multifactorial action from individualised care planning and routine review with medication review may reduce odds of living at home. For instrumental activities of daily living, evidence favoured multifactorial action from individualised care planning and routine 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: combined activities of daily living training, aids, and exercise; and combined activities of daily living training, aids, education, exercise, and multifactorial action from individualised care planning and routine review with medication review and self-management strategies. For personal activities of daily living, evidence favoured combined exercise, multifactorial action from individualised care planning, and routine review with medication review and self-management strategies (0.16, -0.51 to 0.82; low certainty). For homecare recipients, evidence favoured addition of multifactorial action from individualised care planning and routine review with medication review (0.60, 0.32 to 0.88; low certainty). High risk of bias 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. CONCLUSIONS The intervention most likely to sustain independence is individualised care planning including medicines optimisation and regular follow-up reviews resulting in multifactorial action. Homecare recipients may particularly benefit from this intervention. Unexpectedly, some combinations may reduce independence. Further research is needed to investigate which combinations of interventions work best for different participants and contexts. REGISTRATION PROSPERO CRD42019162195.
Collapse
Affiliation(s)
- Thomas F Crocker
- 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
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, 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
| | - 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, School of Medicine, Keele University, Keele, UK
| | - Matthew Bond
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, 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
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Deirdre Andre
- Research Support Team, Leeds University Library, University of Leeds, Leeds, 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
| | - Lubena Mirza
- 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
| | - Ismail Patel
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, 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 and Ageing Research, Academic Unit of Injury, Inflammation and Recovery Sciences, University of Nottingham, Nottingham, UK
- 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
| |
Collapse
|
4
|
Kasa AS, Drury P, Traynor V, Lee SC, Chang HCR. The effectiveness of nurse-led interventions to manage frailty in community-dwelling older people: a systematic review. Syst Rev 2023; 12:182. [PMID: 37777786 PMCID: PMC10543273 DOI: 10.1186/s13643-023-02335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 08/25/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND The global increase in the number of frail older people and the accompanying increase in chronic conditions underline the need to develop effective health promotion and preventive interventions for these population groups. Wide ranging of physical, psychological, and social health factors influence frailty in older people and leads to increased vulnerability to many adverse outcomes. To reverse or reduce the progression of frailty, nurses play a pivotal role in delivering health promotion and preventive interventions. The purpose of the review is to determine the effectiveness of nurse-led interventions in reducing frailty in community-dwelling older people. METHODS The following electronic databases: PubMed, MEDLINE, Web of Science, SCOPUS, CINAHL, PsychInfo, and WHO Global Index Medicus were searched until June 2022. Nurse-led, "nurse led", education, training, intervention, program, teaching, frail*, fragile*, "frailty syndrome", debility, infirmity, elder*, aged*, old*, geriatric, "community based settings", "community-based", "community setting", community were the search terms. Before data extraction, eligible articles were assessed for their methodological quality. The JBI critical appraisal checklist for reporting experimental studies was utilised to appraise the methodological quality of the studies. Data were systematically examined using a narrative review to determine the effectiveness of the intervention. RESULTS Of the 156 studies identified, from the search, six studies with samples ranging from 40 to 1387 older people were eligible for inclusion in the review. Two quasi-experimental studies and one Randomised Controlled Trial (RCT) showed a moderate risk of bias. The Nurse-led frailty interventions used a multi-component intervention approach across the studies. The interventions reversed frailty progression, improve physical functioning, nutritional status, and quality of life, enhance perceptions of social support, improve mental health, and reduce depression. CONCLUSIONS Few studies have explored the effectiveness of a nurse-led intervention to decrease frailty in older people. Evaluating physical functioning, nutritional status, mental health, and quality of life in community-dwelling frail older people can contribute to developing appropriate interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID of CRD42022348064.
Collapse
Affiliation(s)
- Ayele Semachew Kasa
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.
- Department of Adult Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Peta Drury
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hui-Chen Rita Chang
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Parramatta, NSW, Australia
| |
Collapse
|
5
|
Sadler E, Khadjesari Z, Ziemann A, Sheehan KJ, Whitney J, Wilson D, Bakolis I, Sevdalis N, Sandall J, Soukup T, Corbett T, Gonçalves-Bradley DC, Walker DM. Case management for integrated care of older people with frailty in community settings. Cochrane Database Syst Rev 2023; 5:CD013088. [PMID: 37218645 PMCID: PMC10204122 DOI: 10.1002/14651858.cd013088.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Ageing populations globally have contributed to increasing numbers of people living with frailty, which has significant implications for use of health and care services and costs. The British Geriatrics Society defines frailty as "a distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves". This leads to an increased susceptibility to adverse outcomes, such as reduced physical function, poorer quality of life, hospital admissions, and mortality. Case management interventions delivered in community settings are led by a health or social care professional, supported by a multidisciplinary team, and focus on the planning, provision, and co-ordination of care to meet the needs of the individual. Case management is one model of integrated care that has gained traction with policymakers to improve outcomes for populations at high risk of decline in health and well-being. These populations include older people living with frailty, who commonly have complex healthcare and social care needs but can experience poorly co-ordinated care due to fragmented care systems. OBJECTIVES To assess the effects of case management for integrated care of older people living with frailty compared with usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Health Systems Evidence, and PDQ Evidence and databases from inception to 23 September 2022. We also searched clinical registries and relevant grey literature databases, checked references of included trials and relevant systematic reviews, conducted citation searching of included trials, and contacted topic experts. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared case management with standard care in community-dwelling people aged 65 years and older living with frailty. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures recommended by Cochrane and the Effective Practice and Organisation of Care Group. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 20 trials (11,860 participants), all of which took place in high-income countries. Case management interventions in the included trials varied in terms of organisation, delivery, setting, and care providers involved. Most trials included a variety of healthcare and social care professionals, including nurse practitioners, allied healthcare professionals, social workers, geriatricians, physicians, psychologists, and clinical pharmacists. In nine trials, the case management intervention was delivered by nurses only. Follow-up ranged from three to 36 months. We judged most trials at unclear risk of selection and performance bias; this consideration, together with indirectness, justified downgrading the certainty of the evidence to low or moderate. Case management compared to standard care may result in little or no difference in the following outcomes. • Mortality at 12 months' follow-up (7.0% in the intervention group versus 7.5% in the control group; risk ratio (RR) 0.98, 95% confidence interval (CI) 0.84 to 1.15; I2 = 11%; 14 trials, 9924 participants; low-certainty evidence) • Change in place of residence to a nursing home at 12 months' follow-up (9.9% in the intervention group versus 13.4% in the control group; RR 0.73, 95% CI 0.53 to 1.01; I2 = 0%; 4 trials, 1108 participants; low-certainty evidence) • Quality of life at three to 24 months' follow-up (results not pooled; mean differences (MDs) ranged from -6.32 points (95% CI -11.04 to -1.59) to 6.1 points (95% CI -3.92 to 16.12) when reported; 11 trials, 9284 participants; low-certainty evidence) • Serious adverse effects at 12 to 24 months' follow-up (results not pooled; 2 trials, 592 participants; low-certainty evidence) • Change in physical function at three to 24 months' follow-up (results not pooled; MDs ranged from -0.12 points (95% CI -0.93 to 0.68) to 3.4 points (95% CI -2.35 to 9.15) when reported; 16 trials, 10,652 participants; low-certainty evidence) Case management compared to standard care probably results in little or no difference in the following outcomes. • Healthcare utilisation in terms of hospital admission at 12 months' follow-up (32.7% in the intervention group versus 36.0% in the control group; RR 0.91, 95% CI 0.79 to 1.05; I2 = 43%; 6 trials, 2424 participants; moderate-certainty evidence) • Change in costs at six to 36 months' follow-up (results not pooled; 14 trials, 8486 participants; moderate-certainty evidence), which usually included healthcare service costs, intervention costs, and other costs such as informal care. AUTHORS' CONCLUSIONS We found uncertain evidence regarding whether case management for integrated care of older people with frailty in community settings, compared to standard care, improved patient and service outcomes or reduced costs. There is a need for further research to develop a clear taxonomy of intervention components, to determine the active ingredients that work in case management interventions, and identify how such interventions benefit some people and not others.
Collapse
Affiliation(s)
- Euan Sadler
- School of Health Sciences, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | | | - Alexandra Ziemann
- Department of Social & Policy Sciences, University of Bath, Bath, UK
| | - Katie J Sheehan
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Julie Whitney
- School of Life Course & Population Sciences, King's College London, London, UK
- Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, London, UK
| | - Dan Wilson
- Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Health Service & Population Research Department, King's College London, London, UK
| | - Nick Sevdalis
- Centre for Behavioural & Implementation Science Interventions (BISI), National University of Singapore, Singapore, Singapore
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, London, UK
| | - Tayana Soukup
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Teresa Corbett
- Faculty of Sport, Health and Social Sciences, Solent University, Southampton, UK
| | | | - Dawn-Marie Walker
- School of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
6
|
Eltaybani S, Kawase K, Kato R, Inagaki A, Li CC, Shinohara M, Igarashi A, Sakka M, Sumikawa Y, Fukui C, Yamamoto-Mitani N. Effectiveness of home visit nursing on improving mortality, hospitalization, institutionalization, satisfaction, and quality of life among older people: Umbrella review. Geriatr Nurs 2023; 51:330-345. [PMID: 37060618 DOI: 10.1016/j.gerinurse.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: 11/22/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/17/2023]
Abstract
This umbrella review followed the JBI methodology and synthesized systematic reviews of the effectiveness of long-term home visit nursing for older people (≥ 60 years) on improving mortality, hospitalization, institutionalization, patient satisfaction, and quality of life. Eight bibliographic databases were searched, and 10 reviews with 22 distinct relevant trials (n = 10,765 participants) were included. Mortality was the most frequently examined outcome and satisfaction was the least examined (n = nine and one reviews, respectively). Home visit nursing had a favorable effect on reducing the number of admissions to hospital (n = 1,152 participants in two trials vs. 788 participants in three trials) and no effect on other outcomes. The evidence of the effectiveness of long-term home visit nursing for older people is minimal. Future research needs to be based on a theoretical foundation that explains how interventions are expected to work.
Collapse
Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Global Nursing Research center (GNRC), The University of Tokyo, Tokyo, Japan.
| | - Kiyomi Kawase
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Risako Kato
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Asa Inagaki
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chia-Chien Li
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masumi Shinohara
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Ayumi Igarashi
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Mariko Sakka
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Yuka Sumikawa
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Chie Fukui
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| |
Collapse
|
7
|
Contandriopoulos D, Stajduhar K, Sanders T, Carrier A, Bitschy A, Funk L. A realist review of the home care literature and its blind spots. J Eval Clin Pract 2022; 28:680-689. [PMID: 34614538 DOI: 10.1111/jep.13627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES There is a large body of literature from all over the world that describes, analyzes, or evaluates home care models and interventions. The present article aims to identify the practical lessons that can be gained from a systematic examination of that literature. METHOD We conducted a three-step sequential search process from which 113 documents were selected. That corpus was then narratively analysed according to a realist review approach. RESULTS A first level of observation is that there are multiple blind spots in the existing literature on home care. The definition and delimitation of what constitutes home care services is generally under-discussed. In the same way, the composition of the basket of care provided and its fit with the need of recipients is under-addressed. Finally, the literature relies heavily on RCTs whose practical contribution to decisions or policy is disputable. At a second level, our analysis suggests that three mechanisms (system integration, case management and relational continuity) are core characteristics of home care models' effectiveness. CONCLUSION We conclude by providing advice for supporting the design and implementation of stronger home care delivery systems. Our analysis suggests that doing so implies a series of sequential steps: identify what system-level goals the model should achieve and which populations it should serve; identify what type of services are likely to achieve those goals in order to establish a basket of services; and finally, identify the best ways and specific means to effectively and efficiently provide those services. Those same steps can also support ex-post evaluations of existing home care systems.
Collapse
Affiliation(s)
- Damien Contandriopoulos
- School of Nursing, University of Victoria, Victoria, British-Columbia, Canada.,Institute on Aging and Lifelong Health, University of Victoria, Victoria, British-Columbia, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, British-Columbia, Canada.,Institute on Aging and Lifelong Health, University of Victoria, Victoria, British-Columbia, Canada
| | - Tanya Sanders
- School of Nursing, University of Victoria, Victoria, British-Columbia, Canada.,School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Annie Carrier
- École de Réadaptation, Faculté de Médecine et des Sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Ami Bitschy
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British-Columbia, Canada
| | - Laura Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
8
|
Ohta R, Maiguma K, Yata A, Sano C. Rebuilding Social Capital through Osekkai Conferences in Rural Communities: A Social Network Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137912. [PMID: 35805571 PMCID: PMC9265619 DOI: 10.3390/ijerph19137912] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022]
Abstract
Social prescribing can promote the creation of new relationships, which may then promote the building of social capital in communities. One example of a social prescribing tool in Japan is Osekkai conferences, which increase social participation and mitigate the degree of loneliness in rural communities. A clarification of the changes in social interaction and intensity of connections among people through Osekkai conferences could contribute to better social prescribing in rural communities. This social network study was conducted among people who have participated in an Osekkai conference. The primary outcomes of degrees and centrality were measured as the degree of social capital. The primary outcomes were compared between April and September 2021 and between October 2021 and March 2022. The continuous performance of Osekkai conferences as social prescribing tools led to an increase in conference participation, mainly by middle-aged women in the communities. Based on a social network analysis, the average direct connection with each person did not increase; the network density decreased gradually; the network diameter decreased from 6 to 5. Regarding the node-level statistics, harmonic closeness centrality and eccentricity decreased, and modularity increased. Social prescribing initiatives should focus on improving social capital in communities, which may improve the number and meaningfulness of the collaborations among organizations and indigenous communities.
Collapse
Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, Daito-Cho, Unnan 699-1221, Japan
- Correspondence: ; Tel.: +81-9050605330
| | - Koichi Maiguma
- Department of Law and Economics, Faculty of Law and Literature, Shimane University, 1060 Nishikawatsu Cho, Matsue 690-8504, Japan;
| | - Akiko Yata
- Community Nurse Company, 422 Satokata, Kisuki-Cho, Unnan 699-1311, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan;
| |
Collapse
|
9
|
Veldhuizen J, Hafsteinsdóttir T, Mikkers M, Bleijenberg N, Schuurmans M. Evidence-based interventions and nurse-sensitive outcomes in district nursing care: A systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
10
|
Visconti C, Neiterman E. Shifting to Primary Prevention for an Aging Population: A Scoping Review of Health Promotion Initiatives for Community-Dwelling Older Adults in Canada. Cureus 2021; 13:e17109. [PMID: 34532164 PMCID: PMC8436831 DOI: 10.7759/cureus.17109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
Older adults are healthier and living independently within our communities for longer. This demonstrates the need to build capacity in geriatric preventative services, with the potential to utilize health promotion to encourage successful aging. This scoping review examines the availability and potential of health promotion initiatives for community-dwelling older adults in Canada. Two research databases were searched for empirical articles published in Canada, in English, since 2000. A total of 17 articles met our inclusion criteria. The empirical literature demonstrates successful implementation of different primary prevention programs, with various facilitation methods used to address several health issues in late life. Most programs targeted falls prevention, often using education or exercise programming. Participants reported positive results in various biopsychosocial aspects of aging. Reported positive health outcomes and high engagement rates across examined programs may represent the ability for health promotion to successfully address the needs of older adults in the community, as well as meet the existing desire for participation in such initiatives. Further implementation and investment into health promotion for older adults can increase the accessibility of these programs across Canada, address new needs amongst this population, and alleviate the future healthcare burden posed by the growing aging demographic. The need for preventative services in gerontology is universal, thus the success seen in health promotion programs and policy, and the need for expansion, in Canada may also be relevant in countries with similar demographics.
Collapse
Affiliation(s)
- Christina Visconti
- School of Public Health and Health Systems, University of Waterloo, Waterloo, CAN
| | - Elena Neiterman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, CAN
| |
Collapse
|
11
|
Fiala P, Holmerova I, Ruda T, Steffl M. Financial balance of home nursing care providers in the Czech Republic. HEALTH ECONOMICS REVIEW 2021; 11:32. [PMID: 34406493 PMCID: PMC8375115 DOI: 10.1186/s13561-021-00331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND To enable people to live in old age in their own homes often requires specialised home care services. Despite the high importance of these services, the finance of home nursing care (HNC) is still under-investigated in many countries. The aim of this paper was to describe the finance of HNC in the Czech Republic. METHODS Balancing of revenues and costs was done using structured questionnaires from the closed accounting year 2018 as a monthly average. Nonparametric Kruskal-Wallis and Wilcoxon signed ranks tests were used to test hypotheses. RESULTS Data from 62 providers were analysed. The data included information from a total of 2297 patients and 995 employees. The average of total costs were € 17,591.7 (95% CI 14,175.3 - 21,008.1) and average of total revenues were € 17,276.5 (95% CI 13,923.5 - 20,629.5). The average cost per a patient was € 516.0 (95% CI 465.9-566.1) and the average revenues were € 500.1 (95% CI 457.0-543.3). CONCLUSIONS The overall financial balance of HNC providers seems to be balanced in the Czech Republic. Nevertheless, insurance, although it should, did not cover all the costs. Micro- providers tended to be cheaper regarding the hours worked by nurses.
Collapse
Affiliation(s)
- Petr Fiala
- Faculty of Humanities, Centre of Expertise Longevity and Long Term Care and Centre of Gerontology, Charles University, Prague, Czech Republic
| | - Iva Holmerova
- Faculty of Humanities, Centre of Expertise Longevity and Long Term Care and Centre of Gerontology, Charles University, Prague, Czech Republic
| | - Tomas Ruda
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Michal Steffl
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic.
| |
Collapse
|
12
|
Making the mundane remarkable: an ethnography of the ‘dignity encounter’ in community district nursing. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
The concept of dignity is core to community district nursing practice, yet it is profoundly complex with multiple meanings and interpretations. Dignity does not exist absolutely, but, rather, becomes socially (de)constructed through and within social interactions between nurses and older adult patients in relational aspects of care. It is a concept, however, which has, to date, received little attention in the context of the community nursing care of older adults. Previous research into dignity in health care has often focused on care within institutional environments, very little, however, explores the variety of ways in which dignity is operationalised in community settings where district nursing care is conducted ‘behind closed doors’, largely free from the external gaze. This means dignity (or the lack of it) may go unobserved in community settings. Drawing on observational and interview data, this paper highlights the significance of dignity for older adults receiving nursing care in their own homes. We will demonstrate, in particular, how dignity manifests within the relational aspects of district nursing care delivery and how tasks involving bodywork can be critical to the ways in which dignity is both promoted and undermined. We will further highlight how micro-articulations in caring relationships fundamentally shape the ‘dignity encounter’ through a consideration of the routine and, arguably, mundane aspects of community district nursing care in the home.
Collapse
|
13
|
Frost R, Rait G, Wheatley A, Wilcock J, Robinson L, Harrison Dening K, Allan L, Banerjee S, Manthorpe J, Walters K. What works in managing complex conditions in older people in primary and community care? A state-of-the-art review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1915-1927. [PMID: 32671922 DOI: 10.1111/hsc.13085] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
The number of older people living with complex health conditions is increasing, with the majority of these managed in primary and community settings. Many models of care have been developed to support them, however, there is mixed evidence on their value and they include multiple overlapping components. We aimed to synthesise the evidence to learn what works for managing complex conditions in older people in primary and community care. We carried out a state-of-the-art review of systematic reviews. We searched three databases (January 2009 to July 2019) for models of primary and community care for long-term conditions, frailty, multimorbidity and complex neurological conditions common to older people such as dementia. We narratively synthesised review findings to summarise the evidence for each model type and identify components which influenced effectiveness. Out of 2,129 unique titles and abstracts, 178 full texts were reviewed and 54 systematic reviews were included. We found that the models of care were more likely to improve depressive symptoms and mental health outcomes than physical health or service use outcomes. Interventions including self-management, patient education, assessment with follow-up care procedures, and structured care processes or pathways had greater evidence of effectiveness. The level of healthcare service integration appeared to be more important than inclusion of specific professional types within a team. However, more experienced and qualified nurses were associated with better outcomes. These conclusions are limited by the overlap between reviews, reliance on vote counting within some included reviews and the quality of study reports. In conclusion, primary and community care interventions for complex conditions in older people should include: (a) clear intervention targets; (b) explicit theoretical underpinnings; and (c) elements of self-management and patient education, structured collaboration between healthcare professionals and professional support. Further work needs to determine the optimal intensity, length, team composition and role of technology in interventions.
Collapse
Affiliation(s)
- Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Alison Wheatley
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Louise Allan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jill Manthorpe
- NIHR Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
| |
Collapse
|
14
|
Jacobi CJ, Thiel D, Allum N. Enabling and constraining successful reablement: Individual and neighbourhood factors. PLoS One 2020; 15:e0237432. [PMID: 32886657 PMCID: PMC7473582 DOI: 10.1371/journal.pone.0237432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 07/28/2020] [Indexed: 11/26/2022] Open
Abstract
Using multilevel logistic regression to analyse management data of reablement episodes collected by Essex County Council, a UK local authority, this article identifies constraining and enabling factors for successful reablement. Overall, 59.5% of reablement clients were classed as able to care for themselves when assessed after 13 weeks following the reablement intervention (N = 8,118). Several age-related, disability, referral, and social factors were found to constrain reablement, but some of the largest constraining effects were neighbourhood deprivation as measured through the Index of Multiple Deprivation and, particularly, unfavourable geodemographic profiles as measured through Experian Mosaic consumer classifications. The results suggest that in order to optimise reablement, programmes should consider broader social and environmental influences on reablement rather than only individual and organisational aspects. Reablement might also be better tailored and intensified for client groups with particular underlying disabilities and for those displaying specific geodemographic characteristics.
Collapse
Affiliation(s)
- Christopher Justin Jacobi
- Department of Sociology, Nuffield College, University of Oxford, Oxford, Oxfordshire, United Kingdom
- * E-mail:
| | - Darren Thiel
- Department of Sociology, University of Essex, Colchester, Essex, United Kingdom
| | - Nick Allum
- Department of Sociology, University of Essex, Colchester, Essex, United Kingdom
| |
Collapse
|
15
|
Silva CRDT, Carvalho KMD, Figueiredo MDLF, Silva-Júnior FL, Andrade EMLR, Nogueira LT. Health promotion of frail elderly individuals and at risk of frailty. Rev Bras Enferm 2020; 72:319-327. [PMID: 31826226 DOI: 10.1590/0034-7167-2018-0575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/29/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To identify interventions for the health promotion of frail elderly individuals and those at risk of frailty. METHOD Integrative review of the literature performed in the following databases: LILACS, CINAHL, MEDLINE, Web of Science, COCHRANE and Scopus, using the. DESCRIPTORS "frail elderly", "aging", "health services for the aged" and "health promotion" combined with Boolean operators "AND" and "OR". RESULTS Randomized controlled clinical trials (RCTs) classified as level of evidence II represented 82.6% of studies. Interventions were analyzed according to the following categories: Interventions for the elderly at risk of frailty and Interventions for the frail elderly. CONCLUSION The following interventions were identified: educational multiprofessional group meetings, physical training, home visit/home care program, nutrition assessment and supplementation, health maintenance programs and cognitive training; models/programs of management and monitoring, use of assistive technology devices and hospitalization program for geriatric rehabilitation.
Collapse
|
16
|
Deschodt M, Laurent G, Cornelissen L, Yip O, Zúñiga F, Denhaerynck K, Briel M, Karabegovic A, De Geest S. Core components and impact of nurse-led integrated care models for home-dwelling older people: A systematic review and meta-analysis. Int J Nurs Stud 2020; 105:103552. [PMID: 32200100 DOI: 10.1016/j.ijnurstu.2020.103552] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/09/2020] [Accepted: 02/23/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Integrated care models are highly recommended to overcome care fragmentation in the multimorbid older population. Nurses are potentially ideally situated to fulfil the role as care coordinator to guide integrated care. No systematic review has been conducted specifically focusing on the impact of nurse-led integrated care models for older people in community settings. OBJECTIVES To identify core components of nurse-led integrated care models for the home-dwelling older population; to describe patient, service and process outcomes; and to evaluate the impact of these care models on quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions and mortality. DESIGN Systematic review and meta-analysis. DATA SOURCES English, Dutch, French, German and Spanish articles selected from PubMed and CINAHL, hand-search of reference lists of the included articles and grey literature. REVIEW METHODS A systematic search was conducted to identify prospective experimental or quasi-experimental studies detailing nurse-led integrated care models in the older home-dwelling population. Study characteristics and reported outcomes were tabulated. The core components of the models were mapped using the Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, FInancing, and performancE (SELFIE) framework. A random effects meta-analysis was conducted to study the overall effectiveness of the included care models on health-related quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions or mortality. Risk of bias was appraised using the revised Cochrane risk-of-bias tool for randomized trials and ROBINS-I tool for non-randomized studies. RESULTS Nineteen studies were included studying a total of 22,168 patients. Core components of integrated care for multimorbid patients such as the involvement of a multidisciplinary team, high risk screening, tailored holistic assessment and an individualized care plan, were performed in a vast majority of the studies; however variability was observed in their operationalisation. Twenty-seven different patient, provider and service outcomes were reported, ranging from 1 to 13 per study. The meta-analyses could not demonstrate a beneficial impact on any of the predefined outcomes. Most included studies were of high risk for several biases. CONCLUSION The summarized evidence on nurse-led integrated care models in home-dwelling older people is inconclusive and of low quality. Future studies should include key components of implementation research, such as context analyses, process evaluations and proximal outcomes, to strengthen the evidence-base of nurse-led integrated care.
Collapse
Affiliation(s)
- Mieke Deschodt
- Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Herestraat 49 ON1 box 707, 3000 Leuven, Belgium.
| | - Gwen Laurent
- Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Lonne Cornelissen
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Herestraat 49 ON1 box 707, 3000 Leuven, Belgium
| | - Olivia Yip
- Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Franziska Zúñiga
- Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Kris Denhaerynck
- Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Matthias Briel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada; Department Clinical Research, University of Basel, University Hospital Basel, Schanzenstrasse 55, 4031 Basel, Switzerland.
| | - Azra Karabegovic
- Spitex Zürich Limmat AG Fachentwicklung Chronic Care Kompetenz-Zentrum Spitex Zürich, Rotbuchstrasse 46, 8037 Zürich, Switzerland.
| | - Sabina De Geest
- Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d - box 7001, 3000 Leuven, Belgium.
| | | |
Collapse
|
17
|
Amo-Setién FJ, Abajas-Bustillo R, Torres-Manrique B, Martín-Melón R, Sarabia-Cobo C, Molina-Mula J, Ortego-Mate C. Characteristics of nursing interventions that improve the quality of life of people with chronic diseases. A systematic review with meta-analysis. PLoS One 2019; 14:e0218903. [PMID: 31233569 PMCID: PMC6590814 DOI: 10.1371/journal.pone.0218903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/11/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The objective of this systematic review was to determine the characteristics of the interventions conducted by nurses that attempt to improve the health related quality of life (HRQoL) of people over 18 years of age with chronic diseases. METHODS This systematic review with meta-analysis summarizes 24 studies, conducted in 10 countries, that evaluated HRQoL through the Short-Form Health Survey (SF). Five databases were accessed to find the available studies from December 31st, 2000 to May 22sd, 2017. Selected studies were coded according to the characteristics of the sample and the intervention. A model of random effects was adopted for the overall estimation and to explain the heterogeneity. RESULTS Twenty-four studies were included in the systematic review and meta-analysis providing a sample of 4324 chronic patients aged 63.4 years. Among the 8 subscales and two summary measures that comprise the SF-36, only an overall significant effect size (ES) index was found in the Mental Health Component summary score (ES = 0.14; 95% CI:0.03 - 0.26; I2 = 44.6, p = 0.042) and the Mental Health subscale. This improvement on HRQoL was associated to interventions on "Case Management" and "Treatments and Procedures", which were based on a theory, were of shorter duration, and had a follow-up period. CONCLUSIONS Interventions targeting people with chronic diseases resulted in a slight increase in the HRQoL that was not always significant, which suggests that there is a need for their continuous improvement.
Collapse
Affiliation(s)
| | | | | | | | - Carmen Sarabia-Cobo
- Faculty of Nursing, University of Cantabria, IDIVAL Nursing Group, Santander, Spain
| | - Jesús Molina-Mula
- Nursing and Physiotherapy Department, University of Illes Balears, Palma, Spain
| | - Carmen Ortego-Mate
- Faculty of Nursing, University of Cantabria, IDIVAL Nursing Group, Santander, Spain
| |
Collapse
|
18
|
Amo-Setién FJ, Abajas-Bustillo R, Torres-Manrique B, Martín-Melón R, Sarabia-Cobo C, Molina-Mula J, Ortego-Mate C. Characteristics of nursing interventions that improve the quality of life of people with chronic diseases. A systematic review with meta-analysis. PLoS One 2019. [DOI: https://doi.org/10.1371/journal.pone.0218903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
19
|
Liimatta H, Lampela P, Laitinen-Parkkonen P, Pitkala KH. Effects of preventive home visits on health-related quality-of-life and mortality in home-dwelling older adults. Scand J Prim Health Care 2019; 37:90-97. [PMID: 30810457 PMCID: PMC6452824 DOI: 10.1080/02813432.2019.1569372] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We explored the effectiveness of preventive home visits on the health-related quality-of-life (HRQoL) and mortality among independently community-dwelling older adults. DESIGN A randomised controlled trial. SUBJECTS Independently home-dwelling older adults 75 years and older, consisting of 211 in the intervention and 211 in the control group. SETTING Hyvinkää town municipality, Finland. MAIN OUTCOME MEASURES We used the change in HRQoL measured by the 15D scale as our primary outcome. Mortality at two years was retrieved from central registers. RESULTS At the one-year time point, the HRQoL according to the 15D scores deteriorated in the control group, whereas we found no change in the intervention group. The difference between the 15D score changes between the groups was -0.015 (95% CI -0.029 to -0.0016; p = 0.028, adjusted for age, sex, and baseline value). At the two-year time point as the visits ended, that difference diminished. There was no difference in mortality between the groups during the 24-month follow-up. CONCLUSION Preventive home visits implemented by a multidisciplinary team with CGA appear to help slow down the decline in HRQoL among older adults, although the effect diminishes when the visits end. Key points We are exploring preventive home visits as means to support the health-related quality-of-life (HRQoL) of home-dwelling older adults Multiprofessional preventive home visits in this intervention study helped to maintain the HRQoL when measured using 15D The effects on HRQoL diminished when the intervention ended, so could further benefits be attained with a longer intervention?The clinical trial registration number: ACTRN12616001411437.
Collapse
Affiliation(s)
- Heini Liimatta
- Hyvinkää City Health Centre, Hyvinkää, Finland;
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland;
- CONTACT Heini Liimatta , Hyvinkää City Health Center, Sandelininkatu 1, 05800Hyvinkää, Finland
| | | | | | - Kaisu H. Pitkala
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland;
- Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
20
|
Strandås M, Wackerhausen S, Bondas T. Gaming the system to care for patients: a focused ethnography in Norwegian public home care. BMC Health Serv Res 2019; 19:121. [PMID: 30764824 PMCID: PMC6376668 DOI: 10.1186/s12913-019-3950-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background With its emphasis on cost-reduction and external management, New Public Management emerged as the dominant healthcare policy in many Western countries. The ability to provide comprehensive and customized patient-care is challenged by the formalized, task-oriented organization of home-care services. The aim of this study is to gain deeper understanding of how nurses and the patients they care for, relate to and deal with the organizational systems they are subjected to in Norwegian home care. Methods The focused ethnographic design is based on Roper and Shapira’s framework. Data collection consisted of participant observation with field notes and semi-structured interviews with ten nurses and eight patients from six home care areas located in two Norwegian municipalities. Results Findings indicate cultural patterns regarding nurses’ somewhat disobedient behaviors and manipulations of the organizational systems that they perceive to be based on economic as opposed to caring values. Rigid organization makes it difficult to deviate from predefined tasks and adapt nursing to patients changing needs, and manipulating the system creates some ability to tailor nursing care. The nurses’ actions are founded on assumptions regarding what aspects of nursing are most important and essential to enhance patients’ health and ensure wellbeing – individualized care, nurse-patient relationships and caring – which they perceive to be devalued by New Public Management organization. Findings show that patients share nurses’ perceptions of what constitute high quality nursing, and they adjust their behavior to ease nurses’ work, and avoid placing demands on nurses. Findings were categorized into three main areas: “Rigid organizational systems complicating nursing care at the expense of caring for patients”, “Having the patient’s health and wellbeing at heart” and “Compensating for a flawed system”. Conclusions Our findings indicate that, in many ways, the organizational system hampers provision of high-quality nursing, and that comprehensive care is provided in spite of - not because of - the system. The observed practices of nurses and patients are interpreted as ways of “gaming the system” for caring purposes, in order to ensure the best possible care for patients.
Collapse
Affiliation(s)
- Maria Strandås
- Nord University, Universitetsalleén 11, 8049, Bodø, Norway.
| | | | - Terese Bondas
- Nord University, Universitetsalleén 11, 8049, Bodø, Norway
| |
Collapse
|
21
|
Rodrigues RAP, Bueno ADA, Casemiro FG, Cunha AND, Carvalho LPND, Almeida VC, Reis NAD, Seredynskyj FL. Assumptions of good practices in home care for the elderly: a systematic review. Rev Bras Enferm 2019; 72:302-310. [DOI: 10.1590/0034-7167-2018-0445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/09/2018] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To synthesize the knowledge produced on best nursing practices in long-term care for elderly at home, in order to promote healthy aging. Method: A systematic review, based on the Joanna Briggs Institute’s proposal: without restriction of dates; in the English, Portuguese and Spanish languages; conducted in PubMed, CINAHL, LILACS, Embase and Scopus databases. Results: Among 453 articles identified, 16 were included in the review: seven qualitative and nine quantitative, published between 1996 and 2015. The synthesis of the data identified as best practices identifies a premise of care centered on the elderly and the inclusion of the elderly, family and nurses as agents of this care. Conclusion: According to evidence, good practices in gerontological and nursing home care fundamentally depend on constant planning and reorganization, so that they are indeed comprehensive and contextualized. Thus, providing care will be reasoned by and driven to the elderly, based on their specific and global needs, favoring a process of healthy and active aging.
Collapse
|
22
|
Abstract
ABSTRACTMedical issues facing the aging population are of growing concern with consequences for patients and their caregivers. This study determined the indirect and out-of-pocket costs incurred by the caregivers of elderly patients in Canadian Intensive Care Units (ICUs). Primary family caregivers were surveyed capturing out-of-pocket costs, hours of work, and hours of leisure forgone in providing patient care while the patient was in the ICU. Total costs of care per month were reported across caregiver sex, age, and geographic region. Average out-of-pocket costs were $791 (2016 Canadian dollars) in the first month of ICU care. The mean total cost to family caregivers per patient was $162 per day. Male primary caregivers had higher mean out-of-pocket costs than female caregivers. Subsidization programs covering expenses such as travel, meals, accommodation, and parking are needed to support family caregivers of elderly ICU patients who are incurring considerable out-of-pocket costs.
Collapse
|
23
|
Strandås M, Wackerhausen S, Bondas T. The nurse-patient relationship in the New Public Management era, in public home care: A focused ethnography. J Adv Nurs 2018; 75:400-411. [PMID: 30209811 DOI: 10.1111/jan.13850] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/06/2018] [Accepted: 08/28/2018] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to gain deeper understandings of nurse-patient relationships in the New Public Management era, by exploring beliefs and practices of nurses and patients in Norwegian public home care. BACKGROUND Organization of Norwegian home care services is based on New Public Management-ideologies, which have led to a rigidly formalized and task-oriented nursing practice that may jeopardize individual nursing care. Nurse-patient relationships have several positive effects on patients' health and well-being, but organizational boundaries and time pressure affect the quality of relationships. DESIGN Focused ethnography. METHODS Data were collected between November 2015-July 2016 using participant observation and semi-structured interviews with 10 nurses and eight patients in six different home care areas, in two Norwegian municipalities. Data analysis was based on Roper and Shapiras framework. FINDINGS Findings demonstrate the continued importance of nurse-patient relationships in contemporary home care, while identifying extensive variations in the degree of closeness and emotional involvement. Organizational boundaries, time constraints, high workload, and disharmony between nurses "competence and patients" complex illnesses, influence practice in ways that reduce the significance of nurse-patient relationships and affect conditions under which they develop and evolve. Facing a system nurses perceive to function suboptimal, they govern practices based on their own professional assessments, and findings indicate cultural patterns in the way both nurses and patients prioritize to safeguard nurse-patient relationships. CONCLUSION Home care cultures based on traditional nursing values continue, despite New Public Management influences, but a transition into New Public Management culture may, over time, influence the quality of nurse-patient relationships and meanings attributed to them.
Collapse
|
24
|
Abstract
RÉSUMÉLes prévisions liées au vieillissement de la population canadienne impliquent que la demande en soins à domicile augmentera significativement. À ce jour, peu d’études ont été menées au Canada sur les soins à domicile pour les personnes âgées, notamment sur les caractéristiques des bénéficiaires de soins à domicile, les lacunes dans les services, ou les interventions permettant de répondre aux besoins des clients en matière de soins à domicile. Une revue systématique de sept bases de données électroniques a été réalisée pour les années 2000-2016 afin d’examiner les connaissances actuelles dans le domaine des soins à domicile pour les personnes âgées au Canada. Cette synthèse était centrée sur quatre principaux thèmes retrouvés dans la littérature : les prédicteurs au niveau de la personne âgée, les besoins de soins non comblés, les interventions, les enjeux et les défis dans les soins à domicile. Cette revue a mis en évidence plusieurs lacunes dans les connaissances liées aux soins à domicile pour les personnes âgées au Canada, considérant que plus de la moitié des études étaient centrées sur le contexte ontarien. Bien que des stratégies prometteuses aient été mises en évidence, davantage de recherche et d’évaluation des interventions et des résultats sont requises pour appuyer efficacement le système de soins à domicile au Canada, à court et à long terme.
Collapse
|
25
|
Markle-Reid M, Ploeg J, Valaitis R, Duggleby W, Fisher K, Fraser K, Ganann R, Griffith LE, Gruneir A, McAiney C, Williams A. Protocol for a program of research from the Aging, Community and Health Research Unit: Promoting optimal aging at home for older adults with multimorbidity. JOURNAL OF COMORBIDITY 2018; 8:2235042X18789508. [PMID: 30191144 PMCID: PMC6083759 DOI: 10.1177/2235042x18789508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: The goal of the Aging, Community and Health Research Unit (ACHRU) is to
promote optimal aging at home for older adults with multimorbidity (≥2
chronic conditions) and to support their family/friend caregivers. This
protocol paper reports the rationale and plan for this patient-oriented,
cross-jurisdictional research program. Objectives: The objectives of the ACHRU research program are (i) to codesign integrated
and person-centered interventions with older adults, family/friend
caregivers, and providers; (ii) to examine the feasibility of newly designed
interventions; (iii) to determine the intervention effectiveness on Triple
Aim outcomes: health, patient/caregiver experience, and cost; (iv) to
examine intervention context and implementation barriers and facilitators;
(v) to use diverse integrated knowledge translation (IKT) strategies to
engage knowledge users to support scalability and sustainability of
effective interventions; and (vi) to build patient-oriented research
capacity. Design: The research program was informed by the Knowledge-to-Action Framework and
the Complexity Model. Six individual studies were conceptualized as
integrated pieces of work. The results of the three initial descriptive
studies will inform and be followed by three pragmatic randomized controlled
trials. IKT and capacity building activities will be embedded in all six
studies and tailored to the unique focus of each study. Conclusions: This research program will inform the development of effective and scalable
person-centered interventions that are sustainable through interagency and
intersectoral partnerships with community-based agencies, policy makers, and
other health and social service agencies. Implementation of these
interventions has the potential to transform health-care services and
systems and improve the quality of life for older adults with multimorbidity
and their caregivers. Trial registration: NCT02428387 (study 4), NCT02158741 (study 5), and NCT02209285 (study 6).
Collapse
Affiliation(s)
- Maureen Markle-Reid
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada.,Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada
| | - Ruta Valaitis
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathryn Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Kimberly Fraser
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Ganann
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Griffith
- Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Carrie McAiney
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Program for Interprofessional Practice, Education and Research, McMaster University, Hamilton, Ontario, Canada
| | - Allison Williams
- School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
26
|
Walters K, Frost R, Kharicha K, Avgerinou C, Gardner B, Ricciardi F, Hunter R, Liljas A, Manthorpe J, Drennan V, Wood J, Goodman C, Jovicic A, Iliffe S. Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT. Health Technol Assess 2018; 21:1-128. [PMID: 29214975 DOI: 10.3310/hta21730] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. OBJECTIVES (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). DESIGN Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. INTERVENTION DEVELOPMENT Two systematic reviews (including systematic searches of 14 databases and registries, 1990-2016 and 1980-2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65-94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the 'HomeHealth' intervention in collaboration with older people and multidisciplinary stakeholders. 'HomeHealth' comprised 3-6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. FEASIBILITY RCT Single-blind RCT, individually randomised to 'HomeHealth' or treatment as usual (TAU). SETTING Community settings in London and Hertfordshire, UK. PARTICIPANTS A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. MAIN OUTCOME MEASURES Feasibility - recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. RESULTS We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire -3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. CONCLUSIONS Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. FUTURE WORK A large, definitive RCT of the HomeHealth service is warranted. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London, UK
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Federico Ricciardi
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ann Liljas
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Vari Drennan
- Centre for Health and Social Care Research, Kingston University and St George's, University of London, London, UK
| | - John Wood
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Ana Jovicic
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| |
Collapse
|
27
|
Poitras ME, Maltais ME, Bestard-Denommé L, Stewart M, Fortin M. What are the effective elements in patient-centered and multimorbidity care? A scoping review. BMC Health Serv Res 2018; 18:446. [PMID: 29898713 PMCID: PMC6001147 DOI: 10.1186/s12913-018-3213-8] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions to improve patient-centered care for persons with multimorbidity are in constant growth. To date, the emphasis has been on two separate kinds of interventions, those based on a patient-centered care approach with persons with chronic disease and the other ones created specifically for persons with multimorbidity. Their effectiveness in primary healthcare is well documented. Currently, none of these interventions have synthesized a patient-centered care approach for care for multimorbidity. The objective of this project is to determine the particular elements of patient-centered interventions and interventions for persons with multimorbidity that are associated with positive health-related outcomes for patients. METHOD A scoping review was conducted as the method supports the rapid mapping of the key concepts underpinning a research area and the main sources and types of evidence available. A five-stage approach was adopted: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing and reporting results. We searched for interventions for persons with multimorbidity or patient-centered care in primary care. Relevant studies were identified in four systematic reviews (Smith et al. (2012;2016), De Bruin et al. (2012), and Dwamena et al. (2012)). Inductive analysis was performed. RESULTS Four systematic reviews and 98 original studies were reviewed and analysed. Elements of interventions can be grouped into three main types and clustered into seven categories of interventions: 1) Supporting decision process and evidence-based practice; 2) Providing patient-centered approaches; 3) Supporting patient self-management; 4) Providing case/care management; 5) Enhancing interdisciplinary team approach; 6) Developing training for healthcare providers; and 7) Integrating information technology. Providing patient-oriented approaches, self-management support interventions and developing training for healthcare providers were the most frequent categories of interventions with the potential to result in positive impact for patients with chronic diseases. CONCLUSION This scoping review provides evidence for the adaption of patient-centered interventions for patients with multimorbidity. Findings from this scoping review will inform the development of a toolkit to assist chronic disease prevention and management programs in reorienting patient care.
Collapse
Affiliation(s)
- Marie-Eve Poitras
- Département des sciences de la santé, Université du Québec à Chicoutimi, 555 Boulevard Université, Chicoutimi, Québec, G7H 2B1, Canada.
| | - Marie-Eve Maltais
- Département de médecine de famille, Université de Sherbrooke, Sherbrooke, Canada
| | - Louisa Bestard-Denommé
- Centre for Studies in Family Medicine, The Western Centre for Public Health and Family Medicine, 2nd Floor, London, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, The Western Centre for Public Health and Family Medicine, 2nd Floor, London, Canada
| | - Martin Fortin
- Département de médecine de famille, Université de Sherbrooke, Sherbrooke, Canada
| |
Collapse
|
28
|
Niclasen J, Lund L, Obel C, Larsen L. Mental health interventions among older adults: A systematic review. Scand J Public Health 2018; 47:240-250. [PMID: 29781365 DOI: 10.1177/1403494818773530] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of the present study was to conduct a systematic review to identify documented mental health promotion interventions developed and tested among population-based older adults. METHODS A systematic review based on PRISMA guidelines. The literature was searched in PsycINFO and PubMed between June and September 2016. The Effective Public Health Practice Project tool was used to assess the quality of the included study. RESULTS In total 53 randomized controlled trial studies qualified for the systematic review. Across studies, three types of common conceptual themes emerged for interventions, including: 1) individual characteristics; 2) content and structure of the interventions; and 3) implementation of the interventions. CONCLUSIONS No specific interventions could be recommended on the aforementioned basis. We conclude that a number of factors are of central importance for an intervention to have the desired effect. If these factors are considered, mental health can be successfully promoted among older adults.
Collapse
Affiliation(s)
- Janni Niclasen
- 1 Educational Psychological Services, Furesø municipality, Værløse, Denmark
| | - Lisbeth Lund
- 2 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Lars Larsen
- 4 Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| |
Collapse
|
29
|
Leegaard M, Utne I, Halvorsrud L, Valeberg BT, Torbjørnsen A, Bjørnnes AK, Bjørge H, Grov EK, Løyland B. A review of self-rated generic quality of life instruments used among older patients receiving home care nursing. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e321-e328. [PMID: 28370623 DOI: 10.1111/hsc.12447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 06/07/2023]
Abstract
In the last two decades, quality of life and health-related quality of life have become commonly used outcome measures in the large number of studies evaluating healthcare and home care nursing. The objective of this systematic search and review was to evaluate studies that include self-rated generic quality of life instrument used among elderly patients receiving home care nursing. Searches were conducted in Medline, Embase, PsycINFO and Cinahl for articles published between January 2005 and June 2016, with 17 studies in eight countries meeting the inclusion criteria and assessed for quality. Overall, the review shows great variations in the included studies regarding characteristics of the participants and place of origin, the generic quality of life instruments applied and their dimensions. In this review, we raise the question of whether the generic questionnaires used to measure quality of life do in fact measure what is essential for quality of life in elderly users of home care nursing. The psychological and physical dimensions of quality of life were assessed in almost all included studies, while older-specific dimensions like autonomy, control and sensation were less frequently assessed. There is reason to believe that generic quality of life instruments frequently do not capture the dimensions that are most important for elderly people with health problems in need of home care nursing.
Collapse
Affiliation(s)
- Marit Leegaard
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway
| | - Inger Utne
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway
| | - Liv Halvorsrud
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway
| | - Berit Taraldsen Valeberg
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway
| | - Astrid Torbjørnsen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway
| | - Ann Kristin Bjørnnes
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway
| | - Heidi Bjørge
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway
| | - Ellen Karine Grov
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway
| | - Borghild Løyland
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway
| |
Collapse
|
30
|
Lai C, Cipriani M, Renzi A, Luciani M, Lombardo L, Aceto P. The Effects of the Perception of Being Recognized by Patients With Alzheimer Disease on a Caregiver's Burden and Psychophysical Health. Am J Hosp Palliat Care 2018; 35:1188-1194. [PMID: 29580073 DOI: 10.1177/1049909118766316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Caring for a patient with Alzheimer disease (AD) represents a real challenge that can have considerable long-term psychological and physical consequences. The aim of this study was to evaluate the impact of the perception of being recognized on both the psychophysical health and the level of burden reported in caregivers of patients with AD. The secondary aim was to evaluate the association between the use of a home care assistance service and the burden and psychophysical health in caregivers. The Caregiver Burden Inventory (CBI), the 36-item Short-Form Health Survey (SF-36), and a visual analog scale (VAS) to evaluate the level of perception of being recognized were administered to 31 caregivers of patients with AD. Data were also collected from patients with AD using the Mini-Mental State Examination (MMSE). The level of perception of being recognized was significantly and negatively correlated with total burden ( r = -0.36; P = .045) and objective burden ( r = -0.53; P = .002). It was also significantly and positively correlated with the MMSE score ( r = 41; P = .02). Regression models showed that only the perception of being recognized, and not MMSE, significantly predicted lower caregiver objective burden scores. Furthermore, the use of a home care assistance service significantly predicted higher caregiver physical functioning. The perception of being recognized by an AD relative significantly predicted the caregiver's objective burden associated with a shortage of time. The use of a home care assistance service also resulted in a promotion in the caregiver's social functioning. Further studies are needed to confirm these results.
Collapse
Affiliation(s)
- Carlo Lai
- 1 Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy
| | - Marta Cipriani
- 1 Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy
| | - Alessia Renzi
- 1 Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy
| | - Massimiliano Luciani
- 2 Psychiatry and Psychology Institute, Catholic University of Sacred Heart, Rome, Italy
| | | | - Paola Aceto
- 4 Department of Anaesthesiology and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
| |
Collapse
|
31
|
Burton E, Lewin G, O'Connell H, Petrich M, Boyle E, Hill KD. Can community care workers deliver a falls prevention exercise program? A feasibility study. Clin Interv Aging 2018; 13:485-495. [PMID: 29618925 PMCID: PMC5875587 DOI: 10.2147/cia.s162728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Almost half of older people receiving community care fall each year and this rate has not improved in the last decade. Falls prevention programs targeted at this group are uncommon, and expensively delivered by university trained allied health professionals. Purpose To investigate the feasibility of community care workers delivering a falls prevention exercise program to older clients, at low or medium risk of falling, as part of an existing service provision. Patients and methods Community care workers from 10 community care organizations participated in the training for, and delivery to their clients of, an 8-week evidence-based falls prevention exercise program. Community care workers included assessment staff (responsible for identifying the need for community care services through completing an assessment) and support workers (responsible for providing support in the home). Clients were surveyed anonymously at the completion of the intervention and workers participated in a semi-structured interview. Results Twenty-five community care workers participated in the study. The falls prevention program was delivered to 29 clients, with an average age of 82.7 (SD: 8.72) years and consisting of 65.5% female. The intervention was delivered safely with no adverse events recorded, and the eligibility and assessment tools were completed by the majority of community care workers (93.1%). Assessment staff found it difficult to find time to deliver the intervention. Support workers were able to complete the intervention within their current service delivery period, with the initial assessment taking a small amount of additional time. Support workers reported enjoying the additional responsibility afforded by delivering the falls prevention program and seeing changes in their clients. The majority of clients (82%) reported enjoying the exercises, with 59% reporting that they felt it made a positive change in their health. Clients completed the exercises on average 4.8 (SD: 2.2) days per week. Conclusion Community care workers who have completed appropriate training are able to deliver a falls prevention exercise program to their clients as part of their current services. Further research is required to determine whether the program reduces the rate of falls for community care clients and whether integration of a falls prevention program into an existing service is cost-effective.
Collapse
Affiliation(s)
- Elissa Burton
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Gill Lewin
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Hilary O'Connell
- Independent Living Centre Western Australia, Perth, Western Australia, Australia
| | - Mark Petrich
- Western Australian Department of Health, Perth, Western Australia, Australia.,School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Eileen Boyle
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
32
|
Wong KC, Wong FKY, Yeung WF, Chang K. The effect of complex interventions on supporting self-care among community-dwelling older adults: a systematic review and meta-analysis. Age Ageing 2018; 47:185-193. [PMID: 28927235 DOI: 10.1093/ageing/afx151] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/03/2017] [Indexed: 11/12/2022] Open
Abstract
Background self-care is critical to enable community-dwelling older adults to live independently. Complex interventions have emerged as a strategy to support self-care, but their effectiveness is unknown. Our objective was to review systematically their effectiveness on both positive (increased scores in self-rated health, Activities of Daily Living, Instrumental Activities of Daily Living, quality of life) and negative aspects (increased incidence of falls, fear of falling, hospital and nursing home admission, increased depression score), and to determine which intervention components explain the observed effects. Methods CINAHL, MEDLINE, British Nursing Index, PsycInfo and Cochrane CENTRAL were searched from January 2006 to October 2016. Randomised controlled trials providing at least two of these components: individual assessment, care planning or provision of information were reviewed. Outcomes were pooled by random-effects meta-analysis. Results twenty-two trials with 14,364 participants were included with a low risk of bias. Pooled effects showed significant benefits on positive aspects including self-rated health [standardised mean difference (SMD) 0.09, 95% confidence interval (CI) 0.01-0.17] and the mental subscale of quality of life (SMD 0.44, 95% CI 0.09-0.80) as well as on the negative aspect of incidence of falls [odds ratio (OR) 0.60, 95% CI 0.46-0.79]. There was no significant improvement in ADL, IADL, overall quality of life, fear of falling, reduction in health service utilisation or depression levels. Meta-regression and subgroup analysis did not identify any specific component or characteristic in complex interventions which explained these effects. Conclusion based on current evidence, supporting self-care in community-dwelling older adults using complex interventions effectively increases self-rated health, reduces the occurrence of falls and improves the mental subscale of quality of life.
Collapse
Affiliation(s)
- Kwan Ching Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - W F Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Katherine Chang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| |
Collapse
|
33
|
|
34
|
Wirksamkeit präventiver Hausbesuche bei älteren Menschen. Z Gerontol Geriatr 2017; 51:924-930. [DOI: 10.1007/s00391-017-1331-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/04/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
|
35
|
Ju YJ, Lee HJ, Kim W, Lee SA, Han KT, Park EC. Association between home-visit nursing utilization and all-cause hospitalization among long-term care insurance beneficiaries: A retrospective cohort study. Int J Nurs Stud 2017; 75:93-100. [DOI: 10.1016/j.ijnurstu.2017.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
|
36
|
Bleijenberg N, Imhof L, Mahrer-Imhof R, Wallhagen MI, de Wit NJ, Schuurmans MJ. Patient Characteristics Associated With a Successful Response to Nurse-Led Care Programs Targeting the Oldest-Old: A Comparison of Two RCTs. Worldviews Evid Based Nurs 2017. [PMID: 28632933 DOI: 10.1111/wvn.12235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND To improve the effectiveness of community-based care programs, especially those targeting the oldest-old population (80+), data are needed that elucidate those factors associated with a successful response to the intervention. Two comparable nurse-led care programs have been evaluated in two large randomized controlled trials (RCTs), one in Switzerland and one in the Netherlands. AIMS To identify common patient characteristics that are related to a successful response to proactive nurse-led care, we explored if and to what extent, identical factors were present in both study populations. METHODS A secondary data analysis using trial data from the intervention group of both RCTs was conducted. The study sample consisted 461 older adults, 230 from the U-PROFIT trial (the Netherlands) and 231 from the HPC trial (Switzerland). The mean age of the total sample was 85.1 years (SD 3.7). The UPROFIT intervention, delivered by registered nurses, included a frailty assessment and a comprehensive geriatric assessment (CGA) at home followed by an individualized evidence-based care plan, care coordination, and follow-up. The HCP intervention was delivered by advanced practice nurses consisting of four home visits and three phone calls, and was guided by the principles of health promotion, empowerment, partnership, and family-centeredness. A successful response was defined as "stable" or "no decline" in daily functioning at follow-up. Daily functioning was measured with 13 items of activities of daily living and instrumental activities of daily living. Multivariate logistic regression models were applied to calculate the association between individual characteristics and a successful response. RESULTS Almost half of the participants in the U-PROFIT trial (50.9%), and two-thirds (65.7%) of the participants in the HCP trial had a successful response at follow-up. Fewer comorbidities and a better self-rated health had the strongest predictive value for benefiting from the intervention (OR = 0.83 [95% CI 0.66-1.03], and OR = 1.5 [95% CI 0.92-2.45]), respectively. LINKING EVIDENCE TO ACTION Two large RCTs demonstrated that a preventive nurse-led care program can preserve daily functioning in the oldest-old population. Older people with few comorbidities and higher self-rated health had a higher likelihood of a positive outcome. Unraveling the characteristics associated with a successful response provides important information for further refining and targeting an intervention to obtain maximum effectiveness. More effort is needed to modify interventions for the oldest-old with multiple morbidities and low levels of education.
Collapse
Affiliation(s)
- Nienke Bleijenberg
- Assistant Professor, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lorenz Imhof
- Head of Research Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Romy Mahrer-Imhof
- Professor, Research Institute of Nursing Zurich University of Applied Sciences (ZHAW), Winterthur, Switzerland
| | - Margaret I Wallhagen
- Director, John A. Hartford Center of Gerontological Nursing Excellence, University of California San Francisco, School of Nursing, Department of Physiological Nursing, San Francisco, CA, USA
| | - Niek J de Wit
- Professor, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J Schuurmans
- Professor, Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
37
|
Singer AE, Goebel JR, Kim YS, Dy SM, Ahluwalia SC, Clifford M, Dzeng E, O'Hanlon CE, Motala A, Walling AM, Goldberg J, Meeker D, Ochotorena C, Shanman R, Cui M, Lorenz KA. Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review. J Palliat Med 2016; 19:995-1008. [PMID: 27533892 PMCID: PMC5011630 DOI: 10.1089/jpm.2015.0367] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes. OBJECTIVE To inform how payers and providers should identify patients with "advanced illness" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system. EVIDENCE REVIEW Systematic searches of MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews databases (1/1/2001-1/8/2015). RESULTS Randomized controlled trials (124) met inclusion criteria. The majority of studies in cancer (49%, 38 of 77 studies) demonstrated statistically significant patient or caregiver outcomes (e.g., p < 0.05), as did those in congestive heart failure (CHF) (62%, 13 of 21), chronic obstructive pulmonary disease (COPD; 58%, 11 of 19), and dementia (60%, 15 of 25). Most prognostic criteria used clinicians' judgment (73%, 22 of 30). Most interventions included a nurse (70%, 69 of 98), and many were nurse-only (39%, 27 of 69). Social workers were well represented, and home-based approaches were common (56%, 70 of 124). Home interventions with visits were more effective than those without (64%, 28 of 44; vs. 46%, 12 of 26). Interventions improved communication and care planning (70%, 12 of 18), psychosocial health (36%, 12 of 33, for depressive symptoms; 41%, 9 of 22, for anxiety), and patient (40%, 8 of 20) and caregiver experiences (63%, 5 of 8). Many interventions reduced hospital use (65%, 11 of 17), but most other economic outcomes, including costs, were poorly characterized. Palliative care teams did not reliably lower healthcare costs (20%, 2 of 10). CONCLUSIONS Palliative care improves cancer, CHF, COPD, and dementia outcomes. Effective models include nurses, social workers, and home-based components, and a focus on communication, psychosocial support, and the patient or caregiver experience. High-quality research on intervention costs and cost outcomes in palliative care is limited.
Collapse
Affiliation(s)
- Adam E. Singer
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
- RAND Corporation, Santa Monica, California
| | - Joy R. Goebel
- School of Nursing, California State University, Long Beach, Long Beach, California
| | - Yan S. Kim
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sydney M. Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Elizabeth Dzeng
- Division of Hospital Medicine, University of California at San Francisco, San Francisco, California
| | - Claire E. O'Hanlon
- RAND Corporation, Santa Monica, California
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California
| | | | - Anne M. Walling
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
- RAND Corporation, Santa Monica, California
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jaime Goldberg
- Supportive Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniella Meeker
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | | | | | - Mike Cui
- RAND Corporation, Pittsburgh, Pennsylvania
| | - Karl A. Lorenz
- RAND Corporation, Santa Monica, California
- Stanford University School of Medicine, Stanford, California
| |
Collapse
|
38
|
Bleijenberg N, Drubbel I, Schuurmans MJ, Dam HT, Zuithoff NPA, Numans ME, de Wit NJ. Effectiveness of a Proactive Primary Care Program on Preserving Daily Functioning of Older People: A Cluster Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:1779-88. [PMID: 27459236 DOI: 10.1111/jgs.14325] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To determine the effectiveness of a proactive primary care program on the daily functioning of older people in primary care. DESIGN Single-blind, three-arm, cluster-randomized controlled trial with 1-year follow-up. SETTING Primary care setting, 39 general practices in the Netherlands. PARTICIPANTS Community-dwelling people aged 60 and older (N = 3,092). INTERVENTIONS A frailty screening intervention using routine electronic medical record data to identify older people at risk of adverse events followed by usual care from a general practitioner; after the screening intervention, a nurse-led care program consisting of a comprehensive geriatric assessment, evidence-based care planning, care coordination, and follow-up; usual care. MEASUREMENTS Primary outcome was daily functioning measured using the Katz-15 (6 activities of daily living (ADLs), 8 instrumental activities of daily living (IADLs), one mobility item (range 0-15)); higher scores indicate greater dependence. Secondary outcomes included quality of life, primary care consultations, hospital admissions, emergency department visits, nursing home admissions, and mortality. RESULTS The participants in both intervention arms had less decline in daily functioning than those in the usual care arm at 12 months (mean Katz-15 score: screening arm, 1.87, 95% confidence interval (CI) = 1.77-1.97; screening and nurse-led care arm, 1.88, 95% CI = 1.80-1.96; control group, 2.03, 95% CI = 1.92-2.13; P = .03). No differences in quality of life were observed. CONCLUSION Participants in both intervention groups had less decline than those in the control group at 1-year follow-up. Despite the statistically significant effect, the clinical relevance is uncertain at this point because of the small differences. Greater customizing of the intervention combined with prolonged follow-up may lead to more-robust results.
Collapse
Affiliation(s)
- Nienke Bleijenberg
- Department of General Practice, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands.
| | - Irene Drubbel
- Department of General Practice, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands
| | - Marieke J Schuurmans
- Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands
| | - Hester Ten Dam
- Department of General Practice, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Department of Biostatistics, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, LUMC Leiden, the Netherlands
| | - Niek J de Wit
- Department of General Practice, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands
| |
Collapse
|
39
|
Buigues C, Padilla-Sánchez C, Garrido JF, Navarro-Martínez R, Ruiz-Ros V, Cauli O. The relationship between depression and frailty syndrome: a systematic review. Aging Ment Health 2016; 19:762-72. [PMID: 25319638 DOI: 10.1080/13607863.2014.967174] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Frailty is a geriatric syndrome characterised by the clinical presentation of identifiable physical alterations such as loss of muscle mass and strength, energy and exercise tolerance, and decreased physiological reserve. Frailty and depressive symptoms are common issues facing older adults and may be associated. It is not clear if the depression facilitates the appearance of frailty syndrome or vice versa or these two coexist independently in the same individuals. METHOD We performed searches in several databases (Embase, PubMed, CINAHL, Scopus, and PsycINFO) papers published between November 2003 to February 2014 about frailty syndrome and depression in people aged 65 and older published and the reference lists of from the articles retrieved were pearled in order to identify any which may have been missed in the initial search. Two independent reviewers extracted descriptive information on the prevalence and co-occurrence of frailty and depression in older individuals and of frailty criteria among depressed patients. RESULTS Depression and frailty occur in a significant proportion of frail older individuals. Common pathophysiological alterations and biomarkers in the two syndromes have been recently described. CONCLUSION Studies on the causal relationship between the two syndromes are clearly necessary in the future.
Collapse
Affiliation(s)
- Cristina Buigues
- a Department of Nursing , University of Valencia , Valencia , Spain
| | | | | | | | | | | |
Collapse
|
40
|
Looman WM, Fabbricotti IN, de Kuyper R, Huijsman R. The effects of a pro-active integrated care intervention for frail community-dwelling older people: a quasi-experimental study with the GP-practice as single entry point. BMC Geriatr 2016; 16:43. [PMID: 26879893 PMCID: PMC4755064 DOI: 10.1186/s12877-016-0214-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/01/2016] [Indexed: 12/19/2022] Open
Abstract
Background This study explored the effectiveness of a pro-active, integrated care model for community-dwelling frail older people compared to care as usual by evaluating the effects on a comprehensive set of outcomes: health outcomes (experienced health, mental health and social functioning); functional abilities; and quality of life (general, health-related and well-being). Methods The design of this study was quasi-experimental. In this study, 184 frail older patients of three GP practices that implemented the Walcheren Integrated Care Model were compared with 193 frail older patients of five GP practices that provided care as usual. In the Walcheren Integrated Care Model, community-dwelling elderly were pro-actively screened for frailty from the GP practice using the Groningen Frailty Indicator, and care needs were assessed with the EASYcare instrument. The GP practice functioned as single entry point from which case management was provided, and the GP was the coordinator of care. The entire process was supported by multidisciplinary meetings, multidisciplinary protocols and web-based patient files. The outcomes of this study were obtained at baseline, after 3 months and after 12 months and analyzed with linear mixed models of repeated measures. Results The Walcheren Integrated Care Model had a positive effect on love and friendship and a moderately positive effect on general quality of life. The ability to receive love and friendship and general quality of life decreased in the control group but was preserved in the experimental group. No significant differences were found on health outcomes such as experienced health, mental health, social functioning and functional abilities. Conclusions The results indicated that pro-active, integrated care can be beneficial for frail older people in terms of quality of life and love and friendship but not in terms of health outcomes and functional abilities. Recommendations for future research are to gain greater insight into what specific outcomes can be achieved with proactive and integrated care, considering the specific content of this care, and to allow for the heterogeneity of frail older people in evaluation research. Trial registration Current Controlled Trials ISRCTN05748494. Registration date: 14/03/2013.
Collapse
Affiliation(s)
- Wilhelmina Mijntje Looman
- Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Isabelle Natalina Fabbricotti
- Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Ruben de Kuyper
- Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Robbert Huijsman
- Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| |
Collapse
|
41
|
Jovicic A, Gardner B, Belk C, Kharicha K, Iliffe S, Manthorpe J, Goodman C, Drennan V, Walters K. Identifying the content of home-based health behaviour change interventions for frail older people: a systematic review protocol. Syst Rev 2015; 4:151. [PMID: 26538082 PMCID: PMC4634580 DOI: 10.1186/s13643-015-0138-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Meeting the needs of the growing number of older people is a challenge for health and social care services. Home-based interventions aiming to modify health-related behaviours of frail older people have the potential to improve functioning and well-being. Previous reviews have focused on whether such interventions are effective, rather than what might make them effective. Recent advances in behavioural science make possible the identification of potential 'active ingredients' of effective interventions, such as component behaviour change techniques (BCTs), and intended intervention functions (IFs; e.g. to educate, to impart skills). This paper reports a protocol for a systematic review that seeks to (a) identify health behaviour change interventions for older frail people, (b) describe the content of these interventions, and (c) explore links between intervention content and effectiveness. The protocol is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) 2015 guidelines. METHODS/DESIGN Studies will be identified through a systematic search of 15 electronic databases, supplemented by citation tracking. Studies will be retained for review where they report randomised controlled trials focusing on home-based health promotion delivered by a health professional for frail older people in community settings, written in English, and either published from 1980 onwards, or, for registered trials only, unpublished but completed with results obtainable from authors. Interventions will be coded for their content (BCTs, IFs) and for evidence of effectiveness (outcome data relating to behavioural and health outcomes). Analyses will describe characteristics of all interventions. Interventions for which effectiveness data are available will be categorised into those showing evidence of effectiveness versus those showing no such evidence. The potential for each intervention characteristic to contribute to change in behaviour or health outcomes will be estimated by calculating the percentage of all interventions featuring those characteristics that have shown effectiveness. DISCUSSION Results will reveal the strategies that have been drawn on within home-based interventions to modify the health behaviours of frail older people, and highlight those more associated with positive changes in behaviour and health. Findings from this review will provide a useful basis for understanding, developing, and implementing behaviour change interventions in this field. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014010370.
Collapse
Affiliation(s)
- Ana Jovicic
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| | - Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK. .,UCL Centre for Behaviour Change, University College London, London, UK.
| | - Celia Belk
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK.
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK.
| | - Vari Drennan
- Centre for Health and Social Care Research, St George's, University of London, London, UK.
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| |
Collapse
|
42
|
Snowden MB, Steinman LE, Carlson WL, Mochan KN, Abraido-Lanza AF, Bryant LL, Duffy M, Knight BG, Jeste DV, Leith KH, Lenze EJ, Logsdon RG, Satariano WA, Zweiback DJ, Anderson LA. Effect of physical activity, social support, and skills training on late-life emotional health: a systematic literature review and implications for public health research. Front Public Health 2015; 2:213. [PMID: 25964921 PMCID: PMC4410348 DOI: 10.3389/fpubh.2014.00213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/13/2014] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Given that emotional health is a critical component of healthy aging, we undertook a systematic literature review to assess whether current interventions can positively affect older adults' emotional health. METHODS A national panel of health services and mental health researchers guided the review. Eligibility criteria included community-dwelling older adult (aged ≥ 50 years) samples, reproducible interventions, and emotional health outcomes, which included multiple domains and both positive (well-being) and illness-related (anxiety) dimensions. This review focused on three types of interventions - physical activity, social support, and skills training - given their public health significance and large number of studies identified. Panel members evaluated the strength of evidence (quality and effectiveness). RESULTS In all, 292 articles met inclusion criteria. These included 83 exercise/physical activity, 25 social support, and 40 skills training interventions. For evidence rating, these 148 interventions were categorized into 64 pairings by intervention type and emotional health outcome, e.g., strength training targeting loneliness or social support to address mood. 83% of these pairings were rated at least fair quality. Expert panelists found sufficient evidence of effectiveness only for skills training interventions with health outcomes of decreasing anxiety and improving quality of life and self-efficacy. Due to limitations in reviewed studies, many intervention-outcome pairings yielded insufficient evidence. CONCLUSION Skills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. We discuss the implications and challenges in moving forward in this important area.
Collapse
Affiliation(s)
- Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Lesley E. Steinman
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Whitney L. Carlson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kara N. Mochan
- University of Washington School of Nursing with Environmental Health Focus, Seattle, WA, USA
- Adolescent Medicine, Seattle Children’s, Seattle, WA, USA
| | - Ana F. Abraido-Lanza
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lucinda L. Bryant
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Michael Duffy
- Department of Educational Psychology, Counseling Psychology Program, Texas A&M University, College Station, TX, USA
| | - Bob G. Knight
- Davis School of Gerontology and Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Dilip V. Jeste
- Sam and Rose Stein Institute for Research on Aging and Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Rebecca G. Logsdon
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA
| | | | - Damita J. Zweiback
- Division of Chronic Disease and Injury Prevention, Michigan Department of Community Health, Lansing, MI, USA
- Healthy Aging Council and Health Equity Council, National Association of Chronic Disease Directors, Atlanta, GA, USA
| | - Lynda A. Anderson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
43
|
García Alcaraz F, Delicado Useros V, Alfaro Espín A, López-Torres Hidalgo J. [The use of social healthcare resources and informal care characteristics care of immobilised homecare patients]. Aten Primaria 2015; 47:195-204. [PMID: 25027627 PMCID: PMC6985592 DOI: 10.1016/j.aprim.2014.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/15/2014] [Accepted: 05/07/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To describe the use of social healthcare resources by immobilised patients and informal care characteristics and the level/degree of satisfaction with home care services. METHOD Descriptive observational study carried out in primary care. The target group were 369 randomly selected immobilised home care patients in the area of Albacete, Spain. The variables included were: socio-demographic data of the patient and carer; the use of social healthcare resources; perceived social support (DUKE-UNK questionnaire); family function (APGAR questionnaire); nursing care and home care services satisfaction (SATISFAD 10 questionnaire). RESULTS 66.9% of immobilised homecare patients have high dependency and 18.6% have bedsores. The majority of informal carers are women (83.1%) with an average of 57.7 years of age (DE 15.1). The average intensity of care is 15.7 hours per day (DE 8.5) and the average length of care is 5 years. The average number of visits from nurses per month is 2.1 (DE 2.1), although this measurement is higher in patients with bedsores or multiple diseases. The most widely used social health care resources are telephone care (34.2%) and home care (20.3%), for which 65.6% of immobilised homecare patients receive dependency benefits. Overall satisfaction with home care is of a high degree. CONCLUSION Musculoskeletal disorders is the main reason for immobilisation in home care patients. Most informal carers are older women. The length and intensity of care is high and the main support comes from healthcare professionals. Patients make limited use of social healthcare resources.
Collapse
|
44
|
Whitehead PJ, Worthington EJ, Parry RH, Walker MF, Drummond AER. Interventions to reduce dependency in personal activities of daily living in community dwelling adults who use homecare services: a systematic review. Clin Rehabil 2015; 29:1064-76. [PMID: 25587088 PMCID: PMC4607918 DOI: 10.1177/0269215514564894] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 11/29/2014] [Indexed: 11/30/2022]
Abstract
Objectives: To identify interventions that aim to reduce dependency in activities of daily living (ADL) in homecare service users. To determine: content; effectiveness in improving ability to perform ADL; and whether delivery by qualified occupational therapists influences effectiveness. Data sources: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, OTseeker, PEDro, Web of Science, CIRRIE, and ASSIA. Review methods: We included: randomised controlled trials, non-randomised controlled trials and controlled before and after studies. Two reviewers independently screened studies for inclusion, assessed risk of bias and extracted data. A narrative synthesis of the findings was conducted. Results: Thirteen studies were included, totalling 4975 participants. Ten (77%) were judged to have risk of bias. Interventions were categorised as those termed ‘re-ablement’ or ‘restorative homecare’ (n=5/13); and those involving separate components which were not described using this terminology (n=8/13). Content of the intervention and level of health professional input varied within and between studies. Effectiveness on ADL: eight studies included an ADL outcome, five favoured the intervention group, only two with statistical significance, both these were controlled before and after studies judged at high risk of bias. ADL outcome was reported using seven different measures. Occupational therapy: there was insufficient evidence to determine whether involvement of qualified occupational therapists influenced effectiveness. Conclusion: There is limited evidence that interventions targeted at personal ADL can reduce homecare service users’ dependency with activities, the content of evaluated interventions varies greatly.
Collapse
Affiliation(s)
| | | | - Ruth H Parry
- Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Marion F Walker
- Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | | |
Collapse
|
45
|
Collard RM, Arts M, Comijs HC, Naarding P, Verhaak PF, de Waal MW, Oude Voshaar RC. The role of frailty in the association between depression and somatic comorbidity: Results from baseline data of an ongoing prospective cohort study. Int J Nurs Stud 2015; 52:188-96. [DOI: 10.1016/j.ijnurstu.2014.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/10/2014] [Accepted: 07/15/2014] [Indexed: 12/18/2022]
|
46
|
Collard RM, Comijs HC, Naarding P, Oude Voshaar RC. Physical frailty: vulnerability of patients suffering from late-life depression. Aging Ment Health 2014; 18:570-8. [PMID: 23998249 DOI: 10.1080/13607863.2013.827628] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Frailty, a state of increased risk of negative health outcomes, is increasingly recognized as a relevant concept for identifying older persons in need of preventative geriatric interventions. Even though broader concepts of frailty include psychological characteristics, frailty is largely neglected in mental health care. The aim of the present study is to examine the prevalence of physical frailty in depressed older patients and its potential overlap with depression criteria. METHOD Cross-sectional observational study including 378 depressed and 132 non-depressed adults aged ≥60 years according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Physical frailty was defined as ≥3 out of 5 criteria (handgrip strength, weight loss, poor endurance, walking speed, low physical activity). RESULTS Prevalence rates of physical frailty were 27.2% and 9.1% among depressed and non-depressed participants, respectively, which remained significant after controlling for relevant covariates (odds ratio [OR] = 2.66 [95% confidence interval [C.I.] = 1.36, 5.24], p = .004). Physical frailty in depression was associated with more severe depressive symptoms; this association remained significant in subsequent analyses with purely physical proxies for frailty (hand grip strength, walking speed) and different severity measures of depressive symptoms. CONCLUSION A quarter of depressed older patients is physically frail, especially the most depressed group. This cannot be explained by overlap in criteria and should be examined in future studies, primarily on its presumed clinical relevance.
Collapse
Affiliation(s)
- Rose M Collard
- a Department of Psychiatry , University Medical Centre St. Radboud , Nijmegen , The Netherlands
| | | | | | | |
Collapse
|
47
|
Markle-Reid M, McAiney C, Forbes D, Thabane L, Gibson M, Browne G, Hoch JS, Peirce T, Busing B. An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms. BMC Geriatr 2014; 14:62. [PMID: 24886344 PMCID: PMC4019952 DOI: 10.1186/1471-2318-14-62] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services. Methods A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation. Results Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period. Conclusions Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms. Trial registration Clinicaltrials.gov identifier: NCT01407926.
Collapse
|
48
|
Gorina M, Limonero JT, Peñart X, Jiménez J, Gassó J. [Comparison of level of satisfaction of users of home care: integrated model vs. dispensaries model]. Aten Primaria 2014; 46:276-82. [PMID: 24768653 PMCID: PMC6985639 DOI: 10.1016/j.aprim.2013.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/09/2013] [Accepted: 07/22/2013] [Indexed: 11/25/2022] Open
Abstract
Objetivo Comparar el grado de satisfacción de los usuarios que reciben atención domiciliaria a través de 2 modelos de atención primaria: integrado y dispensarizado. Diseño Estudio transversal, observacional. Emplazamiento Dos centros de atención primaria de la provincia de Barcelona. Participantes Ciento cincuenta y ocho pacientes crónicos mayores de 65 años que recibían atención domiciliaria: 67 mediante el modelo integrado y 91 mediante el modelo dispensarizado. Mediciones principales Se administró la escala de Evaluación de la Satisfacción del Servicio de Atención Domiciliaria (SATISFAD-12), así como preguntas complementarias relacionadas con la satisfacción del servicio de atención domiciliaria y características sociodemográficas. Resultados Los usuarios del modelo dispensarizado estaban más satisfechos que los del modelo integrado. Existía una mayor continuidad asistencial en el modelo dispensarizado y un menor porcentaje de ingresos hospitalarios en el último año. La satisfacción de los usuarios de ambos modelos no estaba asociada al género ni a la percepción de salud y autonomía por parte del paciente. Conclusiones El grado de satisfacción de los pacientes de atención primaria domiciliaria parece depender de las características propias de cada modelo organizativo, siendo el modelo dispensarizado el que presenta un mayor grado de satisfacción o calidad asistencial percibida. Se debería realizar un mayor número de estudios para generalizar estos resultados a otros centros de atención primaria pertenecientes a otras instituciones.
Collapse
Affiliation(s)
- Marta Gorina
- Universitat Autónoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España
| | - Joaquín T Limonero
- Universitat Autónoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Grupo de Investigación en Estrés y Salud (GIES), Universitat Autónoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España.
| | - Xavier Peñart
- Centro de Atención Primaria Oest, Mútua de Terrassa, Terrassa, Barcelona, España
| | - Jordi Jiménez
- Centro de Atención Primaria Valldoreix, Mútua de Terrassa, Sant Cugat del Vallès, Barcelona, España
| | - Javier Gassó
- Egarsat, Mutua de Accidentes de Trabajo de la Seguridad Social núm. 276, Sant Cugat del Vallès, Barcelona, España
| |
Collapse
|
49
|
Mayo-Wilson E, Grant S, Burton J, Parsons A, Underhill K, Montgomery P. Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis. PLoS One 2014; 9:e89257. [PMID: 24622676 PMCID: PMC3951196 DOI: 10.1371/journal.pone.0089257] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 01/16/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalization and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services. METHODS AND FINDINGS DATA SOURCES Ten databases including CENTRAL and Medline searched through December 2012. STUDY SELECTION Randomized controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data. Outcomes were pooled using random effects. MAIN OUTCOMES AND MEASURES Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness. RESULTS Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programs may have small relative effects (relative risk = 0.93 [0.87 to 0.99]; absolute risk = 0.00 [-0.01 to 0.00]). There was moderate quality evidence of no overall effect on the number of people institutionalized (RR = 1.02 [0.88 to 1.18]) or hospitalized (RR = 0.96 [0.91 to 1.01]). There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect (odds ratio = 0.86 [0.73 to 1.01]), but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life (standardised mean difference = -0.06 [-0.11 to -0.01]) and physical functioning (SMD = -0.10 [-0.17 to -0.03]) respectively, but these may not be clinically important. CONCLUSIONS Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programs that are associated with consistent benefits. Due to poor reporting of intervention components and delivery, we cannot exclude the possibility that some programs may be effective.
Collapse
Affiliation(s)
- Evan Mayo-Wilson
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | - Sean Grant
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Jennifer Burton
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Amanda Parsons
- Yale Law School, New Haven, Connecticut, United States of America
| | - Kristen Underhill
- Yale Law School, Yale Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, United States of America
| | - Paul Montgomery
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
50
|
Gustafsson M, Kristensson J, Holst G, Willman A, Bohman D. Case managers for older persons with multi-morbidity and their everyday work - a focused ethnography. BMC Health Serv Res 2013; 13:496. [PMID: 24279695 PMCID: PMC3893533 DOI: 10.1186/1472-6963-13-496] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/25/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Modern-day health systems are complex, making it difficult to assure continuity of care for older persons with multi-morbidity. One way of intervening in a health system that is leading to fragmented care is by utilising Case Management (CM). CM aims to improve co-ordination of healthcare and social services. To better understand and advance the development of CM, there is a need for additional research that provides rich descriptions of CM in practice. This knowledge is important as there could be unknown mechanisms, contextual or interpersonal, that contribute to the success or failure of a CM intervention. Furthermore, the CM intervention in this study is conducted in the context of the Swedish health system, which prior to this intervention was unfamiliar with this kind of coordinative service. The aim of this study was to explore the everyday work undertaken by case managers within a CM intervention, with a focus on their experiences. METHODS The study design was qualitative and inductive, utilising a focused ethnographic approach. Data collection consisted of participant observations with field notes as well as a group interview and individual interviews with nine case managers, conducted in 2012/2013. The interviews were recorded, transcribed verbatim and subjected to thematic analysis. RESULTS An overarching theme emerged from the data: Challenging current professional identity, with three sub-themes. The sub-themes were 1) Adjusting to familiar work in an unfamiliar role; 2) Striving to improve the health system through a new role; 3) Trust is vital to advocacy. CONCLUSIONS Findings from this study shed some light on the complexity of CM for older persons with multi-morbidity, as seen from the perspective of case managers. The findings illustrate how their everyday work as case managers represents a challenge to their current professional identity. These findings could help to understand and promote the development of CM models aimed at a population of older persons with complex health needs.
Collapse
Affiliation(s)
- Markus Gustafsson
- School of Health Science, Blekinge Institute of Technology, Karlskrona SE-379 71, Sweden
- Department of Health Sciences, Lund University, Lund SE-221 00, Sweden
| | | | - Göran Holst
- School of Health Science, Blekinge Institute of Technology, Karlskrona SE-379 71, Sweden
| | - Ania Willman
- School of Health Science, Blekinge Institute of Technology, Karlskrona SE-379 71, Sweden
- Department of Care Science, Malmö University, Malmö, Sweden
| | - Doris Bohman
- School of Health Science, Blekinge Institute of Technology, Karlskrona SE-379 71, Sweden
| |
Collapse
|