Social-media based Health Education plus Exercise Programme (SHEEP) to improve muscle function among community-dwelling young-old adults with possible sarcopenia in China: A study protocol for intervention development

Possible sarcopenia refers to low muscle strength. Prevalence of possible sarcopenia is estimated to be significantly higher in community-dwelling older adults than that of confirmed or severe sarcopenia. However, there are currently far fewer non-pharmacological intervention strategies for possible sarcopenia than for sarcopenia in the community. Meanwhile, one type of non-pharmacological intervention in sarcopenic area, health education, is under-researched, and older people's awareness about sarcopenia is extremely low, necessitating an immediate dissemination tool for prevention. Social media may be a potential, scalable, low-cost tool for this. This study protocol outlines how a social media-based multicomponent intervention will be co-designed with stakeholders to address this evidence gap. Guided by the Medical Research Council's framework, the proposed research covers two phases that employ a co-design approach to develop a theory-based multicomponent intervention to increase sarcopenia prevention in the community. The participants will be recruited from young-old adults (60~69) with possible sarcopenia in the community of Changsha, China. Maximum sample size will be 45 participants in total, with 18~25 participants in the development phase and 15~20 participants in the pre-test phase. During two rounds of focus groups with older adults, a social-media based intervention strategy will be developed from a theory-based conceptual model and an initial intervention plan formulated by the research group. After this, there will be a three-week pre-test phase, followed by a semi-structured interview to further modify the theory-based conceptual model and the social-media based intervention strategy. The focus of the data analysis will be on thematic analysis of qualitative data primarily derived from the group interview and the semi-structured interview with key stakeholders.

Experiences of postmenopausal osteoporosis: a narrative review

PURPOSE

A narrative review was conducted to identify, critically appraise, and synthesise primary research on the lived experiences of postmenopausal women with osteoporosis.

MATERIALS AND METHODS

A systematic search of qualitative studies published between January 1960 and August 2021 was conducted across seven databases. The selected qualitative studies reported the lived experiences of postmenopausal women with osteoporosis, both with and without a history of fragility fractures.

RESULTS

A total of 17 publications (n = 334) were identified. These results suggest that osteoporosis and fragility fractures significantly affected postmenopausal women's lives. They reported difficulties in carrying out daily activities due to pain and change in their routines to cope with health problems. Some women were satisfied with the information provided by healthcare professionals. Their medicine adherence was also determined by their belief in the importance of their scheduled treatment for osteoporosis.

CONCLUSION

Qualitative studies that explored the lived experiences of postmenopausal women with osteoporosis can provide important insights into the impact of the disease on women's lives and potential pathways for improving care and management.Implications for rehabilitationOsteoporosis and fragility fractures affect the quality of life of postmenopausal women worldwide.The provision of targeted and tailored health information for postmenopausal women with osteoporosis is paramount in improving their health literacy and aiding in the long-term management of their bone health.What is already knownOsteoporosis and related fragility fractures are common, affecting more than 200 million people worldwide, including three million people in the UK.Osteoporotic fractures have significant clinical and public health impacts.What this study addsOsteoporosis, particularly fragility fractures, has a significant impact on the lives of postmenopausal women, including pain and functional impairment.Women's belief in the importance of their scheduled treatment plays a significant role in their concordance with the prescribed medications for osteoporosis.Provision of targeted health information for postmenopausal women with osteoporosis is key to their involvement in decision-making and disease management.

Research priorities in HIV, aging and rehabilitation: building on a framework with the Canada-International HIV and Rehabilitation Research Collaborative

BACKGROUND

In 2016, the Canada-International HIV and Rehabilitation Research Collaborative established a framework of research priorities in HIV, aging and rehabilitation. Our aim was to review and identify any new emerging priorities from the perspectives of people living with HIV, clinicians, researchers, and representatives from community organizations.

METHODS

We conducted a multi-stakeholder international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations. Stakeholders convened for a one-day Forum in Manchester, United Kingdom (UK) to discuss research priorities via a web-based questionnaire and facilitated discussions. We analyzed data using conventional content analytical techniques and mapped emerging priorities onto the foundational framework.

RESULTS

Thirty-five stakeholders from the UK(n = 29), Canada(n = 5) and Ireland(n = 1) attended the Forum, representing persons living with HIV or representatives from community-based organizations(n = 12;34%), researchers or academics(n = 10;28%), service providers(n = 6;17%), clinicians(n = 4;11%); and trainees(n = 4;11%). Five priorities mapped onto the Framework of Research Priorities across three content areas: A-Episodic Health and Disability Aging with HIV (disability, frailty, social participation), B-Rehabilitation Interventions for Healthy Aging across the Lifespan (role, implementation and impact of digital and web-based rehabilitation interventions) and C-Outcome Measurement in HIV and Aging (digital and web-based rehabilitation health technology to measure physical activity). Stakeholders indicated methodological considerations for implementing digital and web-based rehabilitation interventions into research and practice and the importance of knowledge transfer and exchange among the broader community.

CONCLUSION

Results highlight the sustained importance of the Framework of Research Priorities and provide further depth and areas of inquiry related to digital and web-based rehabilitation interventions and technology aging with HIV.

Impact of postmenopausal osteoporosis on the lives of Omani women and the use of cultural and religious practises to relieve pain: A hermeneutic phenomenological study

INTRODUCTION

Osteoporosis is a significant clinical and public health concern worldwide. Despite the impact of this condition on women's lives, most studies have focused on its clinical manifestations, drug efficacy, and medical treatment. Furthermore, most studies have been conducted in the West. This study aimed to uncover the personal experiences of postmenopausal Omani women living with osteoporosis.

METHODS

In this interpretive phenomenological study, a purposive sample of 15 postmenopausal Omani women with osteoporosis was recruited from primary and secondary care facilities in Muscat, Oman. Semi-structured one-to-one interviews were conducted via Zoom and telephone because of coronavirus disease 2019 restrictions. The interviews were audio-recorded, and the Ajjawi and Higgs framework was used to analyse the data thematically.

RESULTS

The following key themes were constructed from the interviews: the impact of osteoporosis on religious practices, cultural and social life, and financial status, and the benefits derived from religious and cultural practices and rituals, including Muslim prayer, recitation of Quranic verses, and herbal remedies to cope with osteoporosis-related pain and suffering.

CONCLUSION

Osteoporosis and fragility fractures have a significant impact on the religious, cultural, and financial lives of postmenopausal Omani women with osteoporosis. Muslim prayers, recitation of Quranic verses, and herbal remedies are coping strategies for pain in this population.

PATIENT OR PUBLIC CONTRIBUTION

Postmenopausal Omani women with osteoporosis participated in this study through interviews and contributed their lived experiences. Orthopaedic doctors helped recruit patients with postmenopausal osteoporosis.

A scoping review of the feasibility, acceptability, and effects of physiotherapy delivered remotely

PURPOSE

To review the feasibility, acceptability, and effects of physiotherapy when delivered remotely.

MATERIALS AND METHODS

CINAHL, MEDLINE, EBM Reviews, and Cochrane Library databases (January 2015-February 2022) were searched and screened for papers (of any design) investigating remote physiotherapy. Data were extracted by two independent raters. Methodological quality of the identified papers was not assessed. Thematic content analysis drew out the key issues.

RESULTS

Forty-one papers (including nine systemic reviews and six with meta-analyses) were selected involving musculoskeletal, stroke and neurological, pulmonary, and cardiac conditions. The most commonly delivered intervention was remote exercise provision, usually following assessment which was completed in-person. All studies, which assessed it, found that remote physiotherapy was comparably effective to in-person delivery at lower cost. Patient satisfaction was high, they found remote physiotherapy to be more accessible and convenient. It boosted confidence and motivation by reminding patients when and how to exercise but adherence was mixed. No adverse events were reported. Barriers related to access to the technology; technical problems and concerns about therapists' workload.

CONCLUSIONS

Remote physiotherapy is safe, feasible, and acceptable to patients. Its effects are comparable with traditional care at lower cost.IMPLICATIONS FOR REHABILITATIONRemote physiotherapy is safe, feasible, and acceptable to patients with comparable effects to in-person care.Remote delivery increases access to physiotherapy especially for those who cannot travel to a treatment facility whether due to distance or disability.Remote physiotherapy may increase adherence to exercise by reminding patients when and how to exercise.Remote physiotherapy does not suit everyone, thus a hybrid system with both in-person and remote delivery may be most effective.

The Application of Artificial Intelligence in Digital Physical Activity and Falls Prevention Interventions for Older Adults

This article discusses the practical applications of artificial intelligence in digital physical activity and falls prevention interventions for older adults. It notes the range of technologies that can be used to collect digital datasets on older adult health and how machine learning algorithms can be applied to these to improve our understanding of physical activity and falls. In particular, these advanced computational techniques could help personalize exercises, feedback, and notifications to older people, improve adherence to and reduce attrition from digital health interventions, and enhance monitoring by providing predictive analytics on the physiological and environmental conditions that contribute to physical activity and falls in aging populations.

Non-pharmacological interventions for community-dwelling older adults with possible sarcopenia or sarcopenia: a scoping review

BACKGROUND

Sarcopenia is a progressive, age-related muscle disease that, if left untreated, imposes significant personal, social, and economic burdens.

OBJECTIVE

To compile and document the nature and extent of existing studies exploring non-pharmacological interventions as a strategy to prevent or treat possible sarcopenia or sarcopenia in community-dwelling older adults.

METHOD

Thirteen databases were searched up from January 2010 to March 2023 and filters were limited to English and Chinese language. Studies with older adults (≥60 y) in the community were included. The review was conducted and reported according to the PRISMA-ScR guidance and seven stages of methodology framework. A descriptive synthesis of trial characteristics and effectiveness was conducted.

RESULTS

A total of 59 studies were included in the analysis. Most studies were RCTs. Few studies enrolled older adults with possible sarcopenia. The 70-79 age group has been studied more than any other age group. Six intervention types were identified, including exercise-only, nutrition-only, health education-only, traditional Chinese medicine-only, multicomponent intervention and control type. Majority of exercise-only interventions received resistance-based exercise. In nutrition-only category, overall food intervention or nutrients intervention was more than dietary pattern. Moreover, exercise plus nutrition was the main sub-type in multicomponent interventions. Health education-only and traditional Chinese medicine-only interventions were less frequently identified. Most studies had high and moderate compliance.

CONCLUSION

There is evidence for the effectiveness of exercise and exercise plus nutrition interventions in improving muscle strength and physical performance, whereas the effectiveness of other intervention types or their combinations requires additional research.

SCOPING REVIEW REGISTRATION

Open Science Framework (OSF) Registration DOI 10.17605/OSF.IO/RK3TE.

Exploring the delivery of remote physiotherapy during the COVID-19 pandemic: UK wide service evaluation

INTRODUCTION

During the Coronavirus (Covid-19) pandemic, physiotherapists changed rapidly to working remotely. Research demonstrates the benefits of remote physiotherapy, but little is known about its implementation in practice.

PURPOSE

Explore the take-up and delivery of remote physiotherapy during the pandemic in the United Kingdom.

METHODS

Sequential mixed methods evaluation with physiotherapists leading remote physiotherapy delivery. Two-stage approach included online survey (2020) and semi-structured interviews with documentary/data analysis (2021).

RESULTS

There were 1620 physiotherapists who completed the survey. The most used devices were telephone (n = 942,71.0%) and the AttendAnywhere platform (n = 511, 38.5%). Remote consultations were frequently used for initial assessment (n = 1105, 83%), screening/triage (n = 882, 67%), or to review, monitor, and progress treatment (n = 982-1004, 74%-76%). Qualitative survey responses reflected respondents' response to COVID-19 and delivery of remote physiotherapy. Twelve remote physiotherapy leads were then purposively sampled across clinical areas. Three main themes emerged from interviews: response to Covid-19, delivery of remote physiotherapy, and future of remote physiotherapy.

CONCLUSION

Remote physiotherapy was safe, feasible, and acceptable for those who accessed it. There were patients for which it was deemed unsuitable across clinical areas. In practice, it should be combined with in-person consultation based on patients' needs/preferences. Further research should explore post-pandemic maintenance of remote delivery.

Non-pharmacological interventions for possible sarcopenia or sarcopenia in community-dwelling older adults: a scoping review protocol

INTRODUCTION

Early prevention of sarcopenia is a recommendation to reduce morbidity, mortality and improve quality of life. Several non-pharmacological interventions to reduce the risk of sarcopenia in community-dwelling older people have been proposed. Therefore, there is a need to identify the scope and differences of these interventions. This scoping review will summarise the nature and extent of the existing literature that describes and examines non-pharmacological interventions for community-dwelling older adults with possible sarcopenia or sarcopenia.

METHODS AND ANALYSIS

The seven-stage review methodology framework will be used. Searches will be conducted in the following databases: Embase, Medline, PsycINFO, CINAHL, All EBM Reviews, Web of Science, Scopus, CBM, CNKI, WANFANG and VIP. Grey literature will also be identified from Google scholar. Search dates will be restricted to January 2010 to December 2022, in English and Chinese language only. Screening will be focused on published research, including both quantitative and qualitative study designs, and prospectively registered trials. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be followed when delineating the search decision process. Findings will be synthesised quantitatively and qualitatively as appropriate and classified using key conceptual categories. We will identify whether studies identified have been included in systematic reviews or meta-analyses, and research gaps and opportunities will be identified and summarised.

ETHICS AND DISSEMINATION

As this is a review, ethical approval will not be sought. The results will be published in peer-reviewed scientific journals and also disseminated in relevant disease support groups and conferences. The planned scoping review will help us identify the current status of research and gaps in the literature, so as to develop a future research agenda.

MIRA Rehab Exergames for Older Male Residents in a Care Home Center in Saudi Arabia: Protocol for a Feasibility Randomized Controlled Trial

BACKGROUND

Physical activity leads to improvements in morbidity, mortality, and quality of life, especially when it is progressive, challenging, and regular. There is strong evidence that strength and balance exercises decrease the risk of falling. However, traditional exercises may be tedious and not very motivating for participants. Exergames have been found to increase engagement and enjoyment for older users.

OBJECTIVE

This study will conduct a feasibility randomized controlled trial (RCT) on the use of MIRA Rehab Exergames among older male residents in a care home setting in Saudi Arabia. A sample of 30 eligible participants will be recruited to meet feasibility study requirements.

METHODS

We will recruit 38 residents in the care home who will be randomly allocated to either an intervention or a control group. The intervention participants will perform gamified exercises using the MIRA telerehabilitation platform (30 minutes 3 times per week for 6 weeks). The control group will receive educational advice based on booklets of the Otago exercise program and be encouraged to exercise (30 minutes 3 times per week for 6 weeks). Participants will be assessed at weeks 0, 6, and 12. Assessments will include feasibility measures (eligibility, recruitment and attrition rates, and practicalities of data collection methods) and participant outcome measures (balance, strength, mobility, adherence, quality of life, fear of falling, depression, acceptability, and usability).

RESULTS

Data collection started in November 2021 and ended in March 2022. The study is currently in the data analysis stage, which commenced in May 2022. The findings from this feasibility RCT will be used to design a definitive RCT to test whether the MIRA Rehab Exergame program benefits older people in Saudi Arabia who may not like participating in traditional exercise programs and may be unwilling or unable to leave their homes.

CONCLUSIONS

This study will contribute to our understanding of how to recruit in this specific population and provide information to inform the design of a future RCT.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39148.

Artificial intelligence for falls management in older adult care: A scoping review of nurses' role

AIM

This study aims to synthesize evidence on nurses' involvement in artificial intelligence research for managing falls in older adults.

BACKGROUND

Artificial intelligence techniques are used to analyse health datasets to aid clinical decision making, patient care and service delivery but nurses' involvement in this area of research for managing falls in older adults remains unknown.

EVALUATION

A scoping review was conducted. CINAHL, the Cochrane Library, Embase, MEDLI and PubMed were searched. Results were screened against inclusion criteria. Relevant data were extracted, and studies summarized using a descriptive approach.

KEY ISSUES

The evidence shows many artificial intelligence techniques, particularly machine learning, are used to identify falls risk factors and build predictive models that could help prevent falls in older adults, with nurses leading and participating in this research.

CONCLUSION

Further rigorous experimental research is needed to determine the effectiveness of algorithms in predicting aspects of falls in older adults and how to implement artificial intelligence tools in gerontological nursing practice.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurses should pursue interdisciplinary collaborations and educational opportunities in artificial intelligence, so they can actively contribute to research on falls management. Nurses should facilitate the collection of digital falls datasets to support this emerging research agenda and the care of older adults.

Impact of Charles Bonnet Syndrome on visually impaired older adults’ ability to engage in physical activity: A scoping review

Charles Bonnet syndrome (CBS) is a condition associated with sight loss, characterised by vivid, spontaneous visual hallucinations. Currently, it is unclear whether CBS presents challenges to participation in physical activities, in addition to barriers attributed to sight loss alone. The purpose of this scoping review was to establish the extent of the literature, and gaps in the knowledge base, concerning the impact of CBS on older adults’ engagement in physical activities. Review conduct was informed by Arksey and O’Malley and Levac et al.’s scoping review methodologies. Six academic databases were searched during May 2021, yielding 2709 results: eight articles met eligibility criteria. Two additional sources were located via a reference check of included papers and stakeholder consultation. Quantitative cross-sectional studies ( n = 3) indicate that CBS may interfere with the ability to move around, while qualitative sources (case report/series n = 6; autobiography n = 1) show that sudden presentation of hallucinations in a person’s pathway, or threatening content, may jeopardise safety while walking. Moving to avoid a hallucination could present a fall risk if attention is diverted from environmental hazards. One case report stated that CBS did not affect personal care activities. Due to a limited evidence base, further empirical research is needed to achieve a comprehensive understanding about how CBS affects older adults’ participation in physical activities.

AB1568-PARE LIVED EXPERIENCES OF POSTMENOPAUSAL OMANI WOMEN WITH OSTEOPOROSIS

Background

Osteoporosis is a globally significant clinical public health problem associated with age-related fractures [1,2]. Most research on the impact of the disease has been based on quantitative survey data. There are relatively few qualitative studies exploring women’s lived experience with osteoporosis. Furthermore, most data are from Western countries, with no data from the Middle East. Direct access to lived experiences is a powerful tool for gaining insights into a disease [3]. This study aimed to determine the lived experience of postmenopausal Omani women with osteoporosis.

Objectives

This study sought to answer three questions:

1.What does living with osteoporosis mean for postmenopausal Omani women?

2.How does culture impact the lives of postmenopausal Omani women with osteoporosis?

3.How do postmenopausal Omani women with osteoporosis perceive the support and care provided by healthcare professionals?

Methods

An interpretive phenomenology design was used with a purposive sample of 15 postmenopausal Omani women with osteoporosis and fragility fractures from primary and secondary care facilities in Muscat, Oman. Audio recorded, semi-structured, one-on-one interviews were held by Zoom and telephone; Crist and Tanner’s framework was used to analyze data and identify key themes.

Results

The mean age of the participants was 63 years. Five (33.3%) reported a previous fracture. Just over half (53%) were illiterate; three (20%) had studied in college. Key themes related to their lived experience emerged from the data analysis: culture and religion; health care professionals’ attitudes; and services and treatment regimen. The subjects’ social and cultural lives were negatively impacted by osteoporosis and fragility fractures, which prevented some from attending celebrations such as close family marriages and religious gatherings. Participants played significant care-giving roles as wives, mothers and grandmothers but many were unable to perform many household chores, such as cooking, due to the osteoporosis and fractures. They perceived healthcare professionals through the professionals’ communication styles and information they provided. Participants satisfied with their doctor’s communication style described it as humanistic, with humour added, noting they provide health information and understand patients’ needs. Those not satisfied indicated their doctors had poor communication styles, showed insufficient interest in them, and asked few questions during their appointments. Professionals at in-patient clinics were perceived as more caring and empathetic than those at out-patient clinics. Treatment abroad was preferred by these women, though some were highly satisfied with their treatment from Omani hospitals. Beliefs about and usage of traditional herbal remedies for the management of fragility fractures differed between educated and non-educated women.

Conclusion

This study explored postmenopausal Omani women’s experiences of living with osteoporosis and fragility fractures including the impact of the disease on social and cultural life. It contributes also to our understanding of the experience of the disease in non-western settings.

References

[1]Barake M, El Eid R, Chakhtoura M, Meho L, Mahmoud T, Atieh J, et al. Osteoporotic hip and vertebral fractures in the Arab region: a systematic review. Osteoporosis International [Internet]. 2021. Available from: https://doi.org/10.1007/s00198-021-05937-z

[2]Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International. 2013; 24:23-57.

[3]McIntosh I, Wright, S. Exploring what the notion of ‘lived experience’ offers for social policy analyses. J Soc Policy. 2018;48(3):449-67.

Disclosure of Interests

None declared

Developing, Testing, and Implementing a Falls Prevention and Healthy Aging App (Keep-On-Keep-Up) for Older Adults

Falls are a common and costly concern for older adults. Digital technologies can offer new, inexpensive approaches to increase access and engagement with falls prevention programmes. Keep-On-Keep-Up is a personalised, falls prevention App with strength and balance exercises plus health literacy games. This study reports on the user-centred design, usability testing and implementation of the KOKU App. Older adults aged 55 years and older in the UK were invited to take part in the study. Data collection included focus groups; baseline and 6 week questionnaires and assessments; semi-structured interviews and one focus group with falls prevention therapists to explore App usability. Thirty older adults were invited to use KOKU unsupervised, 3 times a week for 6 weeks. Data were analysed using thematic content analysis. Focus groups (n=11) with 66 older users and 11 therapists informed development. Thirty older adults (mean age = 75) were recruited for the in-depth testing. Mean SUS score was 71 indicating high usability. Qualitative themes included: ease of use (app usability; iPad properties; exercise presentation), usefulness (physical/psychological benefits; falls education), attitude towards the App and intention to use (technological barriers; flexibility of use; exercise class versus App). Therapists (n=6) viewed the KOKU platform positively and suggested extensions for further progression. No adverse events were reported during the study. This research demonstrates that KOKU is an acceptable and easy to use falls prevention intervention that facilitates older adults’ ability to access falls prevention training at a time, and in a location, that suits them.

Clinical and biomechanical factors associated with falls and rheumatoid arthritis: baseline cohort with longitudinal nested case-control study

OBJECTIVE

To identify the clinical and biomechanical characteristics associated with falls in people with RA.

METHODS

A total of 436 people ≥60 years of age with RA completed a 1 year prospective survey of falls in the UK. At baseline, questionnaires recorded data including personal and medical history, pain and fatigue scores, health-related quality of life (HRQoL), physical activity and medication history. The occurrence of falls wasmonitored prospectively over 12 months by monthly self-reporting. A nested sample of 30 fallers (defined as the report of one or more falls in 12 months) and 30 non-fallers was evaluated to assess joint range of motion (ROM), muscle strength and gait parameters. Multivariate regression analyses were undertaken to determine variables associated with falling.

RESULTS

Compared with non-fallers (n = 236), fallers (n = 200) were older (P = 0.05), less likely to be married (P = 0.03), had higher pain scores (P < 0.01), experienced more frequent dizziness (P < 0.01), were frequently taking psychotropic medications (P = 0.02) and reported lower HRQoL (P = 0.02). Among those who underwent gait laboratory assessments, compared with non-fallers, fallers showed a greater anteroposterior (AP; P = 0.03) and medial-lateral (ML) sway range (P = 0.02) and reduced isokinetic peak torque and isometric strength at 60° knee flexion (P = 0.03). Fallers also showed shorter stride length (P = 0.04), shorter double support time (P = 0.04) and reduced percentage time in swing phase (P = 0.02) and in knee range of motion through the gait cycle (P < 0.01).

CONCLUSION

People with RA have distinct clinical and biomechanical characteristics that place them at increased risk of falling. Assessment for these factors may be important to offer more targeted rehabilitation interventions.

A Feasibility Study of Multi-Component Fall Prevention for Homebound Older Adults Facilitated by Lay Coaches and Using a Tablet-Based, Gamified Exercise Application

Although homebound older adults face high risk for falls, they are unable to utilize community-based fall prevention programs due to their mobility limitations. In this article, we report a feasibility study of a four-session, multicomponent fall prevention program for low-income homebound older adults using pre, post, mixed-method design. The manualized program was delivered by lay coaches who were trained and supervised by a physical therapist. The program also used an iPad-based gamified strength and balance exercise app (called KOKU) that was operable without the need to connect to the internet. Participants (N = 28) in this study were highly receptive to the program and approved all components: psychoeducation, the KOKU app, home-safety checks, safe ambulation training, and medication review. The study showed that a brief, multi-component fall prevention program for homebound older adults is feasible and acceptable. Further research is needed to evaluate its effectiveness.

Perspectives of ESCAPE-Pain Programme for Older People With Knee Osteoarthritis in the Community Setting

Background: Functional limitationscommonly affect patients with knee osteoarthritis (OA) which reduces quality of life. The Enabling Self-management and Coping with Arthritic Pain using Exercise (ESCAPE-pain) is an evidence-based programme identified to be suitable for adaptation for the Malaysian health care system. It is important to understand the acceptance from a sociocultural context of the ESCAPE-pain programme from the perspectives of patients with knee OA and healthcare professionals. This qualitative study aims to explore the perspectives of stakeholders to inform the adaptation of the ESCAPE-pain programme into the Malaysian health care system. Method: Semi-structured interviews using interview guides were conducted with 18 patients with knee OA and 14 healthcare professionals including nurses, physiotherapists, occupational therapists, medical doctors, and orthopedic surgeons. The data were transcribed and analyzed using framework analysis. Results: The findings show that patients and healthcare professionals positively accept the programme into their daily living activities and recommend some modifications related to the Malaysian context. This study also highlights strategies to adopt when providing ESCAPE-pain to patients with knee OA. Conclusion: The findings reveal how sociocultural considerations could facilitate uptake and engagement with the ESCAPE-pain programme for home exercise among patients with knee osteoarthritis. These findings may benefit t patients with knee OA in the Malaysian healthcare system, although future research is recommended.

Care Burden and Mental Ill Health in Spouses of People With Parkinson Disease Dementia and Lewy Body Dementia

OBJECTIVES

To explore and compare levels of mental health, care burden, and relationship satisfaction among caregiving spouses of people with mild cognitive impairment or dementia in Parkinson disease (PD-MCI or PDD) or dementia with Lewy bodies (DLB).

METHODS

Spouses (n = 136) completed measures of mood, stress, resilience, general health, quality of life, care burden, and relationship satisfaction, as well as sociodemographic factors. Additionally, data on motor and neuropsychiatric symptom severity of people with PD-MCI, PDD, or DLB were obtained in a subsample.

RESULTS

Most spouses were married women (>85%) who provided a median of 4 years of care and 84 hours of weekly care. Among these, relationship dissatisfaction, stress, anxiety, care burden, and feelings of resentment were common. Spouses of people with PDD and DLB had significantly higher rates of burden, resentment, and depression compared to spouses of people with PD-MCI. Furthermore, unique group differences emerged whereby spouses of people with PDD had significantly longer duration of care provision, higher stress, more relationship dissatisfaction, and fewer positive interactions, compared to PD-MCI group, whereas anxiety and lower levels of mental health were prominent in spouses of people with DLB, compared to PD-MCI group. Despite this, the majority of spouses reported good quality of life, resilience, and satisfaction with the caring role.

CONCLUSION

Both PDD and DLB significantly contribute to poorer mental health and higher levels of care burden in spouses. Clinicians should actively screen the risk of burden, stress, depression, and anxiety among caregiving spouses of people with these conditions.

85 Exploring the Feasibility of the Adapted Lifestyle - Integrated Functional Exercise (ALIFE) Programme to Prevent Falls among Older Adults in Thailand

Background

Falls are the leading cause of injuries in older adults in Thailand. Exercise appears to be a strategy to reduce falls. There is a need to develop a fall prevention exercise programme to encourage participation and adherence. The adapted Lifestyle-integrated Functional Exercise (aLiFE) programme may be suitable by integrating exercise into daily routines as opposed to attending an exercise class. This study aimed to explore the acceptability and feasibility of the aLiFE programme in older Thai adults and identify if modifications are necessary for this population.

Method

To obtain older Thai adults' perspectives and stakeholders’ views, 40 community-dwelling older adults aged ≥ 60 years, in urban and rural locations in Thailand, and 14 stakeholders (e.g. healthcare professionals) working with older Thai adults were included. Qualitative methods were used to conduct focus groups and in-depth interviews with older adults, and semi-structured interviews with stakeholders. Thematic analyses using Framework Approach were conducted.

Results

Findings revealed positive views and identified four themes including: (a) individual factors, (b) perceptions of aLiFE, (c) recommendations for implementing aLiFE in Thailand, and (d) motivation. Older participants expressed interest in performing aLiFE in their daily activities, although some activities may need to be modified to fit the Thai cultural context. Stakeholders were concerned about how to motivate older Thai adults to adhere to aLiFE. Healthcare professionals and family members could play a major role to support older adults in uptake of aLiFE. Benefits (e.g. independence and fall prevention) may motivate older adults to engage in aLiFE. Clear and simple instructions were requested.

Conclusion

The aLiFE programme should be feasible and acceptable among older Thai adults. The aLiFE programme has been appropriately modified to be ‘Thai LiFE (TLiFE)’. A feasibility randomised controlled trial of the TLiFE programme has been conducted in older Thai adults.

86 Developing the Adapted Lifestyle - Integrated Functional Exercise Programme in Thai Context (TLIFE) to Prevent Falls among Older Adults in Thailand: A Mixed Methods Study

Introduction

Falls are the leading cause of injuries in older Thai adults. There is a need to develop a fall prevention exercise programme to encourage participation and adherence. The adapted Lifestyle-integrated Functional Exercise (aLiFE) programme may be suitable by integrating exercise into daily routines as opposed to attending an exercise class. This study aimed to explore the acceptability and feasibility of the aLiFE programme in Thai context (TLiFE) among older Thai adults.

Methods

Based on the findings of a prior qualitative study, a feasibility randomised controlled trial (RCT) of TLiFE was conducted among community-dwelling older adults, comparing the TLiFE intervention group with a usual care control group. Outcome measures were analysed at baseline, 3 months, and after 6 months of the intervention.

Results

We recruited a total of 72 older adults into the RCT, randomised to TLiFE (n=36) and control (n=36). The retention rate at 6 months was 91.7%. Attendance in the intervention group (3 home visits and 4 follow-up calls) was 82.9%. There were no differences in fall incidence between the groups. The acceptability survey reveals TLiFE is easy to perform in daily life, safe, and useful. No adverse events were reported.

Conclusion

The TLiFE programme appears to be acceptable and feasible to deliver to community-dwelling older Thai adults. This feasibility study was not powered to detect a difference between groups. A further fully powered definitive randomised controlled trial of TLiFE is needed to evaluate long-term outcomes and cost-effectiveness before it is integrated within the healthcare system in Thailand.

Moving beyond 'safety' versus 'autonomy': a qualitative exploration of the ethics of using monitoring technologies in long-term dementia care

Background

Use of monitoring technologies (e.g. wearable or environmental sensors) in long-term care generates extensive ethical debate, primarily about their potential to enhance resident safety weighed against concerns about their impacts upon resident autonomy. There are a number of other ethical aspects which are far less debated, including questions about the monitoring of the workforce, and equality of access to technologies. In this paper, we explore the extent to which remote monitoring of the workforce, and equality of access to technologies, were seen to influence the implementation of monitoring technologies within long-term care facilities.

Methods

An embedded multiple-case study design was used with three dementia-specialist care facilities in England that had experience using a range of monitoring technologies. Data were collected through 175 h’ observation of daily practice, semi-structured interviews with 36 staff, residents and relatives, and examination of organisational documentation and technology manufacturer literature. Data were analysed using Framework Analysis.

Results

Use of technologies for workforce monitoring was understood in relation to the ethical obligations to fulfil a duty of care to residents. There was little recognition of any negative implications for the workforce, but staff were susceptible to rumours that technologies were being used for performance management even when this was not the case. There were questions about how far data collected by monitoring technologies could constitute ‘evidence’ of appropriate care delivery. Equality and access to technologies involved a need to compromise between generic designs that were not universally suitable, but were more affordable than bespoke designs. Contracts with suppliers imposed limitations on product choice.

Conclusions

There is an urgent need for greater consideration of the ethical and legal implications that remote technological monitoring might have upon workforce morale, recruitment and retention. Ensuring variety of technological design to facilitate equitable access for residents is financially extremely challenging. It is possible that considerations of equitable access are not deemed a priority due to the current generation of residents’ low levels of technological familiarity and expectation. It might be overstated and unrealistic to view expensive technologies as the pinnacle of innovative practice in care homes.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1155-6) contains supplementary material, which is available to authorized users.

Multidimensional Care Burden in Parkinson-Related Dementia

BACKGROUND AND OBJECTIVE

Providing care to people with Parkinson-related dementia (PwPRD) may result in significant stress, strain, and burden for life partners. A common measurement of life partner burden is the Zarit Burden Interview (ZBI), which considers "burden" as a unitary concept; however, burden is highly complex and most likely comprises several dimensions. This study aimed to explore the factor structure of the ZBI in life partners of PwPRD and to examine the relationships among the emerging factors and the demographic and clinical features.

METHODS

Life partners of PwPRD participated in home-based quantitative assessments and self-completed postal questionnaires. The assessment battery included ZBI, measures of relationship satisfaction, mood, stress, resilience, health, quality of life, feelings related to care provision, and sociodemographic questions. Data on PwPRDs' motor and neuropsychiatric symptom severity were also elicited in home-based assessments.

RESULTS

An exploratory factor analysis (principal axis factoring) of ZBI, conducted with 127 life partners, revealed five burden dimensions: social and psychological constraints, personal strain, interference with personal life, concerns about future, and guilt. These burden factors were associated with lower relationship satisfaction, mental health, and resilience, and higher stress, anxiety, depression, resentment, negative strain, and PwPRD motor severity. In multiple linear regression analyses, where each factor score was the dependent variable, stress, negative strain, and resentment emerged as significant predictors of specific burden dimensions.

CONCLUSIONS

Burden is a complex and multidimensional construct. Interventions should address specific types of burden among life partners of PwPRD to support couples' relationships and maintain quality of life.

Older adults' perceptions of wearable technology hip protectors: implications for further research and development strategies

Purpose: Hip fractures are an important public health issue. Ninety-five percent of hip fractures are caused by falls, with those at greatest risk including residents of long-term care facilities. Hip protectors can be effective in preventing hip fractures, but levels of acceptance and adherence may be low. We report on work to develop research into a new hip protector that aims to overcome some of the acceptance and adherence challenges.

Methods: We held five patient and public consultation events involving 147 older adults and 10 long-term care sector staff in the Midlands and North West of England. At each event, participants were shown the Fall-Safe Assist hip protector, which includes built-in mobile technology to record information about falls and summon help from caregivers.

Results: Participants were positive about the product’s potential utility and impact upon confidence in moving around. However, many participants held highly personal perceptions of their vulnerability and need, and expressed concerns about the esthetics and practicality of the accompanying underwear. Participants highlighted potential challenges from poor mobile connectivity, and expressed concerns about product cost.

Conclusions: Future research will need to ensure flexible and sensitive approaches to recruitment. Further refinement to the product design may be useful. Individual interviews and questionnaires would help capture participants’ perceptions on personal topics, and measures of changes in confidence. Research sites will need to be compatible with technological functionality. It will be necessary to have a robust protocol in place for withdrawal of the product at the end of any clinical research.

Implications for Rehabilitation

Hip protectors can be effective in preventing hip fractures, but levels of acceptance and adherence may be low and may contribute to low-quality research.

A new type of hip protector has been designed to overcome some of the acceptance and adherence challenges.

Older adults suggested that the product was potentially useful, but expressed highly personal concerns about perceived need; aesthetics; practical and technological challenges; and cost, all of which may affect future research design.

Research designs will need to be flexible enough to consider sensitive approaches to recruitment, multiple methods of data collection, site compatibility with technological functionality, and product withdrawal at end of study.

A qualitative study of female caregiving spouses' experiences of intimate relationships as cognition declines in Parkinson's disease

Background

the complex and progressive nature of Parkinson’s disease (PD) and cognitive impairment may necessitate a care provider, a role which is frequently undertaken by a spouse. Providing and receiving care related to dementia impacts on a couple’s partnership and may result in decreased intimacy and relationship satisfaction.

Objective

to explore the changes in long-term intimate relationships in Parkinson’s-related dementia, as perceived by spouses providing care to their partners.

Methods

participants were identified using purposive sampling. Twelve female spouses whose partners had PD and mild cognitive impairment (PD-MCI), PD dementia (PDD) or dementia with Lewy bodies (DLB) completed semi-structured face-to-face interviews. Transcribed data were analysed using inductive thematic analysis. The consolidated criteria for reporting qualitative research (COREQ) were applied.

Results

couples’ relationship satisfaction, intimacy and communication had already reduced in the mild cognitive impairment stage of PD, but the decline in these domains was markedly greater with the emergence of dementia. Increased spousal care responsibilities resulted in partners spending more time together, but feeling emotionally more distanced. Several participants’ roles transitioned from spouse to caregiver and they reported feelings of frustration, resentment, anger, sadness and a worry for the future. Cognitive impairment was significantly harder to accept, manage and cope with than the motor symptoms of PD. Spouses acknowledged their marital commitments and exhibited acceptance, adjustment, resilience and various coping strategies.

Conclusion

this is the first study exploring relationship satisfaction in Parkinson’s-related dementia and has provided valuable insight into the changing patterns of intimate relationships.

Applying Game Thinking to Slips, Trips and Falls Prevention

Gamification is about the way in which 'game thinking' can engage participants and change behaviours in real, non-game contexts. This paper explores how game thinking can be applied to help prevent slips, trips and falls (STF), which are the largest cause of accidental death in older people across Europe. The paper contributes to the assistive technology, digital health and computer science/human behaviour communities by responding to a gap in the literature for papers detailing the innovation process of developing interventions to improve health and quality of life. The aim of the paper is of interest to the many stakeholders involved in enabling older people to live independent, confident, healthy and safe lives in the community.

Crossing professional and organizational boundaries: The implementation of generic Rehabilitation Assistants within three organizations in the northwest of England

PURPOSE

New generic support worker roles are being developed within rehabilitation and intermediate care services throughout the UK, as a consequence of staff shortages and the policy drive to look at new ways of working to meet the needs of older people. This paper describes a joint project between a Primary Care Trust, an Acute Trust and Social Services in one region in the northwest of England. It aims to describe the process of introducing new roles within rehabilitation and evaluates the acceptability and integration within different settings.

METHODS

Thirty support worker staff from an Acute Trust, Primary Care Trust and Social Services were trained over a period of 18 months to become generic Rehabilitation Assistants (RAs). A total of 55 semi-structured interviews of patients, associated professionals and RAs were conducted to examine the acceptability and integration of the new role. The interviews were tape-recorded, concurrently transcribed, inductively analysed and categorized into themes.

RESULTS

Several factors appeared to influence the acceptance and integration of the new role, namely: Prior experience and the degree of role change, familiarity and inter-staff relationships, role distinction and contribution and resources and management. Despite many challenges, patients, professionals and the RAs reported huge appreciation of the new role.

CONCLUSIONS

The evaluation demonstrates how an innovative, inter-organizational approach can deliver new solutions to address workforce issues. Further research is recommended nationally, to track the development and evaluate the effectiveness of similar roles.

New roles in rehabilitation--the implications for nurses and other professionals

RATIONALE, AIMS AND OBJECTIVES

The development of rehabilitation and intermediate care services, and roles therein, is part of current UK health policy to meet the demands of the ever-growing older population. One new role is the rehabilitation assistant (RA). This is a generic support worker trained at a basic level in nursing, physiotherapy, occupational therapy and social work who works under the supervision of the referring professionals, to deliver integrated rehabilitation programmes. RAs were introduced in one region in the north-west of England to increase the rehabilitation activity for patients. An empirical qualitative study was recently undertaken to evaluate the impact of the RAs from the perspectives of patients and associated nurses, therapists, managers and the RAs.

METHODS

Fifty-five semi-structured interviews were used to collect data, which was then inductively analysed into categories and then themes. The categories included variations in role, benefits of role, acceptance and integration of role, difficulties with role, training and retention. This paper focuses on the benefits and difficulties of the role.

RESULTS

It was found that patients, professionals and the RAs expressed great satisfaction with the new role. However, barriers to effective rehabilitation were reported owing to ward routines and organizational systems that interrupted and caused inconsistencies with the rehabilitation care programmes for patients.

CONCLUSIONS

If it is agreed that the majority of patients (unless end stage terminally ill, unwilling or unable) could benefit from some degree of rehabilitation, then there is an issue around how such skills could be widely implemented. This paper discusses the barriers to effective rehabilitation, the benefits and drawbacks of looking at new ways of working and the need for a unified approach by all care workers in rehabilitative care.