A cluster randomised feasibility pilot trial evaluating involving community-dwelling older adults in activities in relation to meals in a rehabilitation program; recruitment, data collection and protocol

Background

Community-dwelling older adults receiving support at home such as meals-on-wheels may lose the ability to preserve social, cognitive, and functional abilities, when becoming accustomed to and dependent of community aged care. When still able to cook older adults often hold some control over the foods that are prepared and which they eat, and which helps to foster identity. The purpose of this study is to assess feasibility of outcome measurements and sample size when conducting a pilot cluster randomized trial to evaluate community-dwelling older adults being involved in activities in relation to meals in a rehabilitation program.

Methods

This cluster randomized controlled study will consist of two clusters of a total of 5 community aged care areas; the intervention cluster, which hold 3 community aged care areas and the control cluster which hold 2 areas. The 130 community-dwelling older adults, receiving meals-on-wheels, will randomly be allocated to either the intervention cluster consisting of 8 weeks of participation in a rehabilitation program led by a Case Manager or the control cluster receiving usual community aged care. The primary outcome will be assessment of data collection (ratio between completed- and non-completed data) and assessment of sample size. The secondary clinical outcomes will be health-related quality of life (EQ-5D-3 L), muscle strength (chair stand), nutritional status (weight/BMI), loneliness (UCLA scale), mental well-being (Warwich-Edinburgh scale), self-efficacy (General Self-Efficacy scale), satisfaction with food-related life (SWFL scale) and refrigerator content.

Discussion

This study evaluates community-dwelling older adults receiving support at home, using involvement in activities related to meals with a rehabilitation approach, and this is a new area of research and will therefore be contributing in developing and refining consistent practices of rehabilitation programs.

Trial registration

ClinicalTrials.gov (registration no: NCT03289598). The protocol has been sent to the Danish Ethical Board which has concluded that approval is not needed and that the study can be carried on as described. Approval by The Danish Data Protection Agency has been giving through general approval for use of data in The City of Odense and will follow rules for obtaining the data accordingly.

Involving community-dwelling older adults in activities related to meals as part of a rehabilitation program: a single-blinded cluster-controlled study

OBJECTIVE

To understand if older adults have improvement in health-related quality of life, muscle strength, and nutritional status when involved in own meals as part of a rehabilitation program.

DESIGN

The study was single-blinded cluster-controlled consisting of two groups: intervention and control.

SUBJECTS

Intervention consisted of 62 participants and control of 61 recruited from, respectively, three and two aged care areas. Age was, respectively, 82.9 (±7.5) vs. 83.5 (±7.7) years. The proportion of female participants was, respectively, 42 (68 %) vs. 41 (67 %).

INTERVENTIONS

The healthcare staff had education related to food, meals, and nutrition, and older adults participated in an eight weeks rehabilitation program. Focus was on shopping, cooking, social context, and ability to eat and included collaborative goal setting with a case manager. Controls received usual community aged care.

MAIN MEASURES

The main outcomes were health-related quality of life measured by EuroQol-5D-3L (EQ-5D-3L), muscle strength (30 seconds chair-stand), and body weight. Data were analyzed with non-parametric and parametric statistics as appropriate.

RESULTS

There was a significant (P = 0.01) improvement of health-related quality of life (converted EQ-5D-3L score) in intervention (0.570 vs. 0.668) compared to the control (0.666 vs. 0.580) from baseline to follow-up. There was no difference in muscle strength between intervention and control: 15 (31 %) vs. 16 (32 %) improved 30 seconds chair-stand. There was no difference in weight change between the groups (-1 vs. -2.4 kg) (P = 0.261).

CONCLUSIONS

Improvement in health-related quality of life was seen when older adults were involved in activities related to meals.

Interventions to Support Older People's Involvement in Activities Related to Meals. A Systematic Review

The objective of this systematic review is to assess whether old people should be actively involved in activities related to meals to support quality of life, nutritional status and functional abilities related to meals. Two electronic databases Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness were searched, supported by PubMed citation, snowball searches. Eleven primary studies were included. The quality was low. No studies assessed the effect on health-related quality of life. Three types of interventions to support activities related to meals were identified: Meal-related activities to facilitate improved autonomy seemed to overall improve nutritional intake, physical and social function related to meals, plus mealtime coping. Interventions of encouragement and reinforcement by staff to facilitate independence in eating seemed to have beneficial effect on nutritional intake and physical function related to meals. Interventions using food preparation and cooking to support participation seemed to have beneficial effects on social function related to meals and mealtime coping. There is an urgent need for good quality, adequately powered studies in this area and among old people in all health care settings.

[Rehabilitation and palliative care in cardiovascular diseases in Denmark]

An increasing number of Danes are living, and dying, with cardiovascular disease. There is good evidence for the impact of cardiac rehabilitation on coronary heart disease, heart failure and symptomatic peripheral arterial disease. However, more high-quality research is needed into a wider range of cardiac diseases including rehabilitation following cardiac arrest, and palliative care for patients with advanced heart disease. In this review it is discussed how to improve the quality of care and identify the direction of future research and development.

A systematic review of the effectiveness of community-based interventions aimed at improving health literacy of parents/carers of children

AIM

The aim of this systematic review was to examine the effectiveness of community-based health literacy interventions in improving the health literacy of parents.

METHODS

A systematic review of six databases - MEDLINE, PsycINFO, CINAHL, Cochrane Library, Embase, and Education Source - was conducted to identify relevant articles. Risk of bias was assessed using version two of the Cochrane risk of bias tool for randomised controlled trials or the Cochrane collaboration risk of bias in non-randomised studies of interventions. The study findings were grouped and synthesised following the synthesis without meta-analysis framework.

RESULTS

Eleven community-based health literacy interventions for parents were identified. Study design included randomised controlled trials (n = 4), non-randomised studies with comparison group (n = 4), and non-randomised studies without a comparison group (n = 3). Interventions were delivered digitally, in person or a combination of the two. The risk of bias was high in over half the studies (n = 7). The main findings of the studies showed some potential for both in person and digital interventions to increase parental health literacy. Studies were heterogeneous preventing a meta-analysis.

CONCLUSION

Community-based, health literacy interventions have been identified as potential methods for enhancing parental health literacy. Due to the small number of included studies and their potential for bias, these results must be interpreted with caution. This study emphasises the need for additional theory and evidence-based research on the long-term effects of community interventions.

A systematic review of the effectiveness of community interventions to improve parent health literacy

Background

Many community-based interventions have been developed to increase parent/caregiver health literacy, yet no systematic review of their effectiveness has been published. Therefore, the aim of this systematic review was to examine the effectiveness of community-based health literacy interventions in improving the health literacy of parents/caregivers.

Methods

A systematic review of six databases; MEDLINE, PsycINFO, CINAHL, Cochrane Library, Embase, and Education Source were conducted to identify relevant articles. Risk of bias were assessed using version two of the Cochrane risk of bias tool for randomised controlled trials or the Cochrane Collaboration Risk of Bias in Non-Randomised Studies of Interventions. The study findings were grouped and synthesised following the Synthesis Without Meta-analysis framework.

Results

Eleven community-based health literacy interventions for parents/caregivers were identified. Study design included randomised controlled trials (n = 4), non-randomised studies with comparison group (n = 4), and non-randomised studies without a comparison group (n = 3). Interventions were delivered digitally, in person or a combination of the two. The main findings of the studies showed some potential for both in person and digital interventions to increase parental health literacy. The risk of bias was high in over half the studies (n = 7) Studies were heterogeneous preventing a meta-analysis.

Discussion

Although no definitive conclusion of the effectiveness of community-based interventions can be drawn there are suggestions of improvement in many of the studies included in this review. The review has brought into question whether the health literacy measurement tools used met the needs of assessing the interventions outcomes. When comparing the cost and resources needed for digital with in person interventions, the findings of this review have implications for both practise and research.

Key messages