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Seijas V, Maritz R, Fernandes P, Bernard RM, Lugo LH, Bickenbach J, Sabariego C. Rehabilitation delivery models to foster healthy ageing-a scoping review. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1307536. [PMID: 38660395 PMCID: PMC11041397 DOI: 10.3389/fresc.2024.1307536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Abstract
Introduction Rehabilitation is essential to foster healthy ageing. Older adults have unique rehabilitation needs due to a higher prevalence of non-communicable diseases, higher susceptibility to infectious diseases, injuries, and mental health conditions. However, there is limited understanding of how rehabilitation is delivered to older adults. To address this gap, we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults' functioning/functional ability and foster healthy ageing. Methods We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models. Results Out of 6,933 identified records, 585 articles were assessed for eligibility, and 283 studies with 69,257 participants were included. We identified six rehabilitation delivery models: outpatient (24%), telerehabilitation (22%), home (18.5%), community (16.3%), inpatient (14.6%), and eldercare (4.7%). These models often involved multidisciplinary teams (31.5%) and follow integrated care principles (30.4%). Most studies used a disease-centred approach (59.0%), while studies addressing multimorbidity (6.0%) and prevalent health problems of older adults, such as pain, low hearing, and vision, or incontinence were scarce. The most frequently provided interventions were therapeutic exercises (54.1%), self-management education (40.1%), and assessment of person-centred goals (40%). Other interventions, such as assistive technology (8.1%) and environmental adaptations (7.4%) were infrequent. Conclusions Focusing on primary studies, this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention, including a lack of systematic assessment of functioning/functional ability, a predominance of disease-centred rehabilitation, and a scarcity of programmes addressing prevalent issues like pain, hearing/vision loss, fall prevention, incontinence, and sexual dysfunctions. Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing. Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness. Future research in the field is needed to expand and validate our findings.
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Affiliation(s)
- Vanessa Seijas
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Roxanne Maritz
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Patricia Fernandes
- Department of Clinical Medicine, Federal University of Parana, Parana, Brazil
| | | | - Luz Helena Lugo
- Rehabilitation in Health Research Group, University of Antioquia, Medellin, Colombia
| | - Jerome Bickenbach
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Carla Sabariego
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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Morrison RT, Taylor S, Buckley J, Twist C, Kite C. High-velocity power training has similar effects to traditional resistance training for functional performance in older adults: a systematic review. J Physiother 2023; 69:148-159. [PMID: 37328359 DOI: 10.1016/j.jphys.2023.05.018] [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: 03/07/2022] [Revised: 02/21/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
QUESTIONS What is the effect of high-velocity power training (HVPT) compared with traditional resistance training (TRT) on functional performance in older adults? What is the quality of intervention reporting for the relevant literature? DESIGN Systematic review and meta-analysis of randomised controlled trials. PARTICIPANTS Older adults (aged > 60 years), regardless of health status, baseline functional capacity or residential status. INTERVENTIONS High-velocity power training with the intent to perform the concentric phase as quickly as possible compared with traditional moderate-velocity resistance training performed with a concentric phase of ≥ 2 seconds. OUTCOME MEASURES Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), five times sit-to-stand test (5-STS), 30-second sit-to-stand test (30-STS), gait speed tests, static or dynamic balance tests, stair climb tests and walking tests for distance. The quality of intervention reporting was assessed with the Consensus on Exercise Reporting Template (CERT) score. RESULTS Nineteen trials with 1,055 participants were included in the meta-analysis. Compared with TRT, HVPT had a weak-to-moderate effect on change from baseline scores for the SPPB (SMD 0.27, 95% CI 0.02 to 0.53; low-quality evidence) and TUG (SMD 0.35, 95% CI 0.06 to 0.63; low-quality evidence). The effect of HVPT relative to TRT for other outcomes remained very uncertain. The average CERT score across all trials was 53%, with two trials rated high quality and four rated moderate quality. CONCLUSION HVPT had similar effects to TRT for functional performance in older adults, but there is considerable uncertainty in most estimates. HVPT had better effects on the SPPB and TUG, but it is unclear whether the benefit is large enough to be clinically worthwhile.
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Affiliation(s)
- Robert T Morrison
- Chester Medical School, Faculty of Health, Medicine and Society, University of Chester, University Centre Shrewsbury, Shrewsbury, UK
| | - Sue Taylor
- Chester Medical School, Faculty of Health, Medicine and Society, University of Chester, University Centre Shrewsbury, Shrewsbury, UK
| | - John Buckley
- The School of Allied Health Professions, Keele University, Staffordshire, UK
| | - Craig Twist
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Chris Kite
- Chester Medical School, Faculty of Health, Medicine and Society, University of Chester, University Centre Shrewsbury, Shrewsbury, UK; School of Public Health Studies, Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Centre for Sport, Exercise & Life Sciences, Coventry University, Coventry, UK.
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Johansson MM, Nätt M, Peolsson A, Öhman A. Frail community-dwelling older persons' everyday lives and their experiences of rehabilitation - a qualitative study. Scand J Occup Ther 2023; 30:65-75. [PMID: 35786360 DOI: 10.1080/11038128.2022.2093269] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The number of older persons with frailty is increasing, and rehabilitation to improve the consequences of frailty are important for both the individual and society. However, the perspective of older persons themselves in research and planning of interventions is scarce. AIM The aim of this study was to describe frail older persons' everyday lives and their experiences and views of rehabilitation. MATERIAL AND METHODS Twenty older persons were interviewed, and analyses were performed using a qualitative content analysis method. RESULTS The two main categories were 'Frailty impacts everyday lifé and 'Experiences and perceptions of rehabilitation'. The participants described that they had to adapt their everyday lives in line with their health conditions. They all used strategies and were dependent on support in their activities of daily living. Their social network had decreased. All participants strived to stay active and independent, and wanted rehabilitation and support from professionals, experiencing decreased access to rehabilitation. CONCLUSIONS AND SIGNIFICANCE Frail older persons are a vulnerable group who often need support in everyday life. There is room for improvement when it comes to helping frail older persons to stay active and facilitate participation in both individual and group interventions.
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Affiliation(s)
- Maria M Johansson
- Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Malin Nätt
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Rehabilitation Medicine in Linköping, and Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden.,Department of Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Unit of Clinical medicine, Linköping University, Linköping, Sweden
| | - Annika Öhman
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Occupational Therapy, Linköping University, Norrköping, Sweden
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Ho S, Culligan M, Friedberg J, Goloubeva O, Marchese V. Examining the impact of physical function performance in predicting patient outcomes after lung-sparing surgery for malignant pleural mesothelioma. Disabil Rehabil 2022; 44:6676-6683. [PMID: 34455883 DOI: 10.1080/09638288.2021.1970256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to examine the impact of physical function performance and pulmonary function on patient outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM). MATERIALS AND METHODS A retrospective review of 54 patients with MPM from 2015 to 2020 was performed. The primary objective was to assess whether physical function, as measured by the Eastern Cooperative Oncology Group Performance Status (ECOG), and pulmonary function tests were predictive of postoperative patient outcomes (ventilator days, chest tube days, hospital length of stay). A secondary objective was to explore demographic and preoperative variables that best predict postoperative physical function and patient outcomes. RESULTS Data include 54 patients who underwent extended pleurectomy-decortication. Preoperative ECOG was a significant predictor of postoperative patient outcomes while preoperative lung function lacked predictive ability. Preoperative ECOG was also predictive of preoperative lung function. Age on the day of surgery was the best predictor of postoperative physical function, which was significantly reduced postoperatively. CONCLUSIONS Preoperative physical function performance was a significant predictor of postoperative outcomes. The results of our study highlight the importance of physical function in patients with MPM and support the need for early rehabilitation and further research to determine optimal rehabilitation interventions.IMPLICATIONS FOR REHABILITATIONPreoperative physical function can predict outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM).Physical function in patients with MPM should be carefully examined.To accurately reflect patients' abilities, patient assessment should include both patient-reported outcomes and performance-based measures.Patients with MPM should receive rehabilitation early after diagnosis and throughout the continuum of care.
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Affiliation(s)
- Simon Ho
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa Culligan
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Joseph Friedberg
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Olga Goloubeva
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.,Division of Biostatistics and Bioinformation, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
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Torpil B, Kaya Ö. Effectiveness of client-centered intervention delivered with face-to-face and telerehabilitation method after total knee arthroplasty—A pilot randomized control trial. Br J Occup Ther 2022. [DOI: 10.1177/03080226211070477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Total knee arthroplasty (TKA) negatively affects the quality of life, perceived occupational performance, and satisfaction. Face-to-face rehabilitation services have been adversely affected by problems such as time, cost, accessibility, and the COVID-19 pandemic. The telerehabilitation (TR) method is recommended for these problems. This pilot study was planned to examine the comparison of client-centered (CC) intervention with TR and face-to-face (FF) method on quality of life, perceived occupational performance, and satisfaction after TKA. Methods Forty-eight older adults that after TKA (13 men and 35 women) were randomized to the TR group ( n = 24; 68.25 ± 3.32 years) or FF group ( n = 24; 68.91 ± 2.56 years). The Nottingham Health Profile (NHP) was used to assess the quality of life, and the Canadian Occupational Performance Measure (COPM) was used to assess perceived occupational performance and satisfaction. Results There was no difference in all parameters between the groups before and after the intervention program (p > .05). The intervention consisting of 4 days a week for 4 weeks and 45 min sessions applied with both methods had a strong effect size (p < .001 for all). Conclusion As a result, CC intervention applied with both methods in the first postoperative week increased quality of life, perceived occupational performance, and satisfaction. Trail Registration: NCT04969432
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Affiliation(s)
- Berkan Torpil
- Occupational Therapy Department, Faculty of Gülhane Health Sciences, University of Health Sciences Turkey, Ankara Turkey
| | - Özgür Kaya
- Department of Orthopedics and Traumatology, Lokman Hekim University, Ankara, Turkey
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Arias-Casais N, Amuthavalli Thiyagarajan J, Rodrigues Perracini M, Park E, Van den Block L, Sumi Y, Sadana R, Banerjee A, Han ZA. What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world. BMJ Open 2022; 12:e054492. [PMID: 35105637 PMCID: PMC8808408 DOI: 10.1136/bmjopen-2021-054492] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/20/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing. DESIGN Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community. INCLUSION CRITERIA Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French. RESULTS 305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13). CONCLUSION The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory for Palliative Care, University of Navarra, Pamplona, Spain
| | | | | | - Eunok Park
- College of Nursing, Jeju National University, Jeju, Republic of Korea
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yuka Sumi
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Ritu Sadana
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Zee-A Han
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Gilmore N, Kehoe L, Bauer J, Xu H, Hall B, Wells M, Lei L, Culakova E, Flannery M, Grossman VA, Sardari RA, Subramanya H, Kadambi S, Belcher E, Kettinger J, O'Rourke MA, Dib EG, Vogelzang NJ, Dale W, Mohile S. The Relationship Between Frailty and Emotional Health in Older Patients with Advanced Cancer. Oncologist 2021; 26:e2181-e2191. [PMID: 34510642 DOI: 10.1002/onco.13975] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/24/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Aging-related deficits that eventually manifest as frailty may be associated with poor emotional health in older patients with advanced cancer. This study aimed to examine the relationship between frailty and emotional health in this population. METHODS This was a secondary analysis of baseline data from a nationwide cluster randomized trial. Patients were aged ≥70 years with incurable stage III/IV solid tumors or lymphomas, had ≥1 geriatric assessment (GA) domain impairment, and had completed the Geriatric Depression Scale, Generalized Anxiety Disorder-7, and Distress Thermometer. Frailty was assessed using a Deficit Accumulation Index (DAI; range 0-1) based on GA, which did not include emotional health variables (depression and anxiety), and participants were stratified into robust, prefrail, and frail categories. Multivariate logistic regression models examined the association of frailty with emotional health outcomes. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. RESULTS Five hundred forty-one patients were included (mean age: 77 years; 70-96). DAI ranged from 0.04 to 0.94; 27% of patients were classified as robust, 42% prefrail, and 31% frail. Compared with robust patients, frail patients had an increased risk of screening positive for depression (aOR = 12.8; 95% CI = 6.1-27.0), anxiety (aOR = 6.6; 95% CI = 2.2-19.7), and emotional distress (aOR = 4.62; 95% CI = 2.9-8.3). Prefrail compared with robust patients also had an increased risk of screening positive for depression (aOR = 2.22; 95% CI = 1.0-4.8) and distress (aOR = 1.71; 95% CI = 1.0-2.8). CONCLUSION In older patients with advanced cancer, frailty is associated with poorer emotional health, which indicates a need for an integrated care approach to treating these patients. IMPLICATIONS FOR PRACTICE A relationship exists between frailty and poor emotional health in older adults with advanced cancer. Identifying areas of frailty can prompt screening for emotional health and guide delivery of appropriate interventions. Alternatively, attention to emotional health may also improve frailty.
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Affiliation(s)
- Nikesha Gilmore
- University of Rochester Medical Center, Rochester, New York, USA
| | - Lee Kehoe
- University of Rochester Medical Center, Rochester, New York, USA
| | - Jessica Bauer
- University of Rochester Medical Center, Rochester, New York, USA
| | - Huiwen Xu
- University of Rochester Medical Center, Rochester, New York, USA
| | - Bianca Hall
- University of Rochester Medical Center, Rochester, New York, USA
| | - Megan Wells
- University of Rochester Medical Center, Rochester, New York, USA
| | - Lianlian Lei
- University of Michigan, Ann Arbor, Michigan, USA
| | - Eva Culakova
- University of Rochester Medical Center, Rochester, New York, USA
| | - Marie Flannery
- University of Rochester Medical Center, Rochester, New York, USA
| | - Valerie Aarne Grossman
- University of Rochester Medical Center, Rochester, New York, USA.,SCOREboard Stakeholder Advisory Group, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Himal Subramanya
- University of Rochester Medical Center, Rochester, New York, USA
| | - Sindhuja Kadambi
- University of Rochester Medical Center, Rochester, New York, USA
| | | | | | - Mark A O'Rourke
- Cancer Centers of the Carolinas, Greenville, South Carolina, USA
| | - Elie G Dib
- Michigan Cancer Research Consortium, Ypsilanti, Michigan, USA
| | | | - William Dale
- City of Hope National Medical Center, Duarte, California, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Rochester, New York, USA
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Welch V, Mathew CM, Babelmorad P, Li Y, Ghogomu ET, Borg J, Conde M, Kristjansson E, Lyddiatt A, Marcus S, Nickerson JW, Pottie K, Rogers M, Sadana R, Saran A, Shea B, Sheehy L, Sveistrup H, Tanuseputro P, Thompson‐Coon J, Walker P, Zhang W, Howe TE. Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1175. [PMID: 37051456 PMCID: PMC8988637 DOI: 10.1002/cl2.1175] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. Objectives This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. Search Methods We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov). Selection Criteria Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. Data Collection and Analysis We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. Main Results After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality.The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication.There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues. Authors' Conclusions There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.
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Affiliation(s)
- Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | | | | | - Yanfei Li
- Evidence‐Based Social Science Research Center, School of Public HealthLanzhou UniversityLanzhouChina
| | | | | | - Monserrat Conde
- Cochrane Campbell Global Ageing Partnership FieldFaroPortugal
| | | | | | - Sue Marcus
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | | | | | - Morwenna Rogers
- NIHR ARC, South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | | | | | - Beverly Shea
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Lisa Sheehy
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Heidi Sveistrup
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
- Faculty of Health SciencesUniversity of OttawaOttawaCanada
| | | | - Joanna Thompson‐Coon
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Peter Walker
- Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Wei Zhang
- Access to Medicines, Vaccines and Health ProductsWorld Health OrganizationGenevaSwitzerland
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Torpil B, Kaya Ö. The Effectiveness of Client-Centered Intervention With Telerehabilitation Method After Total Knee Arthroplasty. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2021; 42:40-49. [PMID: 34423693 DOI: 10.1177/15394492211038293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
There is known to be a decrease in quality of life and perceived occupational performance and satisfaction following total knee arthroplasty (TKA). This study was planned to examine the effectiveness of a client-centered (CC) intervention with the telerehabilitation (TR) method on the quality of life, perceived occupational performance, and satisfaction after TKA. A total of 38 patients who had undergone TKA were randomly assigned to the CC and control groups. A 12-day intervention program was applied to the CC group. The Nottingham Health Profile (NHP) and Canadian Occupational Performance Measure (COPM) were applied before and after intervention. The 12-day intervention showed a strong effect on all parameters in the CC group (p<.001). In the postintervention comparisons, a significant difference was found in favor of the CC group (p < .001). CC interventions with the TR method can be used in post-TKA interventions.
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Affiliation(s)
- Berkan Torpil
- University of Health Sciences Turkey, Ankara, Turkey
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10
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Palutturi S, Saleh LM, Rachmat M, Malek JA, Nam EW. Principles and strategies for aisles communities empowerment in creating Makassar Healthy City, Indonesia. GACETA SANITARIA 2021; 35 Suppl 1:S46-S48. [PMID: 33832625 DOI: 10.1016/j.gaceta.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To discuss the characteristics of the aisles communities and to identify the principles and strategies for empowering alley communities in realizing the Makassar Healthy City. METHOD The method used in this research was a qualitative method. Data collection was carried out through an extensive literature review, FGD, and in-depth interviews. Data were analyzed using thematic analysis. RESULTS This research identified the characteristics of the aisles community. This research also found that empowerment of aisles communities can be built with holistic principles, commitment to alley health, leadership, participation, synergy, independence, equality, and sustainability. The development strategies for the aisle communities can be carried out through regulation, the principles of brains and muscles (thinkers and workers), organizations/work groups, community education, funding, and advocacy. CONCLUSION Synergy and convergence action of the aisles program that has the leverage/effect in realizing a clean, comfortable, safe, healthy, and productive aisles is needed.
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Affiliation(s)
- Sukri Palutturi
- Department of Health Policy and Administration, Faculty of Public Health Universitas Hasanuddin, Indonesia.
| | - Lalu Muhammad Saleh
- Department of Occupational Health and Safety, Faculty of Public Health Universitas Hasanuddin, Indonesia
| | - Muhammad Rachmat
- Department of Health Promotion and Behavioral Sciences, Faculty of Public Health Universitas Hasanuddin, Indonesia
| | - Jalaluddin Abdul Malek
- Center for Development, Social and Environmental Studies, University Kebangsaan Malaysia, Malaysia
| | - Eun Woo Nam
- Department of Health Administration, Head of Healthy City Research Center Yonsei University, Republic of Korea
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11
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Ebrahimi Z, Patel H, Wijk H, Ekman I, Olaya-Contreras P. A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings. Geriatr Nurs 2020; 42:213-224. [PMID: 32863037 DOI: 10.1016/j.gerinurse.2020.08.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
THE PURPOSE of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+). METHOD A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish. RESULTS In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation. CONCLUSION Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.
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Affiliation(s)
- Zahra Ebrahimi
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden.
| | - Harshida Patel
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Chalmers University of Technology, Department of Architecture Sahlgrenska University Hospital Department of Quality Assurance and Patient Safety, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden
| | - Patricia Olaya-Contreras
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Pergolotti M, Deal AM, Williams GR, Bryant AL, McCarthy L, Nyrop KA, Covington KR, Reeve BB, Basch E, Muss HB. Older Adults with Cancer: A Randomized Controlled Trial of Occupational and Physical Therapy. J Am Geriatr Soc 2020; 67:953-960. [PMID: 31034594 DOI: 10.1111/jgs.15930] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/01/2019] [Accepted: 03/20/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The impact of occupational therapy (OT) and physical therapy (PT) on functional outcomes in older adults with cancer is unknown. DESIGN Two-arm single-institution randomized controlled trial of outpatient OT/PT. SETTING Comprehensive cancer center with two off-site OT/PT clinics. PARTICIPANTS We recruited adults 65 years and older with a recent diagnosis or recurrence of cancer within 5 years, with at least one functional limitation as identified by a geriatric assessment. Participants were randomized to OT/PT or usual care. INTERVENTION Rehabilitation consisted of individualized OT and PT that addressed functional activities and strength/endurance needs. MEASUREMENTS Primary outcome was functional status as measured by the Nottingham Extended Activities of Daily Living scale. Secondary outcomes were Patient-Reported Outcomes Measurement Information System-Global Mental Health (GMH) and Global Physical Health (GPH), ability to participate in Social Roles (SR), physical function, and activity expectations and self-efficacy (Possibilities for Activity Scale [PActS]). RESULTS Among those recruited (N = 63), only 45 patients (71%) were evaluable due to loss of follow-up and/or nonreceipt of intervention. The median age was 74 years; 53% were female, and 91% were white. Overall, 30% patients had hematologic malignancies, 30% breast cancer, and 16% colorectal cancers. A total of 65% were in active treatment; 49% had stage 3 or 4 disease. At follow-up, both OT/PT (P = .02) and usual care (P = .03) groups experienced a decline in functional status. PActS scores between groups (P = .04) was significantly improved in the intervention group. GMH and SR met criteria for minimally important clinical difference favoring the intervention, but not statistical significance. Several barriers were noted in the implementation of the intervention program: recruitment, concerns about cost, distance, scheduling, and limited treatment provided. CONCLUSION OT/PT may positively influence activity expectations and self-efficacy. Future research needs to address significant barriers to implementation to increase use of OT/PT services and access to quality care. J Am Geriatr Soc 67:953-960, 2019.
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Affiliation(s)
- Mackenzi Pergolotti
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado.,ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, Pennsylvania
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Grant R Williams
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashley L Bryant
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lauren McCarthy
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kirsten A Nyrop
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelley R Covington
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado
| | - Bryce B Reeve
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Center for Health Measurement, Department of Population Health Sciences and Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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13
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Lee AM, Sénéchal M, Hrubeniuk TJ, Bouchard DR. Is sitting time leading to mobility decline in long-term care residents? Aging Clin Exp Res 2020; 32:183-186. [PMID: 30778873 DOI: 10.1007/s40520-019-01148-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the sitting time in long-term care (LTC) facilities, or if sedentary behaviour affects changes in mobility over time. AIMS The objectives were to document the sitting time of LTC residents and to examine if sitting time could predict changes in mobility. METHODS Twenty residents of an LTC facility, representing three mobility statuses (independent, assisted transfer, and dependent transfer) were included. Sitting time was defined using an ActivPAL. Mobility statuses were reviewed 12 months later. RESULTS Participants spent an average of 21.9 h per day sedentary. At follow-up, five residents experienced a decline in mobility status, but no baseline sitting time variables were associated with the changes in mobility status (P > 0.05). DISCUSSION/CONCLUSION People living in LTC are highly sedentary. Sitting time differs amongst the mobility statues, but is unable to predict upcoming changes in mobility status.
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Affiliation(s)
- A M Lee
- Cardiometabolic Exercise and Lifestyle Laboratory, Fredericton, NB, Canada
- Faculty of Kinesiology, University of New Brunswick, 90 Mackay Drive, (Room 322), Fredericton, NB, E3B 5A3, Canada
| | - M Sénéchal
- Cardiometabolic Exercise and Lifestyle Laboratory, Fredericton, NB, Canada
- Faculty of Kinesiology, University of New Brunswick, 90 Mackay Drive, (Room 322), Fredericton, NB, E3B 5A3, Canada
| | - T J Hrubeniuk
- Cardiometabolic Exercise and Lifestyle Laboratory, Fredericton, NB, Canada
- Interdisciplinary Studies, University of New Brunswick, Fredericton, NB, Canada
| | - D R Bouchard
- Cardiometabolic Exercise and Lifestyle Laboratory, Fredericton, NB, Canada.
- Faculty of Kinesiology, University of New Brunswick, 90 Mackay Drive, (Room 322), Fredericton, NB, E3B 5A3, Canada.
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14
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Anker MS, Anker SD, Coats AJ, von Haehling S. The Journal of Cachexia, Sarcopenia and Muscle stays the front-runner in geriatrics and gerontology. J Cachexia Sarcopenia Muscle 2019; 10:1151-1164. [PMID: 31821753 PMCID: PMC6903443 DOI: 10.1002/jcsm.12518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Markus S. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK) partner site BerlinBerlinGermany
- Department of CardiologyCharité Campus Benjamin FranklinBerlinGermany
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK) partner site BerlinBerlinGermany
- Department of Cardiology (CVK)Charité Universitätsmedizin BerlinBerlinGermany
- Charité Universitätsmedizin BerlinBerlinGermany
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center GöttingenUniversity of Göttingen Medical Center, Georg‐August‐UniversityGöttingenGermany
- German Center for Cardiovascular Medicine (DZHK), partner site GöttingenGöttingenGermany
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15
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Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek-Hutten M, Germini F, D'Avanzo B, Gwyther H, Holland C. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. ACTA ACUST UNITED AC 2019; 16:140-232. [PMID: 29324562 PMCID: PMC5771690 DOI: 10.11124/jbisrir-2017-003382] [Citation(s) in RCA: 291] [Impact Index Per Article: 58.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To summarize the best available evidence regarding the effectiveness of interventions for preventing frailty progression in older adults. INTRODUCTION Frailty is an age-related state of decreased physiological reserves characterized by an increased risk of poor clinical outcomes. Evidence supporting the malleability of frailty, its prevention and treatment, has been presented. INCLUSION CRITERIA The review considered studies on older adults aged 65 and over, explicitly identified as pre-frail or frail, who had been undergoing interventions focusing on the prevention of frailty progression. Participants selected on the basis of specific illness or with a terminal diagnosis were excluded. The comparator was usual care, alternative therapeutic interventions or no intervention. The primary outcome was frailty. Secondary outcomes included: (i) cognition, quality of life, activities of daily living, caregiver burden, functional capacity, depression and other mental health-related outcomes, self-perceived health and social engagement; (ii) drugs and prescriptions, analytical parameters, adverse outcomes and comorbidities; (iii) costs, and/or costs relative to benefits and/or savings associated with implementing the interventions for frailty. Experimental study designs, cost effectiveness, cost benefit, cost minimization and cost utility studies were considered for inclusion. METHODS Databases for published and unpublished studies, available in English, Portuguese, Spanish, Italian and Dutch, from January 2001 to November 2015, were searched. Critical appraisal was conducted using standardized instruments from the Joanna Briggs Institute. Data was extracted using the standardized tools designed for quantitative and economic studies. Data was presented in a narrative form due to the heterogeneity of included studies. RESULTS Twenty-one studies, all randomized controlled trials, with a total of 5275 older adults and describing 33 interventions, met the criteria for inclusion. Economic analyses were conducted in two studies. Physical exercise programs were shown to be generally effective for reducing or postponing frailty but only when conducted in groups. Favorable effects on frailty indicators were also observed after the interventions, based on physical exercise with supplementation, supplementation alone, cognitive training and combined treatment. Group meetings and home visits were not found to be universally effective. Lack of efficacy was evidenced for physical exercise performed individually or delivered one-to-one, hormone supplementation and problem solving therapy. Individually tailored management programs for clinical conditions had inconsistent effects on frailty prevalence. Economic studies demonstrated that this type of intervention, as compared to usual care, provided better value for money, particularly for very frail community-dwelling participants, and had favorable effects in some of the frailty-related outcomes in inpatient and outpatient management, without increasing costs. CONCLUSIONS This review found mixed results regarding the effectiveness of frailty interventions. However, there is clear evidence on the usefulness of such interventions in carefully chosen evidence-based circumstances, both for frailty itself and for secondary outcomes, supporting clinical investment of resources in frailty intervention. Further research is required to reinforce current evidence and examine the impact of the initial level of frailty on the benefits of different interventions. There is also a need for economic evaluation of frailty interventions.
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Affiliation(s)
- João Apóstolo
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Richard Cooke
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
| | - Elzbieta Bobrowicz-Campos
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Silvina Santana
- Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal
| | - Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department. of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Antonio Cano
- Department of Paediatrics, Obstetrics and Gynaecology, Universitat de Valência, Valência, Spain
| | | | - Federico Germini
- Department. of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Barbara D'Avanzo
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Holly Gwyther
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
| | - Carol Holland
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
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16
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Abstract
The global population including Canada's is aging, which demands planning for housing that will support older adults' quality of life. This mixed-method study is the first Canadian study to examine the impact of cohousing on older adults' quality of life and involved 23 participants. The older adults rated their quality of life very high, especially in the environmental, physical, and psychological domains of the World Health Organization Quality of Life (WHOQOL_BREF) survey; quality of life in the social domain was rated low, which was surprising in light of the focus group data findings. Four themes of "belonging in a community", "life in the community", "changes associated with aging," and "aging in place" emerged from the qualitative data to explain factors that influence older adults' quality of life. This research provides foundational, strong evidence that seniors' cohousing is an innovative housing solution that can support older adults' quality of life.
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17
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Fritz H, Seidarabi S, Barbour R, Vonbehren A. Occupational Therapy Intervention to Improve Outcomes Among Frail Older Adults: A Scoping Review. Am J Occup Ther 2019; 73:7303205130p1-7303205130p12. [PMID: 31120843 DOI: 10.5014/ajot.2019.030585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Frailty is common in later life and increases older adults' risk for early disability, institutionalization, and mortality. OBJECTIVE To explore the research literature on occupational therapy interventions to improve outcomes among frail, community-dwelling older adults. DESIGN Scoping review of the peer-reviewed literature about occupational therapy interventions and frailty published between January 1996 and January 2017. RESULTS Ten studies met the inclusion criteria. The majority of the studies focused on adults age 65 yr or older, operationalized frailty as activities of daily living disability, and did not use validated frailty measures to identify frail older adults. Interventions were delivered both as a stand-alone intervention and as part of a multidisciplinary approach. Treatments focused on recommendations and training in use of adaptive devices or assistive technologies, performance of self-care, and recommendations for home modifications. CONCLUSION Additional research is warranted to build the evidence base and better inform the design and selection of occupational therapy interventions to improve outcomes among frail older adults.
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Affiliation(s)
- Heather Fritz
- Heather Fritz, PhD, OTR/L, is Assistant Professor of Occupational Therapy and Gerontology, Eugene Applebaum College of Pharmacy and Health Sciences and Institute of Gerontology, Wayne State University, Detroit, MI;
| | - Sara Seidarabi
- Sara Seidarabi, MOT, is Occupational Therapy Student, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Ryan Barbour
- Ryan Barbour, MOT, is Occupational Therapy Student, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Alexandra Vonbehren
- Alexandra Vonbehren, MOT, is Occupational Therapy Student, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
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18
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Liu CJC. Functional Ability in the Changing Demographic Landscape: Evidence and Opportunities for Occupational Therapy. Am J Occup Ther 2019; 72:7204170010p1-7204170010p5. [PMID: 29953824 DOI: 10.5014/ajot.2018.724002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The growing number of older adults is changing the demographic landscape. Occupational therapy can better serve the older adult population by helping them maintain their functional ability, which is the ability to engage in occupations. This special issue includes both studies of interventions to evaluate and support functional ability in community-dwelling older adults and systematic reviews of such studies. This editorial highlights the six systematic reviews, which were completed in collaboration with the American Occupational Therapy Association's Evidence-Based Practice Project. These reviews compile evidence for the effectiveness of interventions within the scope of occupational therapy practice to promote occupational performance in community-dwelling older adults. The distinct value of occupational therapy in supporting the functional ability of community-dwelling older adults with stable or declining health is discussed using the World Health Organization's framework for healthy aging.
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Affiliation(s)
- Chiung-Ju Cj Liu
- Chiung-ju (CJ) Liu, PhD, OTR, FGSA, is Associate Professor, Indiana University Department of Occupational Therapy, School of Health and Human Sciences, Indiana University, Indianapolis;
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19
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Chronic Pain and Frailty in Community-Dwelling Older Adults: A Systematic Review. Pain Manag Nurs 2019; 20:309-315. [PMID: 31103515 DOI: 10.1016/j.pmn.2019.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/30/2018] [Accepted: 01/17/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Our aim was to examine the relationship between chronic pain and frailty in community-dwelling older adults. DESIGN A systematic review method following the Joanna Briggs Institute Reviewers' Manual 2015. DATA SOURCES MEDLINE, Cochrane Library Plus, Science Direct, Scielo, LILACS, and the Joanna Briggs Institute database of systematic reviews and implementation reports were searched using different combinations of the terms "frail," "frailty," and "pain." REVIEW/ANALYSIS METHODS Original publications of nononcologic chronic pain and frailty status in community-dwelling older adults published in English or Spanish were included. Because of the heterogeneity of the studies, a narrative approach was used to summarize the results. RESULTS A total of 23 studies were finally selected for the systematic review. Most of them (n = 14) were cross-sectional studies, and there were also longitudinal studies (n = 4), cohort studies (n = 3), and randomized controlled trials (n = 2). Most of the studies found an association between chronic pain and frailty in terms of prevalence; approximately 45% of frail patients had chronic pain, and prevalence can reach 70%. CONCLUSIONS The studies analyzed suggest that chronic pain has a predictive effect for frailty in older adults compared with those reporting no pain. Higher pain intensity, chronic widespread pain, and higher pain interference were also related to frailty status. No specific interventions for managing chronic pain in frail or prefrail older adults were found.
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20
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Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, Woo J, Aprahamian I, Sanford A, Lundy J, Landi F, Beilby J, Martin FC, Bauer JM, Ferrucci L, Merchant RA, Dong B, Arai H, Hoogendijk EO, Won CW, Abbatecola A, Cederholm T, Strandberg T, Gutiérrez Robledo LM, Flicker L, Bhasin S, Aubertin-Leheudre M, Bischoff-Ferrari HA, Guralnik JM, Muscedere J, Pahor M, Ruiz J, Negm AM, Reginster JY, Waters DL, Vellas B. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging 2019; 23:771-787. [PMID: 31641726 PMCID: PMC6800406 DOI: 10.1007/s12603-019-1273-z] [Citation(s) in RCA: 451] [Impact Index Per Article: 90.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. METHODS These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.
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Affiliation(s)
- E Dent
- E. Dent, Torrens University Australia, Adelaide, Australia,
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Delaying and reversing frailty: a systematic review of primary care interventions. Br J Gen Pract 2018; 69:e61-e69. [PMID: 30510094 DOI: 10.3399/bjgp18x700241] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/18/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Recommendations for routine frailty screening in general practice are increasing as frailty prevalence grows. In England, frailty identification became a contractual requirement in 2017. However, there is little guidance on the most effective and practical interventions once frailty has been identified. AIM To assess the comparative effectiveness and ease of implementation of frailty interventions in primary care. DESIGN AND SETTING A systematic review of frailty interventions in primary care. METHOD Scientific databases were searched from inception to May 2017 for randomised controlled trials or cohort studies with control groups on primary care frailty interventions. Screening methods, interventions, and outcomes were analysed in included studies. Effectiveness was scored in terms of change of frailty status or frailty indicators and ease of implementation in terms of human resources, marginal costs, and time requirements. RESULTS A total of 925 studies satisfied search criteria and 46 were included. There were 15 690 participants (median study size was 160 participants). Studies reflected a broad heterogeneity. There were 17 different frailty screening methods. Of the frailty interventions, 23 involved physical activity and other interventions involved health education, nutrition supplementation, home visits, hormone supplementation, and counselling. A significant improvement of frailty status was demonstrated in 71% (n = 10) of studies and of frailty indicators in 69% (n=22) of studies where measured. Interventions with both muscle strength training and protein supplementation were consistently placed highest for effectiveness and ease of implementation. CONCLUSION A combination of muscle strength training and protein supplementation was the most effective intervention to delay or reverse frailty and the easiest to implement in primary care. A map of interventions was created that can be used to inform choices for managing frailty.
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Van der Elst M, Schoenmakers B, Duppen D, Lambotte D, Fret B, Vaes B, De Lepeleire J. Interventions for frail community-dwelling older adults have no significant effect on adverse outcomes: a systematic review and meta-analysis. BMC Geriatr 2018; 18:249. [PMID: 30342479 PMCID: PMC6195949 DOI: 10.1186/s12877-018-0936-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to some studies, interventions can prevent or delay frailty, but their effect in preventing adverse outcomes in frail community-dwelling older people is unclear. The aim is to investigate the effect of an intervention on adverse outcomes in frail older adults. METHODS A systematic review and meta-analysis of Medline, Embase, the Cochrane Library, and Social Sciences Citation Index. Randomized controlled studies that aimed to treat frail community-dwelling older adults, were included. The outcomes were mortality, hospitalization, formal health costs, accidental falls, and institutionalization. Several sub-analyses were performed (duration of intervention, average age, dimension, recruitment). RESULTS Twenty-five articles (16 original studies) were included. Six types of interventions were found. The pooled odds ratios (OR) for mortality when allocated in the experimental group were 0.99 [95% CI: 0.79, 1.25] for case management and 0.78 [95% CI: 0.41, 1.45] for provision information intervention. For institutionalization, the pooled OR with case management was 0.92 [95% CI: 0.63, 1.32], and the pooled OR for information provision intervention was 1.53 [95% CI: 0.64, 3.65]. The pooled OR for hospitalization when allocated in the experimental group was 1.13 [95% CI: 0.95, 1.35] for case management. Further sub-analyses did not yield any significant findings. CONCLUSION This systematic review and meta-analysis does not provide sufficient scientific evidence that interventions by frail older adults can be protective against the included adverse outcomes. A sub-analysis for some variables yielded no significant effects, although some findings suggested a decrease in adverse outcomes. TRIAL REGISTRATION Prospero registration CRD42016035429 .
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Affiliation(s)
- Michael Van der Elst
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001, B-3000 Leuven, Belgium
| | - Birgitte Schoenmakers
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001, B-3000 Leuven, Belgium
| | - Daan Duppen
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
| | - Deborah Lambotte
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
| | - Bram Fret
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001, B-3000 Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle-aux-champs 30, B-1200 Brussels, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001, B-3000 Leuven, Belgium
| | - D-SCOPE Consortium
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001, B-3000 Leuven, Belgium
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle-aux-champs 30, B-1200 Brussels, Belgium
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Bunn F, Goodman C, Jones PR, Russell B, Trivedi D, Sinclair A, Bayer A, Rait G, Rycroft-Malone J, Burton C. Managing diabetes in people with dementia: a realist review. Health Technol Assess 2018; 21:1-140. [PMID: 29235986 DOI: 10.3310/hta21750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Dementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes. OBJECTIVES To identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research. DESIGN Realist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders. PARTICIPANTS Twenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference. DATA SOURCES The following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing - UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA). RESULTS We included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context-mechanism-outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia. LIMITATIONS There is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven. CONCLUSIONS This review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes. STUDY REGISTRATION This study is registered as PROSPERO CRD42015020625. FUNDING The NIHR HTA programme.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, UK
| | - Antony Bayer
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Chris Burton
- School of Healthcare Sciences, Bangor University, Bangor, UK
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Nielsen LM, Maribo T, Kirkegaard H, Petersen KS, Oestergaard LG. Development of a complex intervention aimed at reducing the risk of readmission of elderly patients discharged from the emergency department using the intervention mapping protocol. BMC Health Serv Res 2018; 18:588. [PMID: 30055597 PMCID: PMC6064169 DOI: 10.1186/s12913-018-3391-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Limitations in performing daily activities and a incoherent discharge are risk factors for readmission of elderly patients after discharge from the emergency department. This paper describes the development and design of a complex intervention whose aim was to reduce the risk of readmission of elderly patients discharged from the emergency department. Methods The intervention was described using the Intervention Mapping approach. In step 1, a needs assessment was conducted to analyse causes of readmission. In steps 2 and 3, expected improvements in terms of intervention outcomes, performance objectives and change objectives were specified and linked to selected theory- and evidence-based methods. In step 4, the specific intervention components were developed; and in step 5, an implementation plan was described. Finally, in step 6, a plan for evaluating the effectiveness of the intervention was described. The intervention was informed by input from a literature search, informal interviews and an expert steering group. Results A three-phased theory- and evidence-based intervention was developed. The intervention consisted of 1) assessment of performance of daily activities, 2) defining a rehabilitation plan and 3) a follow-up home visit the day after discharge with focus on enhancing the patients’ performance of daily activities. Conclusion The intervention mapping protocol was found to be a useful method to describe and systemize this theory- and evidence-based intervention. Electronic supplementary material The online version of this article (10.1186/s12913-018-3391-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise Moeldrup Nielsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark. .,Department of Occupational Therapy, VIA University College, Aarhus, Denmark.
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region , Aarhus, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR) Department of Clinical Medicin, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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25
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Gwyther H, Bobrowicz-Campos E, Luis Alves Apóstolo J, Marcucci M, Cano A, Holland C. A realist review to understand the efficacy and outcomes of interventions designed to minimise, reverse or prevent the progression of frailty. Health Psychol Rev 2018; 12:382-404. [DOI: 10.1080/17437199.2018.1488601] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Holly Gwyther
- The Centre for Ageing Research, Lancaster University, Lancaster, UK
| | | | | | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- previously IRCCS Ca'Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - Carol Holland
- The Centre for Ageing Research, Lancaster University, Lancaster, UK
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26
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Bossola M, Marzetti E, Di Stasio E, Monteburini T, Cenerelli S, Mazzoli K, Parodi E, Sirolli V, Santarelli S, Ippoliti F, Nebiolo PE, Bonomini M, Melatti R, Vulpio C. Prevalence and associated variables of post-dialysis fatigue: Results of a prospective multicentre study. Nephrology (Carlton) 2018; 23:552-558. [DOI: 10.1111/nep.13059] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 12/29/2022]
Affiliation(s)
| | - Emanuele Marzetti
- Department of Geriatric and Gerontology; Catholic University; Rome Italy
| | - Enrico Di Stasio
- Department of Clinical Chemistry; Catholic University; Rome Italy
| | | | | | | | | | | | | | | | | | | | | | - Carlo Vulpio
- Hemodialysis Service; Catholic University; Rome Italy
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27
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Nielsen LM, Maribo T, Kirkegaard H, Petersen KS, Lisby M, Oestergaard LG. Effectiveness of the "Elderly Activity Performance Intervention" on elderly patients' discharge from a short-stay unit at the emergency department: a quasi-experimental trial. Clin Interv Aging 2018; 13:737-747. [PMID: 29731615 PMCID: PMC5927350 DOI: 10.2147/cia.s162623] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To examine the effectiveness of the Elderly Activity Performance Intervention on reducing the risk of readmission in elderly patients discharged from a short-stay unit at the emergency department. Patients and methods The study was conducted as a nonrandomized, quasi-experimental trial. Three hundred and seventy-five elderly patients were included and allocated to the Elderly Activity Performance Intervention (n=144) or usual practice (n=231). The intervention consisted of 1) assessment of the patients’ performance of daily activities, 2) referral to further rehabilitation, and 3) follow-up visit the day after discharge. Primary outcome was readmission (yes/no) within 26 weeks. The study was registered in ClinicalTrial.gov (NCT02078466). Results No between-group differences were found in readmission. Overall, 44% of the patients in the intervention group and 42% in the usual practice group were readmitted within 26 weeks (risk difference=0.02, 95% CI: [−0.08; 0.12] and risk ratio=1.05, 95% CI: [0.83; 1.33]). No between-group differences were found in any of the secondary outcomes. Conclusion The Elderly Activity Performance Intervention showed no effectiveness in reducing the risk of readmission in elderly patients discharged from a short-stay unit at the emergency department. The study revealed that 60% of the elderly patients had a need for further rehabilitation after discharge.
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Affiliation(s)
- Louise Moeldrup Nielsen
- Department of Occupational Therapy, VIA University College.,Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital
| | - Thomas Maribo
- Department of Public Health, Aarhus University, DEFACTUM
| | - Hans Kirkegaard
- Department of Clinical Medicine, Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus
| | | | - Marianne Lisby
- Department of Clinical Medicine, Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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28
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Nielsen TL, Andersen NT, Petersen KS, Polatajko H, Nielsen CV. Intensive client-centred occupational therapy in the home improves older adults' occupational performance. Results from a Danish randomized controlled trial. Scand J Occup Ther 2018; 26:325-342. [PMID: 29325486 DOI: 10.1080/11038128.2018.1424236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is growing interest in enabling older adults' occupational performance. We tested whether 11 weeks of intensive client-centred occupational therapy (ICC-OT) was superior to usual practice in improving the occupational performance of home-dwelling older adults. METHODS An assessor-masked randomized controlled trial among adults 60 + with chronic health issues, who received or applied for homecare services. Recruitment took place September 2012 to April 2014. All participants received practical and personal assistance and meal delivery as needed. In addition, they were randomized to receive either a maximum 22 sessions of occupation-based ICC-OT (N = 59) or to receive usual practice with a maximum three sessions of occupational therapy (N = 60). The primary outcome was self-rated occupational performance assessed with the Canadian Occupational Performance Measure (COPM). RESULTS No important adverse events occurred. ICC-OT was accepted by 46 participants (88%), usual practice by 60 (100%). After 3 months, the ICC-OT-group had improved 1.86 points on COPM performance; the Usual-Practice group had improved 0.61 points. The between-group difference was statistically significant (95% confidence interval 0.50 to 2.02), t-test: p = 0.001. CONCLUSIONS ICC-OT improved older adults' occupational performance more effectively than usual practice. This result may benefit older adults and support programmatic changes.
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Affiliation(s)
- Tove Lise Nielsen
- a Section for Clinical Social Medicine and Rehabilitation, Department of Public Health , Aarhus University , Aarhus , Denmark.,b Department of Occupational Therapy , VIA University College , Aarhus , Denmark.,c DEFACTUM Central Denmark Region , Aarhus , Denmark
| | - Niels Trolle Andersen
- d Section for Biostatistics, Department of Public Health , Aarhus University , Aarhus , Denmark
| | - Kirsten Schultz Petersen
- e Department of Health Science and Technology, The Faculty of Medicine, Public Health and Epidemiology Group , Aalborg University , Aalborg , Denmark
| | - Helene Polatajko
- f Department of Occupational Science and Occupational Therapy, and Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada
| | - Claus Vinther Nielsen
- a Section for Clinical Social Medicine and Rehabilitation, Department of Public Health , Aarhus University , Aarhus , Denmark.,c DEFACTUM Central Denmark Region , Aarhus , Denmark
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29
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Koolhaas CM, Dhana K, van Rooij FJA, Schoufour JD, Hofman A, Franco OH. Physical Activity Types and Health-Related Quality of Life among Middle-Aged and Elderly Adults: The Rotterdam Study. J Nutr Health Aging 2018; 22:246-253. [PMID: 29380852 DOI: 10.1007/s12603-017-0902-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Physical activity (PA) is associated with health-related quality of life (HRQL). The specific PA types that provide beneficial effects in an older population remain unclear. We assessed the association of total PA, walking, cycling, domestic work, sports and gardening with HRQL in middle-aged and elderly adults. DESIGN Cross-sectional study. SETTING Rotterdam, the Netherlands. PARTICIPANTS 5,554 participants, with a mean age of 69 years. MEASUREMENTS Total PA was categorized in five groups to evaluate the dose-response effect of PA and specific PA types were categorized in tertiles. HRQL was measured with the EuroQoL 5-dimension. The outcome of every HRQL domain (i.e. mobility, self-care, daily activities, pain and mood) was expressed as having any problems versus not having problems. Logistic and linear regression analyses were used, adjusting for confounders, to examine associations of total PA and PA types with HRQL domains. RESULTS In both middle-aged (<65 years) and elderly adults (>65 years), we found a dose-response association between total PA and better HRQL (i.e. lower odds of having problems in HRQL domains). In the middle-aged, sports was the only PA type associated with lower odds of having problems with all HRQL domains. In the elderly, all PA types were associated with less problems with HRQL domains, but cycling contributed most to the beneficial effect. CONCLUSIONS Total PA was associated with better HRQL. Sports and cycling were the activity types that contributed most to this association in the middle-aged and elderly, respectively. Since PA levels tend to decline with aging, cycling and sports should be promoted with the aim to improve HRQL.
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Affiliation(s)
- C M Koolhaas
- Chantal M. Koolhaas, MSc, Department of Epidemiology - Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands, Tel. +31 10 7043484,
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30
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Bunn F, Goodman C, Reece Jones P, Russell B, Trivedi D, Sinclair A, Bayer A, Rait G, Rycroft-Malone J, Burton C. What works for whom in the management of diabetes in people living with dementia: a realist review. BMC Med 2017; 15:141. [PMID: 28750628 PMCID: PMC5532771 DOI: 10.1186/s12916-017-0909-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/04/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD. METHODS This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories and their validation with a purposive sample of stakeholders. Twenty-six stakeholders - user/patient representatives, dementia care providers, clinicians specialising in diabetes or dementia and researchers - took part in interviews, and 24 participated in a consensus conference. RESULTS We included 89 papers. Ten focused on PLWD and diabetes, and the remainder related to people with either dementia, diabetes or other long-term conditions. We identified six context-mechanism-outcome configurations which provide an explanatory account of how interventions might work to improve the management of diabetes in PLWD. This includes embedding positive attitudes towards PLWD, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. An overarching contingency emerged concerning the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. CONCLUSIONS Evidence highlighted the need for personalised care, continuity and family-centred approaches, although there was limited evidence that this happens routinely. This review suggests there is a need for a flexible service model that prioritises quality of life, independence and patient and carer priorities. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to their needs. TRIAL REGISTRATION PROSPERO, CRD42015020625. Registered on 18 May 2015.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | | | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, LU1 3UA, UK
| | - Antony Bayer
- Division of Population Medicine, Cardiff University, Cardiff, Wales, CF10 3AT, LL57 2EF, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | | | - Christopher Burton
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
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Singapore Healthy Older People Everyday (HOPE) Study: Prevalence of Frailty and Associated Factors in Older Adults. J Am Med Dir Assoc 2017. [PMID: 28623152 DOI: 10.1016/j.jamda.2017.04.020] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the context of a rapidly ageing population, Singapore is anticipating a rise in multimorbidity, disability, and dependency, which are driven by physical frailty. Healthy Older People Everyday (HOPE) is an epidemiologic population-based study on community-dwelling older adults aged 65 years and older in Singapore. OBJECTIVE To investigate the prevalence of frail and prefrail states and their association with polypharmacy, multimorbidity, cognitive and functional status, and perceived health status among community-dwelling older adults in Singapore. METHODS Participants for HOPE were older adults aged 65 years and older recruited from a cohort study on the northwest region of Singapore. Analysis was performed on data collected from a combination of interviewer-administered questionnaires (including FRAIL scale, EQ-5D, Mini Mental State Examination, Barthel index, and Lawton IADL scale), clinical assessments, and physical measurements (including hand grip strength and Timed-Up-and-Go [TUG] test). RESULTS A total of 1051 older adults (mean age 71.2 years) completed the study. More than half (57.2%) were female. The prevalence of frailty and prefrailty was 6.2% and 37%, respectively. Frailty was associated with older age, female gender, Indian (instead of Chinese) ethnicity, multimorbidity, polypharmacy, cognitive and functional impairment, weaker hand grip strength, longer TUG times, and poor perceived health status. Those with underlying cognitive impairment and frailty were at greater risk of adverse health outcome. CONCLUSION Frailty is a complex health state with multiple domains and dimensions. In our study in a multiethnic Asian population, we identified nonmodifiable factors and modifiable risk factors (multimorbidity, polypharmacy, cognitive and functional impairment) that were associated with frailty. Interventions will have to be multipronged and will require a collaborated effort in order to effect change and improve the health span in rapidly ageing populations.
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Henchoz Y, Büla C, Guessous I, Santos-Eggimann B. Association between Physical Frailty and Quality of Life in a Representative Sample of Community-Dwelling Swiss Older People. J Nutr Health Aging 2017; 21:585-592. [PMID: 28448091 DOI: 10.1007/s12603-016-0772-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Though the association between physical frailty and health is well established, little is known about its association with other domains of quality of life (QoL). This study investigated the association between physical frailty and multiple domains of QoL in community-dwelling older people. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Data of the 2011 annual assessment of 927 older people (age 73-77 years) from the Lc65+ cohort study were used. MEASUREMENTS Physical frailty was assessed by Fried's five criteria: 'shrinking'; 'weakness'; 'poor endurance, exhaustion'; 'slowness'; and 'low activity'. QoL was assessed using 28 items yielding a QoL score and seven domain-specific QoL subscores (Feeling of safety; Health and mobility; Autonomy; Close entourage; Material resources; Esteem and recognition; and Social and cultural life). Low QoL (QoL score or QoL subscores in the lowest quintile) was used as dependent variable in logistic regression analyses adjusted for age and sex (model 1), and additionally for socioeconomic (model 2) and health (model 3) covariates. RESULTS Physical frailty was associated with a low QoL score, as well as decreased QoL subscores in all seven specific domains, even after adjusting for socio-economic covariates. However, when performing additional adjustment for health covariates, only the domain Health and mobility remained significantly associated with physical frailty. Among each specific Fried's criteria, 'slowness' had the strongest association with a low QoL score. CONCLUSION Physical frailty is associated with all QoL domains, but these associations are largely explained by poor health characteristics. Longitudinal studies are needed to better understand temporal relationships between physical frailty, health and QoL.
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Affiliation(s)
- Y Henchoz
- Yves Henchoz; Institute of Social and Preventive Medicine (IUMSP), University of Lausanne Hospital Centre, Route de la Corniche 10, CH-1010 Lausanne, Switzerland; ; Tel.:+41 21 314 84 23; Fax: +41 21 314 97 67
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Nielsen TL, Petersen KS, Nielsen CV, Strøm J, Ehlers MM, Bjerrum M. What are the short-term and long-term effects of occupation-focused and occupation-based occupational therapy in the home on older adults’ occupational performance? A systematic review. Scand J Occup Ther 2016; 24:235-248. [DOI: 10.1080/11038128.2016.1245357] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tove Lise Nielsen
- Division of Rehabilitation, DEFACTUM, Central Denmark Region, Aarhus, Denmark
- VIA Department of Occupational Therapy, Aarhus, Denmark
| | | | - Claus Vinther Nielsen
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Denmark
| | - Janni Strøm
- Division of Rehabilitation, DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Silkeborg Regional Hospital, Interdisciplinary Research Unit, Elective Surgery Center, Denmark
| | | | - Merete Bjerrum
- Division of Rehabilitation, DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Section for Nursing Science, Aarhus University, Denmark
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