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Crocker TF, Lam N, Ensor J, Jordão M, Bajpai R, Bond M, Forster A, Riley RD, Andre D, Brundle C, Ellwood A, Green J, Hale M, Morgan J, Patetsini E, Prescott M, Ramiz R, Todd O, Walford R, Gladman J, Clegg A. Community-based complex interventions to sustain independence in older people, stratified by frailty: a systematic review and network meta-analysis. Health Technol Assess 2024; 28:1-194. [PMID: 39252602 PMCID: PMC11403382 DOI: 10.3310/hnrp2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Background Sustaining independence is important for older people, but there is insufficient guidance about which community health and care services to implement. Objectives To synthesise evidence of the effectiveness of community services to sustain independence for older people grouped according to their intervention components, and to examine if frailty moderates the effect. Review design Systematic review and network meta-analysis. Eligibility criteria Studies: Randomised controlled trials or cluster-randomised controlled trials. Participants: Older people (mean age 65+) living at home. Interventions: community-based complex interventions for sustaining independence. Comparators: usual care, placebo or another complex intervention. Main outcomes Living at home, instrumental activities of daily living, personal activities of daily living, care-home placement and service/economic outcomes at 1 year. Data sources We searched MEDLINE (1946-), Embase (1947-), CINAHL (1972-), PsycINFO (1806-), CENTRAL and trial registries from inception to August 2021, without restrictions, and scanned reference lists. Review methods Interventions were coded, summarised and grouped. Study populations were classified by frailty. A random-effects network meta-analysis was used. We assessed trial-result risk of bias (Cochrane RoB 2), network meta-analysis inconsistency and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation for network meta-analysis). Results We included 129 studies (74,946 participants). Nineteen intervention components, including 'multifactorial-action' (multidomain assessment and management/individualised care planning), were identified in 63 combinations. The following results were of low certainty unless otherwise stated. For living at home, compared to no intervention/placebo, evidence favoured: multifactorial-action and review with medication-review (odds ratio 1.22, 95% confidence interval 0.93 to 1.59; moderate certainty) multifactorial-action with medication-review (odds ratio 2.55, 95% confidence interval 0.61 to 10.60) cognitive training, medication-review, nutrition and exercise (odds ratio 1.93, 95% confidence interval 0.79 to 4.77) and activities of daily living training, nutrition and exercise (odds ratio 1.79, 95% confidence interval 0.67 to 4.76). Four intervention combinations may reduce living at home. For instrumental activities of daily living, evidence favoured multifactorial-action and review with medication-review (standardised mean difference 0.11, 95% confidence interval 0.00 to 0.21; moderate certainty). Two interventions may reduce instrumental activities of daily living. For personal activities of daily living, evidence favoured exercise, multifactorial-action and review with medication-review and self-management (standardised mean difference 0.16, 95% confidence interval -0.51 to 0.82). For homecare recipients, evidence favoured the addition of multifactorial-action and review with medication-review (standardised mean difference 0.60, 95% confidence interval 0.32 to 0.88). Care-home placement and service/economic findings were inconclusive. Limitations High risk of bias in most results and imprecise estimates meant that most evidence was low or very low certainty. Few studies contributed to each comparison, impeding evaluation of inconsistency and frailty. Studies were diverse; findings may not apply to all contexts. Conclusions Findings for the many intervention combinations evaluated were largely small and uncertain. However, the combinations most likely to sustain independence include multifactorial-action, medication-review and ongoing review of patients. Some combinations may reduce independence. Future work Further research is required to explore mechanisms of action and interaction with context. Different methods for evidence synthesis may illuminate further. Study registration This study is registered as PROSPERO CRD42019162195. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128862) and is published in full in Health Technology Assessment; Vol. 28, No. 48. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Thomas Frederick Crocker
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Natalie Lam
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Joie Ensor
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Magda Jordão
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ram Bajpai
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Matthew Bond
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Richard D Riley
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Deirdre Andre
- Research Support Team, Leeds University Library, University of Leeds, Leeds, West Yorkshire, UK
| | - Caroline Brundle
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Alison Ellwood
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Green
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Matthew Hale
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jessica Morgan
- Geriatric Medicine, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Eleftheria Patetsini
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Matthew Prescott
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ridha Ramiz
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Oliver Todd
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rebecca Walford
- Geriatric Medicine, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Gladman
- Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Inflammation and Recovery Sciences, University of Nottingham and Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Fan CW, Drumheller K, Rodriguez M. Examining Patient Outcomes at a Faculty-Led Clinic for Uninsured and Underserved Clients. Am J Occup Ther 2023; 77:7704205170. [PMID: 37595280 DOI: 10.5014/ajot.2023.050024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023] Open
Abstract
IMPORTANCE Routine measurements used in clinical settings can foster evidence-based interventions and show the treatment effectiveness. OBJECTIVE To examine the efficacy of occupational therapy services for health outcomes, as determined by modified self-care and mobility items of the Continuity Assessment Record and Evaluation Tool, also known as Section GG. DESIGN Retrospective and longitudinal. Data were obtained from medical records at four time points over 1 yr. SETTING The study took place at a pro bono, faculty-led clinic. PARTICIPANTS Ninety-one client charts were reviewed; 64 (70%) clients met the inclusion criteria and were enrolled. INTERVENTIONS Interventions were provided by registered occupational therapists and entry-level occupational therapy students under supervision. OUTCOMES AND MEASURES Self-care and mobility function were measured using modified GG0130 and GG0170 items from the Centers for Medicare & Medicaid Services Quality Reporting Program; three additional functional items were added. The 36-Item Short Form Health Survey, Version 2® (SF-36v2) was used to evaluate clients' quality of life at intake. RESULTS Self-care and mobility composites significantly improved throughout the 1-yr intervention period. The additional functional composite significantly improved during the first 6 mo. Clients' scores on the physical function subdomain of the SF-36v2 were significantly related to their self-care, mobility, and additional functional items. CONCLUSIONS AND RELEVANCE Faculty-led clinics can improve the occupational performance of clients in need of occupational therapy services, particularly in the areas of self-care and mobility, which have previously been identified as top priorities for clients. What This Article Adds: This study addressed health disparities in unique and effective ways. By using objective measures of functional mobility and self-care, the study provides robust evidence of the faculty-led clinic's impact in providing underserved and uninsured communities with effective client-centered occupational therapy services.
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Affiliation(s)
- Chia-Wei Fan
- Chia-Wei Fan, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, AdventHealth University, Orlando, FL;
| | - Kathryn Drumheller
- Kathryn Drumheller, MS, OTR/L, is Staff Therapist, Legacy Healthcare Services, Orange City, FL, and PRN Occupational Therapist, Encompass Health, Altamonte Springs, FL. Drumheller was Research Assistant, Department of Occupational Therapy, AdventHealth University, Orlando, FL, at the time this research was completed
| | - Milly Rodriguez
- Milly Rodriguez, OTR/L, is Clinical Faculty, Department of Occupational Therapy, and Director, HOPE Clinic, AdventHealth University, Orlando, FL
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Wolff JL, Peereboom D, Hay N, Polsky D, Ornstein KA, Boyd CM, Samus QM. Advancing the Research-to-Policy and Practice Pipeline in Aging and Dementia Care. THE PUBLIC POLICY AND AGING REPORT 2023; 33:22-28. [PMID: 36873958 PMCID: PMC9976701 DOI: 10.1093/ppar/prac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 06/18/2023]
Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danielle Peereboom
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadia Hay
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel Polsky
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine A Ornstein
- Center for Equity in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Quincy M Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Janssen TI, Voelcker-Rehage C. Leisure-time physical activity, occupational physical activity and the physical activity paradox in healthcare workers: A systematic overview of the literature. Int J Nurs Stud 2023; 141:104470. [PMID: 36966711 DOI: 10.1016/j.ijnurstu.2023.104470] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Physical activity positively influences cardiovascular health. Results from male-dominated physically active occupations suggest that a high level of occupational physical activity may be detrimental to cardiovascular health. This observation is referred to as the physical activity paradox. Whether this phenomenon can also be observed in female-dominated occupations remains unknown. OBJECTIVE We aimed to provide an overview of (1) leisure-time and occupational physical activity in healthcare workers. Therefore, we reviewed studies (2) to assess the relationship between the two physical activity domains and analyzed (3) their effects on cardiovascular health outcomes in relation to the paradox. METHODS Five databases (CINAHAL, PubMed, Scopus, Sportdiscus, Web of Science) were systematically searched. Both authors independently screened the titles, abstracts, and full texts and assessed the quality of the studies using the National Institutes of Health's quality assessment tool for observational cohort and cross-sectional studies. All studies that assessed leisure-time and occupational physical activity in healthcare workers were included. The two authors independently rated the risk of bias using the ROBINS-E tool. The body of evidence was evaluated using the GRADE approach. RESULTS The review included 17 studies that assessed the leisure-time and occupational physical activity of people working in healthcare, determined the relationship between the domains (n = 7) and/or examined their effects on the cardiovascular system (n = 5). Measurements for leisure-time and occupational physical activity varied between studies. Leisure-time physical activity typically ranged between low and high intensity, with a short duration (approx. 0.8-1.5 h). Occupational physical activity was typically performed at light to moderate intensity with a very long duration (approx. 0.5-3 h). Moreover, leisure-time and occupational physical activity were almost negatively related. The few studies investigating effects on cardiovascular parameters revealed a rather unfavorable effect of occupational physical activity, while leisure-time physical activity was beneficial. The study quality was rated as fair and the risk of bias was moderate to high. The body of evidence was low. CONCLUSIONS This review confirmed that leisure-time and occupational physical activity of healthcare workers are opposed in their duration and intensity. Moreover, leisure-time and occupational physical activity seem to be negatively related and should be analyzed according to their relation to each other in specific occupations. Furthermore, results support the relationship between the paradox and cardiovascular parameters. REGISTRATION Preregistered on PROSPERO (CRD42021254572). Date of registration on PROSPERO: 19 May 2021. TWEETABLE ABSTRACT Does occupational physical activity adversely affect the cardiovascular health of healthcare workers in comparison to leisure-time physical activity?
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Affiliation(s)
- Tanja I Janssen
- Neuromotor Behavior and Exercise, Department of Sport and Exercise Sciences, University of Münster, Wilhelm-Schickard-Straße 8, 48149 Münster, Germany.
| | - Claudia Voelcker-Rehage
- Neuromotor Behavior and Exercise, Department of Sport and Exercise Sciences, University of Münster, Wilhelm-Schickard-Straße 8, 48149 Münster, Germany.
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Clair CA, Sandberg SF, Scholle SH, Willits J, Jennings LA, Giovannetti ER. Patient and provider perspectives on using goal attainment scaling in care planning for older adults with complex needs. J Patient Rep Outcomes 2022; 6:37. [PMID: 35416628 PMCID: PMC9008078 DOI: 10.1186/s41687-022-00445-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assess the feasibility of using goal attainment scaling (GAS) in care planning for older adults with complex needs. GAS is an individualized approach to goal setting and follow up using a quantified scale. To date, little is known about the feasibility of GAS among this population. METHODS We conducted a qualitative study with a sample of 28 older adults and 23 providers from diverse settings to evaluate the value and challenges of this approach. We conducted semi-structured interviews and iteratively coded and analyzed interview transcripts for themes related to value, challenges, and implementation. RESULTS Most older adults and providers reported that the GAS approach added value to the care encounter. GAS supported collaboration and patient accountability for their goals, though it could be demotivating to some patients. Some older adults and providers noted that GAS could be confusing and that it was uncomfortable to talk about negative outcomes (i.e., the - 2 and - 1 boxes of the scale). Factors that facilitated implementation included using visual copies of the GAS forms, having an established patient-provider relationship, practicing the approach, and having previous goal-related clinical training. CONCLUSIONS GAS was feasible to implement across diverse settings, and, despite challenges, both older adults and providers reported that it added value to care planning encounters with the potential to improve delivery of person-centered care. Further efforts to demonstrate the applicability and benefit of this method for older adults are warranted, particularly to address implementation of the approach.
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Affiliation(s)
- Catherine A Clair
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Shana F Sandberg
- NORC at the University of Chicago, 4350 East-West Highway, Bethesda, MD, 20814, USA
| | - Sarah H Scholle
- National Committee for Quality Assurance, 1100 13th St, NW, Washington, DC, 20005, USA
| | - Jacqueline Willits
- National Committee for Quality Assurance, 1100 13th St, NW, Washington, DC, 20005, USA
| | - Lee A Jennings
- Reynolds Section of Geriatric Medicine, University of Oklahoma Health Sciences Center, 1122 N.E. 13th Street, ORB 1200, Oklahoma City, OK, 73117, USA
| | - Erin R Giovannetti
- MedStar Health Economics and Aging Research Institute, MedStar Health Research Institute, 5601 Loch Raven Boulevard, Baltimore, MD, 21239, USA
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Taylor JL, Drazich BF, Roberts L, Okoye S, Rivers E, Wenzel J, Wright R, Beach MC, Szanton SL. Pain in low-income older women with disabilities: a qualitative descriptive study. J Women Aging 2020; 32:402-423. [PMID: 32475259 DOI: 10.1080/08952841.2020.1763895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this qualitative study was to identify how low-income older women with disabilities perceive pain, pain management, and communication with healthcare providers. We interviewed 26 low-income women (average age 75 years; SD 7.0), eliciting the following overarching themes: "Invisibility of Pain: Unnoticed or Undetected," "Escalating Pain Leads to Help Seeking," "Communication with Healthcare Providers and Outcomes," "Pain Management Facilitates Function and Accomplishment," and "The Intersection of Pain, Disability, and Depressive Symptoms." Study findings support the ways in which behavior changes from pain can impede pain management.
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Affiliation(s)
- Janiece L Taylor
- School of Nursing, Johns Hopkins University , Baltimore, Maryland, USA
| | | | - Laken Roberts
- School of Nursing, Johns Hopkins University , Baltimore, Maryland, USA
| | - Safiyyah Okoye
- Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland, USA
| | - Emerald Rivers
- School of Nursing, Johns Hopkins University , Baltimore, Maryland, USA
| | - Jennifer Wenzel
- School of Nursing, Johns Hopkins University , Baltimore, Maryland, USA
| | - Rebecca Wright
- School of Nursing, Johns Hopkins University , Baltimore, Maryland, USA
| | | | - Sarah L Szanton
- School of Nursing, Johns Hopkins University , Baltimore, Maryland, USA.,Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland, USA
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Rietkerk W, Uittenbroek RJ, Gerritsen DL, Slaets JPJ, Zuidema SU, Wynia K. Goal planning in person-centred care supports older adults receiving case management to attain their health-related goals. Disabil Rehabil 2019; 43:1682-1691. [PMID: 31589075 DOI: 10.1080/09638288.2019.1672813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Care for older adults should preferably be provided in a person-centred way that includes goal planning. The aim of the present cohort study is to gain an insight into the results of goal planning, in a person-centred care setting for community-living older adults. MATERIALS AND METHODS Within Embrace, a person-centred and integrated care service, older adults set goals with the aim to improve health-related problems. For every goal, they rated severity scores ranging from 0 (no problem) to 10 (extremely severe): a baseline score, a target score and, within one year, an end score to evaluate these goals. The differences between baseline and end scores (goal progress) and target and end scores (goal attainment), and the percentage of goals attained were calculated and compared between health-related domains (i.e., mental health, physical health, mobility, and support). RESULTS Among 233 older adults, 836 goal plans were formulated of which 74% (95% Confidence Interval: 71-77) were attained. Goals related to physical health were the most likely to be attained and goals for mobility and pain the least likely. CONCLUSIONS Older adults are able to attain health-related goals through collaborative goal planning. We recommend future integrated care programmes for older adults to incorporate goal-planning methods to achieve person-centred care.IMPLICATIONS FOR REHABILITATIONOlder adults experiencing frailty or complex care needs and receiving individual support within an integrated care setting are able to formulate and attain goals using goal planning with severity scores.Goal plans of community-living older adults mostly aim at improving health-related problems concerning physical health, mobility, or support.Goals related to physical health are the most likely to be attained, while goals for mobility and pain are the least likely to be attained.
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Affiliation(s)
- Wanda Rietkerk
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ronald J Uittenbroek
- Department of Health and Social Studies, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care and Radboud Alzheimer Centre, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Joris P J Slaets
- Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Leyden Academy on Vitality and Ageing, Leiden, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Klaske Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Dickson KL, Toto PE. Feasibility of Integrating Occupational Therapy Into a Care Coordination Program for Aging in Place. Am J Occup Ther 2019; 72:7204195020p1-7204195020p7. [PMID: 29953832 DOI: 10.5014/ajot.2018.031419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined the feasibility and benefit of integrating occupational therapy into a long-term services and supports (LTSS) care coordination program for aging in place. METHOD Clients referred to occupational therapy during a 16-wk trial were evaluated with the In-Home Occupational Performance Evaluation and received education on strategies for aging in place. Clients who indicated readiness for change were assisted in setting personalized goals with goal attainment scaling and received four additional occupational therapy visits. RESULTS Of the program's feasibility benchmarks, 87% were met. Twenty-three clients were referred, and 16 clients were evaluated; 37.5% of those evaluated indicated readiness for change, establishing 18 goals with 100% goal attainment. CONCLUSION Integration of occupational therapy into an LTSS care coordination program was feasible. Benefits of adding occupational therapy included a performance-based evaluation that revealed personal factors as barriers to aging in place and gave access to a client-centered service to maximize independence.
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Affiliation(s)
- Kelly L Dickson
- Kelly L. Dickson, CScD, OTR/L, is Occupational Therapist, UPMC Centers for Rehab Services, Pittsburgh, PA
| | - Pamela E Toto
- Pamela E. Toto, PhD, OTR/L, BCG, FAOTA, is Associate Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA;
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Yun D, Choi J. Person-centered rehabilitation care and outcomes: A systematic literature review. Int J Nurs Stud 2019; 93:74-83. [DOI: 10.1016/j.ijnurstu.2019.02.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 11/15/2022]
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Taylor JL, Roberts L, Hladek MD, Liu M, Nkimbeng M, Boyd CM, Szanton SL. Achieving self-management goals among low income older adults with functional limitations. Geriatr Nurs 2019; 40:424-430. [PMID: 30799154 DOI: 10.1016/j.gerinurse.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 11/29/2022]
Abstract
Although self-management interventions can improve symptoms and disease among older adults, there is a dearth of literature on how self-management behaviors may improve factors related to the older adults' physical function. To fill this gap in the literature, we describe the patient-directed self-management goals in nursing visits that relate to physical function as part of a multi-component program. We analyze the self-management goals and outcomes of 367 low- income older adults with functional limitations who participated in the CAPABLE program: a program to reduce the health effects of impaired physical function in low-income older adults. We focus on the following self-management goals that participants chose with the nurses: pain management, depressive symptoms, incontinence, fall prevention, and communication with healthcare providers. The majority of participants chose pain (50%) or fall prevention (51%) as goals and partially or fully met their goals. Improvements across these areas may lead to improved physical function.
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Affiliation(s)
- Janiece L Taylor
- Johns Hopkins School of Nursing, USA; Johns Hopkins School of Nursing Center of Innovative Care in Aging, USA.
| | | | | | - Minhui Liu
- Johns Hopkins School of Nursing, USA; Johns Hopkins School of Nursing Center of Innovative Care in Aging, USA
| | | | | | - Sarah L Szanton
- Johns Hopkins School of Nursing, USA; Johns Hopkins School of Nursing Center of Innovative Care in Aging, USA
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Spoelstra SL, Sikorskii A, Gitlin LN, Schueller M, Kline M, Szanton SL. Dissemination of the CAPABLE Model of Care in a Medicaid Waiver Program to Improve Physical Function. J Am Geriatr Soc 2018; 67:363-370. [DOI: 10.1111/jgs.15713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sandra L. Spoelstra
- Kirkhof College of NursingGrand Valley State University Grand Rapids Michigan
| | - Alla Sikorskii
- Department of Psychiatry and Department of Statistics and ProbabilityMichigan State University East Lansing Michigan
| | - Laura N. Gitlin
- College of Nursing and Health ProfessionsDrexel University Philadelphia Pennsylvania
| | - Monica Schueller
- Kirkhof College of NursingGrand Valley State University Grand Rapids Michigan
| | - Margaret Kline
- Kirkhof College of NursingGrand Valley State University Grand Rapids Michigan
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Howard EP, Louvar KE. Examining Life Goals of Community-Dwelling, Low-Income Older Adults. Res Gerontol Nurs 2017; 10:205-214. [PMID: 28926668 PMCID: PMC5890925 DOI: 10.3928/19404921-20170831-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/11/2017] [Indexed: 11/20/2022]
Abstract
Self-care and self-management programs are touted as a means to age successfully. Yet, these programs pay little regard to a critical first step-the personal goals of older adults. The capacity to self-identify goals and pursue actions toward goal achievement transcends age. An examination of life goals identified by community-dwelling, low-income older adults indicates that functional performance mechanisms are valued. Maintenance of health and increased physical activity were the two most commonly identified personal goals within a sample of 161 community-dwelling older adults residing in subsidized housing. A third goal, increased socialization, aligns with relevant psychosocial factors and reflects the need to engage with others. The preferences of the older adult placed at the center of the care planning process strategically support goal attainment. Providing an opportunity to create and pursue self-selected life goals of older adults is worth consideration when developing and testing interventions designed to support successful aging. [Res Gerontol Nurs. 2017; 10(5):205-214.].
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