The effectiveness of tele-transitions of care interventions in high-risk older adults: A systematic review and meta-analysis

Determinants of Having Online Health Consultations During the COVID-19 Pandemic Among Middle-Aged and Older Adults in Germany: Representative Longitudinal Survey Study

Background

During the COVID-19 pandemic, telemedicine services represented a widely implemented alternative to in-person doctor and therapist appointments. Consequently, rates of telemedicine use rapidly increased worldwide, also in Germany. Research regarding longitudinal determinants of telemedicine use is needed, particularly from nationally representative German samples, to improve understanding of the use behavior of major target groups such as middle-aged and older adults.

Objective

This study aimed to longitudinally investigate determinants of online health consultation use among middle-aged and older individuals during the COVID-19 pandemic in Germany.

Methods

Nationally representative longitudinal data of German middle-aged and older adults (≥46 years old) were taken from the German Ageing Survey (DEAS). Data from the Compact Survey (conducted between June and July 2020) and wave 7 (conducted between November 2020 and March 2021) of the DEAS were observed (pooled analytic sample N=5456). Having experienced consultations with doctors or therapists on online platforms served as the outcome measure. Associations with socioeconomic, health- and health behavior-related, psychological, and COVID-19-related determinants were tested using random effects logistic regressions.

Results

In our sample, 49% (2673/5456) of participants were female and the mean age of the participants was 67.8 (SD 9.4) years. Past experience with online health consultations was reported by 10.3% (561/5456) of the sample. Online health consultation use was associated with high education (OR 1.43, 95% CI 1.06-1.93; P=.02), poor self-rated health (OR 0.60, 95% CI 0.49-0.75; P<.001), and higher frequency of physical activity (reference: low frequency; medium frequency: OR 1.58, 95% CI 1.15-2.17; P=.005; high frequency: OR 1.73, 95% CI 1.09-2.76; P=.02). Moreover, greater levels of loneliness (OR 1.43, 95% CI 1.06-1.93; P=.04) and life satisfaction (OR 1.33, 95% CI 1.02-1.73; P=.04) as well as perceiving the COVID-19 crisis as a greater personal threat (OR 1.08, 95% CI 1.01-1.15; P=.02) were associated with having online health consultations during the COVID-19 pandemic.

Conclusions

Online health consultation use does not seem to be exclusively associated with the health of middle-aged and older patients. Study findings emphasize the longitudinal association of education and psychosocial factors as well as health factors with telemedicine use during the COVID-19 pandemic in Germany. This knowledge may help to improve and adapt services to this patient group, which could contribute to higher utilization rates in the future. Future studies are needed to verify these initial findings under postpandemic circumstances and across different countries.

Effects of reminiscence therapy for loneliness in older adults: a systematic review and meta-analysis

BACKGROUND

Loneliness has detrimental effects on the mental well-being of senior citizens. Reminiscence therapies have emerged as a potential intervention to alleviate loneliness. This study aimed to systematically review and quantitatively analyse the effects of reminiscence therapy on loneliness among older adults.

METHODS

A comprehensive search was performed across 11 electronic databases, meta-analyses were used to explore the effectiveness of reminiscence therapy on loneliness among older adults, while multiple subgroup analyses were conducted to explore differences in the effectiveness of different types of reminiscence therapy. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

RESULTS

Twenty-two studies were included in the systematic review meta-analysis. The meta-analysis indicated that reminiscence therapy significantly reduced loneliness in older adults (standard mean difference = -1.52, 95% CI [-2.11, -0.93], P < .01). Subgroup analyses showed significant effects for both simple reminiscence and life review therapy. Group reminiscence therapy was more effective than individual reminiscence therapy, and that reminiscence therapy conducted by professional facilitators was more effective than that led by non-professionals.

CONCLUSIONS

Reminiscence therapy is an effective intervention for reducing loneliness among older adults, highlighting its importance in clinical practice. Future research should explore the best practices for different types of reminiscence therapies, tailored to the personal needs and backgrounds of older adults.

Barriers and Facilitators to Implementing a Nurse-Led Information System for Older Adult Patients' Post-Discharge Self-Care: An Exploratory Sequential Mixed-Methods Study

AIM

To explore determinants impacting an Electronic Health Record-based information system implementation and their association with implementation fidelity based on the Theoretical Domains Framework (TDF) from nurses' perspectives.

DESIGN

Exploratory sequential mixed-method design.

METHODS

In stage one, semi-structured interviews with 53 purposively selected nurses informed the exploration of TDF domains influencing the implementation of the information system with directed content analysis. In stage two, a cross-sectional survey, informed by the qualitative findings, was conducted among 482 nurses to identify the most relevant and relatively important TDF domains by running generalised linear regression models.

RESULTS

The qualitative interviews generated 13 TDF domains that were identified as major influencing factors, including technology characteristics, knowledge, attitudes, role agreement, self-efficacy, goal-setting, information circulation, and communication among nurses. Quantitative findings showed that 70% of nurses used and printed the written form through the information system, and only 34% offered verbal education consistently. Regression analysis identified nine domains that were relevant and important factors for implementation fidelity, including knowledge, skills, role identity, beliefs in consequences, beliefs in capabilities, intentions, goals, memory and decision processes, and environmental context.

CONCLUSION

Our findings confirmed previous evidence on determinants of implementing digital health technologies, including knowledge, competencies, perceived effectiveness, role agreement, intentions, decision processes, and environmental context. Additionally, we highlighted the importance of goal-setting for successful implementation.

IMPACT

This study investigated the relatively important associated factors that can impact the successful implementation of the nurse-led information system for post-acute care based on nurses' perspectives. These results can guide nurse practitioners in implementing similar initiatives and support evidence-based decision-making. Researchers can also further investigate the relationships between the identified determinants.

REPORTING METHOD

Journal Article Reporting Standards for Mixed Methods Research.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Interventions to Support People With HIV Following Hospital Discharge: A Systematic Review

Background

Individuals hospitalized with HIV-related complications face high post-discharge mortality and morbidity, particularly in resource-limited settings. This systematic review evaluated the impact of interventions to reduce post-hospital mortality, lower readmissions, and improve linkage to care.

Methods

We searched the PubMed, Embase, and Cochrane databases up to 1 October 2024 for studies reporting outcomes of post-discharge interventions. Two independent reviewers performed study selection, extracted data, and assessed risk of bias. We pooled data using random effects meta-analysis.

Results

We included 4 randomized controlled trials (conducted in Spain, South Africa, Tanzania, and the United States) and 6 observational studies (Canada, Thailand, Zambia, and the United States). Interventions included pre-discharge counseling, medication review, referral to care, and goal setting, as well as post-discharge follow-up via home visits, telephone calls, and support from social workers or community health workers. Pooled data from randomized controlled trials showed no difference between post-discharge interventions and usual care in mortality, but the estimate was imprecise (relative risk [RR], 0.98; 95% CI, .59-1.63). However, interventions may reduce readmissions (RR, 0.82; 95% CI, .52-1.30) and may slightly improve linkage/retention in care (RR, 1.10; 95% CI, .95-1.27). Observational studies reported similar results, with no mortality effect but potential reductions in readmissions (RR, 0.77; 95% CI, .48-1.25) and improved linkage/retention (RR, 1.42; 95% CI, 1.11-1.81). Interventions were largely feasible, acceptable, and low cost.

Conclusions

Interventions that include pre-discharge care planning and post-discharge follow-up, such as telephone contact and home visits, may improve linkage to care and reduce readmissions. However, interventions were not associated with reduced post-discharge mortality.

Effects of telehealth interventions on the caregiver burden and mental health for caregivers of people with dementia: a systematic review and meta-analysis

OBJECTIVES

To systematically evaluate the effects of telehealth interventions on the caregiver burden and mental health of caregivers for people with dementia (PWD).

METHOD

Relevant randomized controlled trials (RCTs) of telehealth interventions on caregivers were extracted from nine electronic databases (PubMed, The Cochrane Library, Web of Science, Embase, CINAHL, SinoMed, CNKI, WanFang, and VIP). The retrieval time was from inception to 26 July 2023.

RESULTS

Twenty-two articles with 2132 subjects were included in the final analysis. The meta-analysis demonstrated that telehealth interventions exerted a significant effect in reducing caregiver burden (SMD: -0.14, 95 % CI: -0.25, -0.02, p = 0.02), depression (SMD = -0.17; 95%CI: -0.27, -0.07, p < 0.001) and stress (SMD = -0.20, 95%CI: -0.37, -0.04, p = 0.01). However, no statistically significant effect was observed on anxiety (SMD = -0.12, 95%CI: -0.27, 0.03, p = 0.12). Moreover, subgroup analysis showed that tailored interventions were associated with more evident reductions in depression (SMD = -0.26; 95%CI: -0.40, -0.13, p < 0.001) than standardized interventions (SMD = -0.08; 95%CI: -0.22, 0.06, p = 0.25). In addition, telehealth was effective in relieving depression in Internet-based (SMD = -0.17, 95%CI: -0.30, -0.03, p = 0.01) and Telephone-based group (SMD = -0.18, 95%CI: -0.34, -0.02, p = 0.03), while there was no significant difference in the Internet and Telephone-based group (SMD = -0.18, 95%CI: -0.54, 0.18, p = 0.32).

CONCLUSION

Telehealth could effectively reduce the burden and relieve the depression and stress of caregivers of PWD, while its effect on anxiety requires further research. Overall, telehealth has potential benefits in dementia care.

Effect of Tele-exercise Interventions on Quality of Life in Cancer Patients: A Meta-analysis

PURPOSE

To evaluate the impacts of tele-exercise intervention with cancer patients' quality of life, taking into account the influence of the duration of tele-exercise intervention, type of intervention, and gender of cancer patients on quality of life.

METHODS

The PubMed (MEDLINE), Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and PsycINFO databases were searched from inception to August 21, 2023. The Cochrane Collaboration's risk of bias tool 2 was utilized to estimate the risk of bias, and the Grading of Recommendations, Assessment. For statistical analyses, R Studio was employed.

RESULTS

This meta-analysis contained eight trials. When compared to controls, tele-exercise interventions (SMD = 0.41, 95% CI: 0.12 to 0.70, p < .010; I2 = 54%, p = .030) have a positive influence on boosting the quality of life within cancer patients. Subgroup analyses demonstrated the greater effectiveness of tele-exercise in enhancing the quality of life of cancer patients when the duration was greater than or equal to 10 weeks. Furthermore, tele-exercise was found to have a stronger advantageous effect on quality of life among female cancer. In addition, among the types of interventions for tele-exercise, neither web-based nor telephone-based formats significantly enhanced quality of life among cancer patients.

CONCLUSION

Tele-exercise interventions are a cost-effective and feasible non-pharmacologic complementary way to promote cancer patients' quality of life. Additional large-sample, carefully designed randomized controlled trials are warranted to further validate the impact of tele-exercise concerning cancer patients' quality of life.

REGISTRATION NUMBER

CRD42023477147.

The Effect of Education and Monitoring via Tele-Nursing to Elderly Cancer Patients Using Oral Anticancer Agents on Self-efficacy and Medication Adherence: A Randomized Controlled Trial

OBJECTIVES

This study was conducted as a randomized controlled trial to determine the effect of the education and monitoring provided via tele-nursing to elderly cancer patients using oral anticancer agents on their medication treatment adherence self-efficacy and medication adherence.

METHODS

The sample of the study consisted of 60 elderly cancer patients who presented to the oncology outpatient clinics of a medical faculty hospital in Turkey. An Elderly Information Form, the Oral Chemotherapy Adherence Scale, the Medication Adherence Self-Efficacy Scale, a Tele-nursing Evaluation Form, and a Telephone Monitoring Form were used to collect data. Patients in the intervention group were sent text messages and educational videos via WhatsApp® for the first four weeks, and after the fifth week, they were monitored by phone for eight weeks. Data collection tools were applied to the control and intervention groups at weeks 1, 8, and 12. Independent samples t-test, Repeated measurements analysis of variance chi-square test, and Pearson correlation test were used to analyze the data.

RESULTS

In the study, while there was no significant difference between the mean scores of the intervention and control groups on the pretest application of the Oral Chemotherapy Adherence Scale and the Medication Adherence Self-Efficacy Scale (p > .05), a significant difference was found between the mean posttest scores of the groups (p < .05).

CONCLUSIONS

In this study, it was determined that the education and monitoring provided to elderly cancer patients via tele-nursing positively affected their self-efficacy and medication adherence.

IMPLICATIONS FOR NURSING PRACTICE

In line with the research results, it is recommended that nurses use tele-nursing applications in the care of elderly cancer patients using oral anticancer agents.

[Frailty: Prevention]

The Frailty syndrome is usually related to the aging process and chronological age, but it is not an inevitable consequence of it - at least until the final phase of life. Primary care interventions that promote physical activity and nutrition can prevent the progression from pre-frailty to frailty. This article presents the current state of knowledge on primary and secondary prevention of frailty.

Effectiveness of Digital Health Literacy Interventions in Older Adults: Single-Arm Meta-Analysis

BACKGROUND

In a world of rapid digital technology development, the lack of digital health literacy (DHL) among older people cannot be ignored. DHL is becoming an essential competency that can facilitate the health status and health management of older adults. DHL interventions that are feasible and appropriate can be implemented on a large scale through the health care system for older people.

OBJECTIVE

The purpose of this meta-analysis was to assess the effectiveness of DHL interventions for older adults.

METHODS

English publications in PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to November 20, 2022. Two reviewers independently completed the data extraction and quality assessment. Review Manager (version 5.4; Cochrane Informatics & Technology Services) software was used for all meta-analyses.

RESULTS

A total of 7 studies, including 2 randomized controlled trials and 5 quasi-experimental studies, involving 710 older adults were considered eligible. The main outcome was scores on the eHealth Literacy Scale, and secondary outcomes were knowledge, self-efficacy, and skills. Quasi-experimental studies compared baseline and postintervention outcomes, while randomized controlled trials compared pre- and postintervention outcomes in the intervention group. Of the 7 studies, 3 used face-to-face instruction, while 4 adopted web-based interventions. Among them, 4 of the interventions were conducted using theoretical guidance, while 3 were not. Intervention duration varied from 2 to 8 weeks. In addition, the studies included were all conducted in developed countries, mainly in the United States. Pooled analysis presented that DHL interventions had positive effects on eHealth literacy efficacy (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001). Subgroup analysis revealed that DHL interventions that chose face-to-face teaching (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), were guided by a conceptual framework (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), and were sustained over 4 weeks (standardized mean difference 1.1, 95% CI 0.46 to 1.84; P=.001) had a more significant effect. Moreover, the outcomes showed considerable gains in knowledge (standardized mean difference 0.93, 95% CI 0.54 to 1.31; P<.001) and self-efficacy (standardized mean difference 0.96, 95% CI 0.16 to 1.77; P=.02). No statistically significant effect was found for skills (standardized mean difference 0.77, 95% CI -0.30 to 1.85; P=.16). The small number of studies, variable study quality, and heterogeneity are some limitations of this review.

CONCLUSIONS

DHL interventions have positive effects on the health status and health management of older adults. Practical and effective DHL interventions are crucial for the use of modern digital information technology in managing the health of older people.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42023410204; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410204.