Community-based interventions to enhance healthy aging in disadvantaged areas: perceptions of older adults and health care professionals

Community-based interventions to detect visual impairment in community-dwelling older adults aged ≥ 75 years: a systematic review

BACKGROUND

Globally, 2.2 billion individuals live with visual impairment (VI). However, many cases remain undetected, particularly among older adults. Therefore, novel interventions for detection are needed. Community-based interventions (CBIs) that target people where they live provide a promising approach. This systematic review aimed to synthesize the existing literature describing potentials and barriers regarding uptake, feasibility, and effects of CBIs in detecting VI among community-dwelling older adults aged ≥ 75 years.

METHODS

We conducted a mixed methods systematic literature review. PubMed, Scopus, CINAHL, PsycInfo, Cochrane, and Embase were searched for articles with no restrictions on publication date. Studies were eligible if they reported on a CBI to detect VI among older adults aged ≥ 75 years. Two reviewers independently extracted data and appraised the quality and risk of bias of the included studies using the Mixed Methods Appraisal Tool. A narrative meta-synthesis of the relevant evidence was conducted.

RESULTS

We identified 3,019 articles of which 26 of varying methodological quality were included. The VI detection methods included surveys, optometric tests, eye examinations, and self-reported visual status. Potentials and barriers regarding the uptake, feasibility, and effects of the interventions were identified at the individual, interpersonal, and community and system levels. Key potentials that may lead to successful interventions included leveraging community resources, tailoring of interventions, targeting underserved populations, high participant satisfaction, increased accessibility, and the use of tele-ophthalmology technology. Conversely, barriers that may negatively affect intervention uptake, feasibility, and effectiveness included financial constraints, poor general health, lack of eye-health awareness, poor referral systems, lack of institutional resources or access to detection technology, and technological challenges.

CONCLUSION

The synthesized results emphasize the importance of developing CBIs that target multiple levels, including the individual, interpersonal, community and system levels. Our results indicate that this may involve combining components such as eye health education, targeted strategies, use of appropriate detection methodologies, and ensuring affordability. These results may inform the development of novel CBIs to foster more effective detection of VI among older populations, improve community eye health, and reduce the burden of VI.

TRIAL REGISTRATION

CRD42023468155.

Examining the Impact of the Design-Thinking Intergenerational Service-Learning Model on Older Adults' Self-Care Behaviors and Well-Being

The Design-Thinking Intergenerational Service-Learning Model (DTISLM), rooted in the biopsychosocial model, aims to empower older adults to improve their chronic-disease management behavior through tailored programs addressing their specific healthcare needs. This study, conducted in Taiwan, used a convenience sampling method (n = 172) to evaluate the impact of DTISLM on Taiwan's adult day center participants' perception of self-care behaviors, feelings of happiness, depression, and perceived social support using pretest-posttest surveys. The results indicated a significant enhancement in participants' perception of self-care behaviors, reduction in depression score, and improvements in perceived social support following the completion of the program. The findings underscore the efficacy of applying a design-thinking framework in an intergenerational context. Future studies should investigate how the DTISLM can be scaled to various demographics and healthcare settings to enhance its applicability and understand its long-term effects.

Effect of Elderly School Policy on Quality of Life among Thailand's Senior Citizens: A Propensity Score Matching Approach

Background

As Thailand's population ages, promoting senior citizens' quality of life (QoL) is crucial. In 2017, the Ministry of Social Development and Human Security launched the "elderly school" initiative to foster lifelong learning and enhance the QoL among senior citizens. However, comprehensive evaluations of its impact on QoL remain limited.

Methods

This cross-sectional survey aimed to assess the policy's effect on QoL in Phetchabun province, Thailand. Using quota and systematic sampling, 1,374 senior citizens aged 60-80 participated. Propensity score matching (PSM) with a 1:1 match was employed to estimate the average treatment effect (ATE) of attending the elderly school on QoL. Additionally, multiple linear regression was analyzed to assess the association between QoL and its associated factors.

Results

PSM were matched successfully, the standardized difference was less than 10 percent, and the baseline after matching indicated balances with 687 elderly people in each group. The mean QoL score of the non-attending group was 44.40 (SD = 7.11), and that of the attending group was 57.50 (SD = 7.53). The ATE for elderly people attending school was 10.67 scores (95% CI: 9.67 - 11.67 scores) higher than those unattended. Being female, having monthly income higher than 20,000, having employment, having a caregiver, and attendance at elderly school were positively associated with QoL, and the standardized beta coefficients were 0.078, 0.059, 0.094, 0.066, and 0.550, respectively. Additionally, higher education was positively associated with higher QoL.

Conclusion

The elderly school policy significantly enhanced the QoL of the attending senior citizens. Findings suggest continued collaboration among stakeholders to sustain and optimize this policy for improved seniors' QoL, which has the potential to utilize lifelong learning to create an inclusive framework for healthy aging among senior citizens.

'Why do GPs want to come here?': residents' intentions to register with new-coming GPs in a disadvantaged neighbourhood in Copenhagen with a GP shortage: a qualitative study

OBJECTIVE AND INTERVENTION

To explore contextual factors influencing residents' intentions to register with one of the new-coming GPs established as a result of a municipally driven GP coverage intervention in a disadvantaged neighbourhood in Copenhagen with a GP shortage.

DESIGN

A qualitative study design informed by realist methodology was used to conduct the study. Data were obtained through a survey with residents (n = 67), two focus group interviews with residents (n = 21), semi-structured interviews with the project- and local community stakeholders (n = 8) and participant observations in the neighbourhood. The analysis was carried out through systematic text condensation and interpreted and structured by Pawson's layers of contextual influence (infrastructural and institutional). The concept of collective explanations by Macintyre et al. and Wacquant's framework of territorial stigmatisation were applied to analyse and discuss the empirical findings.

SUBJECT AND SETTING

Residents from five local community organisations in a disadvantaged neighbourhood in Copenhagen.

MAIN OUTCOME MEASURES

Infrastructural and institutional contextual factors influencing residents' intentions to register with one of the new-coming GPs.

RESULTS

Infrastructural contextual factors included the national shortage of GPs, the administration fee for registering with a new GP, and the neighbourhood's reputation as being feared and unattractive for GPs to establish themselves. Institutional contextual factors included mistrust towards municipal authorities and the new-coming GPs shared by many residents, the duration without a local GP, GPs' reputation and a perceived lack of information about the GP coverage intervention, and an experience of not being involved.

CONCLUSION AND IMPLICATION

Infrastructural and institutional contextual factors influenced residents' intentions to register with one of the new-coming GPs. The findings will be helpful in adjusting, implementing, and disseminating the intervention and developing and implementing future complex interventions in disadvantaged neighbourhoods.

Effectiveness of a resilience-building nursing intervention on psychological well-being in Arab community-dwelling older adults

BACKGROUND

Psychological resilience plays a crucial role in the well-being of community-dwelling older adults. This study aimed to evaluate the effectiveness of a resilience-building nursing intervention on enhancing psychological well-being in this population.

METHODS

A randomized controlled trial was conducted with 84 community-dwelling older adults in Abha, Saudi Arabia. Participants were randomly assigned to either the intervention group (resilience-building nursing intervention) or the control group (standard care). Psychological resilience and quality of life were assessed using validated scales at baseline, post-intervention, and follow-up.

RESULTS

The intervention group showed significant improvements in psychological resilience (mean difference: +3.2, p = 0.001) and quality of life (mean difference: +5.4, p = 0.002) at follow-up compared to the control group. Factors influencing resilience included age, gender, socioeconomic status, health status, intervention exposure, community engagement, and living arrangements.

CONCLUSION

The resilience-building nursing intervention effectively enhanced psychological well-being among community-dwelling older adults. Integrating such interventions into routine nursing care can promote holistic well-being and enable older adults to thrive within their communities.

Perceptions and experiences of a multi-domain preventive health programme: a qualitative study informing future community-based health interventions in singapore

BACKGROUND

Despite global popularity, Community-based Health Intervention (CBHI) programmes have yet to be fully incorporated into Singapore's public healthcare systems, with most initiatives focusing on specific diseases. This qualitative study aimed to evaluate older adults' perceptions of the "Get Well, Live Well" multi-domain preventive health programme, explore the effectiveness of Community Health Workers (CHWs) in promoting health literacy and modifying health behaviours, and examine participants' experiences in the CHW-delivered CBHI programme.

METHODS

Purposeful sampling was used to recruit study subjects from participants in the "Get Well, Live Well" programme until data saturation was achieved. In-depth, semi-structured, one-to-one telephone interviews were conducted in English or Chinese with participants aged ≥ 40 years. Audio recordings were translated into English as needed and transcribed in full. The collected data were anonymised, and thematic analysis was performed by three trained evaluators using a structured process.

RESULTS

The final study sample included 19 subjects (median age of 64 years; 84% women; and 95% Chinese). Three key themes emerged regarding the programme's value, interactions with CHW, also known as Care Connectors, and their facilitation of health services/behaviours. Participants acknowledged that the "Get Well, Live Well" programme provided physical/emotional support, improved health literacy, and enhanced social interaction. The programme's effectiveness may depend on Care Connector's personal qualities, service quality beyond expectation, connection with participants, and their proactive and authoritative roles in facilitating health services/behaviours.

CONCLUSION

The findings suggest that future Community-based Health Interventions could benefit from deploying CHWs with strong people skills to enhance the programme's success.

Community Paramedicine Program in Social Housing and Health Service Utilization: A Cluster Randomized Clinical Trial

Importance

Community Paramedicine at Clinic (CP@clinic) is a chronic disease prevention program that decreases 911 calls for emergency medical services, but its wider system effects are unknown.

Objective

To evaluate the effects of CP@clinic vs usual care on individual-level health service utilization outcomes.

Design, Setting, and Participants

This open-label, pragmatic cluster randomized clinical trial evaluated all residents 55 years or older in 30 social housing buildings in Ontario, Canada, that had (1) a unique postal code, (2) at least 50 apartments, (3) 60% or more residents 55 years or older, and (4) a similar building for pairing (15 intervention and 15 control buildings, pair-matched randomization). The 12-month intervention had a staggered start date from January 1, 2015, to December 1, 2015, and ended between December 31, 2015, and November 30, 2016. Administrative health data analysis was conducted in May 2022.

Intervention

CP@clinic was a health promotion and disease prevention program led by specially trained community paramedics who held weekly drop-in sessions in social housing buildings. These paramedics conducted 1-on-1 risk assessments, provided health education and referrals to relevant community resources, and, with consent, sent assessments to family physicians. Control buildings received usual care (universal health care, including free primary and specialty medical care).

Main Outcome and Measures

Individual-level health service utilization was measured from administrative health data, with ED visits via ambulance as the primary outcome; secondary outcomes included ED visits for any reason, primary care visits, hospitalizations, length of hospital stay, laboratory tests, receipt of home care, transfer to long-term care, and medication initiation. Generalized estimating equations were used to estimate intervention effects on individual-level health service utilization, accounting for trial design and individual-level baselines.

Results

The 30 social housing buildings had 3695 residents (1846 control and 1849 intervention participants; mean [SD] age, 72.8 [9.1] years; 2400 [65.0%] female). Intention-to-treat analysis found no significant difference in ED visits by ambulance (445 of 1849 [24.1%] vs 463 of 1846 [25.1%]; adjusted odds ratio [AOR], 0.97; 95% CI, 0.89-1.05) but found higher antihypertensive medication initiation (74 of 500 [14.8%] vs 47 of 552 [8.5%]; AOR, 1.74; 95% CI, 1.19-2.53) and lower anticoagulant initiation (48 of 1481 [3.2%] vs 69 of 1442 [4.8%]; AOR, 0.68; 95% CI, 0.53-0.86) in the intervention arm vs the control arm. CP@clinic attendance was associated with higher incidence of primary care visits (adjusted incidence rate ratio, 1.10; 95% CI, 1.03-1.17), higher odds of receiving home care (AOR, 1.07; 95% CI, 1.01-1.13), and lower odds of long-term care transfers (AOR, 0.32; 95% CI, 0.13-0.81).

Conclusions and Relevance

In this cluster randomized clinical trial of CP@clinic, the intervention did not affect the rate of ED visits by ambulance; however, there were increased primary care visits and connections to home care services, which may have increased antihypertensive medication initiation and reduced long-term care transfers from social housing. Health policymakers should consider CP@clinic's impact as an upstream approach to improve care for older adults with low income.

Trial Registration

ClinicalTrials.gov Identifier: NCT02152891.

Life Chances, Subjective Perceptions, and Healthy Lifestyles in Older Adults: Longitudinal Evidence From China

OBJECTIVES

Previous studies and theories show that healthy lifestyles are affected by life chances and subjective perceptions. However, it remains unclear how older adults change between different lifestyle profiles as they age. We proposed the healthy lifestyle duality framework and tested it among older Chinese adults using a longitudinal design.

METHODS

Data were obtained from 4 Chinese Longitudinal Healthy Longevity Surveys conducted between 2008 and 2018 (N = 31,445). Latent transition analysis and hierarchical multinomial growth curve models were performed to investigate healthy lifestyle profiles and their associations with life chances and subjective perceptions over time.

RESULTS

Four distinct healthy lifestyle profiles were identified: healthy, risky, low-standard, and mixed groups, and their changes show path dependency. Across 10 years, the proportion of the healthy group ranged from 11.16% to 16.97%. Both life chances and subjective perceptions were longitudinally associated with healthy lifestyles, with age and cohort effects observed.

DISCUSSION

Our findings support the healthy lifestyle duality framework and reveal that life chances and subjective perceptions influence lifestyle changes over time. Public health policies and health intervention programs should adapt to the specific needs of different age groups and generations.

Social Participation and Loneliness in Older Adults in a Rural Australian Context: Individual and Organizational Perspectives

A rise in aging populations globally calls attention to factors that influence the well-being and health of older adults, including social participation. In Australia, rural older adults face cultural, social, and physical challenges that place them at risk for isolation. Thus, research surrounding social participation and healthy aging is increasingly relevant, especially in rural areas. This qualitative study in a remote town in Western Australia explores barriers and facilitators to older adults' social participation. To investigate multiple perspectives, 23 adults aged 50+ and 19 organizations from a rural town were interviewed. A stakeholder reference group was engaged to refine the research design and validate the findings. Feedback from early interviews was used to refine the data collection process, thus enhancing the validity of the findings. Thematic analysis showed that health and mobility issues, inadequate infrastructure, poor sustainability, and cultural tensions commonly impacted social participation. Themes of rural town culture, cultural power dynamics, and rural stoicism were identified as cultural aspects that inhibited participation. Based on results of this study and the supporting literature, recommendations for inclusive activities include supporting community-designed programs, utilizing culturally sensitive language and personnel, expanding services using existing community resources, and diversifying older adults' roles in existing groups.

Co-designing community-level integral interventions for active ageing: a systematic review from the lens of community-based participatory research

BACKGROUND

While community-level interventions for promoting active ageing have received increasing attention and there is a trend to leverage technology to support traditional physical or social interventions, little hands-on guidance exists for designing these integral interventions. This study aimed to examine the interventions reported in the literature guided by Community-Based Participatory Research (CBPR) principles. The goal is to extract insights that inform future practices in co-designing integral interventions for active ageing.

METHODS

The systematic review focused on community-level interventions promoting active ageing that integrated physical, social, and digital elements, i.e., integral interventions. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The included interventions were analysed abductively based on the CBPR principles.

RESULTS

A total of 13 studies were included, and 24 design considerations were generated under eight categories. Further reflection identified the interrelated nature of these design considerations and pinpointed the gaps in current research. This study highlights the urgency and importance of sharing recruitment methods and resource allocation details, recording and reporting collaboration specifics, and disseminating findings to stakeholders beyond academia.

CONCLUSIONS

This study offers valuable insights and practical guidance to researchers and practitioners developing community-level integral interventions for active ageing. The findings also serve as a starting point for accumulating knowledge and practice in co-designing integral interventions for active ageing at the community level. The next crucial phase involves evaluating these design considerations within real-world cases to assess their applicability and identify potential areas for improvement.

Factors Affecting Health Policies for Older People in Iran

Globally, the number and proportion of people aged 60 years and older is growing fast. As people age, health needs become more complex, and the health system's responsiveness to older people's needs requires evidence-informed policies. Hence, this study explores the factors affecting the health policy development process for older people in Iran. We conducted 32 interviewers with people aged 60 years and older and 21 interviews with key informants involved in policy making related to older people. Qualitative data were analyzed using thematic analysis. Actors and stakeholders, policy structure, selected health policy processes, the health care service delivery system, government financial support, and community and culture building are the most influential factors in health policy making for older people. Government policies and health priority interventions are needed to address these influential factors for older people to ensure healthy aging over the life course.

A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic

BACKGROUND

Health inequities exist within and between societies at different hierarchical levels. Despite overall improvements in health status in European Union countries, disparities persist among socially, economically, and societally disadvantaged individuals. This study aims to develop a holistic model of health determinants, examining the complex relationship between various determinants of health inequalities and their association with health condition.

METHODS

Health inequalities and conditions were assessed at the territorial level of Local Administrative Units (LAU1) in the Czech Republic. A dataset of 57 indicators was created, categorized into seven determinants of health and one health condition category. The necessary data were obtained from publicly available databases. Comparisons were made between 2001-2003 and 2016-2019. Various methods were employed, including composite indicator creation, correlation analysis, the Wilcoxon test, aggregate index calculation, cluster analysis, and data visualization using the LISA method.

RESULTS

The correlation matrix revealed strong relationships between health inequality categories in both periods. The most significant associations were observed between Economic status and social protection and Education in the first period. However, dependencies weakened in the later period, approaching values of approximately 0.50. The Wilcoxon test confirmed variations in determinant values over time, except for three specific determinants. Data visualization identified persistently adverse or worsening health inequalities in specific LAU1, focusing on categories such as Economic status and social protection, Education, Demographic situation, Environmental status, Individual living status, and Road safety and crime. The health condition indices showed no significant change over time, while the aggregate index of health inequalities improved with widened differences.

CONCLUSION

Spatial inequalities in health persist in the Czech Republic, influenced by economic, social, demographic, and environmental factors, as well as local healthcare accessibility. Both inner and outer peripheries exhibit poor health outcomes, challenging the assumption that urban areas fare better. The combination of poverty and vulnerabilities exacerbates these inequalities. Despite the low rates of social exclusion and poverty, regional health inequalities persist in the long term. Effectively addressing health inequalities requires interdisciplinary collaboration and evidence-based policy interventions. Efforts should focus on creating supportive social and physical environments, strengthening the healthcare system, and fostering cooperation with non-medical disciplines.

Ethical challenges in caring for healthy older adults: Qualitative perspectives

BACKGROUND

Healthy aging is one of the essential aspects of a health promotion program in the elderly.

AIM

Exploring ethical challenges in healthy elderly care from the perspective of nurses, older adults, and families in the Iranian context.

RESEARCH DESIGN

This qualitative study was conducted using a content analysis approach in 4 health centers in northeastern Iran from 2017 to 2019. Semi-structured interviews, observation, review of elderly files, and focus groups were used to collect data.

ETHICAL CONSIDERATIONS

The ethics committee of the university approved this study in Iran. This study adhered to the principles of the Helsinki Declaration. Ethical principles autonomy, confidentiality, and anonymity were considered for the participants. Participants were informed about the purpose of the study and submitted written informed consent regarding their participation.

FINDINGS

The central theme was: An unfair approach to caring for healthy older adults. The three categories were as follows: Forgotten human care, disrespect, and lack of a meaningful and trustworthy relationship. The 14 subcategories highlighted the ethical challenges of healthy aging care in health centers.

DISCUSSION

The findings showed that due to nurses' unfamiliarity with the concept of healthy aging, older adults are discriminated against in care centers. Creating a standard care program for healthy older adults ensures that ethical principles are followed for these clients.

CONCLUSION

Various individual and organizational factors lead to an unfair approach to caring for healthy elderly in health centers. The following factors can help improve the care of healthy aging and reduce ethical challenges in this area: Introducing nurses to the concept of healthy old age and its dimensions, creating a community-based approach in health centers, prioritizing health issues over health issues, Involvement of families and older adults in needs assessment-goal setting-implementation and evaluation of health services, and design of home visit programs to provide services to healthy elderly.

Policy requirements in promoting older people health care in Iran: A qualitative study

BACKGROUND

The demographic structure of Iran as a developing country has undergone various changes in recent years. Therefore, the present study sought to analyze policy and upstream documents related to the older people health in Iran in order to identify and analyze the requirements considered by health policymakers to promote the older people health in Iran.

MATERIALS AND METHODS

This is a qualitative study conducted in 2021 through national qualitative document analysis. All upstream documents published and related to older people health were reviewed between February 1979 and October 2021. The Scott's four-step method was used to extract the related documents.

RESULTS

Policy requirements for promoting older people healthcare in Iran were categorized into 4 main themes in the form of a conceptual framework and 15 sub-themes. Thus, in order to ensure the health of the older people in Iran, it is necessary to take into account the four categories of managerial requirements, financing, infrastructures, and providing older people services. In other words, the sustainable financing requirements and the infrastructural requirements should firstly exist together as basic requirements. Then, geriatric health management requirements are needed to provide the older people health services along with the previous requirements and finally ensure the health of the older people in Iran.

CONCLUSION

The results of this study can be helpful in the review of upstream older people health policy documents by policy makers in order to better promote the health of the older people and pave the way for new policies to enter the agenda of policy makers.

Understanding factors affecting implementation success and sustainability of a comprehensive prevention program for cardiovascular disease in primary health care: a qualitative process evaluation study combining RE-AIM and CFIR

AIM

Our aim was to evaluate the implementation process of a comprehensive cardiovascular disease prevention program in general practice, to enhance understanding of influencing factors to implementation success and sustainability, and to learn how to overcome barriers.

BACKGROUND

Cardiovascular disease and its risk factors are the world's leading cause of mortality, yet can be prevented by addressing unhealthy lifestyle behavior. Nevertheless, the transition toward a prevention-oriented primary health care remains limited. A better understanding of factors facilitating or hindering implementation success and sustainability of prevention programs, and how barriers may be addressed, is needed. This work is part of Horizon 2020 project 'SPICES', which aims to implement validated preventive interventions in vulnerable populations.

METHODS

We conducted a qualitative process evaluation with participatory action research approach of implementation in five general practices. Data were collected through 38 semi-structured individual and small group interviews with seven physicians, 11 nurses, one manager and one nursing assistant, conducted before, during, and after the implementation period. We applied adaptive framework analysis guided by RE-AIM Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) and Consolidated Framework for Implementation Research (CFIR).

FINDINGS

Multiple facilitators and barriers affected reach of vulnerable target populations: adoption by primary health care providers, implementation and fidelity and intention to maintain the program into routine practice. In addition, our study revealed concrete actions, linked to implementation strategies, that can be undertaken to address identified barriers. Prioritization of prevention in general practice vision, ownership, and shared responsibility of all team members, compatibility with existing work processes and systems, expanding nurse's roles and upskilling competence profiles, supportive financial and regulatory frameworks, and a strong community - health care link are crucial to increase implementation success and long-term maintenance of prevention programs. COVID-19 was a major barrier to the implementation. RE-AIM QuEST, CFIR, and participatory strategies are useful to guide implementation of prevention programs in primary health care.

A Qualitative Inquiry of Older Afghan Refugee Women's Individual and Sociocultural Factors of Health and Health Care Experiences in the United States

INTRODUCTION

Approximately 132,000 Afghans have resettled in the United States since the 1980s and are now aging. As older adults, sociocultural factors influence health and health-related behaviors. This study aimed to explore older Afghan refugee women's perceptions of individual and sociocultural factors of health and health care experiences.

METHODS

A focused ethnography methodology was conducted with 27 semi-structured interviews with older Afghan refugee women, family members, and community key informants in Southern California. Recorded interviews were transcribed and analyzed using inductive thematic analysis.

RESULTS

Five themes were identified as key to health promotion in the post-migration setting: (a) health promotion through Islam, (b) the centrality of family, (c) ongoing stressors that impact health, (d) needing support in navigating health services, and (e) miscommunication leading to mistrust of health care providers.

DISCUSSION

Health interventions should consider social and cultural contexts and faith-based and family-centered approaches when addressing older Afghan refugee women's long-term health and well-being.

Social relations and health in an ethnically diverse social housing area selected for large structural changes compared to municipal levels: a Danish survey study

BACKGROUND

This study aims to describe demographics, social relations and health in an ethnically diverse social housing area selected to undergo large structural changes and compare it to the surrounding municipality. Furthermore, to explore the association between social relations and self-rated health (SRH) and the interaction with country of origin in both populations.

METHODS

Data sources include a multilingual interviewer-driven survey study in a social housing area (N = 209) and a municipal health survey (N = 1,638) among residents aged 45 + years. Information on social relations include contact frequency with and support from family, friends, and neighbors. Descriptive and multivariate logistic regression analyses adjusted for age, sex, and country of origin are presented, as well as joint effect analyses of social relations and country of origin on SRH.

RESULTS

In the social housing area, 38.8% of the respondents reported poor SRH compared to 19.5% in the municipality. In both study populations low contact frequency was associated with poor SRH, however insignificantly in the social housing area compared to the municipality sample, OR = 1.50 (0.65-3.46) vs. OR = 2.42 (1.70-3.45). Joint exposure to having non-Western background and low contact frequency was strongly associated with poor SRH in the social housing area, OR = 6.28 (1.80-21.89) but less so in the municipality, OR = 3.67 (1.55-8.69). The same tendency was seen regarding low support from social relations.

CONCLUSIONS

This study provides insight to a population that is generally underrepresented in survey studies. In the social housing area, approximately twice as many reported poor SRH compared to the municipality data. In both populations, low contact frequency and low support were associated with poor SRH. Residents with weak social relations and non-Western origin simultaneously were more likely to report poor SRH in the social housing area specifically but less so in the municipality, indicating a higher vulnerability among the residents in the social housing area.

Health and wellness for disadvantaged older adults: The AFRESH pilot study

Introduction

Older adults are unaware of the biological mechanisms that contribute to the development of disabilities, chronic conditions, and frailty, yet, when made aware, desire to employ lifestyle changes to mitigate these conditions. We developed the AFRESH health and wellness program and report on pilot testing undertaken in a local older adults apartment community.

Materials and methods

After program development, pilot testing was conducted. Participants: Older adults (N = 20; age 62+) residing in an apartment community. Procedures: Collection of baseline objective and self-report measures with a focus on physical activity; administration of the 10-week AFRESH program via weekly sessions; collection of follow-up data 12 and 36 weeks after baseline data collection. Data analysis: Descriptive statistics, growth curve analyses.

Results

Significant increases were observed for grip strength (lbs) (T1:56.2; T2:65.0 [d = 0.77]; T3:69.4 [d = 0.62], p = .001), the 6-min walk test (meters) (T1:327m: T2:388.7 m [d = 0.99]; T3:363.3 m [d = 0.60], p = .001), the Rapid Assessment of Physical Activity (RAPA) strength and flexibility score, and the Pittsburg Sleep Quality Index (PSQI) global score. These effects showed some attenuation by the final time point.

Conclusion

By combining novel educational content (bioenergetics), facilitation of physical activity, and habit formation, AFRESH is a multicomponent intervention that shows promise for future research.

Association Between Urban Regeneration and Healthcare-Seeking Behavior of Affected Residents: A Natural Experiment in two Multi-Ethnic Deprived Housing Areas in Denmark

Area regeneration of deprived neighborhoods is being used to reduce health inequality, socioeconomic deprivation and ethnic segregation. This quasi-experimental study examines if long-term graded exposure to urban regeneration is associated with primary healthcare-seeking behavior among residents. We compared general practitioner (GP) contacts from 2015-2020 in two adjacent, deprived social housing areas, one exposed to area regeneration. Populations were into Western and non-Western males and females aged 15 years and older (N = 3,960). Mean annual GP contact frequency for each group were estimated and a difference-in-difference (DiD) analysis was conducted with adjustments for propensity scores based on baseline characteristics. GP contact frequency increased for all groups across time with a systematically higher level and faster increase in the control groups. In particular, the mean difference between the exposed and control area for non-Western women more than doubled from -0.61 to -1.47 annual contacts across the period. The mean differences in contact frequency increased for all groups but results of the DiD analyses were insignificant. In conclusion, an emerging gap in GP contact frequency, with the highest levels in the control area, was observed for all comparisons across time. More long-term research is needed to understand how the emerging gaps evolve.

The association between social integration and neighborhood dissatisfaction and unsafety: a cross-sectional survey study among social housing residents in Denmark

Background

Social integration and perceived neighborhood environment are recognized as important social determinants of health. However, little is known about the association between social integration and perceived neighborhood environment among underrepresented population groups, such as residents in disadvantaged neighborhoods, in public health research. The aim of this study is to: 1) Describe the levels of social integration and 2) Investigate the association between social integration and neighborhood dissatisfaction and unsafety among middle-aged and older social housing residents.

Methods

A multilingual face-to-face interviewer-administrated survey questionnaire was conducted among 206 residents aged 45 years and above (response rate: 34.1%) of various nationalities in disadvantaged socioeconomic positions in a social housing area in Denmark. The assessment of social integration was based on cohabitation status, frequency of face-to-face and non-face-to-face interaction with social relations and participation in local association activities. Neighborhood dissatisfaction measured the level of dissatisfaction with the neighborhood, and neighborhood unsafety assessed the level of unsafety being outdoors in the neighborhood. Descriptive statistics were conducted to illustrate respondent characteristics and the distribution of social integration among the study population. Logistic regression models were applied to analyze associations between social integration and neighborhood dissatisfaction and unsafety, adjusted for age, sex, country of origin, educational attainment and employment status.

Results

In total, 23.8% of the respondents reported low levels of social integration. A medium level of social integration was associated with higher odds of neighborhood dissatisfaction (OR: 2.36; 95% CI: 1.04–5.38) compared to the highest level of integration. A low frequency of face-to-face interaction was associated with higher odds of neighborhood dissatisfaction (OR: 2.65; 95% CI: 1.16–6.06) and neighborhood unsafety (OR: 2.41; 95% CI: 1.04–5.57) compared to the highest frequency of face-to-face interaction.

Conclusions

Almost one-fourth of respondents reported low levels of social integration. A medium level of social integration was associated with neighborhood dissatisfaction. A low frequency of face-to-face interaction was associated with neighborhood dissatisfaction and unsafety. The results suggest that targeted health promotion interventions designed to foster face-to-face interaction, hold potential to reduce neighborhood dissatisfaction and unsafety among residents in disadvantaged neighborhoods.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00945-9.

Prevention of Cardiovascular Diseases in Community Settings and Primary Health Care: A Pre-Implementation Contextual Analysis Using the Consolidated Framework for Implementation Research

Cardiovascular diseases are the world’s leading cause of mortality, with a high burden especially among vulnerable populations. Interventions for primary prevention need to be further implemented in community and primary health care settings. Context is critically important to understand potential implementation determinants. Therefore, we explored stakeholders’ views on the evidence-based SPICES program (EBSP); a multicomponent intervention for the primary prevention of cardiovascular disease, to inform its implementation. In this qualitative study, we conducted interviews and focus groups with 24 key stakeholders, 10 general practitioners, 9 practice nurses, and 13 lay community partners. We used adaptive framework analysis. The Consolidated Framework for Implementation Research guided our data collection, analysis, and reporting. The EBSP was valued as an opportunity to improve risk awareness and health behavior, especially in vulnerable populations. Its relative advantage, evidence-based design, adaptability to the needs and resources of target communities, and the alignment with policy evolutions and local mission and vision, were seen as important facilitators for its implementation. Concerns remain around legal and structural characteristics and intervention complexity. Our results highlight context dimensions that need to be considered and tailored to primary care and community needs and capacities when planning EBSP implementation in real life settings.

Group-based nutrition interventions to promote healthy eating and mobility in community-dwelling older adults: a systematic review

OBJECTIVE

To identify the efficacy of group-based nutrition interventions to increase healthy eating, reduce nutrition risk, improve nutritional status and improve physical mobility among community-dwelling older adults.

DESIGN

Systematic review. Electronic databases MEDLINE, CINAHL, EMBASE, PsycINFO and Sociological Abstracts were searched on July 15, 2020 for studies published in English since January 2010. Study selection, critical appraisal (using the Joanna Briggs Institute's tools) and data extraction were performed in duplicate by two independent reviewers.

SETTING

Nutrition interventions delivered to groups in community-based settings were eligible. Studies delivered in acute or long-term care settings were excluded.

PARTICIPANTS

Community-dwelling older adults aged 55+ years. Studies targeting specific disease populations or promoting weight loss were excluded.

RESULTS

Thirty-one experimental and quasi-experimental studies with generally unclear to high risk of bias were included. Interventions included nutrition education with behaviour change techniques (BCT) (e.g. goal setting, interactive cooking demonstrations) (n 21), didactic nutrition education (n 4), interactive nutrition education (n 2), food access (n 2) and nutrition education with BCT and food access (n 2). Group-based nutrition education with BCT demonstrated the most promise in improving food and fluid intake, nutritional status and healthy eating knowledge compared with baseline or control. The impact on mobility outcomes was unclear.

CONCLUSIONS

Group-based nutrition education with BCT demonstrated the most promise for improving healthy eating among community-dwelling older adults. Our findings should be interpreted with caution related to generally low certainty, unclear to high risk of bias and high heterogeneity across interventions and outcomes. Higher quality research in group-based nutrition education for older adults is needed.

Healthy Lifetime (HL): An Internet-Based Behavioral Health Coaching Protocol for Older Adults

By 2060, the number of Americans 65 years and older will more than double, comprising nearly one-quarter of the population in the United States. While there are many advantages to living longer, a byproduct of aging is also a growing incidence of chronic illness and functional health limitations associated with a concurrent rise in chronic disease and disability that impair independent living in the community. We describe a personalized, behavioral health coaching protocol for early intervention that is delivered online to enhance a participant's independent functioning and to increase their self-care capacity with a goal to maintain independent living throughout aging. The electronic platform provides secure access to fillable surveys, health tracking, “just in time” communication with coaches and scheduling of two-way videos launched from the platform site. The 2-month protocol used two-way video conferencing which allowed high fidelity communication to sustain a complex behavioral intervention. Participants indicate high satisfaction with the intervention, the use of the platform, and the technology. While many health systems across the U.S. have ramped up virtual delivery of care in a proactive manner with now more than 70% of out-patient visits conducted through virtual delivery modes in some health systems, there remains much unevenness in this capability across the U.S. Our approach is to create a stable, interoperable, virtual outreach system for personalized professional health coaching that is complementary to medically oriented services that supports the health and functioning of participants as they age.

Effect of a 12-week community-based intervention to improve social capital, quality of life, self-care, and health literacy among older people: A quasi-experimental trial

Introduction:

The aim of this study was to assess the effect of a community-based intervention on social capital, quality of life, self-care, and health literacy among elderly.

Materials and Methods:

This quasi-experimental trial was conducted at two health-care centers in Isfahan, Iran, which assigned to the intervention and control groups. A total of 86 elderly (60 years or above) enrolled in the study. The intervention program consisted of 12 weekly group sessions with various health topics. Nine sessions held in the health-care center and three local tours in different locations of the neighborhood. The control group received routine care of health centers. Social capital, quality of life, self-care, and health literacy were assessed at baseline and 1 month after the intervention in two groups.

Results:

Mental component of quality of life (P = 0.026), self-care, and health literacy (P < 0.001) showed a significant increase in the intervention group compared to the control group at 1 month after the intervention. The total score of social capital and the dimensions of local community participation, social agency, feelings of security and trust, interactions with neighbors, and interactions with family and friends improved in the intervention group (P < 0.001). However, there was no significant difference in the dimensions of tolerance of diversity (P = 0.241) and value of life (P = 0.928).

Conclusions:

This community-based interventions with a variety of diverse and participatory components can be used as a strategy to promote the health of the elderly in primary health care.

Prioritizing supports and services to help older adults age in place: A Delphi study comparing the perspectives of family/friend care partners and healthcare stakeholders

Background

Aging in place (AIP) is a policy strategy designed to help older adults remain in their community. While planners internationally have modified aspects of the older adult care continuum (e.g., home care, assisted living, nursing homes) to facilitate AIP, further improvements to community-based supports and services are also required. This study compared and constrasted the community-based factors (e.g., supports, services and personal strategies or characteristics) that family/friend care partners and healthcare stakeholders (i.e., planners/providers) view as most important to help older adults successfully AIP.

Methods

An initial list of factors shown to influence AIP was created from the academic literature. These factors were used to develop a Delphi survey implemented separately on care partners and healthcare stakeholders. Respondents rated the importance of each factor using a 10-point Likert Scale (1 = not important; 10 = absolutely critical). Consensus in each group was defined when at least 80% of participants scored a factor ≥8 (“very important”), with an interquartile range ≤2. Respondents suggested additional factors during Delphi round one.

Results

Care partners (N = 25) and healthcare stakeholders (N = 36) completed two and three Delphi rounds, respectively. These groups independently agreed that the following 3 (out of 27) factors were very important to help older adults age in place: keeping one’s home safe, maintaining strong inter-personal relationships, and coordinating care across formal providers. While healthcare stakeholders did not reach consensus on other factors, care partners agreed that 7 additional factors (e.g., access to affordable housing, having mental health programs) were important for AIP.

Conclusions

Compared to healthcare stakeholders, care partners felt that more and diverse community-based factors are important to support older adults to successfully AIP. Future research should replicate these findings in other jurisdictions, examine the availability and accessibility of the priority factors, and develop sustainable solutions to enhance their effectiveness.

Challenges and lessons learnt from conducting a health survey in an ethnically diverse population

Aim: To document the challenges of developing and executing an interviewer-driven survey questionnaire in an ethnically diverse and deprived social housing area undergoing reconstruction in Denmark. Methods: The survey was initially planned to be conducted in three waves (before, during and after reconstruction of the housing area), based on a questionnaire covering health, wellbeing and social relations. The first two waves took place in 2018 and 2019 (invited n=~600 per wave) and the third wave will be conducted once the reconstruction is finalised. The approach to the third wave is under revision by the research team. The questionnaire was translated from Danish into the seven most common languages in the housing area. A bilingual interview team went door to door interviewing residents. Field notes were collected systematically during each wave to document the process. Results: The response rates were 35% (n=209) and 22% (n=132) for waves 1 and 2, respectively. There was an overall decrease in response rates between waves 1 and 2 for all language groups, but particularly for Arabic and Turkish-speaking men. The most frequently stated reasons for non-participation included illness and language barriers. The key lessons learnt were that overcoming linguistic and cultural barriers to conducting research among residents in this social housing area requires time and resources. Conclusions: Several challenges are associated with conducting a survey in ethnically diverse and deprived social housing areas. Documenting the challenges and learning from experience are both important, in order to include this hard-to-reach population in health research.

Elder abuse risk factors: Perceptions among older Chinese, Korean, Punjabi, and Tamil immigrants in Toronto

Objectives

Elder abuse is a significant concern worldwide. Several factors are reported to increase the risk for elder abuse, but little is known about which factors are most relevant to immigrant communities. This study explored perceptions of risk factors for elder abuse among older immigrants, which is the first step toward designing effective interventions.

Methods

This cross-sectional quantitative study was conducted between 2017 and 2019 in the Greater Toronto Area, Ontario, Canada and involved a convenience sample (N = 173) of older women and men from Chinese, Korean, Punjabi, and Tamil immigrant communities. Participants completed a questionnaire about the frequency and importance of risk factors of elder abuse in their respective community. Descriptive statistics were used to analyze the data within each immigrant community and analysis of variance to compare the factor ratings across communities.

Results

The immigrant communities differed (p < .05) in their perception of the risk factors. Factors rated as frequent and important (x̅ > 2.0 – midpoint of the rating scale) were social isolation, financial dependence, and lack of knowledge of English for Korean; financial dependence, physical dependence, and emotional dependence for Chinese; lack of knowledge of English, emotional dependence, and physical dependence for Tamil; and social isolation for Punjabi.

Conclusion

The findings highlight the need for collaboration among public health and social services to work with immigrant communities in co-designing interventions to address these key risk factors and thereby reduce the risk of elder abuse.

Targeting preventive home visits to older adults in disadvantaged communities: Perspectives of professionals

This study explored the implementation of multidimensional preventive home visits targeted to older adults living in a disadvantaged community in Denmark. The intervention was adapted to include the following key components: involvement of community members in recruitment processes; a combination of individual and group-based dissemination; adaptation of materials to overcome language barriers; and diversity-sensitivity training for professionals. The study took place over 12 months between August 2016 and August 2017 and used various data sources: registry-based data, participant observations, combined with individual and focus group interviews with the target population (n = 22) and relevant health care professionals (n = 8). Here, we report on findings pertaining to implementation barriers and facilitators as seen from the perspective of professionals. Socioeconomic vulnerability was prominent, and uptake of health care services was low, indicating under-utilisation. Implementation facilitators and barriers were identified including potentials in nurturing local partnerships and proximity during recruitment; overcoming language barriers; offering diversity-sensitivity training for professionals; and a need for a more multidisciplinary, comprehensive scope of preventive visits for diverse older adults in disadvantaged communities. Thus, more focus on participatory, comprehensive and community-based health promotion are needed to ensure healthy ageing in the context of social inequality and ethnic diversity.

A Study on Supply-Demand Satisfaction of Community-Based Senior Care Combined with the Psychological Perception of the Elderly

Based on Maslow’s hierarchy of needs theory and customer satisfaction theory, we constructed a satisfaction model for supply–demand satisfaction for community-based senior care (SSCSC) combined with the psychological perspective of the elderly, and four dimensions of basic living needs (BLNs), living environment (LE), personal traits (PTs), and livability for the aged (LA) were selected to construct the model. The data were obtained from 296 questionnaires from seniors over 50 years old (or completed by relatives on their behalf, according to their actual situation). Twenty-two observed variables were selected for the five latent variables, and their interactions were explored using structural equation modeling. The results showed that LA was the most significant factor influencing SSCSC, and it was followed by BLNs and LE. PTs did not show a direct effect on LA, but they could have an indirect effect on SSCSC through influencing BLNs and LE. Based on the current state of community aging satisfaction, we propose to establish a community elderly care service system based on the basic needs of the elderly population, providing differentiated and refined elderly care services and improving the level of aging-friendly communities. This study provides references for the government to formulate relevant policies and other supply entities to make strategic decisions and has important implications for further enhancing community elderly services to become an important part of the social security system for the elderly.

Efficacy of community-based self-care interventions to improve biophysical, psychosocial or behavioural outcomes among community-dwelling older adults with type 2 diabetes: A systematic review and meta-analysis

AIMS

This review assessed the efficacy of self-care interventions to improve biophysical, psychosocial or behavioural outcomes among older adults with diabetes.

METHODS

Computerised and manual searches were performed. A total of 18 randomised control trials were included in the review, of which eight were subsequently included in the meta-analysis.

RESULTS

Most studies were from the United States of America and adopted a collaborative approach with participants. The specific needs of older adults were often not considered, and there was a predominance of biophysical measures. Meta-analysis revealed that among intervention condition participants, there were improvements in HbA1c (pooled weighted mean difference (WMD) -0.33, 95%CI -0.48 to -0.17), systolic blood pressure (WMD -1.55, 95%CI -2.93 to -0.18), diastolic blood pressure (WMD -1.41 95%CI -2.08 to -0.20), triglyceride (WMD -13.25, 95%CI -23.31 to -3.20), high-density lipoprotein (WMD 2.05, 95%CI 1.04 to 3.06) and Diabetes Self-Care Activities score (mean 4.10, 95%CI 3.11 to 5.10) compared to the control group. There was no significant change for low-density lipoprotein (WMD -5.93, 95%CI -12.08 to 0.22).

CONCLUSIONS

While continuing to adopt a collaborative approach, future self-care interventions should incorporate psychosocial and behavioural outcomes, consider the specific needs of older adults, and focus on more ethnically diverse populations.

Towards Inclusive Healthcare Delivery: Potentials and Challenges of Human-Centred Design in Health Innovation Processes to Increase Healthy Aging

National healthcare systems need to adjust services and operations to accommodate the needs of complex, aging populations living with multimorbidity and polypharmacy. This paper suggests the use of a human-centred design as a method to engage older adults and key professionals in innovation processes aiming to design person-centred healthcare services and improve quality of life in older adults. We outline three innovation phases and highlight how such processes can create engagement and new insights on how life experiences of older adult's shape preferences, beliefs, and habits. It is important to incorporate these insights into the design of successful strategies for ensuring age-friendly healthcare services. Our viewpoint is contextualised through a small-scale case study focusing on polypharmacy in older adults. From this case study, we extracted three challenges to producing co-designed health research: recruitment, time and resources, and funding. We discuss how to address these challenges. We argue for the involvement of older adults and professional stakeholders at an early stage in the design process to align expectations and to increase the likelihood of successful implementation of healthcare innovations that improve the quality of life for older adults.

Social Relations, Community Engagement and Potentials: A Qualitative Study Exploring Resident Engagement in a Community-Based Health Promotion Intervention in a Deprived Social Housing Area

Emerging evidence points towards a lower quality of life, fragile social relations and suboptimal health behavior and status of residents living in social housing areas characterized by ethnic diversity and socioeconomic deprivation. Community-based health promotion interventions developed in collaboration with the target group and adjusted to the local context can affect the acceptance of and engagement in such interventions. However, few studies have investigated the potential of community-based interventions in deprived social housing areas. This study explores residents’ perspectives on engagement in a community-based health promotion intervention focusing on enhancing social relations. The study builds on qualitative methods including participant observations combined with pre- and post-intervention interviews with a selected group of residents (n = 9). Data were thematically analyzed with focuses on participation in an everyday life context, concepts of othering, and territorial stigmatization. Engagement in the intervention was motivated by the need to establish and enhance social relations, and to explore the world outside the housing area. However, barriers including cultural and language differences among residents, and competing contextual factors, challenged engagement. We conclude that participatory community-based interventions have a potential to enhance social relations in deprived social housing areas. However, adequate support and efforts to overcome the identified barriers are needed.

Community-Based Healthcare Programs Sustainability Impact on the Sustainability of Host Organizations: A Structural Equation Modeling Analysis

The sustainability of community-based programs represents a major focus of the literature on community-based interventions in the last few decades. However, without sustainable host organizations to effectively implement them, many are prone to failure. This paper analyzes the influence of the sustainability factors of healthcare community-based programs on the host organization’s sustainability. Based on a sample of 11 community-based healthcare programs and 401 respondents and using structural equation modeling, the study investigated if program specific, organization specific, and community specific factors are indeed measures of community-based programs’ sustainability, if social and economic dimensions are measures of host organization sustainability, and if the sustainability of the community-based program influences thee host organization’s sustainability. The results confirmed all three research hypothesis. The main contribution of the paper is to demonstrate a direct relationship between the sustainability of community-based programs and the overall sustainability of the organizations implementing them.

Ethnic inequality within the elderly population in utilizing healthcare services

The accessibility of minority ethnic groups to healthcare services is challenging in many societies, most especially among the elderly population. Elderly individuals from minority groups have been found to have lower levels of utilizing healthcare services, including preventive care, intensive hospital care, advanced technological procedures and rehabilitation. Universal health coverage is incapable of addressing all of healthcare's access inequities and there is a need to assess the overall outcomes, including mortality rates over time, functionality of discharged patients, quality of life and/or unplanned readmissions that may indicate low quality hospital discharge processes. There is a need to investigate the impact of perceived trust/distrust in the healthcare system of elderly patients from minority ethnicities on their willingness to consume medical services.To ensure equity in service provision, there is a need to examine whether medical providers, even unconsciously, prioritize vital services, such as rehabilitation services to populations that share similar social backgrounds. An essential measure is enhancement of health literacy at all levels, from the individual to policy-makers and strategic adoption of health literacy programs that encompass all ethnicities, considering their respective needs, norms and expectations.Ethnic equality in accessing medical services is crucial in view of the numerous migrants and asylum-seekers who look for refuge in varied societies globally. Such populations are perceived as faring worse in healthcare quality of care, and this highlights the need to adapt the healthcare systems to the varied health behaviors, contextual factors, language barriers, lower health literacy levels and limited access to timely care. Improving equity and access to medical care is dependent on enhanced health literacy; policies that consider diverse needs of majority and minority groups; and advanced research. Concurrent implementation of these measures will be well aligned with the global strive to promote the Sustainable Development Goals (SDGs).