1
|
Lorito CD, Pollock K, Booth V, Howe L, Goldberg S, Godfrey M, Dunlop M, Harwood RH, Wardt VVD. Social participation in the promoting activity, independence and stability in early dementia (PrAISED), a home-based therapy intervention for people living with dementia: a realist evaluation. BMC Geriatr 2024; 24:615. [PMID: 39026228 PMCID: PMC11264791 DOI: 10.1186/s12877-024-05086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 05/16/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Interventions promoting social activity may reduce behavioural psychological symptoms and improve quality of life in people living with dementia. This study aimed to identify social benefits for participants living with dementia in the context of Promoting Activity, Independence and Stability in Early Dementia (PrAISED), an exercise intervention programme promoting physical activity and independence in participants living with dementia in England. METHODS This was a multi-method realist evaluation undertaking secondary analysis of data collected during the PrAISED process evaluation, including qualitative interviews with participants with dementia, caregivers and therapists, personal notes of researchers, and video recordings of therapy sessions. The study consisted of four phases: (1) Setting operational definition of social outcomes in PrAISED; (2) Developing Context, Mechanisms, Outcome (CMO) configurations; (3) Testing and refining CMOs; and (4) Synthesising definitive CMOs into a middle range theory. RESULTS Two CMOs were identified. (1) When therapists were able to make therapy sessions engaging and had the caregivers' support, the participants experienced therapy sessions as an opportunity to achieve goals in areas they were interested in. They also found the sessions enjoyable. This all led to the participants being highly engaged in their social interactions with the therapists. (2) When the participants realised that they were gaining benefits and progress through the PrAISED intervention, such as increased balance, this boosted their confidence in physical ability. It might also reduce caregivers' risk-aversion/gatekeeping attitude, which in turn would lead to participants' increased participation in social activities. CONCLUSION The PrAISED intervention supported social participation in participants living with dementia. Under certain circumstances, home-based therapy interventions can be beneficial for social health (regardless of physical health gains). Given the limitations of currently available outcome measures to assess social participation, qualitative methods should be used to explore social health outcomes.
Collapse
Affiliation(s)
- Claudio Di Lorito
- Department of Primary Care & Population Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Vicky Booth
- School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Louise Howe
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Sarah Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Maureen Godfrey
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Marianne Dunlop
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | | |
Collapse
|
2
|
Khalagi K, Hoveidaei AH, AziziKia H, Karimi A, Sattarpour R, Fahimfar N, Sanjari M, Mansourzadeh MJ, Nabipour I, Larijani B, Ostovar A. Identifying determinants for falls among Iranian older adults: insights from the Bushehr Elderly Health Program. BMC Geriatr 2024; 24:588. [PMID: 38982344 PMCID: PMC11232168 DOI: 10.1186/s12877-024-05180-1] [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] [Received: 08/16/2023] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Falls are a common cause of fractures in older adults. This study aimed to investigate the factors associated with spontaneous falls among people aged ≥ 60 years in southern Iran. METHODS The baseline data of 2,426 samples from the second stage of the first phase of a prospective cohort, the Bushehr Elderly Health (BEH) program, were included in the analysis. A history of spontaneous falls in the year before recruitment was measured by self-report using a standardized questionnaire. Demographic characteristics, as well as a history of osteoarthritis, rheumatoid arthritis, low back pain, Alzheimer's disease, epilepsy, depression, and cancer, were measured using standardized questionnaires. A tandem gait (heel-to-toe) exam, as well as laboratory tests, were performed under standard conditions. A multiple logistic regression model was used in the analysis and fitted backwardly using the Hosmer and Lemeshow approach. RESULTS The mean (standard deviation) age of the participants was 69.34 (6.4) years, and 51.9% of the participants were women. A total of 260 (10.7%, 95% CI (9.5-12.0)%) participants reported a spontaneous fall in the year before recruitment. Adjusted for potential confounders, epilepsy (OR = 4.31), cancer (OR = 2.73), depression (OR = 1.81), low back pain (OR = 1.79), and osteoarthritis (OR = 1.49) increased the risk of falls in older adults, while the ability to stand ≥ 10 s in the tandem gait exam (OR = 0.49), being male (OR = 0.60), engaging in physical activity (OR = 0.69), and having high serum triglyceride levels (OR = 0.72) reduced the risk of falls. CONCLUSION The presence of underlying diseases, combined with other risk factors, is significantly associated with an increased risk of falls among older adults. Given the relatively high prevalence of falls in this population, it is crucial to pay special attention to identifying and addressing these risk factors.
Collapse
Affiliation(s)
- Kazem Khalagi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute , Tehran University of Medical Sciences, No.10- Jalal-e-ale-ahmad st, Chamran hwy, 14117-13137, Tehran, Iran
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Human Hoveidaei
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hani AziziKia
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Sattarpour
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute , Tehran University of Medical Sciences, No.10- Jalal-e-ale-ahmad st, Chamran hwy, 14117-13137, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute , Tehran University of Medical Sciences, No.10- Jalal-e-ale-ahmad st, Chamran hwy, 14117-13137, Tehran, Iran
| | - Mohammad Javad Mansourzadeh
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute , Tehran University of Medical Sciences, No.10- Jalal-e-ale-ahmad st, Chamran hwy, 14117-13137, Tehran, Iran
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bagher Larijani
- Endocrinology Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute , Tehran University of Medical Sciences, No.10- Jalal-e-ale-ahmad st, Chamran hwy, 14117-13137, Tehran, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
3
|
Mead ES, Teeling SP, McNamara M. A Realist Review Protocol into the Contexts and Mechanisms That Enable the Inclusion of Environmental Sustainability Outcomes in the Design of Lean Healthcare Improvement Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:868. [PMID: 39063445 PMCID: PMC11276605 DOI: 10.3390/ijerph21070868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024]
Abstract
Healthcare makes a significant contribution to the social, economic and environmental benefits of communities. It is correspondingly a significant employer and consumer of both energy and consumables, often at high costs. Lean, a quality improvement methodology focuses on the elimination of non-value add (NVA) activities (steps that do not add value from the perspective of the customer) to improve the flow of people, information or goods. Increasingly, Lean thinking is evolving from its initial focus on eliminating NVA to a more holistic approach that encompasses sustainability. However, little work has been undertaken intentionally, including environmental sustainability outcomes in Lean healthcare interventions. Realist review methodology facilitates an understanding of the extent to which an intervention works, for whom, in what context, why and how, and has proven useful in research relating to Lean interventions in healthcare settings. This protocol provides details for a realist review that will enable an understanding of the specific contexts in which certain mechanisms are activated that enable the inclusion of environmental sustainability outcomes in the design of Lean healthcare improvement interventions.
Collapse
Affiliation(s)
- Elaine Shelford Mead
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
| | - Seán Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
- Centre for Person-Centered Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
| |
Collapse
|
4
|
Baydan M, Caliskan H, Balam-Yavuz B, Aksoy S, Böke B. The Interaction Between Mild Cognitive Impairment with Vestibulo-ocular Reflex, Dynamic Visual Acuity and Postural Balance in Older Adults. Exp Gerontol 2020; 130:110785. [DOI: 10.1016/j.exger.2019.110785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
|
5
|
Booth V, Harwood R, Hancox JE, Hood-Moore V, Masud T, Logan P. Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review. BMJ Open 2019; 9:e024982. [PMID: 31221867 PMCID: PMC6588958 DOI: 10.1136/bmjopen-2018-024982] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 03/13/2019] [Accepted: 05/21/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This review aimed to identify mechanisms underlying participation in falls prevention interventions, in older adults with cognitive impairment. In particular we studied the role of motivation. DESIGN A realist review of the literature. DATA SOURCES EMBASE, MEDLINE, CINAHL, the Cochrane Library, PsycINFO and PEDRO. ELIGIBILITY CRITERIA Publications reporting exercise-based interventions for people with cognitive impairment, including dementia, living in the community. DATA EXTRACTION AND SYNTHESIS A 'rough programme theory' (a preliminary model of how an intervention works) was developed, tested against findings from the published literature and refined. Data were collected according to elements of the programme theory and not isolated to outcomes. Motivation emerged as a key element, and was prioritised for further study. RESULTS An individual will access mechanisms to support participation when they think that exercise will be beneficial to them. Supportive mechanisms include having a 'gate-keeper', such as a carer or therapist, who shares responsibility for the perception of exercise as beneficial. Lack of access to support decreases adherence and participation in exercise. Motivational mechanisms were particularly relevant for older adults with mild-to-moderate dementia, where the exercise intervention was multicomponent, in a preferred setting, at the correct intensity and level of progression, correctly supported and considered, and flexibly delivered. CONCLUSION Motivation is a key element enabling participation in exercise-based interventions for people with cognitive impairment. Many of the mechanisms identified in this review have parallels in motivational theory. Clinically relevant recommendations were derived and will be used to further develop and test a motivationally considered exercise-based falls intervention for people with mild dementia. PROSPERO REGISTRATION NUMBER CRD42015030169.
Collapse
Affiliation(s)
- Vicky Booth
- Division of Rehabilitation Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rowan Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jennie E Hancox
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Victoria Hood-Moore
- Division of Rehabilitation Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tahir Masud
- Health Care of the Older Person, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Phillipa Logan
- Division of Rehabilitation Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
6
|
Floate HJ, Marks GC, Durham J. Cash transfer programmes in lower-income and middle-income countries: understanding pathways to nutritional change-a realist review protocol. BMJ Open 2019; 9:e028314. [PMID: 31133594 PMCID: PMC6537996 DOI: 10.1136/bmjopen-2018-028314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Child malnutrition continues to be a significant global public health concern. Nutrition-related interventions have changed and diversified over the last two decades, with increasing emphasis on nutrition-sensitive programmes that address underlying determinants of child malnutrition. Cash transfer programmes (CTPs) are used with increasing popularity in lower-income and middle-income countries to improve both food/nutrition insecurity and resilience. Available studies, however, provide mixed findings on the outcomes of CTPs for child nutritional status. This review is the first stage of a research project to develop evidence-informed theories of how CTPs affect child malnutrition. These will be empirically tested in the field and contribute to a better understanding of how, why, for whom and in what circumstances CTPs can be implemented to optimise impacts on child nutritional status. METHODS AND ANALYSIS This realist review is informed by available standards for realist reviews and follows a five-step process. In step 1, an initial scoping of literature identified potential contextual factors and underlying mechanisms that influence nutritional outcomes, and potential theories developed to address our research question. In step 2, a systematic literature search using multiple databases will be undertaken with papers screened using defined inclusion/exclusion criteria. In step 3, included studies will be appraised, data extracted into a bespoke data extraction tool and used to test and further refine our explanatory framework. The fourth step will synthesise, using a mix of inductive and deductive analytical processes to identify patterns, link chains of inference and tracking and linking of articles. The final step involves dissemination of a preliminary theory for feedback prior to empirically testing it in Kenya and Ethiopia where large-scale CTPs are being implemented. ETHICS AND DISSEMINATION This review will not involve primary data collection. Findings will be presented in accordance with Realist and Meta-Narrative Evidence Synthesis: Evolving Standards guidelines and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER CRD42018110735.
Collapse
Affiliation(s)
- Hilary J Floate
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Geoffrey C Marks
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Jo Durham
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
7
|
|
8
|
Booth V, Harwood RH, Hood-Moore V, Bramley T, Hancox JE, Robertson K, Hall J, Van Der Wardt V, Logan PA. Promoting activity, independence and stability in early dementia and mild cognitive impairment (PrAISED): development of an intervention for people with mild cognitive impairment and dementia. Clin Rehabil 2018; 32:855-864. [PMID: 29436253 PMCID: PMC6039861 DOI: 10.1177/0269215518758149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/15/2018] [Indexed: 11/15/2022]
Abstract
This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless, they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is an understanding of how to develop an intervention for people with mild cognitive impairment and dementia to promote their independence, stability, and physical activity. INTRODUCTION Older adults with dementia are at a high risk of falls. Standard interventions have not been shown to be effective in this patient population potentially due to poor consideration of dementia-specific risk factors. An intervention is required that addresses the particular needs of older people with dementia in a community setting. METHODS We followed guidelines for the development of an intervention, which recommend a structured approach considering theory, evidence and practical issues. The process used 15 information sources. Data from literature reviews, clinician workshops, expert opinion meetings, patient-relative interviews, focus groups with people with dementia and clinicians, a cross-sectional survey of risk factors, a pre-post intervention study and case studies were included. Data were synthesized using triangulation to produce an intervention suitable for feasibility testing. Practical consideration of how an intervention could be delivered and implemented were considered from the outset. RESULTS Elements of the intervention included individually tailored, dementia-appropriate, balance, strength and dual-task exercises, functional training, and activities aimed at improving environmental access, delivered using a motivational approach to support adherence and long-term continuation of activity. We focussed on promoting safe activity rather than risk or prevention of falls. CONCLUSION We used a systematic process to develop a dementia-specific intervention to promote activity and independence while reducing falls risk in older adults with mild dementia.
Collapse
Affiliation(s)
- Vicky Booth
- University of Nottingham, Nottingham,
UK
- Nottingham University Hospitals NHS
Trust, Nottingham, UK
| | | | | | - Trevor Bramley
- University of Nottingham, Nottingham,
UK
- Nottinghamshire Healthcare NHS
Foundation Trust, Nottingham, UK
| | | | | | - Judith Hall
- Nottingham University Hospitals NHS
Trust, Nottingham, UK
| | | | | |
Collapse
|
9
|
Abstract
Falls in the elderly are an increasing problem causing a high degree of morbidity, mortality, and use of health care services. Identification of risk factors through medical assessment supports the provision of appropriate interventions that reduce rates of falling. Evaluation and intervention strategies are generally challenging because of the complex and multifactorial nature of falls. The clinician should consider screening for falls an important part of the functional evaluation in older adults. Several potential interventions have proven helpful as preventive strategies. Optimal approaches involve interdisciplinary collaboration in assessment and interventions, particularly exercise, attention to coexisting medical conditions, and reduction of environmental hazards.
Collapse
Affiliation(s)
- Ramon Cuevas-Trisan
- Physical Medicine and Rehabilitation Service, West Palm Beach VA Medical Center, University of Miami Miller School of Medicine, Nova Southeastern University College of Osteopathic Medicine, 7305 North Military Trail, PM&RS (117), West Palm Beach, FL 33410-6400, USA.
| |
Collapse
|